Promoting Outpatient Access to Non-Opioid Treatments Act
This bill requires the Centers for Medicare & Medicaid Services (CMS) to review payments under Medicare for opioid and non-opioid pain management procedures, specifically with respect to ambulatory outpatient surgical procedures and hospital outpatient department services. The CMS must ensure that there are no payment incentives for using opioids instead of non-opioid alternatives and must make revisions accordingly.
[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5778 Introduced in House (IH)]
<DOC>
115th CONGRESS
2d Session
H. R. 5778
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.
_______________________________________________________________________
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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Promoting Outpatient Access to Non-
Opioid Treatments Act''.
SEC. 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).''.
<all>
Introduced in House
Introduced in House
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.
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.
Referred to the Subcommittee on Health.
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