IIB 

115TH CONGRESS 

2D SESSION H. R. 5801 

IN THE SENATE OF THE UNITED STATES 

JUNE 20, 2018 

Received; read twice and referred to the Committee on Finance 

AN ACT 

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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Medicaid Providers 

3 Are Required To Note Experiences in Record Systems to 

4 Help In-need Patients Act’’ or the ‘‘Medicaid PARTNER5 SHIP Act’’. 

6 SEC. 2. MEDICAID PROVIDERS ARE REQUIRED TO NOTE EX7 PERIENCES IN RECORD SYSTEMS TO HELP 

8 IN-NEED PATIENTS. 

9 (a) REQUIREMENTS UNDER THE MEDICAID PRO10 GRAM RELATING TO QUALIFIED PRESCRIPTION DRUG

11 MONITORING PROGRAMS AND PRESCRIBING CERTAIN

12 CONTROLLED SUBSTANCES.—Title XIX of the Social Se13 curity Act (42 U.S.C. 1396 et seq.) is amended by insert14 ing after section 1943 the following new section: 

15 ‘‘SEC. 1944. REQUIREMENTS RELATING TO QUALIFIED PRE16 SCRIPTION DRUG MONITORING PROGRAMS 

17 AND PRESCRIBING CERTAIN CONTROLLED 

18 SUBSTANCES. 

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

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

21 provider to check, in accordance with such timing, man22 ner, and form as specified by the State, the prescription 

23 drug history of a covered individual being treated by the 

24 covered provider through a qualified prescription drug 

25 monitoring program described in subsection (b) before 

26 prescribing to such individual a controlled substance. 


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1 ‘‘(b) QUALIFIED PRESCRIPTION DRUG MONITORING

2 PROGRAM DESCRIBED.—A qualified prescription drug 

3 monitoring program described in this subsection is, with 

4 respect to a State, a prescription drug monitoring pro5 gram administered by the State that, at a minimum, satis6 fies each of the following criteria: 

7 ‘‘(1) The program facilitates access by a cov8 ered provider to, at a minimum, the following infor9 mation with respect to a covered individual, in as 

10 close to real-time as possible: 

11 ‘‘(A) Information regarding the prescrip12 tion drug history of a covered individual with 

13 respect to controlled substances. 

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

15 substances prescribed to and filled for the cov16 ered individual during at least the most recent 

17 12-month period. 

18 ‘‘(C) The name, location, and contact in19 formation (or other identifying number selected 

20 by the State, such as a national provider identi21 fier issued by the National Plan and Provider 

22 Enumeration System of the Centers for Medi23 care & Medicaid Services) of each covered pro24 vider who prescribed a controlled substance to 


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1 the covered individual during at least the most 

2 recent 12-month period. 

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

4 information described in paragraph (1) into the 

5 workflow of a covered provider, which may include 

6 the electronic system the covered provider uses to 

7 prescribe controlled substances. 

8 A qualified prescription drug monitoring program de9 scribed in this subsection, with respect to a State, may 

10 have in place, in accordance with applicable State and 

11 Federal law, a data sharing agreement with the State 

12 Medicaid program that allows the medical director and 

13 pharmacy director of such program (and any designee of 

14 such a director who reports directly to such director) to 

15 access the information described in paragraph (1) in an 

16 electronic format. The State Medicaid program under this 

17 title may facilitate reasonable and limited access, as deter18 mined by the State and ensuring documented beneficiary 

19 protections regarding the use of such data, to such quali20 fied prescription drug monitoring program for the medical 

21 director or pharmacy director of any managed care entity 

22 (as defined under section 1932(a)(1)(B)) that has a con23 tract with the State under section 1903(m) or under sec24 tion 1905(t)(3), or the medical director or pharmacy direc25 tor of any entity has a contract to manage the pharmaVerDate Sep 11 2014 01:24 Jun 21, 2018 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5801.RFS H5801

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1 ceutical benefit with respect to individuals enrolled in the 

2 State plan (or waiver of the State plan). All applicable 

3 State and Federal security and privacy laws shall apply 

4 to the directors or designees of such directors of any State 

5 Medicaid program or entity accessing a qualified prescrip6 tion drug monitoring program under this section. 

7 ‘‘(c) APPLICATION OF PRIVACY RULES CLARIFICA8 TION.—The Secretary shall clarify privacy requirements, 

9 including requirements under the regulations promulgated 

10 pursuant to section 264(c) of the Health Insurance Port11 ability and Accountability Act of 1996 (42 U.S.C. 1320d– 

12 2 note), related to the sharing of data under subsection 

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

14 subparagraph (J) of section 1860D–4(c)(5) to clarify pri15 vacy requirements related to the sharing of data described 

16 in such subparagraph. 

17 ‘‘(d) ENSURING ACCESS.—In order to ensure reason18 able access to health care, the Secretary shall waive the 

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

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

21 similar situations, and in the case of the provision of emer22 gency services (as defined for purposes of section 1860D– 

23 4(c)(5)(D)(ii)(II)). 

24 ‘‘(e) REPORTS.— 


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1 ‘‘(1) STATE REPORTS.—Each State shall in2 clude in the annual report submitted to the Sec3 retary under section 1927(g)(3)(D), beginning with 

4 such reports submitted for 2023, information includ5 ing, at a minimum, the following information for the 

6 most recent 12-month period: 

7 ‘‘(A) The percentage of covered providers 

8 (as determined pursuant to a process estab9 lished by the State) who checked the prescrip10 tion drug history of a covered individual 

11 through a qualified prescription drug moni12 toring program described in subsection (b) be13 fore prescribing to such individual a controlled 

14 substance. 

15 ‘‘(B) Aggregate trends with respect to pre16 scribing controlled substances such as— 

17 ‘‘(i) the quantity of daily morphine 

18 milligram equivalents prescribed for con19 trolled substances; 

20 ‘‘(ii) the number and quantity of daily 

21 morphine milligram equivalents prescribed 

22 for controlled substances per covered indi23 vidual; and 

24 ‘‘(iii) the types of controlled sub25 stances prescribed, including the dates of 


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1 such prescriptions, the supplies authorized 

2 (including the duration of such supplies), 

3 and the period of validity of such prescrip4 tions, in different populations (such as in5 dividuals who are elderly, individuals with 

6 disabilities, and individuals who are en7 rolled under both this title and title 

8 XVIII). 

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

10 (and a detailed explanation as to why the State 

11 does or does not require) pharmacists to check 

12 the prescription drug history of a covered indi13 vidual through a qualified drug management 

14 program before dispensing a controlled sub15 stance to such individual. 

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

17 1, 2023, the Administrator of the Centers for Medi18 care & Medicaid Services shall publish on the pub19 licly available website of the Centers for Medicare & 

20 Medicaid Services a report including the following 

21 information: 

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

23 can increase the percentage of covered providers 

24 who use qualified prescription drug monitoring 

25 programs described in subsection (b). 


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

2 covered providers should use such qualified pre3 scription drug monitoring programs to reduce 

4 the occurrence of abuse of controlled sub5 stances. 

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

7 CERTAIN EXPENDITURES RELATING TO QUALIFIED PRE8 SCRIPTION DRUG MANAGEMENT PROGRAMS.—The Sec9 retary shall increase the Federal medical assistance per10 centage or Federal matching rate that would otherwise 

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

12 quarter occurring during the period beginning October 1, 

13 2018, and ending September 30, 2021, for expenditures 

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

15 of the State plan) to implement a prescription drug man16 agement program that satisfies the criteria described in 

17 paragraphs (1) and (2) of subsection (b) if the State (in 

18 this subsection referred to as the ‘administering State’) 

19 has in place agreements with all States that are contig20 uous to such administering State that, when combined, en21 able covered providers in all such contiguous States to ac22 cess, through the prescription drug management program, 

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

24 covered individuals of such administering State and that 

25 covered providers in such administering State are able to 


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

2 under this subsection result in a Federal medical assist3 ance percentage or Federal matching rate that exceeds 

4 100 percent. 

5 ‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec6 tion prevents a State from requiring pharmacists to check 

7 the prescription drug history of covered individuals 

8 through a qualified drug management program before dis9 pensing controlled substances to such individuals. 

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

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

12 ‘controlled substance’ means a drug that is included 

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

14 Substances Act and, at the option of the State in15 volved, a drug included in schedule III or IV of such 

16 section. 

17 ‘‘(2) COVERED INDIVIDUAL.—The term ‘cov18 ered individual’ means, with respect to a State, an 

19 individual who is enrolled in the State plan (or 

20 under a waiver of such plan). Such term does not in21 clude an individual who— 

22 ‘‘(A) is receiving— 

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

24 ‘‘(ii) treatment for cancer; 


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1 ‘‘(B) is a resident of a long-term care facil2 ity, of a facility described in section 1905(d), or 

3 of another facility for which frequently abused 

4 drugs are dispensed for residents through a 

5 contract with a single pharmacy; or 

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

7 from such term. 

8 ‘‘(3) COVERED PROVIDER.— 

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

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

11 with respect to a State, a health care provider 

12 who is participating under the State plan (or 

13 waiver of the State plan) and licensed, reg14 istered, or otherwise permitted by the State to 

15 prescribe a controlled substance (or the des16 ignee of such provider). 

17 ‘‘(B) EXCEPTIONS.— 

18 ‘‘(i) IN GENERAL.—Beginning Octo19 ber 1, 2021, for purposes of this section, 

20 such term does not include a health care 

21 provider included in any type of health 

22 care provider determined by the Secretary 

23 to be exempt from application of this sec24 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 (b) GUIDANCE.—Not later than October 1, 2019, the 

14 Administrator of the Centers for Medicare & Medicaid 

15 Services, in consultation with the Director of the Centers 

16 for Disease Control and Prevention, shall issue guidance 

17 on best practices on the uses of prescription drug moni18 toring programs required of prescribers and on protecting 

19 the privacy of Medicaid beneficiary information main20 tained in and accessed through prescription drug moni21 toring programs. 

22 (c) DEVELOPMENT OF MODEL STATE PRACTICES.— 

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

24 2020, the Secretary of Health and Human Services 

25 shall develop and publish model practices to assist 


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1 State Medicaid program operations in identifying 

2 and implementing strategies to utilize data sharing 

3 agreements described in the matter following para4 graph (2) of section 1944(b) of the Social Security 

5 Act, as added by subsection (a), for the following 

6 purposes: 

7 (A) Monitoring and preventing fraud, 

8 waste, and abuse. 

9 (B) Improving health care for individuals 

10 enrolled in a State plan under title XIX of such 

11 Act (or waiver of such plan) who— 

12 (i) transition in and out of coverage 

13 under such title; 

14 (ii) may have sources of health care 

15 coverage in addition to coverage under 

16 such title; or 

17 (iii) pay for prescription drugs with 

18 cash. 

19 (C) Any other purposes specified by the 

20 Secretary. 

21 (2) ELEMENTS OF MODEL PRACTICES.—The 

22 model practices described in paragraph (1)— 

23 (A) shall include strategies for assisting 

24 States in allowing the medical director or phar25 macy director (or designees of such a director) 


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1 of managed care organizations or pharma2 ceutical benefit managers to access information 

3 with respect to all covered individuals served by 

4 such managed care organizations or pharma5 ceutical benefit managers to access as a single 

6 data set, in an electronic format; and 

7 (B) shall include any appropriate bene8 ficiary protections and privacy guidelines. 

9 (3) CONSULTATION.—In developing model prac10 tices under this subsection, the Secretary shall con11 sult with the National Association of Medicaid Di12 rectors, managed care entities (as defined in section 

13 1932(a)(1)(B) of the Social Security Act) with con14 tracts with States pursuant to section 1903(m) of 

15 such Act, pharmaceutical benefit managers, physi16 cians and other health care providers, beneficiary 

17 advocates, and individuals with expertise in health 

18 care technology related to prescription drug moni19 toring programs and electronic health records. 

20 (d) REPORT BY COMPTROLLER GENERAL.—Not later 

21 than October 1, 2020, the Comptroller General of the 

22 United States shall issue a report examining the operation 

23 of prescription drug monitoring programs administered by 


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1 States, including data security and access standards used 

2 by such programs. 

Passed the House of Representatives June 19, 2018. 

Attest: KAREN L. HAAS, 

Clerk. 


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