79–008 

115TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 115–766 

PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 6) TO PROVIDE FOR 

OPIOID USE DISORDER PREVENTION, RECOVERY, AND TREATMENT, 

AND FOR OTHER PURPOSES; PROVIDING FOR CONSIDERATION OF THE 

BILL (H.R. 5797) TO AMEND TITLE XIX OF THE SOCIAL SECURITY ACT TO 

ALLOW STATES TO PROVIDE UNDER MEDICAID SERVICES FOR CERTAIN 

INDIVIDUALS WITH OPIOID USE DISORDERS IN INSTITUTIONS FOR MENTAL DISEASES; AND PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 

6082) TO AMEND THE PUBLIC HEALTH SERVICE ACT TO PROTECT THE 

CONFIDENTIALITY OF SUBSTANCE USE DISORDER PATIENT RECORDS 

JUNE 19, 2018.—Referred to the House Calendar and ordered to be printed 

Mr. BURGESS, from the Committee on Rules, 

submitted the following 

R E P O R T 

[To accompany H. Res. 949] 

The Committee on Rules, having had under consideration House 

Resolution 949, by a record vote of 7 to 3, report the same to the 

House with the recommendation that the resolution be adopted. 

SUMMARY OF PROVISIONS OF THE RESOLUTION

The resolution provides for consideration of H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and 

Treatment for Patients and Communities Act, under a structured 

rule. The resolution provides one hour of general debate equally divided and controlled by the chair and ranking minority member of 

the Committee on Committee on Energy and Commerce. The resolution waives all points of order against consideration of the bill. 

The resolution provides that an amendment in the nature of a substitute consisting of the text of Rules Committee Print 115–76, 

modified by Rules Committee Print 115–78 and the amendment 

printed in part A of this report, shall be considered as adopted and 

the bill, as amended, shall be considered as read. The resolution 

waives all points of order against provisions in the bill, as amended. The resolution makes in order only those further amendments 

printed in part B of this report. Each such amendment may be offered only in the order printed in this report, may be offered only 

by a Member designated in this report, shall be considered as read, 

shall be debatable for the time specified in this report equally divided and controlled by the proponent and an opponent, shall not 

be subject to amendment, and shall not be subject to a demand for 


dlhill on DSK3GLQ082PROD with HEARING
2 

division of the question in the House or in the Committee of the 

Whole. The resolution waives all points of order against the amendments printed in part B of this report. The resolution provides one 

motion to recommit with or without instructions. 

Section 2 of the resolution provides for consideration of H.R. 

5797, the Individuals in Medicaid Deserve Care that is Appropriate 

and Responsible in its Delivery Act, under a structured rule. The 

resolution provides one hour of general debate equally divided and 

controlled by the chair and ranking minority member of the Committee on Energy and Commerce. The resolution waives all points 

of order against consideration of the bill. The resolution provides 

that the amendment in the nature of a substitute recommended by 

the Committee on Energy and Commerce now printed in the bill, 

modified by the amendment printed in part C of this report, shall 

be considered as adopted and the bill, as amended, shall be considered as read. The resolution waives all points of order against provisions in the bill, as amended. The resolution makes in order only 

those further amendments printed in part D of this report. Each 

such amendment may be offered only in the order printed in this 

report, may be offered only by a Member designated in this report, 

shall be considered as read, shall be debatable for the time specified in this report equally divided and controlled by the proponent 

and an opponent, shall not be subject to amendment, and shall not 

be subject to a demand for division of the question in the House 

or in the Committee of the Whole. The resolution waives all points 

of order against the amendments printed in part D of this report. 

The resolution provides one motion to recommit with or without instructions. 

Section 3 of the resolution provides for consideration of H.R. 

6082, the Overdose Prevention and Patient Safety Act, under a 

closed rule. The resolution provides one hour of debate equally divided and controlled by the chair and ranking minority member of 

the Committee on Energy and Commerce. The resolution waives all 

points of order against consideration of the bill. The resolution provides that an amendment in the nature of a substitute consisting 

of the text of Rules Committee Print 115–75 shall be considered as 

adopted, and the bill, as amended, shall be considered as read. The 

resolution waives all points of order against provisions in the bill, 

as amended. The resolution provides one motion to recommit with 

or without instructions. 

Section 4 the resolution directs the Clerk to, in the engrossment 

of H.R. 6, add the text of H.R. 2851, H.R. 5735, and H.R. 5797 as 

passed by the House as a new matter at the end of H.R. 6 and 

make technical and conforming modifications in the engrossment. 

EXPLANATION OF WAIVERS

The waiver of all points of order against consideration of H.R. 6 

includes a waiver of the following: 

Section 302(f) of the Congressional Budget Act, which prohibits 

consideration of legislation providing new budget authority in excess of a 302(a) allocation of such authority; and 

Section 306 of the Congressional Budget Act, which prohibits 

consideration of legislation within the jurisdiction of the Committee 

on the Budget unless referred to or reported by the Budget Committee; and 


dlhill on DSK3GLQ082PROD with HEARING
3 

Section 311 of the Congressional Budget Act, which prohibits 

consideration of legislation that would cause the level of total new 

budget authority for the first fiscal year to be exceeded, or would 

cause revenues to be less than the level of total revenues for the 

first fiscal year or for the total of that first fiscal year and the ensuing fiscal years for which allocations are provided. 

Although the resolution waives all points of order against provisions in H.R. 6, as amended, the Committee is not aware of any 

points of order. The waiver is prophylactic in nature. 

Although the resolution waives all points of order against the 

amendments to H.R. 6 printed in part B of this report, the Committee is not aware of any points of order. The waiver is prophylactic in nature. 

The waiver of all points of order against consideration of H.R. 

5797 includes a waiver of the following: 

Section 302(f) of the Congressional Budget Act, which prohibits 

consideration of legislation providing new budget authority in excess of a 302(a) allocation of such authority; and 

Section 311 of the Congressional Budget Act, which prohibits 

consideration of legislation that would cause the level of total new 

budget authority for the first fiscal year to be exceeded. 

Although the resolution waives all points of order against provisions in H.R. 5797, as amended, the Committee is not aware of any 

points of order. The waiver is prophylactic in nature. 

Although the resolution waives all points of order against the 

amendments to H.R. 5797 printed in Part D of this report, the 

Committee is not aware of any points of order. The waiver is prophylactic in nature. 

Although the resolution waives all points of order against consideration of the H.R. 6082, the Committee is not aware of any points 

of order. The waiver is prophylactic in nature. 

Although the resolution waives all points of order against provisions in H.R. 6082, as amended, the Committee is not aware of any 

points of order. The waiver is prophylactic. 

Rules Committee record vote No. 236 

Motion by Mr. McGovern to make in order and provide the appropriate waivers to amendment # 7 to H.R. 5797, offered by Rep. 

Kennedy (MA), which expands the eligible population to individuals with all substance use disorders; whereas the current bill only 

makes eligible those individuals with opioid use disorder. Additionally, it would require states to provide the full continuum of care 

so that patients have access to critical services when they are discharged from IMDs. Defeated: 3–7 

Majority Members Vote Minority Members Vote 

Mr. Cole ........................................................ ....................... Mr. McGovern ............................................... Yea 

Mr. Woodall .................................................. Nay Mr. Hastings of Florida ............................... Yea 

Mr. Burgess .................................................. Nay Mr. Polis ....................................................... .......................

Mr. Collins .................................................... ....................... Mrs. Torres ................................................... Yea 

Mr. Byrne ...................................................... Nay 

Mr. Newhouse ............................................... Nay 

Mr. Buck ....................................................... Nay 

Ms. Cheney ................................................... Nay 

Mr. Sessions, Chairman ............................... Nay 


dlhill on DSK3GLQ082PROD with HEARING
4 

Rules Committee record vote No. 237 

Motion by Mr. Hastings of Florida to make in order and provide 

the appropriate waivers to amendment #9 to H.R. 5797, offered by 

Rep. Waters (CA), which requires states to expand Medicaid pursuant to the Affordable Care Act as a condition for using Medicaid 

funds to treat people with opioid abuse disorders in Institutions for 

Mental Disease (IMDs). Defeated: 3–7 

Majority Members Vote Minority Members Vote 

Mr. Cole ........................................................ ....................... Mr. McGovern ............................................... Yea 

Mr. Woodall .................................................. Nay Mr. Hastings of Florida ............................... Yea 

Mr. Burgess .................................................. Nay Mr. Polis ....................................................... .......................

Mr. Collins .................................................... ....................... Mrs. Torres ................................................... Yea 

Mr. Byrne ...................................................... Nay 

Mr. Newhouse ............................................... Nay 

Mr. Buck ....................................................... Nay 

Ms. Cheney ................................................... Nay 

Mr. Sessions, Chairman ............................... Nay 

Rules Committee record vote No. 238 

Motion by Mr. Woodall to report the rule. Adopted: 7–3 

Majority Members Vote Minority Members Vote 

Mr. Cole ........................................................ ....................... Mr. McGovern ............................................... Nay 

Mr. Woodall .................................................. Yea Mr. Hastings of Florida ............................... Nay 

Mr. Burgess .................................................. Yea Mr. Polis ....................................................... .......................

Mr. Collins .................................................... ....................... Mrs. Torres ................................................... Nay 

Mr. Byrne ...................................................... Yea 

Mr. Newhouse ............................................... Yea 

Mr. Buck ....................................................... Yea 

Ms. Cheney ................................................... Yea 

Mr. Sessions, Chairman ............................... Yea 

SUMMARY OF THE AMENDMENT TO H.R. 6 IN PART A CONSIDERED AS

ADOPTED

1. Walden (OR): Makes a technical correction to ensure that the 

matter incorporated into H.R. 6 is identical to the legislation previously adopted by the House. 

SUMMARY OF THE AMENDMENTS TO H.R. 6 IN PART B MADE IN ORDER

1. Walden (OR), Pallone (NJ), Brady, Kevin (TX), Neal (MA): 

Calls for Medicaid, Medicare, and public health reforms to help 

combat the opioid crisis. The policies contained in H.R. 6 were advanced through regular order by the House Energy and Commerce 

and Ways and Means Committees. (10 minutes) 

2. Dunn (FL), Marshall (KS), Harris (MD), Roe (TN): Strikes language expanding the classes of health care workers who are authorized to dispense narcotics for narcotic treatment. (10 minutes) 

3. Barton (TX), Meadows (NC), Kuster, Ann (NH): Directs the 

Commissioner of Food and Drugs to develop high-quality, evidencebased opioid analgesic prescribing guidelines for the indication-specific treatment of acute pain. In developing such guidelines, it 

would require the Commissioner of Food and Drugs to gather input 

through a public workshop and comment period, and to provide a 

report to Congress on how such guidelines will be used to protect 

the public health. (10 minutes) 


dlhill on DSK3GLQ082PROD with HEARING
5 

4. Curtis, John (UT): Requires a report from HHS on opioid prescribing practices and opioid misuse during pregnancy, and evaluating non-opiate pain management practices during pregnancy. (10 

minutes) 

5. Keating (MA), Rothfus (PA): Directs HHS to issue guidelines 

for prescribing naloxone in situations involving any type of prescription or illicit opioid use. (10 minutes) 

6. Meadows (NC): Requires the Government Accountability Office 

to conduct a comprehensive report on health care policy changes 

that may have contributed to the increase in opioid overdoses and 

deaths. (10 minutes) 

7. Waters (CA): Directs the Secretary of Health and Human 

Services (HHS) to conduct a survey of organizations that provide 

substance abuse treatment services. Under the amendment, HHS 

is required to develop, and submit to Congress, a plan to direct appropriate resources to address inadequacies in services or funding 

for specific types of drug addictions identified through the survey. 

(10 minutes) 

8. Turner (OH), Kuster, Ann (NH): Eliminates Substance Abuse 

and Mental Health Services Administration’s (SAMHSA) policy 

that prevents SAMHSA funding from going toward substance 

abuse treatment services for individuals who are incarcerated. (10 

minutes) 

SUMMARY OF THE AMENDMENT TO H.R. 5797 IN PART C CONSIDERED

AS ADOPTED

1. Walters, Mimi (CA): Provides an incentive for states to voluntarily adopt a medical loss ratio (MLR) requirement for their Medicaid managed care organizations (MCOs) of 85 percent. 

SUMMARY OF THE AMENDMENTS TO H.R. 5797 IN PART D MADE IN

ORDER

1. Rush (IL): Expands treatment coverage to individuals suffering from cocaine use disorder (which includes crack cocaine). (10 

minutes) 

2. Kildee (MI): Adds two requirements to the report that states 

are required to submit. The first would be information regarding 

the number of individuals suffering from co-occuring disorders and 

the disorders from which they suffer and the second would be information regarding access to community care for individuals suffering from a mental illness other than substance use disorder. (10 

minutes) 

3. Fitzpatrick (PA): Provides flexibility for States to allow the 

State plan amendment to include assessments to determine level of 

care and length of stay recommendations based upon criteria established or endorsed by a State agency pursuant to 1932(b)(1)(A)(i) 

of the Public Health Service Act. (10 minutes) 

PART A—TEXT OF AMENDMENT TO H.R. 6 CONSIDERED AS ADOPTED

Page 49, strike line 15 and all that follows through page 50, line 

4, and insert the following: 

‘‘(1) ADMINISTRATIVE FUNDING.—For the purposes of implementing, administering, and carrying out the Program (other 

than for purposes described in paragraph (2)), $5,000,000 shall 


dlhill on DSK3GLQ082PROD with HEARING
6 

be available from the Federal Supplementary Medical Insurance Trust Fund under section 1841. 

‘‘(2) CARE MANAGEMENT FEES AND INCENTIVES.—For the pur- poses of making payments under subsection (e), $10,000,000 

shall be available from the Federal Supplementary Medical Insurance Trust Fund under section 1841 for each of fiscal years 

2021 through 2024.’’. 

Page 53, strike lines 16 through 24, and insert the following: 

(f) FUNDING.—For purposes of implementing this section, $75,000,000 shall be available from the Federal Supplementary 

Medical Insurance Trust Fund under section 1841 of the Social Security Act (42 U.S.C. 1395t), to remain available until expended. 

PART B—TEXT OF AMENDMENTS TO H.R. 6 MADE IN ORDER

1. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE WALDEN

OF OREGON OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

Page 65, line 18, insert ‘‘(as described in paragraph (4)(F))’’ after 

‘‘telehealth services’’. 

Page 68, line 21, insert ‘‘, as determined by the Secretary’’ after 

‘‘clinical improvement’’. 

Page 70, line 24, strike ‘‘certified’’. 

Page 70, after line 25, insert the following: 

(b) CLARIFICATION.—Nothing in the amendments made by subsection (a) shall be construed to prohibit separate payment for 

structured assessment and intervention services for substance 

abuse furnished to an individual on the same day as an initial preventive physical examination. 

Page 71, line 1, redesignate the subsection (b) as a subsection (c). 

Page 71, strike line 21 and all that follows through page 72, line 

2, and insert the following: 

‘‘(ii) For purposes of clause (i), the term ‘targeted 

procedure’ means a procedure to which Healthcare 

Common Procedure Coding System code 62310 (or, for 

years beginning after 2016, 62321), 62311 (or, for 

years beginning after 2016, 62323), 62264, 64490, 

64493, or G0260, or any successor code, apply.’’. 

Page 95, line 1, strike ‘‘100 or more’’ and insert ‘‘more than 100’’. 

Page 95, line 2, strike ‘‘30 or more’’ and insert ‘‘more than 30’’. 

Page 95, line 13, insert ‘‘the frequency of toxicology testing, including’’ before ‘‘the average’’. 

page 96, line 10, strike ‘‘2025’’ and insert ‘‘2024’’. 

page 97, strike line 7, and insert ‘‘that is at least 85 percent but 

not greater than the minimum medical loss ratio (as so defined) 

that such State applied as of May 31, 2018; or’’. 

2. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE DUNN OF

FLORIDA OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

Page 93, strike lines 18 through 22 and insert the following: 

(2) in subclause (II), by striking ‘‘during the period beginning 

on the date of enactment of the Comprehensive Addiction and 

Recovery Act of 2016 and ending on October 1, 2021,’’. 

Page 93, strike line 23 and all that follows through page 94, line 

17. 


dlhill on DSK3GLQ082PROD with HEARING
7 

Page 94, line 18, strike ‘‘(e)’’ and insert ‘‘(c)’’. 

3. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE BARTON OF

TEXAS OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

At the end of title III, insert the following new section: 

SEC. 304. HIGH-QUALITY, EVIDENCE-BASED OPIOID ANALGESIC PRESCRIBING GUIDELINES AND REPORT. 

(a) GUIDELINES.—The Commissioner of Food and Drugs shall develop high-quality, evidence-based opioid analgesic prescribing 

guidelines for the indication-specific treatment of acute pain in the 

relevant therapeutic areas where such guidelines do not exist. 

(b) PUBLIC INPUT.—In developing the guidelines under subsection 

(a), the Commissioner of Food and Drugs shall— 

(1) conduct a public workshop, open to representatives of 

State medical societies and medical boards, various medical 

specialties including pain medicine specialty societies, patient 

groups, pharmacists, universities, and others; and 

(2) provide a period for the submission of comments by the 

public. 

(c) REPORT.—Not later than the date that is 2 years after the 

date of enactment of this Act, the Commissioner of Food and Drugs 

shall submit to the Committee on Energy and Commerce of the 

House of Representatives and the Committee on Health, Education, 

Labor, and Pensions of the Senate, and post on the public website 

of the Food and Drug Administration, a report on how the guidelines under subsection (a) will be utilized to protect the public 

health. 

(d) UPDATES.—The Commissioner of Food and Drugs shall periodically— 

(1) update the guidelines under subsection (a), informed by 

public input described in subsection (b); and 

(2) submit to the committees specified in subsection (c) and 

post on the public website of the Food and Drug Administration an updated report under subsection (c). 

(e) STATEMENT TO ACCOMPANY GUIDELINES AND RECOMMENDATIONS.—The Commissioner of Food and Drugs shall ensure that 

any opioid analgesic prescribing guidelines and other recommendations developed under this section are accompanied by a clear 

statement that such guidelines or recommendations, as applicable— 

(1) are intended to help inform clinical decisionmaking by 

prescribers and patients; and 

(2) should not be used by other parties, including pharmacy 

benefit management companies, retail or community pharmacies, or public and private payors, for the purposes of restricting, limiting, delaying, or denying coverage for or access 

to a prescription issued for a legitimate medical purpose by an 

individual practitioner acting in the usual course of professional practice. 

(f) DEFINITION.—In this section, the term ‘‘evidence-based’’ means 

informed by a robust and systemic review of treatment efficacy and 

clinical evidence. 


dlhill on DSK3GLQ082PROD with HEARING
8 

4. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE CURTIS OF

UTAH OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

Add at the end of title III the following: 

SEC. 304. REPORT ON OPIOIDS PRESCRIBING PRACTICES FOR PREGNANT WOMEN. 

(a) IN GENERAL.—Not later than 180 days after the date of the 

enactment of this Act, the Secretary of Health and Human Services, in coordination with the Centers for Disease Control and Prevention, the National Institutes of Health, and the Substance 

Abuse and Mental Health Services Administration shall develop 

and submit to the Congress a report— 

(1) on opioids prescribing practices for pregnant women and 

recommendations for such practices; 

(2) that provides recommendations for identifying and reducing opioids misuse during pregnancy; 

(3) on prescription opioid misuse during pregnancy in urban 

and rural areas; 

(4) on prescription opioid use during pregnancy for the purpose of medication-assisted treatment in urban and rural 

areas; 

(5) evaluating current utilization of non-opiate pain management practices in place of prescription opioids during pregnancy; 

(6) providing guidelines encouraging the use of non-opioid 

pain management practices during pregnancy when safe and 

effective; and 

(7) that provides recommendations for increasing public 

awareness and education of opioid use disorder in pregnancy, 

including available treatment resources in urban and rural 

areas. 

(b) NO ADDITIONAL FUNDS.—No additional funds are authorized 

to be appropriated for purposes of carrying out subsection (a). 

5. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE KEATING

OF MASSACHUSETTS OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

Add at the end of title III the following: 

SEC. 304. GUIDELINES FOR PRESCRIBING NALOXONE. 

(a) IN GENERAL.—Not later than 180 days after the date of the 

enactment of this Act, the Secretary of Health and Human Services 

shall issue guidelines for prescribing an opioid overdose reversal 

drug. 

(b) CONTENTS.—In issuing guidelines under subsection (a), the 

Secretary shall address the following: 

(1) Co-prescribing an opioid overdose reversal drug in conjunction with any prescribed opioid. 

(2) Dosage safety. 

(3) Prescribing an opioid overdose reversal drug to an individual other than a patient. 

(4) Standing orders. 

(5) Other distribution, education, and safety measures as determined necessary. 


dlhill on DSK3GLQ082PROD with HEARING
9 

6. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE MEADOWS

OF NORTH CAROLINA OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

At the end of title III, insert the following new section: 

SEC. 304. GAO STUDY AND REPORT ON POLICY CHANGES THAT MAY 

HAVE CONTRIBUTED TO THE OPIOID EPIDEMIC. 

Not later than 2 years after the date of enactment of this Act, 

the Comptroller General of the United States shall complete a 

study and submit a report to Congress on health care policy 

changes that may have contributed to the increase in opioid 

overdoses and deaths during the 10 years preceding the date of enactment of this Act. Such study shall include— 

(1) a review of health care-related legislative, administrative, 

and judicial decisions by officers and employees of the Federal 

Government that have affected access to pain management 

strategies with an emphasis on pharmaceuticals; 

(2) an analysis of what is known about the costs and benefits, whether financial or nonfinancial, of reversing or revising 

such decisions individually or in combination, including whether the reversals or revisions would be expected to achieve a reduction in abuse of, addiction to, overdose on, and death from 

opioids; 

(3) an analysis of the differences among State-based prescription drug monitoring programs, including an analysis of 

what is known about the effects of such differences on monitoring for abuse of, addiction to, overdose on, and death from 

opioids; 

(4) an analysis of what is known about positive and negative 

impacts that prescribing limitations, both State and Federal, 

have on patient medical outcomes, including for chronic pain 

patients; and 

(5) an analysis of what is known about the costs and benefits 

to payers of using abuse-deterrent formulations of opioid pain 

medications, compared to opioid pain medications without 

abuse-deterrent features. 

7. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE WATERS OF

CALIFORNIA OR HER DESIGNEE, DEBATABLE FOR 10 MINUTES

Add at the end of title III the following new section: 

SEC. lll. REQUIRING A SURVEY OF SUBSTANCE USE DISORDER 

TREATMENT PROVIDERS RECEIVING FEDERAL FUNDING. 

(a) IN GENERAL.—The Secretary of Health and Human Services 

(in this section referred to as the ‘‘Secretary’’) shall conduct a survey of all entities that receive Federal funding for the purpose of 

providing substance use disorder treatment services. The survey 

shall direct such entities to provide the following information: 

(1) The length of time the entity has provided substance use 

disorder treatment services. 

(2) A detailed description of the patient population served by 

the entity, including but not limited to the number of patients, 

type of addictions, geographic area served, as well as gender, 

racial, ethnic and socioeconomic demographics of such patients. 


dlhill on DSK3GLQ082PROD with HEARING
10 

(3) A detailed description of the types of addiction for which 

the entity has the experience, capability, and capacity to provide such services. 

(4) An explanation of how the entity handles patients requiring treatment for a substance use disorder that the organization is not able to treat. 

(5) A description of what is needed, in the opinion of the entity, in order to improve the entity’s ability to meet the addiction treatment needs of the communities served by that entity. 

(6) Based on the identified needs of the communities served, 

a description of unmet needs and inadequate services and how 

such needs and services could be better addressed through additional Federal, State, or local government resources or funding to treat addiction to methamphetamine, crack cocaine, 

other types of cocaine, heroin, opioids, and other commonly 

abused drugs. 

(b) REPORT.—Not later than 1 year after the date of the enactment of this Act, the Secretary shall develop and submit to Congress a plan to direct appropriate resources to entities that provide 

substance use disorder treatment services in order to address inadequacies in services or funding identified through the survey described in subsection (a). 

8. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE TURNER OF

OHIO OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

Add at the end of title III the following: 

SEC. 304. NO SAMSHA POLICY AGAINST SUBSTANCE ABUSE TREATMENT FOR INCARCERATED INDIVIDUALS. 

The Substance Abuse and Mental Health Services Administration shall not establish, maintain, or implement any memorandum 

of understanding or other policy that prohibits or restricts the Administration’s provision or support of substance abuse treatment or 

related services for incarcerated individuals, so long as such provision or support— 

(1) is statutorily authorized (by provisions of law other than 

this section) for such type of treatment or services; and 

(2) not statutorily prohibited or restricted with respect to incarcerated individuals. 

PART C—TEXT OF AMENDMENT TO H.R. 5796 CONSIDERED AS ADOPTED

Add at the end the following: 

SEC. 3. PROMOTING VALUE IN MEDICAID MANAGED CARE. 

Section 1903(m) of the Social Security Act (42 U.S.C. 1396b(m)) 

is amended by adding at the end the following new paragraph: 

‘‘(7)(A) With respect to expenditures described in subparagraph 

(B) that are incurred by a State for any fiscal year after fiscal year 

2020 (and before fiscal year 2025), in determining the pro rata 

share to which the United States is equitably entitled under subsection (d)(3), the Secretary shall substitute the Federal medical 

assistance percentage that applies for such fiscal year to the State 

under section 1905(b) (without regard to any adjustments to such 

percentage applicable under such section or any other provision of 


dlhill on DSK3GLQ082PROD with HEARING
11 

law) for the percentage that applies to such expenditures under 

section 1905(y). 

‘‘(B) Expenditures described in this subparagraph, with respect 

to a fiscal year to which subparagraph (A) applies, are expenditures incurred by a State for payment for medical assistance provided to individuals described in subclause (VIII) of section 

1902(a)(10)(A)(i) by a managed care entity, or other specified entity 

(as defined in subparagraph (D)(iii)), that are treated as remittances because the State— 

‘‘(i) has satisfied the requirement of section 438.8 of title 42, 

Code of Federal Regulations (or any successor regulation), by 

electing— 

‘‘(I) in the case of a State described in subparagraph (C), 

to apply a minimum medical loss ratio (as defined in subparagraph (D)(ii)) that is at least 85 percent but not greater than the minimum medical loss ratio (as so defined) 

that such State applied as of May 31, 2018; or 

‘‘(II) in the case of a State not described in subparagraph 

(C), to apply a minimum medical loss ratio that is equal 

to 85 percent; and 

‘‘(ii) recovered all or a portion of the expenditures as a result 

of the entity’s failure to meet such ratio. 

‘‘(C) For purposes of subparagraph (B), a State described in this 

subparagraph is a State that as of May 31, 2018, applied a minimum medical loss ratio (as calculated under subsection (d) of section 438.8 of title 42, Code of Federal Regulations (as in effect on 

June 1, 2018)) for payment for services provided by entities described in such subparagraph under the State plan under this title 

(or a waiver of the plan) that is equal to or greater than 85 percent. 

‘‘(D) For purposes of this paragraph: 

‘‘(i) The term ‘managed care entity’ means a medicaid managed care organization described in section 1932(a)(1)(B)(i). 

‘‘(ii) The term ‘minimum medical loss ratio’ means, with respect to a State, a minimum medical loss ratio (as calculated 

under subsection (d) of section 438.8 of title 42, Code of Federal Regulations (as in effect on June 1, 2018)) for payment for 

services provided by entities described in subparagraph (B) 

under the State plan under this title (or a waiver of the plan). 

‘‘(iii) The term ‘other specified entity’ means— 

‘‘(I) a prepaid inpatient health plan, as defined in section 

438.2 of title 42, Code of Federal Regulations (or any successor regulation); and 

‘‘(II) a prepaid ambulatory health plan, as defined in 

such section (or any successor regulation).’’. 

PART D—TEXT OF AMENDMENTS TO H.R. 5797 MADE IN ORDER

1. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE RUSH OF

ILLINOIS OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

In section 2, strike ‘‘INDIVIDUALS WITH OPIOID USE DISORDERS’’ 

and insert ‘‘INDIVIDUALS WITH TARGETED SUDS’’. 

In the subsection (l) proposed to be added by section 2 of the bill 

to section 1915 of the Social Security Act, strike ‘‘eligible individVerDate Sep 11 2014 05:56 Jun 20, 2018 Jkt 079008 PO 00000 Frm 00011 Fmt 6659 Sfmt 6602 E:\HR\OC\HR766.XXX HR766

dlhill on DSK3GLQ082PROD with HEARING
12 

uals with opioid use disorders’’ each place it appears and insert ‘‘eligible individuals with targeted SUDs’’ each such place. 

In the subsection (l) proposed to be added by section 2 of the bill 

to section 1915 of the Social Security Act, strike ‘‘eligible individual 

with an opioid use disorder’’ each place it appears and insert ‘‘eligible individual with a targeted SUD’’ each such place. 

Page 5, beginning on line 19, strike ‘‘individuals with opioid use 

disorder’’ and insert ‘‘eligible individuals with targeted SUDs’’. 

Page 6, beginning on line 1, strike ‘‘eligible individuals with an 

opioid use disorder’’ and insert ‘‘eligible individuals with targeted 

SUDs’’. 

Page 6, line 7, insert before the period the following: ‘‘and to determine the appropriate setting for such care’’. 

Page 7, line 12, strike ‘‘opioid use disorder’’ and insert ‘‘targeted 

SUD’’. 

In the subsection (l)(4) proposed to be added by section 2 of the 

bill to section 1915 of the Social Security Act, strike subparagraph 

(D), redesignate subparagraph (E) as subparagraph (D), and add at 

the end the following: 

‘‘(E) TARGETED SUD.— ‘‘(i) IN GENERAL.—The term ‘targeted SUD’ means 

an opioid use disorder or a cocaine use disorder. 

‘‘(ii) COCAINE USE DISORDER.—The term ‘cocaine use 

disorder’ means a disorder that meets the criteria of 

the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (or a successor edition), for either 

dependence or abuse for cocaine, including cocaine 

base (commonly referred to as ‘crack cocaine’). 

‘‘(iii) OPIOID USE DISORDER.—The term ‘opioid use 

disorder’ means a disorder that meets the criteria of 

the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (or a successor edition), for heroin 

use disorder or pain reliever use disorder (including 

with respect to opioid prescription pain relievers).’’. 

Strike all that follows after section 2 and insert the following: 

SEC. 3. PROMOTING VALUE IN MEDICAID MANAGED CARE. 

Section 1903(m) of the Social Security Act (42 U.S.C. 1396b(m)) 

is amended by adding at the end the following new paragraph: 

‘‘(7)(A) With respect to expenditures described in subparagraph 

(B) that are incurred by a State for any fiscal year after fiscal year 

2020 (and before fiscal year 2024), in determining the pro rata 

share to which the United States is equitably entitled under subsection (d)(3), the Secretary shall substitute the Federal medical 

assistance percentage that applies for such fiscal year to the State 

under section 1905(b) (without regard to any adjustments to such 

percentage applicable under such section or any other provision of 

law) for the percentage that applies to such expenditures under 

section 1905(y). 

‘‘(B) Expenditures described in this subparagraph, with respect 

to a fiscal year to which subparagraph (A) applies, are expenditures incurred by a State for payment for medical assistance provided to individuals described in subclause (VIII) of section 

1902(a)(10)(A)(i) by a managed care entity, or other specified entity 

(as defined in subparagraph (D)(iii)), that are treated as remittances because the State— 


dlhill on DSK3GLQ082PROD with HEARING
13 

‘‘(i) has satisfied the requirement of section 438.8 of title 42, 

Code of Federal Regulations (or any successor regulation), by 

electing— 

‘‘(I) in the case of a State described in subparagraph (C), 

to apply a minimum medical loss ratio (as defined in subparagraph (D)(ii)) that is at least 85 percent but not greater than the minimum medical loss ratio (as so defined) 

that such State applied as of May 31, 2018; or 

‘‘(II) in the case of a State not described in subparagraph 

(C), to apply a minimum medical loss ratio that is equal 

to 85 percent; and 

‘‘(ii) recovered all or a portion of the expenditures as a result 

of the entity’s failure to meet such ratio. 

‘‘(C) For purposes of subparagraph (B), a State described in this 

subparagraph is a State that as of May 31, 2018, applied a minimum medical loss ratio (as calculated under subsection (d) of section 438.8 of title 42, Code of Federal Regulations (as in effect on 

June 1, 2018)) for payment for services provided by entities described in such subparagraph under the State plan under this title 

(or a waiver of the plan) that is equal to or greater than 85 percent. 

‘‘(D) For purposes of this paragraph: 

‘‘(i) The term ‘managed care entity’ means a medicaid managed care organization described in section 1932(a)(1)(B)(i). 

‘‘(ii) The term ‘minimum medical loss ratio’ means, with respect to a State, a minimum medical loss ratio (as calculated 

under subsection (d) of section 438.8 of title 42, Code of Federal Regulations (as in effect on June 1, 2018)) for payment for 

services provided by entities described in subparagraph (B) 

under the State plan under this title (or a waiver of the plan). 

‘‘(iii) The term ‘other specified entity’ means— 

‘‘(I) a prepaid inpatient health plan, as defined in section 

438.2 of title 42, Code of Federal Regulations (or any successor regulation); and 

‘‘(II) a prepaid ambulatory health plan, as defined in 

such section (or any successor regulation).’’. 

2. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE KILDEE OF

MICHIGAN OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

Page 6, line 19, strike ‘‘and’’. 

Page 6, line 23, strike the period at the end and insert ‘‘; and’’. 

Page 6, after line 23, insert the following: 

‘‘(iv) the number of eligible individuals with any cooccuring disorders who received services pursuant to 

such State plan amendment and the co-occuring disorders from which they suffer; and 

‘‘(v) information regarding the effects of a State plan 

amendment on access to community care for individuals suffering from a mental disease other than substance use disorder.’’. 


dlhill on DSK3GLQ082PROD with HEARING
14 

3. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE

FITZPATRICK OF PENNSYLVANIA OR HIS DESIGNEE, DEBATABLE

FOR 10 MINUTES

Page 6, line 7, insert before the period the following: ‘‘or criteria 

established or endorsed by the State agency identified by the State 

pursuant to section 1932(b)(1)(A)(i) of the Public Health Service 

Act’’. 

Æ 


dlhill on DSK3GLQ082PROD with HEARING