I 

115TH CONGRESS 

2D SESSION H. R. 5558 

To require the Secretary of Health and Human Services to carry out under 

the Medicare program an alternatives to opioids in emergency departments demonstration project. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 18, 2018 

Mr. BUCHANAN (for himself and Mr. HASTINGS) 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 require the Secretary of Health and Human Services 

to carry out under the Medicare program an alternatives 

to opioids in emergency departments demonstration 

project. 

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 ‘‘Alternatives to Opioids 

5 Prescribing Act’’. 


lotter on DSKBCFDHB2PROD with BILLS
2 

•HR 5558 IH

1 SEC. 2. ALTERNATIVES TO OPIOIDS IN EMERGENCY DE2 PARTMENTS MEDICARE DEMONSTRATION 

3 PROJECT. 

4 (a) ESTABLISHMENT.—Beginning not later than one 

5 year after the date of the enactment of this Act, the Sec6 retary of Health and Human Services (in this Act referred 

7 to as the ‘‘Secretary’’) shall carry out a 5-year demonstra8 tion project under which payment shall be made under the 

9 hospital outpatient prospective payment system under part 

10 B of title XVIII of the Social Security Act (42 U.S.C. 

11 1395j et seq.) to participating hospitals for items and 

12 services furnished as alternatives to opioid medications to 

13 individuals enrolled under such part to treat conditions 

14 designated under subsection (c)(1) for purposes of evalu15 ating the benefits of using, instead of opioid medications, 

16 such alternatives to treat in emergency departments such 

17 symptoms and conditions. 

18 (b) EMERGENCY DEPARTMENTS.— 

19 (1) SELECTION.—The Secretary shall select 

20 from hospitals with emergency departments volun21 tarily submitting applications under paragraph (4), 

22 not fewer than 30 hospitals with emergency depart23 ments, and not more than 50 hospitals with emer24 gency departments, for participation in the dem25 onstration project. 


lotter on DSKBCFDHB2PROD with BILLS
3 

•HR 5558 IH

1 (2) DIVERSITY.—In selecting hospitals with 

2 emergency departments, the Secretary shall ensure 

3 such hospitals and emergency departments are di4 verse in geography and size. 

5 (3) VOLUNTARY PARTICIPATION.—Participation 

6 in the demonstration project under this section shall 

7 be on a voluntary basis. 

8 (4) APPLICATIONS.— 

9 (A) IN GENERAL.—To participate in the 

10 demonstration project, a hospital with an emer11 gency department shall submit to the Secretary 

12 an application at such time, in such manner, 

13 and containing such information (in addition to 

14 the written commitment described in subpara15 graph (B)) as specified by the Secretary. The 

16 Secretary shall take such measures as is nec17 essary to make available such application form 

18 to potential participants no later than 180 days 

19 after the date of the enactment of this Act. 

20 (B) INFORMATION REQUIRED.—Each ap21 plication submitted by a hospital under sub22 paragraph (A) shall include a binding written 

23 commitment to participate in the demonstration 

24 project for the duration of the project signed by 

25 the Chief Executive Officer of the hospital, the 


lotter on DSKBCFDHB2PROD with BILLS
4 

•HR 5558 IH

1 physician medical director of the emergency de2 partment of the hospital, the nursing director of 

3 the emergency department of the hospital, and 

4 the pharmacy director of the emergency depart5 ment of the hospital. 

6 (c) ELEMENTS OF DEMONSTRATION PROJECT.— 

7 Under the demonstration project, the following shall 

8 apply: 

9 (1) The Secretary shall designate no fewer than 

10 five conditions or sets of symptoms that will be mon11 itored during the demonstration project. 

12 (2) The performance during each year of the 

13 demonstration project, with respect to such condi14 tions designated under paragraph (1), of all emer15 gency departments of hospitals participating in the 

16 demonstration project will be measured against the 

17 performance of such emergency departments during 

18 a base year, which shall represent the most recent 

19 set of full year data available before the first date 

20 of the demonstration project. 

21 (3) The Secretary shall provide hospitals par22 ticipating in the demonstration project with a de23 scription of clearly defined treatments that are con24 sidered alternatives to opioids to be applied for pur25 poses of subsection (a). 


lotter on DSKBCFDHB2PROD with BILLS
5 

•HR 5558 IH

1 (d) INCENTIVE PAYMENT.—Under the demonstration 

2 project, the Secretary shall create a payment structure 

3 under which hospitals participating in the demonstration 

4 project that increase the use of alternatives to opioids and 

5 decrease the use of opioids may receive a shared savings 

6 bonus in addition to what would otherwise be made for 

7 items and services furnished under subsection (a). The 

8 amount of such shared savings shall be based on the dif9 ference between readmission rates for individuals treated 

10 with an alternative to opioids at the emergency depart11 ment of the participating hospital and the average rate 

12 of readmissions for individuals treated with opioids and 

13 discharged from a representative group of emergency de14 partments of hospitals not participating in the demonstra15 tion project in the same region as the participating hos16 pital over a period of five years. 

17 (e) CLARIFICATION.—Nothing under this section 

18 shall prevent a health care provider from prescribing an 

19 opioid if an opioid is a medically necessary treatment. 

20 (f) REPORTS TO CONGRESS.— 

21 (1) INITIAL REPORT.—Not later than 180 days 

22 after the date of the enactment of this Act, the Sec23 retary shall submit to Congress a report that in24 cludes— 


lotter on DSKBCFDHB2PROD with BILLS
6 

•HR 5558 IH

1 (A) the application form described in sub2 section (b)(4)(A) that is to be made available to 

3 potential participants; and 

4 (B) a progress report with respect to des5 ignating the conditions under subsection (c)(1) 

6 and establishing the description of clearly de7 fined treatments described in subsection (c)(3). 

8 (2) PERIODIC DEMONSTRATION REPORTS.—Be9 ginning after the first year of the demonstration 

10 project and annually thereafter for each year of the 

11 demonstration project and not later than one year 

12 after the completion of the demonstration, the Sec13 retary shall submit to Congress a report that in14 cludes the following data for each hospital partici15 pating under the demonstration project: 

16 (A) With respect to each condition or set 

17 of symptom designated under subsection (c)(1), 

18 the number of individuals treated. 

19 (B) With respect to each such condition, 

20 the number of individuals treated only with an 

21 alternative to opioids. 

22 (C) With respect to each such condition, 

23 the number of individuals treated first with an 

24 alternative to opioids, followed by an opioid in 

25 the same visit. 


lotter on DSKBCFDHB2PROD with BILLS
7 

•HR 5558 IH

1 (D) With respect to each such condition, 

2 the number of individuals treated only with an 

3 opioid. 

4 (E) With respect to each individual de5 scribed in subparagraph (A) treated for such a 

6 condition or set of symptoms, whether or not 

7 the individual involved returned to the emer8 gency department of the hospital or an emer9 gency department of a different hospital for the 

10 same condition or symptoms. 

11 (F) The difference in cost between treating 

12 an individual with an alternative to opioid 

13 versus an opioid. 

14 (G) Any additional information the Sec15 retary determines necessary. 

Æ 


lotter on DSKBCFDHB2PROD with BILLS