H.R. 5774House115th Congress (2017-2019)Passed House

COACH Act of 2018

Introduced May 11, 2018

AI-Generated Summary

Updated April 15, 2026 at 9:52 PM UTC

The COACH Act of 2018 directs the Department of Health and Human Services to create and publish guidance for hospitals that receive Medicare Part A payments on how to manage pain and prevent opioid use disorder. It also sets up expert panels to review opioid‑related quality measures and to recommend ways to cut opioid use in surgical settings. The law requires data collection on peri‑operative opioid prescribing and mandates that existing opioid prescribing guidance be posted online and kept up‑to‑date for Medicare beneficiaries.

Key Provisions

  • HHS must issue, by Jan. 1 2019, publicly‑available guidance for Medicare‑Part‑A hospitals covering best practices for opioid screening, patient education, non‑opioid pain treatments, naloxone prescribing, and tracking of opioid prescribing trends.
  • A technical expert panel is to be created within 180 days to review and recommend improvements to opioid‑related quality measures, with an expedited endorsement process for new measures.
  • Another expert panel must be convened within six months to recommend ways to reduce opioid use in inpatient and outpatient surgical settings and to produce a report with an action plan within one year.
  • The Secretary must collect and report detailed data on peri‑operative opioid use, including prescribing patterns, doses, and outcomes, and suggest ways to improve data collection.
  • Within 180 days, HHS must post all opioid‑prescribing guidance for Medicare beneficiaries on the CMS website and update it periodically in consultation with medical groups, providers, and consumer representatives.

Legislative Activity

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14 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 Ways and Means, and in addition to the Committee on Energy and Commerce, 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.

May 31, 2018

HouseCommittee

Reported (Amended) by the Committee on Ways and Means. H. Rept. 115-762, Part I.

June 19, 2018

HouseCommittee

Committee on Energy and Commerce discharged.

June 19, 2018

HouseCalendars

Placed on the Union Calendar, Calendar No. 593.

June 19, 2018

HouseFloor

Mrs. Walorski moved to suspend the rules and pass the bill, as amended.

June 19, 2018 • 3:53 PM

HouseFloor

Considered under suspension of the rules. (consideration: CR H5254-5255)

June 19, 2018 • 3:53 PM

HouseFloor

DEBATE - The House proceeded with forty minutes of debate on H.R. 5774.

June 19, 2018 • 3:53 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 H5254-5256)

June 19, 2018 • 4:00 PM

HouseFloor

On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote. (text: CR H5254-5256)

June 19, 2018 • 4:00 PM

HouseFloor

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

June 19, 2018 • 4:01 PM

SenateIntro Referral

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

June 20, 2018

Floor Debate

8 members

What members said about H.R. 5774 on the floor

7 Republicans1 Democrat
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…

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…

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,…

Show 3 more
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

4 versions available

Reading Mode
Latest
Referred in SenateIssued June 20, 2018

IIB

115th CONGRESS

2d Session

H. R. 5774

IN THE SENATE OF THE UNITED STATES

June 20, 2018

Received; read twice and referred to the Committee on Finance

AN ACT

To require the Secretary of Health and Human Services to develop guidance on pain management and opioid use disorder prevention for hospitals receiving payment under part A of the Medicare program, provide for opioid quality measures development, and provide for a technical expert panel on reducing surgical setting opioid use and data collection on perioperative opioid use, and for other purposes.

1.

Short title

This Act may be cited as the Combating Opioid Abuse for Care in Hospitals Act of 2018 or the COACH Act of 2018.

2.

Developing guidance on pain management and opioid use disorder prevention for hospitals receiving payment under part A of the Medicare program

(a)

In general

Not later than January 1, 2019, the Secretary of Health and Human Services (in this section referred to as the Secretary) shall develop and publish on the public website of the Centers for Medicare & Medicaid Services guidance for hospitals receiving payment under part A of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.) on pain management strategies and opioid use disorder prevention strategies with respect to individuals entitled to benefits under such part.

(b)

Consultation

In developing the guidance described in subsection (a), the Secretary shall consult with relevant stakeholders, including—

(1)

medical professional organizations;

(2)

providers and suppliers of services (as such terms are defined in section 1861 of the Social Security Act (42 U.S.C. 1395x));

(3)

health care consumers or groups representing such consumers; and

(4)

other entities determined appropriate by the Secretary.

(c)

Contents

The guidance described in subsection (a) shall include, with respect to hospitals and individuals described in such subsection, the following:

(1)

Best practices regarding evidence-based screening and practitioner education initiatives relating to screening and treatment protocols for opioid use disorder, including—

(A)

methods to identify such individuals at-risk of opioid use disorder, including risk stratification;

(B)

ways to prevent, recognize, and treat opioid overdoses; and

(C)

resources available to such individuals, such as opioid treatment programs, peer support groups, and other recovery programs.

(2)

Best practices for such hospitals to educate practitioners furnishing items and services at such hospital with respect to pain management and substance use disorders, including education on—

(A)

the adverse effects of prolonged opioid use;

(B)

non-opioid, evidence-based, non-pharmacological pain management treatments;

(C)

monitoring programs for individuals who have been prescribed opioids; and

(D)

the prescribing of naloxone along with an initial opioid prescription.

(3)

Best practices for such hospitals to make such individuals aware of the risks associated with opioid use (which may include use of the notification template described in paragraph (4)).

(4)

A notification template developed by the Secretary, for use as appropriate, for such individuals who are prescribed an opioid that—

(A)

explains the risks and side effects associated with opioid use (including the risks of addiction and overdose) and the importance of adhering to the prescribed treatment regimen, avoiding medications that may have an adverse interaction with such opioid, and storing such opioid safely and securely;

(B)

highlights multimodal and evidence-based non-opioid alternatives for pain management;

(C)

encourages such individuals to talk to their health care providers about such alternatives;

(D)

provides for a method (through signature or otherwise) for such an individual, or person acting on such individual’s behalf, to acknowledge receipt of such notification template;

(E)

is worded in an easily understandable manner and made available in multiple languages determined appropriate by the Secretary; and

(F)

includes any other information determined appropriate by the Secretary.

(5)

Best practices for such hospital to track opioid prescribing trends by practitioners furnishing items and services at such hospital, including—

(A)

ways for such hospital to establish target levels, taking into account the specialties of such practitioners and the geographic area in which such hospital is located, with respect to opioids prescribed by such practitioners;

(B)

guidance on checking the medical records of such individuals against information included in prescription drug monitoring programs;

(C)

strategies to reduce long-term opioid prescriptions; and

(D)

methods to identify such practitioners who may be over-prescribing opioids.

(6)

Other information the Secretary determines appropriate, including any such information from the Opioid Safety Initiative established by the Department of Veterans Affairs or the Opioid Overdose Prevention Toolkit published by the Substance Abuse and Mental Health Services Administration.

3.

Requiring the review of quality measures relating to opioids and opioid use disorder treatments furnished under the medicare program and other federal health care programs

(a)

In general

Section 1890A of the Social Security Act (42 U.S.C. 1395aaa–1) is amended by adding at the end the following new subsection:

(g)

Technical expert panel review of opioid and opioid use disorder quality measures

(1)

In general

Not later than 180 days after the date of the enactment of this subsection, the Secretary shall establish a technical expert panel for purposes of reviewing quality measures relating to opioids and opioid use disorders, including care, prevention, diagnosis, health outcomes, and treatment furnished to individuals with opioid use disorders. The Secretary may use the entity with a contract under section 1890(a) and amend such contract as necessary to provide for the establishment of such technical expert panel.

(2)

Review and assessment

Not later than 1 year after the date the technical expert panel described in paragraph (1) is established (and periodically thereafter as the Secretary determines appropriate), the technical expert panel shall—

(A)

review quality measures that relate to opioids and opioid use disorders, including existing measures and those under development;

(B)

identify gaps in areas of quality measurement that relate to opioids and opioid use disorders, and identify measure development priorities for such measure gaps; and

(C)

make recommendations to the Secretary on quality measures with respect to opioids and opioid use disorders for purposes of improving care, prevention, diagnosis, health outcomes, and treatment, including recommendations for revisions of such measures, need for development of new measures, and recommendations for including such measures in the Merit-Based Incentive Payment System under section 1848(q), the alternative payment models under section 1833(z)(3)(C), the shared savings program under section 1899, the quality reporting requirements for inpatient hospitals under section 1886(b)(3)(B)(viii), and the hospital value-based purchasing program under section 1886(o).

(3)

Consideration of measures by secretary

The Secretary shall consider—

(A)

using opioid and opioid use disorder measures (including measures used under the Merit-Based Incentive Payment System under section 1848(q), measures recommended under paragraph (2)(C), and other such measures identified by the Secretary) in alternative payment models under section 1833(z)(3)(C) and in the shared savings program under section 1899; and

(B)

using opioid measures described in subparagraph (A), as applicable, in the quality reporting requirements for inpatient hospitals under section 1886(b)(3)(B)(viii),and in the hospital value-based purchasing program under section 1886(o).

(4)

Prioritization of measure development

The Secretary shall prioritize for measure development the gaps in quality measures identified under paragraph (2)(B).

.

(b)

Expedited endorsement process for opioid measures

Section 1890(b)(2) of the Social Security Act (42 U.S.C. 1395aaa(b)(2)) is amended by adding at the end the following new flush sentence:

Such endorsement process shall, as determined practicable by the entity, provide for an expedited process with respect to the endorsement of such measures relating to opioids and opioid use disorders.

.

4.

Technical expert panel on reducing surgical setting opioid use; Data collection on perioperative opioid use

(a)

Technical expert panel on reducing surgical setting opioid use

(1)

In general

Not later than 6 months after the date of the enactment of this Act, the Secretary of Health and Human Services shall convene a technical expert panel, including medical and surgical specialty societies and hospital organizations, to provide recommendations on reducing opioid use in the inpatient and outpatient surgical settings and on best practices for pain management, including with respect to the following:

(A)

Approaches that limit patient exposure to opioids during the perioperative period, including pre-surgical and post-surgical injections, and that identify such patients at risk of opioid use disorder pre-operation.

(B)

Shared decision making with patients and families on pain management, including recommendations for the development of an evaluation and management code for purposes of payment under the Medicare program under title XVIII of the Social Security Act that would account for time spent on shared decision making.

(C)

Education on the safe use, storage, and disposal of opioids.

(D)

Prevention of opioid misuse and abuse after discharge.

(E)

Development of a clinical algorithm to identify and treat at-risk, opiate-tolerant patients and reduce reliance on opioids for acute pain during the perioperative period.

(2)

Report

Not later than 1 year after the date of the enactment of this Act, the Secretary shall submit to Congress and make public a report containing the recommendations developed under paragraph (1) and an action plan for broader implementation of pain management protocols that limit the use of opioids in the perioperative setting and upon discharge from such setting.

(b)

Data collection on perioperative opioid use

Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report that contains the following:

(1)

The diagnosis-related group codes identified by the Secretary as having the highest volume of surgeries.

(2)

With respect to each of such diagnosis-related group codes so identified, a determination by the Secretary of the data that is both available and reported on opioid use following such surgeries, such as with respect to—

(A)

surgical volumes, practices, and opioid prescribing patterns;

(B)

opioid consumption, including—

(i)

perioperative days of therapy;

(ii)

average daily dose at the hospital, including dosage greater than 90 milligram morphine equivalent;

(iii)

post-discharge prescriptions and other combination drugs that are used before intervention and after intervention;

(iv)

quantity and duration of opioid prescription at discharge; and

(v)

quantity consumed and number of refills;

(C)

regional anesthesia and analgesia practices, including pre-surgical and post-surgical injections;

(D)

naloxone reversal;

(E)

post-operative respiratory failure;

(F)

information about storage and disposal; and

(G)

such other information as the Secretary may specify.

(3)

Recommendations for improving data collection on perioperative opioid use, including an analysis to identify and reduce barriers to collecting, reporting, and analyzing the data described in paragraph (2), including barriers related to technological availability.

5.

Requiring the posting and periodic update of opioid prescribing guidance for Medicare beneficiaries

(a)

In general

Not later than 180 days after the date of the enactment of this Act, the Secretary of Health and Human Services (in this section referred to as the Secretary) shall post on the public website of the Centers for Medicare & Medicaid Services all guidance published by the Department of Health and Human Services on or after January 1, 2016, relating to the prescribing of opioids and applicable to opioid prescriptions for individuals entitled to benefits under part A of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.) or enrolled under part B of such title of such Act (42 U.S.C. 1395j et seq.).

(b)

Update of guidance

(1)

Periodic update

The Secretary shall, in consultation with the entities specified in paragraph (2), periodically (as determined appropriate by the Secretary) update guidance described in subsection (a) and revise the posting of such guidance on the website described in such subsection.

(2)

Consultation

The entities specified in this paragraph are the following:

(A)

Medical professional organizations.

(B)

Providers and suppliers of services (as such terms are defined in section 1861 of the Social Security Act (42 U.S.C. 1395x)).

(C)

Health care consumers or groups representing such consumers.

(D)

Other entities determined appropriate by the Secretary.

Passed the House of Representatives June 19, 2018.

Karen L. Haas,

Clerk