IB 
Union Calendar No. 566 
115TH CONGRESS 
2D SESSION 
H. R. 5477 
[Report No. 115–731] 
To amend title XIX of the Social Security Act to provide for a demonstration 
project to increase substance use provider capacity under the Medicaid 
program. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 11, 2018 
Mr. O’HALLERAN introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
JUNE 12, 2018 
Additional sponsors: Mrs. BLACKBURN, Mr. WALDEN, and Mr. MITCHELL 
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 April 11, 2018] 
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A BILL 
To amend title XIX of the Social Security Act to provide 
for a demonstration project to increase substance use 
provider capacity under the Medicaid program. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Rural Development of 
Opioid Capacity Services Act’’ or the ‘‘Rural DOCS Act’’. 
SEC. 2. DEMONSTRATION PROJECT TO INCREASE SUB-
STANCE USE PROVIDER CAPACITY UNDER 
THE MEDICAID PROGRAM. 
Section 1903 of the Social Security Act (42 U.S.C. 
1396b) is amended by adding at the end the following new 
subsection: 
‘‘(aa) DEMONSTRATION PROJECT TO INCREASE SUB-
STANCE USE PROVIDER CAPACITY.— 
‘‘(1) IN GENERAL.—Not later than the date that 
is 180 days after the date of the enactment of this sec-
tion, the Secretary shall, in consultation, as appro-
priate, with the Director of the Agency for Healthcare 
Research and Quality and the Assistant Secretary for 
Mental Health and Substance Use, conduct a 5-year 
demonstration project for the purpose described in 
paragraph (2) under which the Secretary shall— 
‘‘(A) for the first 18-month period of such 
project, award planning grants described in 
paragraph (3); and 
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‘‘(B) for the remaining 42-month period of 
such project, provide to each State selected under 
paragraph (4) payments in accordance with 
paragraph (5). 
‘‘(2) PURPOSE.—The purpose described in this 
paragraph is for each State selected under paragraph 
(4) to increase the treatment capacity of providers 
participating under the State plan (or a waiver of 
such plan) to provide substance use disorder treat-
ment or recovery services under such plan (or waiver) 
through the following activities: 
‘‘(A) For the purpose described in para-
graph (3)(C)(i), activities that support an ongo-
ing assessment of the behavioral health treatment 
needs of the State, taking into account the mat-
ters described in subclauses (I) through (IV) of 
such paragraph. 
‘‘(B) Activities that, taking into account the 
results of the assessment described in subpara-
graph (A), support the recruitment, training, 
and provision of technical assistance for pro-
viders participating under the State plan (or a 
waiver of such plan) that offer substance use dis-
order treatment or recovery services. 
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‘‘(C) Improved reimbursement for and ex-
pansion of, through the provision of education, 
training, and technical assistance, the number or 
treatment capacity of providers participating 
under the State plan (or waiver) that— 
‘‘(i) are authorized to dispense drugs 
approved by the Food and Drug Adminis-
tration for individuals with a substance use 
disorder who need withdrawal management 
or maintenance treatment for such disorder; 
‘‘(ii) have in effect a registration or 
waiver under section 303(g) of the Con-
trolled Substances Act for purposes of dis-
pensing narcotic drugs to individuals for 
maintenance treatment or detoxification 
treatment and are in compliance with any 
regulation promulgated by the Assistant 
Secretary for Mental Health and Substance 
Use for purposes of carrying out the re-
quirements of such section 303(g); and 
‘‘(iii) are qualified under applicable 
State law to provide substance use disorder 
treatment or recovery services. 
‘‘(D) Improved reimbursement for and ex-
pansion of, through the provision of education, 
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training, and technical assistance, the number or 
treatment capacity of providers participating 
under the State plan (or waiver) that have the 
qualifications to address the treatment or recov-
ery needs of— 
‘‘(i) individuals enrolled under the 
State plan (or a waiver of such plan) who 
have neonatal abstinence syndrome, in ac-
cordance with guidelines issued by the 
American Academy of Pediatrics and Amer-
ican College of Obstetricians and Gyne-
cologists relating to maternal care and in-
fant care with respect to neonatal absti-
nence syndrome; 
‘‘(ii) pregnant women, postpartum 
women, and infants, particularly the con-
current treatment, as appropriate, and com-
prehensive case management of pregnant 
women, postpartum women and infants, en-
rolled under the State plan (or a waiver of 
such plan); 
‘‘(iii) adolescents and young adults be-
tween the ages of 12 and 21 enrolled under 
the State plan (or a waiver of such plan); 
or 
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‘‘(iv) American Indian and Alaska Na-
tive individuals enrolled under the State 
plan (or a waiver of such plan). 
‘‘(3) PLANNING GRANTS.— 
‘‘(A) IN
GENERAL.—The Secretary shall, 
with respect to the first 18-month period of the 
demonstration project conducted under para-
graph (1), award planning grants to at least 10 
States selected in accordance with subparagraph 
(B) for purposes of preparing an application de-
scribed in paragraph (4)(C) and carrying out 
the activities described in subparagraph (C). 
‘‘(B) SELECTION.—In selecting States for 
purposes of this paragraph, the Secretary shall— 
‘‘(i) select States that have a State 
plan (or waiver of the State plan) approved 
under this title; 
‘‘(ii) select States in a manner that en-
sures geographic diversity; and 
‘‘(iii) give preference to States with a 
prevalence of substance use disorders (in 
particular opioid use disorders) that is com-
parable to or higher than the national aver-
age prevalence, as measured by aggregate 
per capita drug overdoses, or any other 
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measure that the Secretary deems appro-
priate. 
‘‘(C) ACTIVITIES
DESCRIBED.—Activities 
described in this subparagraph are, with respect 
to a State, each of the following: 
‘‘(i) Activities that support the develop-
ment of an initial assessment of the behav-
ioral health treatment needs of the State to 
determine the extent to which providers are 
needed (including the types of such pro-
viders and geographic area of need) to im-
prove the network of providers that treat 
substance use disorders under the State plan 
(or waiver), including the following: 
‘‘(I) An estimate of the number of 
individuals enrolled under the State 
plan (or a waiver of such plan) who 
have a substance use disorder. 
‘‘(II) Information on the capacity 
of providers to provide substance use 
disorder treatment or recovery services 
to individuals enrolled under the State 
plan (or waiver), including informa-
tion on providers who provide such 
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‘‘(D) FUNDING.—For purposes of subpara-
graph (A), there is appropriated, out of any 
funds in the Treasury not otherwise appro-
priated, $50,000,000, to remain available until 
expended. 
‘‘(4) POST-PLANNING STATES.— 
‘‘(A) IN
GENERAL.—The Secretary shall, 
with respect to the remaining 42-month period of 
the demonstration project conducted under para-
graph (1), select not more than 5 States in ac-
cordance with subparagraph (B) for purposes of 
carrying out the activities described in para-
graph (2) and receiving payments in accordance 
with paragraph (5). 
‘‘(B) SELECTION.—In selecting States for 
purposes of this paragraph, the Secretary shall— 
‘‘(i) select States that received a plan-
ning grant under paragraph (3); 
‘‘(ii) select States that submit to the 
Secretary an application in accordance 
with the requirements in subparagraph (C), 
taking into consideration the quality of each 
such application; 
‘‘(iii) select States in a manner that 
ensures geographic diversity; and 
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‘‘(iv) give preference to States with a 
prevalence of substance use disorders (in 
particular opioid use disorders) that is com-
parable to or higher than the national aver-
age prevalence, as measured by aggregate 
per capita drug overdoses, or any other 
measure that the Secretary deems appro-
priate. 
‘‘(C) APPLICATIONS.— 
‘‘(i) IN GENERAL.—A State seeking to 
be selected for purposes of this paragraph 
shall submit to the Secretary, at such time 
and in such form and manner as the Sec-
retary requires, an application that in-
cludes such information, provisions, and as-
surances, as the Secretary may require, in 
addition to the following: 
‘‘(I) A proposed process for car-
rying out the ongoing assessment de-
scribed in paragraph (2)(A), taking 
into account the results of the initial 
assessment described in paragraph 
(3)(C)(i). 
‘‘(II) A review of reimbursement 
methodologies and other policies related 
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to substance use disorder treatment or 
recovery services under the State plan 
(or waiver) that may create barriers to 
increasing the number of providers de-
livering such services. 
‘‘(III) The development of a plan, 
taking into account activities carried 
out under paragraph (3)(C)(ii), that 
will result in long-term and sustain-
able provider networks under the State 
plan (or waiver) that will offer a con-
tinuum of care for substance use dis-
orders. Such plan shall include the fol-
lowing: 
‘‘(aa) Specific activities to 
increase the number of providers 
(including providers that spe-
cialize in providing substance use 
disorder treatment or recovery 
services, hospitals, health care sys-
tems, Federally qualified health 
centers, and, as applicable, cer-
tified 
community 
behavioral 
health clinics) that offer substance 
use disorder treatment, recovery, 
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or support services, including 
short-term detoxification services, 
outpatient substance use disorder 
services, and evidence-based peer 
recovery services. 
‘‘(bb) Strategies that will 
incentivize providers described in 
subparagraphs (C) and (D) of 
paragraph (2) to obtain the nec-
essary training, education, and 
support to deliver substance use 
disorder treatment or recovery 
services in the State. 
‘‘(cc) Milestones and timeli-
ness for implementing activities 
set forth in the plan. 
‘‘(dd) 
Specific 
measurable 
targets for increasing the sub-
stance use disorder treatment and 
recovery provider network under 
the State plan (or a waiver of 
such plan). 
‘‘(IV) A proposed process for re-
porting the information required under 
paragraph (6)(A), including informa-
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tion to assess the effectiveness of the ef-
forts of the State to expand the capac-
ity of providers to deliver substance use 
disorder treatment or recovery services 
during the period of the demonstration 
project under this subsection. 
‘‘(V) The expected financial im-
pact of the demonstration project under 
this subsection on the State. 
‘‘(VI) A description of all funding 
sources available to the State to pro-
vide substance use disorder treatment 
or recovery services in the State. 
‘‘(VII) A preliminary plan for 
how the State will sustain any increase 
in the capacity of providers to deliver 
substance use disorder treatment or re-
covery services resulting from the dem-
onstration project under this subsection 
after the termination of such dem-
onstration project. 
‘‘(VIII) A description of how the 
State will coordinate the goals of the 
demonstration project with any waiver 
received pursuant to section 1115 for 
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the delivery of substance use services 
under the State plan, as applicable. 
‘‘(ii) CONSULTATION.—In completing 
an application under clause (i), a State 
shall consult with relevant stakeholders, in-
cluding Medicaid managed care plans, 
health care providers, and Medicaid bene-
ficiary advocates, and include in such ap-
plication a description of such consultation. 
‘‘(5) PAYMENT.— 
‘‘(A) IN GENERAL.—For each quarter occur-
ring during the period for which the demonstra-
tion project is conducted (after the first 18 
months of such period), the Secretary shall pay 
under this subsection, subject to subparagraphs 
(C) and (D), to each State selected under para-
graph (4) an amount equal to 80 percent of so 
much of the qualified sums expended during such 
quarter. 
‘‘(B) QUALIFIED SUMS DEFINED.—For pur-
poses of subparagraph (A), the term ‘qualified 
sums’ means, with respect to a State and a quar-
ter, the amount equal to the amount (if any) by 
which the sums expended by the State during 
such quarter attributable to substance use treat-
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order treatment or recovery services under 
the demonstration project compared to the 
estimated number of such individuals who 
would have otherwise received such services 
in the absence of such demonstration 
project. 
‘‘(iv) Other matters as determined by 
the Secretary. 
‘‘(B) CMS REPORTS.— 
‘‘(i) INITIAL REPORT.—Not later than 
October 1, 2020, the Administrator of the 
Centers for Medicare & Medicaid Services 
shall, in consultation with the Director of 
the Agency for Healthcare Research and 
Quality and the Assistant Secretary for 
Mental Health and Substance Use, submit 
to Congress an initial report on— 
‘‘(I) the States awarded planning 
grants under paragraph (3); 
‘‘(II) the criteria used in such se-
lection; and 
‘‘(III) the activities carried out by 
such States under such planning 
grants. 
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‘‘(ii) INTERIM
REPORT.—Not later 
than October 1, 2022, the Administrator of 
the Centers for Medicare & Medicaid Serv-
ices shall, in consultation with the Director 
of the Agency for Healthcare Research and 
Quality and the Assistant Secretary for 
Mental Health and Substance Use, submit 
to Congress an interim report— 
‘‘(I) on activities carried out 
under the demonstration project under 
this subsection; 
‘‘(II) on the extent to which States 
selected under paragraph (4) have 
achieved the stated goals submitted in 
their applications under subparagraph 
(C) of such paragraph; 
‘‘(III) with a description of the 
strengths and limitations of such dem-
onstration project; and 
‘‘(IV) with a plan for the sustain-
ability of such project. 
‘‘(iii) FINAL REPORT.—Not later than 
October 1, 2024, the Administrator of the 
Centers for Medicare & Medicaid Services 
shall, in consultation with the Director of 
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the Agency for Healthcare Research and 
Quality and the Assistant Secretary for 
Mental Health and Substance Use, submit 
to Congress a final report— 
‘‘(I) providing updates on the 
matters reported in the interim report 
under clause (ii); 
‘‘(II) including a description of 
any changes made with respect to the 
demonstration project under this sub-
section after the submission of such in-
terim report; and 
‘‘(III) evaluating such demonstra-
tion project. 
‘‘(C) AHRQ REPORT.—Not later than three 
years after the date of the enactment of this sub-
section, the Director of the Agency for Healthcare 
Research and Quality shall submit to Congress a 
summary on the experiences of States awarded 
planning grants under paragraph (3) and States 
selected under paragraph (4). 
‘‘(7) DATA
SHARING
AND
BEST
PRACTICES.— 
During the period of the demonstration project under 
this subsection, the Secretary shall, in collaboration 
with States selected under paragraph (4), facilitate 
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data sharing and the development of best practices be-
tween such States and States that were not so selected. 
‘‘(8) CMS FUNDING.—There is appropriated, out 
of any funds in the Treasury not otherwise appro-
priated, $5,000,000 to the Centers for Medicare & 
Medicaid Services for purposes of implementing this 
subsection. Such amount shall remain available until 
expended.’’. 
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Union Calendar No. 566 
115TH CONGRESS 
2D SESSION 
H. R. 5477 
[Report No. 115–731] 
A BILL 
To amend title XIX of the Social Security Act to 
provide for a demonstration project to increase 
substance use provider capacity under the Med-
icaid program. 
JUNE 12, 2018 
Reported with an amendment, committed to the Com-
mittee of the Whole House on the State of the Union, 
and ordered to be printed 
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