Combating Opioid Abuse for Care in Hospitals Act of 2018

Summary: Combating Opioid Abuse for Care in Hospitals Act of 2018 or the COACH Act of 2018 (Sec. 2) This bill requires the Centers for Medicare &amp; Medicaid Services (CMS) to publish guidance for hospitals on pain management and opioid-use disorder prevention strategies for Medicare beneficiaries. (Sec. 3) The CMS must also convene a technical expert panel to recommend opioid and opioid-use disorder quality measures for possible use in hospital payment and reporting models under Medicare. (Sec. 4) The Department of Health and Human Services must: (1) convene a technical expert panel to recommend ways to reduce opioid use in surgical settings and best practices for pain management, specifically during the perioperative (pre-operative through post-operative) period; and (2) report on diagnosis-related group codes that have the highest volume of surgeries and the availability of associated data regarding post-operative opioid use, including prescription patterns and rates of consumption.  (Sec. 5) The CMS must also publish and periodically update all guidance issued since January 1, 2016, related to the prescription of opioids for Medicare beneficiaries.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Combating Opioid Abuse for Care in 
Hospitals Act of 2018'' or the ``COACH Act of 2018''.

SEC. 2. DEVELOPING GUIDANCE ON PAIN MANAGEMENT AND OPIOID USE DISORDER 
              PREVENTION FOR HOSPITALS RECEIVING PAYMENT UNDER PART A 
              OF THE MEDICARE PROGRAM.

    (a) In General.--Not later than January 1, 2019, the Secretary of 
Health and Human Services (in this section referred to as the 
``Secretary'') shall develop and publish on the public website of the 
Centers for Medicare & Medicaid Services guidance for hospitals 
receiving payment under part A of title XVIII of the Social Security 
Act (42 U.S.C. 1395c et seq.) on pain management strategies and opioid 
use disorder prevention strategies with respect to individuals entitled 
to benefits under such part.
    (b) Consultation.--In developing the guidance described in 
subsection (a), the Secretary shall consult with relevant stakeholders, 
including--
            (1) medical professional organizations;
            (2) providers and suppliers of services (as such terms are 
        defined in section 1861 of the Social Security Act (42 U.S.C. 
        1395x));
            (3) health care consumers or groups representing such 
        consumers; and
            (4) other entities determined appropriate by the Secretary.
    (c) Contents.--The guidance described in subsection (a) shall 
include, with respect to hospitals and individuals described in such 
subsection, the following:
            (1) Best practices regarding evidence-based screening and 
        practitioner education initiatives relating to screening and 
        treatment protocols for opioid use disorder, including--
                    (A) methods to identify such individuals at-risk of 
                opioid use disorder, including risk stratification;
                    (B) ways to prevent, recognize, and treat opioid 
                overdoses; and
                    (C) resources available to such individuals, such 
                as opioid treatment programs, peer support groups, and 
                other recovery programs.
            (2) Best practices for such hospitals to educate 
        practitioners furnishing items and services at such hospital 
        with respect to pain management and substance use disorders, 
        including education on--
                    (A) the adverse effects of prolonged opioid use;
                    (B) non-opioid, evidence-based, non-pharmacological 
                pain management treatments;
                    (C) monitoring programs for individuals who have 
                been prescribed opioids; and
                    (D) the prescribing of naloxone along with an 
                initial opioid prescription.
            (3) Best practices for such hospitals to make such 
        individuals aware of the risks associated with opioid use 
        (which may include use of the notification template described 
        in paragraph (4)).
            (4) A notification template developed by the Secretary, for 
        use as appropriate, for such individuals who are prescribed an 
        opioid that--
                    (A) explains the risks and side effects associated 
                with opioid use (including the risks of addiction and 
                overdose) and the importance of adhering to the 
                prescribed treatment regimen, avoiding medications that 
                may have an adverse interaction with such opioid, and 
                storing such opioid safely and securely;
                    (B) highlights multimodal and evidence-based non-
                opioid alternatives for pain management;
                    (C) encourages such individuals to talk to their 
                health care providers about such alternatives;
                    (D) provides for a method (through signature or 
                otherwise) for such an individual, or person acting on 
                such individual's behalf, to acknowledge receipt of 
                such notification template;
                    (E) is worded in an easily understandable manner 
                and made available in multiple languages determined 
                appropriate by the Secretary; and
                    (F) includes any other information determined 
                appropriate by the Secretary.
            (5) Best practices for such hospital to track opioid 
        prescribing trends by practitioners furnishing items and 
        services at such hospital, including--
                    (A) ways for such hospital to establish target 
                levels, taking into account the specialties of such 
                practitioners and the geographic area in which such 
                hospital is located, with respect to opioids prescribed 
                by such practitioners;
                    (B) guidance on checking the medical records of 
                such individuals against information included in 
                prescription drug monitoring programs;
                    (C) strategies to reduce long-term opioid 
                prescriptions; and
                    (D) methods to identify such practitioners who may 
                be over-prescribing opioids.
            (6) Other information the Secretary determines appropriate, 
        including any such information from the Opioid Safety 
        Initiative established by the Department of Veterans Affairs or 
        the Opioid Overdose Prevention Toolkit published by the 
        Substance Abuse and Mental Health Services Administration.

SEC. 3. REQUIRING THE REVIEW OF QUALITY MEASURES RELATING TO OPIOIDS 
              AND OPIOID USE DISORDER TREATMENTS FURNISHED UNDER THE 
              MEDICARE PROGRAM AND OTHER FEDERAL HEALTH CARE PROGRAMS.

    (a) In General.--Section 1890A of the Social Security Act (42 
U.S.C. 1395aaa-1) is amended by adding at the end the following new 
subsection:
    ``(g) Technical Expert Panel Review of Opioid and Opioid Use 
Disorder Quality Measures.--
            ``(1) In general.--Not later than 180 days after the date 
        of the enactment of this subsection, the Secretary shall 
        establish a technical expert panel for purposes of reviewing 
        quality measures relating to opioids and opioid use disorders, 
        including care, prevention, diagnosis, health outcomes, and 
        treatment furnished to individuals with opioid use disorders. 
        The Secretary may use the entity with a contract under section 
        1890(a) and amend such contract as necessary to provide for the 
        establishment of such technical expert panel.
            ``(2) Review and assessment.--Not later than 1 year after 
        the date the technical expert panel described in paragraph (1) 
        is established (and periodically thereafter as the Secretary 
        determines appropriate), the technical expert panel shall--
                    ``(A) review quality measures that relate to 
                opioids and opioid use disorders, including existing 
                measures and those under development;
                    ``(B) identify gaps in areas of quality measurement 
                that relate to opioids and opioid use disorders, and 
                identify measure development priorities for such 
                measure gaps; and
                    ``(C) make recommendations to the Secretary on 
                quality measures with respect to opioids and opioid use 
                disorders for purposes of improving care, prevention, 
                diagnosis, health outcomes, and treatment, including 
                recommendations for revisions of such measures, need 
                for development of new measures, and recommendations 
                for including such measures in the Merit-Based 
                Incentive Payment System under section 1848(q), the 
                alternative payment models under section 1833(z)(3)(C), 
                the shared savings program under section 1899, the 
                quality reporting requirements for inpatient hospitals 
                under section 1886(b)(3)(B)(viii), and the hospital 
                value-based purchasing program under section 1886(o).
            ``(3) Consideration of measures by secretary.--The 
        Secretary shall consider--
                    ``(A) using opioid and opioid use disorder measures 
                (including measures used under the Merit-Based 
                Incentive Payment System under section 1848(q), 
                measures recommended under paragraph (2)(C), and other 
                such measures identified by the Secretary) in 
                alternative payment models under section 1833(z)(3)(C) 
                and in the shared savings program under section 1899; 
                and
                    ``(B) using opioid measures described in 
                subparagraph (A), as applicable, in the quality 
                reporting requirements for inpatient hospitals under 
                section 1886(b)(3)(B)(viii),and in the hospital value-
                based purchasing program under section 1886(o).
            ``(4) Prioritization of measure development.--The Secretary 
        shall prioritize for measure development the gaps in quality 
        measures identified under paragraph (2)(B).''.
    (b) Expedited Endorsement Process for Opioid Measures.--Section 
1890(b)(2) of the Social Security Act (42 U.S.C. 1395aaa(b)(2)) is 
amended by adding at the end the following new flush sentence:
        ``Such endorsement process shall, as determined practicable by 
        the entity, provide for an expedited process with respect to 
        the endorsement of such measures relating to opioids and opioid 
        use disorders.''.

SEC. 4. TECHNICAL EXPERT PANEL ON REDUCING SURGICAL SETTING OPIOID USE; 
              DATA COLLECTION ON PERIOPERATIVE OPIOID USE.

    (a) Technical Expert Panel on Reducing Surgical Setting Opioid 
Use.--
            (1) In general.--Not later than 6 months after the date of 
        the enactment of this Act, the Secretary of Health and Human 
        Services shall convene a technical expert panel, including 
        medical and surgical specialty societies and hospital 
        organizations, to provide recommendations on reducing opioid 
        use in the inpatient and outpatient surgical settings and on 
        best practices for pain management, including with respect to 
        the following:
                    (A) Approaches that limit patient exposure to 
                opioids during the perioperative period, including pre-
                surgical and post-surgical injections, and that 
                identify such patients at risk of opioid use disorder 
                pre-operation.
                    (B) Shared decision making with patients and 
                families on pain management, including recommendations 
                for the development of an evaluation and management 
                code for purposes of payment under the Medicare program 
                under title XVIII of the Social Security Act that would 
                account for time spent on shared decision making.
                    (C) Education on the safe use, storage, and 
                disposal of opioids.
                    (D) Prevention of opioid misuse and abuse after 
                discharge.
                    (E) Development of a clinical algorithm to identify 
                and treat at-risk, opiate-tolerant patients and reduce 
                reliance on opioids for acute pain during the 
                perioperative period.
            (2) Report.--Not later than 1 year after the date of the 
        enactment of this Act, the Secretary shall submit to Congress 
        and make public a report containing the recommendations 
        developed under paragraph (1) and an action plan for broader 
        implementation of pain management protocols that limit the use 
        of opioids in the perioperative setting and upon discharge from 
        such setting.
    (b) Data Collection on Perioperative Opioid Use.--Not later than 1 
year after the date of the enactment of this Act, the Secretary of 
Health and Human Services shall submit to Congress a report that 
contains the following:
            (1) The diagnosis-related group codes identified by the 
        Secretary as having the highest volume of surgeries.
            (2) With respect to each of such diagnosis-related group 
        codes so identified, a determination by the Secretary of the 
        data that is both available and reported on opioid use 
        following such surgeries, such as with respect to--
                    (A) surgical volumes, practices, and opioid 
                prescribing patterns;
                    (B) opioid consumption, including--
                            (i) perioperative days of therapy;
                            (ii) average daily dose at the hospital, 
                        including dosage greater than 90 milligram 
                        morphine equivalent;
                            (iii) post-discharge prescriptions and 
                        other combination drugs that are used before 
                        intervention and after intervention;
                            (iv) quantity and duration of opioid 
                        prescription at discharge; and
                            (v) quantity consumed and number of 
                        refills;
                    (C) regional anesthesia and analgesia practices, 
                including pre-surgical and post-surgical injections;
                    (D) naloxone reversal;
                    (E) post-operative respiratory failure;
                    (F) information about storage and disposal; and
                    (G) such other information as the Secretary may 
                specify.
            (3) Recommendations for improving data collection on 
        perioperative opioid use, including an analysis to identify and 
        reduce barriers to collecting, reporting, and analyzing the 
        data described in paragraph (2), including barriers related to 
        technological availability.

SEC. 5. REQUIRING THE POSTING AND PERIODIC UPDATE OF OPIOID PRESCRIBING 
              GUIDANCE FOR MEDICARE BENEFICIARIES.

    (a) In General.--Not later than 180 days 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 post on the public 
website of the Centers for Medicare & Medicaid Services all guidance 
published by the Department of Health and Human Services on or after 
January 1, 2016, relating to the prescribing of opioids and applicable 
to opioid prescriptions for individuals entitled to benefits under part 
A of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.) 
or enrolled under part B of such title of such Act (42 U.S.C. 1395j et 
seq.).
    (b) Update of Guidance.--
            (1) Periodic update.--The Secretary shall, in consultation 
        with the entities specified in paragraph (2), periodically (as 
        determined appropriate by the Secretary) update guidance 
        described in subsection (a) and revise the posting of such 
        guidance on the website described in such subsection.
            (2) Consultation.--The entities specified in this paragraph 
        are the following:
                    (A) Medical professional organizations.
                    (B) Providers and suppliers of services (as such 
                terms are defined in section 1861 of the Social 
                Security Act (42 U.S.C. 1395x)).
                    (C) Health care consumers or groups representing 
                such consumers.
                    (D) Other entities determined appropriate by the 
                Secretary.

            Passed the House of Representatives June 19, 2018.

            Attest:

                                                 KAREN L. HAAS,

                                                                 Clerk.