I 
115TH CONGRESS 
2D SESSION 
H. R. 5531 
To provide for a comprehensive, multifaceted approach to preventing and 
treating opioid addiction. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 17, 2018 
Mr. BUCHANAN (for himself and Mrs. MURPHY of Florida) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committees on Ways and Means, the Budg-
et, Veterans’ Affairs, Oversight and Government Reform, and the Judici-
ary, 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 committee concerned 
A BILL 
To provide for a comprehensive, multifaceted approach to 
preventing and treating opioid addiction. 
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 
‘‘Opioid Emergency Response Act’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Alternatives to opioids prescribing. 
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Sec. 3. Opioids and STOP Pain Initiative. 
Sec. 4. Veteran over-medication prevention. 
Sec. 5. Amendment relating to the account for the State response to the opioid 
abuse crisis. 
Sec. 6. Mental health access improvement. 
Sec. 7. Synthetics Trafficking and Overdose Prevention. 
Sec. 8. Stop the Importation and Trafficking of Synthetic Analogues. 
SEC. 2. ALTERNATIVES TO OPIOIDS PRESCRIBING. 
(a) ESTABLISHMENT.—Beginning not later than one 
year after the date of the enactment of this Act, the Sec-
retary of Health and Human Services (in this Act referred 
to as the ‘‘Secretary’’) shall carry out a 5-year demonstra-
tion project under which payment shall be made under the 
hospital outpatient prospective payment system under part 
B of title XVIII of the Social Security Act (42 U.S.C. 
1395j et seq.) to participating hospitals for items and 
services furnished as alternatives to opioid medications to 
individuals enrolled under such part to treat conditions 
designated under subsection (c)(1) for purposes of evalu-
ating the benefits of using, instead of opioid medications, 
such alternatives to treat in emergency departments such 
symptoms and conditions. 
(b) EMERGENCY DEPARTMENTS.— 
(1) SELECTION.—The Secretary shall select 
from hospitals with emergency departments volun-
tarily submitting applications under paragraph (4), 
not fewer than 30 hospitals with emergency depart-
ments, and not more than 50 hospitals with emer-
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gency departments, for participation in the dem-
onstration project. 
(2) DIVERSITY.—In selecting hospitals with 
emergency departments, the Secretary shall ensure 
such hospitals and emergency departments are di-
verse in geography and size. 
(3) VOLUNTARY PARTICIPATION.—Participation 
in the demonstration project under this section shall 
be on a voluntary basis. 
(4) APPLICATIONS.— 
(A) IN GENERAL.—To participate in the 
demonstration project, a hospital with an emer-
gency department shall submit to the Secretary 
an application at such time, in such manner, 
and containing such information (in addition to 
the written commitment described in subpara-
graph (B)) as specified by the Secretary. The 
Secretary shall take such measures as is nec-
essary to make available such application form 
to potential participants no later than 180 days 
after the date of the enactment of this Act. 
(B) INFORMATION REQUIRED.—Each ap-
plication submitted by a hospital under sub-
paragraph (A) shall include a binding written 
commitment to participate in the demonstration 
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project for the duration of the project signed by 
the Chief Executive Officer of the hospital, the 
physician medical director of the emergency de-
partment of the hospital, the nursing director of 
the emergency department of the hospital, and 
the pharmacy director of the emergency depart-
ment of the hospital. 
(c) ELEMENTS
OF DEMONSTRATION PROJECT.— 
Under the demonstration project, the following shall 
apply: 
(1) The Secretary shall designate no fewer than 
five conditions or sets of symptoms that will be mon-
itored during the demonstration project. 
(2) The performance during each year of the 
demonstration project, with respect to such condi-
tions designated under paragraph (1), of all emer-
gency departments of hospitals participating in the 
demonstration project will be measured against the 
performance of such emergency departments during 
a base year, which shall represent the most recent 
set of full year data available before the first date 
of the demonstration project. 
(3) The Secretary shall provide hospitals par-
ticipating in the demonstration project with a de-
scription of clearly defined treatments that are con-
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sidered alternatives to opioids to be applied for pur-
poses of subsection (a). 
(d) INCENTIVE PAYMENT.—Under the demonstration 
project, the Secretary shall create a payment structure 
under which hospitals participating in the demonstration 
project that increase the use of alternatives to opioids and 
decrease the use of opioids may receive a shared savings 
bonus in addition to what would otherwise be made for 
items and services furnished under subsection (a). The 
amount of such shared savings shall be based on the dif-
ference between readmission rates for individuals treated 
with an alternative to opioids at the emergency depart-
ment of the participating hospital and the average rate 
of readmissions for individuals treated with opioids and 
discharged from a representative group of emergency de-
partments of hospitals not participating in the demonstra-
tion project in the same region as the participating hos-
pital over a period of five years. 
(e) CLARIFICATION.—Nothing under this section 
shall prevent a health care provider from prescribing an 
opioid if an opioid is a medically necessary treatment. 
(f) REPORTS TO CONGRESS.— 
(1) INITIAL REPORT.—Not later than 180 days 
after the date of the enactment of this Act, the Sec-
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retary shall submit to Congress a report that in-
cludes— 
(A) the application form described in sub-
section (b)(4)(A) that is to be made available to 
potential participants; and 
(B) a progress report with respect to des-
ignating the conditions under subsection (c)(1) 
and establishing the description of clearly de-
fined treatments described in subsection (c)(3). 
(2) PERIODIC DEMONSTRATION REPORTS.—Be-
ginning after the first year of the demonstration 
project and annually thereafter for each year of the 
demonstration project and not later than one year 
after the completion of the demonstration, the Sec-
retary shall submit to Congress a report that in-
cludes the following data for each hospital partici-
pating under the demonstration project: 
(A) With respect to each condition or set 
of symptom designated under subsection (c)(1), 
the number of individuals treated. 
(B) With respect to each such condition, 
the number of individuals treated only with an 
alternative to opioids. 
(C) With respect to each such condition, 
the number of individuals treated first with an 
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alternative to opioids, followed by an opioid in 
the same visit. 
(D) With respect to each such condition, 
the number of individuals treated only with an 
opioid. 
(E) With respect to each individual de-
scribed in subparagraph (A) treated for such a 
condition or set of symptoms, whether or not 
the individual involved returned to the emer-
gency department of the hospital or an emer-
gency department of a different hospital for the 
same condition or symptoms. 
(F) The difference in cost between treating 
an individual with an alternative to opioid 
versus an opioid. 
(G) Any additional information the Sec-
retary determines necessary. 
SEC. 3. OPIOIDS AND STOP PAIN INITIATIVE. 
(a) ESTABLISHMENT.—There is established an 
Opioids and STOP Pain Initiative, to be administered by 
the Director of the National Institutes of Health, in co-
ordination with other agencies, as appropriate, which shall 
include efforts to support research on the following: 
(1) Section 108 of the Comprehensive Addiction 
and Recovery Act of 2016 (42 U.S.C. 284q–1), 
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known as the STOP Pain Act, which directs the Na-
tional Institutes of Health to intensify and coordi-
nate fundamental, translational, and clinical re-
search with respect to— 
(A) the understanding of pain; 
(B) the discovery and development of 
therapies for chronic pain; and 
(C) the development of alternatives to 
opioids for effective pain treatments. 
(2) Developing improved options and evidence 
for medication-assisted treatment. 
(3) Developing improved options and evidence 
for opioid overdose reversal treatments. 
(4) The Federal Pain Research Strategy, in-
cluding research that focuses on— 
(A) novel drugs, non-addictive, and non- 
pharmacological treatments for pain; 
(B) screening tools and outcome measure 
for assessments across the continuum of pain; 
(C) national registries, datasets, and re-
search networks; 
(D) effective models of care delivery for 
pain management; and 
(E) precision medicine methodology to pre-
vent and treat pain. 
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(5) The components of the Department of 
Health and Human Services five-point strategy to 
address the opioid crisis that states: ‘‘Providing sup-
port for cutting edge research on pain and addic-
tion’’. 
(6) The pain therapy screening program estab-
lished under subsection (c). 
(7) Other elements that the Secretary of Health 
and Human Services may designate, in consultation 
with the Director of the National Institutes of 
Health. 
(b) FUNDING FOR THE OPIOIDS AND STOP PAIN 
INITIATIVE.— 
(1) IN GENERAL.—There is authorized to be 
appropriated, 
and 
there 
is 
appropriated, 
$500,000,000, to be used during the 5-fiscal-year 
period beginning in the fiscal year in which such 
funds are appropriated, to the National Institutes of 
Health Innovation Account to be used to administer 
the Opioids and STOP Pain Initiative established 
under subsection (a). 
(2) EMERGENCY SPENDING.— 
(A) IN GENERAL.—Amounts appropriated 
under paragraph (1) are designated as an emer-
gency requirement pursuant to section 4(g) of 
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the Statutory Pay-As-You-Go Act of 2010 (2 
U.S.C. 933(g)). 
(B) DESIGNATION
IN
THE
SENATE.—In 
the Senate, amounts appropriated under sub-
section (a) are designated as an emergency re-
quirement pursuant to section 403(a) of S. 
Con. Res. 13 (111th Congress), the concurrent 
resolution on the budget for fiscal year 2010. 
(c) PAIN THERAPY SCREENING PROGRAM.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the 
‘‘Secretary’’) shall carry out through the National 
Institutes of Health a program to be known as the 
‘‘Pain Therapy Screening Program’’ that focuses on 
the development of pain therapeutics. 
(2) 
GRANTS.—The 
Secretary 
shall 
award 
grants under the program under paragraph (1) to 
eligible public and private nonprofit entities to sup-
port the development of new pre-clinical models for 
pain disorders, and the application of these models 
in drug, device, or other therapy screening. 
(3) MODEL.—The program under this section 
shall be modeled after the Epilepsy Therapy Screen-
ing Program carried out by the National Institute of 
Neurological Disorders and Stroke. 
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(4) FEES.—The Secretary of Health and 
Human Services may assess reasonable fees on pri-
vate pharmaceutical or medical device industry enti-
ties that utilize the program under this section to 
screen proprietary molecular compounds and devices. 
Such fees shall be paid to the Foundation for the 
National Institutes of Health and transferred to the 
NIH Innovation Account to be used for the Opioids 
and STOP Pain Initiative established under sub-
section (a). 
(5) FUNDING.—The Director of the National 
Institutes of Health shall determine the amount, and 
allocate, funds from the amount appropriated under 
subsection (b), to carry out this section. 
(d) FUNDING PROVISIONS.— 
(1) SUPPLEMENT
NOT
SUPPLANT.—Amounts 
appropriated in this section (including the amend-
ments made by this section) shall be used to supple-
ment, not supplant, current funding for pain and 
opioid research at the National Institutes of Health. 
(2) ACCEPTANCE
OF
DONATIONS.—Notwith-
standing section 1342 of title 31, United States 
Code, the Secretary of Health and Human Services 
may accept donations (including from the pharma-
ceutical and medical device industries) to be used to 
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assist in carrying out programs and activities under 
this section (and the amendments made by this sec-
tion). Such donations shall be paid to the Founda-
tion for the National Institutes of Health and trans-
ferred to the NIH Innovation Account to be used for 
the Opioids and STOP Pain Initiative established 
under subsection (a). 
(3) INCLUSION OF CONTRIBUTION AMOUNTS IN 
BASIC
RESEARCH
FOR
PURPOSES
OF
RESEARCH 
CREDIT.— 
(A) IN GENERAL.—Paragraph (6) of sec-
tion 41(e) of the Internal Revenue Code of 
1986 is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(E) OPIOIDS
AND
STOP
PAIN
INITIA-
TIVE.—The National Institutes of Health, if the 
payment is made in support of the Opioids and 
STOP Pain Initiative, as established by the 
Opioids and STOP Pain Initiative Act.’’. 
(B) EFFECTIVE DATE.—The amendments 
made by this subsection shall apply to taxable 
years beginning after the date of the enactment 
of this Act. 
(e) AUTHORITY.—Notwithstanding any other provi-
sion of the law, the Director of the National Institutes 
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of Health may use funds available under subsection (b) 
to enter into transactions (other than contracts, coopera-
tive agreements, or grants) to carry out research identified 
pursuant to the Opioids and STOP Pain Initiative estab-
lished under subsection (a). 
(f) REPORTS.— 
(1) ANNUAL REPORTS.—Not later than October 
1 of each of fiscal years 2019 through 2026, the Di-
rector of the National Institutes of Health shall sub-
mit to the Committee on Health, Education, Labor, 
and Pensions and the Committee on Appropriations 
of the Senate and the Committee on Energy and 
Commerce and the Committee on Appropriations of 
the House of Representatives, a report that in-
cludes— 
(A) the amount obligated or expended in 
the fiscal year prior to the fiscal year in which 
the report is being submitted for each program 
or activity described in this section (or an 
amendment made by this section); 
(B) a description of all such programs or 
activities carried out using funds provided 
under this section (or amendments); and 
(C) a description of how such programs or 
activities are advancing public health, including 
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the impact on treating pain and addressing 
opioid misuse in the United States. 
(2) ADDITIONAL REPORTS.—At the request of 
the Committee on Health, Education, Labor, and 
Pensions or the Committee on Appropriations of the 
Senate, or the Committee on Energy and Commerce 
or the Committee on Appropriations of the House of 
Representatives, the Director of the National Insti-
tutes of Health shall provide to the relevant com-
mittee an update in the form of testimony and addi-
tional reports concerning the allocation of funding 
under this section (or the amendments made by this 
section) or the description of the programs and ac-
tivities carried out with such funding. 
SEC. 4. VETERAN OVER-MEDICATION PREVENTION. 
(a) REVIEW REQUIRED.— 
(1) IN GENERAL.—Not later than 90 days after 
the date of the enactment of this Act, the Secretary 
of Veterans Affairs shall seek to enter into an agree-
ment with the National Academies of Sciences, En-
gineering, and Medicine under which the National 
Academies shall conduct a review of the deaths of all 
covered veterans who died by suicide during the five- 
year period ending on the date of the enactment of 
this Act, regardless of whether information relating 
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to such deaths has been reported by the Centers for 
Disease Control and Prevention. 
(2) ELEMENTS.—The review required by para-
graph (1) shall include the following: 
(A) The total number of covered veterans 
who died by suicide during the five-year period 
ending on the date of the enactment of this Act. 
(B) The total number of covered veterans 
who died by a violent death during such five- 
year period. 
(C) The total number of covered veterans 
who died by an accidental death during such 
five-year period. 
(D) A description of each covered veteran 
described in subparagraphs (A) through (C), in-
cluding age, gender, race, and ethnicity. 
(E) A comprehensive list of prescribed 
medications and legal or illegal substances as 
annotated on toxicology reports of covered vet-
erans described in subparagraphs (A) through 
(C), specifically listing any medications that 
carried a black box warning, were prescribed for 
off-label use, were psychotropic, or carried 
warnings that included suicidal ideation. 
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(F) A summary of medical diagnoses by 
physicians of the Department of Veterans Af-
fairs or physicians providing services to covered 
veterans through programs of the Department 
that led to the prescribing of medications re-
ferred to in subparagraph (E) in cases of post- 
traumatic stress disorder, traumatic brain in-
jury, military sexual trauma, and other anxiety 
and depressive disorders. 
(G) The number of instances in which a 
covered veteran described in subparagraph (A), 
(B), or (C) was concurrently on multiple medi-
cations prescribed by physicians of the Depart-
ment or physicians providing services to vet-
erans through programs of the Department to 
treat post-traumatic stress disorder, traumatic 
brain injury, military sexual trauma, other anx-
iety and depressive disorders, or instances of 
comorbidity. 
(H) The number of covered veterans de-
scribed in subparagraphs (A) through (C) who 
were not taking any medication prescribed by a 
physician of the Department or a physician pro-
viding services to veterans through a program 
of the Department. 
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(I) With respect to the treatment of post- 
traumatic stress disorder, traumatic brain in-
jury, military sexual trauma, or other anxiety 
and depressive disorders, the percentage of cov-
ered veterans described in subparagraphs (A) 
through (C) who received a non-medication 
first-line treatment compared to the percentage 
of such veterans who received medication only. 
(J) With respect to the treatment of cov-
ered veterans described in subparagraphs (A) 
through (C) for post-traumatic stress disorder, 
traumatic brain injury, military sexual trauma, 
or other anxiety and depressive disorders, the 
number of instances in which a non-medication 
first-line treatment (such as cognitive behav-
ioral therapy) was attempted and determined to 
be ineffective for such a veteran, which subse-
quently led to the prescribing of a medication 
referred to in subparagraph (E). 
(K) A description and example of how the 
Department determines and continually updates 
the clinical practice guidelines governing the 
prescribing of medications. 
(L) An analysis of the use by the Depart-
ment, including protocols or practices at med-
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ical facilities of the Department, of systemati-
cally measuring pain scores during clinical en-
counters under the Pain as the 5th Vital Sign 
Toolkit of the Department and an evaluation of 
the relationship between the use of such meas-
urements and the number of veterans concur-
rently on multiple medications prescribed by 
physicians of the Department. 
(M) A description of the efforts of the De-
partment to maintain appropriate staffing levels 
for mental health professionals, such as mental 
health counselors, marriage and family thera-
pists, and other appropriate counselors, includ-
ing— 
(i) a description of any impediments 
to carry out the education, training, and 
hiring of mental health counselors and 
marriage and family therapists under sec-
tion 7302(a) of title 38, United States 
Code, and strategies for addressing those 
impediments; 
(ii) a description of the objectives, 
goals, and timing of the Department with 
respect to increasing the representation of 
such counselors and therapists in the be-
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havioral health workforce of the Depart-
ment, including— 
(I) a review of eligibility criteria 
for such counselors and therapists and 
a comparison of such criteria to that 
of other behavioral health professions 
in the Department; and 
(II) an assessment of the partici-
pation of such counselors and thera-
pists in the mental health profes-
sionals trainee program of the De-
partment and any impediments to 
such participation; 
(iii) an assessment of the development 
by the Department of hiring guidelines for 
mental health counselors, marriage and 
family therapists, and other appropriate 
counselors; 
(iv) a description of how the Depart-
ment— 
(I) identifies gaps in the supply 
of mental health professionals; and 
(II) determines successful staff-
ing ratios for mental health profes-
sionals of the Department; 
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(v) a description of actions taken by 
the Secretary, in consultation with the Di-
rector of the Office of Personnel Manage-
ment, to create an occupational series for 
mental health counselors and marriage and 
family therapists of the Department and a 
timeline for the creation of such an occu-
pational series; and 
(vi) a description of actions taken by 
the Secretary to ensure that the national, 
regional, and local professional standards 
boards for mental health counselors and 
marriage and family therapists are com-
prised of only mental health counselors and 
marriage and family therapists and that 
the liaison from the Department to such 
boards is a mental health counselor or 
marriage and family therapist. 
(N) The percentage of covered veterans de-
scribed in subparagraphs (A) through (C) with 
combat experience or trauma related to combat 
experience (including military sexual trauma, 
traumatic brain injury, and post-traumatic 
stress). 
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(O) An identification of the medical facili-
ties of the Department with markedly high pre-
scription rates and suicide rates for veterans re-
ceiving treatment at those facilities. 
(P) An analysis, by State, of programs of 
the Department that collaborate with State 
Medicaid agencies and the Centers for Medicare 
and Medicaid Services, including the following: 
(i) An analysis of the sharing of pre-
scription and behavioral health data for 
veterans. 
(ii) An analysis of whether Depart-
ment staff check with State prescription 
drug monitoring programs before pre-
scribing medications to veterans. 
(iii) A description of the procedures of 
the Department for coordinating with pre-
scribers outside of the Department to en-
sure that veterans are not overprescribed. 
(iv) A description of actions that the 
Department takes when a veteran is deter-
mined to be overprescribed. 
(Q) An analysis of the collaboration of 
medical centers of the Department with medical 
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examiners’ offices or local jurisdictions to deter-
mine veteran mortality and cause of death. 
(R) An identification and determination of 
a best practice model to collect and share vet-
eran death certificate data between the Depart-
ment of Veterans Affairs, the Department of 
Defense, States, and tribal entities. 
(S) A description of how data relating to 
death certificates of veterans is collected, deter-
mined, and reported by the Department of Vet-
erans Affairs. 
(T) An assessment of any patterns appar-
ent to the National Academies of Sciences, En-
gineering, and Medicine based on the review 
conducted under paragraph (1). 
(U) Such recommendations for further ac-
tion that would improve the safety and well- 
being of veterans as the National Academies of 
Sciences, Engineering, and Medicine determine 
appropriate. 
(3) COMPILATION OF DATA.— 
(A) FORM
OF
COMPILATION.—The Sec-
retary of Veterans Affairs shall ensure that 
data compiled under paragraph (2) is compiled 
in a manner that allows it to be analyzed across 
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all data fields for purposes of informing and 
updating clinical practice guidelines of the De-
partment of Veterans Affairs. 
(B) COMPILATION
OF
DATA
REGARDING 
COVERED VETERANS.—In compiling data under 
paragraph (2) regarding covered veterans de-
scribed in subparagraphs (A) through (C) of 
such paragraph, data regarding veterans de-
scribed in each such subparagraph shall be 
compiled separately and disaggregated by year. 
(4) COMPLETION OF REVIEW AND REPORT.— 
The agreement entered into under paragraph (1) 
shall require that the National Academies of 
Sciences, Engineering, and Medicine complete the 
review under such paragraph and submit to the Sec-
retary of Veterans Affairs a report containing the 
results of the review not later than 180 days after 
entering into the agreement. 
(b) REPORT.—Not later than 30 days after the com-
pletion by the National Academies of Sciences, Engineer-
ing, and Medicine of the review required under subsection 
(a), the Secretary of Veterans Affairs shall— 
(1) submit to the Committee on Veterans’ Af-
fairs of the Senate and the Committee on Veterans’ 
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Affairs of the House of Representatives a report on 
the results of the review; and 
(2) make such report publicly available. 
(c) DEFINITIONS.—In this section: 
(1) The term ‘‘black box warning’’ means a 
warning displayed on the label of a prescription drug 
that is designed to call attention to the serious or 
life-threatening risk of the prescription drug. 
(2) The term ‘‘covered veteran’’ means a vet-
eran who received hospital care or medical services 
furnished by the Department of Veterans Affairs 
during the five-year period preceding the death of 
the veteran. 
(3) The term ‘‘first-line treatment’’ means a po-
tential intervention that has been evaluated and as-
signed a high score within clinical practice guide-
lines. 
(4) The term ‘‘State’’ means each of the States, 
territories, and possessions of the United States, the 
District of Columbia, and the Commonwealth of 
Puerto Rico. 
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SEC. 5. AMENDMENT RELATING TO THE ACCOUNT FOR THE 
STATE RESPONSE TO THE OPIOID ABUSE CRI-
SIS. 
Section 1003 of the 21st Century Cures Act (Public 
Law 114–255; 42 U.S.C. 290ee–3 note) is amended in 
subsection (b)(3), by adding at the end the following new 
subparagraph: 
‘‘(C) 
APPROPRIATIONS
AFTER
FISCAL 
YEAR 2018.—There is authorized to be appro-
priated, and there is appropriated, out of any 
monies in the Treasury not otherwise appro-
priated, to the Account For the State Response 
to the Opioid Abuse Crisis $500,000,000 for 
each of fiscal years 2019 through 2023.’’. 
SEC. 6. MENTAL HEALTH ACCESS IMPROVEMENT. 
(a) COVERAGE OF SERVICES.— 
(1) IN
GENERAL.—Section 1861(s)(2) of the 
Social Security Act (42 U.S.C. 1395x(s)(2)) is 
amended— 
(A) in subparagraph (FF), by striking 
‘‘and’’ after the semicolon at the end; 
(B) in subparagraph (GG), by inserting 
‘‘and’’ after the semicolon at the end; and 
(C) by adding at the end the following new 
subparagraph: 
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‘‘(HH) marriage and family therapist services 
(as defined in subsection (jjj)(1)) and mental health 
counselor 
services 
(as 
defined 
in 
subsection 
(jjj)(3));’’. 
(2) DEFINITIONS.—Section 1861 of the Social 
Security Act (42 U.S.C. 1395x) is amended by add-
ing at the end the following new subsection: 
‘‘Marriage and Family Therapist Services; Marriage and 
Family Therapist; Mental Health Counselor Serv-
ices; Mental Health Counselor 
‘‘(jjj)(1) The term ‘marriage and family therapist 
services’ means services performed by a marriage and 
family therapist (as defined in paragraph (2)) for the diag-
nosis and treatment of mental illnesses, which the mar-
riage and family therapist is legally authorized to perform 
under State law (or the State regulatory mechanism pro-
vided by State law) of the State in which such services 
are performed, as would otherwise be covered if furnished 
by a physician or as an incident to a physician’s profes-
sional service, but only if no facility or other provider 
charges or is paid any amounts with respect to the fur-
nishing of such services. 
‘‘(2) The term ‘marriage and family therapist’ means 
an individual who— 
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‘‘(A) possesses a master’s or doctoral degree 
which qualifies for licensure or certification as a 
marriage and family therapist pursuant to State 
law; 
‘‘(B) after obtaining such degree has performed 
at least 2 years of clinical supervised experience in 
marriage and family therapy; and 
‘‘(C) in the case of an individual performing 
services in a State that provides for licensure or cer-
tification of marriage and family therapists, is li-
censed or certified as a marriage and family thera-
pist in such State. 
‘‘(3) The term ‘mental health counselor services’ 
means services performed by a mental health counselor (as 
defined in paragraph (4)) for the diagnosis and treatment 
of mental illnesses which the mental health counselor is 
legally authorized to perform under State law (or the 
State regulatory mechanism provided by the State law) of 
the State in which such services are performed, as would 
otherwise be covered if furnished by a physician or as inci-
dent to a physician’s professional service, but only if no 
facility or other provider charges or is paid any amounts 
with respect to the furnishing of such services. 
‘‘(4) The term ‘mental health counselor’ means an 
individual who— 
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‘‘(A) possesses a master’s or doctor’s degree in 
mental health counseling or a related field; 
‘‘(B) after obtaining such a degree has per-
formed at least 2 years of supervised mental health 
counselor practice; and 
‘‘(C) in the case of an individual performing 
services in a State that provides for licensure or cer-
tification of mental health counselors or professional 
counselors, is licensed or certified as a mental health 
counselor or professional counselor in such State.’’. 
(3) PROVISION
FOR
PAYMENT
UNDER
PART 
B.—Section 1832(a)(2)(B) of the Social Security 
Act (42 U.S.C. 1395k(a)(2)(B)) is amended by add-
ing at the end the following new clause: 
‘‘(v) marriage and family therapist 
services (as defined in section 1861(jjj)(1)) 
and mental health counselor services (as 
defined in section 1861(jjj)(3));’’. 
(4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 
of the Social Security Act (42 U.S.C. 1395l(a)(1)) 
is amended— 
(A) by striking ‘‘and (BB)’’ and inserting 
‘‘(BB)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (CC) with respect 
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to marriage and family therapist services and 
mental health counselor services under section 
1861(s)(2)(HH), the amounts paid shall be 80 
percent of the lesser of the actual charge for 
the services or 75 percent of the amount deter-
mined for payment of a psychologist under sub-
paragraph (L)’’. 
(5) EXCLUSION
OF
MARRIAGE
AND
FAMILY 
THERAPIST SERVICES AND MENTAL HEALTH COUN-
SELOR SERVICES FROM SKILLED NURSING FACILITY 
PROSPECTIVE
PAYMENT
SYSTEM.—Section 
1888(e)(2)(A)(ii) of the Social Security Act (42 
U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting 
‘‘marriage and family therapist services (as defined 
in section 1861(jjj)(1)), mental health counselor 
services (as defined in section 1861(jjj)(3)),’’ after 
‘‘qualified psychologist services,’’. 
(6) INCLUSION
OF
MARRIAGE
AND
FAMILY 
THERAPISTS AND MENTAL HEALTH COUNSELORS AS 
PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Sec-
tion 1842(b)(18)(C) of the Social Security Act (42 
U.S.C. 1395u(b)(18)(C)) is amended by adding at 
the end the following new clauses: 
‘‘(vii) A marriage and family therapist (as de-
fined in section 1861(jjj)(2)). 
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‘‘(viii) A mental health counselor (as defined in 
section 1861(jjj)(4)).’’. 
(b) COVERAGE OF CERTAIN MENTAL HEALTH SERV-
ICES PROVIDED IN CERTAIN SETTINGS.— 
(1) RURAL HEALTH CLINICS AND FEDERALLY 
QUALIFIED
HEALTH
CENTERS.—Section 
1861(aa)(1)(B) of the Social Security Act (42 
U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 
by a clinical social worker (as defined in subsection 
(hh)(1))’’ and inserting ‘‘, by a clinical social worker 
(as defined in subsection (hh)(1)), by a marriage 
and family therapist (as defined in subsection 
(jjj)(2)), or by a mental health counselor (as defined 
in subsection (jjj)(4))’’. 
(2) 
HOSPICE
PROGRAMS.—Section 
1861(dd)(2)(B)(i)(III) of the Social Security Act (42 
U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by in-
serting ‘‘, marriage and family therapist, or mental 
health counselor’’ after ‘‘social worker’’. 
(c) AUTHORIZATION
OF MARRIAGE
AND FAMILY 
THERAPISTS
AND MENTAL HEALTH COUNSELORS TO 
DEVELOP DISCHARGE PLANS FOR POST-HOSPITAL SERV-
ICES.—Section 1861(ee)(2)(G) of the Social Security Act 
(42 U.S.C. 1395x(ee)(2)(G)) is amended by inserting ‘‘, 
including a marriage and family therapist and a mental 
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health counselor who meets qualification standards estab-
lished by the Secretary’’ before the period at the end. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to services furnished 
on or after January 1, 2019. 
SEC. 7. SYNTHETICS TRAFFICKING AND OVERDOSE PRE-
VENTION. 
(a) 
FORMAL
ENTRY
REQUIREMENTS—POSTAL 
SERVICE AS CONSIGNEE.—Subparagraph (B) of section 
484(a)(2) of the Tariff Act of 1930 (19 U.S.C. 
1484(a)(2)(B)) is amended to read as follows: 
‘‘(B)(i) When an entry of merchandise is made 
under this section, the required documentation or in-
formation shall be filed or electronically trans-
mitted— 
‘‘(I) by the owner or purchaser of the mer-
chandise; or 
‘‘(II) when appropriately designated by the 
owner, purchaser, or consignee of the merchan-
dise, by a person holding a valid license under 
section 641. 
‘‘(ii) The Postmaster General shall be deemed 
the consignee for merchandise, as defined by section 
498(c), imported through the mail, and the Post-
master General shall, at the Postmaster General’s 
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sole expense, designate a person holding a valid li-
cense under section 641 to file the required docu-
mentation or information or ensure that the owner 
or purchaser of the merchandise or a person holding 
a valid license under section 641 that is designated 
by the owner or purchaser files the required docu-
mentation or information. 
‘‘(iii) When a consignee declares on entry that 
he or she is the owner or purchaser of merchandise, 
U.S. Customs and Border Protection may, without 
liability, accept the declaration. 
‘‘(iv) For the purposes of this Act, the importer 
of record must be one of the parties who is eligible 
to file the documentation or information required by 
this section.’’. 
(b) INFORMAL ENTRIES.—Section 498 of the Tariff 
Act of 1930 (19 U.S.C. 1498) is amended by adding at 
the end the following: 
‘‘(c) APPLICATION TO POSTAL SHIPMENTS.— 
‘‘(1) DEFINITIONS.—In this subsection: 
‘‘(A) DOCUMENT.—The term ‘document’ 
means a piece of written, drawn, printed, or 
digital information, excluding objects of mer-
chandise, that— 
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‘‘(i) is conveyed in an envelope that is 
less than or equal to 165 millimeters in 
width, 245 millimeters in length, and 5 
millimeters in depth; and 
‘‘(ii) weighs 100 grams or less when 
conveyed. 
‘‘(B) MERCHANDISE.—The term ‘merchan-
dise’ has the same meaning as that term is de-
fined in section 401 but does not include a doc-
ument. 
‘‘(2) 
REQUIREMENT.—Notwithstanding 
any 
other provision of law, for merchandise meeting the 
requirements of subsection (a), the Postmaster Gen-
eral shall comply with the entry requirements of sec-
tion 484. 
‘‘(3) REGULATIONS.—Any regulation issued 
pursuant to this subsection shall apply identical 
entry procedures for merchandise imported through 
the mail as are applied for merchandise imported via 
a private carrier.’’. 
(c) DE MINIMIS SHIPMENTS.—Section 321 of the 
Tariff Act of 1930 (19 U.S.C. 1321) is amended by add-
ing at the end the following: 
‘‘(c)(1) For imported articles that qualify for the ad-
ministrative exemption under subsection (a)(2) and that 
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arrive at international mail facilities in the United States, 
the Postmaster General shall be deemed the consignee for 
such articles that are considered merchandise, as the term 
is defined in section 498(c). 
‘‘(2) In addition to the parties that are authorized 
to comply with the entry requirements of sections 498 and 
484, the Postmaster General, as a consignee, may, using 
reasonable care, enter such merchandise that qualifies for 
the administrative exemption under subsection (a)(2).’’. 
(d) CUSTOMS FEES.— 
(1) IN
GENERAL.—Paragraph (6) of section 
13031(a) of the Consolidated Omnibus Budget Rec-
onciliation Act of 1985 (19 U.S.C. 58c(a)(6)) is 
amended to read as follows: 
‘‘(6)(A) For the arrival of shipments of mer-
chandise (as the term is defined in section 498(c) of 
the Trade Act of 1930) or any other item that is 
valued at $2,000 or less (or such higher amount as 
the Secretary of the Treasury may set by regulation 
pursuant to section 498 of the Tariff Act of 1930 
(19 U.S.C. 1498) and subject to adjustment under 
subsection (l)) arriving at an international mail facil-
ity: 
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‘‘(i) $1 per individual airway bill or bill of 
lading (subject to adjustment under subsection 
(l)); or 
‘‘(ii) if such merchandise is formally en-
tered, the fee provided for in paragraph (9), if 
applicable. 
‘‘(B) Notwithstanding section 451 of the Tariff 
Act of 1930 (19 U.S.C. 1451), the payment required 
by subparagraph (A) shall be the only payment re-
quired for reimbursement of U.S. Customs and Bor-
der Protection in connection with the processing of 
an individual airway bill or bill of lading in accord-
ance with such subparagraph and for providing serv-
ices at international mail facilities, except that U.S. 
Customs and Border Protection may require such 
facilities to cover expenses of the agency for ade-
quate office space, equipment, furnishings, supplies, 
and security. 
‘‘(C) The payment required by subparagraphs 
(A) and (B) shall be paid on a quarterly basis by the 
Postmaster General in accordance with regulations 
prescribed by the Secretary of the Treasury. The 
payments shall be allocated as follows: 
‘‘(i) 50 percent of the amount of payments 
received in this paragraph shall, in accordance 
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not more than 15 years, a fine not to exceed the greater 
of that authorized in accordance with the provisions of 
title 18, United States Code, or $500,000 if the defendant 
is an individual or $2,500,000 if the defendant is other 
than an individual, or both. 
‘‘(ii) If any person commits such a violation after a 
prior conviction for a felony drug offense has become final, 
such person shall be sentenced to a term of imprisonment 
of not more than 20 years and if death or serious bodily 
injury results from the use of such substance shall be sen-
tenced to a term of imprisonment of not more than 30 
years, a fine not to exceed the greater of twice that author-
ized in accordance with the provisions of title 18, United 
States Code, or $1,000,000 if the defendant is an indi-
vidual or $5,000,000 if the defendant is other than an in-
dividual, or both. 
‘‘(iii) Any sentence imposing a term of imprisonment 
under this subparagraph shall, in the absence of such a 
prior conviction, impose a term of supervised release of 
not less than 2 years in addition to such term of imprison-
ment and shall, if there was such a prior conviction, im-
pose a term of supervised release of not less than 4 years 
in addition to such term of imprisonment.’’; 
(B) 
in 
section 
403(a) 
(21 
U.S.C. 
843(a))— 
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(i) in paragraph (8), by striking ‘‘or’’ 
at the end; 
(ii) in paragraph (9), by striking the 
period at the end and inserting ‘‘; or’’; and 
(iii) by inserting after paragraph (9) 
the following: 
‘‘(10) to export a substance in violation of the 
controlled substance laws of the country to which 
the substance is exported.’’; and 
(C) in section 404 (21 U.S.C. 844), by in-
serting after subsection (a) the following: 
‘‘(b) A person shall not be subject to a criminal or 
civil penalty under this title or under any other Federal 
law solely for possession of a schedule A controlled sub-
stance.’’. 
(2) CONTROLLED
SUBSTANCES
IMPORT
AND 
EXPORT
ACT.—Section 1010(b) of the Controlled 
Substances Import and Export Act (21 U.S.C. 
960(b)) is amended by adding at the end the fol-
lowing: 
‘‘(8) In the case of a violation under subsection (a) 
involving a controlled substance in schedule A, the person 
committing such violation shall be sentenced to a term of 
imprisonment of not more than 20 years and if death or 
serious bodily injury results from the use of such sub-
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in accordance with this subsection. In evaluating applica-
tions for such registration, the Attorney General shall 
apply the criteria set forth in subsection (f) of this section 
that apply to practitioners seeking a registration to con-
duct research with a schedule I controlled substance, ex-
cept that the applicant shall not be required to submit a 
research protocol. 
‘‘(2) If the applicant is not currently registered under 
subsection (f) to conduct research with a schedule I con-
trolled substance, the Attorney General shall refer the ap-
plication to the Secretary, who shall determine whether 
the applicant will be engaged in bona fide research and 
is qualified to conduct such research. 
‘‘(3) If the applicant is currently registered under 
subsection (f) to conduct research with a schedule I con-
trolled substance, the applicant will be considered qualified 
to conduct research with controlled substances in schedule 
A and the Attorney General shall modify the applicant’s 
registration to include schedule A controlled substances in 
accordance with this paragraph. The applicant shall notify 
the Attorney General of his intent to conduct research 
with a controlled substance in schedule A. Upon receiving 
such notification, the Attorney General shall modify the 
practitioner’s existing registration to authorize research 
with schedule A controlled substances, unless the Attorney 
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