Title: Promoting Outpatient Access to Non-Opioid Treatments Act
Policy area: Health

Summary:
Promoting Outpatient Access to Non-Opioid Treatments Act
This bill requires the Centers for Medicare & Medicaid Services (CMS) to review payments under Medicare for opioid and non-opioid pain management procedures, specifically with respect to ambulatory outpatient surgical procedures and hospital outpatient department services. The CMS must ensure that there are no payment incentives for using opioids instead of non-opioid alternatives and must make revisions accordingly.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5778 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 5778

 To amend title XVIII of the Social Security Act to provide for review 
 and adjustment of payments under the Medicare outpatient prospective 
payment system to avoid financial incentives to use opioids instead of 
       non-opioid alternative treatments, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 11, 2018

Mr. Marchant (for himself and Mr. Levin) 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 provide for review 
 and adjustment of payments under the Medicare outpatient prospective 
payment system to avoid financial incentives to use opioids instead of 
       non-opioid alternative treatments, 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 ``Promoting Outpatient Access to Non-
Opioid Treatments Act''.

SEC. 2. REVIEW AND ADJUSTMENT OF PAYMENTS UNDER THE MEDICARE OUTPATIENT 
              PROSPECTIVE PAYMENT SYSTEM TO AVOID FINANCIAL INCENTIVES 
              TO USE OPIOIDS INSTEAD OF NON-OPIOID ALTERNATIVE 
              TREATMENTS.

    (a) Outpatient Prospective Payment System.--Section 1833(t) of the 
Social Security Act (42 U.S.C. 1395l(t)) is amended by adding at the 
end the following new paragraph:
            ``(22) Review and revisions of payments for non-opioid 
        alternative treatments.--
                    ``(A) In general.--With respect to payments made 
                under this subsection for covered OPD services (or 
                groups of services), including covered OPD services 
                assigned to a comprehensive ambulatory payment 
                classification, the Secretary--
                            ``(i) shall, as soon as practicable, 
                        conduct a review (part of which may include a 
                        request for information) of payments for 
                        opioids and evidence-based non-opioid 
                        alternatives for pain management (including 
                        drugs and devices, nerve blocks, surgical 
                        injections, and neuromodulation) with a goal of 
                        ensuring that there are not financial 
                        incentives to use opioids instead of non-opioid 
                        alternatives;
                            ``(ii) may, as the Secretary determines 
                        appropriate, conduct subsequent reviews of such 
                        payments; and
                            ``(iii) shall consider the extent to which 
                        revisions under this subsection to such 
                        payments (such as the creation of additional 
                        groups of covered OPD services to classify 
                        separately those procedures that utilize 
                        opioids and non-opioid alternatives for pain 
                        management) would reduce payment incentives to 
                        use opioids instead of non-opioid alternatives 
                        for pain management.
                    ``(B) Priority.--In conducting the review under 
                clause (i) of subparagraph (A) and considering 
                revisions under clause (iii) of such subparagraph, the 
                Secretary shall focus on covered OPD services (or 
                groups of services) assigned to a comprehensive 
                ambulatory payment classification, ambulatory payment 
                classifications that primarily include surgical 
                services, and other services determined by the 
                Secretary which generally involve treatment for pain 
                management.
                    ``(C) Revisions.--If the Secretary identifies 
                revisions to payments pursuant to subparagraph 
                (A)(iii), the Secretary shall, as determined 
                appropriate, begin making such revisions for services 
                furnished on or after January 1, 2020. Revisions under 
                the previous sentence shall be treated as adjustments 
                for purposes of application of paragraph (9)(B).
                    ``(D) Rules of construction.--Nothing in this 
                paragraph shall be construed to preclude the 
                Secretary--
                            ``(i) from conducting a demonstration 
                        before making the revisions described in 
                        subparagraph (C); or
                            ``(ii) prior to implementation of this 
                        paragraph, from changing payments under this 
                        subsection for covered OPD services (or groups 
                        of services) which include opioids or non-
                        opioid alternatives for pain management.''.
    (b) Ambulatory Surgical Centers.--Section 1833(i) of the Social 
Security Act (42 U.S.C. 1395l(i)) is amended by adding at the end the 
following new paragraph:
            ``(8) The Secretary shall apply the provisions of paragraph 
        (22) of section 1833(t), including the second sentence of 
        subparagraph (C) of such paragraph, to payment for services 
        under this subsection in an appropriate manner (as determined 
        by the Secretary).''.
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