(2) Information about ways that Medicare bene-
ficiaries familiarize themselves about the availability 
of Medicare payment for qualified psychologist serv-
ices (as defined in section 1861(ii) of the Social Se-
curity Act (42 U.S.C. 1395x(ii)) and ways that the 
provision of such information could be improved. 
SEC. 6. PAIN MANAGEMENT STUDY. 
(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of this Act, the Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall conduct a study analyzing best practices as 
well as payment and coverage for pain management serv-
ices under title XVIII of the Social Security Act and sub-
mit to the Committee on Ways and Means and the Com-
mittee on Energy and Commerce of the House of Rep-
resentatives and the Committee on Finance of the Senate 
a report containing options for revising payment to pro-
viders and suppliers of services and coverage related to 
the use of multi-disciplinary, evidence-based, non-opioid 
treatments for acute and chronic pain management for in-
dividuals entitled to benefits under part A or enrolled 
under part B of title XVIII of the Social Security Act. 
The Secretary shall make such report available on the 
public website of the Centers for Medicare & Medicaid 
Services.
(b) CONSULTATION.—In developing the report de-
scribed in subsection (a), the Secretary shall consult 
with— 
(1) relevant agencies within the Department of 
Health and Human Services; 
(2) licensed and practicing osteopathic and 
allopathic physicians, behavioral health practitioners, 
physician assistants, nurse practitioners, dentists, 
pharmacists, and other providers of health services; 
(3) providers and suppliers of services (as such 
terms are defined in section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x)); 
(4) substance abuse and mental health profes-
sional organizations; 
(5) pain management professional organizations 
and advocacy entities, including individuals who per-
sonally suffer chronic pain; 
(6) medical professional organizations and med-
ical specialty organizations; 
(7) licensed health care providers who furnish 
alternative pain management services; 
(8) organizations with expertise in the develop-
ment of innovative medical technologies for pain 
management; 
(9) beneficiary advocacy organizations; and
(10) other organizations with expertise in the 
assessment, diagnosis, treatment, and management 
of pain, as determined appropriate by the Secretary. 
(c) CONTENTS.—The report described in subsection 
(a) shall include the following: 
(1) An analysis of payment and coverage under 
title XVIII of the Social Security Act with respect 
to the following: 
(A) Evidence-based treatments and tech-
nologies 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 tech-
nologies that monitor substance use withdrawal 
and prevent overdoses of opioids. 
(C) Evidence-based treatments and tech-
nologies that treat substance use disorders. 
(D) Items and services furnished by practi-
tioners through a multi-disciplinary treatment 
model for pain management, including the pa-
tient-centered medical home. 
(E) Medical devices, non-opioid based 
drugs, and other therapies (including inter-
ventional and integrative pain therapies) ap-
proved or cleared by the Food and Drug Ad-
ministration for the treatment of pain. 
(F) Items and services furnished to bene-
ficiaries with psychiatric disorders, substance 
use disorders, or who are at risk of suicide, or 
have comorbidities and require consultation or 
management of pain with one or more special-
ists in pain management, mental health, or ad-
diction treatment. 
(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 subparagraphs (A) 
through (F) of paragraph (1). 
(B) Costs and benefits associated with po-
tential expansion 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 mas-
sage, and items and services furnished by inte-
grated pain management programs. 
(C) Pain management guidance published 
by the Federal Government that may be rel-
evant to coverage determinations or other cov-
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-
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.
(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.
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:
‘‘(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.’’.
(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: 
Clerk.
115TH CONGRESS 
2D SESSION 
H. R. 6110 
AN ACT 
To amend title XVIII of the Social Security Act to 
provide for the review and adjustment of pay-
ments under the Medicare outpatient prospective 
payment system to avoid financial incentives to 
use opioids instead of non-opioid alternative 
treatments, and for other purposes.