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[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5176 Engrossed in House (EH)]

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115th CONGRESS
  2d Session
                                H. R. 5176

_______________________________________________________________________

                                 AN ACT

 
   To require the Secretary of Health and Human Services to provide 
coordinated care to patients who have experienced a non-fatal overdose 
        after emergency room discharge, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Preventing Overdoses While in 
Emergency Rooms Act of 2018''.

SEC. 2. PROGRAM TO SUPPORT EMERGENCY ROOM DISCHARGE AND CARE 
              COORDINATION FOR DRUG OVERDOSE PATIENTS.

    (a) In General.--The Secretary of Health and Human Services shall 
establish a program (in this Act referred to as the ``Program'') to 
develop protocols for discharging patients who have presented with a 
drug overdose and enhance the integration and coordination of care and 
treatment options for individuals with substance use disorder after 
discharge.
    (b) Grant Establishment and Participation.--
            (1) In general.--In carrying out the Program, the Secretary 
        shall award grants on a competitive basis to not more than 20 
        eligible entities described in paragraph (2).
            (2) Eligibility.--
                    (A) In general.--To be eligible for a grant under 
                this subsection, an entity shall be--
                            (i) a health care site described in 
                        subparagraph (B); or
                            (ii) a health care site coordinator 
                        described in subparagraph (C).
                    (B) Health care sites.--To be eligible for a grant 
                under this section, a health care site shall--
                            (i) submit an application to the Secretary 
                        at such time, in such manner, and containing 
                        such information as specified by the Secretary;
                            (ii) have an emergency department;
                            (iii)(I) have a licensed health care 
                        professional onsite who has a waiver under 
                        section 303(g) of the Controlled Substances Act 
                        (21 U.S.C. 823(g)) to dispense or prescribe 
                        covered drugs; or
                            (II) have a demonstrable plan to hire a 
                        sufficient number of full-time licensed health 
                        care professionals who have waivers described 
                        in subclause (I) to administer such treatment 
                        onsite;
                            (iv) have in place an agreement with a 
                        sufficient number and range of entities 
                        certified under applicable State and Federal 
                        law, such as pursuant to registration or a 
                        waiver under section 303(g) of the Controlled 
                        Substances Act (21 U.S.C. 823(g)) or 
                        certification as described in section 8.2 of 
                        title 42 of the Code of Federal Regulations, to 
                        provide treatment for substance use disorder 
                        such that the entity or the resulting network 
                        of entities with an agreement with the hospital 
                        cumulatively are capable of providing all 
                        evidence-based services for the treatment of 
                        substance use disorder, as medically 
                        appropriate for the individual involved, 
                        including--
                                    (I) medication-assisted treatment;
                                    (II) withdrawal and detoxification 
                                services that include patient 
                                evaluation, stabilization, and 
                                readiness for and entry into treatment; 
                                and
                                    (III) counseling;
                            (v) deploy onsite peer recovery specialists 
                        to help connect patients with treatment and 
                        recovery support services; and
                            (vi) include the provision of overdose 
                        reversal medication in discharge protocols for 
                        opioid overdose patients.
                    (C) Health care site coordinators.--To be eligible 
                for a grant under this section, a health care site 
                coordinator shall--
                            (i) be an organization described in section 
                        501(c)(3) of the Internal Revenue Code of 1986 
                        (and exempt from tax under section 501(a) of 
                        such Code) or a State, local, or Tribal 
                        government;
                            (ii) submit an application to the Secretary 
                        at such time, in such manner, and containing 
                        such information as specified by the Secretary; 
                        and
                            (iii) have an agreement with multiple 
                        eligible health care sites described in 
                        subparagraph (B).
            (3) Preference.--In awarding grants under this section, the 
        Secretary may give preference to eligible entities described in 
        paragraph (2) that meet either or both of the following 
        criteria:
                    (A) The eligible health care site is, or the 
                eligible health care site coordinator has an agreement 
                described in paragraph (2)(C)(iii) with a site that is, 
                a critical access hospital (as defined in section 
                1861(mm)(1) of the Social Security Act (42 U.S.C. 
                1395x(mm)(1))), a low-volume hospital (as defined in 
                section 1886(d)(12)(C)(i) of such Act (42 U.S.C. 
                1395ww(d)(12)(C)(i))), or a sole community hospital (as 
                defined in section 1886(d)(5)(D)(iii) of such Act (42 
                U.S.C. 1395ww(d)(5)(D)(iii))).
                    (B) The eligible health care site or the eligible 
                health care site coordinator is located in a geographic 
                area with a drug overdose rate that is higher than the 
                national rate, or in a geographic area with a rate of 
                emergency department visits for overdoses that is 
                higher than the national rate, as determined by the 
                Secretary based on the most recent data from the 
                Centers for Disease Control and Prevention.
            (4) Medication-assisted treatment defined.--For purposes of 
        this section, the term ``medication-assisted treatment'' means 
        the use of a drug approved under section 505 of the Federal 
        Food, Drug, and Cosmetic Act (21 U.S.C. 355) or a biological 
        product licensed under section 351 of the Public Health Service 
        Act (42 U.S.C. 262), in combination with behavioral health 
        services, to provide an individualized approach to the 
        treatment of substance use disorders, including opioid use 
        disorders.
    (c) Period of Grant.--A grant awarded to an eligible entity under 
this section shall be for a period of at least 2 years.
    (d) Grant Uses.--
            (1) Required uses.--A grant awarded under this section to 
        an eligible entity shall be used for both of the following 
        purposes:
                    (A) To establish policies and procedures that 
                address the provision of overdose reversal medication, 
                prescription and dispensing of medication-assisted 
                treatment to an emergency department patient who has 
                had a non-fatal overdose or who is at risk of a drug 
                overdose, and the subsequent referral to evidence-based 
                treatment upon discharge for patients who have 
                experienced a non-fatal drug overdose or who are at 
                risk of a drug overdose.
                    (B) To develop best practices for treating non-
                fatal drug overdoses, including with respect to care 
                coordination and integrated care models for long term 
                treatment and recovery options for individuals who have 
                experienced a non-fatal drug overdose.
            (2) Additional permissible uses.--A grant awarded under 
        this section to an eligible entity may be used for any of the 
        following purposes:
                    (A) To hire emergency department peer recovery 
                specialists; counselors; therapists; social workers; or 
                other licensed medical professionals specializing in 
                the treatment of substance use disorder.
                    (B) To establish integrated models of care for 
                individuals who have experienced a non-fatal drug 
                overdose which may include patient assessment, follow 
                up, and transportation to treatment facilities.
                    (C) To provide for options for increasing the 
                availability and access of medication-assisted 
                treatment and other evidence-based treatment for 
                individuals with substance use disorders.
                    (D) To offer consultation with and referral to 
                other supportive services that help in treatment and 
                recovery.
    (e) Reporting Requirements.--
            (1) Reports by grantees.--Each eligible entity awarded a 
        grant under this section shall submit to the Secretary an 
        annual report for each year for which the entity has received 
        such grant that includes information on--
                    (A) the number of individuals treated at the site 
                (or, in the case of an eligible health care site 
                coordinator, at sites covered by the agreement referred 
                to in subsection (b)(2)(C)(iii)) for non-fatal 
                overdoses in the emergency department;
                    (B) the number of individuals administered each 
                medication-assisted treatment at such site or sites in 
                the emergency department;
                    (C) the number of individuals referred by such site 
                or sites to other treatment facilities after a non-
                fatal overdose, the types of such other facilities, and 
                the number of such individuals admitted to such other 
                facilities pursuant to such referrals;
                    (D) the frequency and number of patient 
                readmissions for non-fatal overdoses and substance use 
                disorder;
                    (E) for what the grant funding was used; and
                    (F) the effectiveness of, and any other relevant 
                additional data regarding, having an onsite health care 
                professional to administer and begin medication-
                assisted treatment for substance use disorders.
            (2) Report by secretary.--Not less than 1 year after the 
        conclusion of the Program, the Secretary shall submit to 
        Congress a report that includes--
                    (A) findings of the Program;
                    (B) overall patient outcomes under the Program, 
                such as with respect to hospital readmission;
                    (C) what percentage of patients treated by a site 
                funded through a grant under this section were 
                readmitted to a hospital for non-fatal or fatal 
                overdose;
                    (D) an evaluation determining the effectiveness of 
                having a practitioner onsite to administer and begin 
                medication-assisted treatment for substance use 
                disorder; and
                    (E) a compilation of voluntary guidelines and best 
                practices from the reports submitted under paragraph 
                (1).
    (f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this Act $50,000,000 for the period of fiscal 
years 2019 through 2023.

            Passed the House of Representatives June 12, 2018.

            Attest:

                                                                 Clerk.
115th CONGRESS

  2d Session

                               H. R. 5176

_______________________________________________________________________

                                 AN ACT

   To require the Secretary of Health and Human Services to provide 
coordinated care to patients who have experienced a non-fatal overdose 
        after emergency room discharge, and for other purposes.
```