HOUSE CONCURRENT RESOLUTION 96
(By Delegates Anderson, Atkinson, Azinger, Butler, Dean, Ellington, Graves, Harshbarger Higginbotham, Hill, Hollen, Hott, D. Jeffries, Jennings, D. Kelly, J. Kelly, Linville, Mandt, Phillips, Queen, Rowan, Shott, Storch, Toney, Westfall, Wilson and Worrell)
[Introduced March 8, 2019]
Requesting the Centers for Medicare & Medicaid Services (CMS) in Baltimore, MD adopt hospital outpatient payment methodologies that encourage the use of non-opioid pain management therapies in the Hospital Outpatient Department Setting (HOPD).
Whereas, In 2016, West Virginia had the highest rate of opioid-related overdose deaths in the United States― 43.4 deaths per 100,000―up from a low of 1.8 deaths per 100,000 in 1999; and
Whereas, The operating room is an unintentional gateway to opioid misuse, such that 3 million patients prescribed opioids after surgery each year transition to persistent opioid use; and
Whereas, In 2017 alone, 909 West Virginians died of opioid-related overdose deaths; and
Whereas, Current federal rules for Medicare, which provides health care for older West Virginians, limit patient access to non-opioid postsurgical pain management therapies; and
Whereas, Medicare reimburses for outpatient surgeries performed in a hospital with a single payment, which includes payment for non-opioid therapies, while opioids may be paid separately through the pharmacy benefit; and
Whereas, CMS amended its payment rules to pay separately for non-opioid pain management therapies in the Ambulatory Surgical Center setting, but not in the Hospital Outpatient Department Setting; and
Whereas, Due to Certificate of Need restrictions in West Virginia, a large number of outpatient surgeries are performed in the outpatient department of a hospital in lieu of an Ambulatory Surgical Center setting; and
Whereas, The use of opioids to manage post-surgical pain can be significantly reduced when a non-opioid therapy is utilized, be it:
Resolved by the Legislature of West Virginia:
That the Legislature hereby requests the federal government and the Centers for Medicare & Medicaid Services (CMS) amend their payment methodologies to exclude non-opioid pain management therapies from the payment bundle in the Hospital Outpatient Department Setting, similar to recent changes enacted for surgeries performed in Ambulatory Surgical Centers, and provide separate reimbursement for the use of non-opioid pain treatments; and be it
Further Resolved, That the Clerk of the Senate is hereby directed to forward a copy of this resolution to the United States Secretary of Health and Human Services, the Administrator of the Centers for Medicare & Medicaid Services, and to the members of the West Virginia congressional delegation.