I 
114TH CONGRESS 
2D SESSION 
H. R. 5145 
To amend title XIX of the Social Security Act to exclude abuse-deterrent 
formulations of prescription drugs from the Medicaid additional rebate 
requirement for new formulations of prescription drugs, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 29, 2016 
Mr. BILIRAKIS (for himself and Mr. YARMUTH) 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 subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XIX of the Social Security Act to exclude 
abuse-deterrent formulations of prescription drugs from 
the Medicaid additional rebate requirement for new for-
mulations of prescription drugs, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. EXCLUDING ABUSE-DETERRENT FORMULA-
TIONS OF PRESCRIPTION DRUGS FROM THE 
MEDICAID ADDITIONAL REBATE REQUIRE-
MENT FOR NEW FORMULATIONS OF PRE-
SCRIPTION DRUGS. 
(a) IN GENERAL.—The last sentence of section 
1927(c)(2)(C) of the Social Security Act (42 U.S.C. 
1396r–8(c)(2)(C)) is amended by inserting before the pe-
riod at the end the following: ‘‘, but does not include an 
abuse-deterrent formulation of the drug (as determined by 
the Secretary), regardless of whether such abuse-deterrent 
formulation is an extended release formulation’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to drugs that are paid for by 
a State in calendar quarters beginning on or after the date 
of the enactment of this Act. 
SEC. 2. LIMITING DISCLOSURE OF PREDICTIVE MODELING 
AND OTHER ANALYTICS TECHNOLOGIES TO 
IDENTIFY AND PREVENT WASTE, FRAUD, AND 
ABUSE. 
(a) IN GENERAL.—Title XI of the Social Security Act 
is amended by inserting after section 1128J (42 U.S.C. 
1320a–7k) the following new section: 
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‘‘SEC. 1128K. DISCLOSURE OF PREDICTIVE MODELING AND 
OTHER ANALYTICS TECHNOLOGIES TO IDEN-
TIFY AND PREVENT WASTE, FRAUD, AND 
ABUSE. 
‘‘(a) REFERENCE TO PREDICTIVE MODELING TECH-
NOLOGIES REQUIREMENTS.—For provisions relating to 
the use of predictive modeling and other analytics tech-
nologies to identify and prevent waste, fraud, and abuse 
with respect to the Medicare program under title XVIII, 
the Medicaid program under title XIX, and the Children’s 
Health Insurance Program under title XXI, see section 
4241 of the Small Business Jobs Act of 2010 (42 U.S.C. 
1320a–7m). 
‘‘(b) LIMITING DISCLOSURE OF PREDICTIVE MOD-
ELING TECHNOLOGIES.—In implementing such provisions 
under such section 4241 with respect to covered algo-
rithms (as defined in subsection (c)), the following shall 
apply: 
‘‘(1) NONAPPLICATION OF FOIA.—The covered 
algorithms used or developed for purposes of such 
section (including by the Secretary or a State (or an 
entity operating under a contract with a State)) 
shall be exempt from disclosure under section 
552(b)(3) of title 5, United States Code. 
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‘‘(2) LIMITATION WITH RESPECT TO USE AND 
DISCLOSURE
OF
INFORMATION
BY
STATE
AGEN-
CIES.— 
‘‘(A) IN GENERAL.—A State agency may 
not use or disclose covered algorithms used or 
developed for purposes of such section except 
for purposes of administering the State plan (or 
a waiver of the plan) under the Medicaid pro-
gram under title XIX or the State child health 
plan (or a waiver of the plan) under the Chil-
dren’s Health Insurance Program under title 
XXI, including by enabling an entity operating 
under a contract with a State to assist the 
State to identify or prevent waste, fraud and 
abuse with respect to such programs. 
‘‘(B) INFORMATION
SECURITY.—A State 
agency shall have in effect data security and 
control policies that the Secretary finds ade-
quate to ensure the security of covered algo-
rithms used or developed for purposes of such 
section 4241 and to ensure that access to such 
information is restricted to authorized persons 
for purposes of authorized uses and disclosures 
described in subparagraph (A). 
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‘‘(C) 
PROCEDURAL
REQUIREMENTS.— 
State agencies to which information is disclosed 
pursuant to such section 4241 shall adhere to 
uniform procedures established by the Sec-
retary. 
‘‘(c) COVERED ALGORITHM DEFINED.—In this sec-
tion, the term ‘covered algorithm’— 
‘‘(1) means a predictive modeling or other ana-
lytics technology, as used for purposes of section 
4241(a) of the Small Business Jobs Act of 2010 (42 
U.S.C. 1320a–7m(a)) to identify and prevent waste, 
fraud, and abuse with respect to the Medicare pro-
gram under title XVIII, the Medicaid program 
under title XIX, and the Children’s Health Insur-
ance Program under title XXI; and 
‘‘(2) includes the mathematical expressions uti-
lized in the application of such technology and the 
means by which such technology is developed.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) MEDICAID STATE PLAN REQUIREMENT.— 
Section 1902(a) of the Social Security Act (42 
U.S.C. 1396a(a)) is amended— 
(A) in paragraph (80), by striking ‘‘and’’ 
at the end; 
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(B) in paragraph (81), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (81) the 
following new paragraph: 
‘‘(82) provide that the State agency responsible 
for administering the State plan under this title pro-
vides assurances to the Secretary that the State 
agency is in compliance with subparagraphs (A), 
(B), and (C) of section 1128K(b)(2).’’. 
(2) STATE
CHILD
HEALTH
PLAN
REQUIRE-
MENT.—Section 2102(a)(7) of the Social Security 
Act (42 U.S.C. 1397bb(a)(7)) is amended— 
(A) in subparagraph (A), by striking ‘‘, 
and’’ at the end and inserting a semicolon; 
(B) in subparagraph (B), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(C) to ensure that the State agency in-
volved is in compliance with subparagraphs (A), 
(B), and (C) of section 1128K(b)(2).’’. 
SEC. 3. MEDICAID IMPROVEMENT FUND. 
Section 1941(b)(1) of the Social Security Act (42 
U.S.C. 1396w–1(b)(1)) is amended to read as follows: 
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‘‘(1) IN GENERAL.—There shall be available to 
the Fund, for expenditures from the Fund for fiscal 
year 2021 and thereafter, $5,000,000.’’. 
Æ 
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