Title: COMPASS Act
Policy area: Health

Summary:
Commit to Opioid Medical Prescriber Accountability and Safety for Seniors Act or the COMPASS Act
This bill requires the Centers for Medicare & Medicaid Services (CMS) to identify outlier prescribers of opioids under the Medicare prescription drug benefit and Medicare Advantage prescription drug plans. Specifically, the CMS must: (1) establish an opioid-prescription threshold for determining whether a prescriber is an outlier compared to other prescribers, based on specialty and geographic area; (2) use National Provider Identifiers (unique provider identification numbers currently included on claims for covered drugs) to identify outlier prescribers; and (3) annually notify identified outlier prescribers of their status and provide them with resources on proper prescribing methods. The CMS may also identify and notify outlier prescribers based on co-prescriptions of covered drugs that have adverse effects when used in combination with opioids.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5716 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 5716

    To amend title XVIII of the Social Security Act to require the 
 Secretary of Health and Human Services to provide notifications under 
        the Medicare program to outlier prescribers of opioids.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 9, 2018

  Mr. Roskam (for himself, Mr. Larson of Connecticut, Mrs. Brooks of 
   Indiana, and Mr. Welch) 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 subsequently 
   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 require the 
 Secretary of Health and Human Services to provide notifications under 
        the Medicare program to outlier prescribers of opioids.

    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 ``Commit to Opioid Medical Prescriber 
Accountability and Safety for Seniors Act'' or the ``COMPASS Act''.

SEC. 2. MEDICARE NOTIFICATIONS TO OUTLIER PRESCRIBERS OF OPIOIDS.

    Section 1860D-4(c)(4) of the Social Security Act (42 U.S.C. 1395w-
104(c)(4)) is amended by adding at the end the following new paragraph:
                    ``(D) Outlier prescriber notification.--
                            ``(i) Notification.--Beginning not later 
                        than two years after the date of the enactment 
                        of this subparagraph, the Secretary shall, in 
                        the case of a prescriber identified by the 
                        Secretary under clause (ii) to be an outlier 
                        prescriber of opioids, provide, subject to 
                        clause (iv), an annual notification to such 
                        prescriber that such prescriber has been so 
                        identified and that includes resources on 
                        proper prescribing methods and other 
                        information specified in accordance with clause 
                        (iii).
                            ``(ii) Identification of outlier 
                        prescribers of opioids.--
                                    ``(I) In general.--The Secretary 
                                shall, subject to subclause (III), 
                                using the valid prescriber National 
                                Provider Identifiers included pursuant 
                                to subparagraph (A) on claims for 
                                covered part D drugs for part D 
                                eligible individuals enrolled in 
                                prescription drug plans under this part 
                                or MA-PD plans under part C and based 
                                on the threshold established under 
                                subclause (II), conduct an analysis to 
                                identify prescribers that are outlier 
                                opioid prescribers for a period 
                                specified by the Secretary.
                                    ``(II) Establishment of 
                                threshold.--For purposes of subclause 
                                (I) and subject to subclause (III), the 
                                Secretary shall, after consultation 
                                with stakeholders, establish a 
                                threshold, based on prescriber 
                                specialty and geographic area, for 
                                identifying whether a prescriber in a 
                                specialty and geographic area is an 
                                outlier prescriber of opioids as 
                                compared to other prescribers of 
                                opioids within such specialty and area.
                                    ``(III) Exclusions.--The Secretary 
                                may exclude the following individuals 
                                and prescribers from the analysis under 
                                this clause:
                                            ``(aa) Individuals 
                                        receiving hospice services.
                                            ``(bb) Individuals with a 
                                        cancer diagnosis.
                                            ``(cc) Prescribers who are 
                                        the subject of an investigation 
                                        by the Centers for Medicare & 
                                        Medicaid Services or the Office 
                                        of Inspector General of the 
                                        Department of Health and Human 
                                        Services.
                            ``(iii) Contents of notification.--The 
                        Secretary shall, based on input from 
                        stakeholders, specify the resources and other 
                        information to be included in notifications 
                        provided under clause (i).
                            ``(iv) Modifications and expansions.--
                                    ``(I) Frequency.--Beginning 5 years 
                                after the date of the enactment of this 
                                subparagraph, the Secretary may change 
                                the frequency of the notifications 
                                described in clause (i) based on 
                                stakeholder input.
                                    ``(II) Expansion to other 
                                prescriptions.--The Secretary may 
                                expand notifications under this 
                                subparagraph to include identifications 
                                and notifications with respect to 
                                concurrent prescriptions of covered 
                                Part D drugs used in combination with 
                                opioids that are considered to have 
                                adverse side effects when so used in 
                                such combination, as determined by the 
                                Secretary.
                            ``(v) Opioids defined.--For purposes of 
                        this subparagraph, the term `opioids' has such 
                        meaning as specified by the Secretary through 
                        program instruction or otherwise.''.
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