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 re-
ferred to the Committee on Ways and Means, and in addition to the 
Committee on Energy and Commerce, for a period to be subsequently de-
termined 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 tech-
nical expert panel on reducing surgical setting opioid 
use and data collection on perioperative opioid use, and 
for other purposes. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Combating Opioid Abuse 
for Care in Hospitals Act of 2018’’ or the ‘‘COACH Act 
of 2018’’. 
SEC. 2. DEVELOPING GUIDANCE ON PAIN MANAGEMENT 
AND OPIOID USE DISORDER PREVENTION 
FOR HOSPITALS RECEIVING PAYMENT UNDER 
PART A OF THE MEDICARE PROGRAM. 
(a) IN GENERAL.—Not later than January 1, 2019, 
the Secretary of Health and Human Services (in this sec-
tion referred to as the ‘‘Secretary’’) shall develop and pub-
lish on the public website of the Centers for Medicare & 
Medicaid Services guidance for hospitals receiving payment 
under part A of title XVIII of the Social Security Act (42 
U.S.C. 1395c et seq.) on pain management strategies and 
opioid use disorder prevention strategies with respect to in-
dividuals entitled to benefits under such part. 
(b) CONSULTATION.—In developing the guidance de-
scribed in subsection (a), the Secretary shall consult with 
relevant stakeholders, including— 
(1) medical professional organizations; 
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(2) providers and suppliers of services (as such 
terms are defined in section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x)); 
(3) health care consumers or groups representing 
such consumers; and 
(4) other entities determined appropriate by the 
Secretary. 
(c) CONTENTS.—The guidance described in subsection 
(a) shall include, with respect to hospitals and individuals 
described in such subsection, the following: 
(1) Best practices regarding evidence-based 
screening and practitioner education initiatives relat-
ing to screening and treatment protocols for opioid 
use disorder, including— 
(A) methods to identify such individuals at- 
risk of opioid use disorder, including risk strati-
fication; 
(B) ways to prevent, recognize, and treat 
opioid overdoses; and 
(C) resources available to such individuals, 
such as opioid treatment programs, peer support 
groups, and other recovery programs. 
(2) Best practices for such hospitals to educate 
practitioners furnishing items and services at such 
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hospital with respect to pain management and sub-
stance use disorders, including education on— 
(A) the adverse effects of prolonged opioid 
use; 
(B) non-opioid, evidence-based, non-phar-
macological pain management treatments; 
(C) monitoring programs for individuals 
who have been prescribed opioids; and 
(D) the prescribing of naloxone along with 
an initial opioid prescription. 
(3) Best practices for such hospitals to make such 
individuals aware of the risks associated with opioid 
use (which may include use of the notification tem-
plate described in paragraph (4)). 
(4) A notification template developed by the Sec-
retary, for use as appropriate, for such individuals 
who are prescribed an opioid that— 
(A) explains the risks and side effects asso-
ciated with opioid use (including the risks of ad-
diction and overdose) and the importance of ad-
hering to the prescribed treatment regimen, 
avoiding medications that may have an adverse 
interaction with such opioid, and storing such 
opioid safely and securely; 
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(B) highlights multimodal and evidence- 
based non-opioid alternatives for pain manage-
ment; 
(C) encourages such individuals to talk to 
their health care providers about such alter-
natives; 
(D) provides for a method (through signa-
ture or otherwise) for such an individual, or per-
son acting on such individual’s behalf, to ac-
knowledge receipt of such notification template; 
(E) is worded in an easily understandable 
manner and made available in multiple lan-
guages determined appropriate by the Secretary; 
and 
(F) includes any other information deter-
mined appropriate by the Secretary. 
(5) Best practices for such hospital to track 
opioid prescribing trends by practitioners furnishing 
items and services at such hospital, including— 
(A) ways for such hospital to establish tar-
get levels, taking into account the specialties of 
such practitioners and the geographic area in 
which such hospital is located, with respect to 
opioids prescribed by such practitioners; 
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(B) guidance on checking the medical 
records of such individuals against information 
included in prescription drug monitoring pro-
grams; 
(C) strategies to reduce long-term opioid 
prescriptions; and 
(D) methods to identify such practitioners 
who may be over-prescribing opioids. 
(6) Other information the Secretary determines 
appropriate, including any such information from the 
Opioid Safety Initiative established by the Depart-
ment of Veterans Affairs or the Opioid Overdose Pre-
vention Toolkit published by the Substance Abuse and 
Mental Health Services Administration. 
SEC. 3. REQUIRING THE REVIEW OF QUALITY MEASURES 
RELATING TO OPIOIDS AND OPIOID USE DIS-
ORDER 
TREATMENTS 
FURNISHED 
UNDER 
THE MEDICARE PROGRAM AND OTHER FED-
ERAL HEALTH CARE PROGRAMS. 
(a) IN GENERAL.—Section 1890A of the Social Secu-
rity Act (42 U.S.C. 1395aaa–1) is amended by adding at 
the end the following new subsection: 
‘‘(g) TECHNICAL EXPERT PANEL REVIEW OF OPIOID 
AND OPIOID USE DISORDER QUALITY MEASURES.— 
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‘‘(1) IN
GENERAL.—Not later than 180 days 
after the date of the enactment of this subsection, the 
Secretary shall establish a technical expert panel for 
purposes of reviewing quality measures relating to 
opioids and opioid use disorders, including care, pre-
vention, diagnosis, health outcomes, and treatment 
furnished to individuals with opioid use disorders. 
The Secretary may use the entity with a contract 
under section 1890(a) and amend such contract as 
necessary to provide for the establishment of such 
technical expert panel. 
‘‘(2) REVIEW AND ASSESSMENT.—Not later than 
1 year after the date the technical expert panel de-
scribed in paragraph (1) is established (and periodi-
cally thereafter as the Secretary determines appro-
priate), the technical expert panel shall— 
‘‘(A) review quality measures that relate to 
opioids and opioid use disorders, including exist-
ing measures and those under development; 
‘‘(B) identify gaps in areas of quality meas-
urement that relate to opioids and opioid use 
disorders, and identify measure development pri-
orities for such measure gaps; and 
‘‘(C) make recommendations to the Sec-
retary on quality measures with respect to 
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opioids and opioid use disorders for purposes of 
improving care, prevention, diagnosis, health 
outcomes, and treatment, including recommenda-
tions for revisions of such measures, need for de-
velopment of new measures, and recommenda-
tions for including such measures in the Merit- 
Based Incentive Payment System under section 
1848(q), the alternative payment models under 
section 1833(z)(3)(C), the shared savings pro-
gram under section 1899, the quality reporting 
requirements for inpatient hospitals under sec-
tion 1886(b)(3)(B)(viii), the hospital value-based 
purchasing program under section 1886(o), and 
under other value-based purchasing programs 
under this title. 
‘‘(3) CONSIDERATION
OF
MEASURES
BY
SEC-
RETARY.—The Secretary shall consider— 
‘‘(A) using opioid and opioid use disorder 
measures (including measures used under the 
Merit-Based Incentive Payment System under 
section 1848(q), measures recommended under 
paragraph (2)(C), and other such measures iden-
tified by the Secretary) in alternative payment 
models under section 1833(z)(3)(C) and in the 
shared savings program under section 1899; and 
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‘‘(B) using opioid measures described in 
subparagraph (A), as applicable, in the quality 
reporting requirements for inpatient hospitals 
under section 1886(b)(3)(B)(viii), in the hospital 
value-based purchasing program under section 
1886(o), and under other value-based purchasing 
programs under this title. 
‘‘(4) PRIORITIZATION
OF
MEASURE
DEVELOP-
MENT.—The Secretary shall prioritize for measure de-
velopment the gaps in quality measures identified 
under paragraph (2)(B).’’. 
(b) EXPEDITED ENDORSEMENT PROCESS FOR OPIOID 
MEASURES.—Section 1890(b)(2) of the Social Security Act 
(42 U.S.C. 1395aaa(b)(2)) is amended by adding at the end 
the following new flush sentence: 
‘‘Such endorsement process shall, as determined prac-
ticable by the entity, provide for an expedited process 
with respect to the endorsement of such measures re-
lating to opioids and opioid use disorders.’’. 
SEC. 4. TECHNICAL EXPERT PANEL ON REDUCING SUR-
GICAL SETTING OPIOID USE; DATA COLLEC-
TION ON PERIOPERATIVE OPIOID USE. 
(a) TECHNICAL EXPERT PANEL ON REDUCING SUR-
GICAL SETTING OPIOID USE.— 
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(1) IN GENERAL.—Not later than 6 months after 
the date of the enactment of this Act, the Secretary of 
Health and Human Services shall convene a technical 
expert panel, including medical and surgical spe-
cialty societies and hospital organizations, to provide 
recommendations on reducing opioid use in the inpa-
tient and outpatient surgical settings and on best 
practices for pain management, including with re-
spect to the following: 
(A) Approaches that limit patient exposure 
to opioids during the perioperative period, in-
cluding pre-surgical and post-surgical injections, 
and that identify such patients at risk of opioid 
use disorder pre-operation. 
(B) Shared decision making with patients 
and families on pain management, including 
recommendations for the development of an eval-
uation and management code for purposes of 
payment under the Medicare program under title 
XVIII of the Social Security Act that would ac-
count for time spent on shared decision making. 
(C) Education on the safe use, storage, and 
disposal of opioids. 
(D) Prevention of opioid misuse and abuse 
after discharge. 
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(E) Development of a clinical algorithm to 
identify and treat at-risk, opiate-tolerant pa-
tients and reduce reliance on opiodes for acute 
pain during the perioperative period. 
(2) REPORT.—Not later than 1 year after the 
date of the enactment of this Act, the Secretary shall 
submit to Congress and make public a report con-
taining the recommendations developed under para-
graph (1) and recommendations for broader imple-
mentation of pain management protocols that limit 
the use of opioids in the perioperative setting and 
upon discharge from such setting. 
(b) DATA COLLECTION
ON PERIOPERATIVE OPIOID 
USE.—Not later than 1 year after the date of the enactment 
of this Act, the Secretary of Health and Human Services 
shall submit to Congress a report that contains the fol-
lowing: 
(1) The diagnosis-related group codes identified 
by the Secretary as having the highest volume of sur-
geries. 
(2) With respect to each of such diagnosis-related 
group codes so identified, a determination by the Sec-
retary of the data that is both available and reported 
on opioid use following such surgeries, such as with 
respect to— 
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(A) surgical volumes, practices, and opioid 
prescribing patterns; 
(B) opioid consumption, including— 
(i) perioperative days of therapy; 
(ii) average daily dose at the hospital, 
including dosage greater than 90 milligram 
morphine equivalent; 
(iii) post-discharge prescriptions and 
other combination drugs that are used be-
fore intervention and after intervention; 
(iv) quantity and duration of opioid 
prescription at discharge; and 
(v) quantity consumed and number of 
refills; 
(C) regional anesthesia and analgesia prac-
tices, including pre-surgical and post-surgical 
injections; 
(D) naloxone reversal; 
(E) post-operative respiratory failure; 
(F) information about storage and disposal; 
and 
(G) such other information as the Secretary 
may specify. 
(3) Recommendations for improving data collec-
tion on perioperative opioid use, including an anal-
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ysis to identify barriers to collecting, reporting, and 
analyzing the data described in paragraph (2), in-
cluding barriers related to technological availability. 
SEC. 5. REQUIRING THE POSTING AND PERIODIC UPDATE 
OF OPIOID PRESCRIBING GUIDANCE FOR 
MEDICARE BENEFICIARIES. 
(a) IN GENERAL.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall post on the public website of the Centers for 
Medicare & Medicaid Services all guidance published by the 
Department of Health and Human Services on or after 
January 1, 2016, relating to the prescribing of opioids and 
applicable to opioid prescriptions for individuals entitled 
to benefits under part A of title XVIII of the Social Security 
Act (42 U.S.C. 1395c et seq.) or enrolled under part B of 
such title of such Act (42 U.S.C. 1395j et seq.). 
(b) UPDATE OF GUIDANCE.— 
(1) PERIODIC UPDATE.—The Secretary shall, in 
consultation with the entities specified in paragraph 
(2), periodically (as determined appropriate by the 
Secretary) update guidance described in subsection 
(a) and revise the posting of such guidance on the 
website described in such subsection. 
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