H.R. 5773House115th Congress (2017-2019)Passed House

PASS Act of 2018

Introduced May 11, 2018

AI-Generated Summary

Updated April 15, 2026 at 9:52 PM UTC

The PASS Act of 2018 amends the Social Security Act to strengthen Medicare Part C and Part D program integrity and curb opioid misuse. It requires electronic prior‑authorization for covered Part D drugs, creates a secure online portal for sharing fraud, waste and abuse information, expands medication‑therapy‑management eligibility, and mandates notifications to doctors who prescribe opioids at unusually high levels. The changes affect Medicare beneficiaries, prescribing clinicians, pharmacies, Medicare Advantage and prescription‑drug plans, and the federal agencies that oversee them.

Key Provisions

  • By Jan 1 2021, Part D plans must use a secure electronic system—meeting standards set by the Secretary—to send and receive prior‑authorization requests for covered drugs, replacing fax or non‑standard portals.
  • The Secretary must establish a secure internet portal within two years for Medicare Advantage and Part D plans to report substantiated fraud, waste, and abuse and to share related data with the government and contracted integrity entities.
  • Starting in plan years beginning Jan 1 2021, Medicare Advantage contracts must require plans to report investigations and actions taken against providers who prescribe a high volume of opioids, using definitions and processes the Secretary will set.
  • Medication‑therapy‑management eligibility is broadened to include beneficiaries identified as at‑risk for prescription‑drug abuse, effective Jan 1 2021.
  • The Secretary must identify opioid‑prescribing outliers using NPI data and a specialty‑ and geography‑based threshold, then send them annual notifications with prescribing‑best‑practice resources; the program can later expand to other risky drug combinations.
  • No new funding is provided; the program must be carried out with existing Medicare appropriations.

Legislative Activity

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13 earlier actions
SenateIntro Referral Latest Action

Received in the Senate and Read twice and referred to the Committee on Finance.

June 20, 2018

View full timeline
HouseIntro Referral

Introduced in House

May 11, 2018

HouseIntro Referral

Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

May 11, 2018

HouseCommittee

Committee Consideration and Mark-up Session Held.

May 16, 2018

HouseCommittee

Ordered to be Reported (Amended) by Voice Vote.

May 16, 2018

HouseCommittee

Referred to the Subcommittee on Health.

June 4, 2018

HouseCommittee

Reported (Amended) by the Committee on Ways and Means. H. Rept. 115-761, Part I.

June 19, 2018

HouseFloor

Mr. Roskam moved to suspend the rules and pass the bill, as amended.

June 19, 2018 • 4:10 PM

HouseFloor

Considered under suspension of the rules. (consideration: CR H5258-5261)

June 19, 2018 • 4:10 PM

HouseFloor

DEBATE - The House proceeded with forty minutes of debate on H.R. 5773.

June 19, 2018 • 4:11 PM

HouseFloor

Passed/agreed to in House: On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote.(text: CR H5258-5259)

June 19, 2018 • 4:21 PM

HouseFloor

On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote. (text: CR H5258-5259)

June 19, 2018 • 4:21 PM

HouseFloor

Motion to reconsider laid on the table Agreed to without objection.

June 19, 2018 • 4:21 PM

HouseFloor

The title of the measure was amended. Agreed to without objection.

June 19, 2018 • 4:21 PM

SenateIntro Referral

Received in the Senate and Read twice and referred to the Committee on Finance.

June 20, 2018

Floor Debate

9 members

What members said about H.R. 5773 on the floor

7 Republicans2 Democrats
Judy Chu
Rep. Judy ChuD-CA-27 · Jun 19, 2018

Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, according to the Centers for Disease Control and Prevention, more than 42,000 Americans died from opioid-related drug overdoses in…

Peter J. Roskam
Rep. Peter J. RoskamR-IL-6 · Jun 19, 2018

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 5676) to amend title XVIII of the Social Security Act to authorize the suspension of payments by Medicare prescription drug plans and…

Jackie Walorski
Rep. Jackie WalorskiR-IN-2 · Jun 19, 2018

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 6110) to amend title XVIII of the Social Security Act to provide for the review and adjustment of payments under the Medicare…

Peter J. Roskam
Rep. Peter J. RoskamR-IL-6 · Jun 19, 2018

Madam Speaker, I move to suspend the rules and pass the bill (H.R. 5773) to amend title XVIII of the Social Security Act to require Medicare prescription drug plans to establish drug management…

Carlos Curbelo
Rep. Carlos CurbeloR-FL-26 · Jun 19, 2018

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 5775) to amend title XVIII of the Social Security Act to require Medicare Advantage plans and part D prescription drug plans to…

Show 8 more
Peter J. Roskam
Rep. Peter J. RoskamR-IL-6 · Jun 19, 2018

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 5723) to require the Medicare Payment Advisory Commission to report on opioid payment, adverse incentives, and data under the Medicare…

Jackie Walorski
Rep. Jackie WalorskiR-IN-2 · Jun 19, 2018

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 5774) to require the Secretary of Health and Human Services to develop guidance on pain management and opioid use disorder prevention…

Terri A. Sewell
Rep. Terri A. SewellD-AL-7 · Jun 22, 2018

Mr. Speaker, I rise today to thank all of the Members who have worked across the aisle on the opioid bills we've passed over the past two weeks. The bipartisan work that has gone into these bills is…

Thomas MacArthur
Rep. Thomas MacArthurR-NJ-3 · Jun 19, 2018

Mr. Speaker, I thank my friend for yielding. As co-chair of the Bipartisan Heroin Task Force, I have spent a lot of my time working on this opioid crisis. Congress must do everything we can to ensure…

Judy Chu
Rep. Judy ChuD-CA-27 · Jun 19, 2018

Madam Speaker, I yield myself such time as I may consume. Madam Speaker, I am pleased to support H.R. 5773, the PASS Act, introduced by Congress Members Sewell and Roskam. This bill focuses on…

Claudia Tenney
Rep. Claudia TenneyR-NY-22 · Jun 19, 2018

Mr. Speaker, I want to thank the gentleman for yielding so much time to me in favor of this legislation that I coauthored with my colleague, Ms. DelBene, on this bipartisan piece, H.R. 5723, the…

Judy Chu
Rep. Judy ChuD-CA-27 · Jun 19, 2018

Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I am pleased to support H.R. 5723, the Expanding Oversight of Opioid Prescribing and Payment Act. As I mentioned earlier, 80…

Judy Chu
Rep. Judy ChuD-CA-27 · Jun 19, 2018

Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I am pleased to support H.R. 5676, the SENIOR Communities Protection Act. The Affordable Care Act granted the Department of Health…

Show 4 more
Judy Chu
Rep. Judy ChuD-CA-27 · Jun 19, 2018

Madam Speaker, I yield myself such time as I may consume. Madam Speaker, I offer my support of H.R. 5775, the PROPER Act. This bill, introduced by my colleagues Representatives Paulsen and Kind,…

Judy Chu
Rep. Judy ChuD-CA-27 · Jun 19, 2018

Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I offer my support for H.R. 5774, the COACH Act, which was introduced by Congress Members DelBene and Curbelo. This bill focuses…

Mike Kelly
Rep. Mike KellyR-PA-3 · Jun 19, 2018

Madam Speaker, I thank Mr. Roskam so much for his time. Madam Speaker, this opioid epidemic is killing 116 people of all ages every day, and it is horribly impacting western Pennsylvania's families…

James B. Renacci
Rep. James B. RenacciR-OH-16 · Jun 19, 2018

Mr. Speaker, I rise today in support of H.R. 5773, which includes a bill I introduced called the Strengthening Partnerships to Prevent Opioid Abuse Act. My home state of Ohio has been at the center…

Bill Text

3 versions available

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Latest
Referred in SenateIssued June 20, 2018

IIB

115th CONGRESS

2d Session

H. R. 5773

IN THE SENATE OF THE UNITED STATES

June 20, 2018

Received; read twice and referred to the Committee on Finance

AN ACT

To amend title XVIII of the Social Security Act to require electronic prior authorization for covered part D drugs and to provide for other program integrity measures under parts C and D of the Medicare program.

1.

Short title

This Act may be cited as the Preventing Addiction for Susceptible Seniors Act of 2018 or the PASS Act of 2018 .

2.

Electronic prior authorization for covered part D drugs

(a)

Inclusion in electronic prescription program

Section 1860D–4(e)(2) of the Social Security Act (42 U.S.C. 1395w–104(e)(2)) is amended by adding at the end the following new subparagraph:

(E)

Electronic prior authorization

(i)

In general

Not later than January 1, 2021, the program shall provide for the secure electronic transmission of—

(I)

a prior authorization request from the prescribing health care professional for coverage of a covered part D drug for a part D eligible individual enrolled in a part D plan (as defined in section 1860D–23(a)(5)) to the PDP sponsor or Medicare Advantage organization offering such plan; and

(II)

a response, in accordance with this subparagraph, from such PDP sponsor or Medicare Advantage organization, respectively, to such professional.

(ii)

Electronic transmission

(I)

Exclusions

For purposes of this subparagraph, a facsimile, a proprietary payer portal that does not meet standards specified by the Secretary, or an electronic form shall not be treated as an electronic transmission described in clause (i).

(II)

Standards

In order to be treated, for purposes of this subparagraph, as an electronic transmission described in clause (i), such transmission shall comply with technical standards adopted by the Secretary in consultation with the National Council for Prescription Drug Programs, other standard setting organizations determined appropriate by the Secretary, and stakeholders including PDP sponsors, Medicare Advantage organizations, health care professionals, and health information technology software vendors.

(III)

Application

Notwithstanding any other provision of law, for purposes of this subparagraph, the Secretary may require the use of such standards adopted under subclause (II) in lieu of any other applicable standards for an electronic transmission described in clause (i) for a covered part D drug for a part D eligible individual.

.

(b)

Sense of Congress regarding electronic prior authorization

It is the sense of the Congress that—

(1)

there should be increased use of electronic prior authorizations for coverage of covered part D drugs for part D eligible individuals enrolled in prescription drug plans under part D of title XVIII of the Social Security Act and MA–PD plans under part C of such title to reduce access delays by resolving coverage issues before prescriptions for such drugs are transmitted; and

(2)

greater priority should be placed on increasing the adoption of use of such electronic prior authorizations among prescribers of such drugs, pharmacies, PDP sponsors, and Medicare Advantage organizations.

3.

Program integrity transparency measures under Medicare parts C and D

(a)

In general

Section 1859 of the Social Security Act (42 U.S.C. 1395w–28) is amended by adding at the end the following new subsection:

(i)

Program integrity transparency measures

(1)

Program integrity portal

(A)

In general

Not later than 2 years after the date of the enactment of this subsection, the Secretary shall, after consultation with stakeholders, establish a secure Internet website portal (or other successor technology) that would allow a secure path for communication between the Secretary, MA plans under this part, prescription drug plans under part D, and an eligible entity with a contract under section 1893 (such as a Medicare drug integrity contractor or an entity responsible for carrying out program integrity activities under this part and part D) for the purpose of enabling through such portal (or other successor technology)—

(i)

the referral by such plans of substantiated fraud, waste, and abuse for initiating or assisting investigations conducted by the eligible entity; and

(ii)

data sharing among such MA plans, prescription drug plans, and the Secretary.

(B)

Required uses of portal

The Secretary shall disseminate the following information to MA plans under this part and prescription drug plans under part D through the secure Internet website portal (or other successor technology) established under subparagraph (A):

(i)

Providers of services and suppliers that have been referred pursuant to subparagraph (A)(i) during the previous 12-month period.

(ii)

Providers of services and suppliers who are the subject of an active exclusion under section 1128 or who are subject to a suspension of payment under this title pursuant to section 1862(o) or otherwise.

(iii)

Providers of services and suppliers who are the subject of an active revocation of participation under this title, including for not satisfying conditions of participation.

(iv)

In the case of such a plan that makes a referral under subparagraph (A)(i) through the portal (or other successor technology) with respect to activities of substantiated fraud, waste, or abuse of a provider of services or supplier, if such provider or supplier has been the subject of an administrative action under this title or title XI with respect to similar activities, a notification to such plan of such action so taken.

(C)

Rulemaking

For purposes of this paragraph, the Secretary shall, through rulemaking, specify what constitutes substantiated fraud, waste, and abuse, using guidance such as what is provided in the Medicare Program Integrity Manual 4.7.1. In carrying out this subsection, a fraud hotline tip (as defined by the Secretary) without further evidence shall not be treated as sufficient evidence for substantiated fraud, waste, or abuse

(D)

HIPAA compliant information only

For purposes of this subsection, communications may only occur if the communications are permitted under the Federal regulations (concerning the privacy of individually identifiable health information) promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996.

(2)

Quarterly reports

Beginning 2 years after the date of enactment of this subsection, the Secretary shall make available to MA plans under this part and prescription drug plans under part D in a timely manner (but no less frequently than quarterly) and using information submitted to an entity described in paragraph (1) through the portal (or other successor technology) described in such paragraph or pursuant to section 1893, information on fraud, waste, and abuse schemes and trends in identifying suspicious activity. Information included in each such report shall—

(A)

include administrative actions, pertinent information related to opioid overprescribing, and other data determined appropriate by the Secretary in consultation with stakeholders; and

(B)

be anonymized information submitted by plans without identifying the source of such information.

(3)

Clarification

Nothing in this subsection shall be construed as precluding or otherwise affecting referrals described in subparagraph (A) that may otherwise be made to law enforcement entities or to the Secretary.

.

(b)

Contract requirement to communicate plan corrective actions against opioid over-prescribers

Section 1857(e) of the Social Security Act (42 U.S.C. 1395w–27(e)) is amended by adding at the end the following new paragraph:

(5)

Communicating plan corrective actions against opioids over-prescribers

(A)

In general

Beginning with plan years beginning on or after January 1, 2021, a contract under this section with an MA organization shall require the organization to submit to the Secretary, through the process established under subparagraph (B), information on the investigations and other actions taken by such plans related to providers of services who prescribe a high volume of opioids.

(B)

Process

Not later than January 1, 2021, the Secretary shall, in consultation with stakeholders, establish a process under which MA plans and prescription drug plans shall submit to the Secretary information described in subparagraph (A).

(C)

Regulations

For purposes of this paragraph, including as applied under section 1860D–12(b)(3)(D), the Secretary shall, pursuant to rulemaking—

(i)

specify a definition for the term high volume of opioids and a method for determining if a provider of services prescribes such a high volume; and

(ii)

establish the process described in subparagraph (B) and the types of information that shall be submitted through such process.

.

(c)

Reference under part D to program integrity transparency measures

Section 1860D–4 of the Social Security Act (42 U.S.C. 1395w–104) is amended by adding at the end the following new subsection:

(m)

Program integrity transparency measures

For program integrity transparency measures applied with respect to prescription drug plan and MA plans, see section 1859(i).

.

4.

Expanding eligibility for medication therapy management programs under part D

Section 1860D–4(c)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395w–104(c)(2)(A)(ii)) is amended—

(1)

by redesignating subclauses (I) through (III) as items (aa) through (cc), respectively, and adjusting the margins accordingly;

(2)

by striking are part D eligible individuals who— and inserting

are the following:

(I)

Part D eligible individuals who—

; and

(3)

by adding at the end the following new subclause:

(II)

Beginning January 1, 2021, at-risk beneficiaries for prescription drug abuse (as defined in paragraph (5)(C)).

.

5.

Medicare notifications 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)

Outlier prescriber notification

(i)

Notification

Beginning not later than 2 years after the date of the enactment of this subparagraph, 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 that such prescriber has been so identified and that includes resources on proper prescribing methods and other information 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 or MA–PD plans under part C and based on the threshold established under subclause (II), conduct an analysis to identify prescribers that are outlier opioid prescribers for a period specified by the Secretary.

(II)

Establishment of threshold

For purposes of subclause (I) and subject to subclause (III), the Secretary shall, after consultation with stakeholders, establish a threshold, based on prescriber specialty and 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 Secretary may exclude the following individuals and prescribers from the analysis under this clause:

(aa)

Individuals receiving hospice services.

(bb)

Individuals with a cancer diagnosis.

(cc)

Prescribers who are the subject of an investigation by the Centers for Medicare & Medicaid Services or the Office of Inspector General of the Department of Health and Human Services.

(iii)

Contents of notification

The Secretary shall, based on input from stakeholders, specify the resources and other information to be included in notifications provided under clause (i).

(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.

(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, as determined by the Secretary.

(v)

Opioids defined

For purposes of this subparagraph, the term opioids has such meaning as specified by the Secretary through program instruction or otherwise.

.

6.

No additional funds authorized

No additional funds are authorized to be appropriated to carry out the requirements of this Act and the amendments made by this Act. Such requirements shall


be carried out using amounts otherwise authorized to be appropriated.

Passed the House of Representatives June 19, 2018.

Karen L. Haas,

Clerk