I 
115TH CONGRESS 
2D SESSION 
H. R. 5801 
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 programs and prescribing certain controlled substances. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 15, 2018 
Mr. GRIFFITH (for himself and Mr. FITZPATRICK) introduced the following 
bill; which was referred to the Committee on Energy and Commerce 
A BILL 
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’’. 
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SEC. 2. REQUIREMENTS UNDER THE MEDICAID PROGRAM 
RELATING 
TO 
QUALIFIED 
PRESCRIPTION 
DRUG MONITORING PROGRAMS AND PRE-
SCRIBING 
CERTAIN 
CONTROLLED 
SUB-
STANCES. 
Title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.) is amended by inserting after section 1943 the 
following new section: 
‘‘SEC. 1944. REQUIREMENTS RELATING TO QUALIFIED 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 the prescription drug history of a cov-
ered individual being treated by the covered provider 
through a qualified prescription drug monitoring program 
described in subsection (b) before prescribing to such indi-
vidual 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: 
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‘‘(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. 
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‘‘(3) The program has in place a data sharing 
agreement with the State Medicaid program that al-
lows, at a minimum, the medical director and phar-
macy 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 for purposes of improving 
health care outcomes of individuals enrolled in the 
State plan (or waiver of such plan) and monitoring 
and preventing fraud, waste, and abuse. 
‘‘(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 may 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-
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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 number of pill counts and 
dosage for controlled substances; 
‘‘(ii) the number and dosage of con-
trolled substances prescribed per covered 
individual; and 
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‘‘(iii) the types of controlled sub-
stances prescribed, including the dates of 
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 
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who use qualified prescription drug monitoring 
programs described in subsection (b). 
‘‘(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) through (3) 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 
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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 
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‘‘(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). 
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‘‘(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.’’. 
SEC. 3. GUIDANCE. 
Not later than October 1, 2019, the Administrator 
of the Centers for Medicare & Medicaid Services, in con-
sultation with the Director of the Centers for Disease Con-
trol and Prevention, shall issue guidance on best practices 
on the uses of prescription drug monitoring programs re-
quired of prescribers and on protecting the privacy of 
Medicaid beneficiary information maintained in and 
accessed through prescription drug monitoring programs. 
SEC. 4. DEVELOPMENT OF MODEL STATE PRACTICES. 
(a) 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 pro-
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gram operations in identifying and implementing strate-
gies to utilize data sharing agreements described in section 
1944(b)(3) of the Social Security Act, as added by section 
2, for the following purposes: 
(1) Monitoring and preventing fraud, waste, 
and abuse. 
(2) Improving health care for individuals en-
rolled in a State plan under title XIX of such Act 
(or waiver of such plan) who— 
(A) transition in and out of coverage under 
such title; 
(B) may have sources of health care cov-
erage in addition to coverage under such title; 
or 
(C) pay for prescription drugs with cash. 
(3) Any other purposes specified by the Sec-
retary. 
(b) ELEMENTS OF MODEL PRACTICES.—The model 
practices described in subsection (a)— 
(1) may include strategies for assisting States 
in allowing the medical director or pharmacy direc-
tor (or designees of such a director) of managed 
care organizations or pharmaceutical benefit man-
agers to access information with respect to all cov-
ered individuals served by such managed care orga-
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nizations or pharmaceutical benefit managers to ac-
cess as a single data set, in an electronic format; 
and 
(2) shall include any appropriate beneficiary 
protections and privacy guidelines. 
(c) CONSULTATION.—In developing model practices 
under this section, the Secretary shall consult with the Na-
tional Association of Medicaid Directors, managed care 
entities (as defined in section 1932(a)(1)(B) of the Social 
Security Act) with contracts with States pursuant to sec-
tion 1903(m) of such Act, pharmaceutical benefit man-
agers, physicians and other health care providers, bene-
ficiary advocates, and individuals with expertise in health 
care technology related to prescription drug monitoring 
programs and electronic health records. 
SEC. 5. REPORT BY COMPTROLLER GENERAL. 
Not later than October 1, 2020, the Comptroller Gen-
eral 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. 
Æ 
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