,i #aafth ,,congress #ast ,session ,h4 ,r4 #eagb ,,in ,,the ,,house ,,of ,,representatives ,november #ai1 #bjai,ms4 ,sewell of ,alabama 7for herself1 ,mr4 ,mc,kinley1 and ,mr4 ,brindisi7 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 of the ,social ,security ,act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting4 #a4 ,short title ,this ,act may be cited as the ,non-,opioids ,prevent ,addiction ,in the ,nation ,act or the ,,nopain ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,the ,united ,states is undergoing an epidemic of addiction and deaths caused by prescription drug overdoses4 ,according to the ,centers for ,disease ,control and ,prevention 7,,cdc71 opioids are the main driver of drug overdose deaths accounting for #dg1fjj overdose deaths in #bjag4 ,every day1 over #acj people die in the ,united ,states from opioid overdoses4 7#b7 ,additionally1 the ,,cdc estimates that the economic costs associated with prescription opioid misuse exceeds #gh billion annually4 ,these costs include those associated with healthcare1 lost productivity1 addiction treatment1 and the criminal justice system4 7#c7 ,certain non-opioid treatments and services can be successful in replacing1 delaying1 or reducing the use of opioids to treat postsurgical pain4 7#d7 ,the ,substance ,use-,disorder ,prevention that ,promotes ,opioid ,recovery and ,treatment 7,,support7 for ,patients and ,communities ,act was enacted on ,october #bd1 #bjah4 ,this law requires that ,,cms review payments under ,medicare's ,outpatient ,prospective ,payment ,system 7,,opps7 and ,,asc ,payment ,system with a goal of ensuring there are not financial incentives to use opioids instead of non-opioid alternatives4 ,additionally1 the bill requires ,,cms to consider the extent to which payment policy revisions 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#e7 ,pursuant to section #cai of the ,public ,health ,service ,act1 the ,acting ,secretary for the ,u4,s4 ,department of ,health ,human ,services determined on ,october #bf1 #bjag1 that a public health emergency exists as a result of the consequences of the opioid crisis1 and the ,secretary renewed this determination on ,october #af1 #bjai4 7#f7 ,the ,president's ,commission on ,combating ,drug ,addiction and the ,opioid ,crisis was established on ,march #bi1 #bjag4 ,the ,commission recommended that ,,cms examine payment policies for certain drugs that function specifically as non-opioid pain management treatments4 ,according to the ,commission's report1 ''' the current ,,cms payment policy for supplies related to surgical procedures creates unintended incentives to prescribe opioid medications to patients for postsurgical pain instead of administering non-opioid pain medications4 ,under current policies1 ,,cms provides one all-inclusive bundled payment to hospitals for all surgical supplies1 which includes hospital administered drug products intended to manage patients' postsurgical pain4 ,this policy results in the hospitals receiving the same fixed fee from ,medicare whether the surgeon administers a non-opioid medication or not4 7#g7 ,the ,pain ,management ,best ,practices ,inter-,agency ,task ,force was authorized by section #aja of the ,comprehensive ,addiction and ,recovery ,act of #bjaf4 ,the ,task ,force consisted of ,federal agency representatives as well as experts and representatives from a broad group of invested stakeholders and was convened to issue recommendations for identifying and addressing gaps and inconsistencies for managing acute pain4 ,in the ,task ,force's ,final ,report on ,best ,practices3 ,updates1 ,gaps1 ,inconsistencies and ,recommendations1 the following gap was identified3 ,multimodal1 non-opioid therapies are underutilized in the perioperative1 inflammatory1 musculoskeletal1 and neuropathic injury settings4 ,the report also states that ,non-opioids should be used as first-line therapy whenever clinically appropriate in the inpatient and outpatient settings4 7#h7 ,research shows that despite ongoing efforts to end the opioid crisis1 patients continue to receive large quantities of opioids to treat postsurgical pain4 ,one #bjah study showed that #ab percent of patients who had a soft tissue or orthopedic operation in the year prior reported that they had become addicted or dependent on opioids4 ,further research shows that patients receiving an opioid prescription after short-stay surgeries have a #dd percent increased risk of opioid use4 7#i7 ,,cms has reiterated its position in rulemaking that it is appropriate to pay separately for certain non-opioid pain management treatments that function as surgical supplies in the ,,asc setting1 it is clear that direction from ,congress is necessary to modify ,medicare's outpatient policies with the goal of encouraging access to non-opioid treatments and services to address the opioid crisis4 #c4 ,access to non-opioid treatments for pain 7a7 ,in general ,section #ahcc7t7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77 is amended-- 7#a7 in paragraph 7#b77;,e71 by inserting and separate payments for non-opioid treatments under paragraph 7#af77;,g71 after payments under paragraph 7#f72 and 7#b7 in paragraph 7#af71 by adding at the end the following new subparagraph3 7,g7 ,access to non-opioid treatments for pain 7i7 ,in general ,notwithstanding any other provision of this subsection1 with respect to a covered ,,opd service 7or group of services7 furnished on or after ,january #a1 #bjbj1 and before ,january #a1 #bjbe1 the ,secretary shall not package1 and shall make a separate payment as specified in clause 7ii7 for1 a non-opioid treatment 7as defined in clause 7iii77 furnished as part of such service 7or group of services74 7ii7 ,amount of payment ,the amount of the payment specified in this clause is1 with respect to a non-opioid treatment that is-- 7,i7 a drug or biological product1 the amount of payment for such drug or biological determined under section #ahdg;,a2 or 7,,ii7 a medical device1 the amount of the hospital's charges for the device1 adjusted to cost4 7iii7 ,definition of non-opioid treatment ,a non-opioid treatment means-- 7,i7 a drug or biological product that is indicated to produce analgesia without acting upon the body's opioid receptors2 or 7,,ii7 an implantable1 reusable1 or disposable medical device cleared or approved by the ,administrator for ,food and ,drugs for the intended use of managing or treating pain2 that has demonstrated the ability to replace or reduce opioid consumption in a clinical trial or through clinical data published in a peer-reviewed journal1 as determined by the ,secretary4 4 7b7 ,ambulatory surgical center payment system ,section #ahcc7;i77#b77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7i77#b77;,d77 is amended-- 7#a7 by aligning the margins of clause 7v7 with the margins of clause 7iv72 7#b7 by redesignating clause 7vi7 as clause 7vii72 and 7#c7 by inserting after clause 7v7 the following new clause3 7vi7 ,in the case of surgical services furnished on or after ,january #a1 #bjbj1 and before ,january #a1 #bjbe1 the payment system described in clause 7i7 shall provide for a separate payment for a non-opioid treatment 7as defined in clause 7iii7 of subsection 7t77#af77;,g77 furnished as part of such services in the amount specified in clause 7ii7 of such subsection4 4 7c7 ,evaluation of therapeutic services for pain management 7#a7 ,report to ,congress ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary71 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall submit to ,congress a report identifying-- 7,a7 limitations1 gaps1 barriers to access1 or deficits in ,medicare coverage or reimbursement for restorative therapies1 behavioral approaches1 and complementary and integrative health services that are identified in the ,pain ,management ,best ,practices ,inter-,agency ,task ,force ,report and that have demonstrated the ability to replace or reduce opioid consumption2 and 7,b7 recommendations to address the limitations1 gaps1 barriers to access1 or deficits identified under subparagraph 7,a7 to improve ,medicare coverage and reimbursement for such therapies1 approaches1 and services4 7#b7 ,public consultation ,in developing the report described in paragraph 7#a71 the ,secretary shall consult with relevant stakeholders as determined appropriate by the ,secretary4 7#c7 ,exclusive treatment ,any drug1 biological product1 or medical device that is a non-opioid treatment 7as defined in section #ahcc7t77#af77;,g77iii7 of the ,social ,security ,act1 as added by subsection 7a77 shall not be considered a therapeutic service for the purpose of the report described in paragraph 7#a74