I 

115TH CONGRESS 

2D SESSION H. R. 5083 

To amend title XVIII of the Social Security Act to provide for coverage 

of certain services furnished by opioid treatment programs under the 

Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 23, 2018 

Mr. NEAL (for himself and Mr. PALLONE) introduced the following bill; which 

was referred to the Committee on Energy and Commerce, and in addition 

to the Committee on Ways and Means, 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 title XVIII of the Social Security Act to provide 

for coverage of certain services furnished by opioid treatment programs under the Medicare program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Expanding Access to 

5 Evidence-Based Opioid Treatment for Seniors Act of 

6 2018’’. 


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1 SEC. 2. MEDICARE COVERAGE OF CERTAIN SERVICES FUR2 NISHED BY OPIOID TREATMENT PROGRAMS. 

3 (a) COVERAGE.—Section 1861(s)(2) of the Social Se4 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 

5 (1) in subparagraph (FF), by striking at the 

6 end ‘‘and’’; 

7 (2) in subparagraph (GG), by inserting at the 

8 end ‘‘; and’’; and 

9 (3) by adding at the end the following new sub10 paragraph: 

11 ‘‘(HH) opioid use disorder treatment serv12 ices (as defined in subsection (jjj)).’’. 

13 (b) OPIOID USE DISORDER TREATMENT SERVICES

14 AND OPIOID TREATMENT PROGRAM DEFINED.—Section 

15 1861 of the Social Security Act is amended by adding at 

16 the end the following new subsection: 

17 ‘‘(jjj) OPIOID USE DISORDER TREATMENT SERV18 ICES; OPIOID TREATMENT PROGRAM.— 

19 ‘‘(1) OPIOID USE DISORDER TREATMENT SERV20 ICES.—The term ‘opioid use disorder treatment serv21 ices’ means items and services that— 

22 ‘‘(A) are furnished for the treatment of 

23 opioid use disorder at an opioid treatment pro24 gram enrolled under section 1866(j) by a physi25 cian or other practitioner that is enrolled under 

26 such section; and 


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1 ‘‘(B) are certified by the Substance Abuse 

2 and Mental Health Services Administration to 

3 be provided by such program for such treat4 ment. 

5 ‘‘(2) OPIOID TREATMENT PROGRAM.—The term 

6 ‘opioid treatment program’ means an opioid treat7 ment program (as defined in section 8.2 of title 42 

8 of the Code of Federal Regulations, or any successor 

9 regulation) that has an opioid treatment program 

10 certification (as defined in such section) in effect 

11 and meets such other conditions of participation as 

12 the Secretary may find necessary in the interest of 

13 the health and safety of individuals who are fur14 nished services by such program.’’. 

15 (c) PAYMENT.— 

16 (1) IN GENERAL.—Section 1833(a)(1) of the 

17 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

18 amended— 

19 (A) by striking ‘‘and (BB)’’ and inserting 

20 ‘‘(BB)’’; and 

21 (B) by inserting before the semicolon at 

22 the end the following ‘‘, and (CC) with respect 

23 to opioid use disorder treatment services, the 

24 amount paid shall be equal to 80 percent of the 

25 amount determined under section 1834(w)’’. 


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1 (2) PAYMENT DETERMINATION.—Section 1834 

2 of the Social Security Act (42 U.S.C. 1395m) is 

3 amended by adding at the end the following new 

4 subsection: 

5 ‘‘(w) OPIOID USE DISORDER TREATMENT SERV6 ICES.— 

7 ‘‘(1) IN GENERAL.—The Secretary shall pay to 

8 an opioid treatment program (as defined in para9 graph (2) of section 1861(jjj)) a bundled payment 

10 under this part for opioid use disorder treatment 

11 services (as defined in paragraph (1) of such sec12 tion) that are furnished during an episode of care 

13 (as defined by the Secretary) beginning on or after 

14 January 1, 2020, to an individual by a physician or 

15 other practitioner at such program. Such payment 

16 shall be in lieu of any payment that would otherwise 

17 be made under this part to such physician or practi18 tioner for furnishing such services. 

19 ‘‘(2) PAYMENT AMOUNT.— 

20 ‘‘(A) IN GENERAL.—Subject to subpara21 graph (B), the amount of a bundled payment 

22 under this subsection, with respect to opioid use 

23 disorder treatment services (as so defined) fur24 nished during an episode of care (as so defined) 

25 beginning during 2020 or a subsequent year, 


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1 shall be an amount determined by the Secretary 

2 that is based on the rates of payment for com3 parable services that are paid under State plans 

4 under title XIX. 

5 ‘‘(B) PERIODIC UPDATES.—The Secretary 

6 shall, as determined necessary by the Secretary 

7 (but not less frequently than once every 5 

8 years), review and update the amount of a bun9 dled payment under this subsection with respect 

10 to opioid use disorder treatment services (as so 

11 defined) furnished during an episode of care (as 

12 so defined).’’. 

13 (d) INCLUDING OPIOID TREATMENT PROGRAMS AS

14 MEDICARE PROVIDERS.—Section 1866 of the Social Secu15 rity Act (42 U.S.C. 1395cc) is amended— 

16 (1) in subsection (e)— 

17 (A) in paragraph (2), by striking at the 

18 end ‘‘and’’; 

19 (B) in paragraph (3), by striking the pe20 riod at the end and inserting ‘‘; and’’; and 

21 (C) by adding at the end the following new 

22 paragraph: 

23 ‘‘(3) opioid treatment programs (as defined in 

24 paragraph (2) of section 1861(jjj)), but only with re25 spect to the furnishing of opioid use disorder treatVerDate Sep 11 2014 20:37 Feb 28, 2018 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5083.IH H5083

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1 ment services (as defined in paragraph (1) of such 

2 section).’’; and 

3 (D) in subsection (j), by adding at the end 

4 the following new paragraph: 

5 ‘‘(10) ENHANCED OVERSIGHT FOR OPIOID

6 TREATMENT PROGRAMS.—The Secretary shall estab7 lish procedures to provide that opioid treatment pro8 grams (as defined in paragraph (2) of section 

9 1866(jjj)) enrolling or reenrolling under this title are 

10 subject to enhanced oversight, including by requiring 

11 annual audits by the Inspector General of the De12 partment of Health and Human Services for each of 

13 the first 5 years of such enrollment or reenrollment 

14 of such program under this title and audits as 

15 deemed necessary by the Inspector General for each 

16 subsequent year of enrollment or reenrollment of 

17 such program under this title to ensure compliance 

18 of the program with the requirements of this sec19 tion.’’. 

Æ 


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