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erage requirements under title XVIII of the So-
cial Security Act. 
(3) An assessment of all guidance published by 
the Department of Health and Human Services on 
or after January 1, 2016, relating to the prescribing 
of opioids. Such assessment shall consider incor-
porating into such guidance relevant elements of the 
‘‘VA/DoD Clinical Practice Guideline for Opioid 
Therapy for Chronic Pain’’ published in February 
2017 by the Department of Veterans Affairs and 
Department of Defense, including adoption of ele-
ments of the Department of Defense and Veterans 
Administration pain rating scale. 
(4) The options described in subsection (d). 
(5) The impact analysis described in subsection 
(e). 
(d) OPTIONS.—The options described in this sub-
section 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 op-
tions for accomplishing the following: 
(1) Improving coverage of and payment for pain 
management therapies without the use of opioids, in-
cluding interventional pain therapies, and options to 
augment opioid therapy with other clinical and com-
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plementary, integrative health services to minimize 
the risk of substance use disorder, including in a 
hospital setting. 
(2) Improving coverage of and payment for 
medical devices and non-opioid based pharma-
cological and non-pharmacological therapies ap-
proved or cleared by the Food and Drug Administra-
tion for the treatment of pain as an alternative or 
augment to opioid therapy. 
(3) Improving and disseminating treatment 
strategies for beneficiaries with psychiatric dis-
orders, 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) Improving and disseminating treatment 
strategies for beneficiaries with comorbidities who 
require a consultation or comanagement of pain with 
one or more specialists in pain management, mental 
health, or addiction treatment, including in a hos-
pital setting. 
(5) Educating providers on risks of coadminis-
tration of opioids and other drugs, particularly 
benzodiazepines. 
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(6) Ensuring appropriate case management for 
beneficiaries who transition between inpatient and 
outpatient hospital settings, or between opioid ther-
apy to non-opioid therapy, which may include the 
use of care transition plans. 
(7) Expanding outreach activities designed to 
educate providers of services and suppliers under the 
Medicare program and individuals entitled to bene-
fits under part A or under part B of such title on 
alternative, non-opioid therapies to manage and 
treat acute and chronic pain. 
(8) Creating a beneficiary education tool on al-
ternatives 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 options described 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. 
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SEC. 7. SUSPENSION OF PAYMENTS BY MEDICARE PRE-
SCRIPTION DRUG PLANS AND MA–PD PLANS 
PENDING INVESTIGATIONS OF CREDIBLE AL-
LEGATIONS OF FRAUD BY PHARMACIES. 
(a) IN GENERAL.—Section 1860D–12(b) of the So-
cial Security Act (42 U.S.C. 1395w–112(b)) is amended 
by adding at the end the following new paragraph: 
‘‘(7) SUSPENSION OF PAYMENTS PENDING IN-
VESTIGATION OF CREDIBLE ALLEGATIONS OF FRAUD 
BY PHARMACIES.— 
‘‘(A) IN GENERAL.—The provisions of sec-
tion 1862(o) shall apply with respect to a PDP 
sponsor with a contract under this part, a phar-
macy, and payments to such pharmacy under 
this part in the same manner as such provisions 
apply with respect to the Secretary, a provider 
of services or supplier, and payments to such 
provider of services or supplier under this title. 
‘‘(B) RULE OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed as limiting 
the authority of a PDP sponsor to conduct 
postpayment review.’’. 
(b) APPLICATION
TO
MA–PD PLANS.—Section 
1857(f)(3) of the Social Security Act (42 U.S.C. 1395w– 
27(f)(3)) is amended by adding at the end the following 
new subparagraph: 
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‘‘(D) SUSPENSION OF PAYMENTS PENDING 
INVESTIGATION OF CREDIBLE ALLEGATIONS OF 
FRAUD
BY
PHARMACIES.—Section 
1860D– 
12(b)(7).’’. 
(c) CONFORMING AMENDMENT.—Section 1862(o)(3) 
of the Social Security Act (42 U.S.C. 1395y(o)(3)) is 
amended by inserting ‘‘, section 1860D–12(b)(7) (includ-
ing as applied pursuant to section 1857(f)(3)(D)),’’ after 
‘‘this subsection’’. 
(d) CLARIFICATION RELATING TO CREDIBLE ALLE-
GATION OF FRAUD.—Section 1862(o) of the Social Secu-
rity Act (42 U.S.C. 1395y(o)) is amended by adding at 
the end the following new paragraph: 
‘‘(4) CREDIBLE
ALLEGATION
OF
FRAUD.—In 
carrying out this subsection, section 1860D– 
12(b)(7) (including as applied pursuant to section 
1857(f)(3)(D)), and section 1903(i)(2)(C), a fraud 
hotline tip (as defined by the Secretary) without fur-
ther evidence shall not be treated as sufficient evi-
dence for a credible allegation of fraud.’’. 
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(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to plan years begin-
ning on or after January 1, 2020. 
Passed the House of Representatives June 19, 2018. 
Attest: 
KAREN L. HAAS, 
Clerk. 
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