119-HR5120

Bill is currently in: House
Path to Law
House Senate President

119th CONGRESS

1st Session

H. R. 5120

1. Short title
2. No-cost coverage of preventive opioid overdose reversal drugs

1. Short title

This Act may be cited as the "Hospitals As Naloxone Distribution Sites Act" or the "HANDS Act".

2. No-cost coverage of preventive opioid overdose reversal drugs

(a) Coverage under Medicare -

(1) Coverage - Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended—

(A) - in subparagraph (JJ), by adding "and" after the semicolon at the end; and

(B) - by adding at the end the following new subparagraph:

(KK) - a preventive opioid overdose reversal drug (as defined in subsection (nnn)) furnished on or after January 1, 2026;

(2) Preventive opioid overdose reversal drug defined - Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:

(nnn) Preventive opioid overdose reversal drug - The term preventive opioid overdose reversal drug means an opioid overdose reversal drug, which may be either intranasal or intramuscular, that is furnished by a physician, nurse practitioner, physician assistant, or other attending clinical personnel (as determined by the Secretary by regulation) to an individual who is an inpatient of a hospital, critical access hospital, or rural emergency hospital, or is a patient of the emergency department of such a hospital or an ambulatory surgical center, but only if—

(1) - such physician, nurse practitioner, physician assistant, or attending clinical professional determines that such individual is at risk for an opioid overdose; and

(2) - such drug is furnished at the time such individual is discharged from the hospital or leaves the emergency department or ambulatory surgical center, as the case may be, together with instructions for the administration of such drug.

(3) Prohibition of cost sharing - Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended—

(A) - in subsection (a)(1)—

(i) - in subparagraph (S)(i), by striking "subparagraph (EE)," and inserting "subparagraphs (EE) and (II),";

(ii) - in subparagraph (GG), by striking "and" at the end; and

(iii) - by inserting ", and (II) with respect to a preventive opioid overdose reversal drug (as defined in section 1861(nnn)) furnished on or after January 1, 2026, the amounts paid shall be 100 percent of the lesser of the actual charges for such drug or the amount determined under section 1842(o)" before the semicolon at the end; and

(B) - in subsection (b)—

(i) - by striking ", and (13)" and inserting "(13)"; and

(ii) - by striking "section 1861(n).." and inserting "section 1861(n), and (14) such deductible shall not apply with respect to a preventive opioid reversal drug (as defined in section 1861(nnn)) furnished on or after January 1, 2026.".

(4) Prohibition of cost sharing for Medicare Advantage plans - Section 1852(a)(1)(B) of the Social Security Act (42 U.S.C. 1395w–22(a)(1)(B)) is amended—

(A) - in clause (iv)—

(i) - by redesignating subclause (VIII) as subclause (IX); and

(ii) - by inserting after subclause (VII) the following new subclause:

(VIII) - A preventive opioid reversal drug (as defined in section 1861(nnn)).

(B) - in clause (v), by striking "and (VI)" and inserting "(VI), and (VIII)".

(b) Coverage under Medicaid -

(1) Mandatory coverage -

(A) In general - Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by striking "and (30)" and inserting "(30), and (32)".

(B) Alternative benefit plans - Section 1937(b) of the Social Security Act (42 U.S.C. 1396u–7(b)) is amended by adding at the end the following new paragraph:

(9) Preventive opioid overdose reversal drugs - Notwithstanding the previous provisions of this section, a State may not provide for medical assistance through enrollment of an individual with benchmark coverage or benchmark-equivalent coverage under this section unless, beginning on January 1, 2026, such coverage includes (and does not impose any deduction, cost sharing, or similar charge for) preventive opioid overdose reversal drugs described in section 1861(nnn).

(2) Inclusion in medical assistance -

(A) In general - Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended—

(i) - in paragraph (31), by striking "and" at the end;

(ii) - by redesignating paragraph (32) as paragraph (33); and

(iii) - by inserting after paragraph (31) the following new paragraph:

(32) - beginning January 1, 2026, preventive opioid overdose reversal drugs described in section 1861(nnn); and

(3) Application of rebate requirements - Section 1927 of the Social Security Act (42 U.S.C. 1396r–8) is amended—

(A) - in subsection (d)(7), by adding at the end the following new subparagraph:

(F) - Preventive opioid overdose reversal drugs described in section 1861(nnn) that are furnished as medical assistance in accordance with section 1905(a)(32) and section 1902(a)(10)(A).

(B) In general - in subsection (k)(4)—

(i) In general - by striking "If a State plan" and inserting:

(A) In general - If a State plan

(ii) Preventive opioid overdose reversal drugs - by adding at the end the following new subparagraph:

(B) Preventive opioid overdose reversal drugs - Beginning January 1, 2026, in applying paragraph (2)(A) to a preventive opioid overdose reversal drug described in section 1861(nnn), such drug shall be deemed a prescribed drug for purposes of section 1905(a)(12).

(4) Prohibition of cost sharing -

(A) In general - Section 1916 of the Social Security Act (42 U.S.C. 1396o) is amended—

(i) - in subsection (a)(2)—

(I) - in subparagraph (I), by striking "or" at the end;

(II) - in subparagraph (J), by striking "; and" at the end and inserting ", or"; and

(III) - by adding at the end the following new subparagraph:

(K) - beginning January 1, 2026, preventive opioid overdose reversal drugs described in section 1861(nnn); and

(ii) - in subsection (b)(2)—

(I) - in subparagraph (I), by striking "or" at the end;

(II) - in subparagraph (J), by striking "; and" at the end and inserting ", or"; and

(III) - by adding at the end the following new subparagraph:

(K) - beginning January 1, 2026, preventive opioid overdose reversal drugs described in section 1861(nnn); and

(B) Application to alternative cost sharing - Section 1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended by adding at the end the following new clause:

(xv) - Beginning January 1, 2026, preventive opioid overdose reversal drugs described in section 1861(nnn).

(c) Coverage under TRICARE - Section 1074g of title 10, United States Code, is amended as follows:

(1) - In subsection (a)(6), by adding at the end the following new subparagraph:

(F) - Notwithstanding subparagraphs (A), (B), and (C), beginning on January 1, 2026, an eligible covered beneficiary shall not be required to pay a cost-sharing amount for a preventive opioid overdose reversal drug.

(2) - In subsection (i), by adding at the end the following new paragraph:

(5) - The term preventive opioid overdose reversal drug has the meaning given such term in section 1861 of the Social Security Act (42 U.S.C. 1395x).

(d) Regulatory guidance -

(1) State boards - Not later than 1 year after the date of the enactment of this Act, the Commissioner of Food and Drugs shall issue guidance for State boards of pharmacy, nursing, and medicine with respect to—

(A) - enhancing safe and effective hospital-based dispensing and distribution of opioid overdose reversal drugs; and

(B) - eliminating barriers to such dispensing and distribution.

(2) Hospital - Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall issue guidance for hospitals with respect to billing for preventive opioid overdose reversal drugs described in section 1861(nnn) of the Social Security Act, as added by subsection (a)(2).

(e) Rule of construction - Nothing in this section shall be construed to require a provider of services or supplier to furnish a preventive opioid overdose reversal drug described in section 1861(nnn) of the Social Security Act, as added by subsection (a)(2), to an individual at risk of an opioid overdose.