,,ib ,union ,calendar ,no4 #eic #aaeth ,,congress #b;d ,session ,h4 ,r4 #eggd ,report ,no4 #aae-gfb1 ,part ,i ,,in ,,the ,,house ,,of ,,representatives ,may #aa1 #bjah ,mr4 ,curbelo of ,florida 7for himself1 ,ms4 ,kuster of ,new ,hampshire1 ,ms4 ,del,bene1 and ,mr4 ,budd7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,june #ai1 #bjah;,additional sponsors3 ,mrs4 ,comstock1 ,mr4 ,sam ,johnson of ,texas1 ,mr4 ,buchanan1 ,mr4 ,paulsen1 ,mr4 ,gottheimer1 and ,mr4 ,higgins of ,new ,york ,june #ai1 #bjah ,reported from the ,committee on ,ways and ,means with an amendment ,strike out all after the enacting clause and insert the part printed in italic ,june #ai1 #bjah;,committee on ,energy and ,commerce discharged2 committed to the ,committee of the ,whole ,house on the ,state of the ,union and ordered to be printed,for text of introduced bill1 see copy of bill as introduced on ,may #aa1 #bjah ,a ,,bill ,to require the ,secretary of ,health and ,human ,services to develop guidance on pain management and opioid use disorder prevention for hospitals receiving payment under part ,a of the ,medicare program1 provide for opioid quality measures development1 and provide for a technical expert panel on reducing surgical setting opioid use and data collection on perioperative opioid use1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,combating ,opioid ,abuse for ,care in ,hospitals ,act of #bjah or the ,,coach ,act of #bjah4 #b4 ,developing guidance on pain management and opioid use disorder prevention for hospitals receiving payment under part ,a of the ,medicare program 7a7 ,in general ,not later than ,january #a1 #bjai1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall develop and publish on the public website of the ,centers for ,medicare ,medicaid ,services guidance for hospitals receiving payment under part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq47 on pain management strategies and opioid use disorder prevention strategies with respect to individuals entitled to benefits under such part4 7b7 ,consultation ,in developing the guidance described in subsection 7a71 the ,secretary shall consult with relevant stakeholders1 including-- 7#a7 medical professional organizations2 7#b7 providers and suppliers of services 7as such terms are defined in section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex772 7#c7 health care consumers or groups representing such consumers2 and 7#d7 other entities determined appropriate by the ,secretary4 7c7 ,contents ,the guidance described in subsection 7a7 shall include1 with respect to hospitals and individuals described in such subsection1 the following3 7#a7 ,best practices regarding evidence-based screening and practitioner education initiatives relating to screening and treatment protocols for opioid use disorder1 including-- 7,a7 methods to identify such individuals at-risk of opioid use disorder1 including risk stratification2 7,b7 ways to prevent1 recognize1 and treat opioid overdoses2 and 7,c7 resources available to such individuals1 such as opioid treatment programs1 peer support groups1 and other recovery programs4 7#b7 ,best practices for such hospitals to educate practitioners furnishing items and services at such hospital with respect to pain management and substance use disorders1 including education on-- 7,a7 the adverse effects of prolonged opioid use2 7,b7 non-opioid1 evidence-based1 non-pharmacological pain management treatments2 7,c7 monitoring programs for individuals who have been prescribed opioids2 and 7,d7 the prescribing of naloxone along with an initial opioid prescription4 7#c7 ,best practices for such hospitals to make such individuals aware of the risks associated with opioid use 7which may include use of the notification template described in paragraph 7#d774 7#d7 ,a notification template developed by the ,secretary1 for use as appropriate1 for such individuals who are prescribed an opioid that-- 7,a7 explains the risks and side effects associated with opioid use 7including the risks of addiction and overdose7 and the importance of adhering to the prescribed treatment regimen1 avoiding medications that may have an adverse interaction with such opioid1 and storing such opioid safely and securely2 7,b7 highlights multimodal and evidence-based non-opioid alternatives for pain management2 7,c7 encourages such individuals to talk to their health care providers about such alternatives2 7,d7 provides for a method 7through signature or otherwise7 for such an individual1 or person acting on such individual's behalf1 to acknowledge receipt of such notification template2 7,e7 is worded in an easily understandable manner and made available in multiple languages determined appropriate by the ,secretary2 and 7,f7 includes any other information determined appropriate by the ,secretary4 7#e7 ,best practices for such hospital to track opioid prescribing trends by practitioners furnishing items and services at such hospital1 including-- 7,a7 ways for such hospital to establish target levels1 taking into account the specialties of such practitioners and the geographic area in which such hospital is located1 with respect to opioids prescribed by such practitioners2 7,b7 guidance on checking the medical records of such individuals against information included in prescription drug monitoring programs2 7,c7 strategies to reduce long-term opioid prescriptions2 and 7,d7 methods to identify such practitioners who may be over-prescribing opioids4 7#f7 ,other information the ,secretary determines appropriate1 including any such information from the ,opioid ,safety ,initiative established by the ,department of ,veterans ,affairs or the ,opioid ,overdose ,prevention ,toolkit published by the ,substance ,abuse and ,mental ,health ,services ,administration4 #c4 ,requiring the review of quality measures relating to opioids and opioid use disorder treatments furnished under the medicare program and other federal health care programs 7a7 ,in general ,section #ahij;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa-#a7 is amended by adding at the end the following new subsection3 7g7 ,technical expert panel review of opioid and opioid use disorder quality measures 7#a7 ,in general ,not later than #ahj days after the date of the enactment of this subsection1 the ,secretary shall establish a technical expert panel for purposes of reviewing quality measures relating to opioids and opioid use disorders1 including care1 prevention1 diagnosis1 health outcomes1 and treatment furnished to individuals with opioid use disorders4 ,the ,secretary may use the entity with a contract under section #ahij7;a7 and amend such contract as necessary to provide for the establishment of such technical expert panel4 7#b7 ,review and assessment ,not later than #a year after the date the technical expert panel described in paragraph 7#a7 is established 7and periodically thereafter as the ,secretary determines appropriate71 the technical expert panel shall-- 7,a7 review quality measures that relate to opioids and opioid use disorders1 including existing measures and those under development2 7,b7 identify gaps in areas of quality measurement that relate to opioids and opioid use disorders1 and identify measure development priorities for such measure gaps2 and 7,c7 make recommendations to the ,secretary on quality measures with respect to opioids and opioid use disorders for purposes of improving care1 prevention1 diagnosis1 health outcomes1 and treatment1 including recommendations for revisions of such measures1 need for development of new measures1 and recommendations for including such measures in the ,merit-,based ,incentive ,payment ,system under section #ahdh7q71 the alternative payment models under section #ahcc7z77#c77;,c71 the shared savings program under section #ahii1 the quality reporting requirements for inpatient hospitals under section #ahhf7;b77#c77;,b77viii71 the hospital value-based purchasing program under section #ahhf7o71 and under other value-based purchasing programs under this title4 7#c7 ,consideration of measures by secretary ,the ,secretary shall consider-- 7,a7 using opioid and opioid use disorder measures 7including measures used under the ,merit-,based ,incentive ,payment ,system under section #ahdh7q71 measures recommended under paragraph 7#b77;,c71 and other such measures identified by the ,secretary7 in alternative payment models under section #ahcc7z77#c77;,c7 and in the shared savings program under section #ahii2 and 7,b7 using opioid measures described in subparagraph 7,a71 as applicable1 in the quality reporting requirements for inpatient hospitals under section #ahhf7;b77#c77;,b77viii71 in the hospital value-based purchasing program under section #ahhf7o71 and under other value-based purchasing programs under this title4 7#d7 ,prioritization of measure development ,the ,secretary shall prioritize for measure development the gaps in quality measures identified under paragraph 7#b77;,b74 4 7b7 ,expedited endorsement process for opioid measures ,section #ahij7;b77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7b77#b77 is amended by adding at the end the following new flush sentence3 ,such endorsement process shall1 as determined practicable by the entity1 provide for an expedited process with respect to the endorsement of such measures relating to opioids and opioid use disorders4 4 #d4 ,technical expert panel on reducing surgical setting opioid use2 ,data collection on perioperative opioid use 7a7 ,technical expert panel on reducing surgical setting opioid use 7#a7 ,in general ,not later than #f months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall convene a technical expert panel1 including medical and surgical specialty societies and hospital organizations1 to provide recommendations on reducing opioid use in the inpatient and outpatient surgical settings and on best practices for pain management1 including with respect to the following3 7,a7 ,approaches that limit patient exposure to opioids during the perioperative period1 including pre-surgical and post-surgical injections1 and that identify such patients at risk of opioid use disorder pre-operation4 7,b7 ,shared decision making with patients and families on pain management1 including recommendations for the development of an evaluation and management code for purposes of payment under the ,medicare program under title ,,xviii of the ,social ,security ,act that would account for time spent on shared decision making4 7,c7 ,education on the safe use1 storage1 and disposal of opioids4 7,d7 ,prevention of opioid misuse and abuse after discharge4 7,e7 ,development of a clinical algorithm to identify and treat at-risk1 opiate-tolerant patients and reduce reliance on opiodes for acute pain during the perioperative period4 7#b7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress and make public a report containing the recommendations developed under paragraph 7#a7 and recommendations for broader implementation of pain management protocols that limit the use of opioids in the perioperative setting and upon discharge from such setting4 7b7 ,data collection on perioperative opioid use ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall submit to ,congress a report that contains the following3 7#a7 ,the diagnosis-related group codes identified by the ,secretary as having the highest volume of surgeries4 7#b7 ,with respect to each of such diagnosis-related group codes so identified1 a determination by the ,secretary of the data that is both available and reported on opioid use following such surgeries1 such as with respect to-- 7,a7 surgical volumes1 practices1 and opioid prescribing patterns2 7,b7 opioid consumption1 including-- 7i7 perioperative days of therapy2 7ii7 average daily dose at the hospital1 including dosage greater than #ij milligram morphine equivalent2 7iii7 post-discharge prescriptions and other combination drugs that are used before intervention and after intervention2 7iv7 quantity and duration of opioid prescription at discharge2 and 7v7 quantity consumed and number of refills2 7,c7 regional anesthesia and analgesia practices1 including pre-surgical and post-surgical injections2 7,d7 naloxone reversal2 7,e7 post-operative respiratory failure2 7,f7 information about storage and disposal2 and 7,g7 such other information as the ,secretary may specify4 7#c7 ,recommendations for improving data collection on perioperative opioid use1 including an analysis to identify barriers to collecting1 reporting1 and analyzing the data described in paragraph 7#b71 including barriers related to technological availability4 #e4 ,requiring the posting and periodic update of opioid prescribing guidance for ,medicare beneficiaries 7a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall post on the public website of the ,centers for ,medicare ,medicaid ,services all guidance published by the ,department of ,health and ,human ,services on or after ,january #a1 #bjaf1 relating to the prescribing of opioids and applicable to opioid prescriptions for individuals entitled to benefits under part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq47 or enrolled under part ,b of such title of such ,act 7#db ,u4,s4,c4 #acie;j et seq474 7b7 ,update of guidance 7#a7 ,periodic update ,the ,secretary shall1 in consultation with the entities specified in paragraph 7#b71 periodically 7as determined appropriate by the ,secretary7 update guidance described in subsection 7a7 and revise the posting of such guidance on the website described in such subsection4 7#b7 ,consultation ,the entities specified in this paragraph are the following3 7,a7 ,medical professional organizations4 7,b7 ,providers and suppliers of services 7as such terms are defined in section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex774 7,c7 ,health care consumers or groups representing such consumers4 7,d7 ,other entities determined appropriate by the ,secretary4 ,june #ai1 #bjah ,reported from the ,committee on ,ways and ,means with an amendment,june #ai1 #bjah;,committee on ,energy and ,commerce discharged2 committed to the ,committee of the ,whole ,house on the ,state of the ,union and ordered to be printed