,i #aaeth ,,congress #b;d ,session ,h4 ,r4 #eggf ,,in ,,the ,,house ,,of ,,representatives ,may #aa1 #bjah,mr4 ,neal 7for himself1 ,mr4 ,holding1 ,mr4 ,cartwright1 and ,mr4 ,taylor7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 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 ,a ,,bill ,to amend title ,,xviii to provide for ,medicare coverage of certain services furnished by opioid treatment programs1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,medicare and ,opioid ,safe ,treatment ,act or the ,,most ,act4 #b4 ,medicare coverage of certain services furnished by opioid treatment programs 7a7 ,coverage ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is amended-- 7#a7 in subparagraph 7,,ff71 by striking at the end and2 7#b7 in subparagraph 7,,gg71 by inserting at the end 2 and2 and 7#c7 by adding at the end the following new subparagraph3 7,,hh7 opioid use disorder treatment services 7as defined in subsection 7jjj774 4 7b7 ,opioid use disorder treatment services and opioid treatment program defined ,section #ahfa of the ,social ,security ,act is amended by adding at the end the following new subsection3 7jjj7 ,opioid use disorder treatment services2 opioid treatment program 7#a7 ,opioid use disorder treatment services ,the term opioid use disorder treatment services means items and services that are furnished by an opioid treatment program for the treatment of opioid abuse disorder1 including-- 7,a7 opioid agonist treatment medications 7including oral versions7 that are approved by the ,food and ,drug ,administration under section #eje of the ,federal ,food1 ,drug and ,cosmetic ,act for use in the treatment of opioid use disorder2 7,b7 dispensing and administration of such medications1 if applicable2 7,c7 substance abuse counseling by a professional to the extent authorized under ,state law to furnish such services2 7,d7 behavioral individual and group therapy with physicians or psychologists 7or other mental health professionals to the extent authorized under ,state law72 7,e7 toxicology testing2 and 7,f7 other items and services that the ,secretary determines are appropriate4 7#b7 ,opioid treatment program ,the term opioid treatment program means an opioid treatment program 7as defined in section #h4b of title #db of the ,code of ,federal ,regulations1 or any successor regulation7 that-- 7,a7 is enrolled under section #ahff7;j72 7,b7 has in effect a certification by the ,substance ,abuse and ,mental ,health ,services ,administration for such a program2 7,c7 is accredited by an accrediting body approved by the ,substance ,abuse and ,mental ,health ,services ,administration2 and 7,d7 meets such additional conditions as the ,secretary may find necessary to ensure-- 7i7 the health and safety of individuals being furnished services under such program2 and 7ii7 the effective and efficient furnishing of such services4 4 7c7 ,payment 7#a7 ,in general ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7,a7 by striking and 7,,bb7 and inserting 7,,bb72 and 7,b7 by inserting before the semicolon at the end the following 1 and 7,,cc7 with respect to opioid use disorder treatment services furnished during an episode of care1 the amount paid shall be equal to the amount payable in accordance with section #ahcd7w7 less any copayment required as specified by the ,secretary4 7#b7 ,payment determination ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7w7 ,opioid use disorder treatment services 7#a7 ,in general ,the ,secretary shall pay to an opioid treatment program 7as defined in paragraph 7#b7 of section #ahfa7;jjj77 an amount that is equal to #ajj percent of a bundled payment under this part for opioid use disorder treatment services 7as defined in paragraph 7#a7 of such section7 that are furnished by such program to an individual during an episode of care 7as defined by the ,secretary7 beginning on or after ,january #a1 #bjbj4 ,the ,secretary shall ensure that no duplicative payments are made under this part or part ,d to a physician1 practitioner1 or pharmacy for items and services furnished by an opioid treatment program4 7#b7 ,considerations ,the ,secretary may implement this subsection through one or more bundles based on the type of medication provided 7such as buprenorphine1 methadone1 naltrexone1 or a new innovative drug71 the frequency of services1 the scope of services furnished1 characteristics of the individuals furnished such services1 or other factors as the ,secretary determine appropriate4 ,in developing such bundles1 the ,secretary may consider payment rates paid to opioid treatment programs for comparable services under ,state plans under title ,,xix1 under the ,,tricare program under chapter #ee of title #aj of the ,united ,states ,code1 or by other health care payers4 7#c7 ,annual updates ,the ,secretary shall provide an update each year to the bundled payment amounts under this subsection4 4 7d7 ,including opioid treatment programs as ,medicare providers ,section #ahff7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7e77 is amended-- 7#a7 in paragraph 7#b71 by striking at the end and2 7#b7 in paragraph 7#c71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following new paragraph3 7#c7 opioid treatment programs 7as defined in paragraph 7#b7 of section #ahfa7;jjj771 but only with respect to the furnishing of opioid treatment program services 7as defined in paragraph 7#a7 of such section74 4 #c4 ,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 7a7 ,outpatient prospective payment system ,section #ahcc7t7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77 is amended by adding at the end the following new paragraph3 7#bb7 ,review and revisions of payments for non-opioid alternative treatments 7,a7 ,in general ,with respect to payments made under this subsection for covered ,,opd services 7or groups of services71 including covered ,,opd services assigned to a comprehensive ambulatory payment classification1 the ,secretary-- 7i7 shall1 as soon as practicable1 conduct a review 7part of which may include a request for information7 of payments for opioids and evidence-based non-opioid alternatives for pain management 7including drugs and devices1 nerve blocks1 surgical injections1 and neuromodulation7 with a goal of ensuring that there are not financial incentives to use opioids instead of non-opioid alternatives2 7ii7 may1 as the ,secretary determines appropriate1 conduct subsequent reviews of such payments2 and 7iii7 shall consider the extent to which revisions under this subsection to such payments 7such as the creation of additional groups of covered ,,opd services to classify separately those procedures that utilize opioids and non-opioid alternatives for pain management7 would reduce payment incentives to use opioids instead of non-opioid alternatives for pain management4 7,b7 ,priority ,in conducting the review under clause 7i7 of subparagraph 7,a7 and considering revisions under clause 7iii7 of such subparagraph1 the ,secretary shall focus on covered ,,opd services 7or groups of services7 assigned to a comprehensive ambulatory payment classification1 ambulatory payment classifications that primarily include surgical services1 and other services determined by the ,secretary which generally involve treatment for pain management4 7,c7 ,revisions ,if the ,secretary identifies revisions to payments pursuant to subparagraph 7,a77iii71 the ,secretary shall1 as determined appropriate1 begin making such revisions for services furnished on or after ,january #a1 #bjbj4 ,revisions under the previous sentence shall be treated as adjustments for purposes of application of paragraph 7#i77;,b74 7,d7 ,rules of construction ,nothing in this paragraph shall be construed to preclude the ,secretary-- 7i7 from conducting a demonstration before making the revisions described in subparagraph 7,c72 or 7ii7 prior to implementation of this paragraph1 from changing payments under this subsection for covered ,,opd services 7or groups of services7 which include opioids or non-opioid alternatives for pain management4 4 7b7 ,ambulatory surgical centers ,section #ahcc7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7i77 is amended by adding at the end the following new paragraph3 7#h7 ,the ,secretary shall apply the provisions of paragraph 7#bb7 of section #ahcc7t71 including the second sentence of subparagraph 7,c7 of such paragraph1 to payment for services under this subsection in an appropriate manner 7as determined by the ,secretary74 4 #d4 ,expanding access under the ,medicare program to addiction treatment in ,federally qualified health centers and rural health clinics 7a7 ,federally qualified health centers ,section #ahcd7o7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7o77 is amended by adding at the end the following new paragraph3 7#c7 ,additional payments for certain ,f,q,h,cs with practitioners receiving ,,data #bjjj certification 7,a7 ,in general ,in the case of a ,federally qualified health center with respect to which1 beginning ,january #a1 #bjai1 ,federally-qualified health center services 7as defined in section #ahfa7;aa77#c77 are furnished by a health care practitioner who first receives on or after such date a registration or waiver under section #cjc7;g7 of the ,controlled ,substances ,act to prescribe or dispense methadone1 buprenorphine1 or suboxone for the purpose of maintenance or detoxification treatment1 the ,secretary shall1 subject to availability of funds under subparagraph 7,b71 make a payment 7in accordance with such timing1 method1 and procedures as specified by the ,secretary7 to such ,federally qualified health center in an amount determined by the ,secretary1 based on an approximation of the cost to receive training for purposes of such registration or waiver1 as applicable4 ,for purposes of the previous sentence1 a ,federally-qualified health center shall apply for a payment described in such sentence at such time and in such manner as specified by the ,secretary and may apply for such a payment for each practitioner furnishing such services at such center who is described in such sentence4 7,b7 ,funding ,for purposes of making payments under this paragraph1 there are appropriated1 out of amounts in the ,treasury not otherwise appropriated1 #f1jjj1jjj1 which shall remain available until expended4 4 7b7 ,rural health clinic ,section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 is amended-- 7#a7 by redesignating the subsection 7z7 relating to medical review of spinal subluxation services as subsection 7aa72 and 7#b7 by adding at the end the following new subsection3 7bb7 ,additional payments for certain rural health clinics with practitioners receiving ,,data #bjjj certification 7#a7 ,in general ,in the case of a rural health clinic with respect to which1 beginning ,january #a1 #bjai1 rural health clinic services 7as defined in section #ahfa7;aa77#a77 are furnished by a health care practitioner who first receives on or after such date a registration or waiver under section #cjc7;g7 of the ,controlled ,substances ,act to prescribe or dispense methadone1 buprenorphine1 or suboxone for the purpose of maintenance or detoxification treatment1 the ,secretary shall1 subject to availability of funds under subparagraph 7,b71 make a payment 7in accordance with such timing1 method1 and procedures as specified by the ,secretary7 to such rural health clinic in an amount determined by the ,secretary1 based on an approximation of the cost to receive training for purposes of such registration or waiver1 as applicable4 ,for purposes of the previous sentence1 a rural health clinic shall apply for a payment described in such sentence at such time and in such manner as specified by the ,secretary and may apply for such a payment for each practitioner furnishing such services at such clinic who is described in such sentence4 7#b7 ,funding ,for purposes of making payments under this subsection1 there are appropriated1 out of amounts in the ,treasury not otherwise appropriated1 #b1jjj1jjj1 which shall remain available until expended4 4 #e4 ,studying the availability of supplemental benefits designed to treat or prevent substance use disorders under ,medicare ,advantage plans 7a7 ,in general ,not later than #b years 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 submit to ,congress a report on the availability of supplemental health care benefits 7as described in section #aheb7;a77#c77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;a77#c77;,a777 designed to treat or prevent substance use disorders under ,medicare ,advantage plans offered under part ,c of title ,,xviii of such ,act4 ,such report shall include the analysis described in subsection 7c7 and any differences in the availability of such benefits under specialized ,,ma plans for special needs individuals 7as defined in section #ahei7;b77#f7 of such ,act 7#db ,u4,s4,c4 #aciew-#bh7;b77#f777 offered to individuals entitled to medical assistance under title ,,xix of such ,act and other such ,medicare ,advantage plans4 7b7 ,consultation ,the ,secretary shall develop the report described in subsection 7a7 in consultation with relevant stakeholders1 including-- 7#a7 individuals entitled to benefits under part ,a or enrolled under part ,b of title ,,xviii of the ,social ,security ,act2 7#b7 entities who advocate on behalf of such individuals2 7#c7 ,medicare ,advantage organizations2 7#d7 pharmacy benefit managers2 and 7#e7 providers of services and suppliers 7as such terms are defined in section #ahfa of such ,act 7#db ,u4,s4,c4 #aciex774 7c7 ,contents ,the report described in subsection 7a7 shall include an analysis on the following3 7#a7 ,the extent to which plans described in such subsection offer supplemental health care benefits relating to coverage of-- 7,a7 medication-assisted treatments for opioid use1 substance use disorder counseling1 peer recovery support services1 or other forms of substance use disorder treatments 7whether furnished in an inpatient or outpatient setting72 and 7,b7 non-opioid alternatives for the treatment of pain4 7#b7 ,challenges associated with such plans offering supplemental health care benefits relating to coverage of items and services described in subparagraph 7,a7 or 7,b7 of paragraph 7#a74 7#c7 ,the impact1 if any1 of increasing the applicable rebate percentage determined under section #ahed7;b77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bd7;b77#a77;,c77 for plans offering such benefits relating to such coverage would have on the availability of such benefits relating to such coverage offered under ,medicare ,advantage plans4 7#d7 ,potential ways to improve upon such coverage or to incentivize such plans to offer additional supplemental health care benefits relating to such coverage4 #f4 ,clinical psychologist services models under the ,center for ,medicare and ,medicaid ,innovation2 ,,gao study and report 7a7 ,,cmi models ,section #aaae;,a7b77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b77 is amended by adding at the end the following new clauses3 7xxv7 ,supporting ways to familiarize individuals with the availability of coverage under part ,b of title ,,xviii for qualified psychologist services 7as defined in section #ahfa7;ii774 7xxvi7 ,exploring ways to avoid unnecessary hospitalizations or emergency department visits for mental and behavioral health services 7such as for treating depression7 through use of a #bd-;hour1 #g-;day a week help line that may inform individuals about the availability of treatment options1 including the availability of qualified psychologist services 7as defined in section #ahfa7;ii774 4 7b7 ,,gao study and report ,not later than #ah months after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall conduct a study1 and submit to ,congress a report1 on mental and behavioral health services under the ,medicare program under title ,,xviii of the ,social ,security ,act1 including an examination of the following3 7#a7 ,information about services furnished by psychiatrists1 clinical psychologists1 and other professionals4 7#b7 ,information about ways that ,medicare beneficiaries familiarize themselves about the availability of ,medicare payment for qualified psychologist services 7as defined in section #ahfa7;ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ii777 and ways that the provision of such information could be improved4 #g4 ,pain management study 7a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 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 payment to providers and suppliers of services and coverage related to the use of multi-disciplinary1 evidence-based1 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 revised4 ,the ,secretary shall make such report available on the public website of the ,centers for ,medicare ,medicaid ,services4 7b7 ,consultation ,in developing the report described in subsection 7a71 the ,secretary shall consult with-- 7#a7 relevant agencies within the ,department of ,health and ,human ,services2 7#b7 licensed and practicing osteopathic and allopathic physicians1 behavioral health practitioners1 physician assistants1 nurse practitioners1 dentists1 pharmacists1 and other providers of health services2 7#c7 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#d7 substance abuse and mental health professional organizations2 7#e7 pain management professional organizations and advocacy entities1 including individuals who personally suffer chronic pain2 7#f7 medical professional organizations and medical specialty organizations2 7#g7 licensed health care providers who furnish alternative pain management services2 7#h7 organizations with expertise in the development of innovative medical technologies for pain management2 7#i7 beneficiary advocacy organizations2 and 7#aj7 other organizations with expertise in the assessment1 diagnosis1 treatment1 and management of pain1 as determined appropriate by the ,secretary4 7c7 ,contents ,the report described in subsection 7a7 shall include the following3 7#a7 ,the recommendations described in subsection 7d74 7#b7 ,the impact analysis described in subsection 7e74 7#c7 ,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 ,act4 ,such assessment shall consider incorporating into such guidance relevant elements of the ,va_/,do,d ,clinical ,practice ,guideline for ,opioid ,therapy for ,chronic ,pain published in ,february #bjag by the ,department of ,veterans ,affairs and ,department of ,defense1 including adoption of elements of the ,department of ,defense and ,veterans ,administration pain rating scale4 7#d7 ,an evaluation of the following3 7,a7 ,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 7,a7 through 7,f7 of paragraph 7#f74 7,b7 ,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 pain1 such as cognitive behavioral interventions1 physical therapy1 occupational therapy1 physical medicine1 biofeedback therapy1 and chiropractic therapy1 and other pain treatments services furnished in a hospital or post-acute care setting4 7,c7 ,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 pain1 such as acupuncture1 therapeutic massage1 and items and services furnished by integrated pain management programs4 7#e7 ,an analysis on payment and coverage under title ,,xviii of the ,social ,security ,act with respect to the following3 7,a7 ,evidence-based treatments and technologies for chronic or acute pain1 including such treatments that are covered1 not covered1 or have limited coverage under such title4 7,b7 ,evidence-based treatments and technologies that monitor substance use withdrawal and prevent overdoses of opioids4 7,c7 ,evidence-based treatments and technologies that treat substance use disorders4 7,d7 ,items and services furnished by practitioners through a multi-disciplinary treatment model for pain management1 including the patient-centered medical home4 7,e7 ,medical devices1 non-opioid based drugs1 and other therapies 7including interventional and integrative pain therapies7 approved or cleared by the ,food and ,drug ,administration for the treatment of pain4 7,f7 ,items and services furnished to beneficiaries with psychiatric disorders1 substance use disorders1 or who are at risk of suicide1 or have comorbidities and require consultation or management of pain with one or more specialists in pain management1 mental health1 or addiction treatment4 7d7 ,recommendations ,the recommendations described in this subsection are1 with respect to individuals entitled to benefits under part ,a or enrolled under part ,b of title ,,xviii of the ,social ,security ,act1 legislative and administrative recommendations on the following3 7#a7 ,options for additional coverage of pain management therapies without the use of opioids1 including interventional pain therapies1 and options to augment opioid therapy with other clinical and complementary1 integrative health services to minimize the risk of substance use disorder1 including in a hospital setting4 7#b7 ,options for coverage and payment modifications of medical devices and non-opioid based pharmacological and non-pharmacological therapies 7including interventional and integrative pain therapies7 approved or cleared by the ,food and ,drug ,administration for the treatment of pain as an alternative or augment to opioid therapy4 7#c7 ,treatment strategies for beneficiaries with psychiatric disorders1 substance use disorders1 or who are at risk of suicide1 and treatment strategies to address health disparities related to opioid use and opioid abuse treatment4 7#d7 ,treatment strategies for beneficiaries with comorbidities who require a consultation or comanagement of pain with one or more specialists in pain management1 mental health1 or addiction treatment1 including in a hospital setting4 7#e7 ,coadministration of opioids and other drugs1 particularly benzodiazepines4 7#f7 ,appropriate case management for beneficiaries who transition between inpatient and outpatient hospital settings1 or between opioid therapy to non-opioid therapy1 which may include the use of care transition plans4 7#g7 ,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 alternative1 non-opioid therapies to manage and treat acute and chronic pain4 7#h7 ,creation of a beneficiary education tool on alternatives to opioids for chronic pain management4 7e7 ,impact analysis ,the impact analysis described in this subsection consists of an analysis of any potential effects implementing the recommendations described in subsection 7d7 would have-- 7#a7 on expenditures under the ,medicare program2 and 7#b7 on preventing or reducing opioid addiction for individuals receiving benefits under the ,medicare program4