Non-Opioids Prevent Addiction In the Nation Act or the NOPAIN Act
This bill temporarily establishes separate payments for certain non-opioid treatments under the Medicare prospective payment system for hospital outpatient department services and the payment system for ambulatory surgical center services. The bill applies to pain management treatments that are able to replace or reduce opioid consumption, as shown through clinical trials or data.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3067 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
1st Session
S. 3067
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
December 17, 2019
Mrs. Capito (for herself, Mr. Jones, Ms. Ernst, Mrs. Shaheen, 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 treatments in the hospital
outpatient setting.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Non-Opioids Prevent Addiction In the
Nation Act'' or the ``NOPAIN Act''.
SEC. 2. ACCESS TO NON-OPIOID TREATMENTS FOR PAIN.
(a) In General.--Section 1833(t) of the Social Security Act (42
U.S.C. 1395l(t)) is amended--
(1) in paragraph (2)(E), by inserting ``and separate
payments for non-opioid treatments under paragraph (16)(G),''
after ``payments under paragraph (6)''; and
(2) in paragraph (16), by adding at the end the following
new subparagraph:
``(G) Access to non-opioid treatments for pain.--
``(i) In general.--Notwithstanding any
other provision of this subsection, with
respect to a covered OPD service (or group of
services) furnished on or after January 1,
2020, and before January 1, 2025, the Secretary
shall not package, and shall make a separate
payment as specified in clause (ii) for, a non-
opioid treatment (as defined in clause (iii))
furnished as part of such service (or group of
services).
``(ii) Amount of payment.--The amount of
the payment specified in this clause is, with
respect to a non-opioid treatment that is--
``(I) a drug or biological product,
the amount of payment for such drug or
biological determined under section
1847A; or
``(II) a medical device, the amount
of the hospital's charges for the
device, adjusted to cost.
``(iii) Definition of non-opioid
treatment.--A `non-opioid treatment' means--
``(I) a drug or biological product
that is indicated to produce analgesia
without acting upon the body's opioid
receptors; or
``(II) an implantable, reusable, or
disposable medical device cleared or
approved by the Administrator for Food
and Drugs for the intended use of
managing or treating pain,
that has demonstrated the ability to replace or
reduce opioid consumption in a clinical trial
or through clinical data published in a peer-
reviewed journal.''.
(b) Ambulatory Surgical Center Payment System.--Section
1833(i)(2)(D) of the Social Security Act (42 U.S.C. 1395l(i)(2)(D)) is
amended--
(1) by aligning the margins of clause (v) with the margins
of clause (iv);
(2) by redesignating clause (vi) as clause (vii); and
(3) by inserting after clause (v) the following new clause:
``(vi) In the case of surgical services
furnished on or after January 1, 2020, and
before January 1, 2025, the payment system
described in clause (i) shall provide for a
separate payment for a non-opioid treatment (as
defined in clause (iii) of subsection
(t)(16)(G)) furnished as part of such services
in the amount specified in clause (ii) of such
subsection.''.
(c) Evaluation of Therapeutic Services for Pain Management.--
(1) Report to congress.--Not later than 1 year after the
date of the enactment of this Act, the Secretary of Health and
Human Services (in this subsection referred to as the
``Secretary''), acting through the Administrator of the Centers
for Medicare & Medicaid Services, shall submit to Congress a
report identifying--
(A) limitations, gaps, barriers to access, or
deficits in Medicare coverage or reimbursement for
restorative therapies, behavioral approaches, and
complementary and integrative health services that are
identified in the Pain Management Best Practices Inter-
Agency Task Force Report and that have demonstrated the
ability to replace or reduce opioid consumption; and
(B) recommendations to address the limitations,
gaps, barriers to access, or deficits identified under
subparagraph (A) to improve Medicare coverage and
reimbursement for such therapies, approaches, and
services.
(2) Public consultation.--In developing the report
described in paragraph (1), the Secretary shall consult with
relevant stakeholders as determined appropriate by the
Secretary.
(3) Exclusive treatment.--Any drug, biological product, or
medical device that is a non-opioid treatment (as defined in
section 1833(t)(16)(G)(iii) of the Social Security Act, as
added by subsection (a)) shall not be considered a therapeutic
service for the purpose of the report described in paragraph
(1).
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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