IIB 
115TH CONGRESS 
2D SESSION 
H. R. 5774 
IN THE SENATE OF THE UNITED STATES 
JUNE 20, 2018 
Received; read twice and referred to the Committee on Finance 
AN ACT 
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 pay-
ment under part A of title XVIII of the Social Security 
Act (42 U.S.C. 1395c et seq.) on pain management strate-
gies and opioid use disorder prevention strategies with re-
spect to individuals 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 rep-
resenting such consumers; and 
(4) other entities determined appropriate by the 
Secretary. 
(c) CONTENTS.—The guidance described in sub-
section (a) shall include, with respect to hospitals and indi-
viduals 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 
stratification; 
(B) ways to prevent, recognize, and treat 
opioid overdoses; and 
(C) resources available to such individuals, 
such as opioid treatment programs, peer sup-
port 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 
template described in paragraph (4)). 
(4) A notification template developed by the 
Secretary, for use as appropriate, for such individ-
uals who are prescribed an opioid that— 
(A) explains the risks and side effects asso-
ciated with opioid use (including the risks of 
addiction and overdose) and the importance of 
adhering 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 
person 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 Sec-
retary; 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 De-
partment of Veterans Affairs or the Opioid Overdose 
Prevention 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, 
prevention, diagnosis, health outcomes, and treat-
ment furnished to individuals with opioid use dis-
orders. The Secretary may use the entity with a con-
tract under section 1890(a) and amend such con-
tract 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 
described in paragraph (1) is established (and peri-
odically thereafter as the Secretary determines ap-
propriate), the technical expert panel shall— 
‘‘(A) review quality measures that relate to 
opioids and opioid use disorders, including ex-
isting measures and those under development; 
‘‘(B) identify gaps in areas of quality 
measurement that relate to opioids and opioid 
use disorders, and identify measure develop-
ment priorities 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 
rec-
ommendations for revisions of such measures, 
need for development of new measures, and rec-
ommendations 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 program under section 1899, the qual-
ity reporting requirements for inpatient hos-
pitals under section 1886(b)(3)(B)(viii), and 
the hospital value-based purchasing program 
under section 1886(o). 
‘‘(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 
identified by the Secretary) in alternative pay-
ment 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),and in the 
hospital value-based purchasing program under 
section 1886(o). 
‘‘(4) PRIORITIZATION OF MEASURE DEVELOP-
MENT.—The Secretary shall prioritize for measure 
development the gaps in quality measures identified 
under paragraph (2)(B).’’. 
(b) EXPEDITED
ENDORSEMENT
PROCESS
FOR 
OPIOID MEASURES.—Section 1890(b)(2) of the Social Se-
curity Act (42 U.S.C. 1395aaa(b)(2)) is amended by add-
ing at the end the following new flush sentence: 
‘‘Such endorsement process shall, as determined 
practicable by the entity, provide for an expedited 
process with respect to the endorsement of such 
measures relating to opioids and opioid use dis-
orders.’’. 
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 Sec-
retary of Health and Human Services shall convene 
a technical expert panel, including medical and sur-
gical specialty societies and hospital organizations, 
to provide recommendations on reducing opioid use 
in the inpatient and outpatient surgical settings and 
on best practices for pain management, including 
with respect to the following: 
(A) Approaches that limit patient exposure 
to opioids during the perioperative period, in-
cluding pre-surgical and post-surgical injec-
tions, 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 
evaluation and management code for purposes 
of payment under the Medicare program under 
title XVIII of the Social Security Act that 
would account for time spent on shared decision 
making. 
(C) Education on the safe use, storage, 
and disposal of opioids. 
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(D) Prevention of opioid misuse and abuse 
after discharge. 
(E) Development of a clinical algorithm to 
identify and treat at-risk, opiate-tolerant pa-
tients and reduce reliance on opioids 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 
containing the recommendations developed under 
paragraph (1) and an action plan 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 enact-
ment of this Act, the Secretary of Health and Human 
Services shall submit to Congress a report that contains 
the following: 
(1) The diagnosis-related group codes identified 
by the Secretary as having the highest volume of 
surgeries. 
(2) With respect to each of such diagnosis-re-
lated group codes so identified, a determination by 
the Secretary of the data that is both available and 
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reported on opioid use following such surgeries, such 
as with respect to— 
(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 dis-
posal; and 
(G) such other information as the Sec-
retary may specify. 
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(3) Recommendations for improving data collec-
tion on perioperative opioid use, including an anal-
ysis to identify and reduce barriers to collecting, re-
porting, and analyzing the data described in para-
graph (2), including 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 
‘‘Secretary’’) shall post on the public website of the Cen-
ters for Medicare & Medicaid Services all guidance pub-
lished 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 indi-
viduals 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 
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Secretary) update guidance described in subsection 
(a) and revise the posting of such guidance on the 
website described in such subsection. 
(2) CONSULTATION.—The entities specified in 
this paragraph are the following: 
(A) Medical professional organizations. 
(B) Providers and suppliers of services (as 
such terms are defined in section 1861 of the 
Social Security Act (42 U.S.C. 1395x)). 
(C) Health care consumers or groups rep-
resenting such consumers. 
(D) Other entities determined appropriate 
by the Secretary. 
Passed the House of Representatives June 19, 2018. 
Attest: 
KAREN L. HAAS, 
Clerk. 
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