IIB 

115TH CONGRESS 

2D SESSION H. R. 5197 

IN THE SENATE OF THE UNITED STATES 

JUNE 13, 2018 

Received; read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

AN ACT 

To direct the Secretary of Health and Human Services to 

conduct a demonstration program to test alternative pain 

management protocols to limit the use of opioids in emergency departments. 

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. SHORT TITLE. 

2 This Act may be cited as the ‘‘Alternatives to Opioids 

3 in the Emergency Department Act’’ or the ‘‘ALTO Act’’. 

4 SEC. 2. EMERGENCY DEPARTMENT ALTERNATIVES TO 

5 OPIOIDS DEMONSTRATION PROGRAM. 

6 (a) DEMONSTRATION PROGRAM GRANTS.—The Sec7 retary of Health and Human Services (in this section re8 ferred to as the ‘‘Secretary’’) shall carry out a demonstra9 tion program under which the Secretary shall award 

10 grants to hospitals and emergency departments, including 

11 freestanding emergency departments, to develop, imple12 ment, enhance, or study alternative pain management pro13 tocols and treatments that limit the use and prescription 

14 of opioids in emergency departments. 

15 (b) ELIGIBILITY.—To be eligible to receive a grant 

16 under subsection (a), a hospital or emergency department 

17 shall submit an application to the Secretary at such time, 

18 in such manner, and containing such information as the 

19 Secretary may require. 

20 (c) GEOGRAPHIC DIVERSITY.—In awarding grants 

21 under this section, the Secretary shall seek to ensure geo22 graphical diversity among grant recipients. 

23 (d) USE OF FUNDS.—Grants under subsection (a) 

24 shall be used to— 


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1 (1) target common painful conditions, such as 

2 renal colic, sciatica, headaches, musculoskeletal pain, 

3 and extremity fractures; 

4 (2) train providers and other hospital personnel 

5 on protocols and the use of treatments that limit the 

6 use and prescription of opioids in the emergency de7 partment; and 

8 (3) provide alternatives to opioids to patients 

9 with painful conditions, not including patients who 

10 present with pain related to cancer, end-of-life symp11 tom palliation, or complex multisystem trauma. 

12 (e) CONSULTATION.—The Secretary shall implement 

13 a process for recipients of grants under subsection (a) to 

14 consult (in a manner that allows for sharing of evidence15 based best practices) with each other and with persons 

16 having robust knowledge, including emergency depart17 ments and physicians that have successfully deployed al18 ternative pain management protocols, such as non-drug 

19 approaches studied through the National Center for Com20 plimentary and Integrative Health including acupuncture 

21 that limit the use of opioids. The Secretary shall offer to 

22 each recipient of a grant under subsection (a) technical 

23 support as necessary. 

24 (f) REPORT TO THE SECRETARY.—Each recipient of 

25 a grant under this section shall submit to the Secretary 


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1 (during the period of such grant) annual reports on the 

2 progress of the program funded through the grant. These 

3 reports shall include, in accordance with State and Fed4 eral statutes and regulations regarding disclosure of pa5 tient information— 

6 (1) a description of and specific information 

7 about the alternative pain management protocols 

8 employed; 

9 (2) data on the alternative pain management 

10 protocols and treatments employed, including— 

11 (A) during a baseline period before the 

12 program began, as defined by the Secretary; 

13 (B) at various stages of the program, as 

14 determined by the Secretary; and 

15 (C) the conditions for which the alternative 

16 pain management protocols and treatments 

17 were employed; 

18 (3) the success of each specific alternative pain 

19 management protocol; 

20 (4) data on the opioid prescriptions written, in21 cluding— 

22 (A) during a baseline period before the 

23 program began, as defined by the Secretary; 

24 (B) at various stages of the program, as 

25 determined by the Secretary; and 


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1 (C) the conditions for which the opioids 

2 were prescribed; 

3 (5) the demographic characteristics of patients 

4 who were treated with an alternative pain manage5 ment protocol, including age, sex, race, ethnicity, 

6 and insurance status and type; 

7 (6) data on patients who were eventually pre8 scribed opioids after alternative pain management 

9 protocols and treatments were employed; and 

10 (7) any other information the Secretary deems 

11 necessary. 

12 (g) REPORT TO CONGRESS.—Not later than 1 year 

13 after completion of the demonstration program under this 

14 section, the Secretary shall submit a report to the Con15 gress on the results of the demonstration program and in16 clude in the report— 

17 (1) the number of applications received and the 

18 number funded; 

19 (2) a summary of the reports described in sub20 section (f), including standardized data; and 

21 (3) recommendations for broader implementa22 tion of pain management protocols that limit the use 

23 and prescription of opioids in emergency depart24 ments or other areas of the health care delivery sys25 tem. 


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1 (h) AUTHORIZATION OF APPROPRIATIONS.—To carry 

2 out this section, there is authorized to be appropriated 

3 $10,000,000 for each of fiscal years 2019 through 2021. 

Passed the House of Representatives June 12, 2018. 

Attest: KAREN L. HAAS, 

Clerk. 


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