II 

115TH CONGRESS 

2D SESSION S. 2769 

To require the Secretary of Health and Human Services to provide for 

an action plan on recommendations for changes under Medicare and 

Medicaid to prevent opioids addictions and enhance access to medicationassisted treatment, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 26, 2018 

Mr. HELLER (for himself, Mr. MENENDEZ, and Mr. ISAKSON) introduced the 

following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To require the Secretary of Health and Human Services 

to provide for an action plan on recommendations for 

changes under Medicare and Medicaid to prevent opioids 

addictions and enhance access to medication-assisted 

treatment, and for other purposes. 

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


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1 SECTION 1. ACTION PLAN ON RECOMMENDATIONS FOR 

2 CHANGES UNDER MEDICARE AND MEDICAID 

3 TO PREVENT OPIOIDS ADDICTIONS AND EN4 HANCE ACCESS TO MEDICATION-ASSISTED 

5 TREATMENT. 

6 (a) IN GENERAL.—Not later than January 1, 2019, 

7 the Secretary of Health and Human Services (in this sec8 tion referred to as the ‘‘Secretary’’), in collaboration with 

9 the Pain Management Best Practices Inter-Agency Task 

10 Force convened under section 101(b) of the Comprehen11 sive Addiction and Recovery Act of 2016 (Public Law 

12 114–198), shall develop an action plan that provides rec13 ommendations described in subsection (b). 

14 (b) ACTION PLAN COMPONENTS.—Recommendations 

15 provided under the action plan under subsection (a) shall 

16 include recommendations on the following: 

17 (1) Recommendations on changes to the Medi18 care program under title XVIII of the Social Secu19 rity Act and the Medicaid program under title XIX 

20 of such Act that would enhance coverage and reim21 bursement under such programs of all medication22 assisted treatment approved by the Food and Drug 

23 Administration for the treatment of opioid addiction 

24 and other therapies that manage chronic and acute 

25 pain and treat and minimize risk of opioid addiction, 

26 including recommendations on changes to the MediVerDate Sep 11 2014 00:27 May 04, 2018 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2769.IS S2769

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1 care prospective payment system for hospital inpa2 tient department services under section 1886(d) of 

3 such Act (42 U.S.C. 1395ww(d)) and the Medicare 

4 prospective payment system for hospital outpatient 

5 department services under section 1833(t) of such 

6 Act (42 U.S.C. 1395l(t)) that would allow for sepa7 rate reimbursement for such therapies to encourage 

8 development and adoption of such therapies, if medi9 cally appropriate. 

10 (2) Recommendations for payment and service 

11 delivery models to be tested by the Center for Medi12 care and Medicaid Innovation and other federally 

13 authorized demonstration projects, including value14 based models, that may encourage the use of appro15 priate medication-assisted treatment approved by the 

16 Food and Drug Administration for the treatment of 

17 opioid addiction and other therapies that manage 

18 chronic and acute pain and treat and minimize risk 

19 of opioid addiction. 

20 (3) Recommendations for data collection that 

21 can facilitate research and policy making regarding 

22 prevention of opioid addiction and coverage and re23 imbursement under the Medicare program and the 

24 Medicaid program of appropriate opioid addiction 

25 treatments. 


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1 (4) Recommendations for provider education 

2 that can expand patient access to the full range of 

3 medication-assisted treatment approved by the Food 

4 and Drug Administration for the treatment of opioid 

5 addiction and other therapies that manage chronic 

6 and acute pain and treat and minimize risk of opioid 

7 addiction. 

8 (5) Recommendations for policies under the 

9 Medicare program and under the Medicaid program 

10 that can expand access for rural, or medically under11 served communities to the full range of medication12 assisted treatment approved by the Food and Drug 

13 Administration for the treatment of opioid addiction 

14 and other therapies that manage chronic and acute 

15 pain and treatment and minimize risk of opioid ad16 diction. 

17 (c) STAKEHOLDER MEETINGS.— 

18 (1) IN GENERAL.—Beginning not later than 3 

19 months after the date of the enactment of this Act, 

20 the Secretary shall convene a public stakeholder 

21 meeting to solicit public comment on the components 

22 of the action plan recommendations described in 

23 subsection (b). 

24 (2) PARTICIPANTS.—Participants of meetings 

25 described in paragraph (1) shall include representaVerDate Sep 11 2014 00:27 May 04, 2018 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2769.IS S2769

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1 tives from the Food and Drug Administration and 

2 National Institutes of Health, biopharmaceutical in3 dustry members, medical researchers, health care 

4 providers, the medical device industry, the Medicare 

5 program, the Medicaid program, and patient advo6 cates. 

7 (d) REQUEST FOR INFORMATION.—Not later than 3 

8 months after the date of the enactment of this section, 

9 the Secretary shall issue a request for information seeking 

10 public feedback regarding ways in which the Centers for 

11 Medicare & Medicaid Services can help address the opioid 

12 crisis through the development of and application of the 

13 action plan. 

14 (e) REPORT TO CONGRESS.—Not later than March 

15 1, 2019, the Secretary shall submit to Congress, and make 

16 public, a report that includes a summary of steps taken 

17 under the action plan, recommendations that have 

18 emerged under the action plan, and the Secretary’s 

19 planned next steps with respect to the action plan. 

20 (f) DEFINITION OF MEDICATION-ASSISTED TREAT21 MENT.—In this section, the term ‘‘medication-assisted 

22 treatment’’ includes opioid treatment programs, behav23 ioral therapy, and medications to treat substance abuse 

24 disorder. 


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1 SEC. 2. REPORT ON COVERAGE, CODING, AND REIMBURSE2 MENT POLICIES UNDER MEDICARE. 

3 (a) IN GENERAL.—Not later than 1 year after the 

4 date of the enactment of this Act, the Secretary of Health 

5 and Human Services (in this section referred to as the 

6 ‘‘Secretary’’) shall— 

7 (1) identify— 

8 (A) medical devices that are non-opioid 

9 based treatments approved by the Food and 

10 Drug Administration for the management of 

11 acute pain and chronic pain; 

12 (B) medical devices that are non-opioid 

13 based treatments approved by the Food and 

14 Drug Administration that monitor substance 

15 use withdrawal and prevent overdoses of con16 trolled substances; and 

17 (C) medical devices that are non-opioid 

18 based treatments approved by the Food and 

19 Drug Administration that treat substance use 

20 disorder; and 

21 (2) submit to the Committee on Finance of the 

22 Senate and the Committees on Ways and Means and 

23 Energy and Commerce of the House of Representa24 tives, and publish on a public Internet website of the 

25 Department of Health and Human Services, a re26 port containing recommendations on ways to encourVerDate Sep 11 2014 00:27 May 04, 2018 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2769.IS S2769

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1 age the use of such medical devices by individuals 

2 entitled to benefits under part A of title XVIII of 

3 the Social Security Act and enrolled under part B 

4 of such title (including individuals enrolled in a 

5 Medicare Advantage plan under part C of such title 

6 or in a prescription drug plan under part D of such 

7 title) and individuals enrolled under a State plan 

8 under title XIX of such Act. 

9 (b) CONTENTS.—The report under subsection (a) 

10 shall include an analysis of the following, with respect to 

11 the Medicare program under title XVIII of the Social Se12 curity Act and the Medicaid program under title XIX of 

13 such Act: 

14 (1) Various opioid alternatives for pain treat15 ment that are covered under such programs, that 

16 are not covered under such programs, that have lim17 ited coverage under such program, or with respect to 

18 which there are payment barriers under such pro19 grams. 

20 (2) Various medical devices that monitor sub21 stance use withdrawal and prevent overdose of con22 trolled substances that are covered so covered, that 

23 are not so covered, that have such limited coverage, 

24 or with respect to which there are such payment 

25 barriers. 


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1 (3) Various medical devices that treat substance 

2 use disorder and opioid use disorder that are so cov3 ered, that are not so covered, that have such limited 

4 coverage, or with respect to which there are such 

5 payment barriers. 

6 (4) Access to payment codes used by health 

7 care providers that promote alternative options for 

8 pain management therapies without the use of 

9 opioids, including minimally invasive pain therapies. 

10 (5) Ways to improve communications between 

11 Medicare prescription drug plans and Medicare Ad12 vantage plans, Medicare and Medicaid health care 

13 providers, and Medicare beneficiaries and Medicaid 

14 beneficiaries on the potential harm associated with 

15 the use of opioids and other controlled substances, 

16 including the need to safely store and dispose of sup17 plies relating to the use of opioids and other con18 trolled substances. 

Æ 


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