NOPAIN Act
Bill: S.586 | Sponsor: Sen. Capito, Shelley Moore (R-WV)
Policy area: Health

Summary:
Non-Opioids Prevent Addiction In the Nation Act or the NOPAIN Act
This bill temporarily establishes separate payments for certain non-opioid treatments under the Medicare prospective payment system for hospital outpatient department services and the payment system for ambulatory surgical center services. The bill applies to pain management treatments that are able to replace or reduce opioid consumption, as shown through clinical trials or data.

To amend title XVIII of the Social Security Act to combat the opioid 
  crisis by promoting access to non-opioid treatments in the hospital 
                          outpatient setting.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Non-Opioids Prevent Addiction In the 
Nation Act'' or the ``NOPAIN Act''.

SEC. 2. ACCESS TO NON-OPIOID TREATMENTS FOR PAIN.

    (a) In General.--Section 1833(t) of the Social Security Act (42 
U.S.C. 1395l(t)) is amended--
            (1) in paragraph (2)(E), by inserting ``and separate 
        payments for non-opioid treatments under paragraph (16)(G),'' 
        after ``payments under paragraph (6)''; and
            (2) in paragraph (16), by adding at the end the following 
        new subparagraph:
                    ``(G) Access to non-opioid treatments for pain.--
                            ``(i) In general.--Notwithstanding any 
                        other provision of this subsection, with 
                        respect to a covered OPD service (or group of 
                        services) furnished on or after January 1, 
                        2022, and before January 1, 2027, the Secretary 
                        shall not package, and shall make a separate 
                        payment as specified in clause (ii) for, a non-
                        opioid treatment (as defined in clause (iii)) 
                        furnished as part of such service (or group of 
                        services).
                            ``(ii) Amount of payment.--The amount of 
                        the payment specified in this clause is, with 
                        respect to a non-opioid treatment that is--
                                    ``(I) a drug or biological product, 
                                the amount of payment for such drug or 
                                biological determined under section 
                                1847A; or
                                    ``(II) a medical device, the amount 
                                of the hospital's charges for the 
                                device, adjusted to cost.
                            ``(iii) Definition of non-opioid 
                        treatment.--A `non-opioid treatment' means--
                                    ``(I) a drug or biological product 
                                that is indicated to produce analgesia 
                                without acting upon the body's opioid 
                                receptors; or
                                    ``(II) an implantable, reusable, or 
                                disposable medical device cleared or 
                                approved by the Administrator for Food 
                                and Drugs for the intended use of 
                                managing or treating pain;
                        that has demonstrated the ability to replace, 
                        reduce, or avoid opioid use or the quantity of 
                        opioids prescribed in a clinical trial or 
                        through data published in a peer-reviewed 
                        journal.''.
    (b) Ambulatory Surgical Center Payment System.--Section 
1833(i)(2)(D) of the Social Security Act (42 U.S.C. 1395l(i)(2)(D)) is 
amended--
            (1) by aligning the margins of clause (v) with the margins 
        of clause (iv);
            (2) by redesignating clause (vi) as clause (vii); and
            (3) by inserting after clause (v) the following new clause:
                            ``(vi) In the case of surgical services 
                        furnished on or after January 1, 2022, and 
                        before January 1, 2027, the payment system 
                        described in clause (i) shall provide, in a 
                        budget-neutral manner, for a separate payment 
                        for a non-opioid treatment (as defined in 
                        clause (iii) of subsection (t)(16)(G)) 
                        furnished as part of such services in the 
                        amount specified in clause (ii) of such 
                        subsection.''.
    (c) Evaluation of Therapeutic Services for Pain Management.--
            (1) Report to congress.--Not later than 1 year after the 
        date of the enactment of this Act, the Secretary of Health and 
        Human Services (in this subsection referred to as the 
        ``Secretary''), acting through the Administrator of the Centers 
        for Medicare & Medicaid Services, shall submit to Congress a 
        report identifying--
                    (A) limitations, gaps, barriers to access, or 
                deficits in Medicare coverage or reimbursement for 
                restorative therapies, behavioral approaches, and 
                complementary and integrative health services that are 
                identified in the Pain Management Best Practices Inter-
                Agency Task Force Report and that have demonstrated the 
                ability to replace or reduce opioid consumption; and
                    (B) recommendations to address the limitations, 
                gaps, barriers to access, or deficits identified under 
                subparagraph (A) to improve Medicare coverage and 
                reimbursement for such therapies, approaches, and 
                services.
            (2) Public consultation.--In developing the report 
        described in paragraph (1), the Secretary shall consult with 
        relevant stakeholders as determined appropriate by the 
        Secretary.
            (3) Exclusive treatment.--Any drug, biological product, or 
        medical device that is a non-opioid treatment (as defined in 
        section 1833(t)(16)(G)(iii) of the Social Security Act, as 
        added by subsection (a)) shall not be considered a therapeutic 
        service for the purpose of the report described in paragraph 
        (1).
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