I 

115TH CONGRESS 

2D SESSION H. R. 5722 

To direct the Secretary of Health and Human Services to conduct a study 

and submit to Congress a report containing recommendation on how 

to improve the use of non-opioid treatments for acute and chronic pain 

management for individuals entitled to benefits under part A or enrolled 

under part B of the Medicare program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 9, 2018 

Mrs. WALORSKI (for herself and Ms. JUDY CHU of California) introduced the 

following bill; which was referred to the Committee on Ways and Means, 

and in addition to the Committee on Energy and Commerce, 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 direct the Secretary of Health and Human Services to 

conduct a study and submit to Congress a report containing recommendation on how to improve the use of 

non-opioid treatments for acute and chronic pain management for individuals entitled to benefits under part 

A or enrolled under part B of the Medicare program, 

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 ‘‘Dr. Todd Graham Pain 

3 Management Improvement Act of 2018’’. 

4 SEC. 2. PAIN MANAGEMENT STUDY. 

5 (a) IN GENERAL.—Not later than 1 year after the 

6 date of enactment of this Act, the Secretary of Health and 

7 Human Services (referred to in this section as the ‘‘Sec8 retary’’) shall conduct a study and submit to the Com9 mittee on Ways and Means and the Committee on Energy 

10 and Commerce of the House of Representatives and the 

11 Committee on Finance of the Senate a report containing 

12 recommendations on whether and how reimbursement to 

13 providers and suppliers of services, coverage, and coding 

14 policies related to the use of multi-disciplinary, evidence15 based, non-opioid treatments for acute and chronic pain 

16 management for individuals entitled to benefits under part 

17 A or enrolled under part B of title XVIII of the Social 

18 Security Act should be revised. The Secretary shall make 

19 such report available on the public website of the Centers 

20 for Medicare & Medicaid Services. 

21 (b) CONSULTATION.—In developing the report de22 scribed in subsection (a), the Secretary shall consult 

23 with— 

24 (1) relevant agencies within the Department of 

25 Health and Human Services; 


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1 (2) licensed and practicing osteopathic and 

2 allopathic physicians, physician assistants, nurse 

3 practitioners, dentists, and pharmacists; 

4 (3) hospitals and other medical facilities, in5 cluding acute care hospitals, cancer hospitals, psy6 chiatric hospitals, hospital emergency departments, 

7 facilities furnishing urgent care services, ambulatory 

8 surgical centers, and post-acute care and long-term 

9 care facilities (such as skilled nursing facilities, inpa10 tient rehabilitation facilities, long-term care hos11 pitals, and home health agencies); 

12 (4) substance abuse and mental health profes13 sional organizations; 

14 (5) pain management professional organizations 

15 and advocacy entities, including individuals who per16 sonally suffer chronic pain; 

17 (6) medical professional organizations and med18 ical specialty organizations; 

19 (7) licensed health care providers who furnish 

20 alternative pain management services; 

21 (8) organizations with expertise in the develop22 ment of innovative medical technologies for pain 

23 management; 

24 (9) beneficiary advocacy organizations; and 


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1 (10) other organizations with expertise in the 

2 assessment, diagnosis, treatment, and management 

3 of pain, as determined appropriate by the Secretary. 

4 (c) CONTENTS.—The report described in subsection 

5 (a) shall include the following: 

6 (1) The recommendations described in sub7 section (d). 

8 (2) The impact analysis described in subsection 

9 (e). 

10 (3) An assessment of pain management guid11 ance published by the Federal Government that may 

12 be relevant to coverage determinations or other cov13 erage requirements under title XVIII of the Social 

14 Security Act. 

15 (4) Recommendations for updating, including 

16 expanding, the ‘‘CDC Guideline for Prescribing 

17 Opioids for Chronic Pain—United States, 2016’’ 

18 published in March 2016 by the Centers for Disease 

19 Control and Prevention, including for purposes of 

20 management of pain. Such recommendations shall— 

21 (A) consider incorporating relevant ele22 ments of the ‘‘Va/DoD Clinical Practice Guide23 line for Opioid Therapy for Chronic Pain’’ pub24 lished in February 2017 by the Department of 

25 Veterans Affairs and Department of Defense, 


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1 including adoption of elements of the Depart2 ment of Defense and Veterans Administration 

3 pain rating scale; and 

4 (B) include recommendations on how the 

5 ‘‘CDC Guideline for Prescribing Opioids for 

6 Chronic Pain—United States, 2016’’, as so up7 dated, could be adopted by health care pro8 viders across clinical settings. 

9 (5) An evaluation of the following: 

10 (A) Barriers inhibiting individuals entitled 

11 to benefits under part A or enrolled under part 

12 B of such title from accessing treatments and 

13 technologies described in subparagraphs (A) 

14 through (C) of paragraph (6). 

15 (B) Potential legislative and administrative 

16 changes under such title to improve individuals’ 

17 access to items and services currently covered 

18 under such title and used for the treatment of 

19 pain, such as cognitive behavioral interventions, 

20 physical therapy, occupational therapy, physical 

21 medicine, biofeedback therapy, and chiropractic 

22 therapy, and other pain treatments services fur23 nished in a hospital or post-acute care setting. 

24 (C) Costs and benefits associated with po25 tential expansion of coverage under such title to 


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1 include items and services not covered under 

2 such title that may be used for the treatment 

3 of pain, such as acupuncture, therapeutic mas4 sage, and items and services furnished by inte5 grated pain management programs. 

6 (6) An analysis on reimbursement, coverage, 

7 and coding policies (including DRG classification, 

8 CPT, HCPCS, NDC, and other applicable codes) 

9 under title XVIII of the Social Security Act with re10 spect to the following: 

11 (A) Non-opioid based treatments and tech12 nologies for chronic or acute pain, including 

13 such treatments that are covered, not covered, 

14 or have limited coverage under such title. 

15 (B) Non-opioid based treatments and tech16 nologies that monitor substance use withdrawal 

17 and prevent overdoses of opioids. 

18 (C) Non-opioid based treatments and tech19 nologies that treat substance use disorders. 

20 (D) Items and services furnished by practi21 tioners through a multi-disciplinary treatment 

22 model for pain management. 

23 (E) Medical devices, non-opioid based 

24 drugs, and other therapies (including inter25 ventional and integrative pain therapies) apVerDate Sep 11 2014 02:18 May 16, 2018 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5722.IH H5722

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1 proved or cleared by the Food and Drug Ad2 ministration for the treatment of pain. 

3 (F) Items and services furnished to bene4 ficiaries with psychiatric disorders, substance 

5 use disorders, or who are at risk of suicide, or 

6 have comorbidities and require consultation or 

7 management of pain with one or more special8 ists in pain management, mental health, or ad9 diction treatment. 

10 (d) RECOMMENDATIONS.—The recommendations de11 scribed in this subsection are, with respect to individuals 

12 entitled to benefits under part A or enrolled under part 

13 B of title XVIII of the Social Security Act, legislative and 

14 administrative recommendations on the following: 

15 (1) Options for additional coverage of pain 

16 management therapies without the use of opioids, in17 cluding interventional pain therapies, and options to 

18 augment opioid therapy with other clinical and com19 plementary, integrative health services to minimize 

20 the risk of substance use disorder, including in a 

21 hospital setting. 

22 (2) Options for coverage and reimbursement 

23 modifications of medical devices and non-opioid 

24 based pharmacological and non-pharmacological 

25 therapies (including interventional and integrative 


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1 pain therapies) approved or cleared by the Food and 

2 Drug Administration for the treatment of pain as an 

3 alternative or augment to opioid therapy. 

4 (3) Treatment strategies for beneficiaries with 

5 psychiatric disorders, substance use disorders, or 

6 who are at risk of suicide, and treatment strategies 

7 to address health disparities related to opioid use 

8 and opioid abuse treatment. 

9 (4) Treatment strategies for beneficiaries with 

10 comorbidities who require a consultation or co11 management of pain with one or more specialists in 

12 pain management, mental health, or addiction treat13 ment, including in a hospital setting. 

14 (5) Coadministration of opioids and other 

15 drugs, particularly benzodiazepines. 

16 (6) Appropriate case management for bene17 ficiaries who transition between inpatient and out18 patient hospital settings, or between opioid therapy 

19 to non-opioid therapy, which may include the use of 

20 care transition plans. 

21 (7) Outreach activities designed to educate pro22 viders of services and suppliers under the Medicare 

23 program and individuals entitled to benefits under 

24 part A or under part B of such title on alternative, 


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1 non-opioid therapies to manage and treat acute and 

2 chronic pain. 

3 (8) Creation of a beneficiary education tool on 

4 alternatives to opioids for chronic pain management. 

5 (e) IMPACT ANALYSIS.—The impact analysis de6 scribed in this subsection consists of an analysis of any 

7 potential effects implementing the recommendations de8 scribed in subsection (d) would have— 

9 (1) on expenditures under the Medicare pro10 gram; and 

11 (2) on preventing or reducing opioid addiction 

12 for individuals receiving benefits under the Medicare 

13 program. 

Æ 


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