NOPAIN Act

II 117TH CONGRESS 1ST SESSION S. 586 To amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treatments in the hospital outpatient setting. IN THE SENATE OF THE UNITED STATES MARCH 4, 2021 Mrs. CAPITO (for herself, Mrs. SHAHEEN, Mr. PORTMAN, and Mr. MANCHIN) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to combat the opioid crisis by promoting access to non-opioid treat- ments in the hospital outpatient setting. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Non-Opioids Prevent 4 Addiction In the Nation Act’’ or the ‘‘NOPAIN Act’’. 5 SEC. 2. ACCESS TO NON-OPIOID TREATMENTS FOR PAIN. 6 (a) IN GENERAL.—Section 1833(t) of the Social Se- 7 curity Act (42 U.S.C. 1395l(t)) is amended— 8 VerDate Sep 11 2014 21:06 Apr 02, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S586.IS S586 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 586 IS (1) in paragraph (2)(E), by inserting ‘‘and sep- 1 arate payments for non-opioid treatments under 2 paragraph (16)(G),’’ after ‘‘payments under para- 3 graph (6)’’; and 4 (2) in paragraph (16), by adding at the end the 5 following new subparagraph: 6 ‘‘(G) ACCESS TO NON-OPIOID TREATMENTS 7 FOR PAIN.— 8 ‘‘(i) IN GENERAL.—Notwithstanding 9 any other provision of this subsection, with 10 respect to a covered OPD service (or group 11 of services) furnished on or after January 12 1, 2022, and before January 1, 2027, the 13 Secretary shall not package, and shall 14 make a separate payment as specified in 15 clause (ii) for, a non-opioid treatment (as 16 defined in clause (iii)) furnished as part of 17 such service (or group of services). 18 ‘‘(ii) AMOUNT OF PAYMENT.—The 19 amount of the payment specified in this 20 clause is, with respect to a non-opioid 21 treatment that is— 22 ‘‘(I) a drug or biological product, 23 the amount of payment for such drug 24 VerDate Sep 11 2014 21:06 Apr 02, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S586.IS S586 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 586 IS or biological determined under section 1 1847A; or 2 ‘‘(II) a medical device, the 3 amount of the hospital’s charges for 4 the device, adjusted to cost. 5 ‘‘(iii) DEFINITION OF NON-OPIOID 6 TREATMENT.—A ‘non-opioid treatment’ 7 means— 8 ‘‘(I) a drug or biological product 9 that is indicated to produce analgesia 10 without acting upon the body’s opioid 11 receptors; or 12 ‘‘(II) an implantable, reusable, or 13 disposable medical device cleared or 14 approved by the Administrator for 15 Food and Drugs for the intended use 16 of managing or treating pain; 17 that has demonstrated the ability to re- 18 place, reduce, or avoid opioid use or the 19 quantity of opioids prescribed in a clinical 20 trial or through data published in a peer- 21 reviewed journal.’’. 22 (b) AMBULATORY SURGICAL CENTER PAYMENT SYS- 23 TEM.—Section 1833(i)(2)(D) of the Social Security Act 24 (42 U.S.C. 1395l(i)(2)(D)) is amended— 25 VerDate Sep 11 2014 21:06 Apr 02, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S586.IS S586 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 586 IS (1) by aligning the margins of clause (v) with 1 the margins of clause (iv); 2 (2) by redesignating clause (vi) as clause (vii); 3 and 4 (3) by inserting after clause (v) the following 5 new clause: 6 ‘‘(vi) In the case of surgical services 7 furnished on or after January 1, 2022, and 8 before January 1, 2027, the payment sys- 9 tem described in clause (i) shall provide, in 10 a budget-neutral manner, for a separate 11 payment for a non-opioid treatment (as de- 12 fined in clause (iii) of subsection 13 (t)(16)(G)) furnished as part of such serv- 14 ices in the amount specified in clause (ii) 15 of such subsection.’’. 16 (c) EVALUATION OF THERAPEUTIC SERVICES FOR 17 PAIN MANAGEMENT.— 18 (1) REPORT TO CONGRESS.—Not later than 1 19 year after the date of the enactment of this Act, the 20 Secretary of Health and Human Services (in this 21 subsection referred to as the ‘‘Secretary’’), acting 22 through the Administrator of the Centers for Medi- 23 care & Medicaid Services, shall submit to Congress 24 a report identifying— 25 VerDate Sep 11 2014 21:06 Apr 02, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S586.IS S586 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 586 IS (A) limitations, gaps, barriers to access, or 1 deficits in Medicare coverage or reimbursement 2 for restorative therapies, behavioral approaches, 3 and complementary and integrative health serv- 4 ices that are identified in the Pain Management 5 Best Practices Inter-Agency Task Force Report 6 and that have demonstrated the ability to re- 7 place or reduce opioid consumption; and 8 (B) recommendations to address the limi- 9 tations, gaps, barriers to access, or deficits 10 identified under subparagraph (A) to improve 11 Medicare coverage and reimbursement for such 12 therapies, approaches, and services. 13 (2) PUBLIC CONSULTATION.—In developing the 14 report described in paragraph (1), the Secretary 15 shall consult with relevant stakeholders as deter- 16 mined appropriate by the Secretary. 17 (3) EXCLUSIVE TREATMENT.—Any drug, bio- 18 logical product, or medical device that is a non- 19 opioid treatment (as defined in section 20 1833(t)(16)(G)(iii) of the Social Security Act, as 21 added by subsection (a)) shall not be considered a 22 therapeutic service for the purpose of the report de- 23 scribed in paragraph (1). 24 Æ VerDate Sep 11 2014 21:06 Apr 02, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\S586.IS S586 pbinns on DSKJLVW7X2PROD with BILLS