Title: ALTO Act
Policy area: Health

Summary:
Alternatives to Opioids (ALTO) in the Emergency Department Act
This bill requires the Department of Health and Human Services to carry out a three-year demonstration program awarding grants to hospitals and emergency departments to develop, implement, enhance, or study alternative pain management protocols and treatments that promote limited use of opioids in emergency departments.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5197 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 5197

   To direct the Secretary of Health and Human Services to conduct a 
demonstration program to test alternative pain management protocols to 
           limit the use of opioids in emergency departments.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 7, 2018

 Mr. Pascrell (for himself, Mr. McKinley, Ms. DeGette, and Mr. Tipton) 
 introduced the following bill; which was referred to the Committee on 
                          Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
   To direct the Secretary of Health and Human Services to conduct a 
demonstration program to test alternative pain management protocols to 
           limit the use of opioids in emergency departments.

    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 ``Alternatives to Opioids (ALTO) in 
the Emergency Department Act''.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Opioids contributed to the deaths of more than 42,000 
        people in 2016, more than any year on official record. Forty 
        percent of all opioid overdose deaths involve a prescription 
        opioid.
            (2) The economic burden of prescription opioid misuse in 
        the United States is estimated to be $78,500,000,000 per year. 
        This includes costs stemming from health care, including 
        addiction treatment, lost productivity, and criminal justice 
        involvement.
            (3) Over 200 million opioid prescriptions are written in 
        the United States each year, and 2,000,000 Americans have the 
        symptoms of substance use disorder.
            (4) Approximately 21 to 29 percent of patients prescribed 
        opioids for chronic pain misuse them.
            (5) Emergency departments in several States, including in 
        New Jersey and Colorado, have developed innovative programs to 
        more widely utilize non-opioid pain treatments to reduce the 
        use of opioids.

SEC. 3. EMERGENCY DEPARTMENT ALTERNATIVES TO OPIOIDS DEMONSTRATION 
              PROGRAM.

    (a) Demonstration Program Grants.--The Secretary of Health and 
Human Services acting through the Assistant Secretary for Mental Health 
and Substance Use (in this section referred to as the ``Secretary'') 
shall carry out a 3-year demonstration program under which the 
Secretary shall award grants to eligible hospitals and emergency 
departments, including freestanding emergency departments, to develop, 
implement, enhance, or study alternative pain management protocols and 
treatments that promote the appropriate limited use of opioids in 
emergency departments.
    (b) Eligibility.--To be eligible to receive a grant under 
subsection (a), a hospital or emergency department shall submit an 
application to the Secretary at such time, in such manner, and 
containing such information as the Secretary may require.
    (c) Geographic Diversity.--In awarding grants under this section, 
the Secretary shall seek to ensure geographical diversity among grant 
recipients.
    (d) Use of Funds.--In addition to the activities described in 
subsection (a), grants under this section shall be used to--
            (1) target common painful conditions, which may include 
        renal colic, sciatica, headaches, musculoskeletal pain, and 
        extremity fractures;
            (2) train providers and other hospital personnel on 
        protocols and use of treatments that promote the appropriate 
        limited use of opioids in the emergency department;
            (3) collect data, including data required for the reporting 
        requirement established under subsection (f); and
            (4) provide alternatives to opioids to patients with 
        painful conditions, not including patients who present with 
        pain related to cancer, end-of-life symptom palliation, or 
        complex multisystem trauma.
    (e) Duties of the Secretary.--The Secretary shall offer to each 
recipient of a grant under subsection (a) technical support through a 
process that provides for--
            (1) the provision of information by the Secretary on 
        alternative pain management protocols and treatments, which may 
        include--
                    (A) non-opioid medications;
                    (B) protocols and treatments that do not involve a 
                medication;
                    (C) alternative pain management protocols and 
                treatments that are appropriate to use for specific 
                common painful conditions, such as renal colic, back 
                pain, pain from fractures, and other common painful 
                conditions that present to the emergency department;
                    (D) the alternative pain management protocol or 
                treatments, if any, that are appropriate for certain 
                patient populations, such as geriatric patients, 
                pregnant patients, and pediatric patients; and
                    (E) any other information the Secretary determines 
                necessary; and
            (2) the provision of information by emergency departments 
        and providers that have successfully implemented alternatives 
        to opioids programs in the emergency department, promoting non-
        opioid protocols and medications while appropriately limiting 
        the use of opioids.
    (f) Report to the Secretary.--Each recipient of a grant under this 
section shall submit to the Secretary annual evaluations of the 
progress of the program funded through the grant. These evaluations 
shall include--
            (1) a description of and specific information about the 
        alternative pain management protocols and treatments employed;
            (2) data on the alternative pain management protocols and 
        treatments employed, including--
                    (A) during a baseline period before the program 
                began, as defined by the Secretary;
                    (B) at various stages of the program, as determined 
                by the Secretary;
                    (C) the conditions for which the alternative pain 
                management protocols and treatments were employed; and
                    (D) data on patients' self-reported pain rating, 
                using a pain scale model provided by the Secretary, 
                before and after the alternative pain management 
                protocol or treatment was provided;
            (3) data on the opioid prescriptions written, including--
                    (A) during a baseline period before the program 
                began, as defined by the Secretary;
                    (B) at various stages of the program, as determined 
                by the Secretary;
                    (C) the conditions for which the opioids were 
                prescribed; and
                    (D) data on patients' self-reported pain rating, 
                using a pain scale model provided by the Secretary, 
                before and after the opioid prescription was provided;
            (4) the demographic characteristics of patients who were 
        treated with an alternative pain management protocol, including 
        age, sex, race, ethnicity, and insurance status and type;
            (5) data on patients who were eventually prescribed opioids 
        after alternative pain management protocols and treatments were 
        employed;
            (6) data on patients who were transitioned to inpatient 
        care following treatment with an alternative pain management 
        protocol and treatment; and
            (7) any other information the Secretary deems necessary.
    (g) Report to Congress.--Not later than 120 days after completion 
of the demonstration program under this section, the Secretary shall 
submit a report to the Congress on the results of the demonstration 
program and include in the report--
            (1) the number of applications received and the number 
        funded;
            (2) a summary of the evaluations described in subsection 
        (f), including standardized data; and
            (3) recommendations for broader implementation of pain 
        management protocols that limit the use of opioids in emergency 
        departments or other areas of the health care delivery system.
    (h) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $10,000,000 for each of fiscal 
years 2019 through 2021.
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