IB 

Union Calendar No. 566 

115TH CONGRESS 

2D SESSION H. R. 5477 

[Report No. 115–731] 

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 

JUNE 12, 2018 

Additional sponsors: Mrs. BLACKBURN, Mr. WALDEN, and Mr. MITCHELL

JUNE 12, 2018 

Reported with an amendment, committed to the Committee of the Whole 

House on the State of the Union, and ordered to be printed 

[Strike out all after the enacting clause and insert the part printed in italic] 

[For text of introduced bill, see copy of bill as introduced on April 11, 2018] 


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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. 


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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 of 

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

6 SEC. 2. DEMONSTRATION PROJECT TO INCREASE SUB7 STANCE USE PROVIDER CAPACITY UNDER 

8 THE MEDICAID PROGRAM. 

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

10 1396b) is amended by adding at the end the following new 

11 subsection: 

12 ‘‘(aa) DEMONSTRATION PROJECT TO INCREASE SUB13 STANCE USE PROVIDER CAPACITY.— 

14 ‘‘(1) IN GENERAL.—Not later than the date that 

15 is 180 days after the date of the enactment of this sec16 tion, the Secretary shall, in consultation, as appro17 priate, with the Director of the Agency for Healthcare 

18 Research and Quality and the Assistant Secretary for 

19 Mental Health and Substance Use, conduct a 5-year 

20 demonstration project for the purpose described in 

21 paragraph (2) under which the Secretary shall— 

22 ‘‘(A) for the first 18-month period of such 

23 project, award planning grants described in 

24 paragraph (3); and 


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1 ‘‘(B) for the remaining 42-month period of 

2 such project, provide to each State selected under 

3 paragraph (4) payments in accordance with 

4 paragraph (5). 

5 ‘‘(2) PURPOSE.—The purpose described in this 

6 paragraph is for each State selected under paragraph 

7 (4) to increase the treatment capacity of providers 

8 participating under the State plan (or a waiver of 

9 such plan) to provide substance use disorder treat10 ment or recovery services under such plan (or waiver) 

11 through the following activities: 

12 ‘‘(A) For the purpose described in para13 graph (3)(C)(i), activities that support an ongo14 ing assessment of the behavioral health treatment 

15 needs of the State, taking into account the mat16 ters described in subclauses (I) through (IV) of 

17 such paragraph. 

18 ‘‘(B) Activities that, taking into account the 

19 results of the assessment described in subpara20 graph (A), support the recruitment, training, 

21 and provision of technical assistance for pro22 viders participating under the State plan (or a 

23 waiver of such plan) that offer substance use dis24 order treatment or recovery services. 


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1 ‘‘(C) Improved reimbursement for and ex2 pansion of, through the provision of education, 

3 training, and technical assistance, the number or 

4 treatment capacity of providers participating 

5 under the State plan (or waiver) that— 

6 ‘‘(i) are authorized to dispense drugs 

7 approved by the Food and Drug Adminis8 tration for individuals with a substance use 

9 disorder who need withdrawal management 

10 or maintenance treatment for such disorder; 

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

12 waiver under section 303(g) of the Con13 trolled Substances Act for purposes of dis14 pensing narcotic drugs to individuals for 

15 maintenance treatment or detoxification 

16 treatment and are in compliance with any 

17 regulation promulgated by the Assistant 

18 Secretary for Mental Health and Substance 

19 Use for purposes of carrying out the re20 quirements of such section 303(g); and 

21 ‘‘(iii) are qualified under applicable 

22 State law to provide substance use disorder 

23 treatment or recovery services. 

24 ‘‘(D) Improved reimbursement for and ex25 pansion of, through the provision of education, 


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1 training, and technical assistance, the number or 

2 treatment capacity of providers participating 

3 under the State plan (or waiver) that have the 

4 qualifications to address the treatment or recov5 ery needs of— 

6 ‘‘(i) individuals enrolled under the 

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

8 have neonatal abstinence syndrome, in ac9 cordance with guidelines issued by the 

10 American Academy of Pediatrics and Amer11 ican College of Obstetricians and Gyne12 cologists relating to maternal care and in13 fant care with respect to neonatal absti14 nence syndrome; 

15 ‘‘(ii) pregnant women, postpartum 

16 women, and infants, particularly the con17 current treatment, as appropriate, and com18 prehensive case management of pregnant 

19 women, postpartum women and infants, en20 rolled under the State plan (or a waiver of 

21 such plan); 

22 ‘‘(iii) adolescents and young adults be23 tween the ages of 12 and 21 enrolled under 

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

25 or 


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1 ‘‘(iv) American Indian and Alaska Na2 tive individuals enrolled under the State 

3 plan (or a waiver of such plan). 

4 ‘‘(3) PLANNING GRANTS.— 

5 ‘‘(A) IN GENERAL.—The Secretary shall, 

6 with respect to the first 18-month period of the 

7 demonstration project conducted under para8 graph (1), award planning grants to at least 10 

9 States selected in accordance with subparagraph 

10 (B) for purposes of preparing an application de11 scribed in paragraph (4)(C) and carrying out 

12 the activities described in subparagraph (C). 

13 ‘‘(B) SELECTION.—In selecting States for 

14 purposes of this paragraph, the Secretary shall— 

15 ‘‘(i) select States that have a State 

16 plan (or waiver of the State plan) approved 

17 under this title; 

18 ‘‘(ii) select States in a manner that en19 sures geographic diversity; and 

20 ‘‘(iii) give preference to States with a 

21 prevalence of substance use disorders (in 

22 particular opioid use disorders) that is com23 parable to or higher than the national aver24 age prevalence, as measured by aggregate 

25 per capita drug overdoses, or any other 


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1 measure that the Secretary deems appro2 priate. 

3 ‘‘(C) ACTIVITIES DESCRIBED.—Activities 

4 described in this subparagraph are, with respect 

5 to a State, each of the following: 

6 ‘‘(i) Activities that support the develop7 ment of an initial assessment of the behav8 ioral health treatment needs of the State to 

9 determine the extent to which providers are 

10 needed (including the types of such pro11 viders and geographic area of need) to im12 prove the network of providers that treat 

13 substance use disorders under the State plan 

14 (or waiver), including the following: 

15 ‘‘(I) An estimate of the number of 

16 individuals enrolled under the State 

17 plan (or a waiver of such plan) who 

18 have a substance use disorder. 

19 ‘‘(II) Information on the capacity 

20 of providers to provide substance use 

21 disorder treatment or recovery services 

22 to individuals enrolled under the State 

23 plan (or waiver), including informa24 tion on providers who provide such 


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1 services and their participation under 

2 the State plan (or waiver). 

3 ‘‘(III) Information on the gap in 

4 substance use disorder treatment or re5 covery services under the State plan 

6 (or waiver) based on the information 

7 described in subclauses (I) and (II). 

8 ‘‘(IV) Projections regarding the 

9 extent to which the State participating 

10 under the demonstration project would 

11 increase the number of providers offer12 ing substance use disorder treatment or 

13 recovery services under the State plan 

14 (or waiver) during the period of the 

15 demonstration project. 

16 ‘‘(ii) Activities that, taking into ac17 count the results of the assessment described 

18 in clause (i), support the development of 

19 State infrastructure to, with respect to the 

20 provision of substance use disorder treat21 ment or recovery services under the State 

22 plan (or a waiver of such plan), recruit 

23 prospective providers and provide training 

24 and technical assistance to such providers. 


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1 ‘‘(D) FUNDING.—For purposes of subpara2 graph (A), there is appropriated, out of any 

3 funds in the Treasury not otherwise appro4 priated, $50,000,000, to remain available until 

5 expended. 

6 ‘‘(4) POST-PLANNING STATES.— 

7 ‘‘(A) IN GENERAL.—The Secretary shall, 

8 with respect to the remaining 42-month period of 

9 the demonstration project conducted under para10 graph (1), select not more than 5 States in ac11 cordance with subparagraph (B) for purposes of 

12 carrying out the activities described in para13 graph (2) and receiving payments in accordance 

14 with paragraph (5). 

15 ‘‘(B) SELECTION.—In selecting States for 

16 purposes of this paragraph, the Secretary shall— 

17 ‘‘(i) select States that received a plan18 ning grant under paragraph (3); 

19 ‘‘(ii) select States that submit to the 

20 Secretary an application in accordance 

21 with the requirements in subparagraph (C), 

22 taking into consideration the quality of each 

23 such application; 

24 ‘‘(iii) select States in a manner that 

25 ensures geographic diversity; and 


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1 ‘‘(iv) give preference to States with a 

2 prevalence of substance use disorders (in 

3 particular opioid use disorders) that is com4 parable to or higher than the national aver5 age prevalence, as measured by aggregate 

6 per capita drug overdoses, or any other 

7 measure that the Secretary deems appro8 priate. 

9 ‘‘(C) APPLICATIONS.— 

10 ‘‘(i) IN GENERAL.—A State seeking to 

11 be selected for purposes of this paragraph 

12 shall submit to the Secretary, at such time 

13 and in such form and manner as the Sec14 retary requires, an application that in15 cludes such information, provisions, and as16 surances, as the Secretary may require, in 

17 addition to the following: 

18 ‘‘(I) A proposed process for car19 rying out the ongoing assessment de20 scribed in paragraph (2)(A), taking 

21 into account the results of the initial 

22 assessment described in paragraph 

23 (3)(C)(i). 

24 ‘‘(II) A review of reimbursement 

25 methodologies and other policies related 


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1 to substance use disorder treatment or 

2 recovery services under the State plan 

3 (or waiver) that may create barriers to 

4 increasing the number of providers de5 livering such services. 

6 ‘‘(III) The development of a plan, 

7 taking into account activities carried 

8 out under paragraph (3)(C)(ii), that 

9 will result in long-term and sustain10 able provider networks under the State 

11 plan (or waiver) that will offer a con12 tinuum of care for substance use dis13 orders. Such plan shall include the fol14 lowing: 

15 ‘‘(aa) Specific activities to 

16 increase the number of providers 

17 (including providers that spe18 cialize in providing substance use 

19 disorder treatment or recovery 

20 services, hospitals, health care sys21 tems, Federally qualified health 

22 centers, and, as applicable, cer23 tified community behavioral 

24 health clinics) that offer substance 

25 use disorder treatment, recovery, 


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1 or support services, including 

2 short-term detoxification services, 

3 outpatient substance use disorder 

4 services, and evidence-based peer 

5 recovery services. 

6 ‘‘(bb) Strategies that will 

7 incentivize providers described in 

8 subparagraphs (C) and (D) of 

9 paragraph (2) to obtain the nec10 essary training, education, and 

11 support to deliver substance use 

12 disorder treatment or recovery 

13 services in the State. 

14 ‘‘(cc) Milestones and timeli15 ness for implementing activities 

16 set forth in the plan. 

17 ‘‘(dd) Specific measurable 

18 targets for increasing the sub19 stance use disorder treatment and 

20 recovery provider network under 

21 the State plan (or a waiver of 

22 such plan). 

23 ‘‘(IV) A proposed process for re24 porting the information required under 

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1 tion to assess the effectiveness of the ef2 forts of the State to expand the capac3 ity of providers to deliver substance use 

4 disorder treatment or recovery services 

5 during the period of the demonstration 

6 project under this subsection. 

7 ‘‘(V) The expected financial im8 pact of the demonstration project under 

9 this subsection on the State. 

10 ‘‘(VI) A description of all funding 

11 sources available to the State to pro12 vide substance use disorder treatment 

13 or recovery services in the State. 

14 ‘‘(VII) A preliminary plan for 

15 how the State will sustain any increase 

16 in the capacity of providers to deliver 

17 substance use disorder treatment or re18 covery services resulting from the dem19 onstration project under this subsection 

20 after the termination of such dem21 onstration project. 

22 ‘‘(VIII) A description of how the 

23 State will coordinate the goals of the 

24 demonstration project with any waiver 

25 received pursuant to section 1115 for 


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1 the delivery of substance use services 

2 under the State plan, as applicable. 

3 ‘‘(ii) CONSULTATION.—In completing 

4 an application under clause (i), a State 

5 shall consult with relevant stakeholders, in6 cluding Medicaid managed care plans, 

7 health care providers, and Medicaid bene8 ficiary advocates, and include in such ap9 plication a description of such consultation. 

10 ‘‘(5) PAYMENT.— 

11 ‘‘(A) IN GENERAL.—For each quarter occur12 ring during the period for which the demonstra13 tion project is conducted (after the first 18 

14 months of such period), the Secretary shall pay 

15 under this subsection, subject to subparagraphs 

16 (C) and (D), to each State selected under para17 graph (4) an amount equal to 80 percent of so 

18 much of the qualified sums expended during such 

19 quarter. 

20 ‘‘(B) QUALIFIED SUMS DEFINED.—For pur21 poses of subparagraph (A), the term ‘qualified 

22 sums’ means, with respect to a State and a quar23 ter, the amount equal to the amount (if any) by 

24 which the sums expended by the State during 

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1 ment or recovery services furnished by providers 

2 participating under the State plan (or a waiver 

3 of such plan) exceeds 1/4 of such sums expended 

4 by the State during fiscal year 2018 attributable 

5 to substance use treatment or recovery services. 

6 ‘‘(C) NON-DUPLICATION OF PAYMENT.—In 

7 the case that payment is made under subpara8 graph (A) with respect to expenditures for sub9 stance use treatment or recovery services fur10 nished by providers participating under the 

11 State plan (or a waiver of such plan), payment 

12 may not also be made under subsection (a) with 

13 respect to expenditures for the same services so 

14 furnished. 

15 ‘‘(D) CONDITIONS.—In the case of a State 

16 selected under paragraph (4) that provides sub17 stance use disorder treatment and recovery serv18 ices under a waiver under section 1115, such 

19 State shall, as a condition of receiving payments 

20 under subparagraph (A)— 

21 ‘‘(i) coordinate such services under 

22 such waiver with substance use disorder 

23 treatment and recovery services provided 

24 under the demonstration project under this 

25 subsection; and 


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1 ‘‘(ii) take such actions as appropriate 

2 under the demonstration project to expand 

3 such services under such waiver. 

4 ‘‘(6) REPORTS.— 

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

6 payments under paragraph (5) shall, for the pe7 riod of the demonstration project under this sub8 section, submit to the Secretary a quarterly re9 port, with respect to expenditures for substance 

10 use treatment or recovery services for which pay11 ment is made to the State under this subsection, 

12 on the following: 

13 ‘‘(i) The specific activities with respect 

14 to which payment under this subsection was 

15 provided. 

16 ‘‘(ii) The number of providers that de17 livered substance use disorder treatment or 

18 recovery services in the State under the 

19 demonstration project compared to the esti20 mated number of providers that would have 

21 otherwise delivered such services in the ab22 sence of such demonstration project. 

23 ‘‘(iii) The number of individuals en24 rolled under the State plan (or a waiver of 

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1 order treatment or recovery services under 

2 the demonstration project compared to the 

3 estimated number of such individuals who 

4 would have otherwise received such services 

5 in the absence of such demonstration 

6 project. 

7 ‘‘(iv) Other matters as determined by 

8 the Secretary. 

9 ‘‘(B) CMS REPORTS.— 

10 ‘‘(i) INITIAL REPORT.—Not later than 

11 October 1, 2020, the Administrator of the 

12 Centers for Medicare & Medicaid Services 

13 shall, in consultation with the Director of 

14 the Agency for Healthcare Research and 

15 Quality and the Assistant Secretary for 

16 Mental Health and Substance Use, submit 

17 to Congress an initial report on— 

18 ‘‘(I) the States awarded planning 

19 grants under paragraph (3); 

20 ‘‘(II) the criteria used in such se21 lection; and 

22 ‘‘(III) the activities carried out by 

23 such States under such planning 

24 grants. 


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1 ‘‘(ii) INTERIM REPORT.—Not later 

2 than October 1, 2022, the Administrator of 

3 the Centers for Medicare & Medicaid Serv4 ices shall, in consultation with the Director 

5 of the Agency for Healthcare Research and 

6 Quality and the Assistant Secretary for 

7 Mental Health and Substance Use, submit 

8 to Congress an interim report— 

9 ‘‘(I) on activities carried out 

10 under the demonstration project under 

11 this subsection; 

12 ‘‘(II) on the extent to which States 

13 selected under paragraph (4) have 

14 achieved the stated goals submitted in 

15 their applications under subparagraph 

16 (C) of such paragraph; 

17 ‘‘(III) with a description of the 

18 strengths and limitations of such dem19 onstration project; and 

20 ‘‘(IV) with a plan for the sustain21 ability of such project. 

22 ‘‘(iii) FINAL REPORT.—Not later than 

23 October 1, 2024, the Administrator of the 

24 Centers for Medicare & Medicaid Services 

25 shall, in consultation with the Director of 


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1 the Agency for Healthcare Research and 

2 Quality and the Assistant Secretary for 

3 Mental Health and Substance Use, submit 

4 to Congress a final report— 

5 ‘‘(I) providing updates on the 

6 matters reported in the interim report 

7 under clause (ii); 

8 ‘‘(II) including a description of 

9 any changes made with respect to the 

10 demonstration project under this sub11 section after the submission of such in12 terim report; and 

13 ‘‘(III) evaluating such demonstra14 tion project. 

15 ‘‘(C) AHRQ REPORT.—Not later than three 

16 years after the date of the enactment of this sub17 section, the Director of the Agency for Healthcare 

18 Research and Quality shall submit to Congress a 

19 summary on the experiences of States awarded 

20 planning grants under paragraph (3) and States 

21 selected under paragraph (4). 

22 ‘‘(7) DATA SHARING AND BEST PRACTICES.— 

23 During the period of the demonstration project under 

24 this subsection, the Secretary shall, in collaboration 

25 with States selected under paragraph (4), facilitate 


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1 data sharing and the development of best practices be2 tween such States and States that were not so selected. 

3 ‘‘(8) CMS FUNDING.—There is appropriated, out 

4 of any funds in the Treasury not otherwise appro5 priated, $5,000,000 to the Centers for Medicare & 

6 Medicaid Services for purposes of implementing this 

7 subsection. Such amount shall remain available until 

8 expended.’’. 


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Union Calendar No. 566 

115TH CONGRESS 

2D SESSION H. R. 5477 

[Report No. 115–731] 

A BILL 

To amend title XIX of the Social Security Act to 

icaid program. substance use provider capacity under the Medprovide for a demonstration project to increase 

JUNE 12, 2018 

Reported with an amendment, committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union, 


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