[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2920 Introduced in Senate (IS)]
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115th CONGRESS
2d Session
S. 2920
To amend title XVIII of the Social Security Act to impose certain
requirements under the Medicare program with respect to outlier
prescribers of opioids.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 22, 2018
Mrs. McCaskill (for herself and Mr. Toomey) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to impose certain
requirements under the Medicare program with respect to outlier
prescribers of opioids.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Commit to Opioid Medical Prescriber
Accountability and Safety for Seniors Act of 2018''.
SEC. 2. MEDICARE REQUIREMENTS WITH RESPECT TO OUTLIER PRESCRIBERS OF
OPIOIDS.
Section 1860D-4(c)(4) of the Social Security Act (42 U.S.C. 1395w-
104(c)(4)) is amended by adding at the end the following new
subparagraph:
``(D) Notification and additional requirements with
respect to outlier prescribers of opioids.--
``(i) Notification.--Not later than January
1, 2021, the Secretary shall, in the case of a
prescriber identified by the Secretary under
clause (ii) to be an outlier prescriber of
opioids, provide, subject to clause (iv), an
annual notification to such prescriber (during
the period in which such provider maintains
such identification) that such prescriber has
been so identified and including such resources
on proper prescribing methods and such other
information as specified in accordance with
clause (iii).
``(ii) Identification of outlier
prescribers of opioids.--
``(I) In general.--The Secretary
shall, subject to subclause (III),
using the valid prescriber National
Provider Identifiers included pursuant
to subparagraph (A) on claims for
covered part D drugs for part D
eligible individuals enrolled in
prescription drug plans under this part
and MA-PD plans under part C and based
on the thresholds established under
subclause (II), identify prescribers
that are outlier opioids prescribers
for a period of time specified by the
Secretary.
``(II) Establishment of
thresholds.--For purposes of subclause
(I) and subject to subclause (III), the
Secretary shall, after consultation
with stakeholders, establish
thresholds, based on prescriber
specialty and, as determined
appropriate by the Secretary,
geographic area, for identifying
whether a prescriber in a specialty and
geographic area is an outlier
prescriber of opioids as compared to
other prescribers of opioids within
such specialty and area.
``(III) Exclusions.--The following
shall not be included in the process
for identifying outlier prescribers of
opioids under this clause:
``(aa) Claims for covered
part D drugs for part D
eligible individuals who are
receiving hospice care under
this title.
``(bb) Claims for covered
part D drugs for part D
eligible individuals who are
receiving oncology services
under this title.
``(cc) Prescribers who are
the subject of an investigation
by the Centers for Medicare &
Medicaid Services or the Office
of the Inspector General of the
Department of Health and Human
Services.
``(iii) Contents of notification.--The
Secretary shall include the following
information in the notifications provided under
clause (i):
``(I) Information on how such
prescriber compares to other
prescribers within the same specialty
and, if determined appropriate by the
Secretary, geographic area.
``(II) Information on opioid
prescribing guidelines, based on input
from stakeholders, that may include the
Centers for Disease Control and
Prevention guidelines for prescribing
opioids for chronic pain and guidelines
developed by physician organizations.
``(III) Other information
determined appropriate by the
Secretary.
``(iv) Modifications and expansions.--
``(I) Frequency.--Beginning 5 years
after the date of the enactment of this
subparagraph, the Secretary may change
the frequency of the notifications
described in clause (i) based on
stakeholder input and changes in opioid
prescribing utilization and trends.
``(II) Expansion to other
prescriptions.--The Secretary may
expand notifications under this
subparagraph to include identifications
and notifications with respect to
concurrent prescriptions of covered
part D drugs used in combination with
opioids that are considered to have
adverse side effects when so used in
such combination.
``(v) Additional requirements for
persistent outlier prescribers.--In the case of
a prescriber who the Secretary determines is
persistently identified under clause (ii) as an
outlier prescriber of opioids, the following
shall apply:
``(I) The Secretary shall connect
such prescriber with an entity that
provides technical or educational
resources on opioid prescribing
guidelines (such as the guidelines
described in clause (iii)(II)), which
may include a quality improvement
organization under part B of title XI,
as available and appropriate.
``(II) Such prescriber may be
required to enroll in the program under
this title under section 1866(j) if
such prescriber is not otherwise
required to enroll. The Secretary shall
determine the length of the period for
which such prescriber is required to
maintain such enrollment.
``(III) Not less frequently than
annually (and in a form and manner
determined appropriate by the
Secretary), the Secretary shall
communicate information on such
prescribers to sponsors of a
prescription drug plan and Medicare
Advantage organizations offering an MA-
PD plan.
``(vi) Public availability of
information.--The Secretary shall make
aggregate information under this subparagraph
available on the Internet website of the
Centers for Medicare & Medicaid Services. Such
information shall be in a form and manner
determined appropriate by the Secretary and
shall not identify any specific prescriber. In
carrying out this clause, the Secretary shall
consult with interested stakeholders.
``(vii) Opioids defined.--For purposes of
this subparagraph, the term `opioids' has such
meaning as specified by the Secretary.
``(viii) Other activities.--Nothing in this
subparagraph shall preclude the Secretary from
conducting activities that provide prescribers
with information as to how they compare to
other prescribers that are in addition to the
activities under this subparagraph, including
activities that were being conducted as of the
date of the enactment of this subparagraph.''.
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