I 
115TH CONGRESS 
2D SESSION 
H. R. 6 
To provide for opioid use disorder prevention, recovery, and treatment, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 13, 2018 
Mr. WALDEN (for himself, Mr. PALLONE, Mr. BRADY of Texas, Mr. NEAL, 
Mr. ROE of Tennessee, Mr. SHUSTER, Ms. FOXX, Mr. GOODLATTE, Mr. 
WALZ, Mr. DEFAZIO, and Mr. BURGESS) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committees on Ways and Means, and the Judiciary, for 
a period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To provide for opioid use disorder prevention, recovery, and 
treatment, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Substance Use-Disorder Prevention that Promotes 
Opioid Recovery and Treatment for Patients and Commu-
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nities Act’’ or the ‘‘SUPPORT for Patients and Commu-
nities Act’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
the Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—MEDICAID PROVISIONS TO ADDRESS THE OPIOID 
CRISIS 
Sec. 101. At-risk youth Medicaid protection. 
Sec. 102. Health Insurance for Former Foster Youth. 
Sec. 103. Demonstration project to increase substance use provider capacity 
under the Medicaid program. 
Sec. 104. Drug management program for at-risk beneficiaries. 
Sec. 105. Medicaid drug review and utilization. 
Sec. 106. Guidance to improve care for infants with neonatal abstinence syn-
drome and their mothers; GAO study on gaps in Medicaid cov-
erage for pregnant and postpartum women with substance use 
disorder. 
Sec. 107. Medicaid health homes for opioid-use-disorder Medicaid enrollees. 
TITLE II—MEDICARE PROVISIONS TO ADDRESS THE OPIOID 
CRISIS 
Sec. 201. Authority not to apply certain Medicare telehealth requirements in 
the case of certain treatment of a substance use disorder or co- 
occurring mental health disorder. 
Sec. 202. Encouraging the use of non-opioid analgesics for the management of 
post-surgical pain. 
Sec. 203. Requiring a review of current opioid prescriptions for chronic pain 
and screening for opioid use disorder to be included in the Wel-
come to Medicare initial preventive physical examination. 
Sec. 204. Modification of payment for certain outpatient surgical services. 
Sec. 205. Requiring e-prescribing for coverage of covered part D controlled sub-
stances. 
Sec. 206. Requiring prescription drug plan sponsors under Medicare to estab-
lish drug management programs for at-risk beneficiaries. 
Sec. 207. Medicare coverage of certain services furnished by opioid treatment 
programs. 
TITLE III—OTHER HEALTH PROVISIONS TO ADDRESS THE 
OPIOID CRISIS 
Sec. 301. Clarifying FDA regulation of non-addictive pain and addiction thera-
pies. 
Sec. 302. Surveillance and Testing of Opioids to Prevent Fentanyl Deaths. 
Sec. 303. Allowing for more flexibility with respect to medication-assisted treat-
ment for opioid use disorders. 
TITLE IV—OFFSETS 
Sec. 401. Promoting value in Medicaid managed care. 
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Sec. 402. Extending period of application of Medicare secondary payer rules for 
individuals with end stage renal disease. 
Sec. 403. Requiring reporting by group health plans of prescription drug cov-
erage information for purposes of identifying primary payer sit-
uations under the Medicare program. 
TITLE I—MEDICAID PROVISIONS 
TO ADDRESS THE OPIOID CRISIS 
SEC. 101. AT-RISK YOUTH MEDICAID PROTECTION. 
(a) IN GENERAL.—Section 1902 of the Social Secu-
rity Act (42 U.S.C. 1396a) is amended— 
(1) in subsection (a)— 
(A) by striking ‘‘and’’ at the end of para-
graph (82); 
(B) by striking the period at the end of 
paragraph (83) and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (83) the 
following new paragraph: 
‘‘(84) provide that— 
‘‘(A) the State shall not terminate eligi-
bility for medical assistance under the State 
plan for an individual who is an eligible juvenile 
(as defined in subsection (nn)(2)) because the 
juvenile is an inmate of a public institution (as 
defined in subsection (nn)(3)), but may suspend 
coverage during the period the juvenile is such 
an inmate; 
‘‘(B) in the case of an individual who is an 
eligible juvenile described in paragraph (2)(A) 
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of subsection (nn), the State shall, prior to the 
individual’s release from such a public institu-
tion, conduct a redetermination of eligibility for 
such individual with respect to such medical as-
sistance (without requiring a new application 
from the individual) and, if the State deter-
mines pursuant to such redetermination that 
the individual continues to meet the eligibility 
requirements for such medical assistance, the 
State shall restore coverage for such medical 
assistance to such an individual upon the indi-
vidual’s release from such public institution; 
and 
‘‘(C) in the case of an individual who is an 
eligible juvenile described in paragraph (2)(B) 
of subsection (nn), the State shall process any 
application for medical assistance submitted by, 
or on behalf of, such individual such that the 
State makes a determination of eligibility for 
such individual with respect to such medical as-
sistance upon release of such individual from 
such public institution.’’; and 
(2) by adding at the end the following new sub-
section: 
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‘‘(nn) JUVENILE; ELIGIBLE JUVENILE; PUBLIC IN-
STITUTION.—For purposes of subsection (a)(84) and this 
subsection: 
‘‘(1) JUVENILE.—The term ‘juvenile’ means an 
individual who is— 
‘‘(A) under 21 years of age; or 
‘‘(B) 
described 
in 
subsection 
(a)(10)(A)(i)(IX). 
‘‘(2) ELIGIBLE JUVENILE.—The term ‘eligible 
juvenile’ means a juvenile who is an inmate of a 
public institution and who— 
‘‘(A) was determined eligible for medical 
assistance under the State plan immediately be-
fore becoming an inmate of such a public insti-
tution; or 
‘‘(B) is determined eligible for such med-
ical assistance while an inmate of a public insti-
tution. 
‘‘(3) INMATE OF A PUBLIC INSTITUTION.—The 
term ‘inmate of a public institution’ has the meaning 
given such term for purposes of applying the sub-
division (A) following paragraph (29) of section 
1905(a), taking into account the exception in such 
subdivision for a patient of a medical institution.’’. 
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(b) NO CHANGE IN EXCLUSION FROM MEDICAL AS-
SISTANCE
FOR INMATES
OF PUBLIC INSTITUTIONS.— 
Nothing in this section shall be construed as changing the 
exclusion from medical assistance under the subdivision 
(A) following paragraph (29) of section 1905(a) of the So-
cial Security Act (42 U.S.C. 1396d(a)), including any ap-
plicable restrictions on a State submitting claims for Fed-
eral financial participation under title XIX of such Act 
for such assistance. 
(c) NO CHANGE IN CONTINUITY OF ELIGIBILITY BE-
FORE ADJUDICATION OR SENTENCING.—Nothing in this 
section shall be construed to mandate, encourage, or sug-
gest that a State suspend or terminate coverage for indi-
viduals before they have been adjudicated or sentenced. 
(d) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by subsection (a) 
shall apply to eligibility of juveniles who become in-
mates of public institutions on or after the date that 
is 1 year after the date of the enactment of this Act. 
(2) RULE
FOR
CHANGES
REQUIRING
STATE 
LEGISLATION.—In the case of a State plan for med-
ical assistance under title XIX of the Social Security 
Act which the Secretary of Health and Human Serv-
ices determines requires State legislation (other than 
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legislation appropriating funds) in order for the plan 
to meet the additional requirements imposed by the 
amendments made by subsection (a), the State plan 
shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its 
failure to meet these additional requirements before 
the first day of the first calendar quarter beginning 
after the close of the first regular session of the 
State legislature that begins after the date of the en-
actment of this Act. For purposes of the previous 
sentence, in the case of a State that has a 2-year 
legislative session, each year of such session shall be 
deemed to be a separate regular session of the State 
legislature. 
SEC. 102. HEALTH INSURANCE FOR FORMER FOSTER 
YOUTH. 
(a) COVERAGE CONTINUITY FOR FORMER FOSTER 
CARE CHILDREN UP TO AGE 26.— 
(1) 
IN
GENERAL.—Section 
1902(a)(10)(A)(i)(IX) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(A)(i)(IX)) is amended— 
(A) in item (bb), by striking ‘‘are not de-
scribed in or enrolled under’’ and inserting ‘‘are 
not described in and are not enrolled under’’; 
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‘‘(A) is identified as such an at-risk bene-
ficiary through the use of publicly available evi-
dence-based guidelines that indicate misuse or 
abuse of a controlled substance; or 
‘‘(B) the State received notification from a 
PDP sponsor or Medicare Advantage organiza-
tion that such individual was identified as being 
an at-risk beneficiary for prescription drug 
abuse for enrollment in a drug management 
program established by the sponsor or organiza-
tion pursuant to section 1860D–4(c)(5) and 
such identification has not been terminated 
under subparagraph (F) of such section. 
‘‘(2) EXEMPTED INDIVIDUAL DESCRIBED.—For 
purposes of paragraph (1), an exempted individual 
described in this paragraph is an individual who— 
‘‘(A) is receiving— 
‘‘(i) hospice or palliative care; or 
‘‘(ii) treatment for cancer; 
‘‘(B) is a resident of a long-term care facil-
ity, of a facility described in section 1905(d), or 
of another facility for which frequently abused 
drugs are dispensed for residents through a 
contract with a single pharmacy; or 
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‘‘(C) the State elects to treat as an ex-
empted individual for purposes of paragraph 
(1). 
‘‘(d) APPLICATION OF PRIVACY RULES CLARIFICA-
TION.—The Secretary shall clarify privacy requirements, 
including requirements under the regulations promulgated 
pursuant to section 264(c) of the Health Insurance Port-
ability and Accountability Act of 1996 (42 U.S.C. 1320d– 
2 note), related to the sharing of data under subsection 
(b)(6) in the same manner as the Secretary is required 
under subparagraph (J) of section 1860D–4(c)(5) to clar-
ify privacy requirements related to the sharing of data de-
scribed in such subparagraph. 
‘‘(e) REPORTS.— 
‘‘(1) ANNUAL REPORTS.—A State operating a 
qualified drug management program shall include in 
the annual report submitted to the Secretary under 
section 1927(g)(3)(D), beginning with such reports 
submitted for 2021, the following information: 
‘‘(A) The number of individuals enrolled 
under the State plan (or waiver of the State 
plan) who are enrolled under the program and 
the percentage of individuals enrolled under the 
State plan (or waiver) who are enrolled under 
such program. 
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‘‘(B) The number of prescriptions for con-
trolled substances that were dispensed per 
month during each such year per individual en-
rolled under the program, including the daily 
morphine milligram equivalents and the quan-
tity prescribed for each such prescription. 
‘‘(C) The number of pharmacies filling pre-
scriptions for controlled substances for individ-
uals enrolled under such program. 
‘‘(D) The number of health care providers 
writing prescriptions for controlled substances 
(other than prescriptions for a refill) for indi-
viduals enrolled under such program. 
‘‘(E) Any other data that the Secretary 
may require. 
‘‘(F) Any report submitted by a managed 
care entity under subsection (f)(1)(B) with re-
spect to the year involved. 
For each such report for a year after 2021, the in-
formation described in this paragraph shall be pro-
vided in a manner that compares such information 
with respect to the prior calendar year to such infor-
mation with respect to the second prior calendar 
year. 
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‘‘(2) MACPAC REPORTS
AND
REVIEW.—Not 
later than two years after the date of the enactment 
of this section, the Medicaid and CHIP Payment 
and Access Commission (in this section referred to 
as ‘MACPAC’), in consultation with the National 
Association of Medicaid Directors, pharmacy benefit 
managers, managed care organizations, health care 
providers (including pharmacists), beneficiary advo-
cates, and other stakeholders, shall publish a report 
that includes— 
‘‘(A) best practices for operating drug 
management programs, based on a review of a 
representative sample of States administering 
such a program; 
‘‘(B) a summary of the experience of the 
appeals process under drug management pro-
grams operated by several States, such as the 
frequency at which individuals appealed the 
identification of being an at-risk individual, the 
frequency at which individuals appealed the se-
lection of a health care provider or pharmacy 
under such a program, the timeframes for such 
appeals, a summary of the reasons for such ap-
peals, and the design of such appeals processes; 
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‘‘(C) a summary of trends and the effec-
tiveness of qualified drug management pro-
grams operated under this section; and 
‘‘(D) recommendations to States on how 
improvements can be made with respect to the 
operation of such programs. 
In reporting on State practices, the MACPAC shall 
consider how such programs have been implemented 
in rural areas, under fee-for-service as well as man-
aged care arrangements, and the extent to which 
such programs have resulted in increased efficiencies 
to such States or to the Federal Government under 
this title. 
‘‘(3) REPORT
ON
PLAN
FOR
COORDINATED 
CARE.—Not later than January 1, 2021, each State 
operating a qualified drug management program 
shall submit to the Administrator of the Centers for 
Medicare & Medicaid Services a report on how such 
State plans to provide coordinated care for individ-
uals enrolled under the State plan (or waiver of the 
State plan) and— 
‘‘(A) who are enrolled under the program; 
or 
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‘‘(B) who are enrolled with a managed care 
entity and enrolled under such a qualified drug 
management program operated by such entity. 
‘‘(f) APPLICABILITY
TO
MANAGED
CARE
ENTI-
TIES.— 
‘‘(1) IN GENERAL.—With respect to any con-
tract that a State enters into on or after January 
1, 2020, with a managed care entity (as defined in 
section 1932(a)(1)(B)) pursuant to section 1903(m), 
the State shall, as a condition of the contract, re-
quire the managed care entity— 
‘‘(A) to operate a qualified drug manage-
ment program (as defined in subsection (b)) for 
at-risk beneficiaries who are enrolled with such 
entity and identified by the managed care entity 
by means of application of paragraph (2); 
‘‘(B) to submit to the State an annual re-
port on the matters described in subparagraphs 
(A) through (E) of subsection (e)(1); and 
‘‘(C) to submit to the State a list (and as 
necessary update such list) of individuals en-
rolled with such entity under the qualified drug 
management program operated by such entity 
under subparagraph (A) for purposes of allow-
ing State plans for which medical assistance is 
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gram operated by the State shall be deemed a ref-
erence to individuals enrolled under the qualified 
drug management program operated by the man-
aged care entity. 
‘‘(g) CONTROLLED SUBSTANCE DEFINED.—For pur-
poses of this section, the term ‘controlled substance’ 
means a drug that is included in schedule II, III, or IV 
of section 202(c) of the Controlled Substances Act, or any 
combination thereof, as specified by the State.’’. 
(b) 
GUIDANCE
ON
AT-RISK
POPULATION 
TRANSITIONING BETWEEN MEDICAID FFS AND MAN-
AGED CARE.—Not later than October 1, 2019, the Sec-
retary of Health and Human Services shall issue guidance 
for State Medicaid programs, with respect to individuals 
who are enrolled under a State plan (or waiver of such 
plan) under title XIX of the Social Security Act and under 
a drug management program, for purposes of providing 
best practices— 
(1) for transitioning, as applicable, such indi-
viduals from fee-for-service Medicaid (and such a 
program operated by the State) to receiving medical 
assistance under such title through a managed care 
entity (as defined in section 1932(a)(1)(B) of the 
Social Security Act) with a contract that with the 
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State pursuant to section 1903(m) of such Act (and 
such a program operated by such entity); and 
(2) for transitioning, as applicable, such indi-
viduals from receiving medical assistance under such 
title through a managed care entity (as defined in 
section 1932(a)(1)(B) of the Social Security Act) 
with a contract that with the State pursuant to sec-
tion 1903(m) of such Act (and such a program oper-
ated by such entity) to fee-for-service Medicaid (and 
such a program operated by the State). 
(c) 
GUIDANCE
ON
AT-RISK
POPULATION 
TRANSITIONING TO MEDICARE.— 
(1) IN GENERAL.—Not later than January 1, 
2020, the Secretary of Health and Human Services, 
after consultation with the Federal Coordinated 
Health Care Office established under section 2602 
of the Patient Protection and Affordable Care Act 
(42 U.S.C. 1315b), shall issue guidance for State 
Medicaid programs, with respect to transitioning in-
dividuals, providing for— 
(A) notification to be submitted by the 
State to the Centers for Medicare & Medicaid 
Services and such individuals of the status of 
such individuals as transitioning individuals; 
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(B) notification to such individuals about 
enrollment under a prescription drug plan 
under part D of such title or under a MA–PD 
plan under part C of such title; 
(C) best practices for transitioning such in-
dividuals to such a plan; and 
(D) best practices for coordination between 
the qualified drug management program (as de-
scribed in section 1927A(b) of the Social Secu-
rity Act, as added by subsection (a)) carried out 
by the State and a drug management program 
carried out under such a plan pursuant to sec-
tion 1860D–4(c)(5) of the Social Security Act 
(42 U.S.C. 1395w–10(c)(5)). 
(2) TRANSITIONING
INDIVIDUALS.—For pur-
poses of paragraph (1), a transitioning individual is 
an individual who, with respect to a month— 
(A) is enrolled under the State plan (or 
waiver of the State plan) and under the quali-
fied drug management program (as described in 
section 1927A(b) of the Social Security Act, as 
added by subsection (a)) carried out by the 
State; and 
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(B) is expected to become eligible for the 
Medicare program under title XVIII of such 
Act during the subsequent 12-month period. 
SEC. 105. MEDICAID DRUG REVIEW AND UTILIZATION. 
(a) MEDICAID DRUG UTILIZATION REVIEW.— 
(1) 
STATE
PLAN
REQUIREMENT.—Section 
1902(a) of the Social Security Act (42 U.S.C. 
1396a(a)), as amended by section 101, is further 
amended— 
(A) in paragraph (83), at the end, by 
striking ‘‘and’’; 
(B) in paragraph (84), at the end, by 
striking the period and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (84) the 
following new paragraph: 
‘‘(85) provide that the State is in compliance 
with the drug review and utilization requirements 
under subsection (oo)(1).’’. 
(2) DRUG REVIEW AND UTILIZATION REQUIRE-
MENTS.—Section 1902 of the Social Security Act 
(42 U.S.C. 1396a), as amended by section 101, is 
further amended by adding at the end the following 
new subsection: 
‘‘(oo) DRUG REVIEW AND UTILIZATION REQUIRE-
MENTS.— 
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‘‘(1) IN GENERAL.—For purposes of subsection 
(a)(85), the drug review and utilization requirements 
under this subsection are, subject to paragraph (3) 
and beginning October 1, 2019, the following: 
‘‘(A) CLAIMS REVIEW LIMITATIONS.— 
‘‘(i) IN GENERAL.—The State has in 
place— 
‘‘(I) safety edits (as specified by 
the State) for subsequent fills for 
opioids and a claims review automated 
process (as designed and implemented 
by the State) that indicates when an 
individual enrolled under the State 
plan (or under a waiver of the State 
plan) is prescribed a subsequent fill of 
opioids in excess of any limitation 
that may be identified by the State; 
‘‘(II) safety edits (as specified by 
the State) on the maximum daily mor-
phine equivalent that can be pre-
scribed to an individual enrolled under 
the State plan (or under a waiver of 
the State plan) for treatment of 
chronic pain and a claims review auto-
mated process (as designed and imple-
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mented by the State) that indicates 
when an individual enrolled under the 
plan (or waiver) is prescribed the mor-
phine equivalent for such treatment in 
excess of any limitation that may be 
identified by the State; and 
‘‘(III) a claims review automated 
process (as designed and implemented 
by the State) that monitors when an 
individual enrolled under the State 
plan (or under a waiver of the State 
plan) 
is 
concurrently 
prescribed 
opioids and— 
‘‘(aa) benzodiazepines; or 
‘‘(bb) antipsychotics. 
‘‘(ii) MANAGED CARE ENTITIES.—The 
State requires each managed care entity 
(as defined in section 1932(a)(1)(B)) with 
respect to which the State has a contract 
under section 1903(m) or under section 
1905(t)(3) to have in place, subject to 
paragraph (3), with respect to individuals 
who are eligible for medical assistance 
under the State plan (or under a waiver of 
the State plan) and who are enrolled with 
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