H. R. 6—105 
(A) Evidence-based treatments and technologies for 
chronic or acute pain, including such treatments that are 
covered, not covered, or have limited coverage under such 
title. 
(B) Evidence-based treatments and technologies that 
monitor substance use withdrawal and prevent overdoses 
of opioids. 
(C) Evidence-based treatments and technologies that 
treat substance use disorders. 
(D) Items and services furnished by practitioners 
through a multi-disciplinary treatment model for pain 
management, including the patient-centered medical home. 
(E) Items and services furnished to beneficiaries with 
psychiatric disorders, substance use disorders, or who are 
at risk of suicide, or have comorbidities and require con-
sultation or management of pain with one or more special-
ists in pain management, mental health, or addiction treat-
ment. 
(2) 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 sub-
paragraphs (A) through (E) of paragraph (1). 
(B) Costs and benefits associated with potential expan-
sion of coverage under such title to include items and 
services not covered under such title that may be used 
for the treatment of pain, such as acupuncture, therapeutic 
massage, and items and services furnished by integrated 
pain management programs. 
(C) Pain management guidance published by the Fed-
eral Government that may be relevant to coverage deter-
minations or other coverage requirements under title XVIII 
of the Social Security Act. 
(3) An assessment of all guidance published by the Depart-
ment of Health and Human Services on or after January 1, 
2016, relating to the prescribing of opioids. Such assessment 
shall consider incorporating into such guidance relevant ele-
ments 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 elements of the Department of Defense 
and Department of Veterans Affairs 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 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 options for accomplishing the fol-
lowing: 
(1) Improving coverage of and payment for pain manage-
ment therapies without the use of opioids, including inter-
ventional pain therapies, and options to augment opioid therapy 
with other clinical and complementary, integrative health serv-
ices 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 pharmacological and non-pharmacological
H. R. 6—106 
therapies approved or cleared by the Food and Drug Adminis-
tration for the treatment of pain as an alternative or augment 
to opioid therapy. 
(3) Improving and disseminating treatment strategies for 
beneficiaries with psychiatric disorders, substance use dis-
orders, 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 hospital setting. 
(5) Educating providers on risks of coadministration of 
opioids and other drugs, particularly benzodiazepines. 
(6) Ensuring appropriate case management for beneficiaries 
who transition between inpatient and outpatient hospital set-
tings, or between opioid therapy to non-opioid therapy, which 
may include the use of care transition plans. 
(7) Expanding 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, non-opioid therapies to 
manage and treat acute and chronic pain. 
(8) Creating a beneficiary education tool on alternatives 
to opioids for chronic pain management. 
(e) IMPACT ANALYSIS.—The impact analysis described in this 
subsection consists of an analysis of any potential effects imple-
menting the options described in subsection (d) would have— 
(1) on expenditures under the Medicare program; and 
(2) on preventing or reducing opioid addiction for individ-
uals receiving benefits under the Medicare program. 
Subtitle J—Combating Opioid Abuse for 
Care in Hospitals 
SEC. 6091. SHORT TITLE. 
This subtitle may be cited as the ‘‘Combating Opioid Abuse 
for Care in Hospitals Act of 2018’’ or the ‘‘COACH Act of 2018’’. 
SEC. 6092. 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 July 1, 2019, the Secretary 
of Health and Human Services (in this section referred to as the 
‘‘Secretary’’) shall develop and publish on the public website of 
the Centers for Medicare & Medicaid Services guidance for hospitals 
receiving payment under part A of title XVIII of the Social Security 
Act (42 U.S.C. 1395c et seq.) on pain management strategies and 
opioid use disorder prevention strategies with respect to individuals 
entitled to benefits under such part. 
(b) CONSULTATION.—In developing the guidance described in 
subsection (a), the Secretary shall consult with relevant stake-
holders, including— 
(1) medical professional organizations;
H. R. 6—107 
(2) providers and suppliers of services (as such terms are 
defined in section 1861 of the Social Security Act (42 U.S.C. 
1395x)); 
(3) health care consumers or groups representing such con-
sumers; and 
(4) other entities determined appropriate by the Secretary. 
(c) CONTENTS.—The guidance described in subsection (a) shall 
include, with respect to hospitals and individuals described in such 
subsection, the following: 
(1) Best practices regarding evidence-based screening and 
practitioner education initiatives relating 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 support groups, and other 
recovery programs. 
(2) Best practices for such hospitals to educate practitioners 
furnishing items and services at such hospital with respect 
to pain management and substance use disorders, including 
education on— 
(A) the adverse effects of prolonged opioid use; 
(B) non-opioid, evidence-based, non-pharmacological 
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 individ-
uals 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 individuals who are prescribed 
an opioid that— 
(A) explains the risks and side effects associated 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; 
(B) highlights multimodal and evidence-based non- 
opioid alternatives for pain management; 
(C) encourages such individuals to talk to their health 
care providers about such alternatives; 
(D) provides for a method (through signature or other-
wise) for such an individual, or person acting on such 
individual’s behalf, to acknowledge receipt of such notifica-
tion template; 
(E) is worded in an easily understandable manner 
and made available in multiple languages determined 
appropriate by the Secretary; and 
(F) includes any other information determined appro-
priate by the Secretary.
H. R. 6—108 
(5) Best practices for such hospital to track opioid pre-
scribing trends by practitioners furnishing items and services 
at such hospital, including— 
(A) ways for such hospital to establish target 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; 
(B) guidance on checking the medical records of such 
individuals against information included in prescription 
drug monitoring programs; 
(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 appro-
priate, including any such information from the Opioid Safety 
Initiative established by the Department of Veterans Affairs 
or the Opioid Overdose Prevention Toolkit published by the 
Substance Abuse and Mental Health Services Administration. 
SEC. 6093. REQUIRING THE REVIEW OF QUALITY MEASURES RELATING 
TO OPIOIDS AND OPIOID USE DISORDER TREATMENTS 
FURNISHED UNDER THE MEDICARE PROGRAM AND 
OTHER FEDERAL HEALTH CARE PROGRAMS. 
Section 1890A of the Social Security 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.— 
‘‘(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 meas-
ures relating to opioids and opioid use disorders, including 
care, prevention, diagnosis, health outcomes, and treatment 
furnished to individuals with opioid use disorders. The Sec-
retary may use the entity with a contract under section 1890(a) 
and amend such contract 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 periodically thereafter as the Secretary 
determines appropriate), the technical expert panel shall— 
‘‘(A) review quality measures that relate to opioids 
and opioid use disorders, including existing measures and 
those under development; 
‘‘(B) identify gaps in areas of quality measurement 
that relate to opioids and opioid use disorders, and identify 
measure development priorities for such measure gaps; 
and 
‘‘(C) make recommendations to the Secretary on quality 
measures with respect to opioids and opioid use disorders 
for purposes of improving care, prevention, diagnosis, 
health outcomes, and treatment, including recommenda-
tions for revisions of such measures, need for development 
of new measures, and recommendations 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