I 
118TH CONGRESS 
1ST SESSION H. R. 5506 
To amend titles XVIII and XIX of the Social Security Act and title 10, 
United States Code, to provide no-cost coverage for the preventive dis-
tribution of opioid overdose reversal drugs. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 14, 2023 
Ms. PETTERSEN (for herself, Ms. SCHRIER, and Ms. BUDZINSKI) introduced 
the following bill; which was referred to the Committee on Energy and 
Commerce, and in addition to the Committees on Ways and Means, and 
Armed Services, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
and title 10, United States Code, to provide no-cost 
coverage for the preventive distribution of opioid overdose 
reversal drugs. 
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 ‘‘Hospitals As Naloxone 
Distribution Sites Act’’ or the ‘‘HANDS Act’’. 
VerDate Sep 11 2014 
05:06 Sep 16, 2023
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5506.IH
H5506
kjohnson on DSK7ZCZBW3PROD with $$_JOB
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Opioid use disorder is a treatable brain dis-
ease from which people can recover. 
(2) Individuals living with opioid use disorder, 
those who use opioids for chronic pain, and those 
who use illicit substances that may be contaminated 
with fentanyl or other illicit additives are at high 
risk for fatal overdose. 
(3) Individuals at-risk of overdose are fre-
quently cared for in emergency departments and 
hospitals, making these locations ideal places to 
screen and intervene. In addition, medical providers 
have the knowledge and ability to provide medically 
accurate information, but also treat the disease of 
addiction once a person is ready for treatment. 
(4) Overdose deaths are preventable with life-
saving opioid overdose reversal medications like 
naloxone. Two-thirds of fatal overdoses have a wit-
ness, who can intervene and prevent overdose death 
if they have access to opioid antagonists. 
(5) Just as individuals with life-threatening al-
lergies should carry an EpiPen, individuals and close 
contacts of those with opioid use disorder should 
carry an opioid overdose reversal medication. 
VerDate Sep 11 2014 
05:06 Sep 16, 2023
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5506.IH
H5506
kjohnson on DSK7ZCZBW3PROD with $$_JOB
(6) While over the counter (OTC) access to re-
versal agents may increase their availability to cer-
tain populations, the hurdles to access these medica-
tions for many of the most at-risk patients will still 
remain. These hurdles include out of pocket costs, 
transportation or access to pharmacies or other 
areas carrying OTC naloxone, stigma by pharmacy 
staff, addiction-related compromised executive func-
tion, and more. Therefore, hospitals are uniquely po-
sitioned as a point of distribution to best serve those 
who would most benefit. 
(7) It is the intent of Congress to increase ac-
cess for all individuals with opioid use disorder, and 
other risk factors, to opioid overdose reversal medi-
cation so that if they experience an overdose, they 
will have a second chance. As long as there is 
breath, there is hope for recovery. 
SEC. 3. NO-COST COVERAGE OF PREVENTIVE OPIOID OVER-
DOSE REVERSAL DRUGS. 
(a) COVERAGE UNDER MEDICARE.— 
(1) COVERAGE.—Section 1861(s)(2) of the So-
cial Security Act (42 U.S.C. 1395x(s)(2)) is amend-
ed— 
(A) in subparagraph (JJ), by adding 
‘‘and’’ after the semicolon at the end; and 
VerDate Sep 11 2014 
05:06 Sep 16, 2023
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5506.IH
H5506
kjohnson on DSK7ZCZBW3PROD with $$_JOB
(B) by adding at the end the following new 
subparagraph: 
‘‘(KK) a preventive opioid overdose rever-
sal drug (as defined in subsection (nnn)) fur-
nished on or after January 1, 2024;’’. 
(2) PREVENTIVE OPIOID OVERDOSE REVERSAL 
DRUG DEFINED.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x) is amended by adding at 
the end the following new subsection: 
‘‘(nnn) PREVENTIVE OPIOID OVERDOSE REVERSAL 
DRUG.—The term ‘preventive opioid overdose reversal 
drug’ means an opioid overdose reversal drug that is fur-
nished by a physician, nurse practitioner, physician assist-
ant, or other attending clinical personnel (as determined 
by the Secretary by regulation) to an individual who is 
an inpatient of a hospital, critical access hospital, or rural 
emergency hospital, or is a patient of the emergency de-
partment of such a hospital or an ambulatory surgical cen-
ter, but only if— 
‘‘(1) such physician, nurse practitioner, physi-
cian assistant, or attending clinical professional de-
termines that such individual is at risk for an opioid 
overdose; and 
‘‘(2) such drug is furnished at the time such in-
dividual is discharged from the hospital or leaves the 
VerDate Sep 11 2014 
05:06 Sep 16, 2023
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5506.IH
H5506
kjohnson on DSK7ZCZBW3PROD with $$_JOB
emergency department or ambulatory surgical cen-
ter, as the case may be, together with instructions 
for the administration of such drug.’’. 
(3) PROHIBITION OF COST SHARING.—Section 
1833 of the Social Security Act (42 U.S.C. 1395l) 
is amended— 
(A) in subsection (a)(1)— 
(i) in subparagraph (S)(i), by striking 
‘‘subparagraph (EE),’’ and inserting ‘‘sub-
paragraphs (EE) and (II),’’; 
(ii) in subparagraph (GG), by striking 
‘‘and’’ at the end; and 
(iii) by inserting ‘‘, and (II) with re-
spect to a preventive opioid overdose rever-
sal drug (as defined in section 1861(nnn)) 
furnished on or after January 1, 2024, the 
amounts paid shall be 100 percent of the 
lesser of the actual charges for such drug 
or the amount determined under section 
1842(o)’’ before the semicolon at the end; 
and 
(B) in subsection (b)— 
(i) by striking ‘‘, and (13)’’ and in-
serting ‘‘(13)’’; and 
VerDate Sep 11 2014 
05:06 Sep 16, 2023
Jkt 039200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H5506.IH
H5506
kjohnson on DSK7ZCZBW3PROD with $$_JOB
(ii) by striking ‘‘section 1861(n)..’’ 
and inserting ‘‘section 1861(n), and (14) 
such deductible shall not apply with re-
spect to a preventive opioid reversal drug 
(as defined in section 1861(nnn)) fur-
nished on or after January 1, 2024.’’. 
(4) PROHIBITION OF COST SHARING FOR MEDI-
CARE ADVANTAGE PLANS.—Section 1852(a)(1)(B) of 
the Social Security Act (42 U.S.C. 1395w– 
22(a)(1)(B)) is amended— 
(A) in clause (iv)— 
(i) by redesignating subclause (VIII) 
as subclause (IX); and 
(ii) by inserting after subclause (VII) 
the following new subclause: 
‘‘(VIII) A preventive opioid rever-
sal drug (as defined in section 
1861(nnn)).’’; and 
(B) in clause (v), by striking ‘‘and (VI)’’ 
and inserting ‘‘(VI), and (VIII)’’. 
(b) COVERAGE UNDER MEDICAID.— 
(1) MANDATORY COVERAGE.— 
(A) IN GENERAL.—Section 1902(a)(10)(A) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
VerDate Sep 11 2014 
21:36 Sep 19, 2023
Jkt 039200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H5506.IH
H5506
kjohnson on DSK7ZCZBW3PROD with $$_JOB
1396a(a)(10)(A)) is amended by striking ‘‘and 
(30)’’ and inserting ‘‘(30), and (31)’’. 
(B) ALTERNATIVE BENEFIT PLANS.—Sec-
tion 1937(b) of the Social Security Act (42 
U.S.C. 1396u–7(b)) is amended by adding at 
the end the following new paragraph: 
‘‘(9) PREVENTIVE OPIOID OVERDOSE REVERSAL 
DRUGS.—Notwithstanding the previous provisions of 
this section, a State may not provide for medical as-
sistance through enrollment of an individual with 
benchmark coverage or benchmark-equivalent cov-
erage under this section unless, beginning on Janu-
ary 1, 2024, such coverage includes (and does not 
impose any deduction, cost sharing, or similar 
charge for) preventive opioid overdose reversal drugs 
described in section 1861(nnn)).’’. 
(2) INCLUSION IN MEDICAL ASSISTANCE.— 
(A) IN GENERAL.—Section 1905(a) of the 
Social Security Act (42 U.S.C. 1396d(a)) is 
amended— 
(i) in paragraph (30), by striking 
‘‘and’’ at the end; 
(ii) by redesignating paragraph (31) 
as paragraph (32); and 
VerDate Sep 11 2014 
05:06 Sep 16, 2023
Jkt 039200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H5506.IH
H5506
kjohnson on DSK7ZCZBW3PROD with $$_JOB
tion 1861(nnn), such drug shall be deemed a 
prescribed 
drug 
for 
purposes 
of 
section 
1905(a)(12).’’. 
(4) PROHIBITION OF COST SHARING.— 
(A) IN GENERAL.—Section 1916 of the So-
cial Security Act (42 U.S.C. 1396o) is amend-
ed— 
(i) in subsection (a)(2)— 
(I) in subparagraph (I), by strik-
ing ‘‘or’’ at the end; 
(II) in subparagraph (J), by 
striking ‘‘; and’’ at the end and in-
serting ‘‘, or’’; and 
(III) by adding at the end the 
following new subparagraph: 
‘‘(K) beginning January 1, 2024, preven-
tive opioid overdose reversal drugs described in 
section 1861(nnn); and’’; and 
(ii) in subsection (b)(2)— 
(I) in subparagraph (I), by strik-
ing ‘‘or’’ at the end; 
(II) in subparagraph (J), by 
striking ‘‘; and’’ at the end and in-
serting ‘‘, or’’; and 
VerDate Sep 11 2014 
05:06 Sep 16, 2023
Jkt 039200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H5506.IH
H5506
kjohnson on DSK7ZCZBW3PROD with $$_JOB
(III) by adding at the end the 
following new subparagraph: 
‘‘(K) beginning January 1, 2024, preven-
tive opioid overdose reversal drugs described in 
section 1861(nnn); and’’. 
(B) APPLICATION TO ALTERNATIVE COST 
SHARING.—Section 1916A(b)(3)(B) of the So-
cial Security Act (42 U.S.C. 1396o–1(b)(3)(B)) 
is amended by adding at the end the following 
new clause: 
‘‘(xv) Beginning January 1, 2024, 
preventive opioid overdose reversal drugs 
described in section 1861(nnn).’’. 
(c) COVERAGE UNDER TRICARE.—Section 1074g 
of title 10, United States Code, is amended as follows: 
(1) In subsection (a)(6), by adding at the end 
the following new subparagraph: 
‘‘(D) Notwithstanding subparagraphs (A) through 
(C), beginning on January 1, 2024, an eligible covered 
beneficiary shall not be required to pay a cost-sharing 
amount for a preventive opioid overdose reversal drug.’’. 
(2) In subsection (i), by adding at the end the 
following new paragraph: 
‘‘(5) The term ‘preventive opioid overdose rever-
sal drug’ has the meaning given such term in section 
VerDate Sep 11 2014 
05:06 Sep 16, 2023
Jkt 039200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H5506.IH
H5506
kjohnson on DSK7ZCZBW3PROD with $$_JOB
1861 of the Social Security Act (42 U.S.C. 
1395x).’’. 
SEC. 4. REGULATORY GUIDANCE. 
Not later than 1 year after the date of the enactment 
of this Act, the Commissioner of Food and Drugs shall 
issue guidance for State boards of pharmacy, nursing, and 
medicine with respect to— 
(1) enhancing safe and effective hospital-based 
dispensing and distribution of opioid overdose rever-
sal drugs; and 
(2) eliminating barriers to such dispensing and 
distribution. 
Æ 
VerDate Sep 11 2014 
05:06 Sep 16, 2023
Jkt 039200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6301
E:\BILLS\H5506.IH
H5506
kjohnson on DSK7ZCZBW3PROD with $$_JOB