IIB 

115TH CONGRESS 

2D SESSION H. R. 5774 

IN THE SENATE OF THE UNITED STATES 

JUNE 20, 2018 

Received; read twice and referred to the Committee on Finance 

AN ACT 

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. 


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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 ‘‘Combating Opioid 

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

6 Act of 2018’’. 

7 SEC. 2. DEVELOPING GUIDANCE ON PAIN MANAGEMENT 

8 AND OPIOID USE DISORDER PREVENTION 

9 FOR HOSPITALS RECEIVING PAYMENT 

10 UNDER PART A OF THE MEDICARE PROGRAM. 

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

12 the Secretary of Health and Human Services (in this sec13 tion referred to as the ‘‘Secretary’’) shall develop and pub14 lish on the public website of the Centers for Medicare & 

15 Medicaid Services guidance for hospitals receiving pay16 ment under part A of title XVIII of the Social Security 

17 Act (42 U.S.C. 1395c et seq.) on pain management strate18 gies and opioid use disorder prevention strategies with re19 spect to individuals entitled to benefits under such part. 

20 (b) CONSULTATION.—In developing the guidance de21 scribed in subsection (a), the Secretary shall consult with 

22 relevant stakeholders, including— 

23 (1) medical professional organizations; 


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

2 terms are defined in section 1861 of the Social Secu3 rity Act (42 U.S.C. 1395x)); 

4 (3) health care consumers or groups rep5 resenting such consumers; and 

6 (4) other entities determined appropriate by the 

7 Secretary. 

8 (c) CONTENTS.—The guidance described in sub9 section (a) shall include, with respect to hospitals and indi10 viduals described in such subsection, the following: 

11 (1) Best practices regarding evidence-based 

12 screening and practitioner education initiatives relat13 ing to screening and treatment protocols for opioid 

14 use disorder, including— 

15 (A) methods to identify such individuals 

16 at-risk of opioid use disorder, including risk 

17 stratification; 

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

19 opioid overdoses; and 

20 (C) resources available to such individuals, 

21 such as opioid treatment programs, peer sup22 port groups, and other recovery programs. 

23 (2) Best practices for such hospitals to educate 

24 practitioners furnishing items and services at such 


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1 hospital with respect to pain management and sub2 stance use disorders, including education on— 

3 (A) the adverse effects of prolonged opioid 

4 use; 

5 (B) non-opioid, evidence-based, non-phar6 macological pain management treatments; 

7 (C) monitoring programs for individuals 

8 who have been prescribed opioids; and 

9 (D) the prescribing of naloxone along with 

10 an initial opioid prescription. 

11 (3) Best practices for such hospitals to make 

12 such individuals aware of the risks associated with 

13 opioid use (which may include use of the notification 

14 template described in paragraph (4)). 

15 (4) A notification template developed by the 

16 Secretary, for use as appropriate, for such individ17 uals who are prescribed an opioid that— 

18 (A) explains the risks and side effects asso19 ciated with opioid use (including the risks of 

20 addiction and overdose) and the importance of 

21 adhering to the prescribed treatment regimen, 

22 avoiding medications that may have an adverse 

23 interaction with such opioid, and storing such 

24 opioid safely and securely; 


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1 (B) highlights multimodal and evidence2 based non-opioid alternatives for pain manage3 ment; 

4 (C) encourages such individuals to talk to 

5 their health care providers about such alter6 natives; 

7 (D) provides for a method (through signa8 ture or otherwise) for such an individual, or 

9 person acting on such individual’s behalf, to ac10 knowledge receipt of such notification template; 

11 (E) is worded in an easily understandable 

12 manner and made available in multiple lan13 guages determined appropriate by the Sec14 retary; and 

15 (F) includes any other information deter16 mined appropriate by the Secretary. 

17 (5) Best practices for such hospital to track 

18 opioid prescribing trends by practitioners furnishing 

19 items and services at such hospital, including— 

20 (A) ways for such hospital to establish tar21 get levels, taking into account the specialties of 

22 such practitioners and the geographic area in 

23 which such hospital is located, with respect to 

24 opioids prescribed by such practitioners; 


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1 (B) guidance on checking the medical 

2 records of such individuals against information 

3 included in prescription drug monitoring pro4 grams; 

5 (C) strategies to reduce long-term opioid 

6 prescriptions; and 

7 (D) methods to identify such practitioners 

8 who may be over-prescribing opioids. 

9 (6) Other information the Secretary determines 

10 appropriate, including any such information from 

11 the Opioid Safety Initiative established by the De12 partment of Veterans Affairs or the Opioid Overdose 

13 Prevention Toolkit published by the Substance 

14 Abuse and Mental Health Services Administration. 

15 SEC. 3. REQUIRING THE REVIEW OF QUALITY MEASURES 

16 RELATING TO OPIOIDS AND OPIOID USE DIS17 ORDER TREATMENTS FURNISHED UNDER 

18 THE MEDICARE PROGRAM AND OTHER FED19 ERAL HEALTH CARE PROGRAMS. 

20 (a) IN GENERAL.—Section 1890A of the Social Secu21 rity Act (42 U.S.C. 1395aaa–1) is amended by adding at 

22 the end the following new subsection: 

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

24 AND OPIOID USE DISORDER QUALITY MEASURES.— 


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

2 after the date of the enactment of this subsection, 

3 the Secretary shall establish a technical expert panel 

4 for purposes of reviewing quality measures relating 

5 to opioids and opioid use disorders, including care, 

6 prevention, diagnosis, health outcomes, and treat7 ment furnished to individuals with opioid use dis8 orders. The Secretary may use the entity with a con9 tract under section 1890(a) and amend such con10 tract as necessary to provide for the establishment 

11 of such technical expert panel. 

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

13 than 1 year after the date the technical expert panel 

14 described in paragraph (1) is established (and peri15 odically thereafter as the Secretary determines ap16 propriate), the technical expert panel shall— 

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

18 opioids and opioid use disorders, including ex19 isting measures and those under development; 

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

21 measurement that relate to opioids and opioid 

22 use disorders, and identify measure develop23 ment priorities for such measure gaps; and 

24 ‘‘(C) make recommendations to the Sec25 retary on quality measures with respect to 


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1 opioids and opioid use disorders for purposes of 

2 improving care, prevention, diagnosis, health 

3 outcomes, and treatment, including rec4 ommendations for revisions of such measures, 

5 need for development of new measures, and rec6 ommendations for including such measures in 

7 the Merit-Based Incentive Payment System 

8 under section 1848(q), the alternative payment 

9 models under section 1833(z)(3)(C), the shared 

10 savings program under section 1899, the qual11 ity reporting requirements for inpatient hos12 pitals under section 1886(b)(3)(B)(viii), and 

13 the hospital value-based purchasing program 

14 under section 1886(o). 

15 ‘‘(3) CONSIDERATION OF MEASURES BY SEC16 RETARY.—The Secretary shall consider— 

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

18 measures (including measures used under the 

19 Merit-Based Incentive Payment System under 

20 section 1848(q), measures recommended under 

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

22 identified by the Secretary) in alternative pay23 ment models under section 1833(z)(3)(C) and 

24 in the shared savings program under section 

25 1899; and 


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1 ‘‘(B) using opioid measures described in 

2 subparagraph (A), as applicable, in the quality 

3 reporting requirements for inpatient hospitals 

4 under section 1886(b)(3)(B)(viii),and in the 

5 hospital value-based purchasing program under 

6 section 1886(o). 

7 ‘‘(4) PRIORITIZATION OF MEASURE DEVELOP8 MENT.—The Secretary shall prioritize for measure 

9 development the gaps in quality measures identified 

10 under paragraph (2)(B).’’. 

11 (b) EXPEDITED ENDORSEMENT PROCESS FOR

12 OPIOID MEASURES.—Section 1890(b)(2) of the Social Se13 curity Act (42 U.S.C. 1395aaa(b)(2)) is amended by add14 ing at the end the following new flush sentence: 

15 ‘‘Such endorsement process shall, as determined 

16 practicable by the entity, provide for an expedited 

17 process with respect to the endorsement of such 

18 measures relating to opioids and opioid use dis19 orders.’’. 

20 SEC. 4. TECHNICAL EXPERT PANEL ON REDUCING SUR21 GICAL SETTING OPIOID USE; DATA COLLEC22 TION ON PERIOPERATIVE OPIOID USE. 

23 (a) TECHNICAL EXPERT PANEL ON REDUCING SUR24 GICAL SETTING OPIOID USE.— 


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

2 after the date of the enactment of this Act, the Sec3 retary of Health and Human Services shall convene 

4 a technical expert panel, including medical and sur5 gical specialty societies and hospital organizations, 

6 to provide recommendations on reducing opioid use 

7 in the inpatient and outpatient surgical settings and 

8 on best practices for pain management, including 

9 with respect to the following: 

10 (A) Approaches that limit patient exposure 

11 to opioids during the perioperative period, in12 cluding pre-surgical and post-surgical injec13 tions, and that identify such patients at risk of 

14 opioid use disorder pre-operation. 

15 (B) Shared decision making with patients 

16 and families on pain management, including 

17 recommendations for the development of an 

18 evaluation and management code for purposes 

19 of payment under the Medicare program under 

20 title XVIII of the Social Security Act that 

21 would account for time spent on shared decision 

22 making. 

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

24 and disposal of opioids. 


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1 (D) Prevention of opioid misuse and abuse 

2 after discharge. 

3 (E) Development of a clinical algorithm to 

4 identify and treat at-risk, opiate-tolerant pa5 tients and reduce reliance on opioids for acute 

6 pain during the perioperative period. 

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

8 date of the enactment of this Act, the Secretary 

9 shall submit to Congress and make public a report 

10 containing the recommendations developed under 

11 paragraph (1) and an action plan for broader imple12 mentation of pain management protocols that limit 

13 the use of opioids in the perioperative setting and 

14 upon discharge from such setting. 

15 (b) DATA COLLECTION ON PERIOPERATIVE OPIOID

16 USE.—Not later than 1 year after the date of the enact17 ment of this Act, the Secretary of Health and Human 

18 Services shall submit to Congress a report that contains 

19 the following: 

20 (1) The diagnosis-related group codes identified 

21 by the Secretary as having the highest volume of 

22 surgeries. 

23 (2) With respect to each of such diagnosis-re24 lated group codes so identified, a determination by 

25 the Secretary of the data that is both available and 


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1 reported on opioid use following such surgeries, such 

2 as with respect to— 

3 (A) surgical volumes, practices, and opioid 

4 prescribing patterns; 

5 (B) opioid consumption, including— 

6 (i) perioperative days of therapy; 

7 (ii) average daily dose at the hospital, 

8 including dosage greater than 90 milligram 

9 morphine equivalent; 

10 (iii) post-discharge prescriptions and 

11 other combination drugs that are used be12 fore intervention and after intervention; 

13 (iv) quantity and duration of opioid 

14 prescription at discharge; and 

15 (v) quantity consumed and number of 

16 refills; 

17 (C) regional anesthesia and analgesia prac18 tices, including pre-surgical and post-surgical 

19 injections; 

20 (D) naloxone reversal; 

21 (E) post-operative respiratory failure; 

22 (F) information about storage and dis23 posal; and 

24 (G) such other information as the Sec25 retary may specify. 


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1 (3) Recommendations for improving data collec2 tion on perioperative opioid use, including an anal3 ysis to identify and reduce barriers to collecting, re4 porting, and analyzing the data described in para5 graph (2), including barriers related to technological 

6 availability. 

7 SEC. 5. REQUIRING THE POSTING AND PERIODIC UPDATE 

8 OF OPIOID PRESCRIBING GUIDANCE FOR 

9 MEDICARE BENEFICIARIES. 

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

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

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

13 ‘‘Secretary’’) shall post on the public website of the Cen14 ters for Medicare & Medicaid Services all guidance pub15 lished by the Department of Health and Human Services 

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

17 of opioids and applicable to opioid prescriptions for indi18 viduals entitled to benefits under part A of title XVIII 

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

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

21 1395j et seq.). 

22 (b) UPDATE OF GUIDANCE.— 

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

24 consultation with the entities specified in paragraph 

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


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1 Secretary) update guidance described in subsection 

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

3 website described in such subsection. 

4 (2) CONSULTATION.—The entities specified in 

5 this paragraph are the following: 

6 (A) Medical professional organizations. 

7 (B) Providers and suppliers of services (as 

8 such terms are defined in section 1861 of the 

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

10 (C) Health care consumers or groups rep11 resenting such consumers. 

12 (D) Other entities determined appropriate 

13 by the Secretary. 

Passed the House of Representatives June 19, 2018. 

Attest: KAREN L. HAAS, 

Clerk. 


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