II 

117TH CONGRESS 

1ST SESSION S. 586 

To amend title XVIII of the Social Security Act to combat the opioid crisis 

by promoting access to non-opioid treatments in the hospital outpatient 

setting. 

IN THE SENATE OF THE UNITED STATES 

MARCH 4, 2021 

Mrs. CAPITO (for herself, Mrs. SHAHEEN, Mr. PORTMAN, and Mr. MANCHIN) 

introduced the following bill; which was read twice and referred to the 

Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to combat 

the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Non-Opioids Prevent 

5 Addiction In the Nation Act’’ or the ‘‘NOPAIN Act’’. 

6 SEC. 2. ACCESS TO NON-OPIOID TREATMENTS FOR PAIN. 

7 (a) IN GENERAL.—Section 1833(t) of the Social Se8 curity Act (42 U.S.C. 1395l(t)) is amended— 


pbinns on DSKJLVW7X2PROD with BILLS
2 

•S 586 IS

1 (1) in paragraph (2)(E), by inserting ‘‘and sep2 arate payments for non-opioid treatments under 

3 paragraph (16)(G),’’ after ‘‘payments under para4 graph (6)’’; and 

5 (2) in paragraph (16), by adding at the end the 

6 following new subparagraph: 

7 ‘‘(G) ACCESS TO NON-OPIOID TREATMENTS

8 FOR PAIN.— 

9 ‘‘(i) IN GENERAL.—Notwithstanding 

10 any other provision of this subsection, with 

11 respect to a covered OPD service (or group 

12 of services) furnished on or after January 

13 1, 2022, and before January 1, 2027, the 

14 Secretary shall not package, and shall 

15 make a separate payment as specified in 

16 clause (ii) for, a non-opioid treatment (as 

17 defined in clause (iii)) furnished as part of 

18 such service (or group of services). 

19 ‘‘(ii) AMOUNT OF PAYMENT.—The 

20 amount of the payment specified in this 

21 clause is, with respect to a non-opioid 

22 treatment that is— 

23 ‘‘(I) a drug or biological product, 

24 the amount of payment for such drug 


pbinns on DSKJLVW7X2PROD with BILLS
3 

•S 586 IS

1 or biological determined under section 

2 1847A; or 

3 ‘‘(II) a medical device, the 

4 amount of the hospital’s charges for 

5 the device, adjusted to cost. 

6 ‘‘(iii) DEFINITION OF NON-OPIOID

7 TREATMENT.—A ‘non-opioid treatment’ 

8 means— 

9 ‘‘(I) a drug or biological product 

10 that is indicated to produce analgesia 

11 without acting upon the body’s opioid 

12 receptors; or 

13 ‘‘(II) an implantable, reusable, or 

14 disposable medical device cleared or 

15 approved by the Administrator for 

16 Food and Drugs for the intended use 

17 of managing or treating pain; 

18 that has demonstrated the ability to re19 place, reduce, or avoid opioid use or the 

20 quantity of opioids prescribed in a clinical 

21 trial or through data published in a peer22 reviewed journal.’’. 

23 (b) AMBULATORY SURGICAL CENTER PAYMENT SYS24 TEM.—Section 1833(i)(2)(D) of the Social Security Act 

25 (42 U.S.C. 1395l(i)(2)(D)) is amended— 


pbinns on DSKJLVW7X2PROD with BILLS
4 

•S 586 IS

1 (1) by aligning the margins of clause (v) with 

2 the margins of clause (iv); 

3 (2) by redesignating clause (vi) as clause (vii); 

4 and 

5 (3) by inserting after clause (v) the following 

6 new clause: 

7 ‘‘(vi) In the case of surgical services 

8 furnished on or after January 1, 2022, and 

9 before January 1, 2027, the payment sys10 tem described in clause (i) shall provide, in 

11 a budget-neutral manner, for a separate 

12 payment for a non-opioid treatment (as de13 fined in clause (iii) of subsection 

14 (t)(16)(G)) furnished as part of such serv15 ices in the amount specified in clause (ii) 

16 of such subsection.’’. 

17 (c) EVALUATION OF THERAPEUTIC SERVICES FOR

18 PAIN MANAGEMENT.— 

19 (1) REPORT TO CONGRESS.—Not later than 1 

20 year after the date of the enactment of this Act, the 

21 Secretary of Health and Human Services (in this 

22 subsection referred to as the ‘‘Secretary’’), acting 

23 through the Administrator of the Centers for Medi24 care & Medicaid Services, shall submit to Congress 

25 a report identifying— 


pbinns on DSKJLVW7X2PROD with BILLS
5 

•S 586 IS

1 (A) limitations, gaps, barriers to access, or 

2 deficits in Medicare coverage or reimbursement 

3 for restorative therapies, behavioral approaches, 

4 and complementary and integrative health serv5 ices that are identified in the Pain Management 

6 Best Practices Inter-Agency Task Force Report 

7 and that have demonstrated the ability to re8 place or reduce opioid consumption; and 

9 (B) recommendations to address the limi10 tations, gaps, barriers to access, or deficits 

11 identified under subparagraph (A) to improve 

12 Medicare coverage and reimbursement for such 

13 therapies, approaches, and services. 

14 (2) PUBLIC CONSULTATION.—In developing the 

15 report described in paragraph (1), the Secretary 

16 shall consult with relevant stakeholders as deter17 mined appropriate by the Secretary. 

18 (3) EXCLUSIVE TREATMENT.—Any drug, bio19 logical product, or medical device that is a non20 opioid treatment (as defined in section 

21 1833(t)(16)(G)(iii) of the Social Security Act, as 

22 added by subsection (a)) shall not be considered a 

23 therapeutic service for the purpose of the report de24 scribed in paragraph (1). 

Æ 


pbinns on DSKJLVW7X2PROD with BILLS