IB 

Union Calendar No. 593 

115TH CONGRESS 

2D SESSION H. R. 5774 

[Report No. 115–762, Part I] 

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 

JUNE 19, 2018 

Additional sponsors: Mrs. COMSTOCK, Mr. SAM JOHNSON of Texas, Mr. 

BUCHANAN, Mr. PAULSEN, Mr. GOTTHEIMER, and Mr. HIGGINS of New York 

JUNE 19, 2018 

Reported from the Committee on Ways and Means with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

JUNE 19, 2018 

Committee on Energy and Commerce discharged; committed to the Committee 

of the Whole House on the State of the Union and ordered to be printed 

[For text of introduced bill, see copy of bill as introduced on May 11, 2018] 


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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. 


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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 Abuse 

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

6 of 2018’’. 

7 SEC. 2. DEVELOPING GUIDANCE ON PAIN MANAGEMENT 

8 AND OPIOID USE DISORDER PREVENTION 

9 FOR HOSPITALS RECEIVING PAYMENT UNDER 

10 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 payment 

16 under part A of title XVIII of the Social Security Act (42 

17 U.S.C. 1395c et seq.) on pain management strategies and 

18 opioid use disorder prevention strategies with respect to in19 dividuals 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 representing 

5 such consumers; and 

6 (4) other entities determined appropriate by the 

7 Secretary. 

8 (c) CONTENTS.—The guidance described in subsection 

9 (a) shall include, with respect to hospitals and individuals 

10 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 at16 risk of opioid use disorder, including risk strati17 fication; 

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 support 

22 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 such 

12 individuals aware of the risks associated with opioid 

13 use (which may include use of the notification tem14 plate described in paragraph (4)). 

15 (4) A notification template developed by the Sec16 retary, for use as appropriate, for such individuals 

17 who are prescribed an opioid that— 

18 (A) explains the risks and side effects asso19 ciated with opioid use (including the risks of ad20 diction and overdose) and the importance of ad21 hering 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 per9 son 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 Secretary; 

14 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 the 

11 Opioid Safety Initiative established by the Depart12 ment of Veterans Affairs or the Opioid Overdose Pre13 vention Toolkit published by the Substance Abuse and 

14 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, the 

3 Secretary shall establish a technical expert panel for 

4 purposes of reviewing quality measures relating to 

5 opioids and opioid use disorders, including care, pre6 vention, diagnosis, health outcomes, and treatment 

7 furnished to individuals with opioid use disorders. 

8 The Secretary may use the entity with a contract 

9 under section 1890(a) and amend such contract as 

10 necessary to provide for the establishment of such 

11 technical expert panel. 

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

13 1 year after the date the technical expert panel de14 scribed in paragraph (1) is established (and periodi15 cally thereafter as the Secretary determines appro16 priate), the technical expert panel shall— 

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

18 opioids and opioid use disorders, including exist19 ing measures and those under development; 

20 ‘‘(B) identify gaps in areas of quality meas21 urement that relate to opioids and opioid use 

22 disorders, and identify measure development pri23 orities 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 recommenda4 tions for revisions of such measures, need for de5 velopment of new measures, and recommenda6 tions for including such measures in the Merit7 Based Incentive Payment System under section 

8 1848(q), the alternative payment models under 

9 section 1833(z)(3)(C), the shared savings pro10 gram under section 1899, the quality reporting 

11 requirements for inpatient hospitals under sec12 tion 1886(b)(3)(B)(viii), the hospital value-based 

13 purchasing program under section 1886(o), and 

14 under other value-based purchasing programs 

15 under this title. 

16 ‘‘(3) CONSIDERATION OF MEASURES BY SEC17 RETARY.—The Secretary shall consider— 

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

19 measures (including measures used under the 

20 Merit-Based Incentive Payment System under 

21 section 1848(q), measures recommended under 

22 paragraph (2)(C), and other such measures iden23 tified by the Secretary) in alternative payment 

24 models under section 1833(z)(3)(C) and in the 

25 shared savings program under section 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), in the hospital 

5 value-based purchasing program under section 

6 1886(o), and under other value-based purchasing 

7 programs under this title. 

8 ‘‘(4) PRIORITIZATION OF MEASURE DEVELOP9 MENT.—The Secretary shall prioritize for measure de10 velopment the gaps in quality measures identified 

11 under paragraph (2)(B).’’. 

12 (b) EXPEDITED ENDORSEMENT PROCESS FOR OPIOID

13 MEASURES.—Section 1890(b)(2) of the Social Security Act 

14 (42 U.S.C. 1395aaa(b)(2)) is amended by adding at the end 

15 the following new flush sentence: 

16 ‘‘Such endorsement process shall, as determined prac17 ticable by the entity, provide for an expedited process 

18 with respect to the endorsement of such measures re19 lating to opioids and opioid use disorders.’’. 

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 after 

2 the date of the enactment of this Act, the Secretary of 

3 Health and Human Services shall convene a technical 

4 expert panel, including medical and surgical spe5 cialty societies and hospital organizations, to provide 

6 recommendations on reducing opioid use in the inpa7 tient and outpatient surgical settings and on best 

8 practices for pain management, including with re9 spect to the following: 

10 (A) Approaches that limit patient exposure 

11 to opioids during the perioperative period, in12 cluding pre-surgical and post-surgical injections, 

13 and that identify such patients at risk of opioid 

14 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 eval18 uation and management code for purposes of 

19 payment under the Medicare program under title 

20 XVIII of the Social Security Act that would ac21 count for time spent on shared decision making. 

22 (C) Education on the safe use, storage, and 

23 disposal of opioids. 

24 (D) Prevention of opioid misuse and abuse 

25 after discharge. 


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1 (E) Development of a clinical algorithm to 

2 identify and treat at-risk, opiate-tolerant pa3 tients and reduce reliance on opiodes for acute 

4 pain during the perioperative period. 

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

6 date of the enactment of this Act, the Secretary shall 

7 submit to Congress and make public a report con8 taining the recommendations developed under para9 graph (1) and recommendations for broader imple10 mentation of pain management protocols that limit 

11 the use of opioids in the perioperative setting and 

12 upon discharge from such setting. 

13 (b) DATA COLLECTION ON PERIOPERATIVE OPIOID

14 USE.—Not later than 1 year after the date of the enactment 

15 of this Act, the Secretary of Health and Human Services 

16 shall submit to Congress a report that contains the fol17 lowing: 

18 (1) The diagnosis-related group codes identified 

19 by the Secretary as having the highest volume of sur20 geries. 

21 (2) With respect to each of such diagnosis-related 

22 group codes so identified, a determination by the Sec23 retary of the data that is both available and reported 

24 on opioid use following such surgeries, such as with 

25 respect to— 


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1 (A) surgical volumes, practices, and opioid 

2 prescribing patterns; 

3 (B) opioid consumption, including— 

4 (i) perioperative days of therapy; 

5 (ii) average daily dose at the hospital, 

6 including dosage greater than 90 milligram 

7 morphine equivalent; 

8 (iii) post-discharge prescriptions and 

9 other combination drugs that are used be10 fore intervention and after intervention; 

11 (iv) quantity and duration of opioid 

12 prescription at discharge; and 

13 (v) quantity consumed and number of 

14 refills; 

15 (C) regional anesthesia and analgesia prac16 tices, including pre-surgical and post-surgical 

17 injections; 

18 (D) naloxone reversal; 

19 (E) post-operative respiratory failure; 

20 (F) information about storage and disposal; 

21 and 

22 (G) such other information as the Secretary 

23 may specify. 

24 (3) Recommendations for improving data collec25 tion on perioperative opioid use, including an analVerDate Sep 11 2014 23:07 Jun 19, 2018 Jkt 079200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6203 E:\BILLS\H5774.RH H5774

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1 ysis to identify barriers to collecting, reporting, and 

2 analyzing the data described in paragraph (2), in3 cluding barriers related to technological availability. 

4 SEC. 5. REQUIRING THE POSTING AND PERIODIC UPDATE 

5 OF OPIOID PRESCRIBING GUIDANCE FOR 

6 MEDICARE BENEFICIARIES. 

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

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

9 and Human Services (in this section referred to as the ‘‘Sec10 retary’’) shall post on the public website of the Centers for 

11 Medicare & Medicaid Services all guidance published by the 

12 Department of Health and Human Services on or after 

13 January 1, 2016, relating to the prescribing of opioids and 

14 applicable to opioid prescriptions for individuals entitled 

15 to benefits under part A of title XVIII of the Social Security 

16 Act (42 U.S.C. 1395c et seq.) or enrolled under part B of 

17 such title of such Act (42 U.S.C. 1395j et seq.). 

18 (b) UPDATE OF GUIDANCE.— 

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

20 consultation with the entities specified in paragraph 

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

22 Secretary) update guidance described in subsection 

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

24 website described in such subsection. 


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1 (2) CONSULTATION.—The entities specified in 

2 this paragraph are the following: 

3 (A) Medical professional organizations. 

4 (B) Providers and suppliers of services (as 

5 such terms are defined in section 1861 of the So6 cial Security Act (42 U.S.C. 1395x)). 

7 (C) Health care consumers or groups rep8 resenting such consumers. 

9 (D) Other entities determined appropriate 

10 by the Secretary. 


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Union Calendar No. 593 

115TH CONGRESS 

2D SESSION H. R. 5774 

[Report No. 115–762, Part I] 

A BILL 

To require the Secretary of Health and Human 

opioid use, and for other purposes. opioid use and data collection on perioperative nical expert panel on reducing surgical setting measures development, and provide for a techMedicare program, provide for opioid quality pitals receiving payment under part A of the ment and opioid use disorder prevention for hosServices to develop guidance on pain manageJUNE 19, 2018 

Reported from the Committee on Ways and Means with 

J

an amendment 

UNE 19, 2018 

Committee on Energy and Commerce discharged; comState of the Union and ordered to be printed mitted to the Committee of the Whole House on the 


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