I 

115TH CONGRESS 

2D SESSION H. R. 5801 

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

under the Medicaid program relating to the use of qualified prescription 

drug monitoring programs and prescribing certain controlled substances. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 15, 2018 

Mr. GRIFFITH (for himself and Mr. FITZPATRICK) 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 requirements under the Medicaid program relating 

to the use of qualified prescription drug monitoring programs and prescribing certain controlled substances. 

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 ‘‘Medicaid Providers 

5 Are Required To Note Experiences in Record Systems to 

6 Help In-need Patients Act’’ or the ‘‘Medicaid PARTNER7 SHIP Act’’. 


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1 SEC. 2. REQUIREMENTS UNDER THE MEDICAID PROGRAM 

2 RELATING TO QUALIFIED PRESCRIPTION 

3 DRUG MONITORING PROGRAMS AND PRE4 SCRIBING CERTAIN CONTROLLED SUB5 STANCES. 

6 Title XIX of the Social Security Act (42 U.S.C. 1396 

7 et seq.) is amended by inserting after section 1943 the 

8 following new section: 

9 ‘‘SEC. 1944. REQUIREMENTS RELATING TO QUALIFIED PRE10 SCRIPTION DRUG MONITORING PROGRAMS 

11 AND PRESCRIBING CERTAIN CONTROLLED 

12 SUBSTANCES. 

13 ‘‘(a) IN GENERAL.—Beginning October 1, 2021, a 

14 State shall, subject to subsection (d), require each covered 

15 provider to check the prescription drug history of a cov16 ered individual being treated by the covered provider 

17 through a qualified prescription drug monitoring program 

18 described in subsection (b) before prescribing to such indi19 vidual a controlled substance. 

20 ‘‘(b) QUALIFIED PRESCRIPTION DRUG MONITORING

21 PROGRAM DESCRIBED.—A qualified prescription drug 

22 monitoring program described in this subsection is, with 

23 respect to a State, a prescription drug monitoring pro24 gram administered by the State that, at a minimum, satis25 fies each of the following criteria: 


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1 ‘‘(1) The program facilitates access by a cov2 ered provider to, at a minimum, the following infor3 mation with respect to a covered individual, in as 

4 close to real-time as possible: 

5 ‘‘(A) Information regarding the prescrip6 tion drug history of a covered individual with 

7 respect to controlled substances. 

8 ‘‘(B) The number and type of controlled 

9 substances prescribed to and filled for the cov10 ered individual during at least the most recent 

11 12-month period. 

12 ‘‘(C) The name, location, and contact in13 formation (or other identifying number selected 

14 by the State, such as a national provider identi15 fier issued by the National Plan and Provider 

16 Enumeration System of the Centers for Medi17 care & Medicaid Services) of each covered pro18 vider who prescribed a controlled substance to 

19 the covered individual during at least the most 

20 recent 12-month period. 

21 ‘‘(2) The program facilitates the integration of 

22 information described in paragraph (1) into the 

23 workflow of a covered provider, which may include 

24 the electronic system the covered provider uses to 

25 prescribe controlled substances. 


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1 ‘‘(3) The program has in place a data sharing 

2 agreement with the State Medicaid program that al3 lows, at a minimum, the medical director and phar4 macy director of such program (and any designee of 

5 such a director who reports directly to such director) 

6 to access the information described in paragraph (1) 

7 in an electronic format for purposes of improving 

8 health care outcomes of individuals enrolled in the 

9 State plan (or waiver of such plan) and monitoring 

10 and preventing fraud, waste, and abuse. 

11 ‘‘(c) APPLICATION OF PRIVACY RULES CLARIFICA12 TION.—The Secretary shall clarify privacy requirements, 

13 including requirements under the regulations promulgated 

14 pursuant to section 264(c) of the Health Insurance Port15 ability and Accountability Act of 1996 (42 U.S.C. 1320d– 

16 2 note), related to the sharing of data under subsection 

17 (b) in the same manner as the Secretary is required under 

18 subparagraph (J) of section 1860D–4(c)(5) to clarify pri19 vacy requirements related to the sharing of data described 

20 in such subparagraph. 

21 ‘‘(d) ENSURING ACCESS.—In order to ensure reason22 able access to health care, the Secretary may waive the 

23 application of the requirement under subsection (a), with 

24 respect to a State, in the case of natural disasters and 

25 similar situations, and in the case of the provision of emerVerDate Sep 11 2014 01:04 May 31, 2018 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5801.IH H5801

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1 gency services (as defined for purposes of section 1860D– 

2 4(c)(5)(D)(ii)(II)). 

3 ‘‘(e) REPORTS.— 

4 ‘‘(1) STATE REPORTS.—Each State shall in5 clude in the annual report submitted to the Sec6 retary under section 1927(g)(3)(D), beginning with 

7 such reports submitted for 2023, information includ8 ing, at a minimum, the following information for the 

9 most recent 12-month period: 

10 ‘‘(A) The percentage of covered providers 

11 (as determined pursuant to a process estab12 lished by the State) who checked the prescrip13 tion drug history of a covered individual 

14 through a qualified prescription drug moni15 toring program described in subsection (b) be16 fore prescribing to such individual a controlled 

17 substance. 

18 ‘‘(B) Aggregate trends with respect to pre19 scribing controlled substances such as— 

20 ‘‘(i) the number of pill counts and 

21 dosage for controlled substances; 

22 ‘‘(ii) the number and dosage of con23 trolled substances prescribed per covered 

24 individual; and 


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1 ‘‘(iii) the types of controlled sub2 stances prescribed, including the dates of 

3 such prescriptions, the supplies authorized 

4 (including the duration of such supplies), 

5 and the period of validity of such prescrip6 tions, in different populations (such as in7 dividuals who are elderly, individuals with 

8 disabilities, and individuals who are en9 rolled under both this title and title 

10 XVIII). 

11 ‘‘(C) Whether or not the State requires 

12 (and a detailed explanation as to why the State 

13 does or does not require) pharmacists to check 

14 the prescription drug history of a covered indi15 vidual through a qualified drug management 

16 program before dispensing a controlled sub17 stance to such individual. 

18 ‘‘(2) REPORT BY CMS.—Not later than October 

19 1, 2023, the Administrator of the Centers for Medi20 care & Medicaid Services shall publish on the pub21 licly available website of the Centers for Medicare & 

22 Medicaid Services a report including the following 

23 information: 

24 ‘‘(A) Guidance for States on how States 

25 can increase the percentage of covered providers 


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1 who use qualified prescription drug monitoring 

2 programs described in subsection (b). 

3 ‘‘(B) Best practices for how States and 

4 covered providers should use such qualified pre5 scription drug monitoring programs to reduce 

6 the occurrence of abuse of controlled sub7 stances. 

8 ‘‘(f) INCREASE TO FEDERAL MATCHING RATE FOR

9 CERTAIN EXPENDITURES RELATING TO QUALIFIED PRE10 SCRIPTION DRUG MANAGEMENT PROGRAMS.—The Sec11 retary shall increase the Federal medical assistance per12 centage or Federal matching rate that would otherwise 

13 apply to a State under section 1903(a) for a calendar 

14 quarter occurring during the period beginning October 1, 

15 2018, and ending September 30, 2021, for expenditures 

16 by the State for activities under the State plan (or waiver 

17 of the State plan) to implement a prescription drug man18 agement program that satisfies the criteria described in 

19 paragraphs (1) through (3) of subsection (b) if the State 

20 (in this subsection referred to as the ‘administering State’) 

21 has in place agreements with all States that are contig22 uous to such administering State that, when combined, en23 able covered providers in all such contiguous States to ac24 cess, through the prescription drug management program, 

25 the information that is described in subsection (b)(1) of 


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1 covered individuals of such administering State and that 

2 covered providers in such administering State are able to 

3 access through such program. In no case shall an increase 

4 under this subsection result in a Federal medical assist5 ance percentage or Federal matching rate that exceeds 

6 100 percent. 

7 ‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec8 tion prevents a State from requiring pharmacists to check 

9 the prescription drug history of covered individuals 

10 through a qualified drug management program before dis11 pensing controlled substances to such individuals. 

12 ‘‘(h) DEFINITIONS.—In this section: 

13 ‘‘(1) CONTROLLED SUBSTANCE.—The term 

14 ‘controlled substance’ means a drug that is included 

15 in schedule II of section 202(c) of the Controlled 

16 Substances Act and, at the option of the State in17 volved, a drug included in schedule III or IV of such 

18 section. 

19 ‘‘(2) COVERED INDIVIDUAL.—The term ‘cov20 ered individual’ means, with respect to a State, an 

21 individual who is enrolled in the State plan (or 

22 under a waiver of such plan). Such term does not in23 clude an individual who— 

24 ‘‘(A) is receiving— 

25 ‘‘(i) hospice or palliative care; or 


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1 ‘‘(ii) treatment for cancer; 

2 ‘‘(B) is a resident of a long-term care facil3 ity, of a facility described in section 1905(d), or 

4 of another facility for which frequently abused 

5 drugs are dispensed for residents through a 

6 contract with a single pharmacy; or 

7 ‘‘(C) the State elects to treat as exempted 

8 from such term. 

9 ‘‘(3) COVERED PROVIDER.— 

10 ‘‘(A) IN GENERAL.—The term ‘covered 

11 provider’ means, subject to subparagraph (B), 

12 with respect to a State, a health care provider 

13 who is participating under the State plan (or 

14 waiver of the State plan) and licensed, reg15 istered, or otherwise permitted by the State to 

16 prescribe a controlled substance (or the des17 ignee of such provider). 

18 ‘‘(B) EXCEPTIONS.— 

19 ‘‘(i) IN GENERAL.—Beginning Octo20 ber 1, 2021, for purposes of this section, 

21 such term does not include a health care 

22 provider included in any type of health 

23 care provider determined by the Secretary 

24 to be exempt from application of this sec25 tion under clause (ii). 


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1 ‘‘(ii) EXCEPTIONS PROCESS.—Not 

2 later than October 1, 2020, the Secretary, 

3 after consultation with the National Asso4 ciation of Medicaid Directors, national 

5 health care provider associations, Medicaid 

6 beneficiary advocates, and advocates for in7 dividuals with rare diseases, shall deter8 mine, based on such consultations, the 

9 types of health care providers (if any) that 

10 should be exempted from the definition of 

11 the term ‘covered provider’ for purposes of 

12 this section.’’. 

13 SEC. 3. GUIDANCE. 

14 Not later than October 1, 2019, the Administrator 

15 of the Centers for Medicare & Medicaid Services, in con16 sultation with the Director of the Centers for Disease Con17 trol and Prevention, shall issue guidance on best practices 

18 on the uses of prescription drug monitoring programs re19 quired of prescribers and on protecting the privacy of 

20 Medicaid beneficiary information maintained in and 

21 accessed through prescription drug monitoring programs. 

22 SEC. 4. DEVELOPMENT OF MODEL STATE PRACTICES. 

23 (a) IN GENERAL.—Not later than October 1, 2020, 

24 the Secretary of Health and Human Services shall develop 

25 and publish model practices to assist State Medicaid proVerDate Sep 11 2014 01:04 May 31, 2018 Jkt 079200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5801.IH H5801

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1 gram operations in identifying and implementing strate2 gies to utilize data sharing agreements described in section 

3 1944(b)(3) of the Social Security Act, as added by section 

4 2, for the following purposes: 

5 (1) Monitoring and preventing fraud, waste, 

6 and abuse. 

7 (2) Improving health care for individuals en8 rolled in a State plan under title XIX of such Act 

9 (or waiver of such plan) who— 

10 (A) transition in and out of coverage under 

11 such title; 

12 (B) may have sources of health care cov13 erage in addition to coverage under such title; 

14 or 

15 (C) pay for prescription drugs with cash. 

16 (3) Any other purposes specified by the Sec17 retary. 

18 (b) ELEMENTS OF MODEL PRACTICES.—The model 

19 practices described in subsection (a)— 

20 (1) may include strategies for assisting States 

21 in allowing the medical director or pharmacy direc22 tor (or designees of such a director) of managed 

23 care organizations or pharmaceutical benefit man24 agers to access information with respect to all cov25 ered individuals served by such managed care orgaVerDate Sep 11 2014 01:04 May 31, 2018 Jkt 079200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H5801.IH H5801

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1 nizations or pharmaceutical benefit managers to ac2 cess as a single data set, in an electronic format; 

3 and 

4 (2) shall include any appropriate beneficiary 

5 protections and privacy guidelines. 

6 (c) CONSULTATION.—In developing model practices 

7 under this section, the Secretary shall consult with the Na8 tional Association of Medicaid Directors, managed care 

9 entities (as defined in section 1932(a)(1)(B) of the Social 

10 Security Act) with contracts with States pursuant to sec11 tion 1903(m) of such Act, pharmaceutical benefit man12 agers, physicians and other health care providers, bene13 ficiary advocates, and individuals with expertise in health 

14 care technology related to prescription drug monitoring 

15 programs and electronic health records. 

16 SEC. 5. REPORT BY COMPTROLLER GENERAL. 

17 Not later than October 1, 2020, the Comptroller Gen18 eral of the United States shall issue a report examining 

19 the operation of prescription drug monitoring programs 

20 administered by States, including data security and access 

21 standards used by such programs. 

Æ 


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