H.R. 5197 — what changed

Alternatives to Opioids in the Emergency Department Act

From Introduced in House to Engrossed in House. 2 sections amended and 1 removed between Introduced in House and Engrossed in House.

Section 1 Short title

changed This Act may be cited as the “Alternatives to Opioids (ALTO) in the Emergency Department Act” or the “ALTO Act”.

Sec. 2 Emergency department alternatives to opioids demonstration program

(a)

added Demonstration program grants— The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall carry out a demonstration program under which the Secretary shall award grants to hospitals and emergency departments, including freestanding emergency departments, to develop, implement, enhance, or study alternative pain management protocols and treatments that limit the use and prescription of opioids in emergency departments.

removed The Congress finds as follows:

(b)

changed Eligibility— Opioids contributed To be eligible to receive a grant under subsection (a), a hospital or emergency department shall submit an application to the deaths of more than 42,000 people Secretary at such time, in 2016, more than any year on official record. Forty percent of all opioid overdose deaths involve a prescription opioid.such manner, and containing such information as the Secretary may require.

(c)

changed Geographic diversity— The economic burden of prescription opioid misuse in In awarding grants under this section, the United States is estimated Secretary shall seek to be $78,500,000,000 per year. This includes costs stemming from health care, including addiction treatment, lost productivity, and criminal justice involvement.ensure geographical diversity among grant recipients.

(d)

changed Use of funds— Over 200 million opioid prescriptions are written in the United States each year, and 2,000,000 Americans have the symptoms of substance use disorder.Grants under subsection (a) shall be used to—

(1)

added target common painful conditions, such as renal colic, sciatica, headaches, musculoskeletal pain, and extremity fractures;

(2)

added train providers and other hospital personnel on protocols and the use of treatments that limit the use and prescription of opioids in the emergency department; and

(3)

added provide alternatives to opioids to patients with painful conditions, not including patients who present with pain related to cancer, end-of-life symptom palliation, or complex multisystem trauma.

(e)

changed Consultation— Approximately 21 to 29 percent The Secretary shall implement a process for recipients of patients prescribed opioids grants under subsection (a) to consult (in a manner that allows for chronic sharing of evidence-based best practices) with each other and with persons having robust knowledge, including emergency departments and physicians that have successfully deployed alternative pain misuse them.management protocols, such as non-drug approaches studied through the National Center for Complimentary and Integrative Health including acupuncture that limit the use of opioids. The Secretary shall offer to each recipient of a grant under subsection (a) technical support as necessary.

(f)

changed Report to the Secretary— Emergency departments in several States, including in New Jersey and Colorado, have developed innovative programs to more widely utilize non-opioid pain treatments Each recipient of a grant under this section shall submit to reduce the use Secretary (during the period of opioids.such grant) annual reports on the progress of the program funded through the grant. These reports shall include, in accordance with State and Federal statutes and regulations regarding disclosure of patient information—

(1)

added a description of and specific information about the alternative pain management protocols employed;

(2)

added data on the alternative pain management protocols and treatments employed, including—

(A)

added during a baseline period before the program began, as defined by the Secretary;

(B)

added at various stages of the program, as determined by the Secretary; and

(C)

added the conditions for which the alternative pain management protocols and treatments were employed;

(3)

added the success of each specific alternative pain management protocol;

(4)

added data on the opioid prescriptions written, including—

(A)

added during a baseline period before the program began, as defined by the Secretary;

(B)

added at various stages of the program, as determined by the Secretary; and

(C)

added the conditions for which the opioids were prescribed;

(5)

added the demographic characteristics of patients who were treated with an alternative pain management protocol, including age, sex, race, ethnicity, and insurance status and type;

(6)

added data on patients who were eventually prescribed opioids after alternative pain management protocols and treatments were employed; and

(7)

added any other information the Secretary deems necessary.

(g)

added Report to Congress— Not later than 1 year after completion of the demonstration program under this section, the Secretary shall submit a report to the Congress on the results of the demonstration program and include in the report—

(1)

added the number of applications received and the number funded;

(2)

added a summary of the reports described in subsection (f), including standardized data; and

(3)

added recommendations for broader implementation of pain management protocols that limit the use and prescription of opioids in emergency departments or other areas of the health care delivery system.

(h)

added Authorization of appropriations— To carry out this section, there is authorized to be appropriated $10,000,000 for each of fiscal years 2019 through 2021.

Sec. 3 Emergency department alternatives to opioids demonstration program

removed

(a)

removed Demonstration program grants— The Secretary of Health and Human Services acting through the Assistant Secretary for Mental Health and Substance Use (in this section referred to as the “Secretary”) shall carry out a 3-year demonstration program under which the Secretary shall award grants to eligible hospitals and emergency departments, including freestanding emergency departments, to develop, implement, enhance, or study alternative pain management protocols and treatments that promote the appropriate limited use of opioids in emergency departments.

(b)

removed Eligibility— To be eligible to receive a grant under subsection (a), a hospital or emergency department shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.

(c)

removed Geographic diversity— In awarding grants under this section, the Secretary shall seek to ensure geographical diversity among grant recipients.

(d)

removed Use of funds— In addition to the activities described in subsection (a), grants under this section shall be used to—

(1)

removed target common painful conditions, which may include renal colic, sciatica, headaches, musculoskeletal pain, and extremity fractures;

(2)

removed train providers and other hospital personnel on protocols and use of treatments that promote the appropriate limited use of opioids in the emergency department;

(3)

removed collect data, including data required for the reporting requirement established under subsection (f); and

(4)

removed provide alternatives to opioids to patients with painful conditions, not including patients who present with pain related to cancer, end-of-life symptom palliation, or complex multisystem trauma.

(e)

removed Duties of the secretary— The Secretary shall offer to each recipient of a grant under subsection (a) technical support through a process that provides for—

(1)

removed the provision of information by the Secretary on alternative pain management protocols and treatments, which may include—

(A)

removed non-opioid medications;

(B)

removed protocols and treatments that do not involve a medication;

(C)

removed alternative pain management protocols and treatments that are appropriate to use for specific common painful conditions, such as renal colic, back pain, pain from fractures, and other common painful conditions that present to the emergency department;

(D)

removed the alternative pain management protocol or treatments, if any, that are appropriate for certain patient populations, such as geriatric patients, pregnant patients, and pediatric patients; and

(E)

removed any other information the Secretary determines necessary; and

(2)

removed the provision of information by emergency departments and providers that have successfully implemented alternatives to opioids programs in the emergency department, promoting non-opioid protocols and medications while appropriately limiting the use of opioids.

(f)

removed Report to the secretary— Each recipient of a grant under this section shall submit to the Secretary annual evaluations of the progress of the program funded through the grant. These evaluations shall include—

(1)

removed a description of and specific information about the alternative pain management protocols and treatments employed;

(2)

removed data on the alternative pain management protocols and treatments employed, including—

(A)

removed during a baseline period before the program began, as defined by the Secretary;

(B)

removed at various stages of the program, as determined by the Secretary;

(C)

removed the conditions for which the alternative pain management protocols and treatments were employed; and

(D)

removed data on patients’ self-reported pain rating, using a pain scale model provided by the Secretary, before and after the alternative pain management protocol or treatment was provided;

(3)

removed data on the opioid prescriptions written, including—

(A)

removed during a baseline period before the program began, as defined by the Secretary;

(B)

removed at various stages of the program, as determined by the Secretary;

(C)

removed the conditions for which the opioids were prescribed; and

(D)

removed data on patients’ self-reported pain rating, using a pain scale model provided by the Secretary, before and after the opioid prescription was provided;

(4)

removed the demographic characteristics of patients who were treated with an alternative pain management protocol, including age, sex, race, ethnicity, and insurance status and type;

(5)

removed data on patients who were eventually prescribed opioids after alternative pain management protocols and treatments were employed;

(6)

removed data on patients who were transitioned to inpatient care following treatment with an alternative pain management protocol and treatment; and

(7)

removed any other information the Secretary deems necessary.

(g)

removed Report to Congress— Not later than 120 days after completion of the demonstration program under this section, the Secretary shall submit a report to the Congress on the results of the demonstration program and include in the report—

(1)

removed the number of applications received and the number funded;

(2)

removed a summary of the evaluations described in subsection (f), including standardized data; and

(3)

removed recommendations for broader implementation of pain management protocols that limit the use of opioids in emergency departments or other areas of the health care delivery system.

(h)

removed Authorization of appropriations— To carry out this section, there is authorized to be appropriated $10,000,000 for each of fiscal years 2019 through 2021.