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. 

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 ‘‘Preventing Overdoses 

3 While in Emergency Rooms Act of 2018’’. 

4 SEC. 2. PROGRAM TO SUPPORT EMERGENCY ROOM DIS5 CHARGE AND CARE COORDINATION FOR 

6 DRUG OVERDOSE PATIENTS. 

7 (a) IN GENERAL.—The Secretary of Health and 

8 Human Services shall establish a program (in this Act re9 ferred to as the ‘‘Program’’) to develop protocols for dis10 charging patients who have presented with a drug over11 dose and enhance the integration and coordination of care 

12 and treatment options for individuals with substance use 

13 disorder after discharge. 

14 (b) GRANT ESTABLISHMENT AND PARTICIPATION.— 

15 (1) IN GENERAL.—In carrying out the Pro16 gram, the Secretary shall award grants on a com17 petitive basis to not more than 20 eligible entities 

18 described in paragraph (2). 

19 (2) ELIGIBILITY.— 

20 (A) IN GENERAL.—To be eligible for a 

21 grant under this subsection, an entity shall 

22 be— 

23 (i) a health care site described in sub24 paragraph (B); or 

25 (ii) a health care site coordinator de26 scribed in subparagraph (C). 
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1 (B) HEALTH CARE SITES.—To be eligible 

2 for a grant under this section, a health care site 

3 shall— 

4 (i) submit an application to the Sec5 retary at such time, in such manner, and 

6 containing such information as specified by 

7 the Secretary; 

8 (ii) have an emergency department; 

9 (iii)(I) have a licensed health care pro10 fessional onsite who has a waiver under 

11 section 303(g) of the Controlled Sub12 stances Act (21 U.S.C. 823(g)) to dispense 

13 or prescribe covered drugs; or 

14 (II) have a demonstrable plan to hire 

15 a sufficient number of full-time licensed 

16 health care professionals who have waivers 

17 described in subclause (I) to administer 

18 such treatment onsite; 

19 (iv) have in place an agreement with 

20 a sufficient number and range of entities 

21 certified under applicable State and Fed22 eral law, such as pursuant to registration 

23 or a waiver under section 303(g) of the 

24 Controlled Substances Act (21 U.S.C. 

25 823(g)) or certification as described in sec-
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1 tion 8.2 of title 42 of the Code of Federal 

2 Regulations, to provide treatment for sub3 stance use disorder such that the entity or 

4 the resulting network of entities with an 

5 agreement with the hospital cumulatively 

6 are capable of providing all evidence-based 

7 services for the treatment of substance use 

8 disorder, as medically appropriate for the 

9 individual involved, including— 

10 (I) medication-assisted treat11 ment; 

12 (II) withdrawal and detoxifica13 tion services that include patient eval14 uation, stabilization, and readiness for 

15 and entry into treatment; and 

16 (III) counseling; 

17 (v) deploy onsite peer recovery special18 ists to help connect patients with treat19 ment and recovery support services; and 

20 (vi) include the provision of overdose 

21 reversal medication in discharge protocols 

22 for opioid overdose patients. 

23 (C) HEALTH CARE SITE COORDINATORS.— 

24 To be eligible for a grant under this section, a 

25 health care site coordinator shall— 
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1 (i) be an organization described in 

2 section 501(c)(3) of the Internal Revenue 

3 Code of 1986 (and exempt from tax under 

4 section 501(a) of such Code) or a State, 

5 local, or Tribal government; 

6 (ii) submit an application to the Sec7 retary at such time, in such manner, and 

8 containing such information as specified by 

9 the Secretary; and 

10 (iii) have an agreement with multiple 

11 eligible health care sites described in sub12 paragraph (B). 

13 (3) PREFERENCE.—In awarding grants under 

14 this section, the Secretary may give preference to eli15 gible entities described in paragraph (2) that meet 

16 either or both of the following criteria: 

17 (A) The eligible health care site is, or the 

18 eligible health care site coordinator has an 

19 agreement described in paragraph (2)(C)(iii) 

20 with a site that is, a critical access hospital (as 

21 defined in section 1861(mm)(1) of the Social 

22 Security Act (42 U.S.C. 1395x(mm)(1))), a 

23 low-volume hospital (as defined in section 

24 1886(d)(12)(C)(i) of such Act (42 U.S.C. 

25 1395ww(d)(12)(C)(i))), or a sole community 
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1 hospital (as defined in section 

2 1886(d)(5)(D)(iii) of such Act (42 U.S.C. 

3 1395ww(d)(5)(D)(iii))). 

4 (B) The eligible health care site or the eli5 gible health care site coordinator is located in 

6 a geographic area with a drug overdose rate 

7 that is higher than the national rate, or in a ge8 ographic area with a rate of emergency depart9 ment visits for overdoses that is higher than the 

10 national rate, as determined by the Secretary 

11 based on the most recent data from the Centers 

12 for Disease Control and Prevention. 

13 (4) MEDICATION-ASSISTED TREATMENT DE14 FINED.—For purposes of this section, the term 

15 ‘‘medication-assisted treatment’’ means the use of a 

16 drug approved under section 505 of the Federal 

17 Food, Drug, and Cosmetic Act (21 U.S.C. 355) or 

18 a biological product licensed under section 351 of 

19 the Public Health Service Act (42 U.S.C. 262), in 

20 combination with behavioral health services, to pro21 vide an individualized approach to the treatment of 

22 substance use disorders, including opioid use dis23 orders. 
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1 (c) PERIOD OF GRANT.—A grant awarded to an eligi2 ble entity under this section shall be for a period of at 

3 least 2 years. 

4 (d) GRANT USES.— 

5 (1) REQUIRED USES.—A grant awarded under 

6 this section to an eligible entity shall be used for 

7 both of the following purposes: 

8 (A) To establish policies and procedures 

9 that address the provision of overdose reversal 

10 medication, prescription and dispensing of 

11 medication-assisted treatment to an emergency 

12 department patient who has had a non-fatal 

13 overdose or who is at risk of a drug overdose, 

14 and the subsequent referral to evidence-based 

15 treatment upon discharge for patients who have 

16 experienced a non-fatal drug overdose or who 

17 are at risk of a drug overdose. 

18 (B) To develop best practices for treating 

19 non-fatal drug overdoses, including with respect 

20 to care coordination and integrated care models 

21 for long term treatment and recovery options 

22 for individuals who have experienced a non-fatal 

23 drug overdose. 
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1 (2) ADDITIONAL PERMISSIBLE USES.—A grant 

2 awarded under this section to an eligible entity may 

3 be used for any of the following purposes: 

4 (A) To hire emergency department peer re5 covery specialists; counselors; therapists; social 

6 workers; or other licensed medical professionals 

7 specializing in the treatment of substance use 

8 disorder. 

9 (B) To establish integrated models of care 

10 for individuals who have experienced a non-fatal 

11 drug overdose which may include patient as12 sessment, follow up, and transportation to 

13 treatment facilities. 

14 (C) To provide for options for increasing 

15 the availability and access of medication-as16 sisted treatment and other evidence-based treat17 ment for individuals with substance use dis18 orders. 

19 (D) To offer consultation with and referral 

20 to other supportive services that help in treat21 ment and recovery. 

22 (e) REPORTING REQUIREMENTS.— 

23 (1) REPORTS BY GRANTEES.—Each eligible en24 tity awarded a grant under this section shall submit 

25 to the Secretary an annual report for each year for 
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1 which the entity has received such grant that in2 cludes information on— 

3 (A) the number of individuals treated at 

4 the site (or, in the case of an eligible health 

5 care site coordinator, at sites covered by the 

6 agreement referred to in subsection 

7 (b)(2)(C)(iii)) for non-fatal overdoses in the 

8 emergency department; 

9 (B) the number of individuals administered 

10 each medication-assisted treatment at such site 

11 or sites in the emergency department; 

12 (C) the number of individuals referred by 

13 such site or sites to other treatment facilities 

14 after a non-fatal overdose, the types of such 

15 other facilities, and the number of such individ16 uals admitted to such other facilities pursuant 

17 to such referrals; 

18 (D) the frequency and number of patient 

19 readmissions for non-fatal overdoses and sub20 stance use disorder; 

21 (E) for what the grant funding was used; 

22 and 

23 (F) the effectiveness of, and any other rel24 evant additional data regarding, having an on25 site health care professional to administer and 
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1 begin medication-assisted treatment for sub2 stance use disorders. 

3 (2) REPORT BY SECRETARY.—Not less than 1 

4 year after the conclusion of the Program, the Sec5 retary shall submit to Congress a report that in6 cludes— 

7 (A) findings of the Program; 

8 (B) overall patient outcomes under the 

9 Program, such as with respect to hospital read10 mission; 

11 (C) what percentage of patients treated by 

12 a site funded through a grant under this section 

13 were readmitted to a hospital for non-fatal or 

14 fatal overdose; 

15 (D) an evaluation determining the effec16 tiveness of having a practitioner onsite to ad17 minister and begin medication-assisted treat18 ment for substance use disorder; and 

19 (E) a compilation of voluntary guidelines 

20 and best practices from the reports submitted 

21 under paragraph (1). 

22 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

23 authorized to be appropriated to carry out this Act 
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1 $50,000,000 for the period of fiscal years 2019 through 

2 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 

poses. emergency room discharge, and for other purwho have experienced a non-fatal overdose after Services to provide coordinated care to patients