IB 

Union Calendar No. 560 

115TH CONGRESS 

2D SESSION H. R. 5801 

[Report No. 115–725] 

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 

JUNE 12, 2018 

Additional sponsor: Mrs. BLACKBURN and Mr. WALDEN

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 May 15, 2018] 


pbinns on DSK79D2C42PROD with BILLS
2 

•HR 5801 RH

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. 


pbinns on DSK79D2C42PROD with BILLS
3 

•HR 5801 RH

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 Are 

5 Required To Note Experiences in Record Systems to Help 

6 In-need Patients Act’’ or the ‘‘Medicaid PARTNERSHIP 

7 Act’’. 

8 SEC. 2. REQUIREMENTS UNDER THE MEDICAID PROGRAM 

9 RELATING TO QUALIFIED PRESCRIPTION 

10 DRUG MONITORING PROGRAMS AND PRE11 SCRIBING CERTAIN CONTROLLED SUB12 STANCES. 

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

14 et seq.) is amended by inserting after section 1943 the fol15 lowing new section: 

16 ‘‘SEC. 1944. REQUIREMENTS RELATING TO QUALIFIED PRE17 SCRIPTION DRUG MONITORING PROGRAMS 

18 AND PRESCRIBING CERTAIN CONTROLLED 

19 SUBSTANCES. 

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

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

22 provider to check the prescription drug history of a covered 

23 individual being treated by the covered provider through a 

24 qualified prescription drug monitoring program described 


pbinns on DSK79D2C42PROD with BILLS
4 

•HR 5801 RH

1 in subsection (b) before prescribing to such individual a 

2 controlled substance. 

3 ‘‘(b) QUALIFIED PRESCRIPTION DRUG MONITORING

4 PROGRAM DESCRIBED.—A qualified prescription drug 

5 monitoring program described in this subsection is, with 

6 respect to a State, a prescription drug monitoring program 

7 administered by the State that, at a minimum, satisfies 

8 each of the following criteria: 

9 ‘‘(1) The program facilitates access by a covered 

10 provider to, at a minimum, the following information 

11 with respect to a covered individual, in as close to 

12 real-time as possible: 

13 ‘‘(A) Information regarding the prescription 

14 drug history of a covered individual with respect 

15 to controlled substances. 

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

17 substances prescribed to and filled for the covered 

18 individual during at least the most recent 12- 

19 month period. 

20 ‘‘(C) The name, location, and contact infor21 mation (or other identifying number selected by 

22 the State, such as a national provider identifier 

23 issued by the National Plan and Provider Enu24 meration System of the Centers for Medicare & 

25 Medicaid Services) of each covered provider who 


pbinns on DSK79D2C42PROD with BILLS
5 

•HR 5801 RH

1 prescribed a controlled substance to the covered 

2 individual during at least the most recent 12- 

3 month period. 

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

5 information described in paragraph (1) into the 

6 workflow of a covered provider, which may include 

7 the electronic system the covered provider uses to pre8 scribe controlled substances. 

9 A qualified prescription drug monitoring program de10 scribed in this subsection, with respect to a State, may have 

11 in place, in accordance with applicable State and Federal 

12 law, a data sharing agreement with the State Medicaid pro13 gram that allows the medical director and pharmacy direc14 tor of such program (and any designee of such a director 

15 who reports directly to such director) to access the informa16 tion described in paragraph (1) in an electronic format. 

17 The State Medicaid program under this title may facilitate 

18 reasonable and limited access, as determined by the State 

19 and ensuring documented beneficiary protections regarding 

20 the use of such data, to such qualified prescription drug 

21 monitoring program for the medical director or pharmacy 

22 director of any managed care entity (as defined under sec23 tion 1932(a)(1)(B)) that has a contract with the State 

24 under section 1903(m) or under section 1905(t)(3), or the 

25 medical director or pharmacy director of any entity has 


pbinns on DSK79D2C42PROD with BILLS
6 

•HR 5801 RH

1 a contract to manage the pharmaceutical benefit with re2 spect to individuals enrolled in the State plan (or waiver 

3 of the State plan). All applicable State and Federal security 

4 and privacy laws shall apply to the directors or designees 

5 of such directors of any State Medicaid program or entity 

6 accessing a qualified prescription drug monitoring program 

7 under this section. 

8 ‘‘(c) APPLICATION OF PRIVACY RULES CLARIFICA9 TION.—The Secretary shall clarify privacy requirements, 

10 including requirements under the regulations promulgated 

11 pursuant to section 264(c) of the Health Insurance Port12 ability and Accountability Act of 1996 (42 U.S.C. 1320d– 

13 2 note), related to the sharing of data under subsection (b) 

14 in the same manner as the Secretary is required under sub15 paragraph (J) of section 1860D–4(c)(5) to clarify privacy 

16 requirements related to the sharing of data described in such 

17 subparagraph. 

18 ‘‘(d) ENSURING ACCESS.—In order to ensure reason19 able access to health care, the Secretary may waive the ap20 plication of the requirement under subsection (a), with re21 spect to a State, in the case of natural disasters and similar 

22 situations, and in the case of the provision of emergency 

23 services (as defined for purposes of section 1860D– 

24 4(c)(5)(D)(ii)(II)). 

25 ‘‘(e) REPORTS.— 


pbinns on DSK79D2C42PROD with BILLS
7 

•HR 5801 RH

1 ‘‘(1) STATE REPORTS.—Each State shall include 

2 in the annual report submitted to the Secretary under 

3 section 1927(g)(3)(D), beginning with such reports 

4 submitted for 2023, information including, at a min5 imum, the following information for the most recent 

6 12-month period: 

7 ‘‘(A) The percentage of covered providers (as 

8 determined pursuant to a process established by 

9 the State) who checked the prescription drug his10 tory of a covered individual through a qualified 

11 prescription drug monitoring program described 

12 in subsection (b) before prescribing to such indi13 vidual a controlled substance. 

14 ‘‘(B) Aggregate trends with respect to pre15 scribing controlled substances such as— 

16 ‘‘(i) the number of pill counts and dos17 age for controlled substances; 

18 ‘‘(ii) the number and dosage of con19 trolled substances prescribed per covered in20 dividual; and 

21 ‘‘(iii) the types of controlled substances 

22 prescribed, including the dates of such pre23 scriptions, the supplies authorized (includ24 ing the duration of such supplies), and the 

25 period of validity of such prescriptions, in 


pbinns on DSK79D2C42PROD with BILLS
8 

•HR 5801 RH

1 different populations (such as individuals 

2 who are elderly, individuals with disabil3 ities, and individuals who are enrolled 

4 under both this title and title XVIII). 

5 ‘‘(C) Whether or not the State requires (and 

6 a detailed explanation as to why the State does 

7 or does not require) pharmacists to check the 

8 prescription drug history of a covered individual 

9 through a qualified drug management program 

10 before dispensing a controlled substance to such 

11 individual. 

12 ‘‘(2) REPORT BY CMS.—Not later than October 1, 

13 2023, the Administrator of the Centers for Medicare 

14 & Medicaid Services shall publish on the publicly 

15 available website of the Centers for Medicare & Med16 icaid Services a report including the following infor17 mation: 

18 ‘‘(A) Guidance for States on how States can 

19 increase the percentage of covered providers who 

20 use qualified prescription drug monitoring pro21 grams described in subsection (b). 

22 ‘‘(B) Best practices for how States and cov23 ered providers should use such qualified prescrip24 tion drug monitoring programs to reduce the oc25 currence of abuse of controlled substances. 


pbinns on DSK79D2C42PROD with BILLS
9 

•HR 5801 RH

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

2 CERTAIN EXPENDITURES RELATING TO QUALIFIED PRE3 SCRIPTION DRUG MANAGEMENT PROGRAMS.—The Sec4 retary shall increase the Federal medical assistance percent5 age or Federal matching rate that would otherwise apply 

6 to a State under section 1903(a) for a calendar quarter oc7 curring during the period beginning October 1, 2018, and 

8 ending September 30, 2021, for expenditures by the State 

9 for activities under the State plan (or waiver of the State 

10 plan) to implement a prescription drug management pro11 gram that satisfies the criteria described in paragraphs (1) 

12 and (2) of subsection (b) if the State (in this subsection 

13 referred to as the ‘administering State’) has in place agree14 ments with all States that are contiguous to such admin15 istering State that, when combined, enable covered pro16 viders in all such contiguous States to access, through the 

17 prescription drug management program, the information 

18 that is described in subsection (b)(1) of covered individuals 

19 of such administering State and that covered providers in 

20 such administering State are able to access through such 

21 program. In no case shall an increase under this subsection 

22 result in a Federal medical assistance percentage or Federal 

23 matching rate that exceeds 100 percent. 

24 ‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec25 tion prevents a State from requiring pharmacists to check 


pbinns on DSK79D2C42PROD with BILLS
10 

•HR 5801 RH

1 the prescription drug history of covered individuals through 

2 a qualified drug management program before dispensing 

3 controlled substances to such individuals. 

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

5 ‘‘(1) CONTROLLED SUBSTANCE.—The term ‘con6 trolled substance’ means a drug that is included in 

7 schedule II of section 202(c) of the Controlled Sub8 stances Act and, at the option of the State involved, 

9 a drug included in schedule III or IV of such section. 

10 ‘‘(2) COVERED INDIVIDUAL.—The term ‘covered 

11 individual’ means, with respect to a State, an indi12 vidual who is enrolled in the State plan (or under a 

13 waiver of such plan). Such term does not include an 

14 individual who— 

15 ‘‘(A) is receiving— 

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

17 ‘‘(ii) treatment for cancer; 

18 ‘‘(B) is a resident of a long-term care facil19 ity, of a facility described in section 1905(d), or 

20 of another facility for which frequently abused 

21 drugs are dispensed for residents through a con22 tract with a single pharmacy; or 

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

24 from such term. 

25 ‘‘(3) COVERED PROVIDER.— 


pbinns on DSK79D2C42PROD with BILLS
11 

•HR 5801 RH

1 ‘‘(A) IN GENERAL.—The term ‘covered pro2 vider’ means, subject to subparagraph (B), with 

3 respect to a State, a health care provider who is 

4 participating under the State plan (or waiver of 

5 the State plan) and licensed, registered, or other6 wise permitted by the State to prescribe a con7 trolled substance (or the designee of such pro8 vider). 

9 ‘‘(B) EXCEPTIONS.— 

10 ‘‘(i) IN GENERAL.—Beginning October 

11 1, 2021, for purposes of this section, such 

12 term does not include a health care provider 

13 included in any type of health care provider 

14 determined by the Secretary to be exempt 

15 from application of this section under 

16 clause (ii). 

17 ‘‘(ii) EXCEPTIONS PROCESS.—Not later 

18 than October 1, 2020, the Secretary, after 

19 consultation with the National Association 

20 of Medicaid Directors, national health care 

21 provider associations, Medicaid beneficiary 

22 advocates, and advocates for individuals 

23 with rare diseases, shall determine, based on 

24 such consultations, the types of health care 

25 providers (if any) that should be exempted 


pbinns on DSK79D2C42PROD with BILLS
12 

•HR 5801 RH

1 from the definition of the term ‘covered pro2 vider’ for purposes of this section.’’. 

3 SEC. 3. GUIDANCE. 

4 Not later than October 1, 2019, the Administrator of 

5 the Centers for Medicare & Medicaid Services, in consulta6 tion with the Director of the Centers for Disease Control 

7 and Prevention, shall issue guidance on best practices on 

8 the uses of prescription drug monitoring programs required 

9 of prescribers and on protecting the privacy of Medicaid 

10 beneficiary information maintained in and accessed 

11 through prescription drug monitoring programs. 

12 SEC. 4. DEVELOPMENT OF MODEL STATE PRACTICES. 

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

14 Secretary of Health and Human Services shall develop and 

15 publish model practices to assist State Medicaid program 

16 operations in identifying and implementing strategies to 

17 utilize data sharing agreements described in the matter fol18 lowing paragraph (2) of section 1944(b) of the Social Secu19 rity Act, as added by section 2, for the following purposes: 

20 (1) Monitoring and preventing fraud, waste, and 

21 abuse. 

22 (2) Improving health care for individuals en23 rolled in a State plan under title XIX of such Act (or 

24 waiver of such plan) who— 


pbinns on DSK79D2C42PROD with BILLS
13 

•HR 5801 RH

1 (A) transition in and out of coverage under 

2 such title; 

3 (B) may have sources of health care cov4 erage in addition to coverage under such title; or 

5 (C) pay for prescription drugs with cash. 

6 (3) Any other purposes specified by the Sec7 retary. 

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

9 practices described in subsection (a)— 

10 (1) may include strategies for assisting States in 

11 allowing the medical director or pharmacy director 

12 (or designees of such a director) of managed care or13 ganizations or pharmaceutical benefit managers to 

14 access information with respect to all covered individ15 uals served by such managed care organizations or 

16 pharmaceutical benefit managers to access as a single 

17 data set, in an electronic format; and 

18 (2) shall include any appropriate beneficiary 

19 protections and privacy guidelines. 

20 (c) CONSULTATION.—In developing model practices 

21 under this section, the Secretary shall consult with the Na22 tional Association of Medicaid Directors, managed care en23 tities (as defined in section 1932(a)(1)(B) of the Social Se24 curity Act) with contracts with States pursuant to section 

25 1903(m) of such Act, pharmaceutical benefit managers, 


pbinns on DSK79D2C42PROD with BILLS
14 

•HR 5801 RH

1 physicians and other health care providers, beneficiary ad2 vocates, and individuals with expertise in health care tech3 nology related to prescription drug monitoring programs 

4 and electronic health records. 

5 SEC. 5. REPORT BY COMPTROLLER GENERAL. 

6 Not later than October 1, 2020, the Comptroller Gen7 eral of the United States shall issue a report examining 

8 the operation of prescription drug monitoring programs ad9 ministered by States, including data security and access 

10 standards used by such programs. 


pbinns on DSK79D2C42PROD with BILLS

pbinns on DSK79D2C42PROD with BILLS
Union Calendar No. 560 

115TH CONGRESS 

2D SESSION H. R. 5801 

[Report No. 115–725] 

A BILL 

To amend title XIX of the Social Security Act to 

tain controlled substances. drug monitoring programs and prescribing cergram relating to the use of qualified prescription provide for requirements under the Medicaid proJUNE 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, 


pbinns on DSK79D2C42PROD with BILLS