text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Alternatives to Opioids (ALTO) in 
  the Emergency Department Act''.
  
  SEC. 2. FINDINGS.
  
      The Congress finds as follows:
              (1) Opioids contributed to the deaths of more than 42,000 
          people in 2016, more than any year on official record. Forty 
          percent of all opioid overdose deaths involve a prescription 
          opioid.
              (2) The economic burden of prescription opioid misuse in 
          the United States is estimated to be $78,500,000,000 per year. 
          This includes costs stemming from health care, including 
          addiction treatment, lost productivity, and criminal justice 
          involvement.
              (3) Over 200 million opioid prescriptions are written in 
          the United States each year, and 2,000,000 Americans have the 
          symptoms of substance use disorder.
              (4) Approximately 21 to 29 percent of patients prescribed 
          opioids for chronic pain misuse them.
              (5) Emergency departments in several States, including in 
          New Jersey and Colorado, have developed innovative programs to 
          more widely utilize non-opioid pain treatments to reduce the 
          use of opioids.
  
  SEC. 3. EMERGENCY DEPARTMENT ALTERNATIVES TO OPIOIDS DEMONSTRATION 
                PROGRAM.
  
      (a) Demonstration Program Grants.--The Secretary of Health and 
  Human Services acting through the Assistant Secretary for Mental Health 
  and Substance Use (in this section referred to as the ``Secretary'') 
  shall carry out a 3-year demonstration program under which the 
  Secretary shall award grants to eligible hospitals and emergency 
  departments, including freestanding emergency departments, to develop, 
  implement, enhance, or study alternative pain management protocols and 
  treatments that promote the appropriate limited use of opioids in 
  emergency departments.
      (b) Eligibility.--To be eligible to receive a grant under 
  subsection (a), a hospital or emergency department shall submit an 
  application to the Secretary at such time, in such manner, and 
  containing such information as the Secretary may require.
      (c) Geographic Diversity.--In awarding grants under this section, 
  the Secretary shall seek to ensure geographical diversity among grant 
  recipients.
      (d) Use of Funds.--In addition to the activities described in 
  subsection (a), grants under this section shall be used to--
              (1) target common painful conditions, which may include 
          renal colic, sciatica, headaches, musculoskeletal pain, and 
          extremity fractures;
              (2) train providers and other hospital personnel on 
          protocols and use of treatments that promote the appropriate 
          limited use of opioids in the emergency department;
              (3) collect data, including data required for the reporting 
          requirement established under subsection (f); and
              (4) provide alternatives to opioids to patients with 
          painful conditions, not including patients who present with 
          pain related to cancer, end-of-life symptom palliation, or 
          complex multisystem trauma.
      (e) Duties of the Secretary.--The Secretary shall offer to each 
  recipient of a grant under subsection (a) technical support through a 
  process that provides for--
              (1) the provision of information by the Secretary on 
          alternative pain management protocols and treatments, which may 
          include--
                      (A) non-opioid medications;
                      (B) protocols and treatments that do not involve a 
                  medication;
                      (C) alternative pain management protocols and 
                  treatments that are appropriate to use for specific 
                  common painful conditions, such as renal colic, back 
                  pain, pain from fractures, and other common painful 
                  conditions that present to the emergency department;
                      (D) the alternative pain management protocol or 
                  treatments, if any, that are appropriate for certain 
                  patient populations, such as geriatric patients, 
                  pregnant patients, and pediatric patients; and
                      (E) any other information the Secretary determines 
                  necessary; and
              (2) the provision of information by emergency departments 
          and providers that have successfully implemented alternatives 
          to opioids programs in the emergency department, promoting non-
          opioid protocols and medications while appropriately limiting 
          the use of opioids.
      (f) Report to the Secretary.--Each recipient of a grant under this 
  section shall submit to the Secretary annual evaluations of the 
  progress of the program funded through the grant. These evaluations 
  shall include--
              (1) a description of and specific information about the 
          alternative pain management protocols and treatments employed;
              (2) data on the alternative pain management protocols and 
          treatments employed, including--
                      (A) during a baseline period before the program 
                  began, as defined by the Secretary;
                      (B) at various stages of the program, as determined 
                  by the Secretary;
                      (C) the conditions for which the alternative pain 
                  management protocols and treatments were employed; and
                      (D) data on patients' self-reported pain rating, 
                  using a pain scale model provided by the Secretary, 
                  before and after the alternative pain management 
                  protocol or treatment was provided;
              (3) data on the opioid prescriptions written, including--
                      (A) during a baseline period before the program 
                  began, as defined by the Secretary;
                      (B) at various stages of the program, as determined 
                  by the Secretary;
                      (C) the conditions for which the opioids were 
                  prescribed; and
                      (D) data on patients' self-reported pain rating, 
                  using a pain scale model provided by the Secretary, 
                  before and after the opioid prescription was provided;
              (4) the demographic characteristics of patients who were 
          treated with an alternative pain management protocol, including 
          age, sex, race, ethnicity, and insurance status and type;
              (5) data on patients who were eventually prescribed opioids 
          after alternative pain management protocols and treatments were 
          employed;
              (6) data on patients who were transitioned to inpatient 
          care following treatment with an alternative pain management 
          protocol and treatment; and
              (7) any other information the Secretary deems necessary.
      (g) Report to Congress.--Not later than 120 days after completion 
  of the demonstration program under this section, the Secretary shall 
  submit a report to the Congress on the results of the demonstration 
  program and include in the report--
              (1) the number of applications received and the number 
          funded;
              (2) a summary of the evaluations described in subsection 
          (f), including standardized data; and
              (3) recommendations for broader implementation of pain 
          management protocols that limit the use of opioids in emergency 
          departments or other areas of the health care delivery system.
      (h) Authorization of Appropriations.--To carry out this section, 
  there is authorized to be appropriated $10,000,000 for each of fiscal 
  years 2019 through 2021.
target: Alternatives to Opioids (ALTO) in the Emergency Department Act This bill requires&nbsp;the Department of Health and Human Services to carry out a three-year demonstration program awarding grants to hospitals and emergency departments to develop, implement, enhance, or study alternative pain management protocols and treatments that promote limited use of opioids in emergency departments.
feat_title: Alternatives to Opioids (ALTO) in the Emergency Department Act