I 
115TH CONGRESS 
2D SESSION 
H. R. 5083 
To amend title XVIII of the Social Security Act to provide for coverage 
of certain services furnished by opioid treatment programs under the 
Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 23, 2018 
Mr. NEAL (for himself and Mr. PALLONE) introduced the following bill; which 
was referred to the Committee on Energy and Commerce, and in addition 
to the Committee on Ways and Means, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for coverage of certain services furnished by opioid treat-
ment programs under the Medicare program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Expanding Access to 
Evidence-Based Opioid Treatment for Seniors Act of 
2018’’. 
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SEC. 2. MEDICARE COVERAGE OF CERTAIN SERVICES FUR-
NISHED BY OPIOID TREATMENT PROGRAMS. 
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) is amended— 
(1) in subparagraph (FF), by striking at the 
end ‘‘and’’; 
(2) in subparagraph (GG), by inserting at the 
end ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(HH) opioid use disorder treatment serv-
ices (as defined in subsection (jjj)).’’. 
(b) OPIOID USE DISORDER TREATMENT SERVICES 
AND OPIOID TREATMENT PROGRAM DEFINED.—Section 
1861 of the Social Security Act is amended by adding at 
the end the following new subsection: 
‘‘(jjj) OPIOID USE DISORDER TREATMENT SERV-
ICES; OPIOID TREATMENT PROGRAM.— 
‘‘(1) OPIOID USE DISORDER TREATMENT SERV-
ICES.—The term ‘opioid use disorder treatment serv-
ices’ means items and services that— 
‘‘(A) are furnished for the treatment of 
opioid use disorder at an opioid treatment pro-
gram enrolled under section 1866(j) by a physi-
cian or other practitioner that is enrolled under 
such section; and 
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‘‘(B) are certified by the Substance Abuse 
and Mental Health Services Administration to 
be provided by such program for such treat-
ment. 
‘‘(2) OPIOID TREATMENT PROGRAM.—The term 
‘opioid treatment program’ means an opioid treat-
ment program (as defined in section 8.2 of title 42 
of the Code of Federal Regulations, or any successor 
regulation) that has an opioid treatment program 
certification (as defined in such section) in effect 
and meets such other conditions of participation as 
the Secretary may find necessary in the interest of 
the health and safety of individuals who are fur-
nished services by such program.’’. 
(c) PAYMENT.— 
(1) IN GENERAL.—Section 1833(a)(1) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)) is 
amended— 
(A) by striking ‘‘and (BB)’’ and inserting 
‘‘(BB)’’; and 
(B) by inserting before the semicolon at 
the end the following ‘‘, and (CC) with respect 
to opioid use disorder treatment services, the 
amount paid shall be equal to 80 percent of the 
amount determined under section 1834(w)’’. 
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(2) PAYMENT DETERMINATION.—Section 1834 
of the Social Security Act (42 U.S.C. 1395m) is 
amended by adding at the end the following new 
subsection: 
‘‘(w) OPIOID USE DISORDER TREATMENT SERV-
ICES.— 
‘‘(1) IN GENERAL.—The Secretary shall pay to 
an opioid treatment program (as defined in para-
graph (2) of section 1861(jjj)) a bundled payment 
under this part for opioid use disorder treatment 
services (as defined in paragraph (1) of such sec-
tion) that are furnished during an episode of care 
(as defined by the Secretary) beginning on or after 
January 1, 2020, to an individual by a physician or 
other practitioner at such program. Such payment 
shall be in lieu of any payment that would otherwise 
be made under this part to such physician or practi-
tioner for furnishing such services. 
‘‘(2) PAYMENT AMOUNT.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the amount of a bundled payment 
under this subsection, with respect to opioid use 
disorder treatment services (as so defined) fur-
nished during an episode of care (as so defined) 
beginning during 2020 or a subsequent year, 
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shall be an amount determined by the Secretary 
that is based on the rates of payment for com-
parable services that are paid under State plans 
under title XIX. 
‘‘(B) PERIODIC UPDATES.—The Secretary 
shall, as determined necessary by the Secretary 
(but not less frequently than once every 5 
years), review and update the amount of a bun-
dled payment under this subsection with respect 
to opioid use disorder treatment services (as so 
defined) furnished during an episode of care (as 
so defined).’’. 
(d) INCLUDING OPIOID TREATMENT PROGRAMS AS 
MEDICARE PROVIDERS.—Section 1866 of the Social Secu-
rity Act (42 U.S.C. 1395cc) is amended— 
(1) in subsection (e)— 
(A) in paragraph (2), by striking at the 
end ‘‘and’’; 
(B) in paragraph (3), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
paragraph: 
‘‘(3) opioid treatment programs (as defined in 
paragraph (2) of section 1861(jjj)), but only with re-
spect to the furnishing of opioid use disorder treat-
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ment services (as defined in paragraph (1) of such 
section).’’; and 
(D) in subsection (j), by adding at the end 
the following new paragraph: 
‘‘(10) ENHANCED
OVERSIGHT
FOR
OPIOID 
TREATMENT PROGRAMS.—The Secretary shall estab-
lish procedures to provide that opioid treatment pro-
grams (as defined in paragraph (2) of section 
1866(jjj)) enrolling or reenrolling under this title are 
subject to enhanced oversight, including by requiring 
annual audits by the Inspector General of the De-
partment of Health and Human Services for each of 
the first 5 years of such enrollment or reenrollment 
of such program under this title and audits as 
deemed necessary by the Inspector General for each 
subsequent year of enrollment or reenrollment of 
such program under this title to ensure compliance 
of the program with the requirements of this sec-
tion.’’. 
Æ 
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