I 
115TH CONGRESS 
2D SESSION 
H. R. 5722 
To direct the Secretary of Health and Human Services to conduct a study 
and submit to Congress a report containing recommendation on how 
to improve the use of non-opioid treatments for acute and chronic pain 
management for individuals entitled to benefits under part A or enrolled 
under part B of the Medicare program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 9, 2018 
Mrs. WALORSKI (for herself and Ms. JUDY CHU of California) introduced the 
following bill; which was referred to the Committee on Ways and Means, 
and in addition to the Committee on Energy and Commerce, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To direct the Secretary of Health and Human Services to 
conduct a study and submit to Congress a report con-
taining recommendation on how to improve the use of 
non-opioid treatments for acute and chronic pain man-
agement for individuals entitled to benefits under part 
A or enrolled under part B of the Medicare program, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Dr. Todd Graham Pain 
Management Improvement Act of 2018’’. 
SEC. 2. PAIN MANAGEMENT STUDY. 
(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of this Act, the Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall conduct a study and submit to the Com-
mittee on Ways and Means and the Committee on Energy 
and Commerce of the House of Representatives and the 
Committee on Finance of the Senate a report containing 
recommendations on whether and how reimbursement to 
providers and suppliers of services, coverage, and coding 
policies related to the use of multi-disciplinary, evidence- 
based, non-opioid treatments for acute and chronic pain 
management for individuals entitled to benefits under part 
A or enrolled under part B of title XVIII of the Social 
Security Act should be revised. The Secretary shall make 
such report available on the public website of the Centers 
for Medicare & Medicaid Services. 
(b) CONSULTATION.—In developing the report de-
scribed in subsection (a), the Secretary shall consult 
with— 
(1) relevant agencies within the Department of 
Health and Human Services; 
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(2) licensed and practicing osteopathic and 
allopathic physicians, physician assistants, nurse 
practitioners, dentists, and pharmacists; 
(3) hospitals and other medical facilities, in-
cluding acute care hospitals, cancer hospitals, psy-
chiatric hospitals, hospital emergency departments, 
facilities furnishing urgent care services, ambulatory 
surgical centers, and post-acute care and long-term 
care facilities (such as skilled nursing facilities, inpa-
tient rehabilitation facilities, long-term care hos-
pitals, and home health agencies); 
(4) substance abuse and mental health profes-
sional organizations; 
(5) pain management professional organizations 
and advocacy entities, including individuals who per-
sonally suffer chronic pain; 
(6) medical professional organizations and med-
ical specialty organizations; 
(7) licensed health care providers who furnish 
alternative pain management services; 
(8) organizations with expertise in the develop-
ment of innovative medical technologies for pain 
management; 
(9) beneficiary advocacy organizations; and 
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(10) other organizations with expertise in the 
assessment, diagnosis, treatment, and management 
of pain, as determined appropriate by the Secretary. 
(c) CONTENTS.—The report described in subsection 
(a) shall include the following: 
(1) The recommendations described in sub-
section (d). 
(2) The impact analysis described in subsection 
(e). 
(3) An assessment of pain management guid-
ance published by the Federal Government that may 
be relevant to coverage determinations or other cov-
erage requirements under title XVIII of the Social 
Security Act. 
(4) Recommendations for updating, including 
expanding, the ‘‘CDC Guideline for Prescribing 
Opioids for Chronic Pain—United States, 2016’’ 
published in March 2016 by the Centers for Disease 
Control and Prevention, including for purposes of 
management of pain. Such recommendations shall— 
(A) consider incorporating relevant ele-
ments of the ‘‘Va/DoD Clinical Practice Guide-
line for Opioid Therapy for Chronic Pain’’ pub-
lished in February 2017 by the Department of 
Veterans Affairs and Department of Defense, 
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including adoption of elements of the Depart-
ment of Defense and Veterans Administration 
pain rating scale; and 
(B) include recommendations on how the 
‘‘CDC Guideline for Prescribing Opioids for 
Chronic Pain—United States, 2016’’, as so up-
dated, could be adopted by health care pro-
viders across clinical settings. 
(5) An evaluation of the following: 
(A) Barriers inhibiting individuals entitled 
to benefits under part A or enrolled under part 
B of such title from accessing treatments and 
technologies described in subparagraphs (A) 
through (C) of paragraph (6). 
(B) Potential legislative and administrative 
changes under such title to improve individuals’ 
access to items and services currently covered 
under such title and used for the treatment of 
pain, such as cognitive behavioral interventions, 
physical therapy, occupational therapy, physical 
medicine, biofeedback therapy, and chiropractic 
therapy, and other pain treatments services fur-
nished in a hospital or post-acute care setting. 
(C) Costs and benefits associated with po-
tential expansion of coverage under such title to 
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include items and services not covered under 
such title that may be used for the treatment 
of pain, such as acupuncture, therapeutic mas-
sage, and items and services furnished by inte-
grated pain management programs. 
(6) An analysis on reimbursement, coverage, 
and coding policies (including DRG classification, 
CPT, HCPCS, NDC, and other applicable codes) 
under title XVIII of the Social Security Act with re-
spect to the following: 
(A) Non-opioid based treatments and tech-
nologies for chronic or acute pain, including 
such treatments that are covered, not covered, 
or have limited coverage under such title. 
(B) Non-opioid based treatments and tech-
nologies that monitor substance use withdrawal 
and prevent overdoses of opioids. 
(C) Non-opioid based treatments and tech-
nologies that treat substance use disorders. 
(D) Items and services furnished by practi-
tioners through a multi-disciplinary treatment 
model for pain management. 
(E) Medical devices, non-opioid based 
drugs, and other therapies (including inter-
ventional and integrative pain therapies) ap-
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proved or cleared by the Food and Drug Ad-
ministration for the treatment of pain. 
(F) Items and services furnished to bene-
ficiaries with psychiatric disorders, substance 
use disorders, or who are at risk of suicide, or 
have comorbidities and require consultation or 
management of pain with one or more special-
ists in pain management, mental health, or ad-
diction treatment. 
(d) RECOMMENDATIONS.—The recommendations de-
scribed in this subsection are, with respect to individuals 
entitled to benefits under part A or enrolled under part 
B of title XVIII of the Social Security Act, legislative and 
administrative recommendations on the following: 
(1) Options for additional coverage of pain 
management therapies without the use of opioids, in-
cluding interventional pain therapies, and options to 
augment opioid therapy with other clinical and com-
plementary, integrative health services to minimize 
the risk of substance use disorder, including in a 
hospital setting. 
(2) Options for coverage and reimbursement 
modifications of medical devices and non-opioid 
based pharmacological and non-pharmacological 
therapies (including interventional and integrative 
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pain therapies) approved or cleared by the Food and 
Drug Administration for the treatment of pain as an 
alternative or augment to opioid therapy. 
(3) Treatment strategies for beneficiaries with 
psychiatric disorders, substance use disorders, or 
who are at risk of suicide, and treatment strategies 
to address health disparities related to opioid use 
and opioid abuse treatment. 
(4) Treatment strategies for beneficiaries with 
comorbidities who require a consultation or co-
management of pain with one or more specialists in 
pain management, mental health, or addiction treat-
ment, including in a hospital setting. 
(5) Coadministration of opioids and other 
drugs, particularly benzodiazepines. 
(6) Appropriate case management for bene-
ficiaries who transition between inpatient and out-
patient hospital settings, or between opioid therapy 
to non-opioid therapy, which may include the use of 
care transition plans. 
(7) Outreach activities designed to educate pro-
viders of services and suppliers under the Medicare 
program and individuals entitled to benefits under 
part A or under part B of such title on alternative, 
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non-opioid therapies to manage and treat acute and 
chronic pain. 
(8) Creation of a beneficiary education tool on 
alternatives to opioids for chronic pain management. 
(e) IMPACT ANALYSIS.—The impact analysis de-
scribed in this subsection consists of an analysis of any 
potential effects implementing the recommendations de-
scribed in subsection (d) would have— 
(1) on expenditures under the Medicare pro-
gram; and 
(2) on preventing or reducing opioid addiction 
for individuals receiving benefits under the Medicare 
program. 
Æ 
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