I 

115TH CONGRESS 

2D SESSION H. R. 5080 

To amend title XVIII to provide for coverage under the Medicare program 

of opioid treatment program services. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 23, 2018 

Mr. HOLDING 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 to provide for coverage under the 

Medicare program of opioid treatment program services. 

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 ‘‘Comprehensive Opioid 

5 Management and Bundled Addiction Treatment Act of 

6 2018’’ or the ‘‘COMBAT Act of 2018’’. 


lotter on DSKBCFDHB2PROD with BILLS
2 

•HR 5080 IH

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 treatment program services 

12 (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 (42 U.S.C. 1395x) is 

16 amended by adding at the end the following new sub17 section: 

18 ‘‘(jjj) OPIOID TREATMENT PROGRAM SERVICES; 

19 OPIOID TREATMENT PROGRAM.— 

20 ‘‘(1) OPIOID TREATMENT PROGRAM SERV21 ICES.— 

22 ‘‘(A) IN GENERAL.—The term ‘opioid 

23 treatment program services’ means items and 

24 services described in subparagraph (B) that are 

25 furnished as part of medication-assisted treat26 ment for the treatment of opioid use disorder at 


lotter on DSKBCFDHB2PROD with BILLS
3 

•HR 5080 IH

1 an opioid treatment program enrolled under 

2 section 1866(j). 

3 ‘‘(B) ITEMS AND SERVICES DESCRIBED.— 

4 For purposes of subparagraph (A), the items 

5 and services described in this subparagraph, 

6 with respect to an individual and episode of 

7 care, are the following: 

8 ‘‘(i) Initial intake and assessment. 

9 ‘‘(ii) Integrated and ongoing psycho10 social and medical treatment for opioid use 

11 disorder. 

12 ‘‘(iii) Additional services, including 

13 urinalysis; medication administration, dis14 pensing, and monitoring; and screening. 

15 ‘‘(iv) One of the following products 

16 (or such other products approved after the 

17 date of the enactment of this subsection by 

18 the Food and Drug Administration for the 

19 purpose of maintenance or detoxification 

20 treatment), as determined appropriate for 

21 the individual by an appropriately licensed 

22 clinician for the treatment of such indi23 vidual: 

24 ‘‘(I) Methadone products. 

25 ‘‘(II) Buprenorphine products. 


lotter on DSKBCFDHB2PROD with BILLS
4 

•HR 5080 IH

1 ‘‘(III) Naltrexone products. 

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

3 ‘opioid treatment program’ means an opioid treat4 ment program (as defined in section 8.2 of title 42 

5 of the Code of Federal Regulations, or any successor 

6 regulation) that— 

7 ‘‘(A) has in effect an opioid treatment pro8 gram certification (as defined in such section); 

9 ‘‘(B) has in effect a certification by the 

10 Substance Abuse and Mental Health Services 

11 Administration for such a program; and 

12 ‘‘(C) is accredited by an accrediting body 

13 approved by the Substance Abuse and Mental 

14 Health Services Administration. 

15 ‘‘(3) MEDICATION-ASSISTED TREATMENT.—The 

16 term ‘medication-assisted treatment’ means the use 

17 of medications, in combination with counseling, be18 havioral therapies, and toxicology testing, to provide 

19 a comprehensive approach to the treatment of sub20 stance use disorders.’’. 

21 (c) PAYMENT.— 

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

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

24 amended— 


lotter on DSKBCFDHB2PROD with BILLS
5 

•HR 5080 IH

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

2 ‘‘(BB)’’; and 

3 (B) by inserting before the semicolon at 

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

5 to opioid treatment program services furnished 

6 during an episode of care, the amount paid 

7 shall be equal to the amount payable in accord8 ance with section 1834(v)’’. 

9 (2) PAYMENT DETERMINATION.—Section 1834 

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

11 amended by adding at the end the following new 

12 subsection: 

13 ‘‘(v) OPIOID TREATMENT PROGRAM SERVICES.— 

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

15 under this part to an opioid treatment program (as 

16 defined in paragraph (2) of section 1861(jjj)) an 

17 amount equal to 120 percent of the bundled pay18 ment amount under a subparagraph of paragraph 

19 (2) for opioid treatment program services (as de20 fined in paragraph (1) of such section 1861(jjj)) de21 scribed in such subparagraph that are furnished 

22 during the episode of care (beginning not later than 

23 January 1, 2019) applicable to such services de24 scribed in such subparagraph, to an individual by a 

25 physician or other practitioner at such program. 


lotter on DSKBCFDHB2PROD with BILLS
6 

•HR 5080 IH

1 Such a bundled payment shall be in lieu of any pay2 ment that would otherwise be made under this part 

3 to such physician or practitioner for furnishing such 

4 services. 

5 ‘‘(2) PAYMENT AMOUNTS AND EPISODE OF

6 CARE BASED ON MEDICATION INVOLVED.—Subject 

7 to paragraph (3): 

8 ‘‘(A) MEDICATION-ASSISTED TREATMENT

9 BUNDLES INCLUDING METHADONE.—In the 

10 case of opioid treatment program services that 

11 include methadone, the bundled payment 

12 amount under this subparagraph is the pay13 ment amount applied for HCPCS code H0020 

14 and shall be for an episode of care, the duration 

15 of which is a week. 

16 ‘‘(B) MEDICATION-ASSISTED TREATMENT

17 BUNDLES INCLUDING BUPRENORPHINE.—In 

18 the case of opioid treatment program services 

19 that include buprenorphine— 

20 ‘‘(i) the bundled payment amount 

21 under this subparagraph shall be the 

22 amount equal to the sum of— 

23 ‘‘(I) with respect to services fur24 nished as part of such bundle, the 


lotter on DSKBCFDHB2PROD with BILLS
7 

•HR 5080 IH

1 payment amount applied for HCPCS 

2 code H0047; and 

3 ‘‘(II) with respect to buprenor4 phine administered or dispensed as 

5 part of such bundle, the payment 

6 amount applied for HCPCS code 

7 J0571, J0572, or J0573, determined 

8 at an amount equal to 95 percent of 

9 the average wholesale price of the 

10 drug; 

11 ‘‘(ii) such bundled payment amount— 

12 ‘‘(I) shall be for an episode of 

13 care, the duration of which is a week; 

14 and 

15 ‘‘(II) shall include payment for 

16 buprenorphine administered during 

17 such episode of care only if the medi18 cation is dispensed or administered by 

19 the opioid treatment program in20 volved; and 

21 ‘‘(iii) any claim for payment for such 

22 services, with respect to such a episode of 

23 care, under this subsection shall include 

24 the National Drug Code for Buprenor25 phine, dosage, and acquisition costs. 


lotter on DSKBCFDHB2PROD with BILLS
8 

•HR 5080 IH

1 ‘‘(C) MEDICATION-ASSISTED TREATMENT

2 BUNDLES INCLUDING NALTREXONE.—In the 

3 case of opioid treatment program services that 

4 include naltrexone— 

5 ‘‘(i) the bundled payment amount 

6 under this subparagraph shall be the 

7 amount equal to the sum of— 

8 ‘‘(I) with respect to services fur9 nished as part of such bundle, the 

10 payment amount applied for HCPCS 

11 code H0047; 

12 ‘‘(II) with respect to the adminis13 tration of naltrexone as part of such 

14 bundle, the payment amount applied 

15 for CPT code 96372; and 

16 ‘‘(III) with respect to naltrexone 

17 administered as part of such bundle, 

18 the payment amount applied for 

19 HCPCS code J2315 for the amount 

20 of milligrams used; and 

21 ‘‘(ii) such bundled amount shall be for 

22 an episode of care, the duration of which 

23 is a month. 

24 In carrying out this paragraph, any reference to 

25 a HCPCS code or CPT code shall be treated as 


lotter on DSKBCFDHB2PROD with BILLS
9 

•HR 5080 IH

1 including a reference to a successor code to the 

2 HCPCS code or CPT code, as determined by 

3 the Secretary pursuant to rulemaking. 

4 ‘‘(3) LIMITATION.—In no case shall the amount 

5 determined under a subparagraph of paragraph (2), 

6 with respect to opioid treatment services described in 

7 a subparagraph of paragraph (2) during an episode 

8 of care described in such subparagraph furnished in 

9 a count be less than the greater of— 

10 ‘‘(A) the rate of payment for comparable 

11 services that are paid under State plans under 

12 title XIX to opioid treatment programs in such 

13 county; or 

14 ‘‘(B) the rate of payment under the 

15 TRICARE program under chapter 55 of title 

16 10, United States Code, for comparable services 

17 paid to opioid treatment programs in such 

18 county.’’. 

19 (d) INCLUDING OPIOID TREATMENT PROGRAMS AS

20 MEDICARE PROVIDERS.—Section 1866(e) of the Social 

21 Security Act (42 U.S.C. 1395cc(e)) is amended— 

22 (1) in paragraph (2), by striking at the end 

23 ‘‘and’’; 

24 (2) in paragraph (3), by striking the period at 

25 the end and inserting ‘‘; and’’; and 


lotter on DSKBCFDHB2PROD with BILLS
10 

•HR 5080 IH

1 (3) by adding at the end the following new 

2 paragraph: 

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

4 paragraph (2) of section 1861(jjj)), but only with re5 spect to the furnishing of opioid treatment program 

6 services (as defined in paragraph (1) of such sec7 tion).’’. 

Æ 


lotter on DSKBCFDHB2PROD with BILLS