II 

115TH CONGRESS 

2D SESSION S. 2875 

To amend title XVIII of the Social Security Act to provide for Medicare 

coverage of certain services furnished by opioid treatment programs, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 17, 2018 

Mr. CASSIDY (for himself, Mr. NELSON, and Mr. CARDIN) introduced the 

following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for Medicare coverage of certain services furnished by 

opioid treatment programs, 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, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Comprehensive Opioid 

5 Management and Bundled Addiction Treatment Act of 

6 2018’’ or the ‘‘COMBAT Act of 2018’’. 


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1 SEC. 2. MEDICARE COVERAGE OF CERTAIN SERVICES FUR2 NISHED BY OPIOID TREATMENT PROGRAMS. 

3 (a) COVERAGE.—Section 1861(s)(2) of the Social Se4 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 

5 (1) in subparagraph (FF), by striking at the 

6 end ‘‘and’’; 

7 (2) in subparagraph (GG), by inserting at the 

8 end ‘‘; and’’; and 

9 (3) by adding at the end the following new sub10 paragraph: 

11 ‘‘(HH) opioid use disorder treatment serv12 ices (as defined in subsection (jjj)).’’. 

13 (b) OPIOID USE DISORDER TREATMENT SERVICES

14 AND OPIOID TREATMENT PROGRAM DEFINED.—Section 

15 1861 of the Social Security Act is amended by adding at 

16 the end the following new subsection: 

17 ‘‘(jjj) OPIOID USE DISORDER TREATMENT SERV18 ICES; OPIOID TREATMENT PROGRAM.— 

19 ‘‘(1) OPIOID USE DISORDER TREATMENT SERV20 ICES.—The term ‘opioid use disorder treatment serv21 ices’ means items and services that are furnished by 

22 an opioid treatment program for the treatment of 

23 opioid abuse disorder, including— 

24 ‘‘(A) opioid agonist treatment medications 

25 (including oral versions) that are approved by 

26 the Food and Drug Administration under secVerDate Sep 11 2014 04:14 May 26, 2018 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2875.IS S2875

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1 tion 505 of the Federal Food, Drug, and Cos2 metic Act for use in the treatment of opioid use 

3 disorder; 

4 ‘‘(B) dispensing and administration of 

5 such medications, if applicable; 

6 ‘‘(C) substance abuse counseling by a pro7 fessional to the extent authorized under State 

8 law to furnish such services; 

9 ‘‘(D) behavioral individual and group ther10 apy with physicians or psychologists (or other 

11 mental health professionals to the extent au12 thorized under State law); 

13 ‘‘(E) toxicology testing, and 

14 ‘‘(F) other items and services that the Sec15 retary determines are appropriate. 

16 ‘‘(2) OPIOID TREATMENT PROGRAM.—The term 

17 ‘opioid treatment program’ means an opioid treat18 ment program (as defined in section 8.2 of title 42 

19 of the Code of Federal Regulations, or any successor 

20 regulation) that— 

21 ‘‘(A) is enrolled under section 1866(j); 

22 ‘‘(B) has in effect a certification by the 

23 Substance Abuse and Mental Health Services 

24 Administration for such a program; 


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1 ‘‘(C) is accredited by an accrediting body 

2 approved by the Substance Abuse and Mental 

3 Health Services Administration; and 

4 ‘‘(D) meets such additional conditions as 

5 the Secretary may find necessary to ensure— 

6 ‘‘(i) the health and safety of individ7 uals being furnished services under such 

8 program; and 

9 ‘‘(ii) the effective and efficient fur10 nishing of such services.’’. 

11 (c) PAYMENT.— 

12 (1) IN GENERAL.—Section 1833(a)(1) of the 

13 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

14 amended— 

15 (A) by striking ‘‘and (BB)’’ and inserting 

16 ‘‘(BB)’’; and 

17 (B) by inserting before the semicolon at 

18 the end the following ‘‘, and (CC) with respect 

19 to opioid use disorder treatment services fur20 nished during an episode of care, the amount 

21 paid shall be equal to the amount payable in ac22 cordance with section 1834(w) less any copay23 ment required as specified by the Secretary’’. 

24 (2) PAYMENT DETERMINATION.—Section 1834 

25 of the Social Security Act (42 U.S.C. 1395m) is 


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1 amended by adding at the end the following new 

2 subsection: 

3 ‘‘(w) OPIOID USE DISORDER TREATMENT SERV4 ICES.— 

5 ‘‘(1) IN GENERAL.—The Secretary shall pay to 

6 an opioid treatment program (as defined in para7 graph (2) of section 1861(jjj)) an amount that is 

8 equal to 100 percent of a bundled payment under 

9 this part for opioid use disorder treatment services 

10 (as defined in paragraph (1) of such section) that 

11 are furnished by such program to an individual dur12 ing an episode of care (as defined by the Secretary) 

13 beginning on or after January 1, 2020. The Sec14 retary shall ensure that no duplicative payments are 

15 made under this part or part D to a physician, prac16 titioner, or pharmacy for items and services fur17 nished by an opioid treatment program. 

18 ‘‘(2) CONSIDERATIONS.—The Secretary may 

19 implement this subsection through one or more bun20 dles based on the type of medication provided (such 

21 as buprenorphine, methadone, naltrexone, or a new 

22 innovative drug), the frequency of services, the scope 

23 of services furnished, characteristics of the individ24 uals furnished such services, or other factors as the 

25 Secretary determines appropriate. In developing 


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1 such bundles, the Secretary may consider payment 

2 rates paid to opioid treatment programs for com3 parable services under State plans under title XIX, 

4 under the TRICARE program under chapter 55 of 

5 title 10 of the United States Code, or by other 

6 health care payers. 

7 ‘‘(3) ANNUAL UPDATES.—The Secretary shall 

8 provide an update each year to the bundled payment 

9 amounts under this subsection.’’. 

10 (d) INCLUDING OPIOID TREATMENT PROGRAMS AS

11 MEDICARE PROVIDERS.—Section 1866(e) of the Social 

12 Security Act (42 U.S.C. 1395cc(e)) is amended— 

13 (1) in paragraph (2), by striking at the end 

14 ‘‘and’’; 

15 (2) in paragraph (3), by striking the period at 

16 the end and inserting ‘‘; and’’; and 

17 (3) by adding at the end the following new 

18 paragraph: 

19 ‘‘(3) opioid treatment programs (as defined in 

20 paragraph (2) of section 1861(jjj)), but only with re21 spect to the furnishing of opioid treatment program 

22 services (as defined in paragraph (1) of such sec23 tion).’’. 

Æ 


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