I 

117TH CONGRESS 

1ST SESSION H. R. 3259 

To amend title XVIII of the Social Security Act to combat the opioid crisis 

by promoting access to non-opioid treatments in the hospital outpatient 

setting. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 14, 2021 

Ms. SEWELL (for herself, Mr. MCKINLEY, Ms. KUSTER, and Mr. 

FITZPATRICK) 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 combat 

the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting. 

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 ‘‘Non-Opioids Prevent 

5 Addiction In the Nation Act’’ or the ‘‘NOPAIN Act’’. 


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1 SEC. 2. ACCESS TO NON-OPIOID TREATMENTS FOR PAIN. 

2 (a) IN GENERAL.—Section 1833(t) of the Social Se3 curity Act (42 U.S.C. 1395l(t)) is amended— 

4 (1) in paragraph (2)(E), by inserting ‘‘and sep5 arate payments for non-opioid treatments under 

6 paragraph (16)(G),’’ after ‘‘payments under para7 graph (6)’’; and 

8 (2) in paragraph (16), by adding at the end the 

9 following new subparagraph: 

10 ‘‘(G) ACCESS TO NON-OPIOID TREATMENTS

11 FOR PAIN.— 

12 ‘‘(i) IN GENERAL.—Notwithstanding 

13 any other provision of this subsection, with 

14 respect to a covered OPD service (or group 

15 of services) furnished on or after January 

16 1, 2022, and before January 1, 2027, the 

17 Secretary shall not package, and shall 

18 make a separate payment as specified in 

19 clause (ii) for, a non-opioid treatment (as 

20 defined in clause (iii)) furnished as part of 

21 such service (or group of services). 

22 ‘‘(ii) AMOUNT OF PAYMENT.—The 

23 amount of the payment specified in this 

24 clause is, with respect to a non-opioid 

25 treatment that is— 


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1 ‘‘(I) a drug or biological product, 

2 the amount of payment for such drug 

3 or biological determined under section 

4 1847A; or 

5 ‘‘(II) a medical device, the 

6 amount of the hospital’s charges for 

7 the device, adjusted to cost. 

8 ‘‘(iii) DEFINITION OF NON-OPIOID

9 TREATMENT.—A ‘non-opioid treatment’ 

10 means— 

11 ‘‘(I) a drug or biological product 

12 that is indicated to produce analgesia 

13 without acting upon the body’s opioid 

14 receptors; or 

15 ‘‘(II) an implantable, reusable, or 

16 disposable medical device cleared or 

17 approved by the Administrator for 

18 Food and Drugs for the intended use 

19 of managing or treating pain, 

20 that has demonstrated the ability to re21 place, reduce, or avoid opioid use or the 

22 quantity of opioids prescribed in a clinical 

23 trial or through data published in a peer24 reviewed journal.’’. 


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1 (b) AMBULATORY SURGICAL CENTER PAYMENT SYS2 TEM.—Section 1833(i)(2)(D) of the Social Security Act 

3 (42 U.S.C. 1395l(i)(2)(D)) is amended— 

4 (1) by aligning the margins of clause (v) with 

5 the margins of clause (iv); 

6 (2) by redesignating clause (vi) as clause (vii); 

7 and 

8 (3) by inserting after clause (v) the following 

9 new clause: 

10 ‘‘(vi) In the case of surgical services 

11 furnished on or after January 1, 2022, and 

12 before January 1, 2027, the payment sys13 tem described in clause (i) shall provide, in 

14 a budget-neutral manner, for a separate 

15 payment for a non-opioid treatment (as de16 fined in clause (iii) of subsection 

17 (t)(16)(G)) furnished as part of such serv18 ices in the amount specified in clause (ii) 

19 of such subsection.’’. 

20 (c) EVALUATION OF THERAPEUTIC SERVICES FOR

21 PAIN MANAGEMENT.— 

22 (1) REPORT TO CONGRESS.—Not later than 1 

23 year after the date of the enactment of this Act, the 

24 Secretary of Health and Human Services (in this 

25 subsection referred to as the ‘‘Secretary’’), acting 


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1 through the Administrator of the Centers for Medi2 care & Medicaid Services, shall submit to Congress 

3 a report identifying— 

4 (A) limitations, gaps, barriers to access, or 

5 deficits in Medicare coverage or reimbursement 

6 for restorative therapies, behavioral approaches, 

7 and complementary and integrative health serv8 ices that are identified in the Pain Management 

9 Best Practices Inter-Agency Task Force Report 

10 and that have demonstrated the ability to re11 place or reduce opioid consumption; and 

12 (B) recommendations to address the limi13 tations, gaps, barriers to access, or deficits 

14 identified under subparagraph (A) to improve 

15 Medicare coverage and reimbursement for such 

16 therapies, approaches, and services. 

17 (2) PUBLIC CONSULTATION.—In developing the 

18 report described in paragraph (1), the Secretary 

19 shall consult with relevant stakeholders as deter20 mined appropriate by the Secretary. 

21 (3) EXCLUSIVE TREATMENT.—Any drug, bio22 logical product, or medical device that is a non23 opioid treatment (as defined in section 

24 1833(t)(16)(G)(iii) of the Social Security Act, as 

25 added by subsection (a)) shall not be considered a 


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1 therapeutic service for the purpose of the report de2 scribed in paragraph (1). 

Æ 


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