I 

115TH CONGRESS 

2D SESSION H. R. 5477 

To amend title XIX of the Social Security Act to provide for a demonstration 

project to increase substance use provider capacity under the Medicaid 

program. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 11, 2018 

Mr. O’HALLERAN introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend title XIX of the Social Security Act to provide 

for a demonstration project to increase substance use 

provider capacity under the Medicaid 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 ‘‘Rural Development 

5 of Opioid Capacity Services Act’’ or the ‘‘Rural DOCS 

6 Act’’. 


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1 SEC. 2. DEMONSTRATION PROJECT TO INCREASE SUB2 STANCE USE PROVIDER CAPACITY UNDER 

3 THE MEDICAID PROGRAM. 

4 Section 1903 of the Social Security Act (42 U.S.C. 

5 1396b) is amended by adding at the end the following new 

6 subsection: 

7 ‘‘(aa) DEMONSTRATION PROJECT TO INCREASE SUB8 STANCE USE PROVIDER CAPACITY.— 

9 ‘‘(1) IN GENERAL.—Beginning January 1, 

10 2019, the Secretary shall conduct a 5-year dem11 onstration project under which the Secretary shall 

12 provide to an eligible State (as defined in paragraph 

13 (2)(A)) payments, in accordance with paragraph (3), 

14 with respect to expenditures by such eligible State 

15 for incentives, training, and technical assistance for 

16 providers under the State plan (or a waiver of such 

17 plan) to expand substance use treatment and recov18 ery services for individuals enrolled under such State 

19 plan (or waiver), including each of the following ac20 tivities: 

21 ‘‘(A) Activities that support the develop22 ment of an assessment of the behavioral health 

23 treatment needs of the State to determine the 

24 extent to which providers are needed (including 

25 the types of such providers and geographic area 

26 of need) to improve the network of providers 


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1 that treat substance use disorders under the 

2 State plan (or waiver), including: 

3 ‘‘(i) An estimate of the number of in4 dividuals enrolled under the State plan (or 

5 a waiver of such plan) who have a sub6 stance use disorder. 

7 ‘‘(ii) Information on the capacity of 

8 providers to provide substance use disorder 

9 services to individuals enrolled under the 

10 State plan (or waiver), including informa11 tion on providers who provide such serv12 ices. 

13 ‘‘(iii) Information on the gap in sub14 stance use disorder treatment under the 

15 State plan (or waiver) based on the infor16 mation described in clauses (i) and (ii). 

17 ‘‘(iv) Projections regarding the extent 

18 to which participating under the dem19 onstration project would increase the num20 ber of providers offering substance use dis21 order services under the State plan (or 

22 waiver) during the period of the dem23 onstration project. 

24 ‘‘(B) Activities that, taking into account 

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1 paragraph (A), support the recruitment, train2 ing, and provision of technical assistance for 

3 current, new, and prospective participating pro4 viders under the State plan (or a waiver of such 

5 plan) that specialize in substance use disorder 

6 treatment and recovery. 

7 ‘‘(C) Activities that specifically expand, in8 cluding through the provision of incentives, the 

9 number of providers participating under the 

10 State plan (or waiver) that— 

11 ‘‘(i) are authorized to dispense drugs 

12 approved by the Food and Drug Adminis13 tration for individuals with a substance use 

14 disorder who need withdrawal management 

15 or maintenance treatment for such dis16 order; 

17 ‘‘(ii) have in effect a registration or 

18 waiver under section 303(g) of the Con19 trolled Substances Act for purposes of dis20 pensing narcotic drugs to individuals for 

21 maintenance treatment or detoxification 

22 treatment and are in compliance with any 

23 regulation promulgated by the Assistant 

24 Secretary for Mental Health and Sub25 stance Use for purposes of carrying out 


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1 the requirements of such section 303(g); 

2 and 

3 ‘‘(iii) are licensed or certified under 

4 applicable State law to provide substance 

5 use disorder treatment and recovery serv6 ices. 

7 ‘‘(D) Activities that specifically expand, in8 cluding through the provision of incentives, the 

9 number of providers participating under the 

10 State plan (or waiver) that have the qualifica11 tions to address the treatment and recovery 

12 needs of— 

13 ‘‘(i) individuals enrolled under the 

14 State plan (or a waiver of such plan) who 

15 have neonatal abstinence syndrome, in ac16 cordance with guidelines issued by the 

17 American Academy of Pediatrics and 

18 American College of Obstetricians and 

19 Gynecologists relating to maternal care 

20 and infant care with respect to neonatal 

21 abstinence syndrome; 

22 ‘‘(ii) postpartum women and infants, 

23 particularly the concurrent treatment and 

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1 partum women and infants, enrolled under 

2 the State plan (or a waiver of such plan); 

3 ‘‘(iii) adolescents and young adults be4 tween the ages of 12 and 21 enrolled 

5 under the State plan (or a waiver of such 

6 plan); or 

7 ‘‘(iv) American Indian and Alaska Na8 tive individuals enrolled under the State 

9 plan (or a waiver of such plan). 

10 ‘‘(2) ELIGIBLE STATES.— 

11 ‘‘(A) DEFINITION.—For purposes of this 

12 subsection, the term ‘eligible State’ means a 

13 State selected by the Secretary under subpara14 graph (B). 

15 ‘‘(B) SELECTION.—For purposes of this 

16 subsection, the Secretary shall select 10 States 

17 that meet the criteria for eligibility under sub18 paragraph (C). In selecting such States, the 

19 Secretary shall— 

20 ‘‘(i) select States in a manner that en21 sures geographic diversity; 

22 ‘‘(ii) give preference to States with a 

23 prevalence of substance use disorders (in 

24 particular opioid use disorders) that is 

25 comparable to or higher than the national 


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1 average prevalence, as measured by aggre2 gate drug overdoses, or any other measure 

3 that the Secretary deems appropriate; and 

4 ‘‘(iii) take into consideration the qual5 ity of applications submitted under sub6 paragraph (D). 

7 ‘‘(C) CRITERIA FOR ELIGIBILITY.—To be 

8 eligible for selection under subparagraph (B), a 

9 State shall— 

10 ‘‘(i) have a State plan (or waiver of 

11 the State plan) approved under this title; 

12 and 

13 ‘‘(ii) submit to the Secretary an appli14 cation in accordance with the requirements 

15 in subparagraph (D). 

16 ‘‘(D) APPLICATIONS.—For purposes of this 

17 paragraph, a State shall submit to the Sec18 retary, at such time and in such form and man19 ner as the Secretary requires, an application 

20 that includes such information, provisions, and 

21 assurances, as the Secretary may require, in ad22 dition to the following: 

23 ‘‘(i) A proposed process for under24 taking the assessment described in para25 graph (1)(A). 


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1 ‘‘(ii) A proposed process for reviewing 

2 reimbursement methodologies and other 

3 policies related to substance use disorder 

4 services under the State plan (or waiver) 

5 that may create barriers to increasing the 

6 number of providers delivering substance 

7 use disorder services. 

8 ‘‘(iii) A proposed process for devel9 oping a plan that will result in long-term 

10 and sustainable provider networks under 

11 the State plan (or waiver) that will offer a 

12 continuum of care for substance use dis13 orders. Such plan shall include the fol14 lowing: 

15 ‘‘(I) Specific activities to increase 

16 access to providers (including pro17 viders that specialize in providing sub18 stance use disorder services, hospitals, 

19 health care systems, and Federally 

20 qualified health centers) that offer 

21 substance use disorder treatment, re22 covery, and support services, including 

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1 ices, and evidence-based peer recovery 

2 services. 

3 ‘‘(II) Strategies that will 

4 incentivize providers described in 

5 paragraph (1)(C) to obtain the nec6 essary training, education, and sup7 port to deliver substance use disorder 

8 services in the State. 

9 ‘‘(III) Milestones and timeliness 

10 for implementing activities set forth in 

11 the plan. 

12 ‘‘(IV) Specific measurable targets 

13 for increasing the substance use dis14 order provider network under the 

15 State plan (or a waiver of such plan). 

16 ‘‘(iv) A proposed process for reporting 

17 the information required under paragraph 

18 (4)(A), including information demonstrat19 ing the progress of the efforts of the State 

20 to expand the capacity of providers to de21 liver substance use disorder services during 

22 the period of the demonstration project 

23 under this subsection. 

24 ‘‘(v) A projected five-year budget for 

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1 onstration project under this subsection 

2 the activities set forth in the plan. 

3 ‘‘(3) PAYMENT.— 

4 ‘‘(A) IN GENERAL.—For each quarter oc5 curring during the period for which the dem6 onstration project is conducted, the Secretary 

7 shall pay under this subsection, subject to sub8 paragraph (B), to each eligible State an amount 

9 equal to 90 percent of so much of the sums ex10 pended during such quarter as are attributable 

11 to activities described in paragraph (1). 

12 ‘‘(B) NON-DUPLICATION OF PAYMENT.—In 

13 the case that payment is made under subpara14 graph (A) with respect to expenditures for ac15 tivities carried out by an eligible State under 

16 the demonstration project under this sub17 section, payment may not also be made under 

18 subsection (a) with respect to expenditures for 

19 the same activities carried out by the eligible 

20 State. 

21 ‘‘(4) REPORTS.— 

22 ‘‘(A) STATE REPORTS.—A State receiving 

23 payments under this subsection shall, for the 

24 period of the demonstration project under this 

25 subsection, submit to the Secretary a quarterly 


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1 report, with respect to expenditures for activi2 ties for which payment is made to the State 

3 under this subsection, on the following: 

4 ‘‘(i) The specific activities with re5 spect to which payment under this sub6 section was provided. 

7 ‘‘(ii) The number of providers that de8 livered substance use disorder services in 

9 the State under the demonstration project 

10 compared to the estimated number of pro11 viders that would have otherwise delivered 

12 such services in the absence of such dem13 onstration project. 

14 ‘‘(iii) The number of individuals en15 rolled under the State plan (or a waiver of 

16 such plan) who received substance use dis17 order services under the demonstration 

18 project compared to the estimated number 

19 of such individuals who would have other20 wise received such services in the absence 

21 of such demonstration project. 

22 ‘‘(iv) Other matters as determined by 

23 the Secretary. 

24 ‘‘(B) CMS REPORTS.— 


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1 ‘‘(i) INTERIM REPORT.—Not later 

2 than October 1, 2022, the Administrator 

3 of the Centers for Medicare & Medicaid 

4 Services shall submit to Congress an in5 terim report on activities carried out under 

6 the demonstration project under this sub7 section. 

8 ‘‘(ii) FINAL REPORT.—Not later than 

9 October 1, 2024, the Administrator of the 

10 Centers for Medicare & Medicaid Services 

11 shall submit to Congress a final report on 

12 activities carried out under the demonstra13 tion project under this subsection.’’. 

Æ 


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