H.R. 5776House115th Congress (2017-2019)In Committee

MOST Act

AI-Generated Summary

Updated April 15, 2026 at 9:51 PM UTC

The Medicare and Opioid Safe Treatment (MOST) Act expands Medicare to cover a range of opioid use disorder treatment services provided by qualified opioid treatment programs. It creates a bundled payment system for these services, adds opioid treatment programs as Medicare providers, and directs reviews of payment incentives that may favor opioid use over non‑opioid alternatives. The bill also provides extra funding for Federally Qualified Health Centers and Rural Health Clinics that have clinicians with DEA waivers to prescribe medication‑assisted treatment, and it requires several studies and reports on supplemental benefits, psychologist services, and pain‑management options under Medicare.

Key Provisions

Adds “opioid use disorder treatment services” – such as FDA‑approved medications, counseling, therapy, toxicology testing and other items – to Medicare coverage.
Defines qualifying opioid treatment programs and requires them to be enrolled, certified, and accredited to receive Medicare payments.
Establishes a 100 % bundled payment for these services, paid at rates comparable to other Medicare bundles, with annual updates.
Allows opioid treatment programs to be listed as Medicare providers for the specific services they deliver.
Mandates a review of outpatient Medicare payments to ensure they do not create financial incentives to use opioids instead of non‑opioid pain treatments.
Provides $6 million for FQHCs and $2 million for rural health clinics to reimburse practitioners who obtain DEA waivers to prescribe medication‑assisted treatment.
Requires the HHS Secretary to report within two years on the availability of substance‑use‑disorder supplemental benefits in Medicare Advantage plans.
Orders a GAO study on Medicare coverage of qualified psychologist services and a separate HHS study on non‑opioid pain‑management coverage and payment recommendations.

Legislative Activity

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5 earlier actions

HouseCommittee Latest Action

Reported (Amended) by the Committee on Ways and Means. H. Rept. 115-764, Part I.

Ways and Means Committee

June 19, 2018

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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.

Energy and Commerce Committee

May 11, 2018

HouseCommittee

Committee Consideration and Mark-up Session Held.

Ways and Means Committee

May 16, 2018

HouseCommittee

Ordered to be Reported (Amended) by Voice Vote.

Ways and Means Committee

May 16, 2018

HouseCommittee

Referred to the Subcommittee on Health.

Health Subcommittee

May 31, 2018

HouseCommittee

Reported (Amended) by the Committee on Ways and Means. H. Rept. 115-764, Part I.

Ways and Means Committee

June 19, 2018

Floor Debate

16 members

What members said about H.R. 5776 on the floor

+11

12 Republicans4 Democrats

Rep. Greg WaldenR-OR-2 · Jun 22, 2018

Mr. Chair, I claim time in opposition to the amendment. Mr. Chair, I certainly appreciate Dr. Dunn and the good work that he has done on many of these issues, and I also appreciate his willingness to…

Mr. Chair, I claim time in opposition to the amendment.

Mr. Chair, I certainly appreciate Dr. Dunn and the good work that he has done on many of these issues, and I also appreciate his willingness to withdraw his amendment.

As a result of our committee process and various member conversations we have had, we have reached bipartisan compromise on the underlying bill on the issue of concern to Mr. Dunn.

I understand that thoughtful Members can find themselves on different sides of an issue at different times, and I certainly respect the gentleman's position. That being said, we believe our underlying policy represents a fair middle ground, and it ensures rigorous analysis on the issue going forward.

Mr. Chair, I appreciate the gentleman from Florida withdrawing the amendment.

Mr. Chair, I yield 2\1/2\ minutes to the gentleman from New York (Mr. Tonko).

Mr. Chairman, I reserve the balance of my time.

Mr. Chairman, I continue to reserve the balance of my time.

Mr. Chairman, I yield back the balance of my time.

I claim time in opposition, Mr. Chairman, although I am not opposed to the amendment, and I will yield to my friend from New Jersey in a second, but I do ask unanimous consent to claim the time in opposition.

Mr. Chair, I rise in support of this amendment, and I want to thank Representatives Barton and Meadows and Kuster. They have really worked hard on this and it is a good amendment.

There is wide variation in the way acute, short-duration pain is treated with opioids, and there are concerns that patients may be over- or underprescribed opioid analgesics to treat that pain.

This amendment would direct the FDA Commissioner to develop high- quality, evidence-based opioid prescribing guidelines for the treatment of acute pain. By arming physicians with this type of information, we can give them more of the tools they need to treat patients' pain without overprescribing addictive medications.

The intent behind this policy is that evidence-based guidelines would add to the universe of available data in a way that would empower providers, patients, caregivers and others to make determinations about treatment in a more informed manner.

I understand that some stakeholders have raised some concerns about limitations on how these evidence-based guidelines can be used; so as we continue to work on these policies with our counterparts in the Senate, we are committed to working to ensure that the language accomplishes what the sponsors intend without having any unintended consequences.

I encourage my colleagues to support adoption of the amendment.

Mr. Chair, I yield to the gentleman from New Jersey (Mr. Pallone) such time as he may consume.

Mr. Chairman, I have no further speakers on this matter. Again, I thank my friend, the former chairman of the full committee, Mr. Barton, for his good leadership on this effort, along with other Members on both sides of the aisle.

I encourage our colleagues to support this amendment, and I yield back the balance of my time.

Mr. Chair, although I am not opposed to the amendment, I ask unanimous consent to claim the time in opposition.

Mr. Chairman, I rise to speak in support of the amendment and to thank my friend from Utah, Mr. Curtis, for his hard work on this very thoughtful piece of legislation.

It is important that women who take opioid pain medications are aware of the possible risks during pregnancy. You heard him delineate those tragic, tragic risks, such as premature birth and neonatal abstinence syndrome, or NAS.

While there is increasing awareness and use of nonopioid approaches in the management of pain over all, information about their use in pregnant patients and unique considerations of mother and child are simply lacking.

So this amendment requires the Department of Health and Human Services to report on the opioid prescribing practices and opioid misuse during pregnancy, and evaluate nonopioid alternatives to pain management during pregnancy.

This will complement the efforts of the Protecting Our Infants Act, which required a report on prenatal opioid exposure and NAS, presenting a strategy and clinical recommendations for preventing and treating infants withdrawal.

I encourage my colleagues to support this amendment.

Mr. Chair, I yield such time as he may consume to the gentleman from Louisiana (Mr. Scalise), a very important Member not only of the U.S. House of Representatives as our whip, but a very influential and effective member on our Energy and Commerce Committee.

Mr. Chairman, I urge passage, and I yield back the balance of my time.

Mr. Chairman, although I am not opposed to the amendment, I ask unanimous consent to claim time in opposition.

Mr. Chairman, I rise to speak in support of the amendment that requires the Department of Health and Human Services to issue guidelines for prescribing an opioid overdose reversal drug.

The guidelines would cover dosage safety, standing orders and other education, and distribution measures.

In April, the Surgeon General issued an advisory calling for more people to carry naloxone.

Expanding the use of this lifesaving drug is a key part of the public health response to the opioid crisis, along with effective prevention, treatment, and recovery programs for substance use disorder.

I can just tell you, Mr. Chairman, from my own district, I have had multiple roundtables in every corner of the district. I have, of course, met with families that have been affected. I have met with addiction treatment specialists. I have met with medical providers. But I have also met with law enforcement.

In Oregon, we lead in a lot of this recovery effort, but also in making sure naloxone is available. This is the antidote.

Mr. Chair, these fentanyls that are coming into our country illegally, if I had a little salt shaker here and put out, I don't know, a half a dozen, a dozen grains of salt, and you put your hand on it, you would likely absorb that through your skin and pass out. And if somebody in this Chamber didn't have naloxone, or the medical people who are nearby didn't get to you in time, you would be one of those 115 people who will die in the next 24 hours, or one of the thousand that will show up in our emergency rooms.

So moving forward with guidelines for prescribing an opioid overdose reversal drug really makes sense. Moving forward with naloxone really makes sense.

We will save lives with this amendment, and I commend my colleagues from Massachusetts and Pennsylvania for their good work on this. We are happy to accept it as part of H.R. 6, and I yield back the balance of my time.

Will the gentleman yield?

Mr. Chairman, because the gentleman raised the issue of these synthetics on other--we have talked a lot about fentanyl being cut into heroin over the course of this debate over 2 weeks.

We haven't talked as much about these synthetics being sprayed on marijuana or other things that you go: Oh, that is natural, mom. I can smoke that.

And what these evil people are doing is taking these deadly synthetics and literally creating a liquid or a spray and then spraying it.

And I talked to a father the other day whose daughter died of a heroin overdose, but when they did the autopsy, they discovered it was 100 percent fentanyl. So I thank the gentleman for his good work on this amendment.

Mr. Chairman, although I am not opposed to the amendment, I ask unanimous consent to claim the time in opposition.

Mr. Chair, I rise to speak in support of this amendment and to thank my friend, Ms. Waters, for her work on this initiative.

Before I go through that, I just want to say we are more than happy to team up with the gentlewoman on this issue of crack cocaine and its effects, and I am sure that Mr. Scalise, although I can't officially speak for him, I am sure that he would work in partnership with the gentlewoman.

The gentlewoman has raised an issue that we have dealt with in other parts of this legislation but not in the part that the gentlewoman has brought to us. There will be more going forward, I assure you, and we would be happy to work with the gentlewoman on that.

Mr. Rush brought an amendment on the IMD issue to make sure that those suffering from cocaine and crack cocaine addiction also could get treatment under expansion in the IMD, so we would be happy to work with the gentlewoman on that.

This amendment directs the Secretary of Health and Human Services to conduct a survey of organizations that provide substance abuse treatment services and then develop a plan to direct resources to address any identified gaps in services for specific types of substance use disorders. This information will help us better understand how our Federal dollars are invested in interdiction treatment at the local level and what more can be done with Federal resources to yield even better returns in reducing drug-related crimes, accidents, overdoses, and deaths.

So I certainly appreciate the gentlewoman's work on this effort. It is important work that will help save lives and bring about the kind of treatment we need in our communities.

I encourage adoption of the amendment, and I yield back the balance of my time.

Mr. Speaker, I claim the time in opposition to the motion.

Mr. Speaker, like a lot of our work here that has been bipartisan, we would hope, going forward, this, too, could become bipartisan, because we believe that getting prescription drug prices down is essential. The Trump administration believes that as well and is doing some things administratively. We are going to be working on this in the committee.

We also agree that this unmet workforce need is important as well. Over the course of five hearings, a full markup in subcommittee, two full markups in the full committee, this issue was never fully brought and vetted. There is more work to be done here, and we are committed to doing work on both the CREATES Act and on the Opioid Workforce Act.

As the gentleman from New York, my friend, knows, we have worked out our differences on many, many issues on this and other topics, and we intend to move forward. It is just that the agreement we have today, Mr. Speaker, is about all of us coming together with bills that were ready for prime time that would not somehow cause problems with the underlying document.

This proposal, while well-intended and, frankly, on the big scope of things makes a lot of sense, it is just not ready and agreed to yet. The gentleman knows that. We know that. We appreciate his passion on this issue. We share it. But I have to reluctantly oppose the motion to recommit because we have agreement that only issues we all agree on are going into this bill--that is, Republicans and Democrats at the top of both committees.

So I take the signal that he remains committed to this effort to fill the gap. We will work with him and others going forward because we have a lot more work to do, Mr. Speaker. This one is just not ready for prime time.

Mr. Speaker, I urge opposition to the motion to recommit, and I yield back the balance of my time.

Mr. Speaker, on that I demand the yeas and nays.

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…

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 2016. That is five times more than the overdose rate in 1999.

As we have heard from countless Members in this Chamber, there is no congressional district that hasn't been impacted by the opioid crisis. No town or city is immune from the devastating impact of addiction, and I hope that the steps we take today are the first of many to address the needs of our communities.

The Substance Abuse and Mental Health Services Administration, or SAMHSA, estimated that in 2016, 11.8 million Americans over the age of 12 had misused opioids in the past year and 3.8 million were currently misusing prescription pain relievers.

But while we are seeing news reports of the devastating toll this crisis is taking on our Nation's young people, it is important to note that our seniors are also suffering. From 2005 to 2014, individuals 65 years and older experienced an 85 percent cumulative increase in opioid-related inpatient stays and a 112 percent cumulative increase in emergency department visits, the largest increase of any age group.

Compared to other age groups, individuals 65 and older have the highest rate of opioid-related inpatient stays in 13 States, including my home State of California.

This crisis is especially acute for the nonelderly Medicare population. In 2015, nonelderly Medicare beneficiaries, or those who qualify on the basis of disability, had opioid utilization rates more than twice that of elderly beneficiaries.

The bill before us, H.R. 6110, contains numerous provisions aimed at improving access to treatment for Medicare beneficiaries suffering from opioid use disorders, including access to nondrug opioid alternatives.

While every alternative will not work for every person, when dealing with a crisis of this magnitude, I believe that we must use every tool in the toolbox.

This bill contains two bipartisan provisions I authored with my colleagues on the Ways and Means Committee.

Mr. Speaker, I thank the gentlewoman from Indiana (Mrs. Walorski) for working with me on language that would direct CMS to study barriers to patient access to nondrug alternatives for opioids in chronic care settings.

Studies conducted by the NIH have concluded that alternative treatments, like acupuncture, can be effective in treating conditions like chronic pain. This issue is very important to me, because I have been working to expand access to acupuncture since I first arrived in the California State legislature many years ago. I have heard firsthand what a difference acupuncture can make in the lives of patients.

I remember very clearly when I heard the testimony of a woman who had severe back pain, but did not want invasive surgery and risk possible addiction to morphine.

Instead, she sought acupuncture, and it worked for her. She avoided the risks associated with surgery and certain pain medications.

Furthermore, we know access to physical and occupational therapy also helps alleviate pain and eliminates the need for an opioid prescription.

By asking CMS to examine where barriers to these alternatives exist, we can open the door to more treatment alternatives for beneficiaries.

I am also proud that this bill includes a provision I authored with the gentlewoman from North Dakota (Mrs. Noem) to address the need for more psychologists in the Medicare program. This bill would direct the Centers for Medicare and Medicaid Innovation to examine ways for beneficiaries to familiarize themselves with coverage for psychologist services and request a study from the General Accountability Office on the viability of mental and behavioral health services in the Medicare program.

As one of only two psychologists in Congress, I firmly believe that expanding access to psychologist services in Medicare is one of the most important things we can do to improve the mental health of our senior population.

We know that those who suffer from depression or other mental health disorders are particularly vulnerable to addiction. For those who have already taken the incredibly difficult step of seeking treatment, we need to ensure that they have access to the full range of mental health professionals who can support them on the journey to recovery.

H.R. 6110 also contains a number of provisions from my colleagues on the Ways and Means Committee. Congress Members Levin and Marchant authored a provision to review certain Medicare payments in outpatient settings to determine whether there are financial incentives in the Medicare program to use or prescribe opioids instead of evidence-based, nonopioid alternatives.

Next, the legislation includes a provision introduced by Congress Members Sanchez and Roskam that would direct the Secretary of HHS to evaluate the extent to which Medicare Advantage programs offer medication-assisted treatment, or MAT, and cover nonopioid alternative treatments not otherwise covered under traditional Medicare as part of a supplemental benefit.

Finally, this bill would also include a provision from Congress Members Danny Davis and Rothfus that would provide grants to federally qualified centers and rural health clinics to help offset the cost of training providers to become certified in dispensing medications for opioid abuse dependence.

While the provisions in the bills before us this afternoon will certainly move us in the right direction, we cannot stop here. For example, the Medicaid program pays for the majority of mental health and substance abuse treatments in this country and, yet, we see multiple attempts by Republicans over the past 4 years to slash this program.

We must maintain protections for those with preexisting conditions so that those who sought treatment for their addiction disorders are not punished for trying to get sober.

We must maintain the progress we have made with the Affordable Care Act and work together to bring down the premiums for American families so that, should they need coverage for mental health counseling or substance abuse treatment, no one is shut out because of how much money they make or what State they live in.

So I hope that today represents the first step, and I hope my colleagues on the other side of the aisle will continue to work with us to invest in prevention, treatment, and recovery efforts all across the country.

I encourage my colleagues to support this legislation, and I reserve the balance of my time.

Mr. Speaker, I yield myself the balance of my time.

Mr. Speaker, I am encouraged to see my colleagues on the other side of the aisle turn their attention to this critical issue. But this is not a new problem, and the coverage expansions under the Affordable Care Act have been among the most significant steps the Federal Government has taken to stem the tide of the opioid crisis. And yet, Republicans in Congress and President Trump have actively worked to repeal this landmark law.

The Medicaid expansion and the increased coverage under the individual market have provided millions of Americans access to health insurance, and research has shown that Medicaid expansion States have seen a greater reduction in deaths from opioids than nonexpansion States.

Again, Medicaid is the biggest payer for substance use disorder treatment in this country. We simply can't afford to go back.

As we discuss this crisis today and in the week to come, we must broaden our understanding of the ways in which we, as a Nation, approach chronic pain. That is exactly what H.R. 6110 does.

While there will always be patients who have a legitimate need for these medications, we need to look beyond a system where an opioid prescription is

the automatic default. This means we need to look to alternative methods of treating pain, whether it be acupuncture or physical therapy or a medical device. It means we must examine existing policies that may have inadvertently incentivized opioid prescribing practices.

But as much as we look forward, we must also address the crisis in front of us. So I am thrilled to see provisions in this bill that would study Medicare Advantage plans already doing groundbreaking work in substance abuse disorder treatment.

I am also glad to see that this bill provides direct resources to the front lines in the form of grants for federally qualified health centers to provide additional training for our providers.

I hope that, in the future, we will work to expand access to alternatives, both within the Medicare program and in the broader population, and ensure that no matter where someone lives or what kind of insurance coverage they have, they are able to seek treatment.

I urge my colleagues to support H.R. 6110, and I yield back the balance of my time.

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 MA-PD plans pending investigations of credible allegations of fraud by pharmacies, as amended.

Mr. Speaker, I ask unanimous consent that all Members have 5 legislative days to revise and extend their remarks and include extraneous material on H.R. 5676, currently under consideration.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I stand today in strong support of H.R. 5676, a bipartisan bill centered on protecting Medicare beneficiaries from abusive opioid prescribing, while ensuring appropriate access to medically necessary medications. This bill strikes a balance, which we need.

H.R. 5676, introduced by our colleagues--Mr. MacArthur, Mr. Blumenauer, Mr. Schweikert, Mr. Collins, Ms. Kuster, and Mr. Tonko-- extends an existing authority in the Medicare fee-for-service program to Medicare Advantage and prescription drug plans.

According to a recent report released by the Department of Health and Human Services' Office of Inspector General, one-third of Medicare part D beneficiaries received an opioid prescription in 2016, costing the program $4.1 billion and representing as many as 79.4 million prescriptions. The report found that as many as half a million part D beneficiaries received high amounts of opioids, with almost 70,000 receiving extreme amounts of opioids, many of them as a result of doctor shopping.

For years, the Medicare fee-for-service program has been able to suspend payments to a provider or a supplier pending an investigation of a credible allegation of fraud against the provider or supplier. Extending this authority to the Medicare Advantage and prescription drug plans will help bridge the gap in the care of beneficiaries and halt the fraudulent activity that contributes to the opioid crisis.

I would like to thank my colleagues on both sides of the aisle on the Ways and Means Committee for their commitment to working cooperatively on this, and also our colleagues on the Energy and Commerce Committee, particularly Congressman Burgess, who chairs the Health Subcommittee, and also Chairman Walden. They played a role in laying the groundwork for policies like this that crack down on abusers.

Mr. Speaker, I look forward to continuing to work on this issue on both sides of the aisle and with the administration on policies that will further strengthen the integrity of the Medicare program.

Mr. Speaker, I reserve the balance of my time.

House of Representatives,

Committee on Ways and Means,

Washington, DC, June 8, 2018.

Hon. Greg Walden,

Chairman, Committee on Energy and Commerce,

Washington, DC.

Dear Chairman Walden: I write to you regarding several

opioid bills the Committee on Ways and Means ordered

favorably reported to address the opioid epidemic. The

following bills were also referred to the Committee on Energy

and Commerce.

I ask that the Committee on Energy and Commerce waive

formal consideration of the following bills so that they may

proceed expeditiously to the House Floor:

H.R. 5774, Combatting Opioid Abuse for Care in Hospitals

(COACH) Act;

H.R. 5775, Providing Reliable Options for Patients and

Educations Resources (PROPER) Act;

H.R. 5776, Medicare and Opioid Safe Treatment (MOST) Act;

H.R. 5773, Preventing Addition for Susceptible Seniors

(PASS) Act;

H.R. 5676, Stop Excessive Narcotics in our Retirement

(SENIOR) Communities Protection Act; and

H.R. 5723, Expanding Oversight of Opioid Prescribing and

Payment Act.

I acknowledge that by waiving formal consideration of the

bills, the Committee on Energy and Commerce is in no way

waiving its jurisdiction over the subject matter contained in

those provisions of the bills that fall within your Rule X

jurisdiction. I would support your effort to seek appointment

of an appropriate number of conferees on any House-Senate

conference involving this legislation.

I will include a copy of our letters in the Congressional

Record during consideration of this legislation on the House

floor.

Sincerely,

Kevin Brady,

Chairman.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I just want to go into a little bit more detail and focus on how it is that we are here today and why there is an urgency to this.

The gentlewoman just mentioned some staggering statistics: 9,000 pills per individual over a decade in a particular town. It tells you that the system has gotten entirely out of balance.

There are a lot of explanations and there are not a lot of clean hands:

We know that there have been government policies that have driven, in part, the opioid crisis by evaluating providers on whether or not pain satisfaction has been completed on the patient side of things;

We know that in some cases there have been healthcare providers that have not gone into the detail of getting to the root of a problem;

We know that we, as a culture, put extraordinary pressure on healthcare providers when we tell them we want them to help us get out of pain; and when we do that, sometimes, Mr. Speaker, unfortunately, we put ourselves at risk, and we know that pharma has a lot to answer for.

All of those things we know are true, and I think what is encouraging to me is this idea of people coming together on both sides and recognizing we don't have to live this way anymore. We don't have to have a system that drives people in this direction.

Let me just go back to this inspector general report from the Department of Health and Human Services that says that 79 million prescriptions involving opioids were prescribed in 2016 alone. That is a staggering number.

And I think that, if we are diligent, if we are forward thinking, and if we continue to work together, both sides of the aisle coming together, Mr. Speaker, I think that, in 10 years, our country will be having a different conversation on opioids. It may take that long, but I think, in 10 years' time, if we do the work, if we are committed to this, we can look back and we can say: That was a time when the United States came together around a public health crisis; that was a time when people had a general understanding that they needed to get over the normal approaches on things; and that was a time that people came together with holistic approaches.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield 3 minutes to the gentleman from New Jersey (Mr. MacArthur)

Mr. Speaker, I yield an additional 1 minute to the gentleman from New Jersey.

Mr. Speaker, I yield myself the balance of my time.

Mr. Speaker, in closing, in a nutshell, I think the gentlewoman from California put it well. What she was arguing was this bill strikes a balance,

which it does. It is designed to focus our time, our attention, and our energies on making sure that the bad actors are weeded out, that the abuse is stopped, and that we can bring balance to the system.

The Stop Excessive Narcotics in Our Retirement Communities Protection Act, or SENIOR Communities Protection Act, is another step in this direction to protect our Nation's seniors. This bill was brought to the floor through a bipartisan committee process, and I urge its passage.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, on that I demand the yeas and nays.

Rep. Paul TonkoD-NY-20 · Jun 22, 2018

Mr. Chair, I thank Chairman Walden for yielding. Although I know my colleague plans to withdraw, I rise in opposition to this amendment, and I just want to articulate a bit of my reasoning. I think…

Mr. Chair, I thank Chairman Walden for yielding.

Although I know my colleague plans to withdraw, I rise in opposition to this amendment, and I just want to articulate a bit of my reasoning.

I think my colleagues and I both share the same goal of safely expanding access to addiction treatment. Where we differ is that I believe that the provisions in H.R. 6 expanding buprenorphine prescribing privileges to advanced practice nurses meet that test.

We all know that there is a dire need for expanded treatment capacity to meet the demands of this current epidemic. As many as 40 percent of counties across the country lack even a single provider that is able to offer buprenorphine. Advanced practice nurses play an outsized role in providing care in rural America, and H.R. 6 will help expand addiction treatment capacity into these communities where it is most needed.

Expanding buprenorphine prescribing privileges to APRNs is supported by medical groups that serve on the front lines of this epidemic, such as the American Society for Addiction Medicine and the American Congress of Obstetricians and Gynecologists.

All advanced practice nurses who wish to prescribe medication- assisted treatment would have to receive a special waiver from the DEA and would have to undergo three times as much specialized addiction training as their physician colleagues.

In addition, in order to receive a waiver, practitioners are required to be able to provide appropriate counseling and ancillary services that are the hallmark of high-quality addiction treatment. All APRNs wishing to prescribe buprenorphine would still be subject to State laws regarding prescription authority, scope of practice, and collaboration or supervision requirements with a physician.

While I understand that providing addiction treatment is a complex and nuanced area of medicine with potential complications if done poorly, I would point out that we don't restrict advanced practice registered nurses in Federal law from providing such high-risk services as delivering babies, administering anesthesia, or prescribing as many opioids as they wish. Why would we want to maintain an outdated barrier in Federal law that prevents these practitioners from being part of the solution to the opioid epidemic?

So in closing, I appreciate that my colleagues are withdrawing this amendment today, and I would urge that, as we move forward toward a potential conference committee, we continue to recognize the role that advanced practice nurses can play in addressing this epidemic.

Mr. Speaker, I have a motion to recommit at the desk.

I am opposed in its current form.

Mr. Speaker, this is the final amendment to the bill, which will not kill the bill or send it back to committee. If adopted, the bill will immediately proceed to final passage, as amended.

For more than a year and a half, Republicans in the House have been engaged in an all-out ideological assault to weaken healthcare for Americans by working to repeal the Affordable Care Act and gutting protections for preexisting conditions. Republicans have repeatedly voted to strip Medicaid coverage for millions struggling with addiction. Thanks to Republican policies, we are seeing this uninsured rate rise sharply for the first time in years.

This attack on our healthcare has had serious consequences for our ability to adequately address the needs of those struggling with the opioid epidemic. I remind my friends that we can't have it both ways: We either are for fighting this epidemic every way we can, or we are not.

I have seen the carnage this epidemic can produce in my own backyard, where my hometown of Amsterdam, New York, with a population of a little over 18,000 people, saw four overdose deaths and a dozen close calls within a single month.

We know that, as of today, less than 20 percent of Americans who need substance abuse treatment are able to receive it. We need to move toward a system of treatment on demand so that, when an individual has that moment of clarity, we are ready with a helping hand to pull them away from the deadly grip of addiction.

While I am pleased that the bill before us will make some incremental progress in our fight against the opioid epidemic and is the product of a significant amount of bipartisan work, every single Member of this Chamber knows that we can and we should be doing more. This motion to recommit is our chance to do just that and to make additional progress in this fight.

First, the motion would invest in our addiction workforce by incorporating a proposal advanced by Representatives Crowley and Costello to add 500 new resident physician slots to hospitals that have developed or are developing training programs in addiction medicine, addiction psychiatry, or pain medicine. We all have seen firsthand the need for more addiction specialists out there, and we have a chance to take action on that right now.

Secondly, this motion would allot an additional $1 billion annually to States through 2021 so that we can continue to invest in locally designed prevention, treatment, and recovery solutions. It is clearly going to take more than 2 years to battle the epidemic, and we need to let providers in States know that we are making sustained, meaningful investments in this area.

Finally, our motion to recommit includes a commonsense prescription drug policy which will reduce prescription drug prices for all Americans by reducing gaming by drug manufacturers to prevent generics from coming to market.

The CREATES Act, introduced by Representatives Marino and Cicilline, is estimated to save the Federal Government some $3.8 billion and patients far more. This legislation has been passed by the Senate Judiciary Committee on a bipartisan basis, but we have been denied a vote on the House floor to consider this practical, positive policy to halt pharma gaming and mischief.

Each of the policies contained in this package is bipartisan, fully paid for, and would bolster our ability to respond to the crisis. We have the opportunity to provide a more robust response for the American people and to save the lives of countless of our friends and neighbors all across this country who could be the next to fall victim to this deadly disease of addiction.

Every day, every week, every month, every year that passes, the challenge rests in our collective laps: Will we do more?

We need to do more. Let's do it for those families living with the pain and loss. Let's do it for those individuals who struggle with the illness of addiction. Let's be the light, the candle that brightens their darkness. Let's go forward with the recovery that is inspired by this legislation.

Mr. Speaker, I urge all of my colleagues on both sides of the aisle to support this motion to recommit, and I yield back the balance of my time.

Mr. Speaker, on that, I demand the yeas and nays.

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…

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 outpatient prospective payment system to avoid financial incentives to use opioids instead of non-opioid alternative treatments, and for other purposes.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks and include extraneous material on H.R. 6110, currently under consideration.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I rise today in support of H.R. 6110, the Dr. Todd Graham Pain Management, Treatment, and Recovery Act.

Solving the opioid epidemic requires everyone to work together at all levels, from the Federal Government down to those on the front lines of this fight.

My legislation focuses on increasing access to pain management alternatives that do not involve opioids and improving recovery treatment options for those suffering from opioid use disorder.

Additionally, my legislation contains the following provisions that will also be vital in overcoming this crisis: H.R. 5778, the Promoting Outpatient Access to Non-Opioid Treatments Act introduced by Representative Kenny Marchant and Health Subcommittee Ranking Member Sander Levin, which requires the Secretary of Health and Human Services, or HHS, to require payments made to hospital outpatient departments and ambulatory surgery centers to ensure there are no financial incentives to use opioids over nonopioid alternatives; H.R. 5769, the Expanding Access to Treatment Act introduced by Representatives Keith Rothfus and Danny Davis, which provides payments to federally qualified health centers and rural health clinics to offset the cost of their providers receiving training so they are able to provide medication-assisted treatment that will help individuals recover from opioid use disorder; H.R. 5725, the Benefit Evaluation of Safe Treatment Act introduced by Health Subcommittee Chairman Peter Roskam and Representatives Linda Sanchez, John Shimkus, and Raul Ruiz, which directs the Secretary of HHS to evaluate the extent to which MA plans offer medication-assisted treatments and cover nonopioid alternative treatments not otherwise covered under a Medicare fee for service as part of a supplemental benefit; and H.R. 5790, the Medicare Nurse Hotline Act introduced by Representatives Kristi Noem and Judy Chu, which directs the Secretary of HHS to educate patients on the availability of psychologist services and explore the use of hotlines to reduce unnecessary hospitalizations and Medicare.

The bill is named after my friend Dr. Todd Graham. He was a double board certified physician in both physical medicine and rehabilitation and pain medicine who lived and worked in my district in northern Indiana.

Last year, he was senselessly murdered after refusing to prescribe an opioid to a patient.

Dr. Graham prided himself on serving his patients in a friendly and caring fashion. He treated each person individually, taking the time to offer specific steps to treat their issues.

One day last year, he had an interaction with a patient demanding opioids, a situation that has become disturbingly all too common. He stood firm in refusing to write a prescription for her, but her husband, who was also there, became increasingly angry throughout that visit. Two hours after they left his office, the husband returned and murdered him in cold blood.

Dr. Graham's loss has been a heavy blow, but his legacy of compassion and enthusiasm lives on through his wife, Julie; their two daughters; and their son, who plans to follow in his father's footsteps.

We are lucky to have the Graham family with us here today to witness the passage of this important bill.

Mr. Speaker, I reserve the balance of my time.

House of Representatives,

Committee on Ways and Means,

Washington, DC, June 8, 2018.

Hon. Greg Walden,

Chairman, Committee on Energy and Commerce,

Washington, DC.

Dear Chairman Walden: I write to you regarding several

opioid bills the Committee on Ways and Means ordered

favorably reported to address the opioid epidemic. The

following bills were also referred to the Committee on Energy

and Commerce.

I ask that the Committee on Energy and Commerce waive

formal consideration of the following bills so that they may

proceed expeditiously to the House Floor:

H.R. 5774, Combatting Opioid Abuse for Care in Hospitals

(COACH) Act;

H.R. 5775, Providing Reliable Options for Patients and

Educations Resources (PROPER) Act;

H.R. 5776, Medicare and Opioid Safe Treatment (MOST) Act;

H.R. 5773, Preventing Addition for Susceptible Seniors

(PASS) Act;

H.R. 5676, Stop Excessive Narcotics in our Retirement

(SENIOR) Communities Protection Act; and

H.R. 5723, Expanding Oversight of Opioid Prescribing and

Payment Act.

I acknowledge that by waiving formal consideration of the

bills, the Committee on Energy and Commerce is in no way

waiving its jurisdiction over the subject matter contained in

those provisions of the bills that fall within your Rule X

jurisdiction. I would support your effort to seek appointment

of an appropriate number of conferees on any House-Senate

conference involving this legislation.

I will include a copy of our letters in the Congressional

Record during consideration of this legislation on the House

floor.

Sincerely,

Kevin Brady,

Chairman.

Mr. Speaker, having no other speakers, I reserve the balance of my time.

Mr. Speaker, I yield myself the balance of my time.

Mr. Speaker, this epidemic knows no boundaries. Opioid abuse continues to devastate families and communities all over this country. As we continue to work toward commonsense solutions to the opioid epidemic, this bipartisan legislation will help break down barriers to nonopioid treatments and give healthcare providers better tools to prevent addiction and to assist in recovery.

I want to thank Chairman Brady for all of his hard work, as well as my friend Ms. Judy Chu of California, who helped develop and introduce this bill.

I urge my colleagues to support this bill, and I yield back the balance of my time.

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Introduced in HouseIssued May 11, 2018

115th CONGRESS

2d Session

H. R. 5776

IN THE HOUSE OF REPRESENTATIVES

May 11, 2018

Mr. Neal (for himself, Mr. Holding, Mr. Cartwright, and Mr. Taylor) introduced the following bill; which was 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

A BILL

To amend title XVIII to provide for Medicare coverage of certain services furnished by opioid treatment programs, and for other purposes.

Short title

This Act may be cited as the Medicare and Opioid Safe Treatment Act or the MOST Act.

Medicare coverage of certain services furnished by opioid treatment programs

(a)

Coverage

Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended—

(1)

in subparagraph (FF), by striking at the end and;

(2)

in subparagraph (GG), by inserting at the end ; and; and

(3)

by adding at the end the following new subparagraph:

(HH)

opioid use disorder treatment services (as defined in subsection (jjj)).

(b)

Opioid use disorder treatment services and opioid treatment program defined

Section 1861 of the Social Security Act is amended by adding at the end the following new subsection:

(jjj)

Opioid use disorder treatment services; opioid treatment program

(1)

Opioid use disorder treatment services

The term opioid use disorder treatment services means items and services that are furnished by an opioid treatment program for the treatment of opioid abuse disorder, including—

(A)

opioid agonist treatment medications (including oral versions) that are approved by the Food and Drug Administration under section 505 of the Federal Food, Drug and Cosmetic Act for use in the treatment of opioid use disorder;

(B)

dispensing and administration of such medications, if applicable;

(C)

substance abuse counseling by a professional to the extent authorized under State law to furnish such services;

(D)

behavioral individual and group therapy with physicians or psychologists (or other mental health professionals to the extent authorized under State law);

(E)

toxicology testing; and

(F)

other items and services that the Secretary determines are appropriate.

(2)

Opioid treatment program

The term opioid treatment program means an opioid treatment program (as defined in section 8.2 of title 42 of the Code of Federal Regulations, or any successor regulation) that—

(A)

is enrolled under section 1866(j);

(B)

has in effect a certification by the Substance Abuse and Mental Health Services Administration for such a program;

(C)

is accredited by an accrediting body approved by the Substance Abuse and Mental Health Services Administration; and

(D)

meets such additional conditions as the Secretary may find necessary to ensure—

(i)

the health and safety of individuals being furnished services under such program; and

(ii)

the effective and efficient furnishing of such services.

(c)

Payment

(1)

In general

Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—

(A)

by striking and (BB) and inserting (BB); and

(B)

by inserting before the semicolon at the end the following , and (CC) with respect to opioid use disorder treatment services furnished during an episode of care, the amount paid shall be equal to the amount payable in accordance with section 1834(w) less any copayment required as specified by the Secretary.

(2)

Payment determination

Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:

(w)

Opioid use disorder treatment services

(1)

In general

The Secretary shall pay to an opioid treatment program (as defined in paragraph (2) of section 1861(jjj)) an amount that is equal to 100 percent of a bundled payment under this part for opioid use disorder treatment services (as defined in paragraph (1) of such section) that are furnished by such program to an individual during an episode of care (as defined by the Secretary) beginning on or after January 1, 2020. The Secretary shall ensure that no duplicative payments are made under this part or part D to a physician, practitioner, or pharmacy for items and services furnished by an opioid treatment program.

(2)

Considerations

The Secretary may implement this subsection through one or more bundles based on the type of medication provided (such as buprenorphine, methadone, naltrexone, or a new innovative drug), the frequency of services, the scope of services furnished, characteristics of the individuals furnished such services, or other factors as the Secretary determine appropriate. In developing such bundles, the Secretary may consider payment rates paid to opioid treatment programs for comparable services under State plans under title XIX, under the TRICARE program under chapter 55 of title 10 of the United States Code, or by other health care payers.

(3)

Annual updates

The Secretary shall provide an update each year to the bundled payment amounts under this subsection.

(d)

Including opioid treatment programs as Medicare providers

Section 1866(e) of the Social Security Act (42 U.S.C. 1395cc(e)) is amended—

(1)

in paragraph (2), by striking at the end and;

(2)

in paragraph (3), by striking the period at the end and inserting ; and; and

(3)

by adding at the end the following new paragraph:

(3)

opioid treatment programs (as defined in paragraph (2) of section 1861(jjj)), but only with respect to the furnishing of opioid treatment program services (as defined in paragraph (1) of such section).

Review and adjustment of payments under the Medicare outpatient prospective payment system to avoid financial incentives to use opioids instead of non-opioid alternative treatments

(a)

Outpatient prospective payment system

Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) is amended by adding at the end the following new paragraph:

(22)

Review and revisions of payments for non-opioid alternative treatments

(A)

In general

With respect to payments made under this subsection for covered OPD services (or groups of services), including covered OPD services assigned to a comprehensive ambulatory payment classification, the Secretary—

(i)

shall, as soon as practicable, conduct a review (part of which may include a request for information) of payments for opioids and evidence-based non-opioid alternatives for pain management (including drugs and devices, nerve blocks, surgical injections, and neuromodulation) with a goal of ensuring that there are not financial incentives to use opioids instead of non-opioid alternatives;

(ii)

may, as the Secretary determines appropriate, conduct subsequent reviews of such payments; and

(iii)

shall consider the extent to which revisions under this subsection to such payments (such as the creation of additional groups of covered OPD services to classify separately those procedures that utilize opioids and non-opioid alternatives for pain management) would reduce payment incentives to use opioids instead of non-opioid alternatives for pain management.

(B)

Priority

In conducting the review under clause (i) of subparagraph (A) and considering revisions under clause (iii) of such subparagraph, the Secretary shall focus on covered OPD services (or groups of services) assigned to a comprehensive ambulatory payment classification, ambulatory payment classifications that primarily include surgical services, and other services determined by the Secretary which generally involve treatment for pain management.

(C)

Revisions

If the Secretary identifies revisions to payments pursuant to subparagraph (A)(iii), the Secretary shall, as determined appropriate, begin making such revisions for services furnished on or after January 1, 2020. Revisions under the previous sentence shall be treated as adjustments for purposes of application of paragraph (9)(B).

(D)

Rules of construction

Nothing in this paragraph shall be construed to preclude the Secretary—

(i)

from conducting a demonstration before making the revisions described in subparagraph (C); or

(ii)

prior to implementation of this paragraph, from changing payments under this subsection for covered OPD services (or groups of services) which include opioids or non-opioid alternatives for pain management.

(b)

Ambulatory surgical centers

Section 1833(i) of the Social Security Act (42 U.S.C. 1395l(i)) is amended by adding at the end the following new paragraph:

(8)

The Secretary shall apply the provisions of paragraph (22) of section 1833(t), including the second sentence of subparagraph (C) of such paragraph, to payment for services under this subsection in an appropriate manner (as determined by the Secretary).

Expanding access under the Medicare program to addiction treatment in Federally qualified health centers and rural health clinics

(a)

Federally qualified health centers

Section 1834(o) of the Social Security Act (42 U.S.C. 1395m(o)) is amended by adding at the end the following new paragraph:

(3)

Additional payments for certain FQHCs with practitioners receiving DATA 2000 certification

(A)

In general

In the case of a Federally qualified health center with respect to which, beginning January 1, 2019, Federally-qualified health center services (as defined in section 1861(aa)(3)) are furnished by a health care practitioner who first receives on or after such date a registration or waiver under section 303(g) of the Controlled Substances Act to prescribe or dispense methadone, buprenorphine, or suboxone for the purpose of maintenance or detoxification treatment, the Secretary shall, subject to availability of funds under subparagraph (B), make a payment (in accordance with such timing, method, and procedures as specified by the Secretary) to such Federally qualified health center in an amount determined by the Secretary, based on an approximation of the cost to receive training for purposes of such registration or waiver, as applicable. For purposes of the previous sentence, a Federally-qualified health center shall apply for a payment described in such sentence at such time and in such manner as specified by the Secretary and may apply for such a payment for each practitioner furnishing such services at such center who is described in such sentence.

(B)

Funding

For purposes of making payments under this paragraph, there are appropriated, out of amounts in the Treasury not otherwise appropriated, $6,000,000, which shall remain available until expended.

(b)

Rural health clinic

Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended—

(1)

by redesignating the subsection (z) relating to medical review of spinal subluxation services as subsection (aa); and

(2)

by adding at the end the following new subsection:

(bb)

Additional payments for certain rural health clinics with practitioners receiving DATA 2000 certification

(1)

In general

In the case of a rural health clinic with respect to which, beginning January 1, 2019, rural health clinic services (as defined in section 1861(aa)(1)) are furnished by a health care practitioner who first receives on or after such date a registration or waiver under section 303(g) of the Controlled Substances Act to prescribe or dispense methadone, buprenorphine, or suboxone for the purpose of maintenance or detoxification treatment, the Secretary shall, subject to availability of funds under subparagraph (B), make a payment (in accordance with such timing, method, and procedures as specified by the Secretary) to such rural health clinic in an amount determined by the Secretary, based on an approximation of the cost to receive training for purposes of such registration or waiver, as applicable. For purposes of the previous sentence, a rural health clinic shall apply for a payment described in such sentence at such time and in such manner as specified by the Secretary and may apply for such a payment for each practitioner furnishing such services at such clinic who is described in such sentence.

(2)

Funding

For purposes of making payments under this subsection, there are appropriated, out of amounts in the Treasury not otherwise appropriated, $2,000,000, which shall remain available until expended.

Studying the availability of supplemental benefits designed to treat or prevent substance use disorders under Medicare Advantage plans

(a)

In general

Not later than 2 years 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 submit to Congress a report on the availability of supplemental health care benefits (as described in section 1852(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w–22(a)(3)(A))) designed to treat or prevent substance use disorders under Medicare Advantage plans offered under part C of title XVIII of such Act. Such report shall include the analysis described in subsection (c) and any differences in the availability of such benefits under specialized MA plans for special needs individuals (as defined in section 1859(b)(6) of such Act (42 U.S.C. 1395w–28(b)(6))) offered to individuals entitled to medical assistance under title XIX of such Act and other such Medicare Advantage plans.

(b)

Consultation

The Secretary shall develop the report described in subsection (a) in consultation with relevant stakeholders, including—

(1)

individuals entitled to benefits under part A or enrolled under part B of title XVIII of the Social Security Act;

(2)

entities who advocate on behalf of such individuals;

(3)

Medicare Advantage organizations;

(4)

pharmacy benefit managers; and

(5)

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

(c)

Contents

The report described in subsection (a) shall include an analysis on the following:

(1)

The extent to which plans described in such subsection offer supplemental health care benefits relating to coverage of—

(A)

medication-assisted treatments for opioid use, substance use disorder counseling, peer recovery support services, or other forms of substance use disorder treatments (whether furnished in an inpatient or outpatient setting); and

(B)

non-opioid alternatives for the treatment of pain.

(2)

Challenges associated with such plans offering supplemental health care benefits relating to coverage of items and services described in subparagraph (A) or (B) of paragraph (1).

(3)

The impact, if any, of increasing the applicable rebate percentage determined under section 1854(b)(1)(C) of the Social Security Act (42 U.S.C. 1395w–24(b)(1)(C)) for plans offering such benefits relating to such coverage would have on the availability of such benefits relating to such coverage offered under Medicare Advantage plans.

(4)

Potential ways to improve upon such coverage or to incentivize such plans to offer additional supplemental health care benefits relating to such coverage.

Clinical psychologist services models under the Center for Medicare and Medicaid Innovation; GAO study and report

(a)

CMI models

Section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the end the following new clauses:

(xxv)

Supporting ways to familiarize individuals with the availability of coverage under part B of title XVIII for qualified psychologist services (as defined in section 1861(ii)).

(xxvi)

Exploring ways to avoid unnecessary hospitalizations or emergency department visits for mental and behavioral health services (such as for treating depression) through use of a 24-hour, 7-day a week help line that may inform individuals about the availability of treatment options, including the availability of qualified psychologist services (as defined in section 1861(ii)).

(b)

GAO study and report

Not later than 18 months after the date of the enactment of this Act, the Comptroller General of the United States shall conduct a study, and submit to Congress a report, on mental and behavioral health services under the Medicare program under title XVIII of the Social Security Act, including an examination of the following:

(1)

Information about services furnished by psychiatrists, clinical psychologists, and other professionals.

(2)

Information about ways that Medicare beneficiaries familiarize themselves about the availability of Medicare payment for qualified psychologist services (as defined in section 1861(ii) of the Social Security Act (42 U.S.C. 1395x(ii))) and ways that the provision of such information could be improved.

Pain management study

(a)

In general

Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services (referred to in this section as the Secretary) shall conduct a study and submit to the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a report containing recommendations on whether and how payment to providers and suppliers of services and coverage related to the use of multi-disciplinary, evidence-based, non-opioid treatments for acute and chronic pain management for individuals entitled to benefits under part A or enrolled under part B of title XVIII of the Social Security Act should be revised. The Secretary shall make such report available on the public website of the Centers for Medicare & Medicaid Services.

(b)

Consultation

In developing the report described in subsection (a), the Secretary shall consult with—

(1)

relevant agencies within the Department of Health and Human Services;

(2)

licensed and practicing osteopathic and allopathic physicians, behavioral health practitioners, physician assistants, nurse practitioners, dentists, pharmacists, and other providers of health services;

(3)

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

(4)

substance abuse and mental health professional organizations;

(5)

pain management professional organizations and advocacy entities, including individuals who personally suffer chronic pain;

(6)

medical professional organizations and medical specialty organizations;

(7)

licensed health care providers who furnish alternative pain management services;

(8)

organizations with expertise in the development of innovative medical technologies for pain management;

(9)

beneficiary advocacy organizations; and

(10)

other organizations with expertise in the assessment, diagnosis, treatment, and management of pain, as determined appropriate by the Secretary.

(c)

Contents

The report described in subsection (a) shall include the following:

(1)

The recommendations described in subsection (d).

(2)

The impact analysis described in subsection (e).

(3)

An assessment of pain management guidance published by the Federal Government that may be relevant to coverage determinations or other coverage requirements under title XVIII of the Social Security Act. Such assessment shall consider incorporating into such guidance relevant elements of the Va/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain published in February 2017 by the Department of Veterans Affairs and Department of Defense, including adoption of elements of the Department of Defense and Veterans Administration pain rating scale.

(4)

An evaluation of the following:

(A)

Barriers inhibiting individuals entitled to benefits under part A or enrolled under part B of such title from accessing treatments and technologies described in subparagraphs (A) through (F) of paragraph (6).

(B)

Potential legislative and administrative changes under such title to improve individuals’ access to items and services currently covered under such title and used for the treatment of pain, such as cognitive behavioral interventions, physical therapy, occupational therapy, physical medicine, biofeedback therapy, and chiropractic therapy, and other pain treatments services furnished in a hospital or post-acute care setting.

(C)

Costs and benefits associated with potential expansion of coverage under such title to include items and services not covered under such title that may be used for the treatment of pain, such as acupuncture, therapeutic massage, and items and services furnished by integrated pain management programs.

(5)

An analysis on payment and coverage under title XVIII of the Social Security Act with respect to the following:

(A)

Evidence-based treatments and technologies for chronic or acute pain, including such treatments that are covered, not covered, or have limited coverage under such title.

(B)

Evidence-based treatments and technologies that monitor substance use withdrawal and prevent overdoses of opioids.

(C)

Evidence-based treatments and technologies that treat substance use disorders.

(D)

Items and services furnished by practitioners through a multi-disciplinary treatment model for pain management, including the patient-centered medical home.

(E)

Medical devices, non-opioid based drugs, and other therapies (including interventional and integrative pain therapies) approved or cleared by the Food and Drug Administration for the treatment of pain.

(F)

Items and services furnished to beneficiaries with psychiatric disorders, substance use disorders, or who are at risk of suicide, or have comorbidities and require consultation or management of pain with one or more specialists in pain management, mental health, or addiction treatment.

(d)

Recommendations

The recommendations described in this subsection are, with respect to individuals entitled to benefits under part A or enrolled under part B of title XVIII of the Social Security Act, legislative and administrative recommendations on the following:

(1)

Options for additional coverage of pain management therapies without the use of opioids, including interventional pain therapies, and options to augment opioid therapy with other clinical and complementary, integrative health services to minimize the risk of substance use disorder, including in a hospital setting.

(2)

Options for coverage and payment modifications of medical devices and non-opioid based pharmacological and non-pharmacological therapies (including interventional and integrative pain therapies) approved or cleared by the Food and Drug Administration for the treatment of pain as an alternative or augment to opioid therapy.

(3)

Treatment strategies for beneficiaries with psychiatric disorders, substance use disorders, or who are at risk of suicide, and treatment strategies to address health disparities related to opioid use and opioid abuse treatment.

(4)

Treatment strategies for beneficiaries with comorbidities who require a consultation or comanagement of pain with one or more specialists in pain management, mental health, or addiction treatment, including in a hospital setting.

(5)

Coadministration of opioids and other drugs, particularly benzodiazepines.

(6)

Appropriate case management for beneficiaries who transition between inpatient and outpatient hospital settings, or between opioid therapy to non-opioid therapy, which may include the use of care transition plans.

(7)

Outreach activities designed to educate providers of services and suppliers under the Medicare program and individuals entitled to benefits under part A or under part B of such title on alternative, non-opioid therapies to manage and treat acute and chronic pain.

(8)

Creation of a beneficiary education tool on alternatives to opioids for chronic pain management.

(e)

Impact analysis

The impact analysis described in this subsection consists of an analysis of any potential effects implementing the recommendations described in subsection (d) would have—

(1)

on expenditures under the Medicare program; and

(2)

on preventing or reducing opioid addiction for individuals receiving benefits under the Medicare program.