Title: Dr. Todd Graham Pain Management Improvement Act of 2018
Policy area: Health

Summary:
Dr. Todd Graham Pain Management Improvement Act of 2018
This bill requires the Centers for Medicare & Medicaid Services to publish a report on whether Medicare payments, coverage, and coding policies for non-opioid pain management treatments should be revised. The report must include an analysis of pain management and prescribing guidelines, access to non-opioid treatments, and the effect of any recommended changes on Medicare and enrollee opioid addiction.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5722 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 5722

To direct the Secretary of Health and Human Services to conduct a study 
  and submit to Congress a report containing recommendation on how to 
  improve the use of non-opioid treatments for acute and chronic pain 
    management for individuals entitled to benefits under part A or 
 enrolled under part B of the Medicare program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 9, 2018

 Mrs. Walorski (for herself and Ms. Judy Chu of California) introduced 
  the following bill; which was referred to the Committee on Ways and 
 Means, and in addition to the Committee on Energy and Commerce, 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 direct the Secretary of Health and Human Services to conduct a study 
  and submit to Congress a report containing recommendation on how to 
  improve the use of non-opioid treatments for acute and chronic pain 
    management for individuals entitled to benefits under part A or 
 enrolled under part B of the Medicare program, and for other purposes.

    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 ``Dr. Todd Graham Pain Management 
Improvement Act of 2018''.

SEC. 2. 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 ``Secretary'') shall conduct a study and submit to 
the Committee on Ways and Means and the Committee on Energy and 
Commerce of the House of Representatives and the Committee on Finance 
of the Senate a report containing recommendations on whether and how 
reimbursement to providers and suppliers of services, coverage, and 
coding policies related to the use of multi-disciplinary, evidence-
based, non-opioid treatments for acute and chronic pain management for 
individuals entitled to benefits under part A or enrolled under part B 
of title XVIII of the Social Security Act should be revised. The 
Secretary shall make such report available on the public website of the 
Centers for Medicare & Medicaid Services.
    (b) Consultation.--In developing the report described 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, physician assistants, nurse practitioners, 
        dentists, and pharmacists;
            (3) hospitals and other medical facilities, including acute 
        care hospitals, cancer hospitals, psychiatric hospitals, 
        hospital emergency departments, facilities furnishing urgent 
        care services, ambulatory surgical centers, and post-acute care 
        and long-term care facilities (such as skilled nursing 
        facilities, inpatient rehabilitation facilities, long-term care 
        hospitals, and home health agencies);
            (4) substance abuse and mental health professional 
        organizations;
            (5) pain management professional organizations and advocacy 
        entities, including individuals who personally suffer chronic 
        pain;
            (6) medical professional organizations and medical 
        specialty organizations;
            (7) licensed health care providers who furnish alternative 
        pain management services;
            (8) organizations with expertise in the development 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) The recommendations described in subsection (d).
            (2) The impact analysis described in subsection (e).
            (3) An assessment of pain management guidance published by 
        the Federal Government that may be relevant to coverage 
        determinations or other coverage requirements under title XVIII 
        of the Social Security Act.
            (4) Recommendations for updating, including expanding, the 
        ``CDC Guideline for Prescribing Opioids for Chronic Pain--
        United States, 2016'' published in March 2016 by the Centers 
        for Disease Control and Prevention, including for purposes of 
        management of pain. Such recommendations shall--
                    (A) consider incorporating 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 elements of the 
                Department of Defense and Veterans Administration pain 
                rating scale; and
                    (B) include recommendations on how the ``CDC 
                Guideline for Prescribing Opioids for Chronic Pain--
                United States, 2016'', as so updated, could be adopted 
                by health care providers across clinical settings.
            (5) 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 (C) of paragraph 
                (6).
                    (B) Potential legislative and administrative 
                changes under such title to improve individuals' access 
                to items and services currently covered under such 
                title and used for the treatment of pain, such as 
                cognitive behavioral interventions, physical therapy, 
                occupational therapy, physical medicine, biofeedback 
                therapy, and chiropractic therapy, and other pain 
                treatments services furnished in a hospital or post-
                acute care setting.
                    (C) Costs and benefits associated with potential 
                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 massage, and items and services furnished 
                by integrated pain management programs.
            (6) An analysis on reimbursement, coverage, and coding 
        policies (including DRG classification, CPT, HCPCS, NDC, and 
        other applicable codes) under title XVIII of the Social 
        Security Act with respect to the following:
                    (A) Non-opioid 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) Non-opioid based treatments and technologies 
                that monitor substance use withdrawal and prevent 
                overdoses of opioids.
                    (C) Non-opioid 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.
                    (E) Medical devices, non-opioid based drugs, and 
                other therapies (including interventional and 
                integrative pain therapies) approved or cleared by the 
                Food and Drug Administration for the treatment of pain.
                    (F) Items and services furnished to beneficiaries 
                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 specialists in pain management, mental health, or 
                addiction treatment.
    (d) Recommendations.--The recommendations 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 recommendations on the following:
            (1) Options for additional coverage of pain management 
        therapies without the use of opioids, including interventional 
        pain therapies, and options to augment opioid therapy with 
        other clinical and complementary, integrative health services 
        to minimize the risk of substance use disorder, including in a 
        hospital setting.
            (2) Options for coverage and reimbursement modifications of 
        medical devices and non-opioid based pharmacological and non-
        pharmacological therapies (including interventional and 
        integrative pain therapies) approved or cleared by the Food and 
        Drug Administration for the treatment of pain as an alternative 
        or augment to opioid therapy.
            (3) Treatment strategies for beneficiaries with psychiatric 
        disorders, 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) 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) Coadministration of opioids and other drugs, 
        particularly benzodiazepines.
            (6) Appropriate case management for beneficiaries who 
        transition between inpatient and outpatient hospital settings, 
        or between opioid therapy to non-opioid therapy, which may 
        include the use of care transition plans.
            (7) Outreach activities designed to educate providers 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) Creation of 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 
implementing the recommendations described in subsection (d) would 
have--
            (1) on expenditures under the Medicare program; and
            (2) on preventing or reducing opioid addiction for 
        individuals receiving benefits under the Medicare program.
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