[Congressional Record Volume 164, Number 102 (Tuesday, June 19, 2018)]
[House]
[Pages H5254-H5256]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        COMBATING OPIOID ABUSE FOR CARE IN HOSPITALS ACT OF 2018

  Mrs. WALORSKI. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 5774) 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 
program, provide for opioid quality measures development, and provide 
for a technical expert panel on reducing surgical setting opioid use 
and data collection on perioperative opioid use, and for other 
purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 5774

       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 ``Combating Opioid Abuse for 
     Care in Hospitals Act of 2018'' or the ``COACH Act of 2018''.

     SEC. 2. DEVELOPING GUIDANCE ON PAIN MANAGEMENT AND OPIOID USE 
                   DISORDER PREVENTION FOR HOSPITALS RECEIVING 
                   PAYMENT UNDER PART A OF THE MEDICARE PROGRAM.

       (a) In General.--Not later than January 1, 2019, the 
     Secretary of Health and Human Services (in this section 
     referred to as the ``Secretary'') 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 (42 U.S.C. 1395c 
     et seq.) on pain management strategies and opioid use 
     disorder prevention strategies with respect to individuals 
     entitled to benefits under such part.
       (b) Consultation.--In developing the guidance described in 
     subsection (a), the Secretary shall consult with relevant 
     stakeholders, including--
       (1) medical professional organizations;
       (2) providers and suppliers of services (as such terms are 
     defined in section 1861 of the Social Security Act (42 U.S.C. 
     1395x));
       (3) health care consumers or groups representing such 
     consumers; and
       (4) other entities determined appropriate by the Secretary.
       (c) Contents.--The guidance described in subsection (a) 
     shall include, with respect to hospitals and individuals 
     described in such subsection, the following:
       (1) Best practices regarding evidence-based screening and 
     practitioner education initiatives relating to screening and 
     treatment protocols for opioid use disorder, including--
       (A) methods to identify such individuals at-risk of opioid 
     use disorder, including risk stratification;
       (B) ways to prevent, recognize, and treat opioid overdoses; 
     and
       (C) resources available to such individuals, such as opioid 
     treatment programs, peer support groups, and other recovery 
     programs.
       (2) Best practices for such hospitals to educate 
     practitioners furnishing items and services at such hospital 
     with respect to pain management and substance use disorders, 
     including education on--
       (A) the adverse effects of prolonged opioid use;
       (B) non-opioid, evidence-based, non-pharmacological pain 
     management treatments;
       (C) monitoring programs for individuals who have been 
     prescribed opioids; and
       (D) the prescribing of naloxone along with an initial 
     opioid prescription.
       (3) Best practices for such hospitals to make such 
     individuals aware of the risks associated with opioid use 
     (which may include use of the notification template described 
     in paragraph (4)).
       (4) A notification template developed by the Secretary, for 
     use as appropriate, for such individuals who are prescribed 
     an opioid that--
       (A) explains the risks and side effects associated with 
     opioid use (including the risks of addiction and overdose) 
     and the importance of adhering to the prescribed treatment 
     regimen, avoiding medications that may have an adverse 
     interaction with such opioid, and storing such opioid safely 
     and securely;
       (B) highlights multimodal and evidence-based non-opioid 
     alternatives for pain management;
       (C) encourages such individuals to talk to their health 
     care providers about such alternatives;
       (D) provides for a method (through signature or otherwise) 
     for such an individual, or person acting on such individual's 
     behalf, to acknowledge receipt of such notification template;
       (E) is worded in an easily understandable manner and made 
     available in multiple languages determined appropriate by the 
     Secretary; and
       (F) includes any other information determined appropriate 
     by the Secretary.
       (5) Best practices for such hospital to track opioid 
     prescribing trends by practitioners furnishing items and 
     services at such hospital, including--
       (A) ways for such hospital to establish target levels, 
     taking into account the specialties of such practitioners and 
     the geographic area in which such hospital is located, with 
     respect to opioids prescribed by such practitioners;
       (B) guidance on checking the medical records of such 
     individuals against information included in prescription drug 
     monitoring programs;
       (C) strategies to reduce long-term opioid prescriptions; 
     and
       (D) methods to identify such practitioners who may be over-
     prescribing opioids.
       (6) Other information the Secretary determines appropriate, 
     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 Administration.

     SEC. 3. 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.

       (a) In General.--Section 1890A of the Social Security Act 
     (42 U.S.C. 1395aaa-1) is amended by adding at the end the 
     following new subsection:
       ``(g) Technical Expert Panel Review of Opioid and Opioid 
     Use Disorder Quality Measures.--
       ``(1) In general.--Not later than 180 days after the date 
     of the enactment of this subsection, the Secretary shall 
     establish a technical expert panel for purposes of reviewing 
     quality measures relating to opioids and opioid use 
     disorders, including care, prevention, diagnosis, health 
     outcomes, and treatment furnished to individuals with opioid 
     use disorders. The Secretary may use the entity with a 
     contract under section 1890(a) and amend such contract as 
     necessary to provide for the establishment of such technical 
     expert panel.
       ``(2) Review and assessment.--Not later than 1 year after 
     the date the technical expert panel described in paragraph 
     (1) is established (and periodically thereafter as the 
     Secretary determines appropriate), the technical expert panel 
     shall--
       ``(A) review quality measures that relate to opioids and 
     opioid use disorders, including existing measures and those 
     under development;
       ``(B) identify gaps in areas of quality measurement that 
     relate to opioids and opioid use disorders, and identify 
     measure development priorities for such measure gaps; and
       ``(C) make recommendations to the Secretary on quality 
     measures with respect to opioids and opioid use disorders for 
     purposes of improving care, prevention, diagnosis, health 
     outcomes, and treatment, including recommendations for 
     revisions of such measures, need for development of new 
     measures, and recommendations for including such

[[Page H5255]]

     measures in the Merit-Based Incentive Payment System under 
     section 1848(q), the alternative payment models under section 
     1833(z)(3)(C), the shared savings program under section 1899, 
     the quality reporting requirements for inpatient hospitals 
     under section 1886(b)(3)(B)(viii), and the hospital value-
     based purchasing program under section 1886(o).
       ``(3) Consideration of measures by secretary.--The 
     Secretary shall consider--
       ``(A) using opioid and opioid use disorder measures 
     (including measures used under the Merit-Based Incentive 
     Payment System under section 1848(q), measures recommended 
     under paragraph (2)(C), and other such measures identified by 
     the Secretary) in alternative payment models under section 
     1833(z)(3)(C) and in the shared savings program under section 
     1899; and
       ``(B) using opioid measures described in subparagraph (A), 
     as applicable, in the quality reporting requirements for 
     inpatient hospitals under section 1886(b)(3)(B)(viii),and in 
     the hospital value-based purchasing program under section 
     1886(o).
       ``(4) Prioritization of measure development.--The Secretary 
     shall prioritize for measure development the gaps in quality 
     measures identified under paragraph (2)(B).''.
       (b) Expedited Endorsement Process for Opioid Measures.--
     Section 1890(b)(2) of the Social Security Act (42 U.S.C. 
     1395aaa(b)(2)) is amended by adding at the end the following 
     new flush sentence:
     ``Such endorsement process shall, as determined practicable 
     by the entity, provide for an expedited process with respect 
     to the endorsement of such measures relating to opioids and 
     opioid use disorders.''.

     SEC. 4. TECHNICAL EXPERT PANEL ON REDUCING SURGICAL SETTING 
                   OPIOID USE; DATA COLLECTION ON PERIOPERATIVE 
                   OPIOID USE.

       (a) Technical Expert Panel on Reducing Surgical Setting 
     Opioid Use.--
       (1) In general.--Not later than 6 months after the date of 
     the enactment of this Act, the Secretary of Health and Human 
     Services shall convene a technical expert panel, including 
     medical and surgical specialty societies and hospital 
     organizations, to provide recommendations on reducing opioid 
     use in the inpatient and outpatient surgical settings and on 
     best practices for pain management, including with respect to 
     the following:
       (A) Approaches that limit patient exposure to opioids 
     during the perioperative period, including pre-surgical and 
     post-surgical injections, and that identify such patients at 
     risk of opioid use disorder pre-operation.
       (B) Shared decision making with patients and families on 
     pain management, 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 making.
       (C) Education on the safe use, storage, and disposal of 
     opioids.
       (D) Prevention of opioid misuse and abuse after discharge.
       (E) Development of a clinical algorithm to identify and 
     treat at-risk, opiate-tolerant patients and reduce reliance 
     on opioids for acute pain during the perioperative period.
       (2) Report.--Not later than 1 year after the date of the 
     enactment of this Act, the Secretary shall submit to Congress 
     and make public a report containing the recommendations 
     developed under paragraph (1) and an action plan for broader 
     implementation of pain management protocols that limit the 
     use of opioids in the perioperative setting and upon 
     discharge from such setting.
       (b) Data Collection on Perioperative Opioid Use.--Not later 
     than 1 year after the date of the enactment of this Act, the 
     Secretary of Health and Human Services shall submit to 
     Congress a report that contains the following:
       (1) The diagnosis-related group codes identified by the 
     Secretary as having the highest volume of surgeries.
       (2) With respect to each of such diagnosis-related group 
     codes so identified, a determination by the Secretary of the 
     data that is both available and reported on opioid use 
     following such surgeries, such as with respect to--
       (A) surgical volumes, practices, and opioid prescribing 
     patterns;
       (B) opioid consumption, including--
       (i) perioperative days of therapy;
       (ii) average daily dose at the hospital, including dosage 
     greater than 90 milligram morphine equivalent;
       (iii) post-discharge prescriptions and other combination 
     drugs that are used before intervention and after 
     intervention;
       (iv) quantity and duration of opioid prescription at 
     discharge; and
       (v) quantity consumed and number of refills;
       (C) regional anesthesia and analgesia practices, including 
     pre-surgical and post-surgical injections;
       (D) naloxone reversal;
       (E) post-operative respiratory failure;
       (F) information about storage and disposal; and
       (G) such other information as the Secretary may specify.
       (3) Recommendations for improving data collection on 
     perioperative opioid use, including an analysis to identify 
     and reduce barriers to collecting, reporting, and analyzing 
     the data described in paragraph (2), including barriers 
     related to technological availability.

     SEC. 5. REQUIRING THE POSTING AND PERIODIC UPDATE OF OPIOID 
                   PRESCRIBING GUIDANCE FOR MEDICARE 
                   BENEFICIARIES.

       (a) In General.--Not later than 180 days after the date of 
     the enactment of this Act, the Secretary of Health and Human 
     Services (in this section referred to as the ``Secretary'') 
     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 1, 2016, 
     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 (42 
     U.S.C. 1395c et seq.) or enrolled under part B of such title 
     of such Act (42 U.S.C. 1395j et seq.).
       (b) Update of Guidance.--
       (1) Periodic update.--The Secretary shall, in consultation 
     with the entities specified in paragraph (2), periodically 
     (as determined appropriate by the Secretary) update guidance 
     described in subsection (a) and revise the posting of such 
     guidance on the website described in such subsection.
       (2) Consultation.--The entities specified in this paragraph 
     are the following:
       (A) Medical professional organizations.
       (B) Providers and suppliers of services (as such terms are 
     defined in section 1861 of the Social Security Act (42 U.S.C. 
     1395x)).
       (C) Health care consumers or groups representing such 
     consumers.
       (D) Other entities determined appropriate by the Secretary.

  The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from 
Indiana (Mrs. Walorski) and the gentlewoman from California (Ms. Judy 
Chu) each will control 20 minutes.
  The Chair recognizes the gentlewoman from Indiana.


                             General Leave

  Mrs. WALORSKI. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks and include extraneous material on H.R. 5744, currently under 
consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Indiana?
  There was no objection.
  Mrs. WALORSKI. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise today in strong support of H.R. 5774, the 
Combating Opioid Abuse for Care in Hospitals Act of 2018, or COACH Act. 
We have learned that, across the continuum of care, screening for 
opioid abuse disorder and education for patients and providers is 
necessary to help eradicate this epidemic.
  This legislation includes efforts to develop quality measures related 
to the treatment of individuals with opioid use disorder, to improve 
and publicize guidance on opioid prescribing, and to develop expert 
recommendations on reducing the use of opioids in the surgical setting. 
These provisions, championed by Representatives Paulsen, Danny Davis, 
Higgins, Buchanan, Lamb, and Jason Smith, will help improve education 
for providers and patients to better ensure prevention and care of 
individuals with opioid use disorder.
  The COACH Act also includes H.R. 5699, the Hospital Opioid Solutions 
Toolkit, which Representative Curbelo introduced with Congresswoman 
Kuster. The toolkit, to be made available by the Centers for Medicare 
and Medicaid Services, or CMS, in consultation with relevant 
stakeholders, will contain resources that hospitals can use to ensure 
the best practices are being utilized for educating patients and 
providers about treatment for pain management, including the 
development of a notification template for hospital staff to better 
inform patients prescribed opioids of potential risks.
  I am thankful for all the hard work on this legislation by Members of 
both sides of the aisle, especially Representatives Curbelo, DelBene, 
Budd, and Kuster.
  I would also like to thank Chairman Brady for his leadership, as well 
as the House Committee on Ways and Means' staff for their efforts.
  Mr. Speaker, I encourage all of my colleagues to vote in favor of 
H.R. 5774, the Combating Opioid Abuse for Care in Hospitals Act of 
2018. This is an issue that affects every congressional district. It is 
imperative that we find solutions that get people into treatment and 
prevent opioid abuse on the front end.
  Mr. Speaker, I reserve the balance of my time.

[[Page H5256]]

                                         House of Representatives,


                                  Committee on Ways and Means,

                                     Washington, DC, June 8, 2018.
     Hon. Greg Walden,
     Chairman, Committee on Energy and Commerce,
     Washington, DC.
       Dear Chairman Walden: I write to you regarding several 
     opioid bills the Committee on Ways and Means ordered 
     favorably reported to address the opioid epidemic. The 
     following bills were also referred to the Committee on Energy 
     and Commerce.
       I ask that the Committee on Energy and Commerce waive 
     formal consideration of the following bills so that they may 
     proceed expeditiously to the House Floor:
       H.R. 5774, Combatting Opioid Abuse for Care in Hospitals 
     (COACH) Act;
       H.R. 5775, Providing Reliable Options for Patients and 
     Educations Resources (PROPER) Act;
       H.R. 5776, Medicare and Opioid Safe Treatment (MOST) Act;
       H.R. 5773, Preventing Addition for Susceptible Seniors 
     (PASS) Act;
       H.R. 5676, Stop Excessive Narcotics in our Retirement 
     (SENIOR) Communities Protection Act; and
       H.R. 5723, Expanding Oversight of Opioid Prescribing and 
     Payment Act.
       I acknowledge that by waiving formal consideration of the 
     bills, the Committee on Energy and Commerce is in no way 
     waiving its jurisdiction over the subject matter contained in 
     those provisions of the bills that fall within your Rule X 
     jurisdiction. I would support your effort to seek appointment 
     of an appropriate number of conferees on any House-Senate 
     conference involving this legislation.
       I will include a copy of our letters in the Congressional 
     Record during consideration of this legislation on the House 
     floor.
           Sincerely,
                                                      Kevin Brady,
     Chairman.
                                  ____

                                         House of Representatives,


                             Committee on Energy and Commerce,

                                     Washington, DC, June 8, 2018.
     Hon. Kevin Brady,
     Chairman, Committee on Ways and Means,
     Washington, DC.
       Dear Chairman Brady: Thank you for your letter regarding 
     the following bills, which were also referred to the 
     Committee on Energy and Commerce:
       H.R. 5774, Combatting Opioid Abuse for Care in Hospitals 
     (COACH) Act;
       H.R. 5775, Providing Reliable Options for Patients and 
     Educations Resources (PROPER) Act;
       H.R. 5776, Medicare and Opioid Safe Treatment (MOST) Act;
       H.R. 5773, Preventing Addition for Susceptible Seniors 
     (PASS) Act;
       H.R. 5676, Stop Excessive Narcotics in our Retirement 
     (SENIOR) Communities Protection Act; and
       H.R. 5723, Expanding Oversight of Opioid Prescribing and 
     Payment Act.
       I wanted to notify you that the Committee will forgo action 
     on these bills so that they may proceed expeditiously to the 
     House floor.
       I appreciate your acknowledgment that by forgoing formal 
     consideration of these bills, the Committee on Energy and 
     Commerce is in no way waiving its jurisdiction over the 
     subject matter contained in those provisions of the bills 
     that fall within its Rule X jurisdiction. I also appreciate 
     your offer to support the Committee's request for the 
     appointment of conferees in the event of a House-Senate 
     conference involving this legislation.
       Thank you for your assistance on this matter.
           Sincerely,
                                                      Greg Walden,
                                                         Chairman.

  Ms. JUDY CHU of California. Mr. Speaker, I yield myself such time as 
I may consume.
  Mr. Speaker, I offer my support for H.R. 5774, the COACH Act, which 
was introduced by Congress Members DelBene and Curbelo.
  This bill focuses specifically on provider education and would 
require the Centers for Medicare and Medicaid Services to develop a 
toolkit that provides best practices to hospitals for reducing opioid 
use.
  Every year, approximately 51 million Americans undergo inpatient 
surgery each year, and 80 percent of those patients receive opioids to 
treat postsurgical pain after a low-risk surgery. This is an alarming 
number, as studies have found that an opioid prescription at discharge 
is an independent risk factor for chronic opioid use. In fact, 
according to the National Institute on Drug Abuse, approximately 10 
percent of patients who are prescribed opioids for long-term use 
develop an opioid use disorder.
  This was the case with my constituent Ryan Hampton, who was a 
promising young college student when he broke his knee in a hiking 
accident and received an opioid prescription at discharge. Ryan fell 
hard into addiction, eventually turning to heroin and becoming 
homeless.
  While Ryan has beaten the odds and is now a national advocate for 
those in recovery from addiction, many are not so lucky. So it is with 
people like Ryan in mind that I support this bill today.
  We should be giving our providers every tool possible to help them 
battle the opioid crisis and, hopefully, change behavior in such a way 
as to limit unnecessary opioid prescriptions.
  In my district, the Los Angeles County Department of Public Health, 
Substance Abuse Prevention and Control program has worked with 
hospitals, plans, cities and providers to develop a 5-year strategic 
plan to address the opioid crisis in our country.
  We know that not every hospital has the resources or ability to 
develop such a plan. By providing a centralized toolkit available to 
all hospitals, under-resourced providers will have the best access to 
best practices that have helped communities combat the opioid epidemic.
  With so many individuals first experiencing opioids via a hospital 
procedure, it is critical that we give our providers every resource 
they need to make the best medical decisions for their patients while 
reducing the number of opioid prescriptions overall.
  I urge my colleagues to support this bill, and I yield back the 
balance of my time.

                              {time}  1600

  Mrs. WALORSKI. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, in closing, I want to remind my colleagues why it is so 
important that we continue working to solve this crisis.
  Thousands of lives have already been lost because of opioid-related 
drug overdoses. Tragically, Indiana has been hit especially hard by 
this crisis. This is a public health emergency, and our response must 
be comprehensive and swift.
  I am proud of the COACH Act, bipartisan legislation that would help 
prevent opioid misuse and reduced dependence on opioids for pain 
management.
  Mr. Speaker, I urge all of my colleagues to support it, and I yield 
back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentlewoman from Indiana (Mrs. Walorski) that the House suspend the 
rules and pass the bill, H.R. 5774, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________