115TH CONGRESS 
2D SESSION 
H. R. 5801 
AN ACT 
To amend title XIX of the Social Security Act to provide 
for requirements under the Medicaid program relating 
to the use of qualified prescription drug monitoring pro-
grams and prescribing certain controlled substances. 
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 ‘‘Medicaid Providers 
Are Required To Note Experiences in Record Systems to 
Help In-need Patients Act’’ or the ‘‘Medicaid PARTNER-
SHIP Act’’. 
SEC. 2. MEDICAID PROVIDERS ARE REQUIRED TO NOTE EX-
PERIENCES 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 
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-
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-
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.—
‘‘(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
‘‘(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
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;
‘‘(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).
‘‘(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
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)
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. 
Passed the House of Representatives June 19, 2018. 
Attest: 
Clerk.