[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.
____________________