I 

118TH CONGRESS 

1ST SESSION H. R. 5506 

To amend titles XVIII and XIX of the Social Security Act and title 10, 

United States Code, to provide no-cost coverage for the preventive distribution of opioid overdose reversal drugs. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 14, 2023 

Ms. PETTERSEN (for herself, Ms. SCHRIER, and Ms. BUDZINSKI) introduced 

the following bill; which was referred to the Committee on Energy and 

Commerce, and in addition to the Committees on Ways and Means, and 

Armed Services, 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 titles XVIII and XIX of the Social Security Act 

and title 10, United States Code, to provide no-cost 

coverage for the preventive distribution of opioid overdose 

reversal drugs. 

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 ‘‘Hospitals As Naloxone 

5 Distribution Sites Act’’ or the ‘‘HANDS Act’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) Opioid use disorder is a treatable brain dis4 ease from which people can recover. 

5 (2) Individuals living with opioid use disorder, 

6 those who use opioids for chronic pain, and those 

7 who use illicit substances that may be contaminated 

8 with fentanyl or other illicit additives are at high 

9 risk for fatal overdose. 

10 (3) Individuals at-risk of overdose are fre11 quently cared for in emergency departments and 

12 hospitals, making these locations ideal places to 

13 screen and intervene. In addition, medical providers 

14 have the knowledge and ability to provide medically 

15 accurate information, but also treat the disease of 

16 addiction once a person is ready for treatment. 

17 (4) Overdose deaths are preventable with life18 saving opioid overdose reversal medications like 

19 naloxone. Two-thirds of fatal overdoses have a wit20 ness, who can intervene and prevent overdose death 

21 if they have access to opioid antagonists. 

22 (5) Just as individuals with life-threatening al23 lergies should carry an EpiPen, individuals and close 

24 contacts of those with opioid use disorder should 

25 carry an opioid overdose reversal medication. 


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1 (6) While over the counter (OTC) access to re2 versal agents may increase their availability to cer3 tain populations, the hurdles to access these medica4 tions for many of the most at-risk patients will still 

5 remain. These hurdles include out of pocket costs, 

6 transportation or access to pharmacies or other 

7 areas carrying OTC naloxone, stigma by pharmacy 

8 staff, addiction-related compromised executive func9 tion, and more. Therefore, hospitals are uniquely po10 sitioned as a point of distribution to best serve those 

11 who would most benefit. 

12 (7) It is the intent of Congress to increase ac13 cess for all individuals with opioid use disorder, and 

14 other risk factors, to opioid overdose reversal medi15 cation so that if they experience an overdose, they 

16 will have a second chance. As long as there is 

17 breath, there is hope for recovery. 

18 SEC. 3. NO-COST COVERAGE OF PREVENTIVE OPIOID OVER19 DOSE REVERSAL DRUGS. 

20 (a) COVERAGE UNDER MEDICARE.— 

21 (1) COVERAGE.—Section 1861(s)(2) of the So22 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend23 ed— 

24 (A) in subparagraph (JJ), by adding 

25 ‘‘and’’ after the semicolon at the end; and 


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1 (B) by adding at the end the following new 

2 subparagraph: 

3 ‘‘(KK) a preventive opioid overdose rever4 sal drug (as defined in subsection (nnn)) fur5 nished on or after January 1, 2024;’’. 

6 (2) PREVENTIVE OPIOID OVERDOSE REVERSAL

7 DRUG DEFINED.—Section 1861 of the Social Secu8 rity Act (42 U.S.C. 1395x) is amended by adding at 

9 the end the following new subsection: 

10 ‘‘(nnn) PREVENTIVE OPIOID OVERDOSE REVERSAL

11 DRUG.—The term ‘preventive opioid overdose reversal 

12 drug’ means an opioid overdose reversal drug that is fur13 nished by a physician, nurse practitioner, physician assist14 ant, or other attending clinical personnel (as determined 

15 by the Secretary by regulation) to an individual who is 

16 an inpatient of a hospital, critical access hospital, or rural 

17 emergency hospital, or is a patient of the emergency de18 partment of such a hospital or an ambulatory surgical cen19 ter, but only if— 

20 ‘‘(1) such physician, nurse practitioner, physi21 cian assistant, or attending clinical professional de22 termines that such individual is at risk for an opioid 

23 overdose; and 

24 ‘‘(2) such drug is furnished at the time such in25 dividual is discharged from the hospital or leaves the 


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1 emergency department or ambulatory surgical cen2 ter, as the case may be, together with instructions 

3 for the administration of such drug.’’. 

4 (3) PROHIBITION OF COST SHARING.—Section 

5 1833 of the Social Security Act (42 U.S.C. 1395l) 

6 is amended— 

7 (A) in subsection (a)(1)— 

8 (i) in subparagraph (S)(i), by striking 

9 ‘‘subparagraph (EE),’’ and inserting ‘‘sub10 paragraphs (EE) and (II),’’; 

11 (ii) in subparagraph (GG), by striking 

12 ‘‘and’’ at the end; and 

13 (iii) by inserting ‘‘, and (II) with re14 spect to a preventive opioid overdose rever15 sal drug (as defined in section 1861(nnn)) 

16 furnished on or after January 1, 2024, the 

17 amounts paid shall be 100 percent of the 

18 lesser of the actual charges for such drug 

19 or the amount determined under section 

20 1842(o)’’ before the semicolon at the end; 

21 and 

22 (B) in subsection (b)— 

23 (i) by striking ‘‘, and (13)’’ and in24 serting ‘‘(13)’’; and 


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1 (ii) by striking ‘‘section 1861(n)..’’ 

2 and inserting ‘‘section 1861(n), and (14) 

3 such deductible shall not apply with re4 spect to a preventive opioid reversal drug 

5 (as defined in section 1861(nnn)) fur6 nished on or after January 1, 2024.’’. 

7 (4) PROHIBITION OF COST SHARING FOR MEDI8 CARE ADVANTAGE PLANS.—Section 1852(a)(1)(B) of 

9 the Social Security Act (42 U.S.C. 1395w– 

10 22(a)(1)(B)) is amended— 

11 (A) in clause (iv)— 

12 (i) by redesignating subclause (VIII) 

13 as subclause (IX); and 

14 (ii) by inserting after subclause (VII) 

15 the following new subclause: 

16 ‘‘(VIII) A preventive opioid rever17 sal drug (as defined in section 

18 1861(nnn)).’’; and 

19 (B) in clause (v), by striking ‘‘and (VI)’’ 

20 and inserting ‘‘(VI), and (VIII)’’. 

21 (b) COVERAGE UNDER MEDICAID.— 

22 (1) MANDATORY COVERAGE.— 

23 (A) IN GENERAL.—Section 1902(a)(10)(A) 

24 of the Social Security Act (42 U.S.C. 


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1 1396a(a)(10)(A)) is amended by striking ‘‘and 

2 (30)’’ and inserting ‘‘(30), and (31)’’. 

3 (B) ALTERNATIVE BENEFIT PLANS.—Sec4 tion 1937(b) of the Social Security Act (42 

5 U.S.C. 1396u–7(b)) is amended by adding at 

6 the end the following new paragraph: 

7 ‘‘(9) PREVENTIVE OPIOID OVERDOSE REVERSAL

8 DRUGS.—Notwithstanding the previous provisions of 

9 this section, a State may not provide for medical as10 sistance through enrollment of an individual with 

11 benchmark coverage or benchmark-equivalent cov12 erage under this section unless, beginning on Janu13 ary 1, 2024, such coverage includes (and does not 

14 impose any deduction, cost sharing, or similar 

15 charge for) preventive opioid overdose reversal drugs 

16 described in section 1861(nnn)).’’. 

17 (2) INCLUSION IN MEDICAL ASSISTANCE.— 

18 (A) IN GENERAL.—Section 1905(a) of the 

19 Social Security Act (42 U.S.C. 1396d(a)) is 

20 amended— 

21 (i) in paragraph (30), by striking 

22 ‘‘and’’ at the end; 

23 (ii) by redesignating paragraph (31) 

24 as paragraph (32); and 


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1 (iii) by inserting after paragraph (30) 

2 the following new paragraph: 

3 ‘‘(31) beginning January 1, 2024, preventive 

4 opioid overdose reversal drugs described in section 

5 1861(nnn); and’’. 

6 (3) APPLICATION OF REBATE REQUIRE7 MENTS.—Section 1927 of the Social Security Act 

8 (42 U.S.C. 1396r–8) is amended— 

9 (A) in subsection (d)(7), by adding at the 

10 end the following new subparagraph: 

11 ‘‘(F) Preventive opioid overdose reversal 

12 drugs described in section 1861(nnn) that are 

13 furnished as medical assistance in accordance 

14 with section 1905(a)(31) and section 

15 1902(a)(10)(A).’’; and 

16 (B) in subsection (k)(4)— 

17 (i) by striking ‘‘If a State plan’’ and 

18 inserting: 

19 ‘‘(A) IN GENERAL.—If a State plan’’; and 

20 (ii) by adding at the end the following 

21 new subparagraph: 

22 ‘‘(B) PREVENTIVE OPIOID OVERDOSE RE23 VERSAL DRUGS.—Beginning January 1, 2024, 

24 in applying paragraph (2)(A) to a preventive 

25 opioid overdose reversal drug described in secVerDate Sep 11 2014 05:06 Sep 16, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5506.IH H5506

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1 tion 1861(nnn), such drug shall be deemed a 

2 prescribed drug for purposes of section 

3 1905(a)(12).’’. 

4 (4) PROHIBITION OF COST SHARING.— 

5 (A) IN GENERAL.—Section 1916 of the So6 cial Security Act (42 U.S.C. 1396o) is amend7 ed— 

8 (i) in subsection (a)(2)— 

9 (I) in subparagraph (I), by strik10 ing ‘‘or’’ at the end; 

11 (II) in subparagraph (J), by 

12 striking ‘‘; and’’ at the end and in13 serting ‘‘, or’’; and 

14 (III) by adding at the end the 

15 following new subparagraph: 

16 ‘‘(K) beginning January 1, 2024, preven17 tive opioid overdose reversal drugs described in 

18 section 1861(nnn); and’’; and 

19 (ii) in subsection (b)(2)— 

20 (I) in subparagraph (I), by strik21 ing ‘‘or’’ at the end; 

22 (II) in subparagraph (J), by 

23 striking ‘‘; and’’ at the end and in24 serting ‘‘, or’’; and 


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1 (III) by adding at the end the 

2 following new subparagraph: 

3 ‘‘(K) beginning January 1, 2024, preven4 tive opioid overdose reversal drugs described in 

5 section 1861(nnn); and’’. 

6 (B) APPLICATION TO ALTERNATIVE COST

7 SHARING.—Section 1916A(b)(3)(B) of the So8 cial Security Act (42 U.S.C. 1396o–1(b)(3)(B)) 

9 is amended by adding at the end the following 

10 new clause: 

11 ‘‘(xv) Beginning January 1, 2024, 

12 preventive opioid overdose reversal drugs 

13 described in section 1861(nnn).’’. 

14 (c) COVERAGE UNDER TRICARE.—Section 1074g 

15 of title 10, United States Code, is amended as follows: 

16 (1) In subsection (a)(6), by adding at the end 

17 the following new subparagraph: 

18 ‘‘(D) Notwithstanding subparagraphs (A) through 

19 (C), beginning on January 1, 2024, an eligible covered 

20 beneficiary shall not be required to pay a cost-sharing 

21 amount for a preventive opioid overdose reversal drug.’’. 

22 (2) In subsection (i), by adding at the end the 

23 following new paragraph: 

24 ‘‘(5) The term ‘preventive opioid overdose rever25 sal drug’ has the meaning given such term in section 


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1 1861 of the Social Security Act (42 U.S.C. 

2 1395x).’’. 

3 SEC. 4. REGULATORY GUIDANCE. 

4 Not later than 1 year after the date of the enactment 

5 of this Act, the Commissioner of Food and Drugs shall 

6 issue guidance for State boards of pharmacy, nursing, and 

7 medicine with respect to— 

8 (1) enhancing safe and effective hospital-based 

9 dispensing and distribution of opioid overdose rever10 sal drugs; and 

11 (2) eliminating barriers to such dispensing and 

12 distribution. 

Æ 


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