H.R. 5774 — what changed
Combating Opioid Abuse for Care in Hospitals Act of 2018
From Reported in House to Engrossed in House. 2 sections amended between Reported in House and Engrossed in House.
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
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
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“(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 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), and under other value-based purchasing programs under this title.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
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“(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), 1886(b)(3)(B)(viii),and in the hospital value-based purchasing program under section 1886(o), and under other value-based purchasing programs under this title.1886(o).
“(4) Prioritization of measure development—The Secretary shall prioritize for measure development the gaps in quality measures identified under paragraph (2)(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:
Sec. 4 Technical expert panel on reducing surgical setting opioid use; Data collection on perioperative opioid use
Technical expert panel on reducing surgical setting opioid use—
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:
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.
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.
Education on the safe use, storage, and disposal of opioids.
Prevention of opioid misuse and abuse after discharge.
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Development of a clinical algorithm to identify and treat at-risk, opiate-tolerant patients and reduce reliance on opiodes opioids for acute pain during the perioperative period.
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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 recommendations 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.
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:
The diagnosis-related group codes identified by the Secretary as having the highest volume of surgeries.
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—
surgical volumes, practices, and opioid prescribing patterns;
opioid consumption, including—
perioperative days of therapy;
average daily dose at the hospital, including dosage greater than 90 milligram morphine equivalent;
post-discharge prescriptions and other combination drugs that are used before intervention and after intervention;
quantity and duration of opioid prescription at discharge; and
quantity consumed and number of refills;
regional anesthesia and analgesia practices, including pre-surgical and post-surgical injections;
naloxone reversal;
post-operative respiratory failure;
information about storage and disposal; and
such other information as the Secretary may specify.
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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.