H. R. 5716
IN THE HOUSE OF REPRESENTATIVES
May 9, 2018
Mr. Roskam (for himself, Mr. Larson of Connecticut, Mrs. Brooks of Indiana, and Mr. Welch) 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
To amend title XVIII of the Social Security Act to require the Secretary of Health and Human Services to provide notifications under the Medicare program to outlier prescribers of opioids.
This Act may be cited as the
Commit to Opioid Medical Prescriber Accountability and Safety for Seniors Act or the
Medicare notifications to outlier prescribers of opioids
Section 1860D–4(c)(4) of the Social Security Act (42 U.S.C. 1395w–104(c)(4)) is amended by adding at the end the following new paragraph:
Outlier prescriber notification
Beginning not later than two years after the date of the enactment of this subparagraph, the Secretary shall, in the case of a prescriber identified by the Secretary under clause (ii) to be an outlier prescriber of opioids, provide, subject to clause (iv), an annual notification to such prescriber that such prescriber has been so identified and that includes resources on proper prescribing methods and other information specified in accordance with clause (iii).
Identification of outlier prescribers of opioids
The Secretary shall, subject to subclause (III), using the valid prescriber National Provider Identifiers included pursuant to subparagraph (A) on claims for covered part D drugs for part D eligible individuals enrolled in prescription drug plans under this part or MA–PD plans under part C and based on the threshold established under subclause (II), conduct an analysis to identify prescribers that are outlier opioid prescribers for a period specified by the Secretary.
Establishment of threshold
For purposes of subclause (I) and subject to subclause (III), the Secretary shall, after consultation with stakeholders, establish a threshold, based on prescriber specialty and geographic area, for identifying whether a prescriber in a specialty and geographic area is an outlier prescriber of opioids as compared to other prescribers of opioids within such specialty and area.
The Secretary may exclude the following individuals and prescribers from the analysis under this clause:
Individuals receiving hospice services.
Individuals with a cancer diagnosis.
Prescribers who are the subject of an investigation by the Centers for Medicare & Medicaid Services or the Office of Inspector General of the Department of Health and Human Services.
Contents of notification
The Secretary shall, based on input from stakeholders, specify the resources and other information to be included in notifications provided under clause (i).
Modifications and expansions
Beginning 5 years after the date of the enactment of this subparagraph, the Secretary may change the frequency of the notifications described in clause (i) based on stakeholder input.
Expansion to other prescriptions
The Secretary may expand notifications under this subparagraph to include identifications and notifications with respect to concurrent prescriptions of covered Part D drugs used in combination with opioids that are considered to have adverse side effects when so used in such combination, as determined by the Secretary.
For purposes of this subparagraph, the term opioids has such meaning as specified by the Secretary through program instruction or otherwise.