H.R. 5778House115th Congress (2017-2019)In Committee

Promoting Outpatient Access to Non-Opioid Treatments Act

Introduced May 11, 2018

AI-Generated Summary

Updated April 15, 2026 at 9:49 PM UTC

The Promoting Outpatient Access to Non‑Opioid Treatments Act would change Medicare’s outpatient payment rules so that doctors and facilities are not financially encouraged to prescribe opioids when non‑opioid pain‑relief options exist. It tells the Health and Human Services Secretary to review how Medicare pays for opioid‑related services and for evidence‑based alternatives like nerve blocks, devices, and neuromodulation, and to adjust those payments if needed. The changes would apply to outpatient services and to ambulatory surgical centers, with any new payment rules taking effect starting in 2020.

Key Provisions

  • Requires the HHS Secretary to review Medicare outpatient payments for opioids and non‑opioid pain‑management treatments to identify any financial incentives favoring opioids.
  • Allows the Secretary to conduct follow‑up reviews and consider revising payment classifications, such as creating separate groups for opioid‑based and non‑opioid procedures.
  • Prioritizes reviews of services in comprehensive ambulatory payment classifications, surgical services, and other pain‑management related services.
  • If changes are needed, the Secretary must begin applying revised payments to services provided on or after Jan 1 2020, treating those changes as payment adjustments.
  • Permits the Secretary to run demonstrations before finalizing payment revisions and to adjust payments for opioid or non‑opioid services even before the formal rule takes effect.
  • Extends the review and revision requirements to ambulatory surgical centers, ensuring they follow the same payment adjustment rules.

Legislative Activity

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2 earlier actions
HouseCommittee Latest Action

Referred to the Subcommittee on Health.

May 31, 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.

May 11, 2018

HouseCommittee

Referred to the Subcommittee on Health.

May 31, 2018

Floor Debate

3 members

What members said about H.R. 5778 on the floor

2 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…

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…

Kenny Marchant
Rep. Kenny MarchantR-TX-24 · Jun 20, 2018

Mr. Speaker, I rise today in support of H.R. 6110, the Dr. Todd Graham Pain Management, Treatment, and Recovery Act of 2018. Introduced by my colleague on the Ways and Means Committee, Representative…

Bill Text

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Introduced in HouseIssued May 11, 2018

I

115th CONGRESS

2d Session

H. R. 5778

IN THE HOUSE OF REPRESENTATIVES

May 11, 2018

Mr. Marchant (for himself and Mr. Levin) 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 of the Social Security Act to provide for 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.

1.

Short title

This Act may be cited as the Promoting Outpatient Access to Non-Opioid Treatments Act.

2.

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).

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