I 
115TH CONGRESS 
2D SESSION 
H. R. 5778 
To amend title XVIII of the Social Security Act to provide for review and 
adjustment of payments under the Medicare outpatient prospective pay-
ment system to avoid financial incentives to use opioids instead of non- 
opioid alternative treatments, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 11, 2018 
Mr. MARCHANT (for himself and Mr. LEVIN) 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 amend title XVIII of the Social Security Act to provide 
for review and adjustment of payments under the Medi-
care outpatient prospective payment system to avoid fi-
nancial incentives to use opioids instead of non-opioid 
alternative treatments, and for other purposes. 
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 ‘‘Promoting Outpatient 
Access to Non-Opioid Treatments Act’’. 
VerDate Sep 11 2014 
01:03 May 31, 2018
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5778.IH
H5778
pbinns on DSK79D2C42PROD with BILLS
SEC. 2. REVIEW AND ADJUSTMENT OF PAYMENTS UNDER 
THE MEDICARE OUTPATIENT PROSPECTIVE 
PAYMENT SYSTEM TO AVOID FINANCIAL IN-
CENTIVES TO USE OPIOIDS INSTEAD OF NON- 
OPIOID ALTERNATIVE TREATMENTS. 
(a) OUTPATIENT
PROSPECTIVE
PAYMENT
SYS-
TEM.—Section 1833(t) of the Social Security Act (42 
U.S.C. 1395l(t)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(22) REVIEW AND REVISIONS OF PAYMENTS 
FOR NON-OPIOID ALTERNATIVE TREATMENTS.— 
‘‘(A) IN GENERAL.—With respect to pay-
ments made under this subsection for covered 
OPD services (or groups of services), including 
covered OPD services assigned to a comprehen-
sive ambulatory payment classification, the Sec-
retary— 
‘‘(i) shall, as soon as practicable, con-
duct a review (part of which may include 
a request for information) of payments for 
opioids and evidence-based non-opioid al-
ternatives for pain management (including 
drugs and devices, nerve blocks, surgical 
injections, and neuromodulation) with a 
goal of ensuring that there are not finan-
VerDate Sep 11 2014 
01:03 May 31, 2018
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5778.IH
H5778
pbinns on DSK79D2C42PROD with BILLS
cial incentives to use opioids instead of 
non-opioid alternatives; 
‘‘(ii) may, as the Secretary determines 
appropriate, conduct subsequent reviews of 
such payments; and 
‘‘(iii) shall consider the extent to 
which revisions under this subsection to 
such payments (such as the creation of ad-
ditional groups of covered OPD services to 
classify separately those procedures that 
utilize opioids and non-opioid alternatives 
for pain management) would reduce pay-
ment incentives to use opioids instead of 
non-opioid alternatives for pain manage-
ment. 
‘‘(B) PRIORITY.—In conducting the review 
under clause (i) of subparagraph (A) and con-
sidering revisions under clause (iii) of such sub-
paragraph, the Secretary shall focus on covered 
OPD services (or groups of services) assigned 
to a comprehensive ambulatory payment classi-
fication, ambulatory payment classifications 
that primarily include surgical services, and 
other services determined by the Secretary 
VerDate Sep 11 2014 
01:03 May 31, 2018
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5778.IH
H5778
pbinns on DSK79D2C42PROD with BILLS
which generally involve treatment for pain man-
agement. 
‘‘(C) REVISIONS.—If the Secretary identi-
fies revisions to payments pursuant to subpara-
graph (A)(iii), the Secretary shall, as deter-
mined appropriate, begin making such revisions 
for services furnished on or after January 1, 
2020. Revisions under the previous sentence 
shall be treated as adjustments for purposes of 
application of paragraph (9)(B). 
‘‘(D) RULES OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed to preclude 
the Secretary— 
‘‘(i) from conducting a demonstration 
before making the revisions described in 
subparagraph (C); or 
‘‘(ii) prior to implementation of this 
paragraph, from changing payments under 
this subsection for covered OPD services 
(or groups of services) which include 
opioids or non-opioid alternatives for pain 
management.’’. 
(b) AMBULATORY
SURGICAL
CENTERS.—Section 
1833(i) of the Social Security Act (42 U.S.C. 1395l(i)) 
VerDate Sep 11 2014 
01:03 May 31, 2018
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5778.IH
H5778
pbinns on DSK79D2C42PROD with BILLS
is amended by adding at the end the following new para-
graph: 
‘‘(8) The Secretary shall apply the provisions of 
paragraph (22) of section 1833(t), including the sec-
ond sentence of subparagraph (C) of such para-
graph, to payment for services under this subsection 
in an appropriate manner (as determined by the 
Secretary).’’. 
Æ 
VerDate Sep 11 2014 
01:03 May 31, 2018
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6301
E:\BILLS\H5778.IH
H5778
pbinns on DSK79D2C42PROD with BILLS