I 
115TH CONGRESS 
2D SESSION 
H. R. 5558 
To require the Secretary of Health and Human Services to carry out under 
the Medicare program an alternatives to opioids in emergency depart-
ments demonstration project. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 18, 2018 
Mr. BUCHANAN (for himself and Mr. HASTINGS) 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 subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To require the Secretary of Health and Human Services 
to carry out under the Medicare program an alternatives 
to opioids in emergency departments demonstration 
project. 
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 
Prescribing Act’’. 
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SEC. 2. ALTERNATIVES TO OPIOIDS IN EMERGENCY DE-
PARTMENTS 
MEDICARE 
DEMONSTRATION 
PROJECT. 
(a) ESTABLISHMENT.—Beginning not later than one 
year after the date of the enactment of this Act, the Sec-
retary of Health and Human Services (in this Act referred 
to as the ‘‘Secretary’’) shall carry out a 5-year demonstra-
tion project under which payment shall be made under the 
hospital outpatient prospective payment system under part 
B of title XVIII of the Social Security Act (42 U.S.C. 
1395j et seq.) to participating hospitals for items and 
services furnished as alternatives to opioid medications to 
individuals enrolled under such part to treat conditions 
designated under subsection (c)(1) for purposes of evalu-
ating the benefits of using, instead of opioid medications, 
such alternatives to treat in emergency departments such 
symptoms and conditions. 
(b) EMERGENCY DEPARTMENTS.— 
(1) SELECTION.—The Secretary shall select 
from hospitals with emergency departments volun-
tarily submitting applications under paragraph (4), 
not fewer than 30 hospitals with emergency depart-
ments, and not more than 50 hospitals with emer-
gency departments, for participation in the dem-
onstration project. 
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(2) DIVERSITY.—In selecting hospitals with 
emergency departments, the Secretary shall ensure 
such hospitals and emergency departments are di-
verse in geography and size. 
(3) VOLUNTARY PARTICIPATION.—Participation 
in the demonstration project under this section shall 
be on a voluntary basis. 
(4) APPLICATIONS.— 
(A) IN GENERAL.—To participate in the 
demonstration project, a hospital with an emer-
gency department shall submit to the Secretary 
an application at such time, in such manner, 
and containing such information (in addition to 
the written commitment described in subpara-
graph (B)) as specified by the Secretary. The 
Secretary shall take such measures as is nec-
essary to make available such application form 
to potential participants no later than 180 days 
after the date of the enactment of this Act. 
(B) INFORMATION REQUIRED.—Each ap-
plication submitted by a hospital under sub-
paragraph (A) shall include a binding written 
commitment to participate in the demonstration 
project for the duration of the project signed by 
the Chief Executive Officer of the hospital, the 
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physician medical director of the emergency de-
partment of the hospital, the nursing director of 
the emergency department of the hospital, and 
the pharmacy director of the emergency depart-
ment of the hospital. 
(c) ELEMENTS
OF DEMONSTRATION PROJECT.— 
Under the demonstration project, the following shall 
apply: 
(1) The Secretary shall designate no fewer than 
five conditions or sets of symptoms that will be mon-
itored during the demonstration project. 
(2) The performance during each year of the 
demonstration project, with respect to such condi-
tions designated under paragraph (1), of all emer-
gency departments of hospitals participating in the 
demonstration project will be measured against the 
performance of such emergency departments during 
a base year, which shall represent the most recent 
set of full year data available before the first date 
of the demonstration project. 
(3) The Secretary shall provide hospitals par-
ticipating in the demonstration project with a de-
scription of clearly defined treatments that are con-
sidered alternatives to opioids to be applied for pur-
poses of subsection (a). 
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(d) INCENTIVE PAYMENT.—Under the demonstration 
project, the Secretary shall create a payment structure 
under which hospitals participating in the demonstration 
project that increase the use of alternatives to opioids and 
decrease the use of opioids may receive a shared savings 
bonus in addition to what would otherwise be made for 
items and services furnished under subsection (a). The 
amount of such shared savings shall be based on the dif-
ference between readmission rates for individuals treated 
with an alternative to opioids at the emergency depart-
ment of the participating hospital and the average rate 
of readmissions for individuals treated with opioids and 
discharged from a representative group of emergency de-
partments of hospitals not participating in the demonstra-
tion project in the same region as the participating hos-
pital over a period of five years. 
(e) CLARIFICATION.—Nothing under this section 
shall prevent a health care provider from prescribing an 
opioid if an opioid is a medically necessary treatment. 
(f) REPORTS TO CONGRESS.— 
(1) INITIAL REPORT.—Not later than 180 days 
after the date of the enactment of this Act, the Sec-
retary shall submit to Congress a report that in-
cludes— 
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(A) the application form described in sub-
section (b)(4)(A) that is to be made available to 
potential participants; and 
(B) a progress report with respect to des-
ignating the conditions under subsection (c)(1) 
and establishing the description of clearly de-
fined treatments described in subsection (c)(3). 
(2) PERIODIC DEMONSTRATION REPORTS.—Be-
ginning after the first year of the demonstration 
project and annually thereafter for each year of the 
demonstration project and not later than one year 
after the completion of the demonstration, the Sec-
retary shall submit to Congress a report that in-
cludes the following data for each hospital partici-
pating under the demonstration project: 
(A) With respect to each condition or set 
of symptom designated under subsection (c)(1), 
the number of individuals treated. 
(B) With respect to each such condition, 
the number of individuals treated only with an 
alternative to opioids. 
(C) With respect to each such condition, 
the number of individuals treated first with an 
alternative to opioids, followed by an opioid in 
the same visit. 
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(D) With respect to each such condition, 
the number of individuals treated only with an 
opioid. 
(E) With respect to each individual de-
scribed in subparagraph (A) treated for such a 
condition or set of symptoms, whether or not 
the individual involved returned to the emer-
gency department of the hospital or an emer-
gency department of a different hospital for the 
same condition or symptoms. 
(F) The difference in cost between treating 
an individual with an alternative to opioid 
versus an opioid. 
(G) Any additional information the Sec-
retary determines necessary. 
Æ 
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