119-hr5120

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5120 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 5120

To amend titles XVIII and XIX of the Social Security Act and title 10, 
 United States Code, to provide no-cost coverage for the preventive 
 distribution of opioid overdose reversal drugs.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 September 3, 2025

Ms. Pettersen (for herself and Mrs. Kiggans of Virginia) introduced the 
 following bill; which was referred to the Committee on Energy and 
 Commerce, and in addition to the Committees on Ways and Means, and 
 Armed Services, for a period to be subsequently determined by the 
 Speaker, in each case for consideration of such provisions as fall 
 within the jurisdiction of the committee concerned

_______________________________________________________________________

 A BILL

To amend titles XVIII and XIX of the Social Security Act and title 10, 
 United States Code, to provide no-cost coverage for the preventive 
 distribution of opioid overdose reversal drugs.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

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

SEC. 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) ).''; and
        (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) .''; and
        (B) in subsection

    (k)

    (4) --
            (i) by striking ``If a State plan'' and 
 inserting:
 ``
        (A) In general.--If a State plan''; and
            (ii) 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''; 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.
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