115TH CONGRESS 
2D SESSION 
H. R. 5197 
AN ACT 
To direct the Secretary of Health and Human Services to 
conduct a demonstration program to test alternative pain 
management protocols to limit the use of opioids in emer-
gency departments. 
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 ‘‘Alternatives to Opioids 
in the Emergency Department Act’’ or the ‘‘ALTO Act’’. 
SEC. 2. EMERGENCY DEPARTMENT ALTERNATIVES TO 
OPIOIDS DEMONSTRATION PROGRAM. 
(a) DEMONSTRATION PROGRAM GRANTS.—The Sec-
retary of Health and Human Services (in this section re-
ferred to as the ‘‘Secretary’’) shall carry out a demonstra-
tion program under which the Secretary shall award 
grants to hospitals and emergency departments, including 
freestanding emergency departments, to develop, imple-
ment, enhance, or study alternative pain management pro-
tocols and treatments that limit the use and prescription 
of opioids in emergency departments. 
(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), a hospital or emergency department 
shall submit an application to the Secretary at such time, 
in such manner, and containing such information as the 
Secretary may require. 
(c) GEOGRAPHIC DIVERSITY.—In awarding grants 
under this section, the Secretary shall seek to ensure geo-
graphical diversity among grant recipients. 
(d) USE OF FUNDS.—Grants under subsection (a) 
shall be used to—
(1) target common painful conditions, such as 
renal colic, sciatica, headaches, musculoskeletal pain, 
and extremity fractures; 
(2) train providers and other hospital personnel 
on protocols and the use of treatments that limit the 
use and prescription of opioids in the emergency de-
partment; and 
(3) provide alternatives to opioids to patients 
with painful conditions, not including patients who 
present with pain related to cancer, end-of-life symp-
tom palliation, or complex multisystem trauma. 
(e) CONSULTATION.—The Secretary shall implement 
a process for recipients of grants under subsection (a) to 
consult (in a manner that allows for sharing of evidence- 
based best practices) with each other and with persons 
having robust knowledge, including emergency depart-
ments and physicians that have successfully deployed al-
ternative pain management protocols, such as non-drug 
approaches studied through the National Center for Com-
plimentary and Integrative Health including acupuncture 
that limit the use of opioids. The Secretary shall offer to 
each recipient of a grant under subsection (a) technical 
support as necessary. 
(f) REPORT TO THE SECRETARY.—Each recipient of 
a grant under this section shall submit to the Secretary
(during the period of such grant) annual reports on the 
progress of the program funded through the grant. These 
reports shall include, in accordance with State and Fed-
eral statutes and regulations regarding disclosure of pa-
tient information— 
(1) a description of and specific information 
about the alternative pain management protocols 
employed; 
(2) data on the alternative pain management 
protocols and treatments employed, including— 
(A) during a baseline period before the 
program began, as defined by the Secretary; 
(B) at various stages of the program, as 
determined by the Secretary; and 
(C) the conditions for which the alternative 
pain management protocols and treatments 
were employed; 
(3) the success of each specific alternative pain 
management protocol; 
(4) data on the opioid prescriptions written, in-
cluding— 
(A) during a baseline period before the 
program began, as defined by the Secretary; 
(B) at various stages of the program, as 
determined by the Secretary; and
(C) the conditions for which the opioids 
were prescribed; 
(5) the demographic characteristics of patients 
who were treated with an alternative pain manage-
ment protocol, including age, sex, race, ethnicity, 
and insurance status and type; 
(6) data on patients who were eventually pre-
scribed opioids after alternative pain management 
protocols and treatments were employed; and 
(7) any other information the Secretary deems 
necessary. 
(g) REPORT TO CONGRESS.—Not later than 1 year 
after completion of the demonstration program under this 
section, the Secretary shall submit a report to the Con-
gress on the results of the demonstration program and in-
clude in the report— 
(1) the number of applications received and the 
number funded; 
(2) a summary of the reports described in sub-
section (f), including standardized data; and 
(3) recommendations for broader implementa-
tion of pain management protocols that limit the use 
and prescription of opioids in emergency depart-
ments or other areas of the health care delivery sys-
tem.
(h) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there is authorized to be appropriated 
$10,000,000 for each of fiscal years 2019 through 2021. 
Passed the House of Representatives June 12, 2018. 
Attest: 
Clerk.
115TH CONGRESS 
2D SESSION 
H. R. 5197 
AN ACT 
To direct the Secretary of Health and Human 
Services to conduct a demonstration program to 
test alternative pain management protocols to 
limit the use of opioids in emergency depart-
ments.