I 

115TH CONGRESS 

2D SESSION H. R. 5716 

To amend title XVIII of the Social Security Act to require the Secretary 

of Health and Human Services to provide notifications under the Medicare program to outlier prescribers of opioids. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 9, 2018 

Mr. ROSKAM (for himself, Mr. LARSON of Connecticut, Mrs. BROOKS of Indiana, and Mr. WELCH) introduced the following bill; which was referred 

to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined 

by the Speaker, in each case for consideration of such provisions as fall 

within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to require 

the Secretary of Health and Human Services to provide 

notifications under the Medicare program to outlier prescribers of opioids. 

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 ‘‘Commit to Opioid 

5 Medical Prescriber Accountability and Safety for Seniors 

6 Act’’ or the ‘‘COMPASS Act’’. 


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1 SEC. 2. MEDICARE NOTIFICATIONS TO OUTLIER PRE2 SCRIBERS OF OPIOIDS. 

3 Section 1860D–4(c)(4) of the Social Security Act (42 

4 U.S.C. 1395w–104(c)(4)) is amended by adding at the end 

5 the following new paragraph: 

6 ‘‘(D) OUTLIER PRESCRIBER NOTIFICA7 TION.— 

8 ‘‘(i) NOTIFICATION.—Beginning not 

9 later than two years after the date of the 

10 enactment of this subparagraph, the Sec11 retary shall, in the case of a prescriber 

12 identified by the Secretary under clause 

13 (ii) to be an outlier prescriber of opioids, 

14 provide, subject to clause (iv), an annual 

15 notification to such prescriber that such 

16 prescriber has been so identified and that 

17 includes resources on proper prescribing 

18 methods and other information specified in 

19 accordance with clause (iii). 

20 ‘‘(ii) IDENTIFICATION OF OUTLIER

21 PRESCRIBERS OF OPIOIDS.— 

22 ‘‘(I) IN GENERAL.—The Sec23 retary shall, subject to subclause (III), 

24 using the valid prescriber National 

25 Provider Identifiers included pursuant 

26 to subparagraph (A) on claims for 


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1 covered part D drugs for part D eligi2 ble individuals enrolled in prescription 

3 drug plans under this part or MA–PD 

4 plans under part C and based on the 

5 threshold established under subclause 

6 (II), conduct an analysis to identify 

7 prescribers that are outlier opioid pre8 scribers for a period specified by the 

9 Secretary. 

10 ‘‘(II) ESTABLISHMENT OF

11 THRESHOLD.—For purposes of sub12 clause (I) and subject to subclause 

13 (III), the Secretary shall, after con14 sultation with stakeholders, establish 

15 a threshold, based on prescriber spe16 cialty and geographic area, for identi17 fying whether a prescriber in a spe18 cialty and geographic area is an 

19 outlier prescriber of opioids as com20 pared to other prescribers of opioids 

21 within such specialty and area. 

22 ‘‘(III) EXCLUSIONS.—The Sec23 retary may exclude the following indi24 viduals and prescribers from the anal25 ysis under this clause: 


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1 ‘‘(aa) Individuals receiving 

2 hospice services. 

3 ‘‘(bb) Individuals with a 

4 cancer diagnosis. 

5 ‘‘(cc) Prescribers who are 

6 the subject of an investigation by 

7 the Centers for Medicare & Med8 icaid Services or the Office of In9 spector General of the Depart10 ment of Health and Human 

11 Services. 

12 ‘‘(iii) CONTENTS OF NOTIFICATION.— 

13 The Secretary shall, based on input from 

14 stakeholders, specify the resources and 

15 other information to be included in notifi16 cations provided under clause (i). 

17 ‘‘(iv) MODIFICATIONS AND EXPAN18 SIONS.— 

19 ‘‘(I) FREQUENCY.—Beginning 5 

20 years after the date of the enactment 

21 of this subparagraph, the Secretary 

22 may change the frequency of the noti23 fications described in clause (i) based 

24 on stakeholder input. 


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1 ‘‘(II) EXPANSION TO OTHER

2 PRESCRIPTIONS.—The Secretary may 

3 expand notifications under this sub4 paragraph to include identifications 

5 and notifications with respect to con6 current prescriptions of covered Part 

7 D drugs used in combination with 

8 opioids that are considered to have 

9 adverse side effects when so used in 

10 such combination, as determined by 

11 the Secretary. 

12 ‘‘(v) OPIOIDS DEFINED.—For pur13 poses of this subparagraph, the term 

14 ‘opioids’ has such meaning as specified by 

15 the Secretary through program instruction 

16 or otherwise.’’. 

Æ 


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