H. R. 6—63 
CHAPTER 9—PREVENTING DRUG DIVERSION 
SEC. 3291. SHORT TITLE. 
This chapter may be cited as the ‘‘Preventing Drug Diversion 
Act of 2018’’. 
SEC. 3292. IMPROVEMENTS TO PREVENT DRUG DIVERSION. 
(a) DEFINITION.—Section 102 of the Controlled Substances Act 
(21 U.S.C. 802) is amended by adding at the end the following: 
‘‘(57) The term ‘suspicious order’ may include, but is not 
limited to— 
‘‘(A) an order of a controlled substance of unusual 
size; 
‘‘(B) an order of a controlled substance deviating 
substantially from a normal pattern; and 
‘‘(C) orders of controlled substances of unusual fre-
quency.’’. 
(b) SUSPICIOUS ORDERS.—Part C of the Controlled Substances 
Act (21 U.S.C. 821 et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 312. SUSPICIOUS ORDERS. 
‘‘(a) REPORTING.—Each registrant shall— 
‘‘(1) design and operate a system to identify suspicious 
orders for the registrant; 
‘‘(2) ensure that the system designed and operated under 
paragraph (1) by the registrant complies with applicable Fed-
eral and State privacy laws; and 
‘‘(3) upon discovering a suspicious order or series of orders, 
notify the Administrator of the Drug Enforcement Administra-
tion and the Special Agent in Charge of the Division Office 
of the Drug Enforcement Administration for the area in which 
the registrant is located or conducts business. 
‘‘(b) SUSPICIOUS ORDER DATABASE.— 
‘‘(1) IN GENERAL.—Not later than 1 year after the date 
of enactment of this section, the Attorney General shall estab-
lish a centralized database for collecting reports of suspicious 
orders. 
‘‘(2) SATISFACTION OF REPORTING REQUIREMENTS.—If a reg-
istrant reports a suspicious order to the centralized database 
established under paragraph (1), the registrant shall be consid-
ered to have complied with the requirement under subsection 
(a)(3) to notify the Administrator of the Drug Enforcement 
Administration and the Special Agent in Charge of the Division 
Office of the Drug Enforcement Administration for the area 
in which the registrant is located or conducts business. 
‘‘(c) SHARING INFORMATION WITH THE STATES.— 
‘‘(1) IN GENERAL.—The Attorney General shall prepare and 
make available information regarding suspicious orders in a 
State, including information in the database established under 
subsection (b)(1), to the point of contact for purposes of adminis-
trative, civil, and criminal oversight relating to the diversion 
of controlled substances for the State, as designated by the 
Governor or chief executive officer of the State. 
‘‘(2) TIMING.—The Attorney General shall provide informa-
tion in accordance with paragraph (1) within a reasonable 
period of time after obtaining the information.
H. R. 6—64 
‘‘(3) COORDINATION.—In establishing the process for the 
provision of information under this subsection, the Attorney 
General shall coordinate with States to ensure that the 
Attorney General has access to information, as permitted under 
State law, possessed by the States relating to prescriptions 
for controlled substances that will assist in enforcing Federal 
law.’’. 
(c) REPORTS TO CONGRESS.— 
(1) DEFINITION.—In this subsection, the term ‘‘suspicious 
order’’ has the meaning given that term in section 102 of 
the Controlled Substances Act, as amended by this chapter. 
(2) ONE-TIME REPORT.—Not later than 1 year after the 
date of enactment of this Act, the Attorney General shall submit 
to Congress a report on the reporting of suspicious orders, 
which shall include— 
(A) a description of the centralized database estab-
lished under section 312 of the Controlled Substances Act, 
as added by this section, to collect reports of suspicious 
orders; 
(B) a description of the system and reports established 
under section 312 of the Controlled Substances Act, as 
added by this section, to share information with States; 
(C) information regarding how the Attorney General 
used reports of suspicious orders before the date of enact-
ment of this Act and after the date of enactment of this 
Act, including how the Attorney General received the 
reports and what actions were taken in response to the 
reports; and 
(D) descriptions of the data analyses conducted on 
reports of suspicious orders to identify, analyze, and stop 
suspicious activity. 
(3) ADDITIONAL REPORTS.—Not later than 1 year after the 
date of enactment of this Act, and annually thereafter until 
the date that is 5 years after the date of enactment of this 
Act, the Attorney General shall submit to Congress a report 
providing, for the previous year— 
(A) the number of reports of suspicious orders; 
(B) a summary of actions taken in response to reports, 
in the aggregate, of suspicious orders; and 
(C) a description of the information shared with States 
based on reports of suspicious orders. 
(4) ONE-TIME GAO REPORT.—Not later than 1 year after 
the date of enactment of this Act, the Comptroller General 
of the United States, in consultation with the Administrator 
of the Drug Enforcement Administration, shall submit to Con-
gress a report on the reporting of suspicious orders, which 
shall include an evaluation of the utility of real-time reporting 
of potential suspicious orders of opioids on a national level 
using computerized algorithms, including the extent to which 
such algorithms— 
(A) would help ensure that potentially suspicious 
orders are more accurately captured, identified, and 
reported in real time to suppliers before orders are filled; 
(B) may produce false positives of suspicious order 
reports that could result in market disruptions for legiti-
mate orders of opioids; and
H. R. 6—65 
(C) would reduce the overall length of an investigation 
that prevents the diversion of suspicious orders of opioids. 
TITLE IV—OFFSETS 
SEC. 4001. PROMOTING VALUE IN MEDICAID MANAGED CARE. 
Section 1903(m) of the Social Security Act (42 U.S.C. 1396b(m)), 
as amended by sections 1013 and 1016, is further amended by 
adding at the end the following new paragraph: 
‘‘(9)(A) With respect to expenditures described in subparagraph 
(B) that are incurred by a State for any fiscal year after fiscal 
year 2020 (and before fiscal year 2024), in determining the pro 
rata share to which the United States is equitably entitled under 
subsection (d)(3), the Secretary shall substitute the Federal medical 
assistance percentage that applies for such fiscal year to the State 
under section 1905(b) (without regard to any adjustments to such 
percentage applicable under such section or any other provision 
of law) for the percentage that applies to such expenditures under 
section 1905(y). 
‘‘(B) Expenditures described in this subparagraph, with respect 
to a fiscal year to which subparagraph (A) applies, are expenditures 
incurred by a State for payment for medical assistance provided 
to 
individuals 
described 
in 
subclause 
(VIII) 
of 
section 
1902(a)(10)(A)(i) by a managed care entity, or other specified entity 
(as defined in subparagraph (D)(iii)), that are treated as remittances 
because the State— 
‘‘(i) has satisfied the requirement of section 438.8 of title 
42, Code of Federal Regulations (or any successor regulation), 
by electing— 
‘‘(I) in the case of a State described in subparagraph 
(C), to apply a minimum medical loss ratio (as defined 
in subparagraph (D)(ii)) that is at least 85 percent but 
not greater than the minimum medical loss ratio (as so 
defined) that such State applied as of May 31, 2018; or 
‘‘(II) in the case of a State not described in subpara-
graph (C), to apply a minimum medical loss ratio that 
is equal to 85 percent; and 
‘‘(ii) recovered all or a portion of the expenditures as a 
result of the entity’s failure to meet such ratio. 
‘‘(C) For purposes of subparagraph (B), a State described in 
this subparagraph is a State that as of May 31, 2018, applied 
a minimum medical loss ratio (as calculated under subsection (d) 
of section 438.8 of title 42, Code of Federal Regulations (as in 
effect on June 1, 2018)) for payment for services provided by entities 
described in such subparagraph under the State plan under this 
title (or a waiver of the plan) that is equal to or greater than 
85 percent. 
‘‘(D) For purposes of this paragraph: 
‘‘(i) The term ‘managed care entity’ means a medicaid man-
aged care organization described in section 1932(a)(1)(B)(i). 
‘‘(ii) The term ‘minimum medical loss ratio’ means, with 
respect to a State, a minimum medical loss ratio (as calculated 
under subsection (d) of section 438.8 of title 42, Code of Federal 
Regulations (as in effect on June 1, 2018)) for payment for 
services provided by entities described in subparagraph (B) 
under the State plan under this title (or a waiver of the plan).
H. R. 6—66 
‘‘(iii) The term ‘other specified entity’ means— 
‘‘(I) a prepaid inpatient health plan, as defined in sec-
tion 438.2 of title 42, Code of Federal Regulations (or 
any successor regulation); and 
‘‘(II) a prepaid ambulatory health plan, as defined in 
such section (or any successor regulation).’’. 
SEC. 4002. REQUIRING REPORTING BY GROUP HEALTH PLANS OF 
PRESCRIPTION DRUG COVERAGE INFORMATION FOR 
PURPOSES OF IDENTIFYING PRIMARY PAYER SITUATIONS 
UNDER THE MEDICARE PROGRAM. 
Clause (i) of section 1862(b)(7)(A) of the Social Security Act 
(42 U.S.C. 1395y(b)(7)(A)) is amended to read as follows: 
‘‘(i) secure from the plan sponsor and plan partici-
pants such information as the Secretary shall specify 
for the purpose of identifying situations where the 
group health plan is or has been— 
‘‘(I) a primary plan to the program under this 
title; or 
‘‘(II) for calendar quarters beginning on or 
after January 1, 2020, a primary payer with 
respect to benefits relating to prescription drug 
coverage under part D; and’’. 
SEC. 4003. ADDITIONAL RELIGIOUS EXEMPTION FROM HEALTH COV-
ERAGE RESPONSIBILITY REQUIREMENT. 
(a) IN GENERAL.—Section 5000A(d)(2)(A) of the Internal Rev-
enue Code of 1986 is amended to read as follows: 
‘‘(A) RELIGIOUS CONSCIENCE EXEMPTIONS.— 
‘‘(i) IN GENERAL.—Such term shall not include any 
individual for any month if such individual has in 
effect an exemption under section 1311(d)(4)(H) of the 
Patient Protection and Affordable Care Act which cer-
tifies that— 
‘‘(I) such individual is a member of a recog-
nized religious sect or division thereof which is 
described in section 1402(g)(1), and is adherent 
of established tenets or teachings of such sect or 
division as described in such section; or 
‘‘(II) such individual is a member of a religious 
sect or division thereof which is not described in 
section 1402(g)(1), who relies solely on a religious 
method of healing, and for whom the acceptance 
of medical health services would be inconsistent 
with the religious beliefs of the individual. 
‘‘(ii) SPECIAL RULES.— 
‘‘(I) MEDICAL HEALTH SERVICES DEFINED.—For 
purposes of this subparagraph, the term ‘medical 
health services’ does not include routine dental, 
vision and hearing services, midwifery services, 
vaccinations, necessary medical services provided 
to children, services required by law or by a third 
party, and such other services as the Secretary 
of Health and Human Services may provide in 
implementing section 1311(d)(4)(H) of the Patient 
Protection and Affordable Care Act. 
‘‘(II) ATTESTATION
REQUIRED.—Clause (i)(II) 
shall apply to an individual for months in a taxable
H. R. 6—67 
year only if the information provided by the indi-
vidual under section 1411(b)(5)(A) of such Act 
includes an attestation that the individual has 
not received medical health services during the 
preceding taxable year.’’. 
(b) EFFECTIVE DATE.—The amendment made by subsection (a) 
shall apply to taxable years beginning after December 31, 2018. 
(c) CONSTRUCTION.—Nothing in the amendment made by sub-
section (a) shall preempt any State law requiring the provision 
of medical treatment for children, especially those who are seriously 
ill. 
SEC. 4004. MODERNIZING THE REPORTING OF BIOLOGICAL AND BIO-
SIMILAR PRODUCTS. 
Subtitle B of title XI of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Public Law 108– 
173) is amended— 
(1) in section 1111, as amended by section 3(1) of the 
Patient Right to Know Drug Prices Act— 
(A) in the paragraph (3) inserted by such section 3(1), 
by striking ‘‘an application’’ and inserting ‘‘a biosimilar 
biological product application’’; 
(B) in the paragraph (4) inserted by such section 3(1), 
by inserting ‘‘application’’ before ‘‘under section 351(k) of 
the Public Health Service Act’’; 
(C) in the paragraph (5) inserted by such section 3(1), 
by striking ‘‘for licensure of a biological product under 
section 351(k) of the Public Health Service Act’’ and 
inserting ‘‘under section 351(k) of the Public Health Service 
Act for licensure of a biological product as biosimilar to, 
or interchangeable with, a reference product’’; 
(D) in paragraph (7), as redesignated and amended 
by such section 3(1), by striking ‘‘or under section 351(a) 
of the Public Health Service Act’’ and inserting ‘‘or the 
owner, or exclusive licensee, of a patent included in a 
list provided under section 351(l)(3) of the Public Health 
Service Act’’; and 
(E) in the paragraph (12) added by such section 3(1), 
by striking ‘‘means a brand name drug for which a license 
is in effect under section 351(a)’’ and inserting ‘‘has the 
meaning given such term in section 351(i)’’; and 
(2) in section 1112, as amended by section 3(2) of the 
Patient Right to Know Drug Prices Act— 
(A) in subsection (a)— 
(i) in paragraph (1), by striking ‘‘for which a state-
ment under section 351(l)(3)(B)(ii)(I) of the Public 
Health Service Act has been provided’’; 
(ii) in paragraph (2)— 
(I) in subparagraph (C)(i), by striking ‘‘brand 
name’’ and inserting ‘‘listed’’; and 
(II) by amending clause (ii) of subparagraph 
(C) to read as follows: 
‘‘(ii) any of the time periods referred to in section 
351(k)(6) of the Public Health Service Act as such 
period applies to such biosimilar biological product 
application or to any other biosimilar biological product 
application based on the same reference product.’’;
H. R. 6—69 
shall require States to use all behavioral health measures 
included in the core set of adult health quality measures 
and any updates or changes to such measures to report 
information, using the standardized format for reporting 
information and procedures developed under subparagraph 
(A), regarding the quality of behavioral health care for 
Medicaid eligible adults.’’; and 
(B) in paragraph (5), by adding at the end the following 
new subparagraph: 
‘‘(C) BEHAVIORAL HEALTH MEASURES.—Beginning with 
respect to State reports required under subsection (d)(1) 
for 2024, the core set of adult health quality measures 
maintained under this paragraph (and any updates or 
changes to such measures) shall include behavioral health 
measures.’’; and 
(2) in subsection (d)(1)(A)— 
(A) by striking ‘‘the such plan’’ and inserting ‘‘such 
plan’’; and 
(B) by striking ‘‘subsection (a)(5)’’ and inserting ‘‘sub-
section (b)(5) and, beginning with the report for 2024, all 
behavioral health measures included in the core set of 
adult health quality measures maintained under such sub-
section (b)(5) and any updates or changes to such measures 
(as required under subsection (b)(3))’’. 
Subtitle B—Medicaid IMD Additional Info 
SEC. 5011. SHORT TITLE. 
This subtitle may be cited as the ‘‘Medicaid Institutes for 
Mental Disease Are Decisive in Delivering Inpatient Treatment 
for Individuals but Opportunities for Needed Access are Limited 
without Information Needed about Facility Obligations Act’’ or the 
‘‘Medicaid IMD ADDITIONAL INFO Act’’. 
SEC. 5012. MACPAC EXPLORATORY STUDY AND REPORT ON INSTITU-
TIONS FOR MENTAL DISEASES REQUIREMENTS AND 
PRACTICES UNDER MEDICAID. 
(a) IN GENERAL.—Not later than January 1, 2020, the Medicaid 
and CHIP Payment and Access Commission established under sec-
tion 1900 of the Social Security Act (42 U.S.C. 1396) shall conduct 
an exploratory study, using data from a representative sample 
of States, and submit to Congress a report on at least the following 
information, with respect to services furnished to individuals 
enrolled under State plans under the Medicaid program under 
title XIX of such Act (42 U.S.C. 1396 et seq.) (or waivers of such 
plans) who are patients in institutions for mental diseases and 
for which payment is made through fee-for-service or managed 
care arrangements under such State plans (or waivers): 
(1) A description of such institutions for mental diseases 
in each such State, including at a minimum— 
(A) the number of such institutions in the State; 
(B) the facility type of such institutions in the State; 
and 
(C) any coverage limitations under each such State 
plan (or waiver) on scope, duration, or frequency of such 
services.
H. R. 6—70 
(2) With respect to each such institution for mental diseases 
in each such State, a description of— 
(A) such services provided at such institution; 
(B) the process, including any timeframe, used by such 
institution to clinically assess and reassess such individ-
uals; and 
(C) the discharge process used by such institution, 
including any care continuum of relevant services or facili-
ties provided or used in such process. 
(3) A description of— 
(A) any Federal waiver that each such State has for 
such institutions and the Federal statutory authority for 
such waiver; and 
(B) any other Medicaid funding sources used by each 
such State for funding such institutions, such as supple-
mental payments. 
(4) A summary of State requirements (such as certification, 
licensure, and accreditation) applied by each such State to 
such institutions in order for such institutions to receive pay-
ment under the State plan (or waiver) and how each such 
State determines if such requirements have been met. 
(5) A summary of State standards (such as quality stand-
ards, clinical standards, and facility standards) that such 
institutions must meet to receive payment under such State 
plans (or waivers) and how each such State determines if 
such standards have been met. 
(6) If determined appropriate by the Commission, rec-
ommendations for policies and actions by Congress and the 
Centers for Medicare & Medicaid Services, such as on how 
State Medicaid programs may improve care and improve stand-
ards and including a recommendation for how the Centers 
for Medicare & Medicaid Services can improve data collection 
from such programs to address any gaps in information. 
(b) STAKEHOLDER INPUT.—In carrying out subsection (a), the 
Medicaid and CHIP Payment and Access Commission shall seek 
input from State Medicaid directors and stakeholders, including 
at a minimum the Substance Abuse and Mental Health Services 
Administration, Centers for Medicare & Medicaid Services, State 
Medicaid officials, State mental health authorities, Medicaid bene-
ficiary advocates, health care providers, and Medicaid managed 
care organizations. 
(c) DEFINITIONS.—In this section: 
(1) REPRESENTATIVE SAMPLE OF STATES.—The term ‘‘rep-
resentative sample of States’’ means a non-probability sample 
in which at least two States are selected based on the knowl-
edge and professional judgment of the selector. 
(2) STATE.—The term ‘‘State’’ means each of the 50 States, 
the District of Columbia, and any commonwealth or territory 
of the United States. 
(3) INSTITUTION FOR MENTAL DISEASES.—The term ‘‘institu-
tion for mental diseases’’ has the meaning given such term 
in section 435.1010 of title 42, Code of Federal Regulations, 
or any successor regulation.
H. R. 6—71 
Subtitle C—CHIP Mental Health and 
Substance Use Disorder Parity 
SEC. 5021. SHORT TITLE. 
This subtitle may be cited as the ‘‘CHIP Mental Health and 
Substance Use Disorder Parity Act’’. 
SEC. 5022. ENSURING ACCESS TO MENTAL HEALTH AND SUBSTANCE 
USE DISORDER SERVICES FOR CHILDREN AND PREGNANT 
WOMEN UNDER THE CHILDREN’S HEALTH INSURANCE 
PROGRAM. 
(a) IN GENERAL.—Section 2103(c)(1) of the Social Security Act 
(42 U.S.C. 1397cc(c)(1)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(E) Mental health and substance use disorder services 
(as defined in paragraph (5)).’’. 
(b) MENTAL HEALTH
AND SUBSTANCE USE DISORDER SERV-
ICES.— 
(1) IN
GENERAL.—Section 2103(c) of the Social Security 
Act (42 U.S.C. 1397cc(c)) is amended— 
(A) by redesignating paragraphs (5), (6), (7), and (8) 
as paragraphs (6), (7), (8), and (9), respectively; and 
(B) by inserting after paragraph (4) the following new 
paragraph: 
‘‘(5) MENTAL HEALTH AND SUBSTANCE USE DISORDER SERV-
ICES.—Regardless of the type of coverage elected by a State 
under subsection (a), child health assistance provided under 
such coverage for targeted low-income children and, in the 
case that the State elects to provide pregnancy-related assist-
ance under such coverage pursuant to section 2112, such preg-
nancy-related assistance for targeted low-income pregnant 
women (as defined in section 2112(d)) shall— 
‘‘(A) include coverage of mental health services 
(including behavioral health treatment) necessary to pre-
vent, diagnose, and treat a broad range of mental health 
symptoms and disorders, including substance use disorders; 
and 
‘‘(B) be delivered in a culturally and linguistically 
appropriate manner.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 2103(a) of the Social Security Act (42 U.S.C. 
1397cc(a)) is amended, in the matter before paragraph 
(1), by striking ‘‘paragraphs (5), (6), and (7)’’ and inserting 
‘‘paragraphs (5), (6), (7), and (8)’’. 
(B) Section 2110(a) of the Social Security Act (42 U.S.C. 
1397jj(a)) is amended— 
(i) in paragraph (18), by striking ‘‘substance abuse’’ 
each place it appears and inserting ‘‘substance use’’; 
and 
(ii) in paragraph (19), by striking ‘‘substance 
abuse’’ and inserting ‘‘substance use’’. 
(C) Section 2110(b)(5)(A)(i) of the Social Security Act 
(42 U.S.C. 1397jj(b)(5)(A)(i)) is amended by striking ‘‘sub-
section (c)(5)’’ and inserting ‘‘subsection (c)(6)’’. 
(c) ASSURING ACCESS TO CARE.—Section 2102(a)(7)(B) of the 
Social Security Act (42 U.S.C. 1397bb(c)(2)) is amended by striking
H. R. 6—72 
‘‘section 2103(c)(5)’’ and inserting ‘‘paragraphs (5) and (6) of section 
2103(c)’’. 
(d) MENTAL HEALTH SERVICES PARITY.—Subparagraph (A) of 
paragraph (7) of section 2103(c) of the Social Security Act (42 
U.S.C. 1397cc(c)) (as redesignated by subsection (b)(1)) is amended 
to read as follows: 
‘‘(A) IN
GENERAL.—A State child health plan shall 
ensure that the financial requirements and treatment 
limitations applicable to mental health and substance use 
disorder services (as described in paragraph (5)) provided 
under such plan comply with the requirements of section 
2726(a) of the Public Health Service Act in the same 
manner as such requirements or limitations apply to a 
group health plan under such section.’’. 
(e) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), the amendments 
made by this section shall take effect with respect to child 
health assistance provided on or after the date that is 1 year 
after the date of the enactment of this Act. 
(2) EXCEPTION
FOR
STATE
LEGISLATION.—In the case of 
a State child health plan under title XXI of the Social Security 
Act (or a waiver of such plan), which the Secretary of Health 
and Human Services determines requires State legislation in 
order for the respective plan (or waiver) to meet any require-
ment imposed by the amendments made by this section, the 
respective plan (or waiver) shall not be regarded as failing 
to comply with the requirements of such title solely on the 
basis of its failure to meet such an additional requirement 
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 enactment of this section. For 
purposes of the previous sentence, in the case of a State that 
has a 2-year legislative session, each year of the session shall 
be considered to be a separate regular session of the State 
legislature. 
Subtitle D—Medicaid Reentry 
SEC. 5031. SHORT TITLE. 
This subtitle may be cited as the ‘‘Medicaid Reentry Act’’. 
SEC. 5032. PROMOTING STATE INNOVATIONS TO EASE TRANSITIONS 
INTEGRATION 
TO 
THE 
COMMUNITY 
FOR 
CERTAIN 
INDIVIDUALS. 
(a) STAKEHOLDER GROUP DEVELOPMENT OF BEST PRACTICES; 
STATE MEDICAID PROGRAM INNOVATION.— 
(1) STAKEHOLDER GROUP BEST PRACTICES.—Not later than 
6 months after the date of the enactment of this Act, the 
Secretary of Health and Human Services shall convene a stake-
holder group of representatives of managed care organizations, 
Medicaid beneficiaries, health care providers, the National 
Association of Medicaid Directors, and other relevant represent-
atives from local, State, and Federal jail and prison systems 
to develop best practices (and submit to the Secretary and 
Congress a report on such best practices) for States—
H. R. 6—73 
(A) to ease the health care-related transition of an 
individual who is an inmate of a public institution from 
the public institution to the community, including best 
practices for ensuring continuity of health insurance cov-
erage or coverage under the State Medicaid plan under 
title XIX of the Social Security Act, as applicable, and 
relevant social services; and 
(B) to carry out, with respect to such an individual, 
such health care-related transition not later than 30 days 
after such individual is released from the public institution. 
(2) STATE MEDICAID PROGRAM INNOVATION.—The Secretary 
of Health and Human Services shall work with States on 
innovative strategies to help individuals who are inmates of 
public institutions and otherwise eligible for medical assistance 
under the Medicaid program under title XIX of the Social 
Security Act transition, with respect to enrollment for medical 
assistance under such program, seamlessly to the community. 
(b) GUIDANCE ON INNOVATIVE SERVICE DELIVERY SYSTEMS DEM-
ONSTRATION PROJECT OPPORTUNITIES.—Not later than 1 year after 
the date of the enactment of this Act, the Secretary of Health 
and Human Services, through the Administrator of the Centers 
for Medicare & Medicaid Services, shall issue a State Medicaid 
Director letter, based on best practices developed under subsection 
(a)(1), regarding opportunities to design demonstration projects 
under section 1115 of the Social Security Act (42 U.S.C. 1315) 
to improve care transitions for certain individuals who are soon- 
to-be former inmates of a public institution and who are otherwise 
eligible to receive medical assistance under title XIX of such Act, 
including systems for, with respect to a period (not to exceed 30 
days) immediately prior to the day on which such individuals are 
expected to be released from such institution— 
(1) providing assistance and education for enrollment under 
a State plan under the Medicaid program under title XIX 
of such Act for such individuals during such period; and 
(2) providing health care services for such individuals 
during such period. 
(c) RULE OF CONSTRUCTION.—Nothing under title XIX of the 
Social Security Act or any other provision of law precludes a State 
from reclassifying or suspending (rather than terminating) eligi-
bility of an individual for medical assistance under title XIX of 
the Social Security Act while such individual is an inmate of a 
public institution. 
Subtitle E—Medicaid Partnership 
SEC. 5041. SHORT TITLE. 
This subtitle may be cited as the ‘‘Medicaid Providers Are 
Required To Note Experiences in Record Systems to Help In-need 
Patients Act’’ or the ‘‘Medicaid PARTNERSHIP Act’’. 
SEC. 5042. MEDICAID PROVIDERS ARE REQUIRED TO NOTE EXPERI-
ENCES IN RECORD SYSTEMS TO HELP IN-NEED PATIENTS. 
(a) REQUIREMENTS UNDER THE MEDICAID PROGRAM RELATING 
TO QUALIFIED PRESCRIPTION DRUG MONITORING PROGRAMS
AND 
PRESCRIBING CERTAIN CONTROLLED SUBSTANCES.—Title XIX of the
H. R. 6—74 
Social Security Act (42 U.S.C. 1396 et seq.) is amended by inserting 
after section 1943 the following new section: 
‘‘SEC. 1944. REQUIREMENTS RELATING TO QUALIFIED PRESCRIPTION 
DRUG MONITORING PROGRAMS AND PRESCRIBING CER-
TAIN CONTROLLED SUBSTANCES. 
‘‘(a) IN GENERAL.—Subject to subsection (d), beginning October 
1, 2021, a State— 
‘‘(1) shall require each covered provider to check, in accord-
ance with such timing, manner, and form as specified by the 
State, the prescription drug history of a covered individual 
being treated by the covered provider through a qualified 
prescription drug monitoring program described in subsection 
(b) before prescribing to such individual a controlled substance; 
and 
‘‘(2) in the case that such a provider is not able to conduct 
such a check despite a good faith effort by such provider— 
‘‘(A) shall require the provider to document such good 
faith effort, including the reasons why the provider was 
not able to conduct the check; and 
‘‘(B) may require the provider to submit, upon request, 
such documentation to the State. 
‘‘(b) QUALIFIED PRESCRIPTION DRUG MONITORING PROGRAM 
DESCRIBED.—A qualified prescription drug monitoring program 
described in this subsection is, with respect to a State, a prescription 
drug monitoring program administered by the State that, at a 
minimum, satisfies each of the following criteria: 
‘‘(1) The program facilitates access by a covered provider 
to, at a minimum, the following information with respect to 
a covered individual, in as close to real-time as possible: 
‘‘(A) Information regarding the prescription drug his-
tory of a covered individual with respect to controlled sub-
stances. 
‘‘(B) The number and type of controlled substances 
prescribed to and filled for the covered individual during 
at least the most recent 12-month period. 
‘‘(C) The name, location, and contact information (or 
other identifying number selected by the State, such as 
a national provider identifier issued by the National Plan 
and Provider Enumeration System of the Centers for Medi-
care & Medicaid Services) of each covered provider who 
prescribed a controlled substance to the covered individual 
during at least the most recent 12-month period. 
‘‘(2) The program facilitates the integration of information 
described in paragraph (1) into the workflow of a covered pro-
vider, which may include the electronic system the covered 
provider uses to prescribe controlled substances. 
A qualified prescription drug monitoring program described in this 
subsection, with respect to a State, may have in place, in accordance 
with applicable State and Federal law, a data-sharing agreement 
with the State Medicaid program that allows the medical director 
and pharmacy director of such program (and any designee of such 
a director who reports directly to such director) to access the 
information described in paragraph (1) in an electronic format. 
The State Medicaid program under this title may facilitate reason-
able and limited access, as determined by the State and ensuring 
documented beneficiary protections regarding the use of such data,
H. R. 6—75 
to such qualified prescription drug monitoring program for the 
medical director or pharmacy director of any managed care entity 
(as defined under section 1932(a)(1)(B)) that has a contract with 
the State under section 1903(m) or under section 1905(t)(3), or 
the medical director or pharmacy director of any entity that has 
a contract to manage the pharmaceutical benefit with respect to 
individuals enrolled in the State plan (or under a waiver of the 
State plan). All applicable State and Federal security and privacy 
laws shall apply to the directors or designees of such directors 
of any State Medicaid program or entity accessing a qualified 
prescription drug monitoring program under this section. 
‘‘(c) APPLICATION OF PRIVACY RULES CLARIFICATION.—The Sec-
retary shall clarify privacy requirements, including requirements 
under the regulations promulgated pursuant to section 264(c) of 
the Health Insurance Portability and Accountability Act of 1996 
(42 U.S.C. 1320d–2 note), related to the sharing of data under 
subsection (b) in the same manner as the Secretary is required 
under subparagraph (J) of section 1860D–4(c)(5) to clarify privacy 
requirements related to the sharing of data described in such 
subparagraph. 
‘‘(d) ENSURING ACCESS.—In order to ensure reasonable access 
to health care, the Secretary shall waive the application of the 
requirement under subsection (a), with respect to a State, in the 
case of natural disasters and similar situations, and in the case 
of the provision of emergency services (as defined for purposes 
of section 1860D–4(c)(5)(D)(ii)(II)). 
‘‘(e) REPORTS.— 
‘‘(1) STATE
REPORTS.—Each State shall include in the 
annual report submitted to the Secretary under section 
1927(g)(3)(D), beginning with such reports submitted for 2023, 
information including, at a minimum, the following information 
for the most recent 12-month period: 
‘‘(A) The percentage of covered providers (as deter-
mined pursuant to a process established by the State) 
who checked the prescription drug history of a covered 
individual through a qualified prescription drug monitoring 
program described in subsection (b) before prescribing to 
such individual a controlled substance. 
‘‘(B) Aggregate trends with respect to prescribing con-
trolled substances such as— 
‘‘(i) the quantity of daily morphine milligram 
equivalents prescribed for controlled substances; 
‘‘(ii) the number and quantity of daily morphine 
milligram equivalents prescribed for controlled sub-
stances per covered individual; and 
‘‘(iii) the types of controlled substances prescribed, 
including the dates of such prescriptions, the supplies 
authorized (including the duration of such supplies), 
and the period of validity of such prescriptions, in 
different populations (such as individuals who are 
elderly, individuals with disabilities, and individuals 
who are enrolled under both this title and title XVIII). 
‘‘(C) Whether or not the State requires (and a detailed 
explanation as to why the State does or does not require) 
pharmacists to check the prescription drug history of a 
covered individual through a qualified prescription drug
H. R. 6—76 
monitoring program described in subsection (b) before dis-
pensing a controlled substance to such individual. 
‘‘(D) An accounting of any data or privacy breach of 
a qualified prescription drug monitoring program described 
in subsection (b), the number of covered individuals 
impacted by each such breach, and a description of the 
steps the State has taken to address each such breach, 
including, to the extent required by State or Federal law 
or otherwise determined appropriate by the State, alerting 
any such impacted individual and law enforcement of the 
breach. 
‘‘(2) REPORT BY CMS.—Not later than October 1, 2023, the 
Administrator of the Centers for Medicare & Medicaid Services 
shall publish on the publicly available website of the Centers 
for Medicare & Medicaid Services a report including the fol-
lowing information: 
‘‘(A) Guidance for States on how States can increase 
the percentage of covered providers who use qualified 
prescription drug monitoring programs described in sub-
section (b). 
‘‘(B) Best practices for how States and covered pro-
viders should use such qualified prescription drug moni-
toring programs to reduce the occurrence of abuse of con-
trolled substances. 
‘‘(f) INCREASE TO FMAP AND FEDERAL MATCHING RATES FOR 
CERTAIN EXPENDITURES RELATING
TO QUALIFIED PRESCRIPTION 
DRUG MONITORING PROGRAMS.— 
‘‘(1) IN GENERAL.—With respect to a State that meets the 
condition described in paragraph (2) and any quarter occurring 
during fiscal year 2019 or fiscal year 2020, the Federal medical 
assistance percentage or Federal matching rate that would 
otherwise apply to such State under section 1903(a) for such 
quarter, with respect to expenditures by the State for activities 
under the State plan (or a waiver of such plan) to design, 
develop, or implement a prescription drug monitoring program 
(and to make connections to such program) that satisfies the 
criteria described in paragraphs (1) and (2) of subsection (b), 
shall be equal to 100 percent. 
‘‘(2) CONDITION.—The condition described in this para-
graph, with respect to a State, is that the State (in this para-
graph referred to as the ‘administering State’) has in place 
agreements with all States that are contiguous to such admin-
istering State that, when combined, enable covered providers 
in all such contiguous States to access, through the prescription 
drug monitoring program, the information that is described 
in subsection (b)(1) of covered individuals of such administering 
State and that covered providers in such administering State 
are able to access through such program. 
‘‘(g) RULE OF CONSTRUCTION.—Nothing in this section prevents 
a State from requiring pharmacists to check the prescription drug 
history of covered individuals through a qualified prescription drug 
monitoring program before dispensing controlled substances to such 
individuals. 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) CONTROLLED SUBSTANCE.—The term ‘controlled sub-
stance’ means a drug that is included in schedule II of section 
202(c) of the Controlled Substances Act and, at the option
H. R. 6—77 
of the State involved, a drug included in schedule III or IV 
of such section. 
‘‘(2) COVERED INDIVIDUAL.—The term ‘covered individual’ 
means, with respect to a State, an individual who is enrolled 
in the State plan (or under a waiver of such plan). Such 
term does not include 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 facility, of a 
facility described in section 1905(d), or of another facility 
for which frequently abused drugs are dispensed for resi-
dents through a contract with a single pharmacy; or 
‘‘(C) the State elects to treat as exempted from such 
term. 
‘‘(3) COVERED PROVIDER.— 
‘‘(A) IN GENERAL.—The term ‘covered provider’ means, 
subject to subparagraph (B), with respect to a State, a 
health care provider who is participating under the State 
plan (or waiver of the State plan) and licensed, registered, 
or otherwise permitted by the State to prescribe a con-
trolled substance (or the designee of such provider). 
‘‘(B) EXCEPTIONS.— 
‘‘(i) IN GENERAL.—Beginning October 1, 2021, for 
purposes of this section, such term does not include 
a health care provider included in any type of health 
care provider determined by the Secretary to be exempt 
from application of this section under clause (ii). 
‘‘(ii) EXCEPTIONS PROCESS.—Not later than October 
1, 2020, the Secretary, after consultation with the 
National Association of Medicaid Directors, national 
health care provider associations, Medicaid beneficiary 
advocates, and advocates for individuals with rare dis-
eases, shall determine, based on such consultations, 
the types of health care providers (if any) that should 
be exempted from the definition of the term ‘covered 
provider’ for purposes of this section.’’. 
(b) GUIDANCE.—Not later than October 1, 2019, the Adminis-
trator of the Centers for Medicare & Medicaid Services, in consulta-
tion with the Director of the Centers for Disease Control and 
Prevention, shall issue guidance on best practices on the uses 
of prescription drug monitoring programs required of prescribers 
and on protecting the privacy of Medicaid beneficiary information 
maintained in and accessed through prescription drug monitoring 
programs. 
(c) DEVELOPMENT OF MODEL STATE PRACTICES.— 
(1) IN GENERAL.—Not later than October 1, 2020, the Sec-
retary of Health and Human Services shall develop and publish 
model practices to assist State Medicaid program operations 
in identifying and implementing strategies to utilize data- 
sharing agreements described in the matter following para-
graph (2) of section 1944(b) of the Social Security Act, as 
added by subsection (a), for the following purposes: 
(A) Monitoring and preventing fraud, waste, and abuse. 
(B) Improving health care for individuals enrolled in 
a State plan under title XIX of such Act (or under a 
waiver of such plan) who—