Sec. 6086. Dr. Todd Graham pain management study
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Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services (referred to in this section as the “Secretary”) shall conduct a study analyzing best practices as well as payment and coverage for pain management services under title XVIII of the Social Security Act and submit to the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a report containing options for revising payment to providers and suppliers of services and coverage related to the use of multi-disciplinary, evidence-based, non-opioid treatments for acute and chronic pain management for individuals entitled to benefits under part A or enrolled under part B of title XVIII of the Social Security Act.
The Secretary shall make such report available on the public website of the Centers for Medicare & Medicaid Services. In developing the report described in subsection (a), the Secretary shall consult with— relevant agencies within the Department of Health and Human Services; licensed and practicing osteopathic and allopathic physicians, behavioral health practitioners, physician assistants, nurse practitioners, dentists, pharmacists, and other providers of health services; providers and suppliers of services (as such terms are defined in section 1861 of the Social Security Act ( 42 U.S.C. 1395x )); substance abuse and mental health professional organizations; pain management professional organizations and advocacy entities, including individuals who personally suffer chronic pain; medical professional organizations and medical specialty organizations; licensed health care providers who furnish alternative pain management services; organizations with expertise in the development of innovative medical technologies for pain management; beneficiary advocacy organizations; and other organizations with expertise in the assessment, diagnosis, treatment, and management of pain, as determined appropriate by the Secretary.
The report described in subsection
(a)shall include the following: An analysis of payment and coverage under title XVIII of the Social Security Act with respect to the following: Evidence-based treatments and technologies for chronic or acute pain, including such treatments that are covered, not covered, or have limited coverage under such title. Evidence-based treatments and technologies that monitor substance use withdrawal and prevent overdoses of opioids. Evidence-based treatments and technologies that treat substance use disorders. Items and services furnished by practitioners through a multi-disciplinary treatment model for pain management, including the patient-centered medical home. Items and services furnished to beneficiaries with psychiatric disorders, substance use disorders, or who are at risk of suicide, or have comorbidities and require consultation or management of pain with one or more specialists in pain management, mental health, or addiction treatment. An evaluation of the following: Barriers inhibiting individuals entitled to benefits under part A or enrolled under part B of such title from accessing treatments and technologies described in subparagraphs
(A)through
(E)of paragraph (1). Costs and benefits associated with potential expansion of coverage under such title to include items and services not covered under such title that may be used for the treatment of pain, such as acupuncture, therapeutic massage, and items and services furnished by integrated pain management programs. Pain management guidance published by the Federal Government that may be relevant to coverage determinations or other coverage requirements under title XVIII of the Social Security Act. An assessment of all guidance published by the Department of Health and Human Services on or after January 1, 2016, relating to the prescribing of opioids. Such assessment shall consider incorporating into such guidance relevant elements of the Va/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain published in February 2017 by the Department of Veterans Affairs and Department of Defense, including adoption of elements of the Department of Defense and Department of Veterans Affairs pain rating scale. The options described in subsection (d). The impact analysis described in subsection (e). The options described in this subsection are, with respect to individuals entitled to benefits under part A or enrolled under part B of title XVIII of the Social Security Act, legislative and administrative options for accomplishing the following: Improving coverage of and payment for pain management therapies without the use of opioids, including interventional pain therapies, and options to augment opioid therapy with other clinical and complementary, integrative health services to minimize the risk of substance use disorder, including in a hospital setting. Improving coverage of and payment for medical devices and non-opioid based pharmacological and non-pharmacological therapies approved or cleared by the Food and Drug Administration for the treatment of pain as an alternative or augment to opioid therapy. Improving and disseminating treatment strategies for beneficiaries with psychiatric disorders, substance use disorders, or who are at risk of suicide, and treatment strategies to address health disparities related to opioid use and opioid abuse treatment. Improving and disseminating treatment strategies for beneficiaries with comorbidities who require a consultation or comanagement of pain with one or more specialists in pain management, mental health, or addiction treatment, including in a hospital setting. Educating providers on risks of coadministration of opioids and other drugs, particularly benzodiazepines. Ensuring appropriate case management for beneficiaries who transition between inpatient and outpatient hospital settings, or between opioid therapy to non-opioid therapy, which may include the use of care transition plans. Expanding outreach activities designed to educate providers of services and suppliers under the Medicare program and individuals entitled to benefits under part A or under part B of such title on alternative, non-opioid therapies to manage and treat acute and chronic pain. Creating a beneficiary education tool on alternatives to opioids for chronic pain management. The impact analysis described in this subsection consists of an analysis of any potential effects implementing the options described in subsection
(d)would have— on expenditures under the Medicare program; and on preventing or reducing opioid addiction for individuals receiving benefits under the Medicare program.
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Sec. 6086
Dr. Todd Graham pain management study
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