HR5120-119

What This Bill Does

The HANDS Act makes take-home opioid overdose reversal drugs a covered, no-cost preventive service in federal health programs. It defines a preventive opioid overdose reversal drug as an intranasal or intramuscular overdose reversal drug furnished by a physician, nurse practitioner, physician assistant, or other attending clinical personnel to a hospital inpatient, critical access hospital patient, rural emergency hospital patient, emergency department patient, or ambulatory surgical center patient when the clinician determines the person is at risk of opioid overdose. The drug must be provided when the person is discharged or leaves the emergency department or ambulatory surgical center, together with administration instructions. Beginning January 1, 2026, Medicare pays 100 percent of the lesser of actual charges or the section 1842(o) amount and the deductible does not apply. Medicare Advantage must cover the service. Medicaid state plans and benchmark coverage must include the drugs without deductions, cost-sharing, or similar charges, the drugs are treated as prescribed drugs for Medicaid purposes, and Medicaid cost-sharing sections are amended to protect the coverage.

Who Benefits and How

Medicare patients at opioid overdose risk benefit because take-home reversal drugs are covered with no deductible at discharge or emergency departure. Medicaid enrollees at opioid overdose risk benefit because state plans and benchmark coverage must include the drugs without cost-sharing. Hospitals and emergency departments benefit from a clear payment path for providing naloxone or similar reversal drugs before patients leave care. Families of overdose-risk patients benefit if patients leave facilities with medication and instructions that can reverse an overdose.

Who Bears the Burden and How

CMS Medicare payment staff must create payment and deductible rules for the new preventive service. Medicare Advantage plans must add coverage for preventive opioid overdose reversal drugs. State Medicaid agencies must update state plans, benchmark coverage, cost-sharing rules, and drug treatment beginning January 1, 2026. Federal taxpayers bear increased costs from broader no-cost coverage of overdose reversal drugs.

Key Provisions

• Adds preventive opioid overdose reversal drugs to Medicare covered medical services.
• Defines covered drugs as intranasal or intramuscular overdose reversal drugs furnished at discharge or departure to patients at overdose risk.
• Provides 100 percent Medicare payment and no deductible beginning January 1, 2026.
• Requires Medicare Advantage coverage for the new service.
• Requires Medicaid and benchmark coverage without deductions, cost-sharing, or similar charges.