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H.R. 5176 — what changed

Preventing Overdoses While in Emergency Rooms Act of 2018

From Introduced in House to Engrossed in House. 1 section amended between Introduced in House and Engrossed in House.

Sec. 2 Program to support emergency room discharge and care coordination for drug overdose patients

(a)
In general— The Secretary of Health and Human Services shall establish a program (in this Act referred to as the “Program”) to develop protocols for discharging patients who have presented with a drug overdose and enhance the integration and coordination of care and treatment options for individuals with substance use disorder after discharge.
(b)
Grant establishment and participation—
(1)
changed In general— In carrying out the Program, the Secretary shall award grants on a competitive basis to not more than 20 eligible health care sites entities described in paragraph (2).
(2)
added Eligibility—
(A)
added In general— To be eligible for a grant under this subsection, an entity shall be—
(i)
added a health care site described in subparagraph (B); or
(ii)
added a health care site coordinator described in subparagraph (C).
(B)
added Health care sites— To be eligible for a grant under this section, a health care site shall—
(2)
removed Eligible health care sites— To be eligible for a grant under this section, a health care site shall—
(i)
renumbered was (3)(3)(3) submit an application to the Secretary at such time, in such manner, and containing such information as specified by the Secretary;
(ii)
renumbered was (3)(3)(4) have an emergency department;
(iii)
added
(I)
added have a licensed health care professional onsite who has a waiver under section 303(g) of the Controlled Substances Act (21 U.S.C. 823(g)) to dispense or prescribe covered drugs; or
(II)
added have a demonstrable plan to hire a sufficient number of full-time licensed health care professionals who have waivers described in subclause (I) to administer such treatment onsite;
(iv)
added have in place an agreement with a sufficient number and range of entities certified under applicable State and Federal law, such as pursuant to registration or a waiver under section 303(g) of the Controlled Substances Act (21 U.S.C. 823(g)) or certification as described in section 8.2 of title 42 of the Code of Federal Regulations, to provide treatment for substance use disorder such that the entity or the resulting network of entities with an agreement with the hospital cumulatively are capable of providing all evidence-based services for the treatment of substance use disorder, as medically appropriate for the individual involved, including—
(C)
removed
(i)
removed have a licensed health care professional on site who has a waiver under section 303(g) of the Controlled Substances Act (21 U.S.C. 823(g)) to administer medication-assisted treatment; or
(ii)
removed have a demonstrable plan to hire a full-time licensed health care professional who has a waiver described in clause (i) to administer such treatment on site;
(D)
removed have in place an agreement with a sufficient number and range of entities certified under applicable State and Federal law, such as pursuant to registration or a waiver under section 303(g) of the Controlled Substances Act (21 U.S.C. 823(g)) or certification as described in section 8.2 of title 42 of the Code of Federal Regulations, to provide treatment for substance use disorder such that, in combination, the resulting network of entities with an agreement with the hospital cumulatively are capable of providing services for all evidence-based services for the treatment of substance use disorder, as medically appropriate for the individual involved, including—
(I)
renumbered was (3)(3)(6)(2) medication-assisted treatment;
(II)
renumbered was (3)(3)(6)(3) withdrawal and detoxification services that include patient evaluation, stabilization, and readiness for and entry into treatment; and
(III)
renumbered was (3)(3)(6)(4) counseling;
(v)
added deploy onsite peer recovery specialists to help connect patients with treatment and recovery support services; and
(E)
removed deploy on-site peer recovery specialists to help connect patients with treatment and recovery support programs; and
(vi)
renumbered was (3)(3)(8) include the provision of overdose reversal medication in discharge protocols for opioid overdose patients.
(C)
added Health care site coordinators— To be eligible for a grant under this section, a health care site coordinator shall—
(i)
added be an organization described in section 501(c)(3) of the Internal Revenue Code of 1986 (and exempt from tax under section 501(a) of such Code) or a State, local, or Tribal government;
(ii)
added submit an application to the Secretary at such time, in such manner, and containing such information as specified by the Secretary; and
(iii)
added have an agreement with multiple eligible health care sites described in subparagraph (B).
(3)
changed Preference— In awarding grants under this section, the Secretary shall may give preference to eligible health care sites entities described in paragraph (2) that meet either or both of the following criteria:
(A)
changed The eligible health care site is is, or the eligible health care site coordinator has an agreement described in paragraph (2)(C)(iii) with a site that is, a critical access hospital (as defined in section 1861(mm)(1) of the Social Security Act (42 U.S.C. 1395x(mm)(1))), a low-volume hospital (as defined in section 1886(d)(12)(C)(i) of such Act (42 U.S.C. 1395ww(d)(12)(C)(i))), or a sole community hospital (as defined in section 1886(d)(5)(D)(iii) of such Act (42 U.S.C. 1395ww(d)(5)(D)(iii))).
(B)
changed The eligible health care site or the eligible health care site coordinator is located in a geographic area with an a drug overdose rate that is higher than the national average, rate, or in a geographic area with a rate of emergency department visits for overdoses that is higher than the national rate, as determined by the Secretary based on the most recent data of from the Centers for Disease Control and Prevention.
(4)
changed Medication-assisted treatment defined— For purposes of this section, the term medication-assisted treatment means the use of medication a drug approved by under section 505 of the Food Federal Food, Drug, and Drug Administration Cosmetic Act (21 U.S.C. 355) or a biological product licensed under section 351 of the Public Health Service Act (42 U.S.C. 262), in combination with behavioral health services services, to provide an individualized approach to the treatment of substance use disorders, including opioid use disorder.disorders.
(c)
changed Period of grant— A grant awarded to an eligible health care site entity under this section shall be for a period of at least 2 years.
(d)
Grant uses—
(1)
changed Required uses— A grant awarded under this section to an eligible health care site entity shall be used for both of the following purposes:
(A)
changed To establish policies and procedures that address the provision of overdose reversal medication, the administration prescription and dispensing of medication-assisted treatment to an emergency department patient who has had a non-fatal overdose patient in the emergency department, or who is at risk of a drug overdose, and the subsequent referral to evidence-based treatment upon discharge for patients who have experienced a non-fatal drug overdose or who are at risk of a drug overdose.
(B)
To develop best practices for treating non-fatal drug overdoses, including with respect to care coordination and integrated care models for long term treatment and recovery options for individuals who have experienced a non-fatal drug overdose.
(2)
changed Additional permissible uses— A grant awarded under this section to an eligible health care site entity may be used for any of the following purposes:
(A)
To hire emergency department peer recovery specialists; counselors; therapists; social workers; or other licensed medical professionals specializing in the treatment of substance use disorder.
(B)
To establish integrated models of care for individuals who have experienced a non-fatal drug overdose which may include patient assessment, follow up, and transportation to treatment facilities.
(C)
To provide for options for increasing the availability and access of medication-assisted treatment and other evidence-based treatment for individuals with substance use disorders.
(D)
added To offer consultation with and referral to other supportive services that help in treatment and recovery.
(e)
Reporting requirements—
(1)
changed Reports by grantees— Each eligible health care site entity awarded a grant under this section shall submit to the Secretary an annual report for each year for which the site entity has received such grant that includes information on—
(A)
changed the number of individuals treated at the site (or, in the case of an eligible health care site coordinator, at sites covered by the agreement referred to in subsection (b)(2)(C)(iii)) for non-fatal overdoses in the emergency department;
(B)
changed the number of individuals administered each medication-assisted treatment at the such site or sites in the emergency department;
(C)
changed the number of individuals referred by the such site or sites to other treatment facilities after a non-fatal overdose, the types of such other facilities, and the number of such individuals admitted to such other facilities pursuant to such referrals;
(D)
changed the frequency and number of patient readmissions for non-fatal overdoses and substance abuse use disorder;
(E)
for what the grant funding was used; and
(F)
the effectiveness of, and any other relevant additional data regarding, having an onsite health care professional to administer and begin medication-assisted treatment for substance use disorders.
(2)
changed Report by Secretary— Not less than one 1 year after the conclusion of the Program, the Secretary shall submit to Congress a report that includes—
(A)
findings of the Program;
(B)
overall patient outcomes under the Program, such as with respect to hospital readmission;
(C)
changed what percentage of patients treated by a site receiving funded through a grant under this section were readmitted to a hospital for non-fatal or fatal overdose; andoverdose;
(D)
added an evaluation determining the effectiveness of having a practitioner onsite to administer and begin medication-assisted treatment for substance use disorder; and
(E)
renumbered was (6)(3)(6) a compilation of voluntary guidelines and best practices from the reports submitted under paragraph (1).
(f)
Authorization of appropriations— There is authorized to be appropriated to carry out this Act $50,000,000 for the period of fiscal years 2019 through 2023.