NOPAIN Act

I 117TH CONGRESS 1ST SESSION H. R. 3259 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 HOUSE OF REPRESENTATIVES MAY 14, 2021 Ms. SEWELL (for herself, Mr. MCKINLEY, Ms. KUSTER, and Mr. FITZPATRICK) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 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 VerDate Sep 11 2014 21:46 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3259.IH H3259 tkelley on DSK125TN23PROD with BILLS 2 •HR 3259 IH SEC. 2. ACCESS TO NON-OPIOID TREATMENTS FOR PAIN. 1 (a) IN GENERAL.—Section 1833(t) of the Social Se- 2 curity Act (42 U.S.C. 1395l(t)) is amended— 3 (1) in paragraph (2)(E), by inserting ‘‘and sep- 4 arate payments for non-opioid treatments under 5 paragraph (16)(G),’’ after ‘‘payments under para- 6 graph (6)’’; and 7 (2) in paragraph (16), by adding at the end the 8 following new subparagraph: 9 ‘‘(G) ACCESS TO NON-OPIOID TREATMENTS 10 FOR PAIN.— 11 ‘‘(i) IN GENERAL.—Notwithstanding 12 any other provision of this subsection, with 13 respect to a covered OPD service (or group 14 of services) furnished on or after January 15 1, 2022, and before January 1, 2027, the 16 Secretary shall not package, and shall 17 make a separate payment as specified in 18 clause (ii) for, a non-opioid treatment (as 19 defined in clause (iii)) furnished as part of 20 such service (or group of services). 21 ‘‘(ii) AMOUNT OF PAYMENT.—The 22 amount of the payment specified in this 23 clause is, with respect to a non-opioid 24 treatment that is— 25 VerDate Sep 11 2014 21:46 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3259.IH H3259 tkelley on DSK125TN23PROD with BILLS 3 •HR 3259 IH ‘‘(I) a drug or biological product, 1 the amount of payment for such drug 2 or biological determined under section 3 1847A; or 4 ‘‘(II) a medical device, the 5 amount of the hospital’s charges for 6 the device, adjusted to cost. 7 ‘‘(iii) DEFINITION OF NON-OPIOID 8 TREATMENT.—A ‘non-opioid treatment’ 9 means— 10 ‘‘(I) a drug or biological product 11 that is indicated to produce analgesia 12 without acting upon the body’s opioid 13 receptors; or 14 ‘‘(II) an implantable, reusable, or 15 disposable medical device cleared or 16 approved by the Administrator for 17 Food and Drugs for the intended use 18 of managing or treating pain, 19 that has demonstrated the ability to re- 20 place, reduce, or avoid opioid use or the 21 quantity of opioids prescribed in a clinical 22 trial or through data published in a peer- 23 reviewed journal.’’. 24 VerDate Sep 11 2014 21:46 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3259.IH H3259 tkelley on DSK125TN23PROD with BILLS 4 •HR 3259 IH (b) AMBULATORY SURGICAL CENTER PAYMENT SYS- 1 TEM.—Section 1833(i)(2)(D) of the Social Security Act 2 (42 U.S.C. 1395l(i)(2)(D)) is amended— 3 (1) by aligning the margins of clause (v) with 4 the margins of clause (iv); 5 (2) by redesignating clause (vi) as clause (vii); 6 and 7 (3) by inserting after clause (v) the following 8 new clause: 9 ‘‘(vi) In the case of surgical services 10 furnished on or after January 1, 2022, and 11 before January 1, 2027, the payment sys- 12 tem described in clause (i) shall provide, in 13 a budget-neutral manner, for a separate 14 payment for a non-opioid treatment (as de- 15 fined in clause (iii) of subsection 16 (t)(16)(G)) furnished as part of such serv- 17 ices in the amount specified in clause (ii) 18 of such subsection.’’. 19 (c) EVALUATION OF THERAPEUTIC SERVICES FOR 20 PAIN MANAGEMENT.— 21 (1) REPORT TO CONGRESS.—Not later than 1 22 year after the date of the enactment of this Act, the 23 Secretary of Health and Human Services (in this 24 subsection referred to as the ‘‘Secretary’’), acting 25 VerDate Sep 11 2014 21:46 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3259.IH H3259 tkelley on DSK125TN23PROD with BILLS 5 •HR 3259 IH through the Administrator of the Centers for Medi- 1 care & Medicaid Services, shall submit to Congress 2 a report identifying— 3 (A) limitations, gaps, barriers to access, or 4 deficits in Medicare coverage or reimbursement 5 for restorative therapies, behavioral approaches, 6 and complementary and integrative health serv- 7 ices that are identified in the Pain Management 8 Best Practices Inter-Agency Task Force Report 9 and that have demonstrated the ability to re- 10 place or reduce opioid consumption; and 11 (B) recommendations to address the limi- 12 tations, gaps, barriers to access, or deficits 13 identified under subparagraph (A) to improve 14 Medicare coverage and reimbursement for such 15 therapies, approaches, and services. 16 (2) PUBLIC CONSULTATION.—In developing the 17 report described in paragraph (1), the Secretary 18 shall consult with relevant stakeholders as deter- 19 mined appropriate by the Secretary. 20 (3) EXCLUSIVE TREATMENT.—Any drug, bio- 21 logical product, or medical device that is a non- 22 opioid treatment (as defined in section 23 1833(t)(16)(G)(iii) of the Social Security Act, as 24 added by subsection (a)) shall not be considered a 25 VerDate Sep 11 2014 21:46 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3259.IH H3259 tkelley on DSK125TN23PROD with BILLS 6 •HR 3259 IH therapeutic service for the purpose of the report de- 1 scribed in paragraph (1). 2 Æ VerDate Sep 11 2014 21:46 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\H3259.IH H3259 tkelley on DSK125TN23PROD with BILLS