Sec. 6065. Commit to opioid medical prescriber accountability and safety for seniors

752 words·~3 min read·/bill/115/hr/6/eah/section-6065

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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 subparagraph: Not later than January 1, 2021, 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 as specified in accordance with clause (iii). 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 thresholds established under subclause (II), identify prescribers that are outlier opioids prescribers for a period of time specified by the Secretary. For purposes of subclause

(I)and subject to subclause (III), the Secretary shall, after consultation with stakeholders, establish thresholds, 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 following shall not be included in the analysis for identifying outlier prescribers of opioids under this clause: Claims for covered part D drugs for part D eligible individuals who are receiving hospice care under this title. Claims for covered part D drugs for part D eligible individuals who are receiving oncology services under this title. Prescribers who are the subject of an investigation by the Centers for Medicare & Medicaid Services or the Inspector General of the Department of Health and Human Services. The Secretary shall include the following information in the notifications provided under clause (i): Information on how such prescriber compares to other prescribers within the same specialty and geographic area. Information on opioid prescribing guidelines, based on input from stakeholders, that may include the Centers for Disease Control and Prevention guidelines for prescribing opioids for chronic pain and guidelines developed by physician organizations. Other information determined appropriate by the Secretary. 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 and changes in opioid prescribing utilization and trends. 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. In the case of a prescriber who the Secretary determines is persistently identified under clause

(ii)as an outlier prescriber of opioids, the following shall apply: Such prescriber may be required to enroll in the program under this title under section 1866(j) if such prescriber is not otherwise required to enroll, but only after other appropriate remedies have been provided, such as the provision of education funded through section 6052 of the SUPPORT for Patients and Communities Act, for a period determined by the Secretary as sufficient to correct the prescribing patterns that lead to identification of such prescriber as a persistent outlier prescriber of opioids. The Secretary shall determine the length of the period for which such prescriber is required to maintain such enrollment, which shall be the minimum period necessary to correct such prescribing patterns. Not less frequently than annually (and in a form and manner determined appropriate by the Secretary), the Secretary, consistent with clause(iv)(I), shall communicate information on such prescribers to sponsors of a prescription drug plan and Medicare Advantage organizations offering an MA–PD plan. The Secretary shall make aggregate information under this subparagraph available on the internet website of the Centers for Medicare & Medicaid Services. Such information shall be in a form and manner determined appropriate by the Secretary and shall not identify any specific prescriber. In carrying out this clause, the Secretary shall consult with interested stakeholders. For purposes of this subparagraph, the term opioids has such meaning as specified by the Secretary. Nothing in this subparagraph shall preclude the Secretary from conducting activities that provide prescribers with information as to how they compare to other prescribers that are in addition to the activities under this subparagraph, including activities that were being conducted as of the date of the enactment of this subparagraph. .

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42 USC 1395w–104(c)(4)

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Sec. 6065

Commit to opioid medical prescriber accountability and safety for seniors

Cite42 USC 1395w–104(c)(4)

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