I 

115TH CONGRESS 

2D SESSION H. R. 5778 

To amend title XVIII of the Social Security Act to provide for review and 

adjustment of payments under the Medicare outpatient prospective payment system to avoid financial incentives to use opioids instead of nonopioid alternative treatments, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 11, 2018 

Mr. MARCHANT (for himself and Mr. LEVIN) 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 provide 

for review and adjustment of payments under the Medicare outpatient prospective payment system to avoid financial incentives to use opioids instead of non-opioid 

alternative treatments, 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, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Promoting Outpatient 

5 Access to Non-Opioid Treatments Act’’. 


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1 SEC. 2. REVIEW AND ADJUSTMENT OF PAYMENTS UNDER 

2 THE MEDICARE OUTPATIENT PROSPECTIVE 

3 PAYMENT SYSTEM TO AVOID FINANCIAL IN4 CENTIVES TO USE OPIOIDS INSTEAD OF NON5 OPIOID ALTERNATIVE TREATMENTS. 

6 (a) OUTPATIENT PROSPECTIVE PAYMENT SYS7 TEM.—Section 1833(t) of the Social Security Act (42 

8 U.S.C. 1395l(t)) is amended by adding at the end the fol9 lowing new paragraph: 

10 ‘‘(22) REVIEW AND REVISIONS OF PAYMENTS

11 FOR NON-OPIOID ALTERNATIVE TREATMENTS.— 

12 ‘‘(A) IN GENERAL.—With respect to pay13 ments made under this subsection for covered 

14 OPD services (or groups of services), including 

15 covered OPD services assigned to a comprehen16 sive ambulatory payment classification, the Sec17 retary— 

18 ‘‘(i) shall, as soon as practicable, con19 duct a review (part of which may include 

20 a request for information) of payments for 

21 opioids and evidence-based non-opioid al22 ternatives for pain management (including 

23 drugs and devices, nerve blocks, surgical 

24 injections, and neuromodulation) with a 

25 goal of ensuring that there are not finanVerDate Sep 11 2014 01:03 May 31, 2018 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5778.IH H5778

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1 cial incentives to use opioids instead of 

2 non-opioid alternatives; 

3 ‘‘(ii) may, as the Secretary determines 

4 appropriate, conduct subsequent reviews of 

5 such payments; and 

6 ‘‘(iii) shall consider the extent to 

7 which revisions under this subsection to 

8 such payments (such as the creation of ad9 ditional groups of covered OPD services to 

10 classify separately those procedures that 

11 utilize opioids and non-opioid alternatives 

12 for pain management) would reduce pay13 ment incentives to use opioids instead of 

14 non-opioid alternatives for pain manage15 ment. 

16 ‘‘(B) PRIORITY.—In conducting the review 

17 under clause (i) of subparagraph (A) and con18 sidering revisions under clause (iii) of such sub19 paragraph, the Secretary shall focus on covered 

20 OPD services (or groups of services) assigned 

21 to a comprehensive ambulatory payment classi22 fication, ambulatory payment classifications 

23 that primarily include surgical services, and 

24 other services determined by the Secretary 


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1 which generally involve treatment for pain man2 agement. 

3 ‘‘(C) REVISIONS.—If the Secretary identi4 fies revisions to payments pursuant to subpara5 graph (A)(iii), the Secretary shall, as deter6 mined appropriate, begin making such revisions 

7 for services furnished on or after January 1, 

8 2020. Revisions under the previous sentence 

9 shall be treated as adjustments for purposes of 

10 application of paragraph (9)(B). 

11 ‘‘(D) RULES OF CONSTRUCTION.—Nothing 

12 in this paragraph shall be construed to preclude 

13 the Secretary— 

14 ‘‘(i) from conducting a demonstration 

15 before making the revisions described in 

16 subparagraph (C); or 

17 ‘‘(ii) prior to implementation of this 

18 paragraph, from changing payments under 

19 this subsection for covered OPD services 

20 (or groups of services) which include 

21 opioids or non-opioid alternatives for pain 

22 management.’’. 

23 (b) AMBULATORY SURGICAL CENTERS.—Section 

24 1833(i) of the Social Security Act (42 U.S.C. 1395l(i)) 


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1 is amended by adding at the end the following new para2 graph: 

3 ‘‘(8) The Secretary shall apply the provisions of 

4 paragraph (22) of section 1833(t), including the sec5 ond sentence of subparagraph (C) of such para6 graph, to payment for services under this subsection 

7 in an appropriate manner (as determined by the 

8 Secretary).’’. 

Æ 


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