115TH CONGRESS 

2D SESSION H. R. 5796 

AN ACT 

To require the Secretary of Health and Human Services 

to provide grants for eligible entities to provide technical 

assistance to outlier prescribers of opioids, and for other 

purposes. 

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

2 This Act may be cited as the ‘‘Responsible Education 

3 Achieves Care and Healthy Outcomes for Users’ Treat4 ment Act of 2018’’ or the ‘‘REACH OUT Act of 2018’’. 

5 SEC. 2. GRANTS TO PROVIDE TECHNICAL ASSISTANCE TO 

6 OUTLIER PRESCRIBERS OF OPIOIDS. 

7 (a) GRANTS AUTHORIZED.—The Secretary of Health 

8 and Human Services (in this section referred to as the 

9 ‘‘Secretary’’) shall, through the Centers for Medicare & 

10 Medicaid Services, award grants, contracts, or cooperative 

11 agreements to eligible entities for the purposes described 

12 in subsection (b). 

13 (b) USE OF FUNDS.—Grants, contracts, and coopera14 tive agreements awarded under subsection (a) shall be 

15 used to support eligible entities through technical assist16 ance— 

17 (1) to educate and provide outreach to outlier 

18 prescribers of opioids about best practices for pre19 scribing opioids; 

20 (2) to educate and provide outreach to outlier 

21 prescribers of opioids about non-opioid pain manage22 ment therapies; and 

23 (3) to reduce the amount of opioid prescriptions 

24 prescribed by outlier prescribers of opioids. 

25 (c) APPLICATION.—Each eligible entity seeking to re26 ceive a grant, contract, or cooperative agreement under 
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1 subsection (a) shall submit to the Secretary an applica2 tion, at such time, in such manner, and containing such 

3 information as the Secretary may require. 

4 (d) GEOGRAPHIC DISTRIBUTION.—In awarding 

5 grants, contracts, and cooperative agreements under this 

6 section, the Secretary shall prioritize establishing technical 

7 assistance resources in each State. 

8 (e) DEFINITIONS.—In this section: 

9 (1) ELIGIBLE ENTITY.—The term ‘‘eligible enti10 ty’’ means— 

11 (A) an organization— 

12 (i) that has demonstrated experience 

13 providing technical assistance to health 

14 care professionals on a State or regional 

15 basis; and 

16 (ii) that has at least— 

17 (I) one individual who is a rep18 resentative of consumers on its gov19 erning body; and 

20 (II) one individual who is a rep21 resentative of health care providers on 

22 its governing body; or 

23 (B) an entity that is a quality improve24 ment entity with a contract under part B of 
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1 title XI of the Social Security Act (42 U.S.C. 

2 1320c et seq.). 

3 (2) OUTLIER PRESCRIBER OF OPIOIDS.—The 

4 term ‘‘outlier prescriber of opioids’’ means a pre5 scriber, identified by the Secretary of Health and 

6 Human Services (through use of prescriber informa7 tion provided by prescriber National Provider Identi8 fiers included pursuant to section 1860D–4(c)(4)(A) 

9 of the Social Security Act (42 U.S.C. 1395w– 

10 104(c)(4)(A)) on claims for covered part D drugs for 

11 part D eligible individuals enrolled in prescription 

12 drug plans under part D of title XVIII of such Act 

13 (42 U.S.C. 1395w–101 et seq.) and MA–PD plans 

14 under part C of such title (42 U.S.C. 1395w–21 et 

15 seq.)) as prescribing, as compared to other pre16 scribers in the specialty of the prescriber and geo17 graphic area, amounts of opioids in excess of a 

18 threshold (and other criteria) specified by the Sec19 retary, after consultation with stakeholders. 

20 (3) PRESCRIBERS.—The term ‘‘prescriber’’ 

21 means any health care professional, including a 

22 nurse practitioner or physician assistant, who is li23 censed to prescribe opioids by the State or territory 

24 in which such professional practices. 
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1 (f) FUNDING.—For purposes of implementing this 

2 section, $75 million shall be available from the Federal 

3 Supplementary Medical Insurance Trust Fund under sec4 tion 1841 of the Social Security Act (42 U.S.C. 1395t), 

5 to remain available until expended. 

6 SEC. 3. PROMOTING VALUE IN MEDICAID MANAGED CARE. 

7 Section 1903(m) of the Social Security Act (42 

8 U.S.C. 1396b(m)) is amended by adding at the end the 

9 following new paragraph: 

10 ‘‘(7)(A) With respect to expenditures described in 

11 subparagraph (B) that are incurred by a State for any 

12 fiscal year after fiscal year 2025 (and before fiscal year 

13 2029), in determining the pro rata share to which the 

14 United States is equitably entitled under subsection 

15 (d)(3), the Secretary shall substitute the Federal medical 

16 assistance percentage that applies for such fiscal year to 

17 the State under section 1905(b) (without regard to any 

18 adjustments to such percentage applicable under such sec19 tion or any other provision of law) for the percentage that 

20 applies to such expenditures under section 1905(y). 

21 ‘‘(B) Expenditures described in this subparagraph, 

22 with respect to a fiscal year to which subparagraph (A) 

23 applies, are expenditures incurred by a State for payment 

24 for medical assistance provided to individuals described in 

25 subclause (VIII) of section 1902(a)(10)(A)(i) by a man-
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1 aged care entity, or other specified entity (as defined in 

2 subparagraph (D)(iii)), that are treated as remittances be3 cause the State— 

4 ‘‘(i) has satisfied the requirement of section 

5 438.8 of title 42, Code of Federal Regulations (or 

6 any successor regulation), by electing— 

7 ‘‘(I) in the case of a State described in 

8 subparagraph (C), to apply a minimum medical 

9 loss ratio (as defined in subparagraph (D)(ii)) 

10 that is at least 85 percent but not greater than 

11 the minimum medical loss ratio (as so defined) 

12 that such State applied as of May 31, 2018; or 

13 ‘‘(II) in the case of a State not described 

14 in subparagraph (C), to apply a minimum med15 ical loss ratio that is equal to 85 percent; and 

16 ‘‘(ii) recovered all or a portion of the expendi17 tures as a result of the entity’s failure to meet such 

18 ratio. 

19 ‘‘(C) For purposes of subparagraph (B), a State de20 scribed in this subparagraph is a State that as of May 

21 31, 2018, applied a minimum medical loss ratio (as cal22 culated under subsection (d) of section 438.8 of title 42, 

23 Code of Federal Regulations (as in effect on June 1, 

24 2018)) for payment for services provided by entities de25 scribed in such subparagraph under the State plan under 
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1 this title (or a waiver of the plan) that is equal to or great2 er than 85 percent. 

3 ‘‘(D) For purposes of this paragraph: 

4 ‘‘(i) The term ‘managed care entity’ means a 

5 medicaid managed care organization described in 

6 section 1932(a)(1)(B)(i). 

7 ‘‘(ii) The term ‘minimum medical loss ratio’ 

8 means, with respect to a State, a minimum medical 

9 loss ratio (as calculated under subsection (d) of sec10 tion 438.8 of title 42, Code of Federal Regulations 

11 (as in effect on June 1, 2018)) for payment for serv12 ices provided by entities described in subparagraph 

13 (B) under the State plan under this title (or a waiv14 er of the plan). 

15 ‘‘(iii) The term ‘other specified entity’ means— 

16 ‘‘(I) a prepaid inpatient health plan, as de17 fined in section 438.2 of title 42, Code of Fed18 eral Regulations (or any successor regulation); 

19 and 
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1 ‘‘(II) a prepaid ambulatory health plan, as 

2 defined in such section (or any successor regu3 lation).’’. 

Passed the House of Representatives June 19, 2018. 

Attest: 

Clerk. 

115TH CONGRESS 

2D SESSION H. R. 5796 

AN ACT 

To require the Secretary of Health and Human 

of opioids, and for other purposes. provide technical assistance to outlier prescribers Services to provide grants for eligible entities to