Alternatives to Opioids Prescribing Act

Summary: Alternatives to Opioids Prescribing Act This bill requires the Centers for Medicare &amp; Medicaid Services (CMS) to carry out a demonstration project to evaluate alternatives to&nbsp;the use of&nbsp;opioids to treat Medicare enrollees&nbsp;in hospital emergency departments. Under the project, the CMS must provide incentive payments to&nbsp;participating hospitals&nbsp;for decreasing the use of opioids and increasing the use of opioid alternatives. 

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Alternatives to Opioids Prescribing 
Act''.

SEC. 2. ALTERNATIVES TO OPIOIDS IN EMERGENCY DEPARTMENTS MEDICARE 
              DEMONSTRATION PROJECT.

    (a) Establishment.--Beginning not later than one year after the 
date of the enactment of this Act, the Secretary of Health and Human 
Services (in this Act referred to as the ``Secretary'') shall carry out 
a 5-year demonstration project under which payment shall be made under 
the hospital outpatient prospective payment system under part B of 
title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.) to 
participating hospitals for items and services furnished as 
alternatives to opioid medications to individuals enrolled under such 
part to treat conditions designated under subsection (c)(1) for 
purposes of evaluating the benefits of using, instead of opioid 
medications, such alternatives to treat in emergency departments such 
symptoms and conditions.
    (b) Emergency Departments.--
            (1) Selection.--The Secretary shall select from hospitals 
        with emergency departments voluntarily submitting applications 
        under paragraph (4), not fewer than 30 hospitals with emergency 
        departments, and not more than 50 hospitals with emergency 
        departments, for participation in the demonstration project.
            (2) Diversity.--In selecting hospitals with emergency 
        departments, the Secretary shall ensure such hospitals and 
        emergency departments are diverse in geography and size.
            (3) Voluntary participation.--Participation in the 
        demonstration project under this section shall be on a 
        voluntary basis.
            (4) Applications.--
                    (A) In general.--To participate in the 
                demonstration project, a hospital with an emergency 
                department shall submit to the Secretary an application 
                at such time, in such manner, and containing such 
                information (in addition to the written commitment 
                described in subparagraph (B)) as specified by the 
                Secretary. The Secretary shall take such measures as is 
                necessary to make available such application form to 
                potential participants no later than 180 days after the 
                date of the enactment of this Act.
                    (B) Information required.--Each application 
                submitted by a hospital under subparagraph (A) shall 
                include a binding written commitment to participate in 
                the demonstration project for the duration of the 
                project signed by the Chief Executive Officer of the 
                hospital, the physician medical director of the 
                emergency department of the hospital, the nursing 
                director of the emergency department of the hospital, 
                and the pharmacy director of the emergency department 
                of the hospital.
    (c) Elements of Demonstration Project.--Under the demonstration 
project, the following shall apply:
            (1) The Secretary shall designate no fewer than five 
        conditions or sets of symptoms that will be monitored during 
        the demonstration project.
            (2) The performance during each year of the demonstration 
        project, with respect to such conditions designated under 
        paragraph (1), of all emergency departments of hospitals 
        participating in the demonstration project will be measured 
        against the performance of such emergency departments during a 
        base year, which shall represent the most recent set of full 
        year data available before the first date of the demonstration 
        project.
            (3) The Secretary shall provide hospitals participating in 
        the demonstration project with a description of clearly defined 
        treatments that are considered alternatives to opioids to be 
        applied for purposes of subsection (a).
    (d) Incentive Payment.--Under the demonstration project, the 
Secretary shall create a payment structure under which hospitals 
participating in the demonstration project that increase the use of 
alternatives to opioids and decrease the use of opioids may receive a 
shared savings bonus in addition to what would otherwise be made for 
items and services furnished under subsection (a). The amount of such 
shared savings shall be based on the difference between readmission 
rates for individuals treated with an alternative to opioids at the 
emergency department of the participating hospital and the average rate 
of readmissions for individuals treated with opioids and discharged 
from a representative group of emergency departments of hospitals not 
participating in the demonstration project in the same region as the 
participating hospital over a period of five years.
    (e) Clarification.--Nothing under this section shall prevent a 
health care provider from prescribing an opioid if an opioid is a 
medically necessary treatment.
    (f) Reports to Congress.--
            (1) Initial report.--Not later than 180 days after the date 
        of the enactment of this Act, the Secretary shall submit to 
        Congress a report that includes--
                    (A) the application form described in subsection 
                (b)(4)(A) that is to be made available to potential 
                participants; and
                    (B) a progress report with respect to designating 
                the conditions under subsection (c)(1) and establishing 
                the description of clearly defined treatments described 
                in subsection (c)(3).
            (2) Periodic demonstration reports.--Beginning after the 
        first year of the demonstration project and annually thereafter 
        for each year of the demonstration project and not later than 
        one year after the completion of the demonstration, the 
        Secretary shall submit to Congress a report that includes the 
        following data for each hospital participating under the 
        demonstration project:
                    (A) With respect to each condition or set of 
                symptom designated under subsection (c)(1), the number 
                of individuals treated.
                    (B) With respect to each such condition, the number 
                of individuals treated only with an alternative to 
                opioids.
                    (C) With respect to each such condition, the number 
                of individuals treated first with an alternative to 
                opioids, followed by an opioid in the same visit.
                    (D) With respect to each such condition, the number 
                of individuals treated only with an opioid.
                    (E) With respect to each individual described in 
                subparagraph (A) treated for such a condition or set of 
                symptoms, whether or not the individual involved 
                returned to the emergency department of the hospital or 
                an emergency department of a different hospital for the 
                same condition or symptoms.
                    (F) The difference in cost between treating an 
                individual with an alternative to opioid versus an 
                opioid.
                    (G) Any additional information the Secretary 
                determines necessary.