I 

115TH CONGRESS 

2D SESSION H. R. 5774 

To require the Secretary of Health and Human Services to develop guidance 

on pain management and opioid use disorder prevention for hospitals 

receiving payment under part A of the Medicare program, provide for 

opioid quality measures development, and provide for a technical expert 

panel on reducing surgical setting opioid use and data collection on 

perioperative opioid use, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 11, 2018 

Mr. CURBELO of Florida (for himself, Ms. KUSTER of New Hampshire, Ms. 

DELBENE, and Mr. BUDD) 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 require the Secretary of Health and Human Services 

to develop guidance on pain management and opioid 

use disorder prevention for hospitals receiving payment 

under part A of the Medicare program, provide for opioid 

quality measures development, and provide for a technical expert panel on reducing surgical setting opioid 

use and data collection on perioperative opioid use, 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 ‘‘Combating Opioid 

3 Abuse for Care in Hospitals Act of 2018’’ or the ‘‘COACH 

4 Act of 2018’’. 

5 SEC. 2. DEVELOPING GUIDANCE ON PAIN MANAGEMENT 

6 AND OPIOID USE DISORDER PREVENTION 

7 FOR HOSPITALS RECEIVING PAYMENT 

8 UNDER PART A OF THE MEDICARE PROGRAM. 

9 (a) IN GENERAL.—Not later than January 1, 2019, 

10 the Secretary of Health and Human Services (in this sec11 tion referred to as the ‘‘Secretary’’) shall develop and pub12 lish on the public website of the Centers for Medicare & 

13 Medicaid Services guidance for hospitals receiving pay14 ment under part A of title XVIII of the Social Security 

15 Act (42 U.S.C. 1395c et seq.) on pain management strate16 gies and opioid use disorder prevention strategies with re17 spect to individuals entitled to benefits under such part. 

18 (b) CONSULTATION.—In developing the guidance de19 scribed in subsection (a), the Secretary shall consult with 

20 relevant stakeholders, including— 

21 (1) medical professional organizations; 

22 (2) providers and suppliers of services (as such 

23 terms are defined in section 1861 of the Social Secu24 rity Act (42 U.S.C. 1395x)); 

25 (3) health care consumers or groups rep26 resenting such consumers; and 


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1 (4) other entities determined appropriate by the 

2 Secretary. 

3 (c) CONTENTS.—The guidance described in sub4 section (a) shall include, with respect to hospitals and indi5 viduals described in such subsection, the following: 

6 (1) Best practices regarding evidence-based 

7 screening and practitioner education initiatives relat8 ing to screening and treatment protocols for opioid 

9 use disorder, including— 

10 (A) methods to identify such individuals 

11 at-risk of opioid use disorder, including risk 

12 stratification; 

13 (B) ways to prevent, recognize, and treat 

14 opioid overdoses; and 

15 (C) resources available to such individuals, 

16 such as opioid treatment programs, peer sup17 port groups, and other recovery programs. 

18 (2) Best practices for such hospitals to educate 

19 practitioners furnishing items and services at such 

20 hospital with respect to pain management and sub21 stance use disorders, including education on— 

22 (A) the adverse effects of prolonged opioid 

23 use; 

24 (B) non-opioid, evidence-based, non-phar25 macological pain management treatments; 


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1 (C) monitoring programs for individuals 

2 who have been prescribed opioids; and 

3 (D) the prescribing of naloxone along with 

4 an initial opioid prescription. 

5 (3) Best practices for such hospitals to make 

6 such individuals aware of the risks associated with 

7 opioid use (which may include use of the notification 

8 template described in paragraph (4)). 

9 (4) A notification template developed by the 

10 Secretary, for use as appropriate, for such individ11 uals who are prescribed an opioid that— 

12 (A) explains the risks and side effects asso13 ciated with opioid use (including the risks of 

14 addiction and overdose) and the importance of 

15 adhering to the prescribed treatment regimen, 

16 avoiding medications that may have an adverse 

17 interaction with such opioid, and storing such 

18 opioid safely and securely; 

19 (B) highlights multimodal and evidence20 based non-opioid alternatives for pain manage21 ment; 

22 (C) encourages such individuals to talk to 

23 their health care providers about such alter24 natives; 


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1 (D) provides for a method (through signa2 ture or otherwise) for such an individual, or 

3 person acting on such individual’s behalf, to ac4 knowledge receipt of such notification template; 

5 (E) is worded in an easily understandable 

6 manner and made available in multiple lan7 guages determined appropriate by the Sec8 retary; and 

9 (F) includes any other information deter10 mined appropriate by the Secretary. 

11 (5) Best practices for such hospital to track 

12 opioid prescribing trends by practitioners furnishing 

13 items and services at such hospital, including— 

14 (A) ways for such hospital to establish tar15 get levels, taking into account the specialties of 

16 such practitioners and the geographic area in 

17 which such hospital is located, with respect to 

18 opioids prescribed by such practitioners; 

19 (B) guidance on checking the medical 

20 records of such individuals against information 

21 included in prescription drug monitoring pro22 grams; 

23 (C) strategies to reduce long-term opioid 

24 prescriptions; and 


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1 (D) methods to identify such practitioners 

2 who may be over-prescribing opioids. 

3 (6) Other information the Secretary determines 

4 appropriate, including any such information from 

5 the Opioid Safety Initiative established by the De6 partment of Veterans Affairs or the Opioid Overdose 

7 Prevention Toolkit published by the Substance 

8 Abuse and Mental Health Services Administration. 

9 SEC. 3. REQUIRING THE REVIEW OF QUALITY MEASURES 

10 RELATING TO OPIOIDS AND OPIOID USE DIS11 ORDER TREATMENTS FURNISHED UNDER 

12 THE MEDICARE PROGRAM AND OTHER FED13 ERAL HEALTH CARE PROGRAMS. 

14 (a) IN GENERAL.—Section 1890A of the Social Secu15 rity Act (42 U.S.C. 1395aaa–1) is amended by adding at 

16 the end the following new subsection: 

17 ‘‘(g) TECHNICAL EXPERT PANEL REVIEW OF OPIOID

18 AND OPIOID USE DISORDER QUALITY MEASURES.— 

19 ‘‘(1) IN GENERAL.—Not later than 180 days 

20 after the date of the enactment of this subsection, 

21 the Secretary shall establish a technical expert panel 

22 for purposes of reviewing quality measures relating 

23 to opioids and opioid use disorders, including care, 

24 prevention, diagnosis, health outcomes, and treat25 ment furnished to individuals with opioid use disVerDate Sep 11 2014 01:37 May 31, 2018 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5774.IH H5774

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1 orders. The Secretary may elect to establish such 

2 panel through a contract with the consensus-based 

3 entity with a contract in effect under section 1890. 

4 ‘‘(2) REVIEW AND ASSESSMENT.—Not later 

5 than 1 year after the date the technical expert panel 

6 described in paragraph (1) is established (and peri7 odically thereafter as the Secretary determines ap8 propriate), the technical expert panel shall— 

9 ‘‘(A) review quality measures that relate to 

10 opioids and opioid use disorders, including ex11 isting measures and those under development; 

12 ‘‘(B) identify gaps in areas of quality 

13 measurement that relate to opioids and opioid 

14 use disorders, and identify measure develop15 ment priorities for such measure gaps; and 

16 ‘‘(C) make recommendations to the Sec17 retary on quality measures with respect to 

18 opioids and opioid use disorders for purposes of 

19 improving care, prevention, diagnosis, health 

20 outcomes, and treatment, including rec21 ommendations for revisions of such measures, 

22 need for development of new measures, and rec23 ommendations for including such measures in 

24 quality reporting programs, value-based pur25 chasing programs, accountable care organizaVerDate Sep 11 2014 01:37 May 31, 2018 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5774.IH H5774

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1 tions, and alternative payment models under 

2 this title. 

3 ‘‘(3) CONSIDERATION OF MEASURES BY SEC4 RETARY.—The Secretary shall consider— 

5 ‘‘(A) using opioid and opioid use disorder 

6 measures (including measures used under the 

7 Merit-Based Incentive Payment System under 

8 section 1848(q), measures recommended under 

9 paragraph (2)(C), and other such measures 

10 identified by the Secretary) in Alternative Pay11 ment Models under section 1833(z)(3)(C) and 

12 in the Shared Savings Program under section 

13 1899; and 

14 ‘‘(B) using opioid measures described in 

15 subparagraph (A), as applicable, in the Hos16 pital Inpatient Quality Reporting program 

17 under section 1886(b)(3)(B)(viii), in the hos18 pital value-based purchasing program under 

19 section 1886(o), and under other value-based 

20 purchasing programs under this title. 

21 ‘‘(4) PRIORITIZATION OF MEASURE DEVELOP22 MENT.—The Secretary shall prioritize for measure 

23 development the gaps in quality measures identified 

24 under paragraph (2)(C).’’. 


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1 (b) EXPEDITED ENDORSEMENT PROCESS FOR

2 OPIOID MEASURES.—Section 1890(b)(2) of the Social Se3 curity Act (42 U.S.C. 1395aaa(b)(2)) is amended by add4 ing at the end the following new flush sentence: 

5 ‘‘Such endorsement process shall, as determined 

6 practicable by the entity, provide for an expedited 

7 process with respect to the endorsement of measures 

8 relating to opioids and opioid use disorders.’’. 

9 SEC. 4. TECHNICAL EXPERT PANEL ON REDUCING SUR10 GICAL SETTING OPIOID USE; DATA COLLEC11 TION ON PERIOPERATIVE OPIOID USE. 

12 (a) TECHNICAL EXPERT PANEL ON REDUCING SUR13 GICAL SETTING OPIOID USE.— 

14 (1) IN GENERAL.—Not later than 6 months 

15 after the date of the enactment of this Act, the Sec16 retary of Health and Human Services shall convene 

17 a technical expert panel, including medical and sur18 gical specialty societies and hospital organizations, 

19 to provide recommendations on reducing opioid use 

20 in the inpatient and outpatient surgical settings and 

21 on best practices for pain management, including 

22 with respect to the following: 

23 (A) Approaches that limit patient exposure 

24 to opioids during the perioperative period, in25 cluding pre-surgical and post-surgical injecVerDate Sep 11 2014 01:37 May 31, 2018 Jkt 079200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5774.IH H5774

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1 tions, and that identify such patients at risk of 

2 opioid use disorder pre-operation. 

3 (B) Shared decision making with patients 

4 and families on pain management, including 

5 recommendations for the development of an 

6 evaluation and management code for purposes 

7 of payment under the Medicare program under 

8 title XVIII of the Social Security Act that 

9 would account for time spent on shared decision 

10 making. 

11 (C) Education on the safe use, storage, 

12 and disposal of opioids. 

13 (D) Prevention of opioid misuse and abuse 

14 after discharge. 

15 (E) Development of a clinical algorithm to 

16 identify and treat at-risk, opioids-tolerant pa17 tients and reduce reliance on opiates for acute 

18 pain during the perioperative period. 

19 (2) REPORT.—Not later than 1 year after the 

20 date of the enactment of this Act, the Secretary 

21 shall submit to Congress and make public a report 

22 containing the recommendations developed under 

23 paragraph (1) and recommendations for broader im24 plementation of pain management protocols that 


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1 limit the use of opioids in the perioperative setting 

2 and upon discharge from such setting. 

3 (b) DATA COLLECTION ON PERIOPERATIVE OPIOID

4 USE.—Not later than 1 year after the date of the enact5 ment of this Act, the Secretary of Health and Human 

6 Services shall submit to Congress a report that contains 

7 the following: 

8 (1) The diagnosis-related group codes identified 

9 by the Secretary as having the highest volume of 

10 surgeries. 

11 (2) With respect to each of such diagnosis-re12 lated group codes so identified, a determination by 

13 the Secretary of the data that is both available and 

14 reported on opioid use following such surgeries, such 

15 as with respect to— 

16 (A) surgical volumes, practices, and opioid 

17 prescribing patterns; 

18 (B) opioid consumption, including— 

19 (i) perioperative days of therapy; 

20 (ii) average daily dose at the hospital, 

21 including dosage greater than 90 milligram 

22 morphine equivalent; 

23 (iii) post-discharge prescriptions and 

24 other combination drugs that are used be25 fore intervention and after intervention; 


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1 (iv) quantity and duration of opioid 

2 prescription at discharge; and 

3 (v) quantity consumed and number of 

4 refills; 

5 (C) regional anesthesia and analgesia prac6 tices, including pre-surgical and post-surgical 

7 injections; 

8 (D) naloxone reversal; 

9 (E) post-operative respiratory failure; 

10 (F) information about storage and dis11 posal; and 

12 (G) such other information as the Sec13 retary may specify. 

14 (3) Recommendations for improving data collec15 tion on perioperative opioid use, including an anal16 ysis to identify barriers to collecting, reporting, and 

17 analyzing the data described in paragraph (2), in18 cluding barriers related to technological availability. 

19 SEC. 5. REQUIRING THE POSTING AND PERIODIC UPDATE 

20 OF OPIOID PRESCRIBING GUIDANCE FOR 

21 MEDICARE BENEFICIARIES. 

22 (a) IN GENERAL.—Not later than 180 days after the 

23 date of the enactment of this Act, the Secretary of Health 

24 and Human Services (in this section referred to as the 

25 ‘‘Secretary’’) shall post on the public website of the CenVerDate Sep 11 2014 01:37 May 31, 2018 Jkt 079200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H5774.IH H5774

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1 ters for Medicare & Medicaid Services all guidance pub2 lished by the Department of Health and Human Services 

3 on or after January 1, 2016, relating to the prescribing 

4 of opioids and applicable to opioid prescriptions for indi5 viduals entitled to benefits under part A of title XVIII 

6 of the Social Security Act (42 U.S.C. 1395c et seq.) or 

7 enrolled under part B of such title of such Act (42 U.S.C. 

8 1395j et seq.). 

9 (b) UPDATE OF GUIDANCE.— 

10 (1) PERIODIC UPDATE.—The Secretary shall, in 

11 consultation with the entities specified in paragraph 

12 (2), periodically (as determined appropriate by the 

13 Secretary) update guidance described in subsection 

14 (a) and revise the posting of such guidance on the 

15 website described in such subsection. 

16 (2) CONSULTATION.—The entities specified in 

17 this paragraph are the following: 

18 (A) Medical professional organizations. 

19 (B) Providers and suppliers of services (as 

20 such terms are defined in section 1861 of the 

21 Social Security Act (42 U.S.C. 1395x)). 

22 (C) Health care consumers or groups rep23 resenting such consumers. 


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1 (D) Other entities determined appropriate 

2 by the Secretary. 

Æ 


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