Commit to Opioid Medical Prescriber Accountability and Safety for Seniors Act of 2018

Summary: Commit to Opioid Medical Prescriber Accountability and Safety for Seniors Act  of 2018 This bill requires the Centers for Medicare &amp; Medicaid Services (CMS) to identify outlier prescribers of opioids under the Medicare prescription drug benefit and Medicare Advantage prescription drug plans. Specifically, the CMS must: (1) establish an opioid-prescription threshold for determining whether a prescriber is an outlier compared to other prescribers, based on specialty and geographic area; (2) use National Provider Identifiers (unique provider identification numbers currently included on claims for covered drugs) to identify outlier prescribers; and (3) annually notify identified outlier prescribers of their status and provide them with resources on proper prescribing methods. The CMS may also identify and notify outlier prescribers based on co-prescriptions of covered drugs that have adverse effects when used in combination with opioids. Persistent outlier prescribers are subject to additional requirements.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Commit to Opioid Medical Prescriber 
Accountability and Safety for Seniors Act of 2018''.

SEC. 2. MEDICARE REQUIREMENTS WITH RESPECT TO OUTLIER PRESCRIBERS OF 
              OPIOIDS.

    Section 1860D-4(c)(4) of the Social Security Act (42 U.S.C. 1395w-
104(c)(4)) is amended by adding at the end the following new 
subparagraph:
                    ``(D) Notification and additional requirements with 
                respect to outlier prescribers of opioids.--
                            ``(i) Notification.--Not later than January 
                        1, 2021, the Secretary shall, in the case of a 
                        prescriber identified by the Secretary under 
                        clause (ii) to be an outlier prescriber of 
                        opioids, provide, subject to clause (iv), an 
                        annual notification to such prescriber (during 
                        the period in which such provider maintains 
                        such identification) that such prescriber has 
                        been so identified and including such resources 
                        on proper prescribing methods and such other 
                        information as specified in accordance with 
                        clause (iii).
                            ``(ii) Identification of outlier 
                        prescribers of opioids.--
                                    ``(I) In general.--The Secretary 
                                shall, subject to subclause (III), 
                                using the valid prescriber National 
                                Provider Identifiers included pursuant 
                                to subparagraph (A) on claims for 
                                covered part D drugs for part D 
                                eligible individuals enrolled in 
                                prescription drug plans under this part 
                                and MA-PD plans under part C and based 
                                on the thresholds established under 
                                subclause (II), identify prescribers 
                                that are outlier opioids prescribers 
                                for a period of time specified by the 
                                Secretary.
                                    ``(II) Establishment of 
                                thresholds.--For purposes of subclause 
                                (I) and subject to subclause (III), the 
                                Secretary shall, after consultation 
                                with stakeholders, establish 
                                thresholds, based on prescriber 
                                specialty and, as determined 
                                appropriate by the Secretary, 
                                geographic area, for identifying 
                                whether a prescriber in a specialty and 
                                geographic area is an outlier 
                                prescriber of opioids as compared to 
                                other prescribers of opioids within 
                                such specialty and area.
                                    ``(III) Exclusions.--The following 
                                shall not be included in the process 
                                for identifying outlier prescribers of 
                                opioids under this clause:
                                            ``(aa) Claims for covered 
                                        part D drugs for part D 
                                        eligible individuals who are 
                                        receiving hospice care under 
                                        this title.
                                            ``(bb) Claims for covered 
                                        part D drugs for part D 
                                        eligible individuals who are 
                                        receiving oncology services 
                                        under this title.
                                            ``(cc) Prescribers who are 
                                        the subject of an investigation 
                                        by the Centers for Medicare & 
                                        Medicaid Services or the Office 
                                        of the Inspector General of the 
                                        Department of Health and Human 
                                        Services.
                            ``(iii) Contents of notification.--The 
                        Secretary shall include the following 
                        information in the notifications provided under 
                        clause (i):
                                    ``(I) Information on how such 
                                prescriber compares to other 
                                prescribers within the same specialty 
                                and, if determined appropriate by the 
                                Secretary, geographic area.
                                    ``(II) Information on opioid 
                                prescribing guidelines, based on input 
                                from stakeholders, that may include the 
                                Centers for Disease Control and 
                                Prevention guidelines for prescribing 
                                opioids for chronic pain and guidelines 
                                developed by physician organizations.
                                    ``(III) Other information 
                                determined appropriate by the 
                                Secretary.
                            ``(iv) Modifications and expansions.--
                                    ``(I) Frequency.--Beginning 5 years 
                                after the date of the enactment of this 
                                subparagraph, the Secretary may change 
                                the frequency of the notifications 
                                described in clause (i) based on 
                                stakeholder input and changes in opioid 
                                prescribing utilization and trends.
                                    ``(II) Expansion to other 
                                prescriptions.--The Secretary may 
                                expand notifications under this 
                                subparagraph to include identifications 
                                and notifications with respect to 
                                concurrent prescriptions of covered 
                                part D drugs used in combination with 
                                opioids that are considered to have 
                                adverse side effects when so used in 
                                such combination.
                            ``(v) Additional requirements for 
                        persistent outlier prescribers.--In the case of 
                        a prescriber who the Secretary determines is 
                        persistently identified under clause (ii) as an 
                        outlier prescriber of opioids, the following 
                        shall apply:
                                    ``(I) The Secretary shall connect 
                                such prescriber with an entity that 
                                provides technical or educational 
                                resources on opioid prescribing 
                                guidelines (such as the guidelines 
                                described in clause (iii)(II)), which 
                                may include a quality improvement 
                                organization under part B of title XI, 
                                as available and appropriate.
                                    ``(II) Such prescriber may be 
                                required to enroll in the program under 
                                this title under section 1866(j) if 
                                such prescriber is not otherwise 
                                required to enroll. The Secretary shall 
                                determine the length of the period for 
                                which such prescriber is required to 
                                maintain such enrollment.
                                    ``(III) Not less frequently than 
                                annually (and in a form and manner 
                                determined appropriate by the 
                                Secretary), the Secretary shall 
                                communicate information on such 
                                prescribers to sponsors of a 
                                prescription drug plan and Medicare 
                                Advantage organizations offering an MA-
                                PD plan.
                            ``(vi) Public availability of 
                        information.--The Secretary shall make 
                        aggregate information under this subparagraph 
                        available on the Internet website of the 
                        Centers for Medicare & Medicaid Services. Such 
                        information shall be in a form and manner 
                        determined appropriate by the Secretary and 
                        shall not identify any specific prescriber. In 
                        carrying out this clause, the Secretary shall 
                        consult with interested stakeholders.
                            ``(vii) Opioids defined.--For purposes of 
                        this subparagraph, the term `opioids' has such 
                        meaning as specified by the Secretary.
                            ``(viii) Other activities.--Nothing in this 
                        subparagraph shall preclude the Secretary from 
                        conducting activities that provide prescribers 
                        with information as to how they compare to 
                        other prescribers that are in addition to the 
                        activities under this subparagraph, including 
                        activities that were being conducted as of the 
                        date of the enactment of this subparagraph.''.