107 
(4) Standing orders. 
(5) Other distribution, education, and safety 
measures as determined necessary. 
SEC. 3007. REQUIRING A SURVEY OF SUBSTANCE USE DIS-
ORDER TREATMENT PROVIDERS RECEIVING 
FEDERAL FUNDING. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall conduct a survey of all entities that receive 
Federal funding for the purpose of providing substance 
use disorder treatment services. The survey shall direct 
such entities to provide the following information: 
(1) The length of time the entity has provided 
substance use disorder treatment services. 
(2) A detailed description of the patient popu-
lation served by the entity, including but not limited 
to the number of patients, type of addictions, geo-
graphic area served, as well as gender, racial, ethnic 
and socioeconomic demographics of such patients. 
(3) A detailed description of the types of addic-
tion for which the entity has the experience, capa-
bility, and capacity to provide such services. 
(4) An explanation of how the entity handles 
patients requiring treatment for a substance use dis-
order that the organization is not able to treat.
108 
(5) A description of what is needed, in the opin-
ion of the entity, in order to improve the entity’s 
ability to meet the addiction treatment needs of the 
communities served by that entity. 
(6) Based on the identified needs of the com-
munities served, a description of unmet needs and 
inadequate services and how such needs and services 
could be better addressed through additional Fed-
eral, State, or local government resources or funding 
to treat addiction to methamphetamine, crack co-
caine, other types of cocaine, heroin, opioids, and 
other commonly abused drugs. 
(b) REPORT.—Not later than 1 year after the date 
of the enactment of this Act, the Secretary shall develop 
and submit to Congress a plan to direct appropriate re-
sources to entities that provide substance use disorder 
treatment services in order to address inadequacies in 
services or funding identified through the survey described 
in subsection (a). 
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)) is amended by adding at the end the 
following new paragraph:
109 
‘‘(7)(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 sec-
tion 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 man-
aged care entity, or other specified entity (as defined in 
subparagraph (D)(iii)), that are treated as remittances be-
cause 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))
110 
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 subparagraph (C), to apply a minimum med-
ical loss ratio that is equal to 85 percent; and 
‘‘(ii) recovered all or a portion of the expendi-
tures as a result of the entity’s failure to meet such 
ratio. 
‘‘(C) For purposes of subparagraph (B), a State de-
scribed in this subparagraph is a State that as of May 
31, 2018, applied a minimum medical loss ratio (as cal-
culated 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 de-
scribed in such subparagraph under the State plan under 
this title (or a waiver of the plan) that is equal to or great-
er than 85 percent. 
‘‘(D) For purposes of this paragraph: 
‘‘(i) The term ‘managed care entity’ means a 
medicaid managed 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 sec-
111 
tion 438.8 of title 42, Code of Federal Regulations 
(as in effect on June 1, 2018)) for payment for serv-
ices provided by entities described in subparagraph 
(B) under the State plan under this title (or a waiv-
er of the plan). 
‘‘(iii) The term ‘other specified entity’ means— 
‘‘(I) a prepaid inpatient health plan, as de-
fined in section 438.2 of title 42, Code of Fed-
eral Regulations (or any successor regulation); 
and 
‘‘(II) a prepaid ambulatory health plan, as 
defined in such section (or any successor regu-
lation).’’. 
SEC. 4002. EXTENDING PERIOD OF APPLICATION OF MEDI-
CARE SECONDARY PAYER RULES FOR INDI-
VIDUALS WITH END STAGE RENAL DISEASE. 
Section 1862(b)(1)(C) of the Social Security Act (42 
U.S.C. 1395y(b)(1)(C)) is amended— 
(1) in the last sentence, by inserting ‘‘and be-
fore January 1, 2020’’ after ‘‘date of enactment of 
the Balanced Budget Act of 1997’’; and 
(2) by adding at the end the following new sen-
tence: ‘‘Effective for items and services furnished on 
or after January 1, 2020 (with respect to periods 
beginning on or after July 1, 2018), clauses (i) and
112 
(ii) shall be applied by substituting ‘33-month’ for 
‘12-month’ each place it appears.’’. 
SEC. 4003. REQUIRING REPORTING BY GROUP HEALTH 
PLANS OF PRESCRIPTION DRUG COVERAGE 
INFORMATION FOR PURPOSES OF IDENTI-
FYING PRIMARY PAYER SITUATIONS UNDER 
THE MEDICARE PROGRAM. 
Clause (i) of section 1862(b)(7)(A) of the Social Se-
curity Act (42 U.S.C. 1395y(b)(7)(A)) is amended to read 
as follows: 
‘‘(i) secure from the plan sponsor and 
plan participants 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 pro-
gram under this title; or 
‘‘(II) for calendar quarters begin-
ning on or after January 1, 2020, a 
primary payer with respect to benefits 
relating to prescription drug coverage 
under part D; and’’.
113 
TITLE V—OTHER MEDICAID 
PROVISIONS 
Subtitle A—Mandatory Reporting 
With Respect to Adult Behav-
ioral Health Measures 
SEC. 5001. MANDATORY REPORTING WITH RESPECT TO 
ADULT BEHAVIORAL HEALTH MEASURES. 
Section 1139B of the Social Security Act (42 U.S.C. 
1320b–9b) is amended— 
(1) in subsection (b)— 
(A) in paragraph (3)— 
(i) by striking ‘‘Not later than Janu-
ary 1, 2013’’ and inserting the following: 
‘‘(A) VOLUNTARY REPORTING.—Not later 
than January 1, 2013’’; and 
(ii) by adding at the end the fol-
lowing: 
‘‘(B) MANDATORY
REPORTING
WITH
RE-
SPECT TO BEHAVIORAL HEALTH MEASURES.— 
Beginning with the State report required under 
subsection (d)(1) for 2024, the Secretary shall 
require States to use all behavioral health meas-
ures included in the core set of adult health 
quality measures and any updates or changes to 
such measures to report information, using the
114 
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 re-
quired under subsection (d)(1) for 2024, the 
core set of adult health quality measures main-
tained under this paragraph (and any updates 
or changes to such measures) shall include be-
havioral health measures.’’; and 
(2) in subsection (d)(1)(A)— 
(A) by striking ‘‘the such plan’’ and insert-
ing ‘‘such plan’’; and 
(B) by striking ‘‘subsection (a)(5)’’ and in-
serting ‘‘subsection (b)(5) and, beginning with 
the report for 2024, all behavioral health meas-
ures 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))’’.
115 
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 Fa-
cility Obligations Act’’ or the ‘‘Medicaid IMD ADDI-
TIONAL INFO Act’’. 
SEC. 5012. MACPAC EXPLORATORY STUDY AND REPORT ON 
INSTITUTIONS FOR MENTAL DISEASES RE-
QUIREMENTS AND PRACTICES UNDER MED-
ICAID. 
(a) IN GENERAL.—Not later than January 1, 2020, 
the Medicaid and CHIP Payment and Access Commission 
established under section 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 infor-
mation, 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
116 
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 min-
imum— 
(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. 
(2) With respect to each such institution for 
mental diseases in each such State, a description 
of— 
(A) such services provided at such institu-
tion; 
(B) the process, including any timeframe, 
used by such institution to clinically assess and 
reassess such individuals; and 
(C) the discharge process used by such in-
stitution, including any care continuum of rel-
evant services or facilities provided or used in 
such process. 
(3) A description of—
117 
(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 insti-
tutions, such as supplemental 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 payment under the State 
plan (or waiver) and how each such State deter-
mines if such requirements have been met. 
(5) A summary of State standards (such as 
quality standards, clinical standards, and facility 
standards) that such institutions must meet to re-
ceive payment under such State plans (or waivers) 
and how each such State determines if such stand-
ards have been met. 
(6) Recommendations for actions by Congress 
and the Centers for Medicare & Medicaid Services. 
such as how State Medicaid programs may improve 
care and improve standards and including a rec-
ommendation for how the Centers for Medicare & 
Medicaid Services can improve data collection from 
such programs to address any gaps in information.
118 
(b) STAKEHOLDER INPUT.—In carrying out sub-
section (a), the Medicaid and CHIP Payment and Access 
Commission shall seek input from State Medicaid direc-
tors and stakeholders, including at a minimum the Sub-
stance 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 ‘‘representative sample of States’’ means 
a non-probability sample in which at least two 
States are selected based on the knowledge and pro-
fessional 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 ‘‘institution for mental diseases’’ has the mean-
ing given such term in section 435.1009 of title 42, 
Code of Federal Regulations, or any successor regu-
lation.
119 
Subtitle C—CHIP Mental Health 
Parity 
SEC. 5021. SHORT TITLE. 
This subtitle may be cited as the ‘‘CHIP Mental 
Health 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 PRO-
GRAM. 
(a) IN GENERAL.—Section 2103(c)(1) of the Social 
Security Act (42 U.S.C. 1397cc(c)(1)) is amended by add-
ing at the end the following new subparagraph: 
‘‘(E) Mental health and substance use dis-
order services (as defined in paragraph (5)).’’. 
(b) MENTAL HEALTH AND SUBSTANCE USE DIS-
ORDER SERVICES.— 
(1) IN GENERAL.—Section 2103(c) of the So-
cial Security Act (42 U.S.C. 1397cc(c)) is amend-
ed— 
(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:
120 
‘‘(5) MENTAL
HEALTH
AND
SUBSTANCE
USE 
DISORDER SERVICES.—Regardless of the type of cov-
erage 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 pregnancy-related assistance for targeted low- 
income women (as defined in section 2112(d)) 
shall— 
‘‘(A) include coverage of mental health 
services (including behavioral health treatment) 
necessary to prevent, diagnose, and treat a 
broad range of mental health symptoms and 
disorders, including substance use disorders; 
and 
‘‘(B) be delivered in a culturally and lin-
guistically 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 ‘‘para-
graphs (5), (6), and (7)’’ and inserting ‘‘para-
graphs (5), (6), (7), and (8)’’.
121 
(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 ‘‘sub-
stance 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 ‘‘subsection (c)(5)’’ and in-
serting ‘‘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 
‘‘section 
2103(c)(5)’’ and inserting ‘‘paragraphs (5) and (6) of sec-
tion 2103(c)’’. 
(d) MENTAL HEALTH SERVICES PARITY.—Subpara-
graph (A) of paragraph (7) of section 2103(c) of the So-
cial 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 require-
ments and treatment limitations applicable to 
mental health and substance use disorder serv-
122 
ices (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 ef-
fect 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 requirement 
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
123 
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 sepa-
rate 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 COMMU-
NITY 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 enact-
ment of this Act, the Secretary of Health and 
Human Services shall convene a stakeholder group 
of representatives of managed care organizations, 
Medicaid beneficiaries, health care providers, the 
National Association of Medicaid Directors, and 
other relevant representatives from local, State, and 
Federal jail and prison systems to develop best prac-
tices (and submit to the Secretary and Congress a 
report on such best practices) for States—
124 
(A) to ease the health care-related transi-
tion of an individual who is an inmate of a pub-
lic institution from the public institution to the 
community, including best practices for ensur-
ing continuity of health insurance coverage or 
coverage under the State Medicaid plan under 
title XIX of the Social Security Act, as applica-
ble, 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 in-
dividuals who are inmates of public institutions and 
otherwise eligible for medical assistance under the 
Medicaid program under title XIX of the Social Se-
curity Act transition, with respect to enrollment for 
medical assistance under such program, seamlessly 
to the community. 
(b) GUIDANCE ON INNOVATIVE SERVICE DELIVERY 
SYSTEMS DEMONSTRATION PROJECT OPPORTUNITIES.— 
Not later than 1 year after the date of the enactment of 
this Act, the Secretary of Health and Human Services,
125 
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 indi-
viduals who are soon-to-be former inmates of a public in-
stitution 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) imme-
diately prior to the day on which such individuals are ex-
pected to be released from such institution— 
(1) providing assistance and education for en-
rollment under a State plan under the Medicaid pro-
gram under title XIX of such Act for such individ-
uals during such period; and 
(2) providing health care services for such indi-
viduals 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) eligibility of an individual for 
medical assistance under title XIX of the Social Security 
Act while such individual is an inmate of a public institu-
tion.
126 
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 PARTNER-
SHIP Act’’. 
SEC. 5042. MEDICAID PROVIDERS ARE REQUIRED TO NOTE 
EXPERIENCES IN RECORD SYSTEMS TO HELP 
IN-NEED PATIENTS. 
(a) REQUIREMENTS UNDER
THE MEDICAID PRO-
GRAM RELATING
TO QUALIFIED PRESCRIPTION DRUG 
MONITORING PROGRAMS
AND PRESCRIBING CERTAIN 
CONTROLLED SUBSTANCES.—Title XIX of the Social Se-
curity Act (42 U.S.C. 1396 et seq.) is amended by insert-
ing after section 1943 the following new section: 
‘‘SEC. 1944. REQUIREMENTS RELATING TO QUALIFIED PRE-
SCRIPTION DRUG MONITORING PROGRAMS 
AND PRESCRIBING CERTAIN CONTROLLED 
SUBSTANCES. 
‘‘(a) IN GENERAL.—Beginning October 1, 2021, a 
State shall, subject to subsection (d), require each covered 
provider to check, in accordance with such timing, man-
ner, 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
127 
monitoring program described in subsection (b) before 
prescribing to such individual a controlled substance. 
‘‘(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 pro-
gram administered by the State that, at a minimum, satis-
fies each of the following criteria: 
‘‘(1) The program facilitates access by a cov-
ered provider to, at a minimum, the following infor-
mation with respect to a covered individual, in as 
close to real-time as possible: 
‘‘(A) Information regarding the prescrip-
tion drug history of a covered individual with 
respect to controlled substances. 
‘‘(B) The number and type of controlled 
substances prescribed to and filled for the cov-
ered individual during at least the most recent 
12-month period. 
‘‘(C) The name, location, and contact in-
formation (or other identifying number selected 
by the State, such as a national provider identi-
fier issued by the National Plan and Provider 
Enumeration System of the Centers for Medi-
care & Medicaid Services) of each covered pro-
128 
vider 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 provider, which may include 
the electronic system the covered provider uses to 
prescribe controlled substances. 
A qualified prescription drug monitoring program de-
scribed 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 reasonable and limited access, as deter-
mined by the State and ensuring documented beneficiary 
protections regarding the use of such data, to such quali-
fied 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 con-
tract with the State under section 1903(m) or under sec-
tion 1905(t)(3), or the medical director or pharmacy direc-
129 
tor of any entity has a contract to manage the pharma-
ceutical benefit with respect to individuals enrolled in the 
State plan (or 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 prescrip-
tion drug monitoring program under this section. 
‘‘(c) 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) in the same manner as the Secretary is required under 
subparagraph (J) of section 1860D–4(c)(5) to clarify pri-
vacy requirements related to the sharing of data described 
in such subparagraph. 
‘‘(d) ENSURING ACCESS.—In order to ensure reason-
able 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 emer-
gency services (as defined for purposes of section 1860D– 
4(c)(5)(D)(ii)(II)). 
‘‘(e) REPORTS.—
130 
‘‘(1) STATE
REPORTS.—Each State shall in-
clude in the annual report submitted to the Sec-
retary under section 1927(g)(3)(D), beginning with 
such reports submitted for 2023, information includ-
ing, at a minimum, the following information for the 
most recent 12-month period: 
‘‘(A) The percentage of covered providers 
(as determined pursuant to a process estab-
lished by the State) who checked the prescrip-
tion drug history of a covered individual 
through a qualified prescription drug moni-
toring program described in subsection (b) be-
fore prescribing to such individual a controlled 
substance. 
‘‘(B) Aggregate trends with respect to pre-
scribing controlled substances such as— 
‘‘(i) the quantity of daily morphine 
milligram equivalents prescribed for con-
trolled substances; 
‘‘(ii) the number and quantity of daily 
morphine milligram equivalents prescribed 
for controlled substances per covered indi-
vidual; and 
‘‘(iii) the types of controlled sub-
stances prescribed, including the dates of
131 
such prescriptions, the supplies authorized 
(including the duration of such supplies), 
and the period of validity of such prescrip-
tions, in different populations (such as in-
dividuals who are elderly, individuals with 
disabilities, and individuals who are en-
rolled 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 indi-
vidual through a qualified drug management 
program before dispensing a controlled sub-
stance to such individual. 
‘‘(2) REPORT BY CMS.—Not later than October 
1, 2023, the Administrator of the Centers for Medi-
care & Medicaid Services shall publish on the pub-
licly available website of the Centers for Medicare & 
Medicaid Services a report including the following 
information: 
‘‘(A) Guidance for States on how States 
can increase the percentage of covered providers 
who use qualified prescription drug monitoring 
programs described in subsection (b).
132 
‘‘(B) Best practices for how States and 
covered providers should use such qualified pre-
scription drug monitoring programs to reduce 
the occurrence of abuse of controlled sub-
stances. 
‘‘(f) INCREASE TO FEDERAL MATCHING RATE FOR 
CERTAIN EXPENDITURES RELATING TO QUALIFIED PRE-
SCRIPTION DRUG MANAGEMENT PROGRAMS.—The Sec-
retary shall increase the Federal medical assistance per-
centage or Federal matching rate that would otherwise 
apply to a State under section 1903(a) for a calendar 
quarter occurring during the period beginning October 1, 
2018, and ending September 30, 2021, for expenditures 
by the State for activities under the State plan (or waiver 
of the State plan) to implement a prescription drug man-
agement program that satisfies the criteria described in 
paragraphs (1) and (2) of subsection (b) if the State (in 
this subsection referred to as the ‘administering State’) 
has in place agreements with all States that are contig-
uous to such administering State that, when combined, en-
able covered providers in all such contiguous States to ac-
cess, through the prescription drug management 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
133 
access through such program. In no case shall an increase 
under this subsection result in a Federal medical assist-
ance percentage or Federal matching rate that exceeds 
100 percent. 
‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec-
tion prevents a State from requiring pharmacists to check 
the prescription drug history of covered individuals 
through a qualified drug management program before dis-
pensing controlled substances to such individuals. 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) CONTROLLED
SUBSTANCE.—The term 
‘controlled substance’ means a drug that is included 
in schedule II of section 202(c) of the Controlled 
Substances Act and, at the option of the State in-
volved, a drug included in schedule III or IV of such 
section. 
‘‘(2) COVERED
INDIVIDUAL.—The term ‘cov-
ered 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 in-
clude an individual who— 
‘‘(A) is receiving— 
‘‘(i) hospice or palliative care; or 
‘‘(ii) treatment for cancer;
134 
‘‘(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 
‘‘(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, reg-
istered, or otherwise permitted by the State to 
prescribe a controlled substance (or the des-
ignee of such provider). 
‘‘(B) EXCEPTIONS.— 
‘‘(i) IN
GENERAL.—Beginning Octo-
ber 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 sec-
tion under clause (ii).
135 
‘‘(ii) 
EXCEPTIONS
PROCESS.—Not 
later than October 1, 2020, the Secretary, 
after consultation with the National Asso-
ciation of Medicaid Directors, national 
health care provider associations, Medicaid 
beneficiary advocates, and advocates for in-
dividuals with rare diseases, shall deter-
mine, 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 
Administrator of the Centers for Medicare & Medicaid 
Services, in consultation with the Director of the Centers 
for Disease Control and Prevention, shall issue guidance 
on best practices on the uses of prescription drug moni-
toring programs required of prescribers and on protecting 
the privacy of Medicaid beneficiary information main-
tained in and accessed through prescription drug moni-
toring programs. 
(c) DEVELOPMENT OF MODEL STATE PRACTICES.— 
(1) IN GENERAL.—Not later than October 1, 
2020, the Secretary of Health and Human Services 
shall develop and publish model practices to assist
136 
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 waiver of such plan) who— 
(i) transition in and out of coverage 
under such title; 
(ii) may have sources of health care 
coverage in addition to coverage under 
such title; or 
(iii) pay for prescription drugs with 
cash. 
(C) Any other purposes specified by the 
Secretary. 
(2) ELEMENTS
OF
MODEL
PRACTICES.—The 
model practices described in paragraph (1)— 
(A) shall include strategies for assisting 
States in allowing the medical director or phar-
macy director (or designees of such a director)
137 
of managed care organizations or pharma-
ceutical benefit managers to access information 
with respect to all covered individuals served by 
such managed care organizations or pharma-
ceutical benefit managers to access as a single 
data set, in an electronic format; and 
(B) shall include any appropriate bene-
ficiary protections and privacy guidelines. 
(3) CONSULTATION.—In developing model prac-
tices under this subsection, the Secretary shall con-
sult with the National Association of Medicaid Di-
rectors, managed care entities (as defined in section 
1932(a)(1)(B) of the Social Security Act) with con-
tracts with States pursuant to section 1903(m) of 
such Act, pharmaceutical benefit managers, physi-
cians and other health care providers, beneficiary 
advocates, and individuals with expertise in health 
care technology related to prescription drug moni-
toring programs and electronic health records. 
(d) REPORT BY COMPTROLLER GENERAL.—Not later 
than October 1, 2020, the Comptroller General of the 
United States shall issue a report examining the operation 
of prescription drug monitoring programs administered by 
States, including data security and access standards used 
by such programs.
138 
TITLE VI—OTHER MEDICARE 
PROVISIONS 
Subtitle A—Testing of Incentive 
Payments for Behavioral Health 
Providers for Adoption and Use 
of Certified Electronic Health 
Record Technology 
SEC. 6001. TESTING OF INCENTIVE PAYMENTS FOR BEHAV-
IORAL HEALTH PROVIDERS FOR ADOPTION 
AND 
USE 
OF 
CERTIFIED 
ELECTRONIC 
HEALTH RECORD TECHNOLOGY. 
Section 1115A(b)(2)(B) of the Social Security Act 
(42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the 
end the following new clause: 
‘‘(xxv) Providing, for the adoption and 
use of certified EHR technology (as de-
fined in section 1848(o)(4)) to improve the 
quality and coordination of care through 
the electronic documentation and exchange 
of health information, incentive payments 
to behavioral health providers (such as 
psychiatric hospitals (as defined in section 
1861(f)), community mental health centers 
(as defined in section 1861(ff)(3)(B)), hos-
pitals that participate in a State plan
139 
under title XIX or a waiver of such plan, 
treatment facilities that participate in such 
a State plan or such a waiver, mental 
health or substance use disorder providers 
that participate in such a State plan or 
such a waiver, clinical psychologists (as de-
fined in section 1861(ii)), nurse practi-
tioners (as defined in section 1861(aa)(5)) 
with respect to the provision of psychiatric 
services, and clinical social workers (as de-
fined in section 1861(hh)(1))).’’. 
Subtitle B—Abuse Deterrent Access 
SEC. 6011. SHORT TITLE. 
This subtitle may be cited at the ‘‘Abuse Deterrent 
Access Act of 2018’’. 
SEC. 6012. STUDY ON ABUSE-DETERRENT OPIOID FORMU-
LATIONS ACCESS BARRIERS UNDER MEDI-
CARE. 
(a) IN GENERAL.—Not later than 1 year after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services shall conduct a study and submit to 
Congress a report on the adequacy of access to abuse-de-
terrent opioid formulations for individuals with chronic 
pain enrolled in an MA–PD plan under part C of title 
XVIII of the Social Security Act or a prescription drug
140 
plan under part D of such title of such Act, taking into 
account any barriers preventing such individuals from ac-
cessing such formulations under such MA–PD or part D 
plans, such as cost-sharing tiers, fail-first requirements, 
the price of such formulations, and prior authorization re-
quirements. 
(b) DEFINITION OF ABUSE-DETERRENT OPIOID FOR-
MULATION.—In this section, the term ‘‘abuse-deterrent 
opioid formulation’’ means an opioid that is a prodrug or 
that has certain abuse-deterrent properties, such as phys-
ical or chemical barriers, agonist or antagonist combina-
tions, aversion properties, delivery system mechanisms, or 
other features designed to prevent abuse of such opioid. 
Subtitle C—Medicare Opioid Safety 
Education 
SEC. 6021. SHORT TITLE. 
This subtitle may be cited as the ‘‘Medicare Opioid 
Safety Education Act of 2018’’. 
SEC. 
6022. 
PROVISION 
OF 
INFORMATION 
REGARDING 
OPIOID USE AND PAIN MANAGEMENT AS 
PART OF MEDICARE & YOU HANDBOOK. 
(a) IN GENERAL.—Section 1804 of the Social Secu-
rity Act (42 U.S.C. 1395b–2) is amended by adding at 
the end the following new subsection:
141 
‘‘(d) The notice provided under subsection (a) shall 
include— 
‘‘(1) educational resources, compiled by the Sec-
retary, regarding opioid use and pain management; 
and 
‘‘(2) a description of alternative, non-opioid 
pain management treatments covered under this 
title.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to notices distributed prior to 
each Medicare open enrollment period beginning after 
January 1, 2019. 
Subtitle D—Opioid Addiction 
Action Plan 
SEC. 6031. SHORT TITLE. 
This subtitle may be cited as the ‘‘Opioid Addiction 
Action Plan Act’’. 
SEC. 6032. ACTION PLAN ON RECOMMENDATIONS FOR 
CHANGES UNDER MEDICARE AND MEDICAID 
TO PREVENT OPIOIDS ADDICTIONS AND EN-
HANCE ACCESS TO MEDICATION-ASSISTED 
TREATMENT. 
(a) IN GENERAL.—Not later than January 1, 2019, 
the Secretary of Health and Human Services (in this sec-
tion referred to as the ‘‘Secretary’’), in collaboration with
142 
the Pain Management Best Practices Inter-Agency Task 
Force convened under section 101(b) of the Comprehen-
sive Addiction and Recovery Act of 2016 (Public Law 
114–198), shall develop an action plan that provides rec-
ommendations described in subsection (b). 
(b) ACTION PLAN COMPONENTS.—Recommendations 
described in this subsection are, based on an examination 
by the Secretary of potential obstacles to an effective re-
sponse to the opioid crisis, recommendations, as deter-
mined appropriate by the Secretary, on the following: 
(1) Recommendations on changes to the Medi-
care program under title XVIII of the Social Secu-
rity Act and the Medicaid program under title XIX 
of such Act that would enhance coverage and pay-
ment under such programs of all medication-assisted 
treatment approved by the Food and Drug Adminis-
tration for the treatment of opioid addiction and 
other therapies that manage chronic and acute pain 
and treat and minimize risk of opioid addiction, in-
cluding recommendations on changes to the Medi-
care prospective payment system for hospital inpa-
tient department services under section 1886(d) of 
such Act (42 U.S.C. 1395ww(d)) and the Medicare 
prospective payment system for hospital outpatient 
department services under section 1833(t) of such
143 
Act (42 U.S.C. 1395l(t)) that would allow for sepa-
rate payment for such therapies, if medically appro-
priate and if necessary to encourage development 
and adoption of such therapies. 
(2) Recommendations for payment and service 
delivery models to be tested by the Center for Medi-
care and Medicaid Innovation and other federally 
authorized demonstration projects, including value- 
based models, that may encourage the use of appro-
priate medication-assisted treatment approved by the 
Food and Drug Administration for the treatment of 
opioid addiction and other therapies that manage 
chronic and acute pain and treat and minimize risk 
of opioid addiction. 
(3) Recommendations for data collection that 
could facilitate research and policy making regarding 
prevention of opioid addiction and coverage and pay-
ment under the Medicare and Medicaid programs of 
appropriate opioid addiction treatments. 
(4) Recommendations for policies under the 
Medicare program and under the Medicaid program 
that can expand access for rural, or medically under-
served communities to the full range of medication- 
assisted treatment approved by the Food and Drug 
Administration for the treatment of opioid addiction
144 
and other therapies that manage chronic and acute 
pain and treatment and minimize risk of opioid ad-
diction. 
(5) Recommendations on changes to the Medi-
care program and the Medicaid program to address 
coverage or payment barriers to patient access to 
medical devices that are non-opioid based treatments 
approved by the Food and Drug Administration for 
the management of acute pain and chronic pain, for 
monitoring substance use withdrawal and preventing 
overdoses of controlled substances, and for treating 
substance use disorder. 
(c) STAKEHOLDER MEETINGS.— 
(1) IN GENERAL.—Beginning not later than 3 
months after the date of the enactment of this Act, 
the Secretary shall convene a public stakeholder 
meeting to solicit public comment on the components 
of the action plan recommendations described in 
subsection (b). 
(2) PARTICIPANTS.—Participants of meetings 
described in paragraph (1) shall include representa-
tives from the Food and Drug Administration and 
National Institutes of Health, biopharmaceutical in-
dustry members, medical researchers, health care 
providers, the medical device industry, the Medicare
145 
program, the Medicaid program, and patient advo-
cates. 
(d) REQUEST FOR INFORMATION.—Not later than 3 
months after the date of the enactment of this section, 
the Secretary shall issue a request for information seeking 
public feedback regarding ways in which the Centers for 
Medicare & Medicaid Services can help address the opioid 
crisis through the development of and application of the 
action plan. 
(e) REPORT TO CONGRESS.—Not later than June 1, 
2019, the Secretary shall submit to Congress, and make 
public, a report that includes— 
(1) a summary of recommendations that have 
emerged under the action plan; 
(2) the Secretary’s planned next steps with re-
spect to the action plan; and 
(3) an evaluation of price trends for drugs used 
to reverse opioid overdoses (such as naloxone), in-
cluding recommendations on ways to lower such 
prices for consumers. 
(f) DEFINITION OF MEDICATION-ASSISTED TREAT-
MENT.—In this section, the term ‘‘medication-assisted 
treatment’’ includes opioid treatment programs, behav-
ioral therapy, and medications to treat substance abuse 
disorder.
146 
Subtitle E—Advancing High Qual-
ity Treatment for Opioid Use 
Disorders in Medicare 
SEC. 6041. SHORT TITLE. 
This subtitle may be cited as the ‘‘Advancing High 
Quality Treatment for Opioid Use Disorders in Medicare 
Act’’. 
SEC. 6042. OPIOID USE DISORDER TREATMENT DEM-
ONSTRATION PROGRAM. 
Title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) is amended by inserting after section 1866E 
(42 U.S.C. 1395cc–5) the following new section: 
‘‘SEC. 1866F. OPIOID USE DISORDER TREATMENT DEM-
ONSTRATION PROGRAM. 
‘‘(a) IMPLEMENTATION OF 4-YEAR DEMONSTRATION 
PROGRAM.— 
‘‘(1) IN GENERAL.—Not later than January 1, 
2021, the Secretary shall implement a 4-year dem-
onstration program under this title (in this section 
referred to as the ‘Program’) to increase access of 
applicable beneficiaries to opioid use disorder treat-
ment services, improve physical and mental health 
outcomes for such beneficiaries, and to the extent 
possible, reduce expenditures under this title. Under 
the Program, the Secretary shall make payments
147 
under subsection (e) to participants (as defined in 
subsection (c)(1)(A)) for furnishing opioid use dis-
order treatment services delivered through opioid use 
disorder care teams, or arranging for such services 
to be furnished, to applicable beneficiaries partici-
pating in the Program. 
‘‘(2) OPIOID USE DISORDER TREATMENT SERV-
ICES.—For purposes of this section, the term ‘opioid 
use disorder treatment services’— 
‘‘(A) means, with respect to an applicable 
beneficiary, services that are furnished for the 
treatment of opioid use disorders and that uti-
lize drugs approved under section 505 of the 
Federal Food, Drug, and Cosmetic Act for the 
treatment of opioid use disorders in an out-
patient setting; and 
‘‘(B) includes— 
‘‘(i) medication assisted treatment; 
‘‘(ii) treatment planning; 
‘‘(iii) psychiatric, psychological, or 
counseling services (or any combination of 
such services), as appropriate; 
‘‘(iv) social support services, as appro-
priate; and
148 
‘‘(v) care management and care co-
ordination services, including coordination 
with other providers of services and sup-
pliers not on an opioid use disorder care 
team. 
‘‘(b) PROGRAM DESIGN.— 
‘‘(1) IN GENERAL.—The Secretary shall design 
the Program in such a manner to allow for the eval-
uation of the extent to which the Program accom-
plishes the following purposes: 
‘‘(A) Reduces hospitalizations and emer-
gency department visits. 
‘‘(B) Increases use of medication-assisted 
treatment for opioid use disorders. 
‘‘(C) Improves health outcomes of individ-
uals with opioid use disorders, including by re-
ducing the incidence of infectious diseases (such 
as hepatitis C and HIV). 
‘‘(D) Does not increase the total spending 
on items and services under this title. 
‘‘(E) Reduces deaths from opioid overdose. 
‘‘(F) Reduces the utilization of inpatient 
residential treatment. 
‘‘(2) CONSULTATION.—In designing the Pro-
gram, including the criteria under subsection
149 
(e)(2)(A), the Secretary shall, not later than 3 
months after the date of the enactment of this sec-
tion, consult with specialists in the field of addiction, 
clinicians in the primary care community, and bene-
ficiary groups. 
‘‘(c) PARTICIPANTS; OPIOID USE DISORDER CARE 
TEAMS.— 
‘‘(1) PARTICIPANTS.— 
‘‘(A) DEFINITION.—In this section, the 
term ‘participant’ means an entity or indi-
vidual— 
‘‘(i) that is otherwise enrolled under 
this title and that is— 
‘‘(I) a physician (as defined in 
section 1861(r)(1)); 
‘‘(II) a group practice comprised 
of at least one physician described in 
subclause (I); 
‘‘(III) a hospital outpatient de-
partment; 
‘‘(IV) a federally qualified health 
center 
(as 
defined 
in 
section 
1861(aa)(4)); 
‘‘(V) a rural health clinic (as de-
fined in section 1861(aa)(2));
150 
‘‘(VI) a community mental health 
center 
(as 
defined 
in 
section 
1861(ff)(3)(B)); 
‘‘(VII) a clinic certified as a cer-
tified community behavioral health 
clinic pursuant to section 223 of the 
Protecting Access to Medicare Act of 
2014; or 
‘‘(VIII) any other individual or 
entity specified by the Secretary; 
‘‘(ii) that applied for and was selected 
to participate in the Program pursuant to 
an application and selection process estab-
lished by the Secretary; and 
‘‘(iii) that establishes an opioid use 
disorder care team (as defined in para-
graph (2)) through employing or con-
tracting with health care practitioners de-
scribed in paragraph (2)(A), and uses such 
team to furnish or arrange for opioid use 
disorder treatment services in the out-
patient setting under the Program. 
‘‘(B) PREFERENCE.—In selecting partici-
pants for the Program, the Secretary shall give 
preference to individuals and entities that are
151 
located in areas with a prevalence of opioid use 
disorders that is higher than the national aver-
age prevalence. 
‘‘(2) OPIOID USE DISORDER CARE TEAMS.— 
‘‘(A) IN GENERAL.—For purposes of this 
section, the term ‘opioid use disorder care team’ 
means a team of health care practitioners es-
tablished by a participant described in para-
graph (1)(A) that— 
‘‘(i) shall include— 
‘‘(I) at least one physician (as 
defined in section 1861(r)(1)) fur-
nishing primary care services or ad-
diction treatment services to an appli-
cable beneficiary; and 
‘‘(II) at least one eligible practi-
tioner 
(as 
defined 
in 
paragraph 
(3)(A)), who may be a physician who 
meets the criterion in subclause (I); 
and 
‘‘(ii) may include other practitioners 
licensed under State law to furnish psy-
chiatric, psychological, counseling, and so-
cial services to applicable beneficiaries.
152 
‘‘(B) REQUIREMENTS
FOR
RECEIPT
OF 
PAYMENT UNDER PROGRAM.—In order to re-
ceive payments under subsection (e), each par-
ticipant in the Program shall— 
‘‘(i) furnish opioid use disorder treat-
ment services through opioid use disorder 
care teams to applicable beneficiaries who 
agree to receive the services; 
‘‘(ii) meet minimum criteria, as estab-
lished by the Secretary; and 
‘‘(iii) submit to the Secretary, in such 
form, manner, and frequency as specified 
by the Secretary, with respect to each ap-
plicable beneficiary for whom opioid use 
disorder treatment services are furnished 
by the opioid use disorder care team, data 
and such other information as the Sec-
retary determines appropriate to— 
‘‘(I) monitor and evaluate the 
Program; 
‘‘(II) determine if minimum cri-
teria are met under clause (ii); and 
‘‘(III) determine the incentive 
payment under subsection (e).
153 
‘‘(3) ELIGIBLE
PRACTITIONERS; OTHER
PRO-
VIDER-RELATED
DEFINITIONS
AND
APPLICATION 
PROVISIONS.— 
‘‘(A) ELIGIBLE PRACTITIONERS.—For pur-
poses of this section, the term ‘eligible practi-
tioner’ means a physician or other health care 
practitioner, such as a nurse practitioner, 
that— 
‘‘(i) 
is 
enrolled 
under 
section 
1866(j)(1); 
‘‘(ii) is authorized to prescribe or dis-
pense narcotic drugs to individuals for 
maintenance treatment or detoxification 
treatment; and 
‘‘(iii) has in effect a waiver in accord-
ance with section 303(g) of the Controlled 
Substances Act for such purpose and is 
otherwise in compliance with regulations 
promulgated by the Substance Abuse and 
Mental Health Services Administration to 
carry out such section. 
‘‘(B) ADDICTION SPECIALISTS.—For pur-
poses of subsection (e)(1)(B)(iv), the term ‘ad-
diction specialist’ means a physician that pos-
sesses expert knowledge and skills in addiction
154 
medicine, as evidenced by appropriate certifi-
cation from a specialty body, a certificate of ad-
vanced qualification in addiction medicine, or 
completion of an accredited residency or fellow-
ship in addiction medicine or addiction psychi-
atry, as determined by the Secretary. 
‘‘(d) 
PARTICIPATION
OF
APPLICABLE
BENE-
FICIARIES.— 
‘‘(1) APPLICABLE BENEFICIARY DEFINED.—In 
this section, the term ‘applicable beneficiary’ means 
an individual who— 
‘‘(A) is entitled to, or enrolled for, benefits 
under part A and enrolled for benefits under 
part B; 
‘‘(B) is not enrolled in a Medicare Advan-
tage plan under part C; 
‘‘(C) has a current diagnosis for an opioid 
use disorder; and 
‘‘(D) meets such other criteria as the Sec-
retary determines appropriate. 
Such term shall include an individual who is dually 
eligible for benefits under this title and title XIX if 
such individual satisfies the criteria described in 
subparagraphs (A) through (D).
155 
‘‘(2) VOLUNTARY BENEFICIARY PARTICIPATION; 
LIMITATION
ON
NUMBER
OF
BENEFICIARIES.—An 
applicable beneficiary may participate in the Pro-
gram on a voluntary basis and may terminate par-
ticipation in the Program at any time. Not more 
than 20,000 applicable beneficiaries may participate 
in the Program at any time. 
‘‘(3) SERVICES.—In order to participate in the 
Program, an applicable beneficiary shall agree to re-
ceive opioid use disorder treatment services from a 
participant. Participation under the Program shall 
not affect coverage of or payment for any other item 
or service under this title for the applicable bene-
ficiary. 
‘‘(4) BENEFICIARY
ACCESS
TO
SERVICES.— 
Nothing in this section shall be construed as encour-
aging providers to limit applicable beneficiary access 
to services covered under this title and applicable 
beneficiaries shall not be required to relinquish ac-
cess to any benefit under this title as a condition of 
receiving services from a participant in the Program. 
‘‘(e) PAYMENTS.— 
‘‘(1) 
PER
APPLICABLE
BENEFICIARY
PER 
MONTH CARE MANAGEMENT FEE.—
156 
‘‘(A) IN
GENERAL.—The Secretary shall 
establish a schedule of per applicable bene-
ficiary per month care management fees. Such 
a per applicable beneficiary per month care 
management fee shall be paid to a participant 
in addition to any other amount otherwise pay-
able under this title to the health care practi-
tioners in the participant’s opioid use disorder 
care team or, if applicable, to the participant. 
A participant may use such per applicable bene-
ficiary per month care management fee to de-
liver additional services to applicable bene-
ficiaries, including services not otherwise eligi-
ble for payment under this title. 
‘‘(B) PAYMENT
AMOUNTS.—In carrying 
out subparagraph (A), the Secretary shall— 
‘‘(i) consider payments otherwise pay-
able under this title for opioid use disorder 
treatment services and the needs of appli-
cable beneficiaries; 
‘‘(ii) pay a higher per applicable bene-
ficiary per month care management fee for 
an applicable beneficiary who receives more 
intensive treatment services from a partici-
pant and for whom those services are ap-
157 
propriate based on clinical guidelines for 
opioid use disorder care; 
‘‘(iii) pay a higher per applicable ben-
eficiary per month care management fee 
for the month in which the applicable ben-
eficiary begins treatment with a partici-
pant than in subsequent months, to reflect 
the greater time and costs required for the 
planning and initiation of treatment, as 
compared to maintenance of treatment; 
‘‘(iv) pay higher per applicable bene-
ficiary per month care management fees 
for participants that have established 
opioid use disorder care teams that include 
an addiction specialist (as defined in sub-
section (c)(3)(B)); and 
‘‘(v) take into account whether a par-
ticipant’s opioid use disorder care team re-
fers applicable beneficiaries to other sup-
pliers or providers for any opioid use dis-
order treatment services. 
‘‘(C) NO DUPLICATE PAYMENT.—The Sec-
retary shall make payments under this para-
graph to only one participant for services fur-
158 
nished to an applicable beneficiary during a cal-
endar month. 
‘‘(2) INCENTIVE PAYMENTS.— 
‘‘(A) IN GENERAL.—Under the Program, 
the Secretary shall establish a performance- 
based incentive payment, which shall be paid 
(using a methodology established and at a time 
determined appropriate by the Secretary) to 
participants based on the performance of par-
ticipants with respect to criteria, as determined 
appropriate by the Secretary, in accordance 
with subparagraph (B). 
‘‘(B) CRITERIA.— 
‘‘(i) IN GENERAL.—Criteria described 
in subparagraph (A) may include consider-
ation of the following: 
‘‘(I) Patient engagement and re-
tention in treatment. 
‘‘(II) Evidence-based medication- 
assisted treatment. 
‘‘(III) Other criteria established 
by the Secretary. 
‘‘(ii) REQUIRED CONSULTATION AND 
CONSIDERATION.—In determining criteria
159 
described in subparagraph (A), the Sec-
retary shall— 
‘‘(I) consult with stakeholders, 
including clinicians in the primary 
care community and in the field of ad-
diction medicine; and 
‘‘(II) consider existing clinical 
guidelines for the treatment of opioid 
use disorders. 
‘‘(C) NO DUPLICATE PAYMENT.—The Sec-
retary shall ensure that no duplicate payments 
under this paragraph are made with respect to 
an applicable beneficiary. 
‘‘(f) MULTIPAYER STRATEGY.—In carrying out the 
Program, the Secretary shall encourage other payers to 
provide similar payments and to use similar criteria as ap-
plied under the Program under subsection (e)(2)(C). The 
Secretary may enter into a memorandum of understanding 
with other payers to align the methodology for payment 
provided by such a payer related to opioid use disorder 
treatment services with such methodology for payment 
under the Program. 
‘‘(g) EVALUATION.— 
‘‘(1) IN GENERAL.—The Secretary shall con-
duct an intermediate and final evaluation of the pro-
160 
gram. Each such evaluation shall determine the ex-
tent to which each of the purposes described in sub-
section (b) have been accomplished under the Pro-
gram. 
‘‘(2) REPORTS.—The Secretary shall submit to 
the Secretary and Congress— 
‘‘(A) a report with respect to the inter-
mediate evaluation under paragraph (1) not 
later than 3 years after the date of the imple-
mentation of the Program; and 
‘‘(B) a report with respect to the final 
evaluation under paragraph (1) not later than 
6 years after such date. 
‘‘(h) FUNDING.— 
‘‘(1) ADMINISTRATIVE FUNDING.—For the pur-
poses of implementing, administering, and carrying 
out the Program (other than for purposes described 
in paragraph (2)), $5,000,000 shall be available 
from the Federal Supplementary Medical Insurance 
Trust Fund under section 1841. 
‘‘(2) CARE
MANAGEMENT
FEES
AND
INCEN-
TIVES.—For the purposes of making payments 
under subsection (e), $10,000,000 shall be available 
from the Federal Supplementary Medical Insurance
161 
Trust Fund under section 1841 for each of fiscal 
years 2021 through 2024. 
‘‘(3) 
AVAILABILITY.—Amounts 
transferred 
under this subsection for a fiscal year shall be avail-
able until expended. 
‘‘(i) WAIVERS.—The Secretary may waive any provi-
sion of this title as may be necessary to carry out the Pro-
gram under this section.’’. 
Subtitle F—Responsible Education 
Achieves Care and Healthy Out-
comes for Users’ Treatment 
SEC. 6051. SHORT TITLE. 
This subtitle may be cited as the ‘‘Responsible Edu-
cation Achieves Care and Healthy Outcomes for Users’ 
Treatment Act of 2018’’ or the ‘‘REACH OUT Act of 
2018’’. 
SEC. 6052. GRANTS TO PROVIDE TECHNICAL ASSISTANCE 
TO OUTLIER PRESCRIBERS OF OPIOIDS. 
(a) GRANTS AUTHORIZED.—The Secretary of Health 
and Human Services (in this section referred to as the 
‘‘Secretary’’) shall, through the Centers for Medicare & 
Medicaid Services, award grants, contracts, or cooperative 
agreements to eligible entities for the purposes described 
in subsection (b).
162 
(b) USE OF FUNDS.—Grants, contracts, and coopera-
tive agreements awarded under subsection (a) shall be 
used to support eligible entities through technical assist-
ance— 
(1) to educate and provide outreach to outlier 
prescribers of opioids about best practices for pre-
scribing opioids; 
(2) to educate and provide outreach to outlier 
prescribers of opioids about non-opioid pain manage-
ment therapies; and 
(3) to reduce the amount of opioid prescriptions 
prescribed by outlier prescribers of opioids. 
(c) APPLICATION.—Each eligible entity seeking to re-
ceive a grant, contract, or cooperative agreement under 
subsection (a) shall submit to the Secretary an applica-
tion, at such time, in such manner, and containing such 
information as the Secretary may require. 
(d) 
GEOGRAPHIC
DISTRIBUTION.—In 
awarding 
grants, contracts, and cooperative agreements under this 
section, the Secretary shall prioritize establishing technical 
assistance resources in each State. 
(e) DEFINITIONS.—In this section: 
(1) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ means— 
(A) an organization—
163 
(i) that has demonstrated experience 
providing technical assistance to health 
care professionals on a State or regional 
basis; and 
(ii) that has at least— 
(I) one individual who is a rep-
resentative of consumers on its gov-
erning body; and 
(II) one individual who is a rep-
resentative of health care providers on 
its governing body; or 
(B) an entity that is a quality improve-
ment entity with a contract under part B of 
title XI of the Social Security Act (42 U.S.C. 
1320c et seq.). 
(2) OUTLIER
PRESCRIBER
OF
OPIOIDS.—The 
term ‘‘outlier prescriber of opioids’’ means a pre-
scriber, identified by the Secretary of Health and 
Human Services (through use of prescriber informa-
tion provided by prescriber National Provider Identi-
fiers included pursuant to section 1860D–4(c)(4)(A) 
of the Social Security Act (42 U.S.C. 1395w– 
104(c)(4)(A)) on claims for covered part D drugs for 
part D eligible individuals enrolled in prescription 
drug plans under part D of title XVIII of such Act
164 
(42 U.S.C. 1395w–101 et seq.) and MA–PD plans 
under part C of such title (42 U.S.C. 1395w–21 et 
seq.)) as prescribing, as compared to other pre-
scribers in the specialty of the prescriber and geo-
graphic area, amounts of opioids in excess of a 
threshold (and other criteria) specified by the Sec-
retary, after consultation with stakeholders. 
(3) PRESCRIBERS.—The term ‘‘prescriber’’ 
means any health care professional, including a 
nurse practitioner or physician assistant, who is li-
censed to prescribe opioids by the State or territory 
in which such professional practices. 
(f) FUNDING.—For purposes of implementing this 
section, $75,000,000 shall be available from the Federal 
Supplementary Medical Insurance Trust Fund under sec-
tion 1841 of the Social Security Act (42 U.S.C. 1395t), 
to remain available until expended. 
Subtitle G—Preventing Addiction 
for Susceptible Seniors 
SEC. 6061. SHORT TITLE. 
This subtitle may be cited as the ‘‘Preventing Addic-
tion for Susceptible Seniors Act of 2018’’ or the ‘‘PASS 
Act of 2018’’.
165 
SEC. 6062. ELECTRONIC PRIOR AUTHORIZATION FOR COV-
ERED PART D DRUGS. 
(a) INCLUSION IN ELECTRONIC PRESCRIPTION PRO-
GRAM.—Section 1860D–4(e)(2) of the Social Security Act 
(42 U.S.C. 1395w–104(e)(2)) is amended by adding at the 
end the following new subparagraph: 
‘‘(E) 
ELECTRONIC
PRIOR
AUTHORIZA-
TION.— 
‘‘(i) IN
GENERAL.—Not later than 
January 1, 2021, the program shall pro-
vide for the secure electronic transmission 
of— 
‘‘(I) a prior authorization request 
from the prescribing health care pro-
fessional for coverage of a covered 
part D drug for a part D eligible indi-
vidual enrolled in a part D plan (as 
defined in section 1860D–23(a)(5)) to 
the PDP sponsor or Medicare Advan-
tage organization offering such plan; 
and 
‘‘(II) a response, in accordance 
with this subparagraph, from such 
PDP sponsor or Medicare Advantage 
organization, respectively, to such pro-
fessional.
166 
‘‘(ii) ELECTRONIC TRANSMISSION.— 
‘‘(I) EXCLUSIONS.—For purposes 
of this subparagraph, a facsimile, a 
proprietary payer portal that does not 
meet standards specified by the Sec-
retary, or an electronic form shall not 
be treated as an electronic trans-
mission described in clause (i). 
‘‘(II) STANDARDS.—In order to 
be treated, for purposes of this sub-
paragraph, as an electronic trans-
mission described in clause (i), such 
transmission shall comply with tech-
nical standards adopted by the Sec-
retary in consultation with the Na-
tional Council for Prescription Drug 
Programs, other standard setting or-
ganizations determined appropriate by 
the Secretary, and stakeholders in-
cluding PDP sponsors, Medicare Ad-
vantage organizations, health care 
professionals, and health information 
technology software vendors. 
‘‘(III) 
APPLICATION.—Notwith-
standing any other provision of law,
167 
for purposes of this subparagraph, the 
Secretary may require the use of such 
standards adopted under subclause 
(II) in lieu of any other applicable 
standards for an electronic trans-
mission described in clause (i) for a 
covered part D drug for a part D eli-
gible individual.’’. 
(b) SENSE OF CONGRESS REGARDING ELECTRONIC 
PRIOR AUTHORIZATION.—It is the sense of the Congress 
that— 
(1) there should be increased use of electronic 
prior authorizations for coverage of covered part D 
drugs for part D eligible individuals enrolled in pre-
scription drug plans under part D of title XVIII of 
the Social Security Act and MA–PD plans under 
part C of such title to reduce access delays by re-
solving coverage issues before prescriptions for such 
drugs are transmitted; and 
(2) greater priority should be placed on increas-
ing the adoption of use of such electronic prior au-
thorizations among prescribers of such drugs, phar-
macies, PDP sponsors, and Medicare Advantage or-
ganizations.
168 
SEC. 6063. PROGRAM INTEGRITY TRANSPARENCY MEAS-
URES UNDER MEDICARE PARTS C AND D. 
(a) IN GENERAL.—Section 1859 of the Social Secu-
rity Act (42 U.S.C. 1395w–28) is amended by adding at 
the end the following new subsection: 
‘‘(i) PROGRAM INTEGRITY TRANSPARENCY MEAS-
URES.— 
‘‘(1) PROGRAM INTEGRITY PORTAL.— 
‘‘(A) IN GENERAL.—Not later than 2 years 
after the date of the enactment of this sub-
section, the Secretary shall, after consultation 
with stakeholders, establish a secure Internet 
website portal (or other successor technology) 
that would allow a secure path for communica-
tion between the Secretary, MA plans under 
this part, prescription drug plans under part D, 
and an eligible entity with a contract under sec-
tion 1893 (such as a Medicare drug integrity 
contractor or an entity responsible for carrying 
out program integrity activities under this part 
and part D) for the purpose of enabling 
through such portal (or other successor tech-
nology)— 
‘‘(i) the referral by such plans of sub-
stantiated fraud, waste, and abuse for ini-
169 
tiating or assisting investigations con-
ducted by the eligible entity; and 
‘‘(ii) data sharing among such MA 
plans, prescription drug plans, and the 
Secretary. 
‘‘(B) REQUIRED USES OF PORTAL.—The 
Secretary shall disseminate the following infor-
mation to MA plans under this part and pre-
scription drug plans under part D through the 
secure Internet website portal (or other suc-
cessor technology) established under subpara-
graph (A): 
‘‘(i) Providers of services and sup-
pliers that have been referred pursuant to 
subparagraph (A)(i) during the previous 
12-month period. 
‘‘(ii) Providers of services and sup-
pliers who are the subject of an active ex-
clusion under section 1128 or who are sub-
ject to a suspension of payment under this 
title pursuant to section 1862(o) or other-
wise. 
‘‘(iii) Providers of services and sup-
pliers who are the subject of an active rev-
ocation of participation under this title, in-
170 
cluding for not satisfying conditions of par-
ticipation. 
‘‘(iv) In the case of such a plan that 
makes a referral under subparagraph 
(A)(i) through the portal (or other suc-
cessor technology) with respect to activities 
of substantiated fraud, waste, or abuse of 
a provider of services or supplier, if such 
provider or supplier has been the subject of 
an administrative action under this title or 
title XI with respect to similar activities, a 
notification to such plan of such action so 
taken. 
‘‘(C) RULEMAKING.—For purposes of this 
paragraph, the Secretary shall, through rule-
making, specify what constitutes substantiated 
fraud, waste, and abuse, using guidance such as 
what is provided in the Medicare Program In-
tegrity Manual 4.7.1. In carrying out this sub-
section, a fraud hotline tip (as defined by the 
Secretary) without further evidence shall not be 
treated as sufficient evidence for substantiated 
fraud, waste, or abuse. 
‘‘(D) HIPAA COMPLIANT
INFORMATION 
ONLY.—For purposes of this subsection, com-
171 
munications may only occur if the communica-
tions are permitted under the Federal regula-
tions (concerning the privacy of individually 
identifiable health information) promulgated 
under section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996. 
‘‘(2) QUARTERLY REPORTS.—Beginning 2 years 
after the date of enactment of this subsection, the 
Secretary shall make available to MA plans under 
this part and prescription drug plans under part D 
in a timely manner (but no less frequently than 
quarterly) and using information submitted to an 
entity described in paragraph (1) through the portal 
(or other successor technology) described in such 
paragraph or pursuant to section 1893, information 
on fraud, waste, and abuse schemes and trends in 
identifying suspicious activity. Information included 
in each such report shall— 
‘‘(A) include administrative actions, perti-
nent information related to opioid overpre-
scribing, and other data determined appropriate 
by the Secretary in consultation with stake-
holders; and
172 
‘‘(B) be anonymized information submitted 
by plans without identifying the source of such 
information. 
‘‘(3) CLARIFICATION.—Nothing in this sub-
section shall be construed as precluding or otherwise 
affecting referrals described in subparagraph (A) 
that may otherwise be made to law enforcement en-
tities or to the Secretary.’’. 
(b) CONTRACT REQUIREMENT
TO COMMUNICATE 
PLAN CORRECTIVE ACTIONS AGAINST OPIOID OVER-PRE-
SCRIBERS.—Section 1857(e) of the Social Security Act 
(42 U.S.C. 1395w–27(e)) is amended by adding at the end 
the following new paragraph: 
‘‘(5) COMMUNICATING
PLAN
CORRECTIVE
AC-
TIONS AGAINST OPIOIDS OVER-PRESCRIBERS.— 
‘‘(A) IN GENERAL.—Beginning with plan 
years beginning on or after January 1, 2021, a 
contract under this section with an MA organi-
zation shall require the organization to submit 
to the Secretary, through the process estab-
lished under subparagraph (B), information on 
the investigations and other actions taken by 
such plans related to providers of services who 
prescribe a high volume of opioids.
173 
‘‘(B) PROCESS.—Not later than January 
1, 2021, the Secretary shall, in consultation 
with stakeholders, establish a process under 
which MA plans and prescription drug plans 
shall submit to the Secretary information de-
scribed in subparagraph (A). 
‘‘(C) REGULATIONS.—For purposes of this 
paragraph, including as applied under section 
1860D–12(b)(3)(D), the Secretary shall, pursu-
ant to rulemaking— 
‘‘(i) specify a definition for the term 
‘high volume of opioids’ and a method for 
determining if a provider of services pre-
scribes such a high volume; and 
‘‘(ii) establish the process described in 
subparagraph (B) and the types of infor-
mation that shall be submitted through 
such process.’’. 
(c) REFERENCE UNDER PART D TO PROGRAM IN-
TEGRITY TRANSPARENCY MEASURES.—Section 1860D–4 
of the Social Security Act (42 U.S.C. 1395w–104) is 
amended by adding at the end the following new sub-
section: 
‘‘(m) PROGRAM INTEGRITY TRANSPARENCY MEAS-
URES.—For program integrity transparency measures ap-
174 
plied with respect to prescription drug plan and MA plans, 
see section 1859(i).’’. 
SEC. 6064. EXPANDING ELIGIBILITY FOR MEDICATION 
THERAPY MANAGEMENT PROGRAMS UNDER 
PART D. 
Section 1860D–4(c)(2)(A)(ii) of the Social Security 
Act (42 U.S.C. 1395w–104(c)(2)(A)(ii)) is amended— 
(1) by redesignating subclauses (I) through 
(III) as items (aa) through (cc), respectively, and 
adjusting the margins accordingly; 
(2) by striking ‘‘are part D eligible individuals 
who—’’ and inserting ‘‘are the following: 
‘‘(I) Part D eligible individuals 
who—’’; and 
(3) by adding at the end the following new sub-
clause: 
‘‘(II) 
Beginning 
January 
1, 
2021, at-risk beneficiaries for pre-
scription drug abuse (as defined in 
paragraph (5)(C)).’’. 
SEC. 6065. MEDICARE NOTIFICATIONS TO OUTLIER PRE-
SCRIBERS OF OPIOIDS. 
Section 1860D–4(c)(4) of the Social Security Act (42 
U.S.C. 1395w–104(c)(4)) is amended by adding at the end 
the following new subparagraph:
175 
‘‘(D) OUTLIER
PRESCRIBER
NOTIFICA-
TION.— 
‘‘(i) NOTIFICATION.—Beginning not 
later than 2 years after the date of the en-
actment of this subparagraph, the Sec-
retary shall, in the case of a prescriber 
identified by the Secretary under clause 
(ii) to be an outlier prescriber of opioids, 
provide, subject to clause (iv), an annual 
notification to such prescriber that such 
prescriber has been so identified and that 
includes resources on proper prescribing 
methods and other information specified in 
accordance with clause (iii). 
‘‘(ii) IDENTIFICATION
OF
OUTLIER 
PRESCRIBERS OF OPIOIDS.— 
‘‘(I) IN
GENERAL.—The Sec-
retary shall, subject to subclause (III), 
using the valid prescriber National 
Provider Identifiers included pursuant 
to subparagraph (A) on claims for 
covered part D drugs for part D eligi-
ble individuals enrolled in prescription 
drug plans under this part or MA–PD 
plans under part C and based on the
176 
threshold established under subclause 
(II), conduct an analysis to identify 
prescribers that are outlier opioid pre-
scribers for a period specified by the 
Secretary. 
‘‘(II) 
ESTABLISHMENT
OF 
THRESHOLD.—For purposes of sub-
clause (I) and subject to subclause 
(III), the Secretary shall, after con-
sultation with stakeholders, establish 
a threshold, based on prescriber spe-
cialty and geographic area, for identi-
fying whether a prescriber in a spe-
cialty and geographic area is an 
outlier prescriber of opioids as com-
pared to other prescribers of opioids 
within such specialty and area. 
‘‘(III) EXCLUSIONS.—The Sec-
retary may exclude the following indi-
viduals and prescribers from the anal-
ysis under this clause: 
‘‘(aa) Individuals receiving 
hospice services. 
‘‘(bb) Individuals with a 
cancer diagnosis.
177 
‘‘(cc) Prescribers who are 
the subject of an investigation by 
the Centers for Medicare & Med-
icaid Services or the Office of In-
spector General of the Depart-
ment of Health and Human 
Services. 
‘‘(iii) CONTENTS OF NOTIFICATION.— 
The Secretary shall, based on input from 
stakeholders, specify the resources and 
other information to be included in notifi-
cations provided under clause (i). 
‘‘(iv) MODIFICATIONS
AND
EXPAN-
SIONS.— 
‘‘(I) FREQUENCY.—Beginning 5 
years after the date of the enactment 
of this subparagraph, the Secretary 
may change the frequency of the noti-
fications described in clause (i) based 
on stakeholder input. 
‘‘(II) 
EXPANSION
TO
OTHER 
PRESCRIPTIONS.—The Secretary may 
expand notifications under this sub-
paragraph to include identifications 
and notifications with respect to con-
178 
current prescriptions of covered Part 
D drugs used in combination with 
opioids that are considered to have 
adverse side effects when so used in 
such combination, as determined by 
the Secretary. 
‘‘(v) OPIOIDS
DEFINED.—For pur-
poses of this subparagraph, the term 
‘opioids’ has such meaning as specified by 
the Secretary through program instruction 
or otherwise.’’. 
SEC. 6066. NO ADDITIONAL FUNDS AUTHORIZED. 
No additional funds are authorized to be appro-
priated to carry out the requirements of this subtitle and 
the amendments made by this subtitle. Such requirements 
shall be carried out using amounts otherwise authorized 
to be appropriated. 
Subtitle H—Expanding Oversight 
of Opioid Prescribing and Payment 
SEC. 6071. SHORT TITLE. 
This subtitle may be cited as the ‘‘Expanding Over-
sight of Opioid Prescribing and Payment Act of 2018’’.
179 
SEC. 6072. MEDICARE PAYMENT ADVISORY COMMISSION 
REPORT ON OPIOID PAYMENT, ADVERSE IN-
CENTIVES, AND DATA UNDER THE MEDICARE 
PROGRAM. 
Not later than March 15, 2019, the Medicare Pay-
ment Advisory Commission shall submit to Congress a re-
port on, with respect to the Medicare program under title 
XVIII of the Social Security Act, the following: 
(1) A description of how the Medicare program 
pays for pain management treatments (both opioid 
and non-opioid pain management alternatives) in 
both inpatient and outpatient hospital settings. 
(2) The identification of incentives under the 
hospital inpatient prospective payment system under 
section 1886 of the Social Security Act (42 U.S.C. 
1395ww) and incentives under the hospital out-
patient prospective payment system under section 
1833(t) of such Act (42 U.S.C. 1395l(t)) for pre-
scribing opioids and incentives under each such sys-
tem for prescribing non-opioid treatments, and rec-
ommendations as the Commission deems appropriate 
for addressing any of such incentives that are ad-
verse incentives. 
(3) A description of how opioid use is tracked 
and monitored through Medicare claims data and 
other mechanisms and the identification of any areas
180 
in which further data and methods are needed for 
improving data and understanding of opioid use. 
SEC. 6073. NO ADDITIONAL FUNDS AUTHORIZED. 
No additional funds are authorized to be appro-
priated to carry out the requirements of this subtitle. Such 
requirements shall be carried out using amounts otherwise 
authorized to be appropriated. 
Subtitle I—Dr. Todd Graham Pain 
Management, 
Treatment, 
and 
Recovery 
SEC. 6081. SHORT TITLE. 
This subtitle may be cited as the ‘‘Dr. Todd Graham 
Pain Management, Treatment, and Recovery Act of 
2018’’. 
SEC. 6082. REVIEW AND ADJUSTMENT OF PAYMENTS 
UNDER THE MEDICARE OUTPATIENT PRO-
SPECTIVE PAYMENT SYSTEM TO AVOID FI-
NANCIAL INCENTIVES TO USE OPIOIDS IN-
STEAD OF NON-OPIOID ALTERNATIVE TREAT-
MENTS. 
(a) OUTPATIENT
PROSPECTIVE
PAYMENT
SYS-
TEM.—Section 1833(t) of the Social Security Act (42 
U.S.C. 1395l(t)) is amended by adding at the end the fol-
lowing new paragraph:
181 
‘‘(22) REVIEW AND REVISIONS OF PAYMENTS 
FOR NON-OPIOID ALTERNATIVE TREATMENTS.— 
‘‘(A) IN GENERAL.—With respect to pay-
ments made under this subsection for covered 
OPD services (or groups of services), including 
covered OPD services assigned to a comprehen-
sive ambulatory payment classification, the Sec-
retary— 
‘‘(i) shall, as soon as practicable, con-
duct a review (part of which may include 
a request for information) of payments for 
opioids and evidence-based non-opioid al-
ternatives for pain management (including 
drugs and devices, nerve blocks, surgical 
injections, and neuromodulation) with a 
goal of ensuring that there are not finan-
cial incentives to use opioids instead of 
non-opioid alternatives; 
‘‘(ii) may, as the Secretary determines 
appropriate, conduct subsequent reviews of 
such payments; and 
‘‘(iii) shall consider the extent to 
which revisions under this subsection to 
such payments (such as the creation of ad-
ditional groups of covered OPD services to
182 
classify separately those procedures that 
utilize opioids and non-opioid alternatives 
for pain management) would reduce pay-
ment incentives to use opioids instead of 
non-opioid alternatives for pain manage-
ment. 
‘‘(B) PRIORITY.—In conducting the review 
under clause (i) of subparagraph (A) and con-
sidering revisions under clause (iii) of such sub-
paragraph, the Secretary shall focus on covered 
OPD services (or groups of services) assigned 
to a comprehensive ambulatory payment classi-
fication, ambulatory payment classifications 
that primarily include surgical services, and 
other services determined by the Secretary 
which generally involve treatment for pain man-
agement. 
‘‘(C) REVISIONS.—If the Secretary identi-
fies revisions to payments pursuant to subpara-
graph (A)(iii), the Secretary shall, as deter-
mined appropriate, begin making such revisions 
for services furnished on or after January 1, 
2020. Revisions under the previous sentence 
shall be treated as adjustments for purposes of 
application of paragraph (9)(B).
183 
‘‘(D) RULES OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed to preclude 
the Secretary— 
‘‘(i) from conducting a demonstration 
before making the revisions described in 
subparagraph (C); or 
‘‘(ii) prior to implementation of this 
paragraph, from changing payments under 
this subsection for covered OPD services 
(or groups of services) which include 
opioids or non-opioid alternatives for pain 
management.’’. 
(b) AMBULATORY
SURGICAL
CENTERS.—Section 
1833(i) of the Social Security Act (42 U.S.C. 1395l(i)) 
is amended by adding at the end the following new para-
graph: 
‘‘(8) The Secretary shall conduct a similar type of 
review as required under paragraph (22) of section 
1833(t)), including the second sentence of subparagraph 
(C) of such paragraph, to payment for services under this 
subsection, and make such revisions under this paragraph, 
in an appropriate manner (as determined by the Sec-
retary).’’.
184 
SEC. 6083. EXPANDING ACCESS UNDER THE MEDICARE 
PROGRAM TO ADDICTION TREATMENT IN 
FEDERALLY QUALIFIED HEALTH CENTERS 
AND RURAL HEALTH CLINICS. 
(a) FEDERALLY QUALIFIED HEALTH CENTERS.— 
Section 1834(o) of the Social Security Act (42 U.S.C. 
1395m(o)) is amended by adding at the end the following 
new paragraph: 
‘‘(3) ADDITIONAL
PAYMENTS
FOR
CERTAIN 
FQHCS WITH PHYSICIANS OR OTHER PRACTITIONERS 
RECEIVING DATA 2000 WAIVERS.— 
‘‘(A) IN GENERAL.—In the case of a Fed-
erally qualified health center with respect to 
which, beginning on or after January 1, 2019, 
Federally-qualified health center services (as de-
fined in section 1861(aa)(3)) are furnished for 
the treatment of opioid use disorder by a physi-
cian or practitioner who meets the requirements 
described in subparagraph (C) the Secretary 
shall, subject to availability of funds under sub-
paragraph (D), make a payment (at such time 
and in such manner as specified by the Sec-
retary) to such Federally qualified health center 
after receiving and approving an application 
submitted by such Federally qualified health 
center under subparagraph (B). Such a pay-
185 
ment shall be in an amount determined by the 
Secretary, based on an estimate of the average 
costs of training for purposes of receiving a 
waiver described in subparagraph (C)(ii). Such 
a payment may be made only one time with re-
spect to each such physician or practitioner. 
‘‘(B) APPLICATION.—In order to receive a 
payment described in subparagraph (A), a Fed-
erally-qualified health center shall submit to the 
Secretary an application for such a payment at 
such time, in such manner, and containing such 
information as specified by the Secretary. A 
Federally-qualified health center may apply for 
such a payment for each physician or practi-
tioner described in subparagraph (A) furnishing 
services described in such subparagraph at such 
center. 
‘‘(C) REQUIREMENTS.—For purposes of 
subparagraph (A), the requirements described 
in this subparagraph, with respect to a physi-
cian or practitioner, are the following: 
‘‘(i) The physician or practitioner is 
employed by or working under contract 
with a Federally qualified health center de-
186 
scribed in subparagraph (A) that submits 
an application under subparagraph (B). 
‘‘(ii) The physician or practitioner 
first receives a waiver under section 303(g) 
of the Controlled Substances Acton or 
after January 1, 2019. 
‘‘(D) FUNDING.—For purposes of making 
payments under this paragraph, there are ap-
propriated, out of amounts in the Treasury not 
otherwise appropriated, $6,000,000, which shall 
remain available until expended.’’. 
(b) RURAL HEALTH CLINIC.—Section 1833 of the 
Social Security Act (42 U.S.C. 1395l) is amended— 
(1) by redesignating the subsection (z) relating 
to medical review of spinal subluxation services as 
subsection (aa); and 
(2) by adding at the end the following new sub-
section: 
‘‘(bb) ADDITIONAL PAYMENTS FOR CERTAIN RURAL 
HEALTH CLINICS WITH PHYSICIANS OR PRACTITIONERS 
RECEIVING DATA 2000 WAIVERS.— 
‘‘(1) IN
GENERAL.—In the case of a rural 
health clinic with respect to which, beginning on or 
after January 1, 2019, rural health clinic services 
(as defined in section 1861(aa)(1)) are furnished for
187 
the treatment of opioid use disorder by a physician 
or practitioner who meets the requirements de-
scribed in paragraph (3), the Secretary shall, subject 
to availability of funds under paragraph (4), make 
a payment (at such time and in such manner as 
specified by the Secretary) to such rural health clinic 
after receiving and approving an application de-
scribed in paragraph (2). Such payment shall be in 
an amount determined by the Secretary, based on an 
estimate of the average costs of training for pur-
poses of receiving a waiver described in paragraph 
(3)(B). Such payment may be made only one time 
with respect to each such physician or practitioner. 
‘‘(2) APPLICATION.—In order to receive a pay-
ment described in paragraph (1), a rural health clin-
ic shall submit to the Secretary an application for 
such a payment at such time, in such manner, and 
containing such information as specified by the Sec-
retary. A rural health clinic may apply for such a 
payment for each physician or practitioner described 
in paragraph (1) furnishing services described in 
such paragraph at such clinic. 
‘‘(3) REQUIREMENTS.—For purposes of para-
graph (1), the requirements described in this para-
188 
graph, with respect to a physician or practitioner, 
are the following: 
‘‘(A) The physician or practitioner is em-
ployed by or working under contract with a 
rural health clinic described in paragraph (1) 
that submits an application under paragraph 
(2). 
‘‘(B) The physician or practitioner first re-
ceives a waiver under section 303(g) of the 
Controlled Substances Acton or after January 
1, 2019. 
‘‘(4) FUNDING.—For purposes of making pay-
ments under this subsection, there are appropriated, 
out of amounts in the Treasury not otherwise appro-
priated, $2,000,000, which shall remain available 
until expended.’’. 
SEC. 6084. STUDYING THE AVAILABILITY OF SUPPLE-
MENTAL BENEFITS DESIGNED TO TREAT OR 
PREVENT 
SUBSTANCE 
USE 
DISORDERS 
UNDER MEDICARE ADVANTAGE PLANS. 
(a) IN GENERAL.—Not later than 2 years after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services (in this section referred to as the 
‘‘Secretary’’) shall submit to Congress a report on the 
availability of supplemental health care benefits (as de-
189 
scribed in section 1852(a)(3)(A) of the Social Security Act 
(42 U.S.C. 1395w–22(a)(3)(A))) designed to treat or pre-
vent substance use disorders under Medicare Advantage 
plans offered under part C of title XVIII of such Act. Such 
report shall include the analysis described in subsection 
(c) and any differences in the availability of such benefits 
under specialized MA plans for special needs individuals 
(as defined in section 1859(b)(6) of such Act (42 U.S.C. 
1395w–28(b)(6))) offered to individuals entitled to med-
ical assistance under title XIX of such Act and other such 
Medicare Advantage plans. 
(b) CONSULTATION.—The Secretary shall develop the 
report described in subsection (a) in consultation with rel-
evant stakeholders, including— 
(1) individuals entitled to benefits under part A 
or enrolled under part B of title XVIII of the Social 
Security Act; 
(2) entities who advocate on behalf of such indi-
viduals; 
(3) Medicare Advantage organizations; 
(4) pharmacy benefit managers; and 
(5) providers of services and suppliers (as such 
terms are defined in section 1861 of such Act (42 
U.S.C. 1395x)).
190 
(c) CONTENTS.—The report described in subsection 
(a) shall include an analysis on the following: 
(1) The extent to which plans described in such 
subsection offer supplemental health care benefits 
relating to coverage of— 
(A) medication-assisted treatments for 
opioid use, substance use disorder counseling, 
peer recovery support services, or other forms 
of substance use disorder treatments (whether 
furnished in an inpatient or outpatient setting); 
and 
(B) non-opioid alternatives for the treat-
ment of pain. 
(2) Challenges associated with such plans offer-
ing supplemental health care benefits relating to cov-
erage of items and services described in subpara-
graph (A) or (B) of paragraph (1). 
(3) The impact, if any, of increasing the appli-
cable rebate percentage determined under section 
1854(b)(1)(C) of the Social Security Act (42 U.S.C. 
1395w–24(b)(1)(C)) for plans offering such benefits 
relating to such coverage would have on the avail-
ability of such benefits relating to such coverage of-
fered under Medicare Advantage plans.
191 
(4) Potential ways to improve upon such cov-
erage or to incentivize such plans to offer additional 
supplemental health care benefits relating to such 
coverage. 
SEC. 6085. CLINICAL PSYCHOLOGIST SERVICES MODELS 
UNDER THE CENTER FOR MEDICARE AND 
MEDICAID INNOVATION; GAO STUDY AND RE-
PORT. 
(a) CMI MODELS.—Section 1115A(b)(2)(B) of the 
Social Security Act (42 U.S.C. 1315a(b)(2)(B) is amend-
ed by adding at the end the following new clauses: 
‘‘(xxv) Supporting ways to familiarize 
individuals with the availability of coverage 
under part B of title XVIII for qualified 
psychologist services (as defined in section 
1861(ii)). 
‘‘(xxvi) Exploring ways to avoid un-
necessary hospitalizations or emergency de-
partment visits for mental and behavioral 
health services (such as for treating de-
pression) through use of a 24-hour, 7-day 
a week help line that may inform individ-
uals about the availability of treatment op-
tions, including the availability of qualified
192 
psychologist services (as defined in section 
1861(ii)).’’. 
(b) GAO STUDY AND REPORT.—Not later than 18 
months after the date of the enactment of this Act, the 
Comptroller General of the United States shall conduct 
a study, and submit to Congress a report, on mental and 
behavioral health services under the Medicare program 
under title XVIII of the Social Security Act, including an 
examination of the following: 
(1) Information about services furnished by 
psychiatrists, clinical psychologists, and other profes-
sionals. 
(2) Information about ways that Medicare bene-
ficiaries familiarize themselves about the availability 
of Medicare payment for qualified psychologist serv-
ices (as defined in section 1861(ii) of the Social Se-
curity Act (42 U.S.C. 1395x(ii)) and ways that the 
provision of such information could be improved. 
SEC. 6086. PAIN MANAGEMENT STUDY. 
(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of this Act, the Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall conduct a study analyzing best practices as 
well as payment and coverage for pain management serv-
ices under title XVIII of the Social Security Act and sub-
193 
mit to the Committee on Ways and Means and the Com-
mittee on Energy and Commerce of the House of Rep-
resentatives and the Committee on Finance of the Senate 
a report containing options for revising payment to pro-
viders and suppliers of services and coverage related to 
the use of multi-disciplinary, evidence-based, non-opioid 
treatments for acute and chronic pain management for in-
dividuals entitled to benefits under part A or enrolled 
under part B of title XVIII of the Social Security Act. 
The Secretary shall make such report available on the 
public website of the Centers for Medicare & Medicaid 
Services. 
(b) CONSULTATION.—In developing the report de-
scribed in subsection (a), the Secretary shall consult 
with— 
(1) relevant agencies within the Department of 
Health and Human Services; 
(2) licensed and practicing osteopathic and 
allopathic physicians, behavioral health practitioners, 
physician assistants, nurse practitioners, dentists, 
pharmacists, and other providers of health services; 
(3) providers and suppliers of services (as such 
terms are defined in section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x));
194 
(4) substance abuse and mental health profes-
sional organizations; 
(5) pain management professional organizations 
and advocacy entities, including individuals who per-
sonally suffer chronic pain; 
(6) medical professional organizations and med-
ical specialty organizations; 
(7) licensed health care providers who furnish 
alternative pain management services; 
(8) organizations with expertise in the develop-
ment of innovative medical technologies for pain 
management; 
(9) beneficiary advocacy organizations; and 
(10) other organizations with expertise in the 
assessment, diagnosis, treatment, and management 
of pain, as determined appropriate by the Secretary. 
(c) CONTENTS.—The report described in subsection 
(a) shall include the following: 
(1) An analysis of payment and coverage under 
title XVIII of the Social Security Act with respect 
to the following: 
(A) Evidence-based treatments and tech-
nologies for chronic or acute pain, including 
such treatments that are covered, not covered, 
or have limited coverage under such title.
195 
(B) Evidence-based treatments and tech-
nologies that monitor substance use withdrawal 
and prevent overdoses of opioids. 
(C) Evidence-based treatments and tech-
nologies that treat substance use disorders. 
(D) Items and services furnished by practi-
tioners through a multi-disciplinary treatment 
model for pain management, including the pa-
tient-centered medical home. 
(E) Medical devices, non-opioid based 
drugs, and other therapies (including inter-
ventional and integrative pain therapies) ap-
proved or cleared by the Food and Drug Ad-
ministration for the treatment of pain. 
(F) Items and services furnished to bene-
ficiaries with psychiatric disorders, substance 
use disorders, or who are at risk of suicide, or 
have comorbidities and require consultation or 
management of pain with one or more special-
ists in pain management, mental health, or ad-
diction treatment. 
(2) An evaluation of the following: 
(A) Barriers inhibiting individuals entitled 
to benefits under part A or enrolled under part 
B of such title from accessing treatments and
196 
technologies described in subparagraphs (A) 
through (F) of paragraph (1). 
(B) Costs and benefits associated with po-
tential expansion of coverage under such title to 
include items and services not covered under 
such title that may be used for the treatment 
of pain, such as acupuncture, therapeutic mas-
sage, and items and services furnished by inte-
grated pain management programs. 
(C) Pain management guidance published 
by the Federal Government that may be rel-
evant to coverage determinations or other cov-
erage requirements under title XVIII of the So-
cial Security Act. 
(3) An assessment of all guidance published by 
the Department of Health and Human Services on 
or after January 1, 2016, relating to the prescribing 
of opioids. Such assessment shall consider incor-
porating into such guidance relevant elements of the 
‘‘Va/DoD Clinical Practice Guideline for Opioid 
Therapy for Chronic Pain’’ published in February 
2017 by the Department of Veterans Affairs and 
Department of Defense, including adoption of ele-
ments of the Department of Defense and Depart-
ment of Veterans Affairs pain rating scale.
197 
(4) The options described in subsection (d). 
(5) The impact analysis described in subsection 
(e). 
(d) OPTIONS.—The options described in this sub-
section are, with respect to individuals entitled to benefits 
under part A or enrolled under part B of title XVIII of 
the Social Security Act, legislative and administrative op-
tions for accomplishing the following: 
(1) Improving coverage of and payment for pain 
management therapies without the use of opioids, in-
cluding interventional pain therapies, and options to 
augment opioid therapy with other clinical and com-
plementary, integrative health services to minimize 
the risk of substance use disorder, including in a 
hospital setting. 
(2) Improving coverage of and payment for 
medical devices and non-opioid based pharma-
cological and non-pharmacological therapies ap-
proved or cleared by the Food and Drug Administra-
tion for the treatment of pain as an alternative or 
augment to opioid therapy. 
(3) Improving and disseminating treatment 
strategies for beneficiaries with psychiatric dis-
orders, substance use disorders, or who are at risk 
of suicide, and treatment strategies to address
198 
health disparities related to opioid use and opioid 
abuse treatment. 
(4) Improving and disseminating treatment 
strategies for beneficiaries with comorbidities who 
require a consultation or comanagement of pain with 
one or more specialists in pain management, mental 
health, or addiction treatment, including in a hos-
pital setting. 
(5) Educating providers on risks of coadminis-
tration of opioids and other drugs, particularly 
benzodiazepines. 
(6) Ensuring appropriate case management for 
beneficiaries who transition between inpatient and 
outpatient hospital settings, or between opioid ther-
apy to non-opioid therapy, which may include the 
use of care transition plans. 
(7) Expanding outreach activities designed to 
educate providers of services and suppliers under the 
Medicare program and individuals entitled to bene-
fits under part A or under part B of such title on 
alternative, non-opioid therapies to manage and 
treat acute and chronic pain. 
(8) Creating a beneficiary education tool on al-
ternatives to opioids for chronic pain management.
199 
(e) IMPACT ANALYSIS.—The impact analysis de-
scribed in this subsection consists of an analysis of any 
potential effects implementing the options described in 
subsection (d) would have— 
(1) on expenditures under the Medicare pro-
gram; and 
(2) on preventing or reducing opioid addiction 
for individuals receiving benefits under the Medicare 
program. 
Subtitle J—Combating Opioid 
Abuse for Care in Hospitals 
SEC. 6091. SHORT TITLE. 
This subtitle may be cited as the ‘‘Combating Opioid 
Abuse for Care in Hospitals Act of 2018’’ or the ‘‘COACH 
Act of 2018’’. 
SEC. 6092. DEVELOPING GUIDANCE ON PAIN MANAGEMENT 
AND OPIOID USE DISORDER PREVENTION 
FOR 
HOSPITALS 
RECEIVING 
PAYMENT 
UNDER PART A OF THE MEDICARE PROGRAM. 
(a) IN GENERAL.—Not later than January 1, 2019, 
the Secretary of Health and Human Services (in this sec-
tion referred to as the ‘‘Secretary’’) shall develop and pub-
lish on the public website of the Centers for Medicare & 
Medicaid Services guidance for hospitals receiving pay-
ment under part A of title XVIII of the Social Security
200 
Act (42 U.S.C. 1395c et seq.) on pain management strate-
gies and opioid use disorder prevention strategies with re-
spect to individuals entitled to benefits under such part. 
(b) CONSULTATION.—In developing the guidance de-
scribed in subsection (a), the Secretary shall consult with 
relevant stakeholders, including— 
(1) medical professional organizations; 
(2) providers and suppliers of services (as such 
terms are defined in section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x)); 
(3) health care consumers or groups rep-
resenting such consumers; and 
(4) other entities determined appropriate by the 
Secretary. 
(c) CONTENTS.—The guidance described in sub-
section (a) shall include, with respect to hospitals and indi-
viduals described in such subsection, the following: 
(1) Best practices regarding evidence-based 
screening and practitioner education initiatives relat-
ing to screening and treatment protocols for opioid 
use disorder, including— 
(A) methods to identify such individuals 
at-risk of opioid use disorder, including risk 
stratification;
201 
(B) ways to prevent, recognize, and treat 
opioid overdoses; and 
(C) resources available to such individuals, 
such as opioid treatment programs, peer sup-
port groups, and other recovery programs. 
(2) Best practices for such hospitals to educate 
practitioners furnishing items and services at such 
hospital with respect to pain management and sub-
stance use disorders, including education on— 
(A) the adverse effects of prolonged opioid 
use; 
(B) non-opioid, evidence-based, non-phar-
macological pain management treatments; 
(C) monitoring programs for individuals 
who have been prescribed opioids; and 
(D) the prescribing of naloxone along with 
an initial opioid prescription. 
(3) Best practices for such hospitals to make 
such individuals aware of the risks associated with 
opioid use (which may include use of the notification 
template described in paragraph (4)). 
(4) A notification template developed by the 
Secretary, for use as appropriate, for such individ-
uals who are prescribed an opioid that—
202 
(A) explains the risks and side effects asso-
ciated with opioid use (including the risks of 
addiction and overdose) and the importance of 
adhering to the prescribed treatment regimen, 
avoiding medications that may have an adverse 
interaction with such opioid, and storing such 
opioid safely and securely; 
(B) highlights multimodal and evidence- 
based non-opioid alternatives for pain manage-
ment; 
(C) encourages such individuals to talk to 
their health care providers about such alter-
natives; 
(D) provides for a method (through signa-
ture or otherwise) for such an individual, or 
person acting on such individual’s behalf, to ac-
knowledge receipt of such notification template; 
(E) is worded in an easily understandable 
manner and made available in multiple lan-
guages determined appropriate by the Sec-
retary; and 
(F) includes any other information deter-
mined appropriate by the Secretary.
203 
(5) Best practices for such hospital to track 
opioid prescribing trends by practitioners furnishing 
items and services at such hospital, including— 
(A) ways for such hospital to establish tar-
get levels, taking into account the specialties of 
such practitioners and the geographic area in 
which such hospital is located, with respect to 
opioids prescribed by such practitioners; 
(B) guidance on checking the medical 
records of such individuals against information 
included in prescription drug monitoring pro-
grams; 
(C) strategies to reduce long-term opioid 
prescriptions; and 
(D) methods to identify such practitioners 
who may be over-prescribing opioids. 
(6) Other information the Secretary determines 
appropriate, including any such information from 
the Opioid Safety Initiative established by the De-
partment of Veterans Affairs or the Opioid Overdose 
Prevention Toolkit published by the Substance 
Abuse and Mental Health Services Administration.
204 
SEC. 6093. REQUIRING THE REVIEW OF QUALITY MEAS-
URES RELATING TO OPIOIDS AND OPIOID 
USE DISORDER TREATMENTS FURNISHED 
UNDER 
THE 
MEDICARE 
PROGRAM 
AND 
OTHER FEDERAL HEALTH CARE PROGRAMS. 
(a) IN GENERAL.—Section 1890A of the Social Secu-
rity Act (42 U.S.C. 1395aaa–1) is amended by adding at 
the end the following new subsection: 
‘‘(g) TECHNICAL EXPERT PANEL REVIEW OF OPIOID 
AND OPIOID USE DISORDER QUALITY MEASURES.— 
‘‘(1) IN GENERAL.—Not later than 180 days 
after the date of the enactment of this subsection, 
the Secretary shall establish a technical expert panel 
for purposes of reviewing quality measures relating 
to opioids and opioid use disorders, including care, 
prevention, diagnosis, health outcomes, and treat-
ment furnished to individuals with opioid use dis-
orders. The Secretary may use the entity with a con-
tract under section 1890(a) and amend such con-
tract as necessary to provide for the establishment 
of such technical expert panel. 
‘‘(2) REVIEW
AND
ASSESSMENT.—Not later 
than 1 year after the date the technical expert panel 
described in paragraph (1) is established (and peri-
odically thereafter as the Secretary determines ap-
propriate), the technical expert panel shall—
205 
‘‘(A) review quality measures that relate to 
opioids and opioid use disorders, including ex-
isting measures and those under development; 
‘‘(B) identify gaps in areas of quality 
measurement that relate to opioids and opioid 
use disorders, and identify measure develop-
ment priorities for such measure gaps; and 
‘‘(C) make recommendations to the Sec-
retary on quality measures with respect to 
opioids and opioid use disorders for purposes of 
improving care, prevention, diagnosis, health 
outcomes, 
and 
treatment, 
including 
rec-
ommendations for revisions of such measures, 
need for development of new measures, and rec-
ommendations for including such measures in 
the Merit-Based Incentive Payment System 
under section 1848(q), the alternative payment 
models under section 1833(z)(3)(C), the shared 
savings program under section 1899, the qual-
ity reporting requirements for inpatient hos-
pitals under section 1886(b)(3)(B)(viii), and 
the hospital value-based purchasing program 
under section 1886(o). 
‘‘(3) CONSIDERATION OF MEASURES BY SEC-
RETARY.—The Secretary shall consider—
206 
‘‘(A) using opioid and opioid use disorder 
measures (including measures used under the 
Merit-Based Incentive Payment System under 
section 1848(q), measures recommended under 
paragraph (2)(C), and other such measures 
identified by the Secretary) in alternative pay-
ment models under section 1833(z)(3)(C) and 
in the shared savings program under section 
1899; and 
‘‘(B) using opioid measures described in 
subparagraph (A), as applicable, in the quality 
reporting requirements for inpatient hospitals 
under section 1886(b)(3)(B)(viii),and in the 
hospital value-based purchasing program under 
section 1886(o). 
‘‘(4) PRIORITIZATION OF MEASURE DEVELOP-
MENT.—The Secretary shall prioritize for measure 
development the gaps in quality measures identified 
under paragraph (2)(B).’’. 
(b) EXPEDITED
ENDORSEMENT
PROCESS
FOR 
OPIOID MEASURES.—Section 1890(b)(2) of the Social Se-
curity Act (42 U.S.C. 1395aaa(b)(2)) is amended by add-
ing at the end the following new flush sentence: 
‘‘Such endorsement process shall, as determined 
practicable by the entity, provide for an expedited
207 
process with respect to the endorsement of such 
measures relating to opioids and opioid use dis-
orders.’’. 
SEC. 6094. TECHNICAL EXPERT PANEL ON REDUCING SUR-
GICAL SETTING OPIOID USE; DATA COLLEC-
TION ON PERIOPERATIVE OPIOID USE. 
(a) TECHNICAL EXPERT PANEL ON REDUCING SUR-
GICAL SETTING OPIOID USE.— 
(1) IN
GENERAL.—Not later than 6 months 
after the date of the enactment of this Act, the Sec-
retary of Health and Human Services shall convene 
a technical expert panel, including medical and sur-
gical specialty societies and hospital organizations, 
to provide recommendations on reducing opioid use 
in the inpatient and outpatient surgical settings and 
on best practices for pain management, including 
with respect to the following: 
(A) Approaches that limit patient exposure 
to opioids during the perioperative period, in-
cluding pre-surgical and post-surgical injec-
tions, and that identify such patients at risk of 
opioid use disorder pre-operation. 
(B) Shared decision making with patients 
and families on pain management, including 
recommendations for the development of an
208 
evaluation and management code for purposes 
of payment under the Medicare program under 
title XVIII of the Social Security Act that 
would account for time spent on shared decision 
making. 
(C) Education on the safe use, storage, 
and disposal of opioids. 
(D) Prevention of opioid misuse and abuse 
after discharge. 
(E) Development of a clinical algorithm to 
identify and treat at-risk, opiate-tolerant pa-
tients and reduce reliance on opioids for acute 
pain during the perioperative period. 
(2) REPORT.—Not later than 1 year after the 
date of the enactment of this Act, the Secretary 
shall submit to Congress and make public a report 
containing the recommendations developed under 
paragraph (1) and an action plan for broader imple-
mentation of pain management protocols that limit 
the use of opioids in the perioperative setting and 
upon discharge from such setting. 
(b) DATA COLLECTION ON PERIOPERATIVE OPIOID 
USE.—Not later than 1 year after the date of the enact-
ment of this Act, the Secretary of Health and Human
209 
Services shall submit to Congress a report that contains 
the following: 
(1) The diagnosis-related group codes identified 
by the Secretary as having the highest volume of 
surgeries. 
(2) With respect to each of such diagnosis-re-
lated group codes so identified, a determination by 
the Secretary of the data that is both available and 
reported on opioid use following such surgeries, such 
as with respect to— 
(A) surgical volumes, practices, and opioid 
prescribing patterns; 
(B) opioid consumption, including— 
(i) perioperative days of therapy; 
(ii) average daily dose at the hospital, 
including dosage greater than 90 milligram 
morphine equivalent; 
(iii) post-discharge prescriptions and 
other combination drugs that are used be-
fore intervention and after intervention; 
(iv) quantity and duration of opioid 
prescription at discharge; and 
(v) quantity consumed and number of 
refills;
210 
(C) regional anesthesia and analgesia prac-
tices, including pre-surgical and post-surgical 
injections; 
(D) naloxone reversal; 
(E) post-operative respiratory failure; 
(F) information about storage and dis-
posal; and 
(G) such other information as the Sec-
retary may specify. 
(3) Recommendations for improving data collec-
tion on perioperative opioid use, including an anal-
ysis to identify and reduce barriers to collecting, re-
porting, and analyzing the data described in para-
graph (2), including barriers related to technological 
availability. 
SEC. 6095. REQUIRING THE POSTING AND PERIODIC UP-
DATE OF OPIOID PRESCRIBING GUIDANCE 
FOR MEDICARE BENEFICIARIES. 
(a) IN GENERAL.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services (in this section referred to as the 
‘‘Secretary’’) shall post on the public website of the Cen-
ters for Medicare & Medicaid Services all guidance pub-
lished by the Department of Health and Human Services 
on or after January 1, 2016, relating to the prescribing
211 
of opioids and applicable to opioid prescriptions for indi-
viduals entitled to benefits under part A of title XVIII 
of the Social Security Act (42 U.S.C. 1395c et seq.) or 
enrolled under part B of such title of such Act (42 U.S.C. 
1395j et seq.). 
(b) UPDATE OF GUIDANCE.— 
(1) PERIODIC UPDATE.—The Secretary shall, in 
consultation with the entities specified in paragraph 
(2), periodically (as determined appropriate by the 
Secretary) update guidance described in subsection 
(a) and revise the posting of such guidance on the 
website described in such subsection. 
(2) CONSULTATION.—The entities specified in 
this paragraph are the following: 
(A) Medical professional organizations. 
(B) Providers and suppliers of services (as 
such terms are defined in section 1861 of the 
Social Security Act (42 U.S.C. 1395x)). 
(C) Health care consumers or groups rep-
resenting such consumers. 
(D) Other entities determined appropriate 
by the Secretary.
212 
Subtitle K—Stop Excessive Nar-
cotics in Our Retirement Com-
munities Protection 
SEC. 6101. SHORT TITLE. 
This subtitle may be cited as the ‘‘Stop Excessive 
Narcotics in our Retirement Communities Protection Act 
of 2018’’ or the ‘‘SENIOR Communities Protection Act 
of 2018’’. 
SEC. 6102. SUSPENSION OF PAYMENTS BY MEDICARE PRE-
SCRIPTION DRUG PLANS AND MA–PD PLANS 
PENDING INVESTIGATIONS OF CREDIBLE AL-
LEGATIONS OF FRAUD BY PHARMACIES. 
(a) IN GENERAL.—Section 1860D–12(b) of the So-
cial Security Act (42 U.S.C. 1395w–112(b)) is amended 
by adding at the end the following new paragraph: 
‘‘(7) SUSPENSION OF PAYMENTS PENDING IN-
VESTIGATION OF CREDIBLE ALLEGATIONS OF FRAUD 
BY PHARMACIES.— 
‘‘(A) IN GENERAL.—The provisions of sec-
tion 1862(o) shall apply with respect to a PDP 
sponsor with a contract under this part, a phar-
macy, and payments to such pharmacy under 
this part in the same manner as such provisions 
apply with respect to the Secretary, a provider
213 
of services or supplier, and payments to such 
provider of services or supplier under this title. 
‘‘(B) RULE OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed as limiting 
the authority of a PDP sponsor to conduct 
postpayment review.’’. 
(b) APPLICATION
TO
MA–PD PLANS.—Section 
1857(f)(3) of the Social Security Act (42 U.S.C. 1395w– 
27(f)(3)) is amended by adding at the end the following 
new subparagraph: 
‘‘(D) SUSPENSION OF PAYMENTS PENDING 
INVESTIGATION OF CREDIBLE ALLEGATIONS OF 
FRAUD
BY
PHARMACIES.—Section 
1860D– 
12(b)(7).’’. 
(c) CONFORMING AMENDMENT.—Section 1862(o)(3) 
of the Social Security Act (42 U.S.C. 1395y(o)(3)) is 
amended by inserting ‘‘, section 1860D–12(b)(7) (includ-
ing as applied pursuant to section 1857(f)(3)(D)),’’ after 
‘‘this subsection’’. 
(d) CLARIFICATION RELATING TO CREDIBLE ALLE-
GATION OF FRAUD.—Section 1862(o) of the Social Secu-
rity Act (42 U.S.C. 1395y(o)) is amended by adding at 
the end the following new paragraph: 
‘‘(4) CREDIBLE
ALLEGATION
OF
FRAUD.—In 
carrying out this subsection, section 1860D–
214 
12(b)(7) (including as applied pursuant to section 
1857(f)(3)(D)), and section 1903(i)(2)(C), a fraud 
hotline tip (as defined by the Secretary) without fur-
ther evidence shall not be treated as sufficient evi-
dence for a credible allegation of fraud.’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to plan years begin-
ning on or after January 1, 2020. 
Subtitle L—Providing Reliable Op-
tions for Patients and Edu-
cational Resources 
SEC. 6111. SHORT TITLE. 
This subtitle may be cited as the ‘‘Providing Reliable 
Options for Patients and Educational Resources Act of 
2018’’ or the ‘‘PROPER Act of 2018’’. 
SEC. 6112. REQUIRING MEDICARE ADVANTAGE PLANS AND 
PART D PRESCRIPTION DRUG PLANS TO IN-
CLUDE INFORMATION ON RISKS ASSOCIATED 
WITH OPIOIDS AND COVERAGE OF NON-
PHARMACOLOGICAL 
THERAPIES 
AND 
NONOPIOID MEDICATIONS OR DEVICES USED 
TO TREAT PAIN. 
Section 1860D–4(a)(1) of the Social Security Act (42 
U.S.C. 1395w–104(a)(1)) is amended—
215 
(1) in subparagraph (A), by inserting ‘‘, subject 
to subparagraph (C),’’ before ‘‘including’’; 
(2) in subparagraph (B), by adding at the end 
the following new clause: 
‘‘(vi) For plan year 2021 and each 
subsequent plan year, subject to subpara-
graph (C), with respect to the treatment of 
pain— 
‘‘(I) the risks associated with 
prolonged opioid use; and 
‘‘(II) coverage of nonpharma-
cological 
therapies, 
devices, 
and 
nonopioid medications— 
‘‘(aa) in the case of an MA- 
PD plan under part C, under 
such plan; and 
‘‘(bb) in the case of a pre-
scription drug plan, under such 
plan and under parts A and B.’’; 
and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(C) TARGETED PROVISION OF INFORMA-
TION.—A PDP sponsor of a prescription drug 
plan may, in lieu of disclosing the information
216 
described in subparagraph (B)(vi) to each en-
rollee under the plan, disclose such information 
through mail or electronic communications to a 
subset of enrollees under the plan, such as en-
rollees who have been prescribed an opioid in 
the previous 2-year period.’’. 
SEC. 6113. REQUIRING MEDICARE ADVANTAGE PLANS AND 
PRESCRIPTION DRUG PLANS TO PROVIDE IN-
FORMATION ON THE SAFE DISPOSAL OF PRE-
SCRIPTION DRUGS. 
(a) MEDICARE ADVANTAGE.—Section 1852 of the 
Social Security Act (42 U.S.C. 1395w–22) is amended by 
adding at the end the following new subsection: 
‘‘(n) PROVISION OF INFORMATION RELATING TO THE 
SAFE DISPOSAL OF CERTAIN PRESCRIPTION DRUGS.— 
‘‘(1) IN GENERAL.—In the case of an individual 
enrolled under an MA or MA-PD plan who is fur-
nished an in-home health risk assessment on or after 
January 1, 2021, such plan shall ensure that such 
assessment includes information on the safe disposal 
of prescription drugs that are controlled substances 
that meets the criteria established under paragraph 
(2). Such information shall include information on 
drug takeback programs that meet such require-
217 
ments determined appropriate by the Secretary and 
information on in-home disposal. 
‘‘(2) CRITERIA.—The Secretary shall, through 
rulemaking, establish criteria the Secretary deter-
mines appropriate with respect to information pro-
vided to an individual to ensure that such informa-
tion sufficiently educates such individual on the safe 
disposal of prescription drugs that are controlled 
substances.’’. 
(b) PRESCRIPTION DRUG PLANS.—Section 1860D– 
4(c)(2)(B) of the Social Security Act (42 U.S.C. 1395w– 
104(c)(2)(B)) is amended— 
(1) by striking ‘‘may include elements that pro-
mote’’; 
(2) by redesignating clauses (i) through (iii) as 
subclauses (I) through (III) and adjusting the mar-
gins accordingly; 
(3) by inserting before subclause (I), as so re-
designated, the following new clause: 
‘‘(i) may include elements that pro-
mote—’’; 
(4) in subclause (III), as so redesignated, by 
striking the period at the end and inserting ‘‘; and’’; 
and
218 
(5) by adding at the end the following new 
clause: 
‘‘(ii) with respect to plan years begin-
ning on or after January 1, 2021, shall 
provide for— 
‘‘(I) the provision of information 
to the enrollee on the safe disposal of 
prescription drugs that are controlled 
substances that meets the criteria es-
tablished under section 1852(n)(2), 
including 
information 
on 
drug 
takeback programs that meet such re-
quirements determined appropriate by 
the Secretary and information on in- 
home disposal; and 
‘‘(II) cost-effective means by 
which an enrollee may so safely dis-
pose of such drugs.’’. 
SEC. 6114. REVISING MEASURES USED UNDER THE HOS-
PITAL 
CONSUMER 
ASSESSMENT 
OF 
HEALTHCARE 
PROVIDERS 
AND 
SYSTEMS 
SURVEY RELATING TO PAIN MANAGEMENT. 
(a) RESTRICTION ON THE USE OF PAIN QUESTIONS 
IN HCAHPS.—Section 1886(b)(3)(B)(viii) of the Social
219 
Security Act (42 U.S.C. 1395ww(b)(3)(B)(viii)) is amend-
ed by adding at the end the following new subclause: 
‘‘(XII)(aa) With respect to a Hospital Consumer As-
sessment of Healthcare Providers and Systems survey (or 
a successor survey) conducted on or after January 1, 
2019, such survey may not include questions about com-
munication by hospital staff with an individual about such 
individual’s pain unless such questions take into account, 
as applicable, whether an individual experiencing pain was 
informed about risks associated with the use of opioids 
and about non-opioid alternatives for the treatment of 
pain. 
‘‘(bb) The Secretary shall not include on the Hospital 
Compare Internet website any measures based on the 
questions appearing on the Hospital Consumer Assess-
ment of Healthcare Providers and Systems survey in 2018 
about communication by hospital staff with an individual 
about such individual’s pain.’’. 
(b) RESTRICTION ON USE OF 2018 PAIN QUESTIONS 
IN
THE HOSPITAL VALUE-BASED PURCHASING PRO-
GRAM.—Section 1886(o)(2)(B) of the Social Security Act 
(42 U.S.C. 1395ww(o)(2)(B)) is amended by adding at the 
end the following new clause: 
‘‘(iii) HCAHPS PAIN
QUESTIONS.— 
The Secretary may not include under sub-
220 
paragraph (A) a measure that is based on 
the questions appearing on the Hospital 
Consumer Assessment of Healthcare Pro-
viders and Systems survey in 2018 about 
communication by hospital staff with an 
individual about the individual’s pain.’’. 
TITLE VII—OTHER HEALTH 
PROVISIONS 
Subtitle A—Synthetic Drug 
Awareness 
SEC. 7001. SHORT TITLE. 
This subtitle may be cited as the ‘‘Synthetic Drug 
Awareness Act of 2018’’. 
SEC. 7002. REPORT ON EFFECTS ON PUBLIC HEALTH OF 
SYNTHETIC DRUG USE. 
(a) IN GENERAL.—Not later than 3 years after the 
date of the enactment of this Act, the Surgeon General 
of the Public Health Service shall submit to Congress a 
report on the health effects of new psychoactive substances 
(including synthetic drugs) used since January 2010 by 
persons who are at least 12 years of age but no more than 
18 years of age. 
(b) NEW PSYCHOACTIVE SUBSTANCE DEFINED.— 
For purposes of subsection (a), the term ‘‘new 
psychoactive substance’’ means a controlled substance
221 
analogue (as defined in section 102(32) of the Controlled 
Substances Act (21 U.S.C. 802(32)). 
Subtitle 
B—Empowering 
Phar-
macists in the Fight Against 
Opioid Abuse 
SEC. 7011. SHORT TITLE. 
This subtitle may be cited as the ‘‘Empowering Phar-
macists in the Fight Against Opioid Abuse Act’’. 
SEC. 7012. PROGRAMS AND MATERIALS FOR TRAINING ON 
CERTAIN CIRCUMSTANCES UNDER WHICH A 
PHARMACIST MAY DECLINE TO FILL A PRE-
SCRIPTION. 
(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of this Act, the Secretary of Health and 
Human Services, in consultation with the Administrator 
of the Drug Enforcement Administration, the Commis-
sioner of Food and Drugs, the Director of the Centers for 
Disease Control and Prevention, and the Assistant Sec-
retary for Mental Health and Substance Use, shall develop 
and disseminate programs and materials for training 
pharmacists, health care providers, and patients on— 
(1) circumstances under which a pharmacist 
may, consistent with section 201 of the Controlled 
Substances Act (21 U.S.C. 811) and regulations 
thereunder, including section 1306.04 of title 21,
222 
Code of Federal Regulations, decline to fill a pre-
scription for a controlled substance because the 
pharmacist suspects the prescription is fraudulent, 
forged, or otherwise indicative of abuse or diversion; 
and 
(2) any Federal requirements pertaining to de-
clining to fill a prescription under such circum-
stances. 
(b) MATERIALS INCLUDED.—In developing materials 
under subsection (a), the Secretary of Health and Human 
Services shall include information educating— 
(1) pharmacists on how to decline to fill a pre-
scription and actions to take after declining to fill a 
prescription; and 
(2) other health care practitioners and the pub-
lic on a pharmacist’s responsibility to decline to fill 
prescriptions in certain circumstances. 
(c) STAKEHOLDER INPUT.—In developing the pro-
grams and materials required under subsection (a), the 
Secretary of Health and Human Services shall seek input 
from relevant national, State, and local associations, 
boards of pharmacy, medical societies, licensing boards, 
health care practitioners, and patients.
223 
Subtitle C—Indexing Narcotics, 
Fentanyl, and Opioids 
SEC. 7021. SHORT TITLE. 
This subtitle may be cited as the ‘‘Indexing Nar-
cotics, Fentanyl, and Opioids Act of 2018’’ or the ‘‘INFO 
Act’’. 
SEC. 7022. ESTABLISHMENT OF SUBSTANCE USE DISORDER 
INFORMATION DASHBOARD. 
Title XVII of the Public Health Service Act (42 
U.S.C. 300u et seq.) is amended by adding at the end 
the following new section: 
‘‘SEC. 1711. ESTABLISHMENT OF SUBSTANCE USE DIS-
ORDER INFORMATION DASHBOARD. 
‘‘(a) IN GENERAL.—Not later than 6 months after 
the date of the enactment of this section, the Secretary 
of Health and Human Services shall, in consultation with 
the Director of National Drug Control Policy, establish 
and periodically update a public information dashboard 
that— 
‘‘(1) coordinates information on programs with-
in the Department of Health and Human Services 
related to the reduction of opioid abuse and other 
substance use disorders; 
‘‘(2) provides access to publicly available data 
from other Federal agencies; State, local, and Tribal
224 
governments; nonprofit organizations; law enforce-
ment; medical experts; public health educators; and 
research institutions regarding prevention, treat-
ment, recovery, and other services for opioid use dis-
order and other substance use disorders; 
‘‘(3) provides comparable data on substance use 
disorder prevention and treatment strategies in dif-
ferent regions and population of the United States; 
‘‘(4) provides recommendations for health care 
providers on alternatives to controlled substances for 
pain management, including approaches studied by 
the National Institutes of Health Pain Consortium 
and the National Center for Complimentary and In-
tegrative Health; and 
‘‘(5) provides guidelines and best practices for 
health care providers regarding treatment of sub-
stance use disorders. 
‘‘(b) CONTROLLED SUBSTANCE DEFINED.—In this 
section, the term ‘controlled substance’ has the meaning 
given that term in section 102 of the Controlled Sub-
stances Act (21 U.S.C. 802).’’. 
SEC. 7023. INTERAGENCY SUBSTANCE USE DISORDER CO-
ORDINATING COMMITTEE. 
(a) ESTABLISHMENT.—Not later than 3 months after 
the date of the enactment of this Act, the Secretary of
225 
Health and Human Services (in this section referred to 
as the ‘‘Secretary’’) shall, in consultation with the Direc-
tor of National Drug Control Policy, establish a com-
mittee, to be known as the Interagency Substance Use 
Disorder Coordinating Committee (in this section referred 
to as the ‘‘Committee’’ ), to coordinate all efforts within 
the Department of Health and Human Services con-
cerning substance use disorder. 
(b) MEMBERSHIP.— 
(1) FEDERAL MEMBERS.—The following indi-
viduals shall be the Federal members of the Com-
mittee: 
(A) The Secretary, who shall service as the 
Chair of the Committee. 
(B) The Attorney General of the United 
States. 
(C) The Secretary of Labor. 
(D) The Secretary of Housing and Urban 
Development. 
(E) The Secretary of Education. 
(F) The Secretary of Veterans Affairs. 
(G) The Commissioner of Social Security. 
(H) The Assistant Secretary for Mental 
Health and Substance Use.
231 
retary shall submit to Congress a recommendation 
on whether or not the operations of the Committee 
should continue after the termination date described 
in subsection (i). 
(g) WORKING GROUPS.—The Committee may estab-
lish working groups for purposes of carrying out the duties 
described in subsection (e). Any such working group shall 
be composed of members of the Committee (or the des-
ignees of such members) and may hold such meetings as 
are necessary to enable the working group to carry out 
the duties delegated to the working group. 
(h) FEDERAL ADVISORY COMMITTEE ACT.—The 
Federal Advisory Committee Act (5 U.S.C. App.) shall 
apply to the Committee only to the extent that the provi-
sions of such Act do not conflict with the requirements 
of this section. 
(i) SUNSET.—The Committee shall terminate on the 
date that is 6 years after the date on which the Committee 
is established under subsection (a). 
Subtitle D—Ensuring Access to 
Quality Sober Living 
SEC. 7031. SHORT TITLE. 
This subtitle may be cited as the ‘‘Ensuring Access 
to Quality Sober Living Act of 2018’’.