119 
† HR 6 EAS 
priated under subparagraph (H) and 
remaining after application of clause 
(i), as the number of live births in the 
State in the previous calendar year 
bears to the number of live births in all 
States in such year. 
‘‘(iii) RATABLE
REDUCTION.—If the 
amount appropriated under subparagraph 
(H) is insufficient to satisfy the require-
ments of clause (ii), the Secretary shall rat-
ably reduce each allotment to a State. 
‘‘(C) APPLICATION.—A State desiring a 
grant under this paragraph shall submit an ap-
plication to the Secretary at such time and in 
such manner as the Secretary may require. Such 
application shall include— 
‘‘(i) a description of— 
‘‘(I) the impact of substance use 
disorder in such State, including with 
respect to the substance or class of sub-
stances with the highest incidence of 
abuse in the previous year in such 
State, including— 
‘‘(aa) the prevalence of sub-
stance use disorder in such State;
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† HR 6 EAS 
‘‘(bb) the aggregate rate of 
births in the State of infants af-
fected by substance abuse or with-
drawal symptoms or a fetal alco-
hol spectrum disorder (as deter-
mined by hospitals, insurance 
claims, claims submitted to the 
State Medicaid program, or other 
records), if available and to the 
extent practicable; and 
‘‘(cc) the number of infants 
identified, for whom a plan of safe 
care was developed, and for whom 
a referral was made for appro-
priate services, as reported under 
section 106(d)(18); 
‘‘(II) the challenges the State faces 
in developing, implementing, and mon-
itoring plans of safe care in accordance 
with section 106(b)(2)(B)(iii); 
‘‘(III) the State’s lead agency for 
the grant program and how that agen-
cy will coordinate with relevant State 
entities and programs, including the 
child welfare agency, the substance use
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† HR 6 EAS 
disorder treatment agency, hospitals 
with labor and delivery units, health 
care providers, the public health and 
mental health agencies, programs fund-
ed by the Substance Abuse and Mental 
Health Services Administration that 
provide substance use disorder treat-
ment for women, the State Medicaid 
program, the State agency admin-
istering the block grant program under 
title V of the Social Security Act (42 
U.S.C. 701 et seq.), the State agency 
administering the programs funded 
under part C of the Individuals with 
Disabilities Education Act (20 U.S.C. 
1431 et seq.), the maternal, infant, and 
early childhood home visiting program 
under section 511 of the Social Secu-
rity Act (42 U.S.C. 711), the State ju-
dicial system, and other agencies, as 
determined by the Secretary, and In-
dian Tribes and tribal organizations, 
as appropriate; 
‘‘(IV) how the State will monitor 
local development and implementation
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† HR 6 EAS 
of plans of safe care, in accordance 
with section 106(b)(2)(B)(iii)(II), in-
cluding how the State will monitor to 
ensure plans of safe care address dif-
ferences between substance use disorder 
and medically supervised substance 
use, including for the treatment of a 
substance use disorder; 
‘‘(V) how the State meets the re-
quirements of section 1927 of the Pub-
lic Health Service Act (42 U.S.C. 
300x–27); 
‘‘(VI) how the State plans to uti-
lize funding authorized under part E 
of title IV of the Social Security Act 
(42 U.S.C. 670 et seq.) to assist in car-
rying out any plan of safe care, in-
cluding such funding authorized under 
section 471(e) of such Act (as in effect 
on October 1, 2018) for mental health 
and substance abuse prevention and 
treatment services and in-home parent 
skill-based programs and funding au-
thorized under such section 472(j) (as 
in effect on October 1, 2018) for chil-
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† HR 6 EAS 
dren with a parent in a licensed resi-
dential family-based treatment facility 
for substance abuse; and 
‘‘(VII) an assessment of the treat-
ment and other services and programs 
available in the State, to effectively 
carry out any plan of safe care devel-
oped, including identification of needed 
treatment, and other services and pro-
grams to ensure the well-being of 
young children and their families af-
fected by substance use disorder, such 
as programs carried out under part C 
of the Individuals with Disabilities 
Education 
Act 
and 
comprehensive 
early childhood development services 
and programs such as Head Start pro-
grams; 
‘‘(ii) a description of how the State 
plans to use funds for activities described in 
subparagraph (D) for the purposes of ensur-
ing State compliance with requirements 
under clauses (ii) and (iii) of section 
106(b)(2)(B); and
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† HR 6 EAS 
‘‘(iii) an assurance that the State 
will— 
‘‘(I) comply with this Act and 
parts B and E of title IV of the Social 
Security Act (42 U.S.C. 621 et seq., 
670 et seq.); and 
‘‘(II) comply with requirements to 
refer a child identified as substance-ex-
posed to early intervention services as 
required pursuant to a grant under 
part C of the Individuals with Disabil-
ities Education Act (20 U.S.C. 1431 et 
seq.). 
‘‘(D) USES OF FUNDS.—Funds awarded to 
a State under this paragraph may be used for 
the following activities, which may be carried 
out by the State directly, or through grants or 
subgrants, contracts, or cooperative agreements: 
‘‘(i) Improving State and local systems 
with respect to the development and imple-
mentation of plans of safe care, which— 
‘‘(I) shall include parent and 
caregiver 
engagement, 
as 
required 
under section 106(b)(2)(B)(iii)(I), re-
garding available treatment and serv-
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† HR 6 EAS 
ice options, which may include re-
sources 
available 
for 
pregnant, 
perinatal, and postnatal women; and 
‘‘(II) may include activities such 
as— 
‘‘(aa) 
developing 
policies, 
procedures, or protocols for the 
administration or development of 
evidence-based 
and 
validated 
screening tools for infants who 
may be affected by substance use 
withdrawal symptoms or a fetal 
alcohol spectrum disorder and 
pregnant, perinatal, and post-
natal women whose infants may 
be affected by substance use with-
drawal symptoms or a fetal alco-
hol spectrum disorder; 
‘‘(bb) improving assessments 
used to determine the needs of the 
infant and family; 
‘‘(cc) improving ongoing case 
management services; and 
‘‘(dd) improving access to 
treatment services, which may be
126 
† HR 6 EAS 
prior to the pregnant woman’s de-
livery date. 
‘‘(ii) Developing policies, procedures, 
or protocols in consultation and coordina-
tion with health professionals, public and 
private health facilities, and substance use 
disorder treatment agencies to ensure that— 
‘‘(I) appropriate notification to 
child protective services is made in a 
timely manner; 
‘‘(II) a plan of safe care is in 
place, in accordance with section 
106(b)(2)(B)(iii), before the infant is 
discharged from the birth or health 
care facility; and 
‘‘(III) such health and related 
agency professionals are trained on 
how to follow such protocols and are 
aware of the supports that may be pro-
vided under a plan of safe care. 
‘‘(iii) Training health professionals 
and health system leaders, child welfare 
workers, substance use disorder treatment 
agencies, and other related professionals
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† HR 6 EAS 
such as home visiting agency staff and law 
enforcement in relevant topics including— 
‘‘(I) State mandatory reporting 
laws and the referral and process re-
quirements for notification to child 
protective services when child abuse or 
neglect reporting is not mandated; 
‘‘(II) the co-occurrence of preg-
nancy and substance use disorder, and 
implications of prenatal exposure; 
‘‘(III) the clinical guidance about 
treating substance use disorder in 
pregnant and postpartum women; 
‘‘(IV) appropriate screening and 
interventions for infants affected by 
substance use disorder, withdrawal 
symptoms, or a fetal alcohol spectrum 
disorder and the requirements under 
section 106(b)(2)(B)(iii); and 
‘‘(V) 
appropriate 
multigenerational strategies to address 
the mental health needs of the parent 
and child together. 
‘‘(iv) Establishing partnerships, agree-
ments, or memoranda of understanding be-
128 
† HR 6 EAS 
tween the lead agency and health profes-
sionals, health facilities, child welfare pro-
fessionals, juvenile and family court judges, 
substance use and mental disorder treat-
ment programs, early childhood education 
programs, and maternal and child health 
and early intervention professionals, includ-
ing home visiting providers, peer-to-peer re-
covery programs such as parent mentoring 
programs, and housing agencies to facilitate 
the implementation of, and compliance with 
section 106(b)(2) and clause (ii) of this sub-
paragraph, in areas which may include— 
‘‘(I) developing a comprehensive, 
multi-disciplinary 
assessment 
and 
intervention process for infants, preg-
nant women, and their families who 
are affected by substance use disorder, 
withdrawal symptoms, or a fetal alco-
hol spectrum disorder, that includes 
meaningful engagement with and takes 
into account the unique needs of each 
family and addresses differences be-
tween medically supervised substance 
use, including for the treatment of sub-
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† HR 6 EAS 
stance use disorder, and substance use 
disorder; 
‘‘(II) ensuring that treatment ap-
proaches for serving infants, pregnant 
women, and perinatal and postnatal 
women whose infants may be affected 
by substance use, withdrawal symp-
toms, or a fetal alcohol spectrum dis-
order, are designed to, where appro-
priate, keep infants with their mothers 
during both inpatient and outpatient 
treatment; and 
‘‘(III) increasing access to all evi-
dence-based medication-assisted treat-
ment approved by the Food and Drug 
Administration, behavioral therapy, 
and counseling services for the treat-
ment of substance use disorders, as ap-
propriate. 
‘‘(v) Developing and updating systems 
of technology for improved data collection 
and 
monitoring 
under 
section 
106(b)(2)(B)(iii), including existing elec-
tronic medical records, to measure the out-
comes achieved through the plans of safe
130 
† HR 6 EAS 
care, including monitoring systems to meet 
the requirements of this Act and submission 
of performance measures. 
‘‘(E) REPORTING.—Each State that receives 
funds under this paragraph, for each year such 
funds are received, shall submit a report to the 
Secretary, disaggregated by geographic location, 
economic status, and major racial and ethnic 
groups, except that such disaggregation shall not 
be required if the results would reveal personally 
identifiable information on, with respect to in-
fants identified under section 106(b)(2)(B)(ii)— 
‘‘(i) the number who experienced re-
moval associated with parental substance 
use; 
‘‘(ii) the number who experienced re-
moval and subsequently are reunified with 
parents, and the length of time between such 
removal and reunification; 
‘‘(iii) the number who are referred to 
community providers without a child pro-
tection case; 
‘‘(iv) the number who receive services 
while in the care of their birth parents;
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† HR 6 EAS 
‘‘(v) the number who receive post-re-
unification services within 1 year after a 
reunification has occurred; and 
‘‘(vi) the number who experienced a re-
turn to out-of-home care within 1 year after 
reunification. 
‘‘(F) 
SECRETARY’S
REPORT
TO
CON-
GRESS.—The Secretary shall submit an annual 
report to the Committee on Health, Education, 
Labor, and Pensions and the Committee on Ap-
propriations of the Senate and the Committee on 
Education and the Workforce and the Committee 
on Appropriations of the House of Representa-
tives that includes the information described in 
subparagraph (E) and recommendations or ob-
servations on the challenges, successes, and les-
sons derived from implementation of the grant 
program. 
‘‘(G) RESERVATION OF FUNDS.—The Sec-
retary shall use the amount reserved under sub-
paragraph (B)(i)(I) for the purposes of— 
‘‘(i) providing technical assistance, in-
cluding programs of in-depth technical as-
sistance, to additional States, territories, 
and Indian Tribes and tribal organizations
132 
† HR 6 EAS 
in accordance with the substance-exposed 
infant initiative developed by the National 
Center on Substance Abuse and Child Wel-
fare; 
‘‘(ii) issuing guidance on the require-
ments of this Act with respect to infants 
born with and identified as being affected 
by substance use or withdrawal symptoms 
or fetal alcohol spectrum disorder, as de-
scribed in clauses (ii) and (iii) of section 
106(b)(2)(B), including by— 
‘‘(I) clarifying key terms; and 
‘‘(II) disseminating best practices 
on implementation of plans of safe 
care, on such topics as differential re-
sponse, collaboration and coordination, 
and identification and delivery of serv-
ices for different populations; 
‘‘(iii) supporting State efforts to de-
velop information technology systems to 
manage plans of safe care; and 
‘‘(iv) preparing the Secretary’s report 
to Congress described in subparagraph (F). 
‘‘(H) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—To carry out the program under this
133 
† HR 6 EAS 
paragraph, there is authorized to be appro-
priated $60,000,000 for each of fiscal years 2019 
through 2023.’’. 
SEC. 1415. REGULATIONS RELATING TO SPECIAL REGISTRA-
TION FOR TELEMEDICINE. 
Section 311(h) of the Controlled Substances Act (21 
U.S.C. 831(h)) is amended by striking paragraph (2) and 
inserting the following: 
‘‘(2) REGULATIONS.— 
‘‘(A) IN GENERAL.—Not later than 1 year 
after the date of enactment of the Opioid Crisis 
Response Act of 2018, in consultation with the 
Secretary, and in accordance with the procedure 
described in subparagraph (B), the Attorney 
General shall promulgate final regulations speci-
fying— 
‘‘(i) the limited circumstances in which 
a special registration under this subsection 
may be issued; and 
‘‘(ii) the procedure for obtaining a spe-
cial registration under this subsection. 
‘‘(B) PROCEDURE.—In promulgating final 
regulations under subparagraph (A), the Attor-
ney General shall—
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† HR 6 EAS 
‘‘(i) issue a notice of proposed rule-
making that includes a copy of the proposed 
regulations; 
‘‘(ii) provide a period of not less than 
60 days for comments on the proposed regu-
lations; 
‘‘(iii) finalize the proposed regulation 
not later than 6 months after the close of the 
comment period; and 
‘‘(iv) publish the final regulations not 
later than 30 days before the effective date 
of the final regulations.’’. 
SEC. 1416. NATIONAL HEALTH SERVICE CORPS BEHAV-
IORAL 
AND 
MENTAL 
HEALTH 
PROFES-
SIONALS PROVIDING OBLIGATED SERVICE IN 
SCHOOLS AND OTHER COMMUNITY-BASED 
SETTINGS. 
Subpart III of part D of title III of the Public Health 
Service Act (42 U.S.C. 254l et seq.) is amended by adding 
at the end the following:
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† HR 6 EAS 
‘‘SEC. 338N. BEHAVIORAL AND MENTAL HEALTH PROFES-
SIONALS PROVIDING OBLIGATED SERVICE IN 
SCHOOLS AND OTHER COMMUNITY-BASED 
SETTINGS. 
‘‘(a) SCHOOLS AND COMMUNITY-BASED SETTINGS.— 
An entity to which a participant in the Scholarship Pro-
gram or the Loan Repayment Program (referred to in this 
section as a ‘participant’) is assigned under section 333 
may direct such participant to provide service as a behav-
ioral or mental health professional at a school or other com-
munity-based setting located in a health professional short-
age area. 
‘‘(b) OBLIGATED SERVICE.— 
‘‘(1) IN GENERAL.—Any service described in sub-
section (a) that a participant provides may count to-
wards such participant’s completion of any obligated 
service requirements under the Scholarship Program 
or the Loan Repayment Program, subject to any limi-
tation imposed under paragraph (2). 
‘‘(2) LIMITATION.—The Secretary may impose a 
limitation on the number of hours of service described 
in subsection (a) that a participant may credit to-
wards completing obligated service requirements, pro-
vided that the limitation allows a member to credit 
service described in subsection (a) for not less than 50
136 
† HR 6 EAS 
percent of the total hours required to complete such 
obligated service requirements. 
‘‘(c) RULE
OF CONSTRUCTION.—The authorization 
under subsection (a) shall be notwithstanding any other 
provision of this subpart or subpart II.’’. 
SEC. 1417. LOAN REPAYMENT FOR SUBSTANCE USE DIS-
ORDER TREATMENT PROVIDERS. 
(a) LOAN REPAYMENT FOR SUBSTANCE USE TREAT-
MENT PROVIDERS.—The Secretary shall enter into con-
tracts under section 338B of the Public Health Service Act 
(42 U.S.C. 254l–1) with eligible health professionals pro-
viding substance use disorder treatment services in sub-
stance use disorder treatment facilities, as defined by the 
Secretary. 
(b) PROVISION OF SUBSTANCE USE DISORDER TREAT-
MENT.—In carrying out the activities described in sub-
section (a)— 
(1) each such facility shall be located in or serv-
ing a mental health professional shortage area des-
ignated under section 332 of the Public Health Serv-
ice Act (42 U.S.C. 254e), or, as the Secretary deter-
mines appropriate, an area with an age-adjusted rate 
of drug overdose deaths that is above the national 
overdose mortality rate;
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† HR 6 EAS 
(2) section 331(a)(3)(D) of such Act (42 U.S.C. 
254d(a)(3)(D)) shall be applied as if the term ‘‘pri-
mary health services’’ includes health services regard-
ing substance use disorder treatment and infections 
associated with illicit drug use; 
(3) section 331(a)(3)(E)(i) of such Act (42 
U.S.C. 254d(a)(3)(E)(i)) shall be applied as if the 
term ‘‘behavioral and mental health professionals’’ in-
cludes master’s level, licensed substance use disorder 
treatment counselors, and other relevant professionals 
or paraprofessionals, as the Secretary determines ap-
propriate; and 
(4) such professionals and facilities shall pro-
vide— 
(A) directly, or through the use of telehealth 
technology, and pursuant to Federal and State 
law, counseling by a program counselor or other 
certified professional who is licensed and quali-
fied by education, training, or experience to as-
sess the psychological and sociological back-
ground of patients, to contribute to the appro-
priate treatment plan for the patient, and to 
monitor progress; and 
(B) medication-assisted treatment, includ-
ing, to the extent practicable, all drugs approved
138 
† HR 6 EAS 
by the Food and Drug Administration to treat 
substance use disorders, pursuant to Federal and 
State law. 
(c) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section 
$25,000,000 for each of fiscal years 2019 through 2023. 
SEC. 1418. PROTECTING MOMS AND INFANTS. 
(a) REPORT.— 
(1) IN GENERAL.—Not later than 60 days after 
the date of enactment of this Act, the Secretary shall 
submit to the appropriate committees of Congress and 
make available to the public on the internet website 
of the Department of Health and Human Services a 
report regarding the implementation of the rec-
ommendations in the strategy relating to prenatal 
opioid use, including neonatal abstinence syndrome, 
developed pursuant to section 2 of the Protecting Our 
Infants Act of 2015 (Public Law 114–91). Such re-
port shall include— 
(A) an update on the implementation of the 
recommendations in the strategy, including in-
formation regarding the agencies involved in the 
implementation; and 
(B) information on additional funding or 
authority the Secretary requires, if any, to im-
139 
† HR 6 EAS 
plement the strategy, which may include au-
thorities needed to coordinate implementation of 
such strategy across the Department of Health 
and Human Services. 
(2) PERIODIC
UPDATES.—The Secretary shall 
periodically update the report under paragraph (1). 
(b) RESIDENTIAL TREATMENT PROGRAMS FOR PREG-
NANT AND POSTPARTUM WOMEN.—Section 508(s) of the 
Public Health Service Act (42 U.S.C. 290bb–1(s)) is amend-
ed by striking ‘‘$16,900,000 for each of fiscal years 2017 
through 2021’’ and inserting ‘‘$29,931,000 for each of fiscal 
years 2019 through 2023’’. 
SEC. 1419. EARLY INTERVENTIONS FOR PREGNANT WOMEN 
AND INFANTS. 
(a) DEVELOPMENT OF EDUCATIONAL MATERIALS BY 
CENTER FOR SUBSTANCE ABUSE PREVENTION.—Section 
515(b) of the Public Health Service Act (42 U.S.C. 290bb– 
21(b)) is amended— 
(1) in paragraph (13), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (14), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(15) in cooperation with relevant stakeholders 
and the Director of the Centers for Disease Control
140 
† HR 6 EAS 
and Prevention, develop educational materials for cli-
nicians to use with pregnant women for shared deci-
sionmaking regarding pain management during preg-
nancy.’’. 
(b) GUIDELINES AND RECOMMENDATIONS BY CENTER 
FOR SUBSTANCE ABUSE TREATMENT.—Section 507(b) of 
the Public Health Service Act (42 U.S.C. 290bb(b)) is 
amended— 
(1) in paragraph (13), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (14), by striking the period at 
the end and inserting a semicolon; and 
(3) by adding at the end the following: 
‘‘(15) in cooperation with the Secretary, imple-
ment and disseminate, as appropriate, the rec-
ommendations in the report entitled ‘Protecting Our 
Infants Act: Final Strategy’ issued by the Depart-
ment of Health and Human Services in 2017; and’’. 
(c) SUPPORT OF PARTNERSHIPS BY CENTER FOR SUB-
STANCE ABUSE TREATMENT.—Section 507(b) of the Public 
Health Service Act (42 U.S.C. 290bb(b)), as amended by 
subsection (b), is further amended by adding at the end the 
following: 
‘‘(16) in cooperation with relevant stakeholders, 
support public-private partnerships to assist with
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† HR 6 EAS 
education about, and support with respect to, sub-
stance use disorder for pregnant women and health 
care providers who treat pregnant women and ba-
bies.’’. 
SEC. 1420. REPORT ON INVESTIGATIONS REGARDING PAR-
ITY IN MENTAL HEALTH AND SUBSTANCE USE 
DISORDER BENEFITS. 
(a) IN GENERAL.—Section 13003 of the 21st Century 
Cures Act (Public Law 114–255) is amended— 
(1) in subsection (a), by striking ‘‘with findings 
of any serious violation regarding’’ and inserting 
‘‘concerning’’; and 
(2) in subsection (b)(1)— 
(A) by inserting ‘‘complaints received and 
number of’’ before ‘‘closed’’; and 
(B) by inserting before the period ‘‘, and, 
for each such investigation closed, which agency 
conducted the investigation, whether the health 
plan that is the subject of the investigation is 
fully insured or not fully insured and a sum-
mary of any coordination between the applicable 
State regulators and the Department of Labor, 
the Department of Health and Human Services, 
or the Department of the Treasury, and ref-
142 
† HR 6 EAS 
erences to any guidance provided by the agencies 
addressing the category of violation committed’’. 
(b) APPLICABILITY.—The amendments made by sub-
section (a) shall apply with respect to the second annual 
report required under such section 13003 and each such an-
nual report thereafter. 
Subtitle E—Prevention 
SEC. 1501. STUDY ON PRESCRIBING LIMITS. 
Not later than 2 years after the date of enactment of 
this Act, the Secretary, in consultation with the Attorney 
General, shall submit to the Committee on Health, Edu-
cation, Labor, and Pensions of the Senate and the Com-
mittee on Energy and Commerce of the House of Represent-
atives a report on the impact of Federal and State laws 
and regulations that limit the length, quantity, or dosage 
of opioid prescriptions. Such report shall address— 
(1) the impact of such limits on— 
(A) the incidence and prevalence of overdose 
related to prescription opioids; 
(B) the incidence and prevalence of overdose 
related to illicit opioids; 
(C) the prevalence of opioid use disorders; 
(D) medically appropriate use of, and ac-
cess to, opioids, including any impact on travel 
expenses and pain management outcomes for pa-
143 
† HR 6 EAS 
tients, whether such limits are associated with 
significantly higher rates of negative health out-
comes, including suicide, and whether the impact 
of such limits differs based on the clinical indi-
cation for which opioids are prescribed; 
(2) whether such limits lead to a significant in-
crease in burden for prescribers of opioids or pre-
scribers of treatments for opioid use disorder, includ-
ing any impact on patient access to treatment, and 
whether any such burden is mitigated by any factors 
such as electronic prescribing or telemedicine; and 
(3) the impact of such limits on diversion or 
misuse of any controlled substance in schedule II, III, 
or IV of section 202(c) of the Controlled Substances 
Act (21 U.S.C. 812(c)). 
SEC. 1502. PROGRAMS FOR HEALTH CARE WORKFORCE. 
(a) PROGRAM FOR EDUCATION AND TRAINING IN PAIN 
CARE.—Section 759 of the Public Health Service Act (42 
U.S.C. 294i) is amended— 
(1) in subsection (a), by striking ‘‘hospices, and 
other public and private entities’’ and inserting ‘‘hos-
pices, tribal health programs (as defined in section 4 
of the Indian Health Care Improvement Act), and 
other public and nonprofit private entities’’; 
(2) in subsection (b)—
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† HR 6 EAS 
(A) in the matter preceding paragraph (1), 
by striking ‘‘award may be made under sub-
section (a) only if the applicant for the award 
agrees that the program carried out with the 
award will include’’ and inserting ‘‘entity re-
ceiving an award under this section shall develop 
a comprehensive education and training plan 
that includes’’; 
(B) in paragraph (1)— 
(i) by inserting ‘‘preventing,’’ after 
‘‘diagnosing,’’; and 
(ii) by inserting ‘‘non-addictive med-
ical products and non-pharmacologic treat-
ments and’’ after ‘‘including’’; 
(C) in paragraph (2)— 
(i) by inserting ‘‘Federal, State, and 
local’’ after ‘‘applicable’’; and 
(ii) by striking ‘‘the degree to which’’ 
and all that follows through ‘‘effective pain 
care’’ and inserting ‘‘opioids’’; 
(D) in paragraph (3), by inserting ‘‘, inte-
grated, evidence-based pain management, and, as 
appropriate, non-pharmacotherapy’’ before the 
semicolon;
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† HR 6 EAS 
(E) in paragraph (4), by striking ‘‘; and’’ 
and inserting ‘‘;’’; and 
(F) by striking paragraph (5) and inserting 
the following: 
‘‘(5) recent findings, developments, and advance-
ments in pain care research and the provision of pain 
care, which may include non-addictive medical prod-
ucts and non-pharmacologic treatments intended to 
treat pain; and 
‘‘(6) the dangers of opioid abuse and misuse, de-
tection of early warning signs of opioid use disorders 
(which may include best practices related to screening 
for opioid use disorders, training on screening, brief 
intervention, and referral to treatment), and safe dis-
posal options for prescription medications (including 
such options provided by law enforcement or other in-
novative deactivation mechanisms).’’; 
(3) in subsection (d), by inserting ‘‘prevention,’’ 
after ‘‘diagnosis,’’; and 
(4) in subsection (e), by striking ‘‘2010 through 
2012’’ and inserting ‘‘2019 through 2023’’. 
(b) MENTAL AND BEHAVIORAL HEALTH EDUCATION 
AND TRAINING PROGRAM.—Section 756(a) of the Public 
Health Service Act (42 U.S.C. 294e–1(a)) is amended—
146 
† HR 6 EAS 
(1) in paragraph (1), by inserting ‘‘, trauma,’’ 
after ‘‘focus on child and adolescent mental health’’; 
and 
(2) in paragraphs (2) and (3), by inserting 
‘‘trauma-informed care and’’ before ‘‘substance use 
disorder prevention and treatment services’’. 
SEC. 1503. EDUCATION AND AWARENESS CAMPAIGNS. 
Section 102 of the Comprehensive Addiction and Re-
covery Act of 2016 (Public Law 114–198) is amended— 
(1) by amending subsection (a) to read as fol-
lows: 
‘‘(a) IN GENERAL.—The Secretary of Health and 
Human Services, acting through the Director of the Centers 
for Disease Control and Prevention and in coordination 
with the heads of other departments and agencies, shall ad-
vance education and awareness regarding the risks related 
to misuse and abuse of opioids, as appropriate, which may 
include developing or improving existing programs, con-
ducting activities, and awarding grants that advance the 
education and awareness of— 
‘‘(1) the public, including patients and con-
sumers; 
‘‘(2) patients, consumers, and other appropriate 
members of the public, regarding such risks related to 
unused opioids and the dispensing options under sec-
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tion 309(f) of the Controlled Substances Act, as appli-
cable; 
‘‘(3) providers, which may include— 
‘‘(A) providing for continuing education on 
appropriate prescribing practices; 
‘‘(B) education related to applicable State 
or local prescriber limit laws, information on the 
use of non-addictive alternatives for pain man-
agement, and the use of overdose reversal drugs, 
as appropriate; 
‘‘(C) disseminating and improving the use 
of evidence-based opioid prescribing guidelines 
across relevant health care settings, as appro-
priate, and updating guidelines as necessary; 
‘‘(D) implementing strategies, such as best 
practices, to encourage and facilitate the use of 
prescriber guidelines, in accordance with State 
and local law; 
‘‘(E) disseminating information to pro-
viders about prescribing options for controlled 
substances, including such options under section 
309(f) of the Controlled Substances Act, as appli-
cable; and 
‘‘(F) disseminating information, as appro-
priate, on the National Pain Strategy developed
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by or in consultation with the Assistant Sec-
retary for Health; and 
‘‘(4) other appropriate entities.’’; and 
(2) in subsection (b)— 
(A) by striking ‘‘opioid abuse’’ each place 
such term appears and inserting ‘‘opioid misuse 
and abuse’’; and 
(B) in paragraph (2), by striking ‘‘safe dis-
posal of prescription medications and other’’ and 
inserting ‘‘non-addictive treatment options, safe 
disposal options for prescription medications, 
and other applicable’’. 
SEC. 
1504. 
ENHANCED 
CONTROLLED 
SUBSTANCE 
OVERDOSES DATA COLLECTION, ANALYSIS, 
AND DISSEMINATION. 
Part J of title III of the Public Health Service Act 
is amended by inserting after section 392 (42 U.S.C. 280b– 
1) the following: 
‘‘SEC. 
392A. 
ENHANCED 
CONTROLLED 
SUBSTANCE 
OVERDOSES DATA COLLECTION, ANALYSIS, 
AND DISSEMINATION. 
‘‘(a) IN GENERAL.—The Director of the Centers for 
Disease Control and Prevention, using the authority pro-
vided to the Director under section 392, may—
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‘‘(1) to the extent practicable, carry out and ex-
pand any controlled substance overdose data collec-
tion, analysis, and dissemination activity described 
in subsection (b); 
‘‘(2) provide training and technical assistance to 
States, localities, and Indian Tribes for the purpose 
of carrying out any such activity; and 
‘‘(3) award grants to States, localities, and In-
dian Tribes for the purpose of carrying out any such 
activity. 
‘‘(b) CONTROLLED SUBSTANCE OVERDOSE DATA COL-
LECTION
AND ANALYSIS ACTIVITIES.—A controlled sub-
stance overdose data collection, analysis, and dissemination 
activity described in this subsection is any of the following 
activities: 
‘‘(1) Improving the timeliness of reporting aggre-
gate data to the public, including data on fatal and 
nonfatal controlled substance overdoses. 
‘‘(2) Enhancing the comprehensiveness of con-
trolled substance overdose data by collecting informa-
tion on such overdoses from appropriate sources such 
as toxicology reports, autopsy reports, death scene in-
vestigations, and emergency department services.
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SEC. 1505. PREVENTING OVERDOSES OF CONTROLLED SUB-
STANCES. 
Part J of title III of the Public Health Service Act 
(42 U.S.C. 280b et seq.), as amended by section 504, is fur-
ther amended by inserting after section 392A the following: 
‘‘SEC. 392B. PREVENTING OVERDOSES OF CONTROLLED 
SUBSTANCES. 
‘‘(a) PREVENTION ACTIVITIES.— 
‘‘(1) IN GENERAL.—The Director of the Centers 
for Disease Control and Prevention (referred to in 
this section as the ‘Director’), using the authority 
provided to the Director under section 392, may— 
‘‘(A) to the extent practicable, carry out and 
expand any prevention activity described in 
paragraph (2); 
‘‘(B) provide training and technical assist-
ance to States, localities, and Indian Tribes to 
carry out any such activity; and 
‘‘(C) award grants to States, localities, and 
Indian Tribes for the purpose of carrying out 
any such activity. 
‘‘(2) PREVENTION ACTIVITIES.—A prevention ac-
tivity described in this paragraph is an activity to 
improve the efficiency and use of a new or currently 
operating prescription drug monitoring program, 
such as—
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‘‘(A) encouraging all authorized users (as 
specified by the State or other entity) to register 
with and use the program; 
‘‘(B) enabling such users to access any data 
updates in as close to real-time as practicable; 
‘‘(C) providing for a mechanism for the pro-
gram to notify authorized users of any potential 
misuse or abuse of controlled substances and any 
detection of inappropriate prescribing or dis-
pensing practices relating to such substances; 
‘‘(D) encouraging the analysis of prescrip-
tion drug monitoring data for purposes of pro-
viding de-identified, aggregate reports based on 
such analysis to State public health agencies, 
State alcohol and drug agencies, State licensing 
boards, and other appropriate State agencies, as 
permitted under applicable Federal and State 
law and the policies of the prescription drug 
monitoring program and not containing any 
protected health information, to prevent inappro-
priate prescribing, drug diversion, or abuse and 
misuse of controlled substances, and to facilitate 
better coordination among agencies; 
‘‘(E) enhancing interoperability between the 
program and any health information technology
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(including certified health information tech-
nology), including by integrating program data 
into such technology; 
‘‘(F) updating program capabilities to re-
spond to technological innovation for purposes of 
appropriately addressing the occurrence and evo-
lution of controlled substance overdoses; 
‘‘(G) developing or enhancing data exchange 
with other sources such as the Medicaid agency, 
the Medicare program, pharmacy benefit man-
agers, coroners’ reports, and workers’ compensa-
tion data; 
‘‘(H) facilitating and encouraging data ex-
change between the program and the prescription 
drug monitoring programs of other States; 
‘‘(I) enhancing data collection and quality, 
including improving patient matching and 
proactively monitoring data quality; and 
‘‘(J) providing prescriber and dispenser 
practice tools, including prescriber practice in-
sight reports for practitioners to review their 
prescribing patterns in comparison to such pat-
ters of other practitioners in the specialty. 
‘‘(b) ADDITIONAL GRANTS.—The Director may award 
grants to States, localities, and Indian Tribes—
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‘‘(1) to carry out innovative projects for grantees 
to rapidly respond to controlled substance misuse, 
abuse, and overdoses, including changes in patterns of 
controlled substance use; and 
‘‘(2) for any other evidence-based activity for 
preventing controlled substance misuse, abuse, and 
overdoses as the Director determines appropriate. 
‘‘(c) RESEARCH.—The Director, in coordination with 
the Assistant Secretary for Mental Health and Substance 
Use and the National Mental Health and Substance Use 
Policy Laboratory established under section 501A, as ap-
propriate and applicable, may conduct studies and evalua-
tions to address substance use disorders, including pre-
venting substance use disorders or other related topics the 
Director determines appropriate. 
‘‘(d) PUBLIC AND PRESCRIBER EDUCATION.—Pursu-
ant to section 102 of the Comprehensive Addiction and Re-
covery Act of 2016, the Director may advance the education 
and awareness of prescribers and the public regarding the 
risk of abuse and misuse of prescription opioids. 
‘‘(e) DEFINITIONS.—In this section— 
‘‘(1) the term ‘controlled substance’ has the 
meaning given that term in section 102 of the Con-
trolled Substances Act; and
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‘‘(2) the term ‘Indian Tribe’ has the meaning 
given the term ‘Indian tribe’ in section 4 of the In-
dian Self-Determination and Education Assistance 
Act. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For pur-
poses of carrying out this section, section 392A of this Act, 
and section 102 of the Comprehensive Addiction and Recov-
ery Act of 2016, there is authorized to be appropriated 
$486,000,000 for each of fiscal years 2019 through 2024.’’. 
SEC. 1506. CDC SURVEILLANCE AND DATA COLLECTION FOR 
CHILD, YOUTH, AND ADULT TRAUMA. 
(a) DATA COLLECTION.—The Director of the Centers 
for Disease Control and Prevention (referred to in this sec-
tion as the ‘‘Director’’) may, in cooperation with the States, 
collect and report data on adverse childhood experiences 
through the Behavioral Risk Factor Surveillance System, 
the Youth Risk Behavior Surveillance System, and other 
relevant public health surveys or questionnaires. 
(b) TIMING.—The collection of data under subsection 
(a) may occur in fiscal year 2019 and every 2 years there-
after. 
(c) DATA FROM RURAL AREAS.—The Director shall 
encourage each State that participates in collecting and re-
porting data under subsection (a) to collect and report data
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† HR 6 EAS 
from tribal and rural areas within such State, in order to 
generate a statistically reliable representation of such areas. 
(d) DATA FROM TRIBAL AREAS.—The Director may, 
in cooperation with Indian Tribes and pursuant to a writ-
ten request from an Indian Tribe, provide technical assist-
ance to such Indian Tribe to collect and report data on 
adverse childhood experiences through the Behavioral Risk 
Factor Surveillance System, the Youth Risk Behavior Sur-
veillance System, or another relevant public health survey 
or questionnaire. 
(e) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there is authorized to be appropriated such 
sums as may be necessary for the period of fiscal years 2019 
through 2021. 
SEC. 1507. REAUTHORIZATION OF NASPER. 
Section 399O of the Public Health Service Act (42 
U.S.C. 280g–3) is amended— 
(1) in subsection (a)— 
(A) in paragraph (1), in the matter pre-
ceding subparagraph (A), by striking ‘‘in con-
sultation with the Administrator of the Sub-
stance Abuse and Mental Health Services Ad-
ministration and Director of the Centers for Dis-
ease Control and Prevention’’ and inserting ‘‘in 
coordination with the Director of the Centers for
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† HR 6 EAS 
Disease Control and the heads of other depart-
ments and agencies as appropriate’’; and 
(B) by adding at the end the following: 
‘‘(4) STATES AND LOCAL GOVERNMENTS.— 
‘‘(A) IN GENERAL.—In the case of a State 
that does not have a prescription drug moni-
toring program, a county or other unit of local 
government within the State that has a prescrip-
tion drug monitoring program shall be treated as 
a State for purposes of this section, including for 
purposes of eligibility for grants under para-
graph (1). 
‘‘(B) PLAN
FOR
INTEROPERABILITY.—For 
purposes of meeting the interoperability require-
ments under subsection (c)(3), a county or other 
unit of local government shall submit a plan out-
lining the methods such county or unit of local 
government will use to ensure the capability of 
data sharing with other counties and units of 
local government within the State and with other 
States, as applicable.’’; 
(2) in subsection (c)— 
(A) in paragraph (1)(A)(iii)—
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† HR 6 EAS 
(i) by inserting ‘‘as such standards be-
come available,’’ after ‘‘interoperability 
standards,’’; and 
(ii) by striking ‘‘generated or identified 
by the Secretary or his or her designee’’ and 
inserting ‘‘recognized by the Office of the 
National Coordinator for Health Informa-
tion Technology’’; and 
(B) in paragraph (3)(A), by inserting ‘‘in-
cluding electronic health records,’’ after ‘‘tech-
nology systems,’’; 
(3) in subsection (d)(1), by striking ‘‘not later 
than 1 week after the date of such dispensing’’ and 
inserting ‘‘in as close to real time as practicable’’; 
(4) in subsection (f)— 
(A) in paragraph (1)(D), by striking ‘‘med-
icaid’’ and inserting ‘‘Medicaid’’; and 
(B) in paragraph (2)— 
(i) in subparagraph (A), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (B), by striking 
the period and inserting a semicolon; and 
(iii) by adding at the end the fol-
lowing:
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‘‘(C) may conduct analyses of controlled 
substance program data for purposes of pro-
viding appropriate State agencies with aggregate 
reports based on such analyses in as close to 
real-time as practicable, regarding prescription 
patterns flagged as potentially presenting a risk 
of misuse, abuse, addiction, overdose, and other 
aggregate information, as appropriate and in 
compliance with applicable Federal and State 
laws and provided that such reports shall not in-
clude protected health information; and 
‘‘(D) may access information about pre-
scriptions, such as claims data, to ensure that 
such prescribing and dispensing history is up-
dated in as close to real-time as practicable, in 
compliance with applicable Federal and State 
laws and provided that such information shall 
not include protected health information.’’; 
(5) in subsection (i), by inserting ‘‘, in collabora-
tion with the National Coordinator for Health Infor-
mation Technology and the Director of the National 
Institute of Standards and Technology,’’ after ‘‘The 
Secretary’’; and 
(6) in subsection (n), by striking ‘‘2021’’ and in-
serting ‘‘2026’’.
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† HR 6 EAS 
SEC. 1508. JESSIE’S LAW. 
(a) BEST PRACTICES.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of this Act, the Secretary, in 
consultation with appropriate stakeholders, including 
a patient with a history of opioid use disorder, an ex-
pert in electronic health records, an expert in the con-
fidentiality of patient health information and records, 
and a health care provider, shall identify or facilitate 
the development of best practices regarding— 
(A) the circumstances under which informa-
tion that a patient has provided to a health care 
provider regarding such patient’s history of 
opioid use disorder should, only at the patient’s 
request, be prominently displayed in the medical 
records (including electronic health records) of 
such patient; 
(B) what constitutes the patient’s request 
for the purpose described in subparagraph (A); 
and 
(C) the process and methods by which the 
information should be so displayed. 
(2) DISSEMINATION.—The Secretary shall dis-
seminate the best practices developed under para-
graph (1) to health care providers and State agencies.
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(b) REQUIREMENTS.—In identifying or facilitating 
the development of best practices under subsection (a), as 
applicable, the Secretary, in consultation with appropriate 
stakeholders, shall consider the following: 
(1) The potential for addiction relapse or over-
dose, including overdose death, when opioid medica-
tions are prescribed to a patient recovering from 
opioid use disorder. 
(2) The benefits of displaying information about 
a patient’s opioid use disorder history in a manner 
similar to other potentially lethal medical concerns, 
including drug allergies and contraindications. 
(3) The importance of prominently displaying 
information about a patient’s opioid use disorder 
when a physician or medical professional is pre-
scribing medication, including methods for avoiding 
alert fatigue in providers. 
(4) The importance of a variety of appropriate 
medical professionals, including physicians, nurses, 
and pharmacists, having access to information de-
scribed in this section when prescribing or dispensing 
opioid medication, consistent with Federal and State 
laws and regulations. 
(5) The importance of protecting patient pri-
vacy, including the requirements related to consent
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for disclosure of substance use disorder information 
under all applicable laws and regulations. 
(6) All applicable Federal and State laws and 
regulations. 
SEC. 1509. DEVELOPMENT AND DISSEMINATION OF MODEL 
TRAINING PROGRAMS FOR SUBSTANCE USE 
DISORDER PATIENT RECORDS. 
(a) INITIAL PROGRAMS AND MATERIALS.—Not later 
than 1 year after the date of the enactment of this Act, the 
Secretary, in consultation with appropriate experts, shall 
identify the following model programs and materials (or 
if no such programs or materials exist, recognize private 
or public entities to develop and disseminate such programs 
and materials): 
(1) Model programs and materials for training 
health care providers (including physicians, emer-
gency medical personnel, psychiatrists, psychologists, 
counselors, therapists, nurse practitioners, physician 
assistants, behavioral health facilities and clinics, 
care managers, and hospitals, including individuals 
such as general counsels or regulatory compliance 
staff who are responsible for establishing provider pri-
vacy policies) concerning the permitted uses and dis-
closures, consistent with the standards and regula-
tions governing the privacy and security of substance
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† HR 6 EAS 
use disorder patient records promulgated by the Sec-
retary under section 543 of the Public Health Service 
Act (42 U.S.C. 290dd–2) for the confidentiality of pa-
tient records. 
(2) Model programs and materials for training 
patients and their families regarding their rights to 
protect and obtain information under the standards 
and regulations described in paragraph (1). 
(b) REQUIREMENTS.—The model programs and mate-
rials described in paragraphs (1) and (2) of subsection (a) 
shall address circumstances under which disclosure of sub-
stance use disorder patient records is needed to— 
(1) facilitate communication between substance 
use disorder treatment providers and other health care 
providers to promote and provide the best possible in-
tegrated care; 
(2) avoid inappropriate prescribing that can 
lead to dangerous drug interactions, overdose, or re-
lapse; and 
(3) notify and involve families and caregivers 
when individuals experience an overdose. 
(c) PERIODIC UPDATES.—The Secretary shall— 
(1) periodically review and update the model 
program and materials identified or developed under 
subsection (a); and
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† HR 6 EAS 
(2) disseminate such updated programs and ma-
terials to the individuals described in subsection 
(a)(1). 
(d) INPUT OF CERTAIN ENTITIES.—In identifying, re-
viewing, or updating the model programs and materials 
under this section, the Secretary shall solicit the input of 
relevant stakeholders. 
(e) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section, such 
sums as may be necessary for each of fiscal years 2019 
through 2023. 
SEC. 1510. COMMUNICATION WITH FAMILIES DURING EMER-
GENCIES. 
(a) PROMOTING AWARENESS OF AUTHORIZED DISCLO-
SURES DURING EMERGENCIES.—The Secretary shall annu-
ally notify health care providers regarding permitted disclo-
sures during emergencies, including overdoses, of certain 
health information to families and caregivers under Federal 
health care privacy laws and regulations. 
(b) USE OF MATERIAL.—For the purposes of carrying 
out subsection (a), the Secretary may use material produced 
under section 1509 of this Act or under section 11004 of 
the 21st Century Cures Act (42 U.S.C. 1320d–2 note).
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SEC. 1511. PRENATAL AND POSTNATAL HEALTH. 
Section 317L of the Public Health Service Act (42 
U.S.C. 247b–13) is amended— 
(1) in subsection (a)— 
(A) by amending paragraph (1) to read as 
follows: 
‘‘(1) to collect, analyze, and make available data 
on prenatal smoking and alcohol and substance abuse 
and misuse, including— 
‘‘(A) data on— 
‘‘(i) the incidence, prevalence, and im-
plications of such activities; and 
‘‘(ii) the incidence and prevalence of 
implications and outcomes, including neo-
natal abstinence syndrome and other mater-
nal and child health outcomes associated 
with such activities; and 
‘‘(B) to inform such analysis, additional in-
formation or data on family health history, 
medication exposures during pregnancy, demo-
graphic information, such as race, ethnicity, geo-
graphic location, and family history, and other 
relevant information, as appropriate;’’; 
(B) in paragraph (2)—
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(i) by striking ‘‘prevention of’’ and in-
serting ‘‘prevention and long-term outcomes 
associated with’’; and 
(ii) by striking ‘‘illegal drug use’’ and 
inserting ‘‘substance abuse and misuse’’; 
(C) in paragraph (3), by striking ‘‘and ces-
sation programs; and’’ and inserting ‘‘, treat-
ment, and cessation programs;’’; 
(D) in paragraph (4), by striking ‘‘illegal 
drug use.’’ and inserting ‘‘substance abuse and 
misuse; and’’; and 
(E) by adding at the end the following: 
‘‘(5) to issue public reports on the analysis of 
data described in paragraph (1), including analysis 
of— 
‘‘(A) long-term outcomes of children affected 
by neonatal abstinence syndrome; 
‘‘(B) health outcomes associated with pre-
natal smoking, alcohol, and substance abuse and 
misuse; and 
‘‘(C) relevant studies, evaluations, or infor-
mation the Secretary determines to be appro-
priate.’’; 
(2) in subsection (b), by inserting ‘‘tribal enti-
ties,’’ after ‘‘local governments,’’;
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† HR 6 EAS 
(3) by redesignating subsection (c) as subsection 
(d); 
(4) by inserting after subsection (b) the fol-
lowing: 
‘‘(c) COORDINATING ACTIVITIES.—To carry out this 
section, the Secretary may— 
‘‘(1) provide technical and consultative assist-
ance to entities receiving grants under subsection (b); 
‘‘(2) ensure a pathway for data sharing between 
States, tribal entities, and the Centers for Disease 
Control and Prevention; 
‘‘(3) ensure data collection under this section is 
consistent with applicable State, Federal, and Tribal 
privacy laws; and 
‘‘(4) coordinate with the National Coordinator 
for Health Information Technology, as appropriate, 
to assist States and Tribes in implementing systems 
that use standards recognized by such National Coor-
dinator, as such recognized standards are available, 
in order to facilitate interoperability between such 
systems and health information technology systems, 
including certified health information technology.’’; 
and
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† HR 6 EAS 
(5) in subsection (d), as so redesignated, by 
striking ‘‘2001 through 2005’’ and inserting ‘‘2019 
through 2023’’. 
SEC. 1512. SURVEILLANCE AND EDUCATION REGARDING IN-
FECTIONS ASSOCIATED WITH ILLICIT DRUG 
USE AND OTHER RISK FACTORS. 
Section 317N of the Public Health Service Act (42 
U.S.C. 247b–15) is amended— 
(1) by amending the section heading to read as 
follows: ‘‘SURVEILLANCE
AND
EDUCATION
RE-
GARDING
INFECTIONS
ASSOCIATED
WITH
IL-
LICIT DRUG USE AND OTHER RISK FACTORS’’; 
(2) in subsection (a)— 
(A) in the matter preceding paragraph (1), 
by inserting ‘‘activities’’ before the colon; 
(B) in paragraph (1)— 
(i) by inserting ‘‘or maintaining’’ after 
‘‘implementing’’; 
(ii) by striking ‘‘hepatitis C virus in-
fection (in this section referred to as ‘HCV 
infection’)’’ and inserting ‘‘infections com-
monly associated with illicit drug use, 
which may include viral hepatitis, human 
immunodeficiency virus, and infective endo-
carditis,’’; and
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† HR 6 EAS 
(iii) by striking ‘‘such infection’’ and 
all that follows through the period at the 
end and inserting ‘‘such infections, which 
may include the reporting of cases of such 
infections.’’; 
(C) in paragraph (2), by striking ‘‘HCV in-
fection’’ and all that follows through the period 
at the end and inserting ‘‘infections as a result 
of illicit drug use, receiving blood transfusions 
prior to July 1992, or other risk factors.’’; 
(D) in paragraphs (4) and (5), by striking 
‘‘HCV infection’’ each place such term appears 
and inserting ‘‘infections described in paragraph 
(1)’’; and 
(E) in paragraph (5), by striking ‘‘pediatri-
cians and other primary care physicians, and 
obstetricians and gynecologists’’ and inserting 
‘‘substance use disorder treatment providers, pe-
diatricians, other primary care providers, and 
obstetrician-gynecologists’’; 
(3) in subsection (b)— 
(A) by striking ‘‘directly and’’ and insert-
ing ‘‘directly or’’; and 
(B) by striking ‘‘hepatitis C,’’ and all that 
follows through the period at the end and insert-
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† HR 6 EAS 
ing ‘‘infections described in subsection (a)(1).’’; 
and 
(4) in subsection (c), by striking ‘‘such sums as 
may be necessary for each of the fiscal years 2001 
through 2005’’ and inserting ‘‘$40,000,000 for each of 
fiscal years 2019 through 2023’’. 
SEC. 1513. TASK FORCE TO DEVELOP BEST PRACTICES FOR 
TRAUMA-INFORMED IDENTIFICATION, REFER-
RAL, AND SUPPORT. 
(a) ESTABLISHMENT.—There is established a task 
force, to be known as the Interagency Task Force on Trau-
ma-Informed Care (in this section referred to as the ‘‘task 
force’’) that shall identify, evaluate, and make recommenda-
tions regarding best practices with respect to children and 
youth, and their families as appropriate, who have experi-
enced or are at risk of experiencing trauma. 
(b) MEMBERSHIP.— 
(1) COMPOSITION.—The task force shall be com-
posed of the heads of the following Federal depart-
ments and agencies, or their designees: 
(A) The Centers for Medicare & Medicaid 
Services. 
(B) The Substance Abuse and Mental 
Health Services Administration.
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(C) The Agency for Healthcare Research 
and Quality. 
(D) The Centers for Disease Control and 
Prevention. 
(E) The Indian Health Service. 
(F) The Department of Veterans Affairs. 
(G) The National Institutes of Health. 
(H) The Food and Drug Administration. 
(I) The Health Resources and Services Ad-
ministration. 
(J) The Department of Defense. 
(K) The Office of Minority Health. 
(L) The Administration for Children and 
Families. 
(M) The Office of the Assistant Secretary 
for Planning and Evaluation. 
(N) The Office for Civil Rights of the De-
partment of Health and Human Services. 
(O) The Office of Juvenile Justice and De-
linquency Prevention of the Department of Jus-
tice. 
(P) The Office of Community Oriented Po-
licing Services of the Department of Justice. 
(Q) The Office on Violence Against Women 
of the Department of Justice.
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(R) The National Center for Education 
Evaluation and Regional Assistance of the De-
partment of Education. 
(S) The National Center for Special Edu-
cation Research of the Institute of Education 
Science. 
(T) The Office of Elementary and Sec-
ondary Education of the Department of Edu-
cation. 
(U) The Office for Civil Rights of the De-
partment of Education. 
(V) The Office of Special Education and 
Rehabilitative Services of the Department of 
Education. 
(W) The Bureau of Indian Affairs of the 
Department of the Interior. 
(X) The Veterans Health Administration of 
the Department of Veterans Affairs. 
(Y) The Office of Special Needs Assistance 
Programs of the Department of Housing and 
Urban Development. 
(Z) The Office of Head Start of the Admin-
istration for Children and Families. 
(AA) The Children’s Bureau of the Admin-
istration for Children and Families.
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(BB) The Bureau of Indian Education of 
the Department of the Interior. 
(CC) Such other Federal agencies as the 
Secretaries determine to be appropriate. 
(2) DATE OF APPOINTMENTS.—The heads of Fed-
eral departments and agencies shall appoint the cor-
responding members of the task force not later than 
6 months after the date of enactment of this Act. 
(3) CHAIRPERSON.—The task force shall be 
chaired by the Assistant Secretary for Mental Health 
and Substance Use. 
(c) TASK FORCE DUTIES.—The task force shall— 
(1) solicit input from stakeholders, including 
frontline service providers, educators, mental health 
professionals, researchers, experts in infant, child, and 
youth trauma, child welfare professionals, and the 
public, in order to inform the activities under para-
graph (2); and 
(2) identify, evaluate, make recommendations, 
and update such recommendations not less than an-
nually, to the general public, the Secretary of Edu-
cation, the Secretary of Health and Human Services, 
the Secretary of Labor, the Secretary of the Interior, 
the Attorney General, and other relevant cabinet Sec-
retaries, and Congress regarding—
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(A) a set of evidence-based, evidence-in-
formed, and promising best practices with re-
spect to— 
(i) the identification of infants, chil-
dren and youth, and their families as ap-
propriate, who have experienced or are at 
risk of experiencing trauma; and 
(ii) the expeditious referral to and im-
plementation of trauma-informed practices 
and supports that prevent and mitigate the 
effects of trauma; 
(B) a national strategy on how the task 
force and member agencies will collaborate, 
prioritize options for, and implement a coordi-
nated approach which may include data sharing 
and the awarding of grants that support infants, 
children, and youth, and their families as appro-
priate, who have experienced or are at risk of ex-
periencing trauma; and 
(C) existing Federal authorities at the De-
partment of Education, Department of Health 
and Human Services, Department of Justice, 
Department of Labor, Department of the Inte-
rior, and other relevant agencies, and specific 
Federal grant programs to disseminate best
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practices on, provide training in, or deliver serv-
ices through, trauma-informed practices, and 
disseminate such information— 
(i) in writing to relevant program of-
fices at such agencies to encourage grant 
applicants in writing to use such funds, 
where appropriate, for trauma-informed 
practices; and 
(ii) to the general public through the 
internet website of the task force. 
(d) BEST PRACTICES.—In identifying, evaluating, 
and recommending the set of best practices under subsection 
(c), the task force shall— 
(1) include guidelines for providing professional 
development for front-line services providers, includ-
ing school personnel, early childhood education pro-
gram providers, providers from child- or youth-serv-
ing organizations, housing and homeless providers, 
primary and behavioral health care providers, child 
welfare and social services providers, juvenile and 
family court personnel, health care providers, individ-
uals who are mandatory reporters of child abuse or 
neglect, trained nonclinical providers (including peer 
mentors and clergy), and first responders, in—
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(A) understanding and identifying early 
signs and risk factors of trauma in infants, chil-
dren, and youth, and their families as appro-
priate, including through screening processes; 
(B) providing practices to prevent and 
mitigate the impact of trauma, including by fos-
tering safe and stable environments and relation-
ships; and 
(C) developing and implementing policies, 
procedures, or systems that— 
(i) are designed to quickly refer in-
fants, children, youth, and their families as 
appropriate, who have experienced or are at 
risk of experiencing trauma to the appro-
priate trauma-informed screening and sup-
port, including age-appropriate treatment, 
and to ensure such infants, children, youth, 
and family members receive such support; 
(ii) utilize and develop partnerships 
with early childhood education programs, 
local social services organizations, such as 
organizations serving youth, and clinical 
mental health or health care service pro-
viders with expertise in providing support 
services (including age-appropriate trauma-
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informed and evidence-based treatment) 
aimed at preventing or mitigating the ef-
fects of trauma; 
(iii) educate children and youth to— 
(I) understand and identify the 
signs, effects, or symptoms of trauma; 
and 
(II) build the resilience and cop-
ing skills to mitigate the effects of expe-
riencing trauma; 
(iv) 
promote 
and 
support 
multi- 
generational practices that assist parents, 
foster parents, and kinship and other care-
givers in accessing resources related to, and 
developing environments conducive to, the 
prevention and mitigation of trauma; and 
(v) collect and utilize data from 
screenings, referrals, or the provision of 
services and supports to evaluate and im-
prove processes for trauma-informed sup-
port and outcomes that are culturally sen-
sitive, linguistically appropriate, and spe-
cific to age ranges and sex, as applicable; 
and
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(2) recommend best practices that are designed 
to avoid unwarranted custody loss or criminal pen-
alties for parents or guardians in connection with in-
fants, children, and youth who have experienced or 
are at risk of experiencing trauma. 
(e) OPERATING PLAN.—Not later than 1 year after the 
date of enactment of this Act, the task force shall hold the 
first meeting. Not later than 2 years after such date of en-
actment, the task force shall submit to the Secretary of Edu-
cation, Secretary of Health and Human Services, Secretary 
of Labor, Secretary of the Interior, the Attorney General, 
and Congress an operating plan for carrying out the activi-
ties of the task force described in subsection (c)(2). Such 
operating plan shall include— 
(1) a list of specific activities that the task force 
plans to carry out for purposes of carrying out duties 
described in subsection (c)(2), which may include 
public engagement; 
(2) a plan for carrying out the activities under 
subsection (c)(2); 
(3) a list of members of the task force and other 
individuals who are not members of the task force 
that may be consulted to carry out such activities; 
(4) an explanation of Federal agency involve-
ment and coordination needed to carry out such ac-
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tivities, including any statutory or regulatory bar-
riers to such coordination; 
(5) a budget for carrying out such activities; and 
(6) other information that the task force deter-
mines appropriate. 
(f) FINAL REPORT.—Not later than 3 years after the 
date of the first meeting of the task force, the task force shall 
submit to the general public, Secretary of Education, Sec-
retary of Health and Human Services, Secretary of Labor, 
Secretary of the Interior, the Attorney General, and other 
relevant cabinet Secretaries, and Congress, a final report 
containing all of the findings and recommendations re-
quired under this section. 
(g) DEFINITION.—In this section, the term ‘‘early 
childhood education program’’ has the meaning given such 
term in section 103 of the Higher Education Act of 1965 
(20 U.S.C. 1003). 
(h) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there is authorized to be appropriated such 
sums as may be necessary for each of fiscal years 2019 
through 2022. 
(i) SUNSET.—The task force shall on the date that is 
60 days after the submission of the final report under sub-
section (f), but not later than September 30, 2022.
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SEC. 1514. GRANTS TO IMPROVE TRAUMA SUPPORT SERV-
ICES AND MENTAL HEALTH CARE FOR CHIL-
DREN AND YOUTH IN EDUCATIONAL SET-
TINGS. 
(a) GRANTS, CONTRACTS, AND COOPERATIVE AGREE-
MENTS AUTHORIZED.—The Secretary, in coordination with 
the Assistant Secretary for Mental Health and Substance 
Use, is authorized to award grants to, or enter into con-
tracts or cooperative agreements with, State educational 
agencies, local educational agencies, Head Start agencies 
(including Early Head Start agencies), State or local agen-
cies that administer public preschool programs, Indian 
Tribes or their tribal educational agencies, a school operated 
by the Bureau of Indian Education, a Regional Corpora-
tion (as defined in section 3 of the Alaska Native Claims 
Settlement Act (43 U.S.C. 1602)), or a Native Hawaiian 
educational organization (as defined in section 6207 of the 
Elementary and Secondary Education Act of 1965 (20 
U.S.C. 7517)), for the purpose of increasing student access 
to evidence-based trauma support services and mental 
health care by developing innovative initiatives, activities, 
or programs to link local school systems with local trauma- 
informed support and mental health systems, including 
those under the Indian Health Service. 
(b) DURATION.—With respect to a grant, contract, or 
cooperative agreement awarded or entered into under this
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section, the period during which payments under such 
grant, contract or agreement are made to the recipient may 
not exceed 4 years. 
(c) USE OF FUNDS.—An entity that receives a grant, 
contract, or cooperative agreement under this section shall 
use amounts made available through such grant, contract, 
or cooperative agreement for evidence-based activities, 
which shall include any of the following: 
(1) Collaborative efforts between school-based 
service systems and trauma-informed support and 
mental health service systems to provide, develop, or 
improve prevention, screening, referral, and treatment 
and support services to students, such as by providing 
universal trauma screenings to identify students in 
need of specialized support. 
(2) To implement schoolwide multi-tiered posi-
tive behavioral interventions and supports, or other 
trauma-informed models of support. 
(3) To provide professional development to teach-
ers, teacher assistants, school leaders, specialized in-
structional support personnel, and mental health pro-
fessionals that— 
(A) fosters safe and stable learning environ-
ments that prevent and mitigate the effects of
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trauma, including through social and emotional 
learning; 
(B) improves school capacity to identify, 
refer, and provide services to students in need of 
trauma support or behavioral health services; or 
(C) reflects the best practices developed by 
the Interagency Task Force on Trauma-Informed 
Care established under section 513. 
(4) To create or enhance services at a full-service 
community school that focuses on trauma-informed 
supports, which may include establishing a school-site 
advisory team, managing, coordinating, or delivering 
pipeline services, hiring a full-time site coordinator, 
or other activities consistent with section 4625 of the 
Elementary and Secondary Education Act of 1965 
(20 U.S.C. 7275). 
(5) Engaging families and communities in ef-
forts to increase awareness of child and youth trau-
ma, which may include sharing best practices with 
law enforcement regarding trauma-informed care and 
working with mental health professionals to provide 
interventions, as well as longer term coordinated care 
within the community for children and youth who 
have experienced trauma and their families.
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(6) To provide technical assistance to school sys-
tems and mental health agencies. 
(7) To evaluate the effectiveness of the program 
carried out under this section in increasing student 
access to evidence-based trauma support services and 
mental health care. 
(d) APPLICATIONS.—To be eligible to receive a grant, 
contract, or cooperative agreement under this section, an 
entity described in subsection (a) shall submit an applica-
tion to the Secretary at such time, in such manner, and 
containing such information as the Secretary may reason-
ably require, which shall include the following: 
(1) A description of the innovative initiatives, 
activities, or programs to be funded under the grant, 
contract, or cooperative agreement, including how 
such program will increase access to evidence-based 
trauma support services and mental health care for 
students, and, as applicable, the families of such stu-
dents. 
(2) A description of how the program will pro-
vide linguistically appropriate and culturally com-
petent services. 
(3) A description of how the program will sup-
port students and the school in improving the school
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climate in order to support an environment conducive 
to learning. 
(4) An assurance that— 
(A) persons providing services under the 
grant, contract, or cooperative agreement are 
adequately trained to provide such services; and 
(B) teachers, school leaders, administrators, 
specialized instructional support personnel, rep-
resentatives of local Indian Tribes or tribal orga-
nizations as appropriate, other school personnel, 
and parents or guardians of students partici-
pating in services under this section will be en-
gaged and involved in the design and implemen-
tation of the services. 
(5) A description of how the applicant will sup-
port and integrate existing school-based services with 
the program in order to provide mental health serv-
ices for students, as appropriate. 
(e) INTERAGENCY AGREEMENTS.— 
(1) DESIGNATION OF LEAD AGENCY.—A recipient 
of a grant, contract, or cooperative agreement under 
this section shall designate a lead agency to direct the 
establishment of an interagency agreement among 
local educational agencies, agencies responsible for 
early childhood education programs, juvenile justice
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† HR 6 EAS 
authorities, mental health agencies, child welfare 
agencies, and other relevant entities in the State or 
Indian Tribe, in collaboration with local entities. 
(2) 
CONTENTS.—The 
interagency 
agreement 
shall ensure the provision of the services described in 
subsection (c), specifying with respect to each agency, 
authority, or entity— 
(A) the financial responsibility for the serv-
ices; 
(B) the conditions and terms of responsi-
bility for the services, including quality, account-
ability, and coordination of the services; and 
(C) the conditions and terms of reimburse-
ment among the agencies, authorities, or entities 
that are parties to the interagency agreement, 
including procedures for dispute resolution. 
(f) EVALUATION.—The Secretary shall reserve not to 
exceed 3 percent of the funds made available under sub-
section (l) for each fiscal year to— 
(1) conduct a rigorous, independent evaluation 
of the activities funded under this section; and 
(2) disseminate and promote the utilization of 
evidence-based practices regarding trauma support 
services and mental health care.
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(g) DISTRIBUTION OF AWARDS.—The Secretary shall 
ensure that grants, contracts, and cooperative agreements 
awarded or entered into under this section are equitably 
distributed among the geographical regions of the United 
States and among tribal, urban, suburban, and rural popu-
lations. 
(h) RULE OF CONSTRUCTION.—Nothing in this section 
shall be construed— 
(1) to prohibit an entity involved with a pro-
gram carried out under this section from reporting a 
crime that is committed by a student to appropriate 
authorities; or 
(2) to prevent Federal, State, and tribal law en-
forcement and judicial authorities from exercising 
their responsibilities with regard to the application of 
Federal, tribal, and State law to crimes committed by 
a student. 
(i) SUPPLEMENT, NOT SUPPLANT.—Any services pro-
vided through programs carried out under this section shall 
supplement, and not supplant, existing mental health serv-
ices, including any special education and related services 
provided under the Individuals with Disabilities Education 
Act (20 U.S.C. 1400 et seq.). 
(j) CONSULTATION WITH INDIAN TRIBES.—In car-
rying out subsection (a), the Secretary shall, in a timely
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† HR 6 EAS 
manner, meaningfully consult, engage, and cooperate with 
Indian Tribes and their representatives to ensure notice of 
eligibility. 
(k) DEFINITIONS.—In this section: 
(1) ELEMENTARY OR SECONDARY SCHOOL.—The 
term ‘‘elementary or secondary school’’ means a pub-
lic elementary and secondary school as such term is 
defined in section 8101 of the Elementary and Sec-
ondary Education Act of 1965 (20 U.S.C. 7801). 
(2) EVIDENCE-BASED.—The term ‘‘evidence- 
based’’ has the meaning given such term in section 
8101(21)(A)(i) of the Elementary and Secondary 
Education Act of 1965 (20 U.S.C. 7801(21)(A)(i)). 
(3) NATIVE HAWAIIAN EDUCATIONAL ORGANIZA-
TION.—The term ‘‘Native Hawaiian educational or-
ganization’’ has the meaning given such term in sec-
tion 6207 of the Elementary and Secondary Edu-
cation Act of 1965 (20 U.S.C. 7517). 
(4) PIPELINE
SERVICES.—The term ‘‘pipeline 
services’’ has the meaning given such term in section 
4622 of the Elementary and Secondary Education 
Act of 1965 (20 U.S.C. 7517). 
(5) SCHOOL LEADER.—The term ‘‘school leader’’ 
has the meaning given such term in section 8101 of
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† HR 6 EAS 
the Elementary and Secondary Education Act of 
1965 (20 U.S.C. 7801). 
(6) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Education. 
(7) SPECIALIZED INSTRUCTIONAL SUPPORT PER-
SONNEL.—The term ‘‘specialized instructional sup-
port personnel’’ has the meaning given such term in 
section 8101 of the Elementary and Secondary Edu-
cation Act of 1965 (20 U.S.C. 7801). 
(l) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section, such 
sums as may be necessary for each of fiscal years 2019 
through 2023. 
SEC. 1515. NATIONAL CHILD TRAUMATIC STRESS INITIA-
TIVE. 
Section 582(j) of the Public Health Service Act (42 
U.S.C. 290hh–1(j)) (relating to grants to address the prob-
lems of persons who experience violence-related stress) is 
amended by striking ‘‘$46,887,000 for each of fiscal years 
2018 through 2022’’ and inserting ‘‘$53,887,000 for each 
of fiscal years 2019 through 2023’’. 
SEC. 1516. NATIONAL MILESTONES TO MEASURE SUCCESS 
IN CURTAILING THE OPIOID CRISIS. 
(a) IN GENERAL.—Not later than 180 days after the 
date of enactment of this Act, the Secretary, in consultation
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with the Administrator of the Drug Enforcement Adminis-
tration and the Director of the Office of National Drug Con-
trol Policy, shall develop or identify existing national indi-
cators (referred to in this section as the ‘‘national mile-
stones’’) to measure success in curtailing the opioid crisis, 
with the goal of significantly reversing the incidence and 
prevalence of opioid misuse and abuse, and opioid-related 
morbidity and mortality in the United States within 5 
years of such date of enactment. 
(b) NATIONAL MILESTONES TO END THE OPIOID CRI-
SIS.—The national milestones under subsection (a) shall in-
clude the following: 
(1) Not fewer than 10 indicators or metrics to 
accurately and expediently measure progress in meet-
ing the goal described in subsection (a), which shall, 
as appropriate, include, indicators or metrics related 
to— 
(A) the number of fatal and non-fatal 
opioid overdoses; 
(B) the number of emergency room visits re-
lated to opioid misuse and abuse; 
(C) the number of individuals in sustained 
recovery from opioid use disorder; 
(D) the number of infections associated with 
illicit drug use, such as HIV, viral hepatitis, and
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† HR 6 EAS 
infective endocarditis, and available capacity for 
treating such infections; 
(E) the number of providers prescribing 
medication assisted treatment for opioid use dis-
orders, including in primary care settings, com-
munity health centers, jails, and prisons; 
(F) the number of individuals receiving 
treatment for opioid use disorder; and 
(G) additional indicators or metrics, as ap-
propriate, such as metrics pertaining to specific 
populations, including women and children, 
American Indians and Alaskan Natives, individ-
uals living in rural and non-urban areas, and 
justice-involved populations, that would further 
clarify the progress made in addressing the 
opioid misuse and abuse crisis. 
(2) A reasonable goal, such as a percentage de-
crease or other specified metric, that signifies progress 
in meeting the goal described in subsection (a), and 
annual targets to help achieve that goal. 
(c) CONSIDERATION OF OTHER SUBSTANCE USE DIS-
ORDERS.—In developing the national milestones under sub-
section (b), the Secretary shall, as appropriate, consider 
other substance use disorders in addition to opioid use dis-
order.
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† HR 6 EAS 
(d) EXTENSION OF PERIOD.—If the Secretary deter-
mines that the goal described in subsection (a) will not be 
achieved with respect to any indicator or metric established 
under subsection (b)(2) within 5 years of the date of enact-
ment of this Act, the Secretary may extend the timeline for 
meeting such goal with respect to that indicator or metric. 
The Secretary shall include with any such extension a ra-
tionale for why additional time is needed and information 
on whether significant changes are needed in order to 
achieve such goal with respect to the indicator or metric. 
(e) ANNUAL STATUS UPDATE.—Not later than one 
year after the enactment of this Act, the Secretary shall 
make available on the internet website of the Department 
of Health and Human Services, and submit to the Com-
mittee on Health, Education, Labor, and Pensions of the 
Senate and the Committee on Energy and Commerce of the 
House of Representatives, an update on the progress, in-
cluding expected progress in the subsequent year, in achiev-
ing the goals detailed in the national milestones. Each such 
update shall include the progress made in the first year or 
since the previous report, as applicable, in meeting each in-
dicator or metric in the national milestones.
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TITLE II—FINANCE 
SEC. 2001. SHORT TITLE. 
This title may be cited as the ‘‘Helping to End Addic-
tion and Lessen Substance Use Disorders Act of 2018’’ or 
the ‘‘HEAL Act of 2018’’. 
Subtitle A—Medicare 
SEC. 2101. MEDICARE OPIOID SAFETY EDUCATION. 
(a) IN GENERAL.—Section 1804 of the Social Security 
Act (42 U.S.C. 1395b–2) is amended by adding at the end 
the following new subsection: 
‘‘(d) The notice provided under subsection (a) shall in-
clude— 
‘‘(1) references to educational resources regarding 
opioid use and pain management; 
‘‘(2) a description of categories of alternative, 
non-opioid pain management treatments covered 
under this title; and 
‘‘(3) a suggestion for the beneficiary to talk to a 
physician regarding opioid use and pain manage-
ment.’’. 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall apply to notices distributed prior to each 
Medicare open enrollment period beginning after January 
1, 2019.
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† HR 6 EAS 
SEC. 2102. EXPANDING THE USE OF TELEHEALTH SERVICES 
FOR THE TREATMENT OF OPIOID USE DIS-
ORDER AND OTHER SUBSTANCE USE DIS-
ORDERS. 
(a) IN GENERAL.—Section 1834(m) of the Social Secu-
rity Act (42 U.S.C. 1395m(m)) is amended— 
(1) in paragraph (2)(B)— 
(A) in clause (i), in the matter preceding 
subclause (I), by striking ‘‘clause (ii)’’ and in-
serting ‘‘clause (ii) and paragraph (6)(C)’’; and 
(B) in clause (ii), in the heading, by strik-
ing ‘‘FOR HOME DIALYSIS THERAPY’’; 
(2) in paragraph (4)(C)— 
(A) in clause (i), by striking ‘‘paragraph 
(6)’’ and inserting ‘‘paragraphs (5), (6), and 
(7)’’; and 
(B) in clause (ii)(X), by inserting ‘‘or tele-
health services described in paragraph (7)’’ be-
fore the period at the end; and 
(3) by adding at the end the following new para-
graph: 
‘‘(7) TREATMENT OF SUBSTANCE USE DISORDER 
SERVICES FURNISHED THROUGH TELEHEALTH.—The 
geographic requirements described in paragraph 
(4)(C)(i) shall not apply with respect to telehealth 
services furnished on or after January 1, 2019, to an
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† HR 6 EAS 
eligible telehealth individual with a substance use dis-
order diagnosis for purposes of treatment of such dis-
order, as determined by the Secretary, at an origi-
nating site described in paragraph (4)(C)(ii) (other 
than an originating site described in subclause (IX) 
of such paragraph).’’. 
(b) IMPLEMENTATION.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) may implement the amendments made by this sec-
tion by interim final rule. 
(c) REPORT.—Not later than 5 years after the date of 
the enactment of this Act, the Secretary shall submit to Con-
gress a report on the impact of the implementation of the 
amendments made by this section with respect to telehealth 
services under section 1834(m) of the Social Security Act 
(42 U.S.C. 1395m(m)) on— 
(1) the utilization of health care items and serv-
ices under title XVIII of such Act (42 U.S.C. 1395 et 
seq.) related to substance use disorders, including 
emergency department visits; and 
(2) health outcomes related to substance use dis-
orders, such as opioid overdose deaths.
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† HR 6 EAS 
SEC. 2103. COMPREHENSIVE SCREENINGS FOR SENIORS. 
(a) INITIAL PREVENTIVE PHYSICAL EXAMINATION.— 
Section 1861(ww) of the Social Security Act (42 U.S.C. 
1395x(ww)) is amended— 
(1) in paragraph (1)— 
(A) by striking ‘‘paragraph (2) and’’ and 
inserting ‘‘paragraph (2),’’; and 
(B) by inserting ‘‘and the furnishing of a 
review of any current opioid prescriptions (as 
defined in paragraph (4)),’’ after ‘‘upon the 
agreement with the individual,’’; and 
(2) in paragraph (2)— 
(A) by redesignating subparagraph (N) as 
subparagraph (O); and 
(B) by inserting after subparagraph (M) the 
following new subparagraph: 
‘‘(N) Screening for potential substance use 
disorders.’’; and 
(3) by adding at the end the following new para-
graph: 
‘‘(4) For purposes of paragraph (1), the term ‘a review 
of any current opioid prescriptions’ means, with respect to 
an individual determined to have a current prescription for 
opioids— 
‘‘(A) a review of the potential risk factors to the 
individual for opioid use disorder;
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† HR 6 EAS 
‘‘(B) an evaluation of the individual’s severity of 
pain and current treatment plan; 
‘‘(C) the provision of information on non-opioid 
treatment options; and 
‘‘(D) a referral to a pain management specialist, 
as appropriate.’’. 
(b) ANNUAL WELLNESS VISIT.—Section 1861(hhh)(2) 
of the Social Security Act (42 U.S.C. 1395x(hhh)(2)) is 
amended— 
(1) by redesignating subparagraph (G) as sub-
paragraph (I); and 
(2) by inserting after subparagraph (F) the fol-
lowing new subparagraphs: 
‘‘(G) Screening for potential substance use 
disorders and referral for treatment as appro-
priate. 
‘‘(H) The furnishing of a review of any cur-
rent opioid prescriptions (as defined in sub-
section (ww)(4)).’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply to examinations and visits furnished on 
or after January 1, 2019.
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† HR 6 EAS 
SEC. 2104. EVERY PRESCRIPTION CONVEYED SECURELY. 
(a) IN GENERAL.—Section 1860D–4(e) of the Social 
Security Act (42 U.S.C. 1395w–104(e)) is amended by add-
ing at the end the following: 
‘‘(7) REQUIREMENT OF E-PRESCRIBING FOR CON-
TROLLED SUBSTANCES.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), a prescription for a covered part D 
drug under a prescription drug plan (or under 
an MA–PD plan) for a schedule II, III, IV, or 
V controlled substance shall be transmitted by a 
health care practitioner electronically in accord-
ance with an electronic prescription drug pro-
gram that meets the requirements of paragraph 
(2). 
‘‘(B) 
EXCEPTION
FOR
CERTAIN
CIR-
CUMSTANCES.—The Secretary shall, through 
rulemaking, specify circumstances and processes 
by which the Secretary may waive the require-
ment under subparagraph (A), with respect to a 
covered part D drug, including in the case of— 
‘‘(i) a prescription issued when the 
practitioner and dispensing pharmacy are 
the same entity; 
‘‘(ii) a prescription issued that cannot 
be transmitted electronically under the most
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† HR 6 EAS 
recently implemented version of the Na-
tional Council for Prescription Drug Pro-
grams SCRIPT Standard; 
‘‘(iii) a prescription issued by a prac-
titioner who received a waiver or a renewal 
thereof for a period of time as determined 
by the Secretary, not to exceed one year, 
from the requirement to use electronic pre-
scribing due to demonstrated economic 
hardship, technological limitations that are 
not reasonably within the control of the 
practitioner, 
or 
other 
exceptional 
cir-
cumstance demonstrated by the practitioner; 
‘‘(iv) a prescription issued by a practi-
tioner under circumstances in which, not-
withstanding the practitioner’s ability to 
submit a prescription electronically as re-
quired by this subsection, such practitioner 
reasonably determines that it would be im-
practical for the individual involved to ob-
tain substances prescribed by electronic pre-
scription in a timely manner, and such 
delay would adversely impact the individ-
ual’s medical condition involved;
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† HR 6 EAS 
‘‘(v) a prescription issued by a practi-
tioner prescribing a drug under a research 
protocol; 
‘‘(vi) a prescription issued by a practi-
tioner for a drug for which the Food and 
Drug Administration requires a prescrip-
tion to contain elements that are not able to 
be included in electronic prescribing such 
as, a drug with risk evaluation and mitiga-
tion strategies that include elements to as-
sure safe use; 
‘‘(vii) a prescription issued by a prac-
titioner— 
‘‘(I) for an individual who re-
ceives hospice care under this title; and 
‘‘(II) that is not covered under the 
hospice benefit under this title; and 
‘‘(viii) a prescription issued by a prac-
titioner for an individual who is— 
‘‘(I) a resident of a nursing facil-
ity (as defined in section 1919(a)); and 
‘‘(II) dually eligible for benefits 
under this title and title XIX. 
‘‘(C) DISPENSING.—(i) Nothing in this 
paragraph shall be construed as requiring a
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† HR 6 EAS 
sponsor of a prescription drug plan under this 
part, MA organization offering an MA–PD plan 
under part C, or a pharmacist to verify that a 
practitioner, with respect to a prescription for a 
covered part D drug, has a waiver (or is other-
wise exempt) under subparagraph (B) from the 
requirement under subparagraph (A). 
‘‘(ii) Nothing in this paragraph shall be 
construed as affecting the ability of the plan to 
cover or the pharmacists’ ability to continue to 
dispense covered part D drugs from otherwise 
valid written, oral or fax prescriptions that are 
consistent with laws and regulations. 
‘‘(iii) Nothing in this paragraph shall be 
construed as affecting the ability of an indi-
vidual who is being prescribed a covered part D 
drug to designate a particular pharmacy to dis-
pense the covered part D drug to the extent con-
sistent with the requirements under subsection 
(b)(1) and under this paragraph. 
‘‘(D) ENFORCEMENT.—The Secretary shall, 
through rulemaking, have authority to enforce 
and specify appropriate penalties for non-com-
pliance with the requirement under subpara-
graph (A).’’.
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† HR 6 EAS 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall apply to coverage of drugs prescribed on 
or after January 1, 2021. 
SEC. 2105. STANDARDIZING ELECTRONIC PRIOR AUTHOR-
IZATION FOR SAFE PRESCRIBING. 
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 Jan-
uary 1, 2021, the program shall provide for 
the secure electronic transmittal of— 
‘‘(I) a prior authorization request 
from the prescribing health care profes-
sional for coverage of a covered part D 
drug for a part D eligible individual 
enrolled in a part D plan (as defined 
in section 1860D–23(a)(5)) to the PDP 
sponsor or Medicare Advantage organi-
zation offering such plan; and 
‘‘(II) a response, in accordance 
with this subparagraph, from such 
PDP sponsor or Medicare Advantage
202 
† HR 6 EAS 
organization, respectively, to such pro-
fessional. 
‘‘(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 subpara-
graph, as an electronic transmission 
described in clause (i), such trans-
mission shall comply with technical 
standards adopted by the Secretary in 
consultation with the National Council 
for Prescription Drug Programs, other 
standard setting organizations deter-
mined appropriate by the Secretary, 
and stakeholders including PDP spon-
sors, Medicare Advantage organiza-
tions, health care professionals, and 
health information technology software 
vendors.
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† HR 6 EAS 
‘‘(III) 
APPLICATION.—Notwith-
standing any other provision of law, 
for purposes of this subparagraph, the 
Secretary may require the use of such 
standards adopted under subclause (II) 
in lieu of any other applicable stand-
ards for an electronic transmission de-
scribed in clause (i) for a covered part 
D drug for a part D eligible indi-
vidual.’’. 
SEC. 2106. STRENGTHENING PARTNERSHIPS TO PREVENT 
OPIOID ABUSE. 
(a) IN GENERAL.—Section 1859 of the Social Security 
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 subsection, 
the Secretary shall, after consultation with stake-
holders, establish a secure Internet website portal 
that would allow a secure path for communica-
tion between the Secretary, MA plans under this 
part, prescription drug plans under part D, and
204 
† HR 6 EAS 
an eligible entity with a contract under section 
1893 (such as a Medicare drug integrity con-
tractor or any successor entity to a Medicare 
drug integrity contractor), in accordance with 
subsection (j)(3) of such section, for the purpose 
of enabling through such portal— 
‘‘(i) the referral by such plans of sus-
picious activities of a provider of services 
(including a prescriber) or supplier related 
to fraud, waste, and abuse for initiating or 
assisting investigations conducted by the eli-
gible entity; and 
‘‘(ii) data sharing among such MA 
plans, prescription drug plans, and the Sec-
retary. 
‘‘(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 established under 
subparagraph (A): 
‘‘(i) Providers of services and suppliers 
that have been referred pursuant to sub-
paragraph (A)(i) during the previous 12- 
month period.
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† HR 6 EAS 
‘‘(ii) Providers of services and sup-
pliers who are the subject of an active exclu-
sion under section 1128 or who are subject 
to a suspension of payment under this title 
pursuant to section 1862(o) or otherwise. 
‘‘(iii) Providers of services and sup-
pliers who are the subject of an active rev-
ocation of participation under this title, in-
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 with respect to suspicious 
activities of a provider of services (includ-
ing a prescriber) or supplier, if such pro-
vider (or prescriber) 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 suspicious ac-
tivities related to fraud, waste, and abuse, using
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† HR 6 EAS 
guidance such as what is provided in the Medi-
care Program Integrity Manual 4.7.1. 
‘‘(2) 
QUARTERLY
REPORTS.—Beginning 
not 
later than 2 years after the date of the 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 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 
‘‘(B) be anonymized information submitted 
by plans without identifying the source of such 
information. 
‘‘(3) CLARIFICATION.—Nothing in this subsection 
shall preclude or otherwise affect referrals to the In-
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† HR 6 EAS 
spector General of the Department of Health and 
Human Services or other law enforcement entities.’’. 
(b) CONTRACT REQUIREMENT TO COMMUNICATE PLAN 
CORRECTIVE
ACTIONS
AGAINST
OPIOIDS
OVER-PRE-
SCRIBERS.—Section 1857(e)(4)(C) of the Social Security 
Act (42 U.S.C. 1395w–27(e)(4)(C)) 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 established 
under subparagraph (B), information on credible 
evidence of suspicious activities of a provider of 
services (including a prescriber) or supplier re-
lated to fraud and other actions taken by such 
plans related to inappropriate prescribing of 
opioids. 
‘‘(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
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† HR 6 EAS 
to the Secretary information described in sub-
paragraph (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 
‘inappropriate prescribing of opioids’ and a 
method for determining if a provider of 
services prescribes such a high volume; and 
‘‘(ii) establish the process described in 
subparagraph (B) and the types of informa-
tion that may be submitted through such 
process.’’. 
(c) REFERENCE UNDER PART D TO PROGRAM INTEG-
RITY 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 subsection: 
‘‘(m) PROGRAM INTEGRITY TRANSPARENCY MEAS-
URES.—For program integrity transparency measures ap-
plied with respect to prescription drug plan and MA plans, 
see section 1859(i).’’.
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† HR 6 EAS 
SEC. 2107. COMMIT TO OPIOID MEDICAL PRESCRIBER AC-
COUNTABILITY AND SAFETY FOR SENIORS. 
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: 
‘‘(D) NOTIFICATION
AND
ADDITIONAL
RE-
QUIREMENTS
WITH
RESPECT
TO
STATISTICAL 
OUTLIER PRESCRIBERS OF OPIOIDS.— 
‘‘(i) NOTIFICATION.—Not later than 
January 1, 2021, the Secretary shall, in the 
case of a prescriber identified by the Sec-
retary under clause (ii) to be a statistical 
outlier prescriber of opioids, provide, subject 
to clause (iv), an annual notification to 
such prescriber that such prescriber has been 
so identified that includes resources on 
proper prescribing methods and other infor-
mation as specified in accordance with 
clause (iii). 
‘‘(ii) IDENTIFICATION OF STATISTICAL 
OUTLIER PRESCRIBERS OF OPIOIDS.— 
‘‘(I) IN GENERAL.—The Secretary 
shall, subject to subclause (III), using 
the valid prescriber National Provider 
Identifiers included pursuant to sub-
paragraph (A) on claims for covered
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† HR 6 EAS 
part D drugs for part D eligible indi-
viduals enrolled in prescription drug 
plans under this part or MA–PD plans 
under part C and based on the thresh-
olds established under subclause (II), 
identify prescribers that are statistical 
outlier opioids prescribers for a period 
of time specified by the Secretary. 
‘‘(II) 
ESTABLISHMENT
OF 
THRESHOLDS.—For purposes of sub-
clause (I) and subject to subclause 
(III), the Secretary shall, after con-
sultation with stakeholders, establish 
thresholds, based on prescriber spe-
cialty and, as determined appropriate 
by the Secretary, geographic area, for 
identifying whether a prescriber in a 
specialty and geographic area is a sta-
tistical outlier prescriber of opioids as 
compared 
to 
other 
prescribers 
of 
opioids within such specialty and area. 
‘‘(III) 
EXCLUSIONS.—The 
fol-
lowing shall not be included in the 
analysis 
for 
identifying 
statistical
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† HR 6 EAS 
outlier prescribers of opioids under this 
clause: 
‘‘(aa) Claims for covered 
part D drugs for part D eligible 
individuals who are receiving hos-
pice care under this title. 
‘‘(bb) Claims for covered part 
D drugs for part D eligible indi-
viduals who are receiving oncol-
ogy services under this title. 
‘‘(cc) Prescribers who are the 
subject of an investigation by the 
Centers for Medicare & Medicaid 
Services or the Inspector General 
of the Department of Health and 
Human Services. 
‘‘(iii) CONTENTS OF NOTIFICATION.— 
The Secretary shall include the following in-
formation in the notifications provided 
under clause (i): 
‘‘(I) Information on how such pre-
scriber compares to other prescribers 
within the same specialty and, if deter-
mined appropriate by the Secretary, 
geographic area.
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† HR 6 EAS 
‘‘(II) Information on opioid pre-
scribing guidelines, based on input 
from stakeholders, that may include the 
Centers for Disease Control and Pre-
vention 
guidelines 
for 
prescribing 
opioids for chronic pain and guidelines 
developed by physician organizations. 
‘‘(III) Other information deter-
mined appropriate by the Secretary. 
‘‘(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 notifica-
tions described in clause (i) based on 
stakeholder input and changes in 
opioid 
prescribing 
utilization 
and 
trends. 
‘‘(II) EXPANSION TO OTHER PRE-
SCRIPTIONS.—The Secretary may ex-
pand notifications under this subpara-
graph to include identifications and 
notifications with respect to concurrent 
prescriptions of covered Part D drugs
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† HR 6 EAS 
used in combination with opioids that 
are considered to have adverse side ef-
fects when so used in such combina-
tion, as determined by the Secretary. 
‘‘(v) ADDITIONAL REQUIREMENTS FOR 
PERSISTENT
STATISTICAL
OUTLIER
PRE-
SCRIBERS.—In the case of a prescriber who 
the Secretary determines is persistently 
identified under clause (ii) as a statistical 
outlier prescriber of opioids, the following 
shall apply: 
‘‘(I) The Secretary shall provide 
an opportunity for such prescriber to 
receive technical assistance or edu-
cational resources on opioid pre-
scribing guidelines (such as the guide-
lines described in clause (iii)(II)) from 
an entity that furnishes such assistance 
or resources, which may include a 
quality 
improvement 
organization 
under part B of title XI, as available 
and appropriate. 
‘‘(II) Such prescriber may be re-
quired to enroll in the program under 
this title under section 1866(j) if such
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† HR 6 EAS 
prescriber is not otherwise required to 
enroll. The Secretary shall determine 
the length of the period for which such 
prescriber is required to maintain such 
enrollment. 
‘‘(III) Not less frequently than an-
nually (and in a form and manner de-
termined appropriate by the Sec-
retary), the Secretary shall commu-
nicate information on such prescribers 
to sponsors of a prescription drug plan 
and Medicare Advantage organizations 
offering an MA–PD plan. 
‘‘(vi) PUBLIC AVAILABILITY OF INFOR-
MATION.—The Secretary shall make aggre-
gate information under this subparagraph 
available on the Internet website of the Cen-
ters for Medicare & Medicaid Services. Such 
information shall be in a form and manner 
determined appropriate by the Secretary 
and shall not identify any specific pre-
scriber. In carrying out this clause, the Sec-
retary shall consult with interested stake-
holders.
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† HR 6 EAS 
‘‘(vii) OPIOIDS
DEFINED.—For pur-
poses of this subparagraph, the term 
‘opioids’ has such meaning as specified by 
the Secretary. 
‘‘(viii) OTHER
ACTIVITIES.—Nothing 
in this subparagraph shall preclude the Sec-
retary from conducting activities that pro-
vide prescribers with information as to how 
they compare to other prescribers that are 
in addition to the activities under this sub-
paragraph, including activities that were 
being conducted as of the date of the enact-
ment of this subparagraph.’’. 
SEC. 2108. FIGHTING THE OPIOID EPIDEMIC WITH SUN-
SHINE. 
(a) INCLUSION
OF INFORMATION REGARDING PAY-
MENTS TO ADVANCE PRACTICE NURSES.— 
(1) IN GENERAL.—Section 1128G(e)(6) of the So-
cial Security Act (42 U.S.C. 1320a–7h(e)(6)) is 
amended— 
(A) in subparagraph (A), by adding at the 
end the following new clauses: 
‘‘(iii) A physician assistant, nurse 
practitioner, or clinical nurse specialist (as
216 
† HR 6 EAS 
such 
terms 
are 
defined 
in 
section 
1861(aa)(5)). 
‘‘(iv) A certified registered nurse anes-
thetist (as defined in section 1861(bb)(2)). 
‘‘(v) A certified nurse-midwife (as de-
fined in section 1861(gg)(2)).’’; and 
(B) in subparagraph (B), by inserting ‘‘, 
physician assistant, nurse practitioner, clinical 
nurse specialist, certified nurse anesthetist, or 
certified nurse-midwife’’ after ‘‘physician’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to infor-
mation required to be submitted under section 1128G 
of the Social Security Act (42 U.S.C. 1320a–7h) on 
or after January 1, 2022. 
(b) SUNSET OF EXCLUSION OF NATIONAL PROVIDER 
IDENTIFIER
OF COVERED RECIPIENT
IN INFORMATION 
MADE
PUBLICLY
AVAILABLE.—Section 
1128G(c)(1)(C)(viii) of the Social Security Act (42 U.S.C. 
1320a–7h(c)(1)(C)(viii))) is amended by striking ‘‘does not 
contain’’ and inserting ‘‘in the case of information made 
available under this subparagraph prior to January 1, 
2022, does not contain’’.
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† HR 6 EAS 
(c) ADMINISTRATION.—Chapter 35 of title 44, United 
States Code, shall not apply to this section or the amend-
ments made by this section. 
SEC. 2109. DEMONSTRATION TESTING COVERAGE OF CER-
TAIN 
SERVICES 
FURNISHED 
BY 
OPIOID 
TREATMENT PROGRAMS. 
Title XVIII of the Social Security Act (42 U.S.C. 1395 
et seq.) is amended by inserting after section 1866E the fol-
lowing: 
‘‘DEMONSTRATION TESTING COVERAGE OF CERTAIN 
SERVICES FURNISHED BY OPIOID TREATMENT PROGRAMS 
‘‘SEC. 1866F. (a) ESTABLISHMENT.— 
‘‘(1) IN GENERAL.—The Secretary shall conduct 
a demonstration (in this section referred to as the 
‘demonstration’) to test coverage of and payment for 
opioid use disorder treatment services (as defined in 
paragraph (2)(B)) furnished by opioid treatment pro-
grams (as defined in paragraph (2)(A)) to individ-
uals under part B using a bundled payment as de-
scribed in paragraph (3). 
‘‘(2) DEFINITIONS.—In this section: 
‘‘(A) OPIOID
TREATMENT
PROGRAM.—The 
term ‘opioid treatment program’ means an enti-
ty that is an opioid treatment program (as de-
fined in section 8.2 of title 42 of the Code of Fed-
218 
† HR 6 EAS 
eral Regulations, or any successor regulation) 
that— 
‘‘(i) is selected for participation in the 
demonstration; 
‘‘(ii) has in effect a certification by the 
Substance Abuse and Mental Health Serv-
ices Administration for such a program; 
‘‘(iii) is accredited by an accrediting 
body approved by the Substance Abuse and 
Mental Health Services Administration; 
‘‘(iv) submits to the Secretary data 
and information needed to monitor the 
quality of services furnished and conduct 
the evaluation described in subsection (c); 
and 
‘‘(v) meets such additional require-
ments as the Secretary may find necessary. 
‘‘(B) OPIOID
USE
DISORDER
TREATMENT 
SERVICES.—The term ‘opioid use disorder treat-
ment services’ means items and services that are 
furnished by an opioid treatment program for 
the treatment of opioid use disorder, including— 
‘‘(i) opioid agonist and antagonist 
treatment medications (including oral, in-
jected, or implanted versions) that are ap-
219 
† HR 6 EAS 
proved by the Food and Drug Administra-
tion under section 505 of the Federal Food, 
Drug and Cosmetic Act for use in the treat-
ment of opioid use disorder; 
‘‘(ii) dispensing and administration of 
such medications, if applicable; 
‘‘(iii) substance use counseling by a 
professional to the extent authorized under 
State law to furnish such services; 
‘‘(iv) individual and group therapy 
with a physician or psychologist (or other 
mental health professional to the extent au-
thorized under State law); 
‘‘(v) toxicology testing; and 
‘‘(vi) other items and services that the 
Secretary determines are appropriate (but 
in no case to include meals or transpor-
tation). 
‘‘(3) BUNDLED PAYMENT UNDER PART B.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
pay, from the Federal Supplementary Medical 
Insurance Trust Fund under section 1841, to an 
opioid treatment program participating in the 
demonstration a bundled payment as determined 
by the Secretary for opioid use disorder treat-
220 
† HR 6 EAS 
ment services that are furnished by such treat-
ment program to an individual under part B 
during an episode of care (as defined by the Sec-
retary). 
‘‘(B) 
CONSIDERATIONS.—The 
Secretary 
may implement this paragraph through one or 
more bundles based on the type of medication 
provided (such as buprenorphine, methadone, 
naltrexone, or a new innovative drug), the fre-
quency of services furnished, the scope of services 
furnished, characteristics of the individuals fur-
nished such services, or other factors as the Sec-
retary determines appropriate. In developing 
such bundles, the Secretary may consider pay-
ment rates paid to opioid treatment programs 
for comparable services under State plans under 
title XIX or under the TRICARE program under 
chapter 55 of title 10 of the United States Code. 
‘‘(b) IMPLEMENTATION.— 
‘‘(1) DURATION.—The demonstration shall be 
conducted for a period of 5 years, beginning not later 
than January 1, 2021. 
‘‘(2) SCOPE.—In carrying out the demonstra-
tion, the Secretary shall limit the number of bene-
221 
† HR 6 EAS 
ficiaries that may participate at any one time in the 
demonstration to 2,000. 
‘‘(3) WAIVER.—The Secretary may waive such 
provisions of this title and title XI as the Secretary 
determines necessary in order to implement the dem-
onstration. 
‘‘(4) ADMINISTRATION.—Chapter 35 of title 44, 
United States Code, shall not apply to this section. 
‘‘(c) EVALUATION AND REPORT.— 
‘‘(1) EVALUATION.—The Secretary shall conduct 
an evaluation of the demonstration. Such evaluation 
shall include analyses of— 
‘‘(A) the impact of the demonstration on— 
‘‘(i) utilization of health care items 
and services related to opioid use disorder, 
including hospitalizations and emergency 
department visits; 
‘‘(ii) beneficiary health outcomes re-
lated to opioid use disorder, including 
opioid overdose deaths; and 
‘‘(iii) overall expenditures under this 
title; and 
‘‘(B) the performance of opioid treatment 
programs participating in the demonstration 
with respect to applicable quality and cost
222 
† HR 6 EAS 
metrics, including whether any additional qual-
ity measures related to opioid use disorder treat-
ment are needed with respect to such programs 
under this title. 
‘‘(2) REPORT.—Not later than 2 years after the 
completion of the demonstration, the Secretary shall 
submit to Congress a report containing the results of 
the evaluation conducted under paragraph (1), to-
gether with recommendations for such legislation and 
administrative action as the Secretary determines ap-
propriate. 
‘‘(d) FUNDING.—For purposes of administering and 
carrying out the demonstration, in addition to funds other-
wise appropriated, there shall be transferred to the Sec-
retary for the Center for Medicare & Medicaid Services Pro-
gram Management Account from the Federal Supple-
mentary Medical Insurance Trust Fund under section 1841 
$5,000,000, to remain available until expended.’’. 
SEC. 2110. ENCOURAGING APPROPRIATE PRESCRIBING 
UNDER MEDICARE FOR VICTIMS OF OPIOID 
OVERDOSE. 
Section 1860D–4(c)(5)(C) of the Social Security Act 
(42 U.S.C. 1395w–104(c)(5)(C)) is amended—
223 
† HR 6 EAS 
(1) in clause (i), in the matter preceding sub-
clause (I), by striking ‘‘For purposes’’ and inserting 
‘‘Except as provided in clause (v), for purposes’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(v) TREATMENT OF ENROLLEES WITH 
A
HISTORY
OF
OPIOID-RELATED
OVER-
DOSE.— 
‘‘(I) 
IN
GENERAL.—For 
plan 
years beginning not later than Janu-
ary 1, 2021, a part D eligible indi-
vidual who is not an exempted indi-
vidual described in clause (ii) and who 
is identified under this clause as a 
part D eligible individual with a his-
tory of opioid-related overdose (as de-
fined by the Secretary) shall be in-
cluded as a potentially at-risk bene-
ficiary for prescription drug abuse 
under the drug management program 
under this paragraph. 
‘‘(II) IDENTIFICATION
AND
NO-
TICE.—For purposes of this clause, the 
Secretary shall—
224 
† HR 6 EAS 
‘‘(aa) identify part D eligible 
individuals with a history of 
opioid-related overdose (as so de-
fined); and 
‘‘(bb) notify the PDP sponsor 
of the prescription drug plan in 
which such an individual is en-
rolled of such identification.’’. 
SEC. 2111. AUTOMATIC ESCALATION TO EXTERNAL REVIEW 
UNDER A MEDICARE PART D DRUG MANAGE-
MENT 
PROGRAM 
FOR 
AT-RISK 
BENE-
FICIARIES. 
(a) IN GENERAL.—Section 1860D–4(c)(5) of the So-
cial Security Act (42 U.S.C. 1395ww–10(c)(5)) is amend-
ed— 
(1) in subparagraph (B), in each of clauses 
(ii)(III) and (iii)(IV), by striking ‘‘and the option of 
an automatic escalation to external review’’ and in-
serting ‘‘, including notice that if on reconsideration 
a PDP sponsor affirms its denial, in whole or in 
part, the case shall be automatically forwarded to the 
independent, outside entity contracted with the Sec-
retary for review and resolution’’; and 
(2) in subparagraph (E), by striking ‘‘and the 
option’’ and all that follows and inserting the fol-
225 
† HR 6 EAS 
lowing: ‘‘and if on reconsideration a PDP sponsor af-
firms its denial, in whole or in part, the case shall 
be automatically forwarded to the independent, out-
side entity contracted with the Secretary for review 
and resolution.’’. 
(b) EFFECTIVE DATE.—The amendments made by sub-
section (a) shall apply beginning not later January 1, 2021. 
SEC. 2112. 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 incentive payments 
to behavioral health providers for the adop-
tion and use of certified electronic health 
record technology (as defined in section 
1848(o)(4)) to improve the quality and co-
ordination of care through the electronic 
documentation and exchange of health infor-
mation. Behavioral health providers may 
include— 
‘‘(I) psychiatric hospitals (as de-
fined in section 1861(f));
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† HR 6 EAS 
‘‘(II) community mental health 
centers 
(as 
defined 
in 
section 
1861(ff)(3)(B)); 
‘‘(III) clinical psychologists (as 
defined in section 1861(ii)); 
‘‘(IV) clinical social workers (as 
defined in section 1861(hh)(1)); and 
‘‘(V) hospitals, treatment facili-
ties, and mental health or substance 
use disorder providers that participate 
in a State plan under title XIX or a 
waiver of such plan.’’. 
SEC. 2113. MEDICARE IMPROVEMENT FUND. 
Section 1898(b)(1) of the Social Security Act (42 
U.S.C. 1395iii(b)(1)) is amended by striking ‘‘fiscal year 
2021, $0’’ and inserting ‘‘fiscal year 2024, $65,000,000’’. 
Subtitle B—Medicaid 
SEC. 2201. CARING RECOVERY FOR INFANTS AND BABIES. 
(a) STATE PLAN AMENDMENT.—Section 1902(a) of the 
Social Security Act (42 U.S.C. 1396a(a)) is amended— 
(1) in paragraph (82), by striking ‘‘and’’ after 
the semicolon; 
(2) in paragraph (83), by striking the period at 
the end and inserting ‘‘; and’’; and
227 
† HR 6 EAS 
(3) by inserting after paragraph (83), the fol-
lowing new paragraph: 
‘‘(84) provide, at the option of the State, for 
making medical assistance available on an inpatient 
or outpatient basis at a residential pediatric recovery 
center (as defined in subsection (nn)) to infants with 
neonatal abstinence syndrome.’’. 
(b) RESIDENTIAL PEDIATRIC RECOVERY CENTER DE-
FINED.—Section 1902 of such Act (42 U.S.C. 1396a) is 
amended by adding at the end the following new subsection: 
‘‘(nn) RESIDENTIAL PEDIATRIC RECOVERY CENTER 
DEFINED.— 
‘‘(1) IN
GENERAL.—For purposes of section 
1902(a)(84), the term ‘residential pediatric recovery 
center’ means a center or facility that furnishes items 
and services for which medical assistance is available 
under the State plan to infants with the diagnosis of 
neonatal abstinence syndrome without any other sig-
nificant medical risk factors. 
‘‘(2) COUNSELING AND SERVICES.—A residential 
pediatric recovery center may offer counseling and 
other services to mothers (and other appropriate fam-
ily members and caretakers) of infants receiving 
treatment at such centers if such services are other-
wise covered under the State plan under this title or
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under a waiver of such plan. Such other services may 
include the following: 
‘‘(A) Counseling or referrals for services. 
‘‘(B) Activities to encourage caregiver-in-
fant bonding. 
‘‘(C) Training on caring for such infants.’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section take effect on the date of enactment of this Act and 
shall apply to medical assistance furnished on or after that 
date, without regard to final regulations to carry out such 
amendments being promulgated as of such date. 
SEC. 2202. PEER SUPPORT ENHANCEMENT AND EVALUA-
TION REVIEW. 
(a) IN GENERAL.—Not later than 2 years after the 
date of the enactment of this Act, the Comptroller General 
of the United States shall submit to the Committee on En-
ergy and Commerce of the House of Representatives, the 
Committee on Finance of the Senate, and the Committee 
on Health, Education, Labor, and Pensions of the Senate 
a report on the provision of peer support services under the 
Medicaid program. 
(b) CONTENT OF REPORT.— 
(1) IN
GENERAL.—The report required under 
subsection (a) shall include the following information:
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† HR 6 EAS 
(A) Information on State coverage of peer 
support services under Medicaid, including— 
(i) the mechanisms through which 
States may provide such coverage, including 
through existing statutory authority or 
through waivers; 
(ii) the populations to which States 
have provided such coverage; 
(iii) the payment models, including 
any alternative payment models, used by 
States to pay providers of such services; and 
(iv) where available, information on 
Federal and State spending under Medicaid 
for peer support services. 
(B) Information on selected State experi-
ences in providing medical assistance for peer 
support services under State Medicaid plans and 
whether States measure the effects of providing 
such assistance with respect to— 
(i) improving access to behavioral 
health services; 
(ii) improving early detection, and 
preventing worsening, of behavioral health 
disorders;
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† HR 6 EAS 
(iii) reducing chronic and comorbid 
conditions; and 
(iv) reducing overall health costs. 
(2) RECOMMENDATIONS.—The report required 
under subsection (a) shall include recommendations, 
including recommendations for such legislative and 
administrative actions related to improving services, 
including peer support services, and access to peer 
support services under Medicaid as the Comptroller 
General of the United States determines appropriate. 
SEC. 2203. MEDICAID SUBSTANCE USE DISORDER TREAT-
MENT VIA TELEHEALTH. 
(a) DEFINITIONS.—In this section: 
(1) COMPTROLLER GENERAL.—The term ‘‘Comp-
troller General’’ means the Comptroller General of the 
United States. 
(2) SCHOOL-BASED HEALTH CENTER.—The term 
‘‘school-based health center’’ has the meaning given 
that term in section 2110(c)(9) of the Social Security 
Act (42 U.S.C. 1397jj(c)(9)). 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(4) TELEHEATH
SERVICES.—The term ‘‘tele-
health services’’ includes remote patient monitoring 
and other key modalities such as live video or syn-
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† HR 6 EAS 
chronous 
telehealth, 
store-and-forward 
or 
asyn-
chronous telehealth, mobile health, telephonic con-
sultation, and electronic consult including provider- 
to-provider e-consults. 
(5) UNDERSERVED
AREA.—The term ‘‘under-
served area’’ means a health professional shortage 
area (as defined in section 332(a)(1)(A) of the Public 
Health Service Act (42 U.S.C. 254e(a)(1)(A))) and a 
medically underserved area (according to a designa-
tion under section 330(b)(3)(A) of the Public Health 
Service Act (42 U.S.C. 254b(b)(3)(A))). 
(b) GUIDANCE TO STATES REGARDING FEDERAL RE-
IMBURSEMENT FOR FURNISHING SERVICES AND TREAT-
MENT FOR SUBSTANCE USE DISORDERS UNDER MEDICAID 
USING TELEHEALTH SERVICES, INCLUDING IN SCHOOL- 
BASED HEALTH CENTERS.—Not later than 1 year after the 
date of enactment of this Act, the Secretary, acting through 
the Administrator of the Centers for Medicare & Medicaid 
Services, shall issue guidance to States on the following: 
(1) State options for Federal reimbursement of 
expenditures under Medicaid for furnishing services 
and treatment for substance use disorders, including 
assessment, medication-assisted treatment, counseling, 
and medication management, using telehealth serv-
ices. Such guidance shall also include guidance on
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† HR 6 EAS 
furnishing services and treatments that address the 
needs of high risk individuals, including at least the 
following groups: 
(A) American Indians and Alaska Natives. 
(B) Adults under the age of 40. 
(C) Individuals with a history of nonfatal 
overdose. 
(2) State options for Federal reimbursement of 
expenditures under Medicaid for education directed to 
providers serving Medicaid beneficiaries with sub-
stance use disorders using the hub and spoke model, 
through contracts with managed care entities, through 
administrative claiming for disease management ac-
tivities, and under Delivery System Reform Incentive 
Payment (‘‘DSRIP’’) programs. 
(3) State options for Federal reimbursement of 
expenditures under Medicaid for furnishing services 
and treatment for substance use disorders for individ-
uals enrolled in Medicaid in a school-based health 
center using telehealth services. 
(c) GAO EVALUATION OF CHILDREN’S ACCESS TO 
SERVICES AND TREATMENT FOR SUBSTANCE USE DIS-
ORDERS UNDER MEDICAID.— 
(1) STUDY.—The Comptroller General shall 
evaluate children’s access to services and treatment
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† HR 6 EAS 
for substance use disorders under Medicaid. The eval-
uation shall include an analysis of State options for 
improving children’s access to such services and treat-
ment and for improving outcomes, including by in-
creasing the number of Medicaid providers who offer 
services or treatment for substance use disorders in a 
school-based health center using telehealth services, 
particularly in rural and underserved areas. The 
evaluation shall include an analysis of Medicaid pro-
vider reimbursement rates for services and treatment 
for substance use disorders. 
(2) REPORT.—Not later than 1 year after the 
date of enactment of this Act, the Comptroller General 
shall submit to Congress a report containing the re-
sults of the evaluation conducted under paragraph 
(1), together with recommendations for such legisla-
tion and administrative action as the Comptroller 
General determines appropriate. 
(d) REPORT ON REDUCING BARRIERS TO USING TELE-
HEALTH SERVICES AND REMOTE PATIENT MONITORING 
FOR PEDIATRIC POPULATIONS UNDER MEDICAID.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of this Act, the Secretary, act-
ing through the Administrator of the Centers for 
Medicare & Medicaid Services, shall issue a report to
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† HR 6 EAS 
the Committee on Finance of the Senate and the Com-
mittee on Energy and Commerce of the House of Rep-
resentative identifying best practices and potential so-
lutions for reducing barriers to using telehealth serv-
ices to furnish services and treatment for substance 
use disorders among pediatric populations under 
Medicaid. The report shall include— 
(A) analyses of the best practices, barriers, 
and potential solutions for using telehealth serv-
ices to diagnose and provide services and treat-
ment for children with substance use disorders, 
including opioid use disorder; and 
(B) identification and analysis of the dif-
ferences, if any, in furnishing services and treat-
ment for children with substance use disorders 
using telehealth services and using services deliv-
ered in person, such as, and to the extent fea-
sible, with respect to— 
(i) utilization rates; 
(ii) costs; 
(iii) avoidable inpatient admissions 
and readmissions; 
(iv) quality of care; and 
(v) patient, family, and provider satis-
faction.
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(2) PUBLICATION.—The Secretary shall publish 
the report required under paragraph (1) on a public 
Internet website of the Department of Health and 
Human Services. 
SEC. 2204. ENHANCING PATIENT ACCESS TO NON-OPIOID 
TREATMENT OPTIONS. 
Not later than January 1, 2019, the Secretary of 
Health and Human Services, acting through the Adminis-
trator of the Centers for Medicare & Medicaid Services, 
shall issue 1 or more final guidance documents, or update 
existing guidance documents, to States regarding manda-
tory and optional items and services that may be provided 
under a State plan under title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.), or under a waiver of such 
a plan, for non-opioid treatment and management of pain, 
including, but not limited to, evidence-based non-opioid 
pharmacological therapies and non-pharmacological thera-
pies. 
SEC. 2205. ASSESSING BARRIERS TO OPIOID USE DISORDER 
TREATMENT. 
(a) STUDY.— 
(1) IN GENERAL.—The Comptroller General of 
the United States (in this section referred to as the 
‘‘Comptroller General’’) shall conduct a study regard-
ing the barriers to providing medication used in the
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† HR 6 EAS 
treatment of substance use disorders under Medicaid 
distribution models such as the ‘‘buy-and-bill’’ model, 
and options for State Medicaid programs to remove 
or reduce such barriers. The study shall include anal-
yses of each of the following models of distribution of 
substance use disorder treatment medications, par-
ticularly 
buprenorphine, 
naltrexone, 
and 
buprenorphine-naloxone combinations: 
(A) The purchasing, storage, and adminis-
tration of substance use disorder treatment medi-
cations by providers. 
(B) The dispensing of substance use dis-
order treatment medications by pharmacists. 
(C) The ordering, prescribing, and obtain-
ing substance use disorder treatment medications 
on demand from specialty pharmacies by pro-
viders. 
(2) REQUIREMENTS.—For each model of dis-
tribution specified in paragraph (1), the Comptroller 
General shall evaluate how each model presents bar-
riers or could be used by selected State Medicaid pro-
grams to reduce the barriers related to the provision 
of substance use disorder treatment by examining 
what is known about the effects of the model of dis-
tribution on—
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† HR 6 EAS 
(A) Medicaid beneficiaries’ access to sub-
stance use disorder treatment medications; 
(B) the differential cost to the program be-
tween each distribution model for medication as-
sisted treatment; and 
(C) provider willingness to provide or pre-
scribe substance use disorder treatment medica-
tions. 
(b) REPORT.—Not later than 15 months after the date 
of the enactment of this Act, the Comptroller General shall 
submit to Congress a report containing the results of the 
study conducted under subsection (a), together with rec-
ommendations for such legislation and administrative ac-
tion as the Comptroller General determines appropriate. 
SEC. 2206. HELP FOR MOMS AND BABIES. 
(a) MEDICAID STATE PLAN.—Section 1905(a) of the 
Social Security Act (42 U.S.C. 1396d(a)) is amended by 
adding at the end the following new sentence: ‘‘In the case 
of a woman who is eligible for medical assistance on the 
basis of being pregnant (including through the end of the 
month in which the 60-day period beginning on the last 
day of her pregnancy ends), who is a patient in an institu-
tion for mental diseases for purposes of receiving treatment 
for a substance use disorder, and who was enrolled for med-
ical assistance under the State plan immediately before be-
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† HR 6 EAS 
coming a patient in an institution for mental diseases or 
who becomes eligible to enroll for such medical assistance 
while such a patient, the exclusion from the definition of 
‘medical assistance’ set forth in the subdivision (B) fol-
lowing paragraph (29) of the first sentence of this subsection 
shall not be construed as prohibiting Federal financial par-
ticipation for medical assistance for items or services that 
are provided to the woman outside of the institution.’’. 
(b) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendment made by subsection (a) 
shall take effect on the date of enactment of this Act. 
(2) RULE FOR CHANGES REQUIRING STATE LEG-
ISLATION.—In the case of a State plan under title 
XIX of the Social Security Act which the Secretary 
of Health and Human Services determines requires 
State legislation (other than legislation appropriating 
funds) in order for the plan to meet the additional re-
quirements imposed by the amendment made by sub-
section (a), the State plan shall not be regarded as 
failing to comply with the requirements of such title 
solely on the basis of its failure to meet these addi-
tional requirements before the first day of the first 
calendar quarter beginning after the close of the first 
regular session of the State legislature that begins
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† HR 6 EAS 
after the date of the enactment of this Act. For pur-
poses of the previous sentence, in the case of a State 
that has a 2-year legislative session, each year of such 
session shall be deemed to be a separate regular ses-
sion of the State legislature. 
SEC. 2207. SECURING FLEXIBILITY TO TREAT SUBSTANCE 
USE DISORDERS. 
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: 
‘‘(7) Payment shall be made under this title to a State 
for expenditures for capitation payments described in sec-
tion 438.6(e) of title 42, Code of Federal Regulations (or 
any successor regulation).’’. 
SEC. 2208. MACPAC STUDY AND REPORT ON MAT UTILIZA-
TION CONTROLS UNDER STATE MEDICAID 
PROGRAMS. 
(a) STUDY.—The Medicaid and CHIP Payment and 
Access Commission shall conduct a study and analysis of 
utilization control policies applied to medication-assisted 
treatment for substance use disorders under State Medicaid 
programs, including policies and procedures applied both 
in fee-for-service Medicaid and in risk-based managed care 
Medicaid, which shall—
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† HR 6 EAS 
(1) include an inventory of such utilization con-
trol policies and related protocols for ensuring access 
to medically necessary treatment; 
(2) determine whether managed care utilization 
control policies and procedures for medication as-
sisted treatment for substance use disorders are con-
sistent with section 438.210(a)(4)(ii) of title 42, Code 
of Federal Regulations; and 
(3) identify policies that— 
(A) limit an individual’s access to medica-
tion-assisted treatment for a substance use dis-
order by limiting the quantity of medication-as-
sisted treatment prescriptions, or the number of 
refills for such prescriptions, available to the in-
dividual as part of a prior authorization process 
or similar utilization protocols; and 
(B) apply without evaluating individual 
instances of fraud, waste, or abuse. 
(b) REPORT.—Not later than 1 year after the date of 
the enactment of this Act, the Medicaid and CHIP Payment 
and Access Commission shall make publicly available a re-
port containing the results of the study conducted under 
subsection (a).
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† HR 6 EAS 
SEC. 2209. OPIOID ADDICTION TREATMENT PROGRAMS EN-
HANCEMENT. 
(a) T–MSIS SUBSTANCE
USE
DISORDER
DATA 
BOOK.— 
(1) IN GENERAL.—Not later than the date that 
is 12 months after the date of enactment of this Act, 
the Secretary of Health and Human Services (in this 
section referred to as the ‘‘Secretary’’) shall publish 
on the public website of the Centers for Medicare & 
Medicaid Services a report with comprehensive data 
on the prevalence of substance use disorders in the 
Medicaid beneficiary population and services pro-
vided for the treatment of substance use disorders 
under Medicaid. 
(2) CONTENT OF REPORT.—The report required 
under paragraph (1) shall include, at a minimum, 
the following data for each State (including, to the ex-
tent available, for the District of Columbia, Puerto 
Rico, the Virgin Islands, Guam, the Northern Mar-
iana Islands, and American Samoa): 
(A) The number and percentage of individ-
uals enrolled in the State Medicaid plan or 
waiver of such plan in each of the major enroll-
ment categories (as defined in a public letter 
from the Medicaid and CHIP Payment and Ac-
cess Commission to the Secretary) who have been
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† HR 6 EAS 
diagnosed with a substance use disorder and 
whether such individuals are enrolled under the 
State Medicaid plan or a waiver of such plan, 
including the specific waiver authority under 
which they are enrolled, to the extent available. 
(B) A list of the substance use disorder 
treatment services by each major type of service, 
such as counseling, medication assisted treat-
ment, peer support, residential treatment, and 
inpatient care, for which beneficiaries in each 
State received at least 1 service under the State 
Medicaid plan or a waiver of such plan. 
(C) The number and percentage of individ-
uals with a substance use disorder diagnosis en-
rolled in the State Medicaid plan or waiver of 
such plan who received substance use disorder 
treatment services under such plan or waiver by 
each major type of service under subparagraph 
(B) within each major setting type, such as out-
patient, inpatient, residential, and other home 
and community-based settings. 
(D) The number of services provided under 
the State Medicaid plan or waiver of such plan 
per individual with a substance use disorder di-
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† HR 6 EAS 
agnosis enrolled in such plan or waiver for each 
major type of service under subparagraph (B). 
(E) The number and percentage of individ-
uals enrolled in the State Medicaid plan or 
waiver, by major enrollment category, who re-
ceived 
substance 
use 
disorder 
treatment 
through— 
(i) a medicaid managed care entity (as 
defined in section 1932(a)(1)(B) of the So-
cial Security Act (42 U.S.C. 1396u– 
2(a)(1)(B))), including the number of such 
individuals who received such assistance 
through a prepaid inpatient health plan or 
a prepaid ambulatory health plan; 
(ii) a fee-for-service payment model; or 
(iii) an alternative payment model, to 
the extent available. 
(F) The number and percentage of individ-
uals with a substance use disorder who receive 
substance use disorder treatment services in an 
outpatient or home and community-based setting 
after receiving treatment in an inpatient or resi-
dential setting, and the number of services re-
ceived by such individuals in the outpatient or 
home and community-based setting.
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† HR 6 EAS 
(3) ANNUAL
UPDATES.—The Secretary shall 
issue an updated version of the report required under 
paragraph (1) not later than January 1 of each cal-
endar year through 2024. 
(4) USE OF T–MSIS DATA.—The report required 
under paragraph (1) and updates required under 
paragraph (3) shall— 
(A) use data and definitions from the 
Transformed Medicaid Statistical Information 
System (‘‘T–MSIS’’) data set that is no more 
than 12 months old on the date that the report 
or update is published; and 
(B) as appropriate, include a description 
with respect to each State of the quality and 
completeness of the data and caveats describing 
the limitations of the data reported to the Sec-
retary by the State that is sufficient to commu-
nicate the appropriate uses for the information. 
(b) MAKING T–MSIS DATA ON SUBSTANCE USE DIS-
ORDERS AVAILABLE TO RESEARCHERS.— 
(1) IN GENERAL.—The Secretary shall publish in 
the Federal Register a system of records notice for the 
data specified in paragraph (2) for the Transformed 
Medicaid Statistical Information System, in accord-
ance with section 552a(e)(4) of title 5, United States
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† HR 6 EAS 
Code. The notice shall outline policies that protect the 
security and privacy of the data that, at a minimum, 
meet the security and privacy policies of SORN 09– 
70–0541 for the Medicaid Statistical Information 
System. 
(2) REQUIRED DATA.—The data covered by the 
systems of records notice required under paragraph 
(1) shall be sufficient for researchers and States to 
analyze the prevalence of substance use disorders in 
the Medicaid beneficiary population and the treat-
ment of substance use disorders under Medicaid 
across all States (including the District of Columbia, 
Puerto Rico, the Virgin Islands, Guam, the Northern 
Mariana Islands, and American Samoa), forms of 
treatment, and treatment settings. 
(3) INITIATION OF DATA-SHARING ACTIVITIES.— 
Not later than January 1, 2019, the Secretary shall 
initiate the data-sharing activities outlined in the no-
tice required under paragraph (1). 
SEC. 2210. BETTER DATA SHARING TO COMBAT THE OPIOID 
CRISIS. 
(a) IN GENERAL.—Section 1903(m) of the Social Secu-
rity Act (42 U.S.C. 1396b(m)), as amended by section 2207, 
is amended by adding at the end the following new para-
graph:
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† HR 6 EAS 
‘‘(8)(A) The State agency administering the State plan 
under this title may have reasonable access, as determined 
by the State, to 1 or more prescription drug monitoring 
program databases administered or accessed by the State 
to the extent the State agency is permitted to access such 
databases under State law. 
‘‘(B) Such State agency may facilitate reasonable ac-
cess, as determined by the State, to 1 or more prescription 
drug monitoring program databases administered or 
accessed by the State, to same extent that the State agency 
is permitted under State law to access such databases, for— 
‘‘(i) any provider enrolled under the State plan 
to provide services to Medicaid beneficiaries; and 
‘‘(ii) any managed care entity (as defined under 
section 1932(a)(1)(B)) that has a contract with the 
State 
under 
this 
subsection 
or 
under 
section 
1905(t)(3). 
‘‘(C) Such State agency may share information in 
such databases, to the same extent that the State agency 
is permitted under State law to share information in such 
databases, with— 
‘‘(i) any provider enrolled under the State plan 
to provide services to Medicaid beneficiaries; and 
‘‘(ii) any managed care entity (as defined under 
section 1932(a)(1)(B)) that has a contract with the
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† HR 6 EAS 
State 
under 
this 
subsection 
or 
under 
section 
1905(t)(3).’’. 
(b) SECURITY AND PRIVACY.—All applicable State and 
Federal security and privacy protections and laws shall 
apply to any State agency, individual, or entity accessing 
1 or more prescription drug monitoring program databases 
or obtaining information in such databases in accordance 
with section 1903(m)(8) of the Social Security Act (42 
U.S.C. 1396b(m)(8)) (as added by subsection (a)). 
(c) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall take effect on the date of enactment of this 
Act. 
SEC. 2211. 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 following: 
‘‘(B) MANDATORY
REPORTING
WITH
RE-
SPECT
TO
BEHAVIORAL
HEALTH
MEASURES.—
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† HR 6 EAS 
Beginning with the State report required under 
subsection (d)(1) for 2024, the Secretary shall re-
quire States to use all behavioral health meas-
ures included in the core set of adult health qual-
ity measures and any updates or changes to such 
measures to report information, using the stand-
ardized format for reporting information and 
procedures developed under subparagraph (A), 
regarding the quality of behavioral health care 
for Medicaid eligible adults.’’; 
(B) in paragraph (5), by adding at the end 
the following new subparagraph: 
‘‘(C) BEHAVIORAL
HEALTH
MEASURES.— 
Beginning with respect to State reports required 
under subsection (d)(1) for 2024, the core set of 
adult health quality measures maintained under 
this paragraph (and any updates or changes to 
such measures) shall include behavioral 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-
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† HR 6 EAS 
ures included in the core set of adult health qual-
ity measures maintained under such subsection 
(b)(5) and any updates or changes to such meas-
ures (as required under subsection (b)(3))’’. 
SEC. 2212. REPORT ON INNOVATIVE STATE INITIATIVES 
AND STRATEGIES TO PROVIDE HOUSING-RE-
LATED SERVICES AND SUPPORTS TO INDIVID-
UALS STRUGGLING WITH SUBSTANCE USE 
DISORDERS UNDER MEDICAID. 
(a) IN GENERAL.—Not later than 1 year after the date 
of enactment of this Act, the Secretary of Health and 
Human Services shall issue a report to Congress describing 
innovative State initiatives and strategies for providing 
housing-related services and supports under a State Med-
icaid program to individuals with substance use disorders 
who are experiencing or at risk of experiencing homeless-
ness. 
(b) CONTENT OF REPORT.—The report required under 
subsection (a) shall describe the following: 
(1) Existing methods and innovative strategies 
developed and adopted by State Medicaid programs 
that have achieved positive outcomes in increasing 
housing stability among Medicaid beneficiaries with 
substance use disorders who are experiencing or at
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† HR 6 EAS 
risk of experiencing homelessness, including Medicaid 
beneficiaries with substance use disorders who are— 
(A) receiving treatment for substance use 
disorders in inpatient, residential, outpatient, or 
home and community-based settings; 
(B) transitioning between substance use dis-
order treatment settings; or 
(C) living in supportive housing or another 
model of affordable housing. 
(2) Strategies employed by Medicaid managed 
care organizations, primary care case managers, hos-
pitals, accountable care organizations, and other care 
coordination providers to deliver housing-related serv-
ices and supports and to coordinate services provided 
under State Medicaid programs across different treat-
ment settings. 
(3) Innovative strategies and lessons learned by 
States with Medicaid waivers approved under section 
1115 or 1915 of the Social Security Act (42 U.S.C. 
1315, 1396n), including— 
(A) challenges experienced by States in de-
signing, securing, and implementing such waiv-
ers or plan amendments; 
(B) how States developed partnerships with 
other organizations such as behavioral health
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† HR 6 EAS 
agencies, State housing agencies, housing pro-
viders, health care services agencies and pro-
viders, 
community-based 
organizations, 
and 
health insurance plans to implement waivers or 
State plan amendments; and 
(C) how and whether States plan to provide 
Medicaid coverage for housing-related services 
and supports in the future, including by cov-
ering such services and supports under State 
Medicaid plans or waivers. 
(4) Existing opportunities for States to provide 
housing-related services and supports through a Med-
icaid waiver under sections 1115 or 1915 of the So-
cial Security Act (42 U.S.C. 1315, 1396n) or through 
a State Medicaid plan amendment, such as the As-
sistance in Community Integration Service pilot pro-
gram, which promotes supportive housing and other 
housing-related supports under Medicaid for individ-
uals with substance use disorders and for which 
Maryland has a waiver approved under such section 
1115 to conduct the program. 
(5) Innovative strategies and partnerships devel-
oped and implemented by State Medicaid programs 
or other entities to identify and enroll eligible indi-
viduals with substance use disorders who are experi-
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† HR 6 EAS 
encing or at risk of experiencing homelessness in 
State Medicaid programs. 
SEC. 2213. TECHNICAL ASSISTANCE AND SUPPORT FOR IN-
NOVATIVE STATE STRATEGIES TO PROVIDE 
HOUSING-RELATED SUPPORTS UNDER MED-
ICAID. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall provide technical assistance and sup-
port to States regarding the development and expansion of 
innovative State strategies (including through State Med-
icaid demonstration projects) to provide housing-related 
supports and services and care coordination services under 
Medicaid to individuals with substance use disorders. 
(b) REPORT.—Not later than 180 days after the date 
of enactment of this Act, the Secretary shall issue a report 
to Congress detailing a plan of action to carry out the re-
quirements of subsection (a). 
Subtitle C—Human Services 
SEC. 2301. SUPPORTING FAMILY-FOCUSED RESIDENTIAL 
TREATMENT. 
(a) DEFINITIONS.—In this section: 
(1) FAMILY-FOCUSED RESIDENTIAL TREATMENT 
PROGRAM.—The 
term 
‘‘family-focused 
residential 
treatment program’’ means a trauma-informed resi-
dential program primarily for substance use disorder
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† HR 6 EAS 
treatment for pregnant and postpartum women and 
parents and guardians that allows children to reside 
with such women or their parents or guardians dur-
ing treatment to the extent appropriate and applica-
ble. 
(2) MEDICAID PROGRAM.—The term ‘‘Medicaid 
program’’ means the program established under title 
XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.). 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(4) TITLE IV–E PROGRAM.—The term ‘‘title IV– 
E program’’ means the program for foster care, pre-
vention, and permanency established under part E of 
title IV of the Social Security Act (42 U.S.C. 670 et 
seq.). 
(b) GUIDANCE
ON FAMILY-FOCUSED RESIDENTIAL 
TREATMENT PROGRAMS.— 
(1) IN GENERAL.—Not later than 180 days after 
the date of enactment of this Act, the Secretary, in 
consultation with divisions of the Department of 
Health and Human Services administering substance 
use disorder or child welfare programs, shall develop 
and issue guidance to States identifying opportunities 
to support family-focused residential treatment pro-
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grams for the provision of substance use disorder 
treatment. Before issuing such guidance, the Secretary 
shall solicit input from representatives of States, 
health care providers with expertise in addiction med-
icine, obstetrics and gynecology, neonatology, child 
trauma, and child development, health plans, recipi-
ents of family-focused treatment services, and other 
relevant stakeholders. 
(2) ADDITIONAL REQUIREMENTS.—The guidance 
required under paragraph (1) shall include descrip-
tions of the following: 
(A) Existing opportunities and flexibilities 
under the Medicaid program, including under 
waivers authorized under section 1115 or 1915 of 
the Social Security Act (42 U.S.C. 1315, 1396n), 
for States to receive Federal Medicaid funding 
for the provision of substance use disorder treat-
ment for pregnant and postpartum women and 
parents and guardians and, to the extent appli-
cable, their children, in family-focused residen-
tial treatment programs. 
(B) How States can employ and coordinate 
funding provided under the Medicaid program, 
the title IV-E program, and other programs ad-
ministered by the Secretary to support the provi-
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† HR 6 EAS 
sion of treatment and services provided by a 
family-focused residential treatment facility such 
as substance use disorder treatment and services, 
including medication-assisted treatment, family, 
group, and individual counseling, case manage-
ment, parenting education and skills develop-
ment, the provision, assessment, or coordination 
of care and services for children, including nec-
essary assessments and appropriate interven-
tions, non-emergency transportation for nec-
essary care provided at or away from a program 
site, transitional services and supports for fami-
lies leaving treatment, and other services. 
(C) How States can employ and coordinate 
funding provided under the Medicaid program 
and the title IV–E program (including as 
amended by the Family First Prevention Serv-
ices Act enacted under title VII of division E of 
Public Law 115–123, and particularly with re-
spect to the authority under subsections (a)(2)(C) 
and (j) of section 472 and section 474(a)(1) of 
the Social Security Act (42 U.S.C. 672, 
674(a)(1)) (as amended by section 50712 of Pub-
lic Law 115–123) to provide foster care mainte-
nance payments for a child placed with a parent
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† HR 6 EAS 
who is receiving treatment in a licensed residen-
tial family-based treatment facility for a sub-
stance use disorder) to support placing children 
with their parents in family-focused residential 
treatment programs. 
SEC. 2302. IMPROVING RECOVERY AND REUNIFYING FAMI-
LIES. 
(a) FAMILY RECOVERY AND REUNIFICATION PROGRAM 
REPLICATION PROJECT.—Section 435 of the Social Secu-
rity Act (42 U.S.C. 629e) is amended by adding at the end 
the following: 
‘‘(e) FAMILY RECOVERY
AND REUNIFICATION PRO-
GRAM REPLICATION PROJECT.— 
‘‘(1) PURPOSE.—The purpose of this subsection 
is to provide resources to the Secretary to support the 
conduct and evaluation of a family recovery and re-
unification program replication project (referred to in 
this subsection as the ‘project’) and to determine the 
extent to which such programs may be appropriate 
for use at different intervention points (such as when 
a child is at risk of entering foster care or when a 
child is living with a guardian while a parent is in 
treatment). The family recovery and reunification 
program conducted under the project shall use a re-
covery coach model that is designed to help reunify
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† HR 6 EAS 
families and protect children by working with parents 
or guardians with a substance use disorder who have 
temporarily lost custody of their children. 
‘‘(2) PROGRAM COMPONENTS.—The family recov-
ery and reunification program conducted under the 
project shall adhere closely to the elements and pro-
tocol determined to be most effective in other recovery 
coaching programs that have been rigorously evalu-
ated and shown to increase family reunification and 
protect children and, consistent with such elements 
and protocol, shall provide such items and services 
as— 
‘‘(A) assessments to evaluate the needs of the 
parent or guardian; 
‘‘(B) assistance in receiving the appropriate 
benefits to aid the parent or guardian in recov-
ery; 
‘‘(C) services to assist the parent or guard-
ian in prioritizing issues identified in assess-
ments, establishing goals for resolving such issues 
that are consistent with the goals of the treat-
ment provider, child welfare agency, courts, and 
other agencies involved with the parent or guard-
ian or their children, and making a coordinated 
plan for achieving such goals;
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† HR 6 EAS 
‘‘(D) home visiting services coordinated 
with the child welfare agency and treatment pro-
vider involved with the parent or guardian or 
their children; 
‘‘(E) case management services to remove 
barriers for the parent or guardian to partici-
pate and continue in treatment, as well as to re- 
engage a parent or guardian who is not partici-
pating or progressing in treatment; 
‘‘(F) access to services needed to monitor the 
parent’s or guardian’s compliance with program 
requirements; 
‘‘(G) frequent reporting between the treat-
ment provider, child welfare agency, courts, and 
other agencies involved with the parent or guard-
ian or their children to ensure appropriate infor-
mation on the parent’s or guardian’s status is 
available to inform decision-making; and 
‘‘(H) assessments and recommendations 
provided by a recovery coach to the child welfare 
caseworker responsible for documenting the par-
ent’s or guardian’s progress in treatment and re-
covery as well as the status of other areas identi-
fied in the treatment plan for the parent or 
guardian, including a recommendation regard-
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† HR 6 EAS 
ing the expected safety of the child if the child 
is returned to the custody of the parent or guard-
ian that can be used by the caseworker and a 
court to make permanency decisions regarding 
the child. 
‘‘(3) RESPONSIBILITIES OF THE SECRETARY.— 
‘‘(A) IN
GENERAL.—The Secretary shall, 
through a grant or contract with 1 or more enti-
ties, conduct and evaluate the family recovery 
and reunification program under the project. 
‘‘(B) REQUIREMENTS.—In identifying 1 or 
more entities to conduct the evaluation of the 
family recovery and reunification program, the 
Secretary shall— 
‘‘(i) determine that the area or areas 
in which the program will be conducted 
have sufficient substance use disorder treat-
ment providers and other resources (other 
than those provided with funds made avail-
able to carry out the project) to successfully 
conduct the program; 
‘‘(ii) determine that the area or areas 
in which the program will be conducted 
have enough potential program partici-
pants, and will serve a sufficient number of
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† HR 6 EAS 
parents or guardians and their children, so 
as to allow for the formation of a control 
group, evaluation results to be adequately 
powered, and preliminary results of the 
evaluation to be available within 4 years of 
the program’s implementation; 
‘‘(iii) provide the entity or entities 
with technical assistance for the program 
design, including by working with 1 or 
more entities that are or have been involved 
in recovery coaching programs that have 
been rigorously evaluated and shown to in-
crease family reunification and protect chil-
dren so as to make sure the program con-
ducted under the project adheres closely to 
the elements and protocol determined to be 
most effective in such other recovery coach-
ing programs; 
‘‘(iv) assist the entity or entities in se-
curing adequate coaching, treatment, child 
welfare, court, and other resources needed to 
successfully conduct the family recovery and 
reunification program under the project; 
and
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† HR 6 EAS 
‘‘(v) ensure the entity or entities will 
be able to monitor the impacts of the pro-
gram in the area or areas in which it is 
conducted for at least 5 years after parents 
or guardians and their children are ran-
domly assigned to participate in the pro-
gram or to be part of the program’s control 
group. 
‘‘(4) EVALUATION REQUIREMENTS.— 
‘‘(A) IN GENERAL.—The Secretary, in con-
sultation with the entity or entities conducting 
the family recovery and reunification program 
under the project, shall conduct an evaluation to 
determine whether the program has been imple-
mented effectively and resulted in improvements 
for children and families. The evaluation shall 
have 3 components: a pilot phase, an impact 
study, and an implementation study. 
‘‘(B) PILOT PHASE.—The pilot phase com-
ponent of the evaluation shall consist of the Sec-
retary providing technical assistance to the enti-
ty or entities conducting the family recovery and 
reunification program under the project to en-
sure—
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† HR 6 EAS 
‘‘(i) the program’s implementation ad-
heres closely to the elements and protocol de-
termined to be most effective in other recov-
ery coaching programs that have been rigor-
ously evaluated and shown to increase fam-
ily reunification and protect children; and 
‘‘(ii) random assignment of parents or 
guardians and their children to be partici-
pants in the program or to be part of the 
program’s control group is being carried 
out. 
‘‘(C) IMPACT
STUDY.—The impact study 
component of the evaluation shall determine the 
impacts of the family recovery and reunification 
program conducted under the project on the par-
ents and guardians and their children partici-
pating in the program. The impact study compo-
nent shall— 
‘‘(i) be conducted using an experi-
mental design that uses a random assign-
ment research methodology; 
‘‘(ii) consistent with previous studies of 
other recovery coaching programs that have 
been rigorously evaluated and shown to in-
crease family reunification and protect chil-
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† HR 6 EAS 
dren, measure outcomes for parents and 
guardians and their children over multiple 
time periods, including for a period of 5 
years; and 
‘‘(iii) include measurements of family 
stability and parent, guardian, and child 
safety for program participants and the 
program control group that are consistent 
with measurements of such factors for par-
ticipants and control groups from previous 
studies of other recovery coaching programs 
so as to allow results of the impact study to 
be compared with the results of such prior 
studies, including with respect to compari-
sons between program participants and the 
program control group regarding— 
‘‘(I) safe family reunification; 
‘‘(II) time to reunification; 
‘‘(III) 
permanency 
(such 
as 
through 
measures 
of 
reunification, 
adoption, or placement with guard-
ians); 
‘‘(IV) safety (such as through 
measures of subsequent maltreatment);
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† HR 6 EAS 
‘‘(V) parental or guardian treat-
ment persistence and engagement; 
‘‘(VI) parental or guardian sub-
stance use; 
‘‘(VII) juvenile delinquency; 
‘‘(VIII) cost; and 
‘‘(IX) other measurements agreed 
upon by the Secretary and the entity 
or entities operating the family recov-
ery and reunification program under 
the project. 
‘‘(D) IMPLEMENTATION STUDY.—The imple-
mentation study component of the evaluation 
shall be conducted concurrently with the conduct 
of the impact study component and shall include, 
in addition to such other information as the Sec-
retary may determine, descriptions and analyses 
of— 
‘‘(i) the adherence of the family recov-
ery and reunification program conducted 
under the project to other recovery coaching 
programs that have been rigorously evalu-
ated and shown to increase family reunifi-
cation and protect children; and
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† HR 6 EAS 
‘‘(ii) the difference in services received 
or proposed to be received by the program 
participants and the program control 
group. 
‘‘(E) REPORT.—The Secretary shall publish 
on an internet website maintained by the Sec-
retary the following information: 
‘‘(i) A report on the pilot phase compo-
nent of the evaluation. 
‘‘(ii) A report on the impact study 
component of the evaluation. 
‘‘(iii) A report on the implementation 
study component of the evaluation. 
‘‘(iv) A report that includes— 
‘‘(I) analyses of the extent to 
which the program has resulted in in-
creased reunifications, increased per-
manency, case closures, net savings to 
the State or States involved (taking 
into account both costs borne by States 
and the Federal government), or other 
outcomes, or if the program did not 
produce such outcomes, an analysis of 
why the replication of the program did 
not yield such results;
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† HR 6 EAS 
‘‘(II) if, based on such analyses, 
the Secretary determines the program 
should be replicated, a replication 
plan; and 
‘‘(III) such recommendations for 
legislation and administrative action 
as the Secretary determines appro-
priate. 
‘‘(5) APPROPRIATION.—In addition to any 
amounts otherwise made available to carry out this 
subpart, out of any money in the Treasury of the 
United States not otherwise appropriated, there are 
appropriated $15,000,000 for fiscal year 2019 to 
carry out the project, which shall remain available 
through fiscal year 2026.’’. 
(b) CLARIFICATION OF PAYER OF LAST RESORT AP-
PLICATION TO CHILD WELFARE PREVENTION AND FAMILY 
SERVICES.—Section 471(e)(10) of the Social Security Act 
(42 U.S.C. 671(e)(10)), as added by section 50711(a)(2) of 
division E of Public Law 115–123, is amended— 
(1) in subparagraph (A), by inserting ‘‘, nor 
shall the provision of such services or programs be 
construed to permit the State to reduce medical or 
other assistance available to a recipient of such serv-
ices or programs’’ after ‘‘under this Act’’; and
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† HR 6 EAS 
(2) by adding at the end the following: 
‘‘(C) PAYER OF LAST RESORT.—In carrying 
out its responsibilities to ensure access to services 
or programs under this subsection, the State 
agency shall not be considered to be a legally lia-
ble third party for purposes of satisfying a fi-
nancial commitment for the cost of providing 
such services or programs with respect to any in-
dividual for whom such cost would have been 
paid for from another public or private source 
but for the enactment of this subsection (except 
that whenever considered necessary to prevent a 
delay in the receipt of appropriate early inter-
vention services by a child or family in a timely 
fashion, funds provided under section 474(a)(6) 
may be used to pay the provider of services or 
programs pending reimbursement from the pub-
lic or private source that has ultimate responsi-
bility for the payment).’’. 
(c) EFFECTIVE DATE.—The amendments made by sub-
section (b) shall take effect as if included in section 50711 
of division E of Public Law 115–123. 
SEC. 2303. BUILDING CAPACITY FOR FAMILY-FOCUSED RES-
IDENTIAL TREATMENT. 
(a) DEFINITIONS.—In this section:
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† HR 6 EAS 
(1) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ means a State, county, local, or tribal health or 
child welfare agency, a private nonprofit organiza-
tion, a research organization, a treatment service pro-
vider, an institution of higher education (as defined 
under section 101 of the Higher Education Act of 
1965 (20 U.S.C. 1001)), or another entity specified by 
the Secretary. 
(2) FAMILY-FOCUSED RESIDENTIAL TREATMENT 
PROGRAM.—The 
term 
‘‘family-focused 
residential 
treatment program’’ means a trauma-informed resi-
dential program primarily for substance use disorder 
treatment for pregnant and postpartum women and 
parents and guardians that allows children to reside 
with such women or their parents or guardians dur-
ing treatment to the extent appropriate and applica-
ble. 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(b) SUPPORT FOR THE DEVELOPMENT OF EVIDENCE- 
BASED FAMILY-FOCUSED RESIDENTIAL TREATMENT PRO-
GRAMS.— 
(1) AUTHORITY TO AWARD GRANTS.—The Sec-
retary shall award grants to eligible entities for pur-
poses of developing, enhancing, or evaluating family-
269 
† HR 6 EAS 
focused residential treatment programs to increase the 
availability of such programs that meet the require-
ments for promising, supported, or well-supported 
practices specified in section 471(e)(4)(C) of the So-
cial Security Act (42 U.S.C. 671(e)(4)(C))) (as added 
by the Family First Prevention Services Act enacted 
under title VII of division E of Public Law 115–123). 
(2) EVALUATION REQUIREMENT.—The Secretary 
shall require any evaluation of a family-focused resi-
dential treatment program by an eligible entity that 
uses funds awarded under this section for all or part 
of the costs of the evaluation be designed to assist in 
the determination of whether the program may qual-
ify as a promising, supported, or well-supported prac-
tice in accordance with the requirements of such sec-
tion 471(e)(4)(C). 
(c) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to the Secretary to carry out 
this section, $20,000,000 for fiscal year 2019, which shall 
remain available through fiscal year 2023.
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Subtitle D—Synthetics Trafficking 
and Overdose Prevention 
SEC. 2401. SHORT TITLE. 
This subtitle may be cited as the ‘‘Synthetics Traf-
ficking and Overdose Prevention Act of 2018’’ or ‘‘STOP 
Act of 2018’’. 
SEC. 2402. CUSTOMS FEES. 
(a) IN GENERAL.—Section 13031(b)(9) of the Consoli-
dated Omnibus Budget Reconciliation Act of 1985 (19 
U.S.C. 58c(b)(9)) is amended by adding at the end the fol-
lowing: 
‘‘(D)(i) With respect to the processing of items 
that are sent to the United States through the inter-
national postal network by ‘Inbound Express Mail 
service’ or ‘Inbound EMS’ (as that service is described 
in the mail classification schedule referred to in sec-
tion 3631 of title 39, United States Code), the fol-
lowing payments are required: 
‘‘(I) $1 per Inbound EMS item. 
‘‘(II) If an Inbound EMS item is formally 
entered, the fee provided for under subsection 
(a)(9), if applicable. 
‘‘(ii) Notwithstanding section 451 of the Tariff 
Act of 1930 (19 U.S.C. 1451), the payments required 
by clause (i), as allocated pursuant to clause (iii)(I),
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† HR 6 EAS 
shall be the only payments required for reimburse-
ment of U.S. Customs and Border Protection for cus-
toms services provided in connection with the proc-
essing of an Inbound EMS item. 
‘‘(iii)(I) The payments required by clause (i)(I) 
shall be allocated as follows: 
‘‘(aa) 50 percent of the amount of the pay-
ments shall be paid on a quarterly basis by the 
United States Postal Service to the Commis-
sioner of U.S. Customs and Border Protection in 
accordance with regulations prescribed by the 
Secretary of the Treasury to reimburse U.S. Cus-
toms and Border Protection for customs services 
provided in connection with the processing of In-
bound EMS items. 
‘‘(bb) 50 percent of the amount of the pay-
ments shall be retained by the Postal Service to 
reimburse the Postal Service for services provided 
in connection with the customs processing of In-
bound EMS items. 
‘‘(II) Payments received by U.S. Customs and 
Border Protection under subclause (I)(aa) shall, in 
accordance with section 524 of the Tariff Act of 1930 
(19 U.S.C. 1524), be deposited in the Customs User 
Fee Account and used to directly reimburse each ap-
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† HR 6 EAS 
propriation for the amount paid out of that appro-
priation for the costs incurred in providing services 
to international mail facilities. Amounts deposited in 
accordance with the preceding sentence shall be avail-
able until expended for the provision of such services. 
‘‘(III) Payments retained by the Postal Service 
under subclause (I)(bb) shall be used to directly reim-
burse the Postal Service for the costs incurred in pro-
viding services in connection with the customs proc-
essing of Inbound EMS items. 
‘‘(iv) Beginning in fiscal year 2021, the Sec-
retary, in consultation with the Postmaster General, 
may adjust, not more frequently than once each fiscal 
year, the amount described in clause (i)(I) to an 
amount commensurate with the costs of services pro-
vided in connection with the customs processing of In-
bound EMS items, consistent with the obligations of 
the United States under international agreements.’’. 
(b) CONFORMING AMENDMENTS.—Section 13031(a) of 
the Consolidated Omnibus Budget Reconciliation Act of 
1985 (19 U.S.C. 58c(a)) is amended— 
(1) in paragraph (6), by inserting ‘‘(other than 
an item subject to a fee under subsection (b)(9)(D))’’ 
after ‘‘customs officer’’; and 
(2) in paragraph (10)—
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† HR 6 EAS 
(A) in subparagraph (C), in the matter pre-
ceding clause (i), by inserting ‘‘(other than In-
bound EMS items described in subsection 
(b)(9)(D))’’ after ‘‘release’’; and 
(B) in the flush at the end, by inserting ‘‘or 
of Inbound EMS items described in subsection 
(b)(9)(D),’’ after ‘‘(C),’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall take effect on January 1, 2020. 
SEC. 2403. MANDATORY ADVANCE ELECTRONIC INFORMA-
TION FOR POSTAL SHIPMENTS. 
(a) MANDATORY ADVANCE ELECTRONIC INFORMA-
TION.— 
(1) IN GENERAL.—Section 343(a)(3)(K) of the 
Trade Act of 2002 (Public Law 107–210; 19 U.S.C. 
2071 note) is amended to read as follows: 
‘‘(K)(i) The Secretary shall prescribe regu-
lations requiring the United States Postal Serv-
ice to transmit the information described in 
paragraphs (1) and (2) to the Commissioner of 
U.S. Customs and Border Protection for inter-
national mail shipments by the Postal Service 
(including shipments to the Postal Service from 
foreign postal operators that are transported by
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† HR 6 EAS 
private carrier) consistent with the requirements 
of this subparagraph. 
‘‘(ii) In prescribing regulations under 
clause (i), the Secretary shall impose require-
ments for the transmission to the Commissioner 
of information described in paragraphs (1) and 
(2) for mail shipments described in clause (i) 
that are comparable to the requirements for the 
transmission of such information imposed on 
similar non-mail shipments of cargo, taking into 
account the parameters set forth in subpara-
graphs (A) through (J). 
‘‘(iii) The regulations prescribed under 
clause (i) shall require the transmission of the 
information described in paragraphs (1) and (2) 
with respect to a shipment as soon as practicable 
in relation to the transportation of the shipment, 
consistent with subparagraph (H). 
‘‘(iv) Regulations prescribed under clause 
(i) shall allow for the requirements for the trans-
mission to the Commissioner of information de-
scribed in paragraphs (1) and (2) for mail ship-
ments described in clause (i) to be implemented 
in phases, as appropriate, by—
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† HR 6 EAS 
‘‘(I) setting incremental targets for in-
creasing the percentage of such shipments 
for which information is required to be 
transmitted to the Commissioner; and 
‘‘(II) taking into consideration— 
‘‘(aa) the risk posed by such ship-
ments; 
‘‘(bb) the volume of mail shipped 
to the United States by or through a 
particular country; and 
‘‘(cc) the capacities of foreign 
postal operators to provide that infor-
mation to the Postal Service. 
‘‘(v)(I) Notwithstanding clause (iv), the 
Postal Service shall, not later than December 31, 
2018, arrange for the transmission to the Com-
missioner of the information described in para-
graphs (1) and (2) for not less than 70 percent 
of the aggregate number of mail shipments, in-
cluding 100 percent of mail shipments from the 
People’s Republic of China, described in clause 
(i). 
‘‘(II) If the requirements of subclause (I) 
are not met, the Comptroller General of the 
United States shall submit to the appropriate
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† HR 6 EAS 
congressional committees, not later than June 
30, 2019, a report— 
‘‘(aa) assessing the reasons for the fail-
ure to meet those requirements; and 
‘‘(bb) identifying recommendations to 
improve the collection by the Postal Service 
of the information described in paragraphs 
(1) and (2). 
‘‘(vi)(I) Notwithstanding clause (iv), the 
Postal Service shall, not later than December 31, 
2020, arrange for the transmission to the Com-
missioner of the information described in para-
graphs (1) and (2) for 100 percent of the aggre-
gate number of mail shipments described in 
clause (i). 
‘‘(II) The Commissioner, in consultation 
with the Postmaster General, may determine to 
exclude a country from the requirement described 
in subclause (I) to transmit information for mail 
shipments described in clause (i) from the coun-
try if the Commissioner determines that the 
country— 
‘‘(aa) does not have the capacity to col-
lect and transmit such information;
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† HR 6 EAS 
‘‘(bb) represents a low risk for mail 
shipments that violate relevant United 
States laws and regulations; and 
‘‘(cc) accounts for low volumes of mail 
shipments that can be effectively screened 
for compliance with relevant United States 
laws and regulations through an alternate 
means. 
‘‘(III) The Commissioner shall, at a min-
imum on an annual basis, re-evaluate any deter-
mination made under subclause (II) to exclude a 
country from the requirement described in sub-
clause (I). If, at any time, the Commissioner de-
termines that a country no longer meets the re-
quirements under subclause (II), the Commis-
sioner may not further exclude the country from 
the requirement described in subclause (I). 
‘‘(IV) The Commissioner shall, on an an-
nual basis, submit to the appropriate congres-
sional committees— 
‘‘(aa) a list of countries with respect to 
which the Commissioner has made a deter-
mination under subclause (II) to exclude the 
countries from the requirement described in 
subclause (I); and
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† HR 6 EAS 
‘‘(bb) information used to support such 
determination with respect to such coun-
tries. 
‘‘(vii)(I) The Postmaster General shall, in 
consultation with the Commissioner, refuse any 
shipments received after December 31, 2020, for 
which the information described in paragraphs 
(1) and (2) is not transmitted as required under 
this subparagraph, except as provided in sub-
clause (II). 
‘‘(II) If remedial action is warranted in 
lieu of refusal of shipments pursuant to sub-
clause (I), the Postmaster General and the Com-
missioner shall take remedial action with respect 
to the shipments, including destruction, seizure, 
controlled delivery or other law enforcement ini-
tiatives, or correction of the failure to provide 
the information described in paragraphs (1) and 
(2) with respect to the shipment. 
‘‘(viii) Nothing in this subparagraph shall 
be construed to limit the authority of the Sec-
retary to obtain information relating to inter-
national mail shipments from private carriers or 
other appropriate parties.
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† HR 6 EAS 
‘‘(ix) In this subparagraph, the term ‘ap-
propriate congressional committees’ means— 
‘‘(I) the Committee on Finance and the 
Committee on Homeland Security and Gov-
ernmental Affairs of the Senate; and 
‘‘(II) the Committee on Ways and 
Means, the Committee on Oversight and 
Government Reform, and the Committee on 
Homeland Security of the House of Rep-
resentatives.’’. 
(2) JOINT STRATEGIC PLAN ON MANDATORY AD-
VANCE INFORMATION.—Not later than 60 days after 
the date of the enactment of this Act, the Secretary of 
Homeland Security and the Postmaster General shall 
develop and submit to the appropriate congressional 
committees a joint strategic plan detailing specific 
performance measures for achieving— 
(A) the transmission of information as re-
quired by section 343(a)(3)(K) of the Trade Act 
of 2002, as amended by paragraph (1); and 
(B) the presentation by the Postal Service to 
U.S. Customs and Border Protection of all mail 
targeted by U.S. Customs and Border Protection 
for inspection. 
(b) CAPACITY BUILDING.—
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† HR 6 EAS 
(1) IN GENERAL.—Section 343(a) of the Trade 
Act of 2002 (Public Law 107–210; 19 U.S.C. 2071 
note) is amended by adding at the end the following: 
‘‘(5) CAPACITY BUILDING.— 
‘‘(A) IN GENERAL.—The Secretary, with the 
concurrence of the Secretary of State, and in co-
ordination with the Postmaster General and the 
heads of other Federal agencies, as appropriate, 
may provide technical assistance, equipment, 
technology, and training to enhance the capacity 
of foreign postal operators— 
‘‘(i) to gather and provide the informa-
tion required by paragraph (3)(K); and 
‘‘(ii) to otherwise gather and provide 
postal shipment information related to— 
‘‘(I) terrorism; 
‘‘(II) items the importation or in-
troduction of which into the United 
States is prohibited or restricted, in-
cluding controlled substances; and 
‘‘(III) such other concerns as the 
Secretary determines appropriate. 
‘‘(B) PROVISION OF EQUIPMENT AND TECH-
NOLOGY.—With respect to the provision of equip-
ment and technology under subparagraph (A),
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the Secretary may lease, loan, provide, or other-
wise assist in the deployment of such equipment 
and technology under such terms and conditions 
as the Secretary may prescribe, including nonre-
imbursable loans or the transfer of ownership of 
equipment and technology.’’. 
(2) JOINT STRATEGIC PLAN ON CAPACITY BUILD-
ING.—Not later than one year after the date of the en-
actment of this Act, the Secretary of Homeland Secu-
rity and the Postmaster General shall, in consultation 
with the Secretary of State, jointly develop and sub-
mit to the appropriate congressional committees a 
joint strategic plan— 
(A) detailing the extent to which U.S. Cus-
toms and Border Protection and the United 
States Postal Service are engaged in capacity 
building efforts under section 343(a)(5) of the 
Trade Act of 2002, as added by paragraph (1); 
(B) describing plans for future capacity 
building efforts; and 
(C) assessing how capacity building has in-
creased the ability of U.S. Customs and Border 
Protection and the Postal Service to advance the 
goals of this subtitle and the amendments made 
by this subtitle.
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(c) REPORT AND CONSULTATIONS BY SECRETARY OF 
HOMELAND SECURITY AND POSTMASTER GENERAL.— 
(1) REPORT.—Not later than 180 days after the 
date of the enactment of this Act, and annually there-
after until 3 years after the Postmaster General has 
met the requirement under clause (vi) of subpara-
graph (K) of section 343(a)(3) of the Trade Act of 
2002, as amended by subsection (a)(1), the Secretary 
of Homeland Security and the Postmaster General 
shall, in consultation with the Secretary of State, 
jointly submit to the appropriate congressional com-
mittees a report on compliance with that subpara-
graph that includes the following: 
(A) An assessment of the status of the regu-
lations required to be promulgated under that 
subparagraph. 
(B) An update regarding new and existing 
agreements reached with foreign postal operators 
for the transmission of the information required 
by that subparagraph. 
(C) A summary of deliberations between the 
United States Postal Service and foreign postal 
operators with respect to issues relating to the 
transmission of that information.
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(D) A summary of the progress made in 
achieving the transmission of that information 
for the percentage of shipments required by that 
subparagraph. 
(E) An assessment of the quality of that in-
formation being received by foreign postal opera-
tors, as determined by the Secretary of Home-
land Security, and actions taken to improve the 
quality of that information. 
(F) A summary of policies established by 
the Universal Postal Union that may affect the 
ability of the Postmaster General to obtain the 
transmission of that information. 
(G) A summary of the use of technology to 
detect illicit synthetic opioids and other illegal 
substances in international mail parcels and 
planned acquisitions and advancements in such 
technology. 
(H) Such other information as the Sec-
retary of Homeland Security and the Postmaster 
General consider appropriate with respect to ob-
taining the transmission of information required 
by that subparagraph. 
(2) CONSULTATIONS.—Not later than 180 days 
after the date of the enactment of this Act, and every
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180 days thereafter until the Postmaster General has 
met the requirement under clause (vi) of section 
343(a)(3)(K) of the Trade Act of 2002, as amended by 
subsection (a)(1), to arrange for the transmission of 
information with respect to 100 percent of the aggre-
gate number of mail shipments described in clause (i) 
of that section, the Secretary of Homeland Security 
and the Postmaster General shall provide briefings to 
the appropriate congressional committees on the 
progress made in achieving the transmission of that 
information for that percentage of shipments. 
(d) GOVERNMENT
ACCOUNTABILITY
OFFICE
RE-
PORT.—Not later than June 30, 2019, the Comptroller Gen-
eral of the United States shall submit to the appropriate 
congressional committees a report— 
(1) assessing the progress of the United States 
Postal Service in achieving the transmission of the 
information required by subparagraph (K) of section 
343(a)(3) of the Trade Act of 2002, as amended by 
subsection (a)(1), for the percentage of shipments re-
quired by that subparagraph; 
(2) assessing the quality of the information re-
ceived from foreign postal operators for targeting pur-
poses;
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(3) assessing the specific percentage of targeted 
mail presented by the Postal Service to U.S. Customs 
and Border Protection for inspection; 
(4) describing the costs of collecting the informa-
tion required by such subparagraph (K) from foreign 
postal operators and the costs of implementing the use 
of that information; 
(5) assessing the benefits of receiving that infor-
mation with respect to international mail shipments; 
(6) assessing the feasibility of assessing a cus-
toms fee under section 13031(b)(9) of the Consolidated 
Omnibus Budget Reconciliation Act of 1985, as 
amended by section 2402, on international mail ship-
ments other than Inbound Express Mail service in a 
manner consistent with the obligations of the United 
States under international agreements; and 
(7) identifying recommendations, including rec-
ommendations for legislation, to improve the compli-
ance of the Postal Service with such subparagraph 
(K), including an assessment of whether the detection 
of illicit synthetic opioids in the international mail 
would be improved by— 
(A) requiring the Postal Service to serve as 
the consignee for international mail shipments 
containing goods; or
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(B) designating a customs broker to act as 
an importer of record for international mail 
shipments containing goods. 
(e) TECHNICAL CORRECTION.—Section 343 of the 
Trade Act of 2002 (Public Law 107–210; 19 U.S.C. 2071 
note) is amended in the section heading by striking ‘‘AD-
VANCED’’ and inserting ‘‘ADVANCE’’. 
(f) APPROPRIATE CONGRESSIONAL COMMITTEES DE-
FINED.—In this section, the term ‘‘appropriate congres-
sional committees’’ means— 
(1) the Committee on Finance and the Com-
mittee on Homeland Security and Governmental Af-
fairs of the Senate; and 
(2) the Committee on Ways and Means, the Com-
mittee on Oversight and Government Reform, and the 
Committee on Homeland Security of the House of 
Representatives. 
SEC. 2404. INTERNATIONAL POSTAL AGREEMENTS. 
(a) EXISTING AGREEMENTS.— 
(1) IN GENERAL.—In the event that any provi-
sion of this subtitle, or any amendment made by this 
subtitle, is determined to be in violation of obligations 
of the United States under any postal treaty, conven-
tion, or other international agreement related to 
international postal services, or any amendment to
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such an agreement, the Secretary of State should ne-
gotiate to amend the relevant provisions of the agree-
ment so that the United States is no longer in viola-
tion of the agreement. 
(2) RULE OF CONSTRUCTION.—Nothing in this 
subsection shall be construed to permit delay in the 
implementation of this subtitle or any amendment 
made by this subtitle. 
(b) FUTURE AGREEMENTS.— 
(1) CONSULTATIONS.—Before entering into, on 
or after the date of the enactment of this Act, any 
postal treaty, convention, or other international 
agreement related to international postal services, or 
any amendment to such an agreement, that is related 
to the ability of the United States to secure the provi-
sion of advance electronic information by foreign 
postal operators, the Secretary of State should consult 
with the appropriate congressional committees (as de-
fined in section 2403(f)). 
(2) EXPEDITED NEGOTIATION OF NEW AGREE-
MENT.—To the extent that any new postal treaty, 
convention, or other international agreement related 
to international postal services would improve the 
ability of the United States to secure the provision of 
advance electronic information by foreign postal oper-
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ators as required by regulations prescribed under sec-
tion 343(a)(3)(K) of the Trade Act of 2002, as 
amended by section 2403(a)(1), the Secretary of State 
should expeditiously conclude such an agreement. 
SEC. 2405. COST RECOUPMENT. 
(a) IN GENERAL.—The United States Postal Service 
shall, to the extent practicable and otherwise recoverable by 
law, ensure that all costs associated with complying with 
this subtitle and amendments made by this subtitle are 
charged directly to foreign shippers or foreign postal opera-
tors. 
(b) COSTS NOT CONSIDERED REVENUE.—The recovery 
of costs under subsection (a) shall not be deemed revenue 
for purposes of subchapter I and II of chapter 36 of title 
39, United States Code, or regulations prescribed under that 
chapter. 
SEC. 2406. DEVELOPMENT OF TECHNOLOGY TO DETECT IL-
LICIT NARCOTICS. 
(a) IN GENERAL.—The Postmaster General and the 
Commissioner of U.S. Customs and Border Protection, in 
coordination with the heads of other agencies as appro-
priate, shall collaborate to identify and develop technology 
for the detection of illicit fentanyl, other synthetic opioids, 
and other narcotics and psychoactive substances entering 
the United States by mail.
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(b) OUTREACH TO PRIVATE SECTOR.—The Postmaster 
General and the Commissioner shall conduct outreach to 
private sector entities to gather information regarding the 
current state of technology to identify areas for innovation 
relating to the detection of illicit fentanyl, other synthetic 
opioids, and other narcotics and psychoactive substances en-
tering the United States. 
SEC. 2407. CIVIL PENALTIES FOR POSTAL SHIPMENTS. 
Section 436 of the Tariff Act of 1930 (19 U.S.C. 1436) 
is amended by adding at the end the following new sub-
section: 
‘‘(e) CIVIL PENALTIES FOR POSTAL SHIPMENTS.— 
‘‘(1) CIVIL PENALTY.—A civil penalty shall be 
imposed against the United States Postal Service if 
the Postal Service accepts a shipment in violation of 
section 343(a)(3)(K)(vii)(I) of the Trade Act of 2002. 
‘‘(2) MODIFICATION OF CIVIL PENALTY.— 
‘‘(A) IN GENERAL.—U.S. Customs and Bor-
der Protection shall reduce or dismiss a civil 
penalty imposed pursuant to paragraph (1) if 
U.S. Customs and Border Protection determines 
that the United States Postal Service— 
‘‘(i) has a low error rate in compliance 
with section 343(a)(3)(K) of the Trade Act 
of 2002;
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‘‘(ii) is cooperating with U.S. Customs 
and Border Protection with respect to the 
violation of section 343(a)(3)(K)(vii)(I) of 
the Trade Act of 2002; or 
‘‘(iii) has taken remedial action to pre-
vent 
future 
violations 
of 
section 
343(a)(3)(K)(vii)(I) of the Trade Act of 
2002. 
‘‘(B) WRITTEN
NOTIFICATION.—U.S. Cus-
toms and Border Protection shall issue a written 
notification to the Postal Service with respect to 
each exercise of the authority of subparagraph 
(A) to reduce or dismiss a civil penalty imposed 
pursuant to paragraph (1). 
‘‘(3) ONGOING LACK OF COMPLIANCE.—If U.S. 
Customs and Border Protection determines that the 
United States Postal Service— 
‘‘(A) has repeatedly committed violations of 
section 343(a)(3)(K)(vii)(I) of the Trade Act of 
2002, 
‘‘(B) has failed to cooperate with U.S. Cus-
toms and Border Protection with respect to vio-
lations of section 343(a)(3)(K)(vii)(I) of the 
Trade Act of 2002, and
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‘‘(C) has an increasing error rate in com-
pliance with section 343(a)(3)(K) of the Trade 
Act of 2002, 
civil penalties may be imposed against the United 
States Postal Service until corrective action, satisfac-
tory to U.S. Customs and Border Protection, is 
taken.’’. 
SEC. 2408. REPORT ON VIOLATIONS OF ARRIVAL, REPORT-
ING, 
ENTRY, 
AND 
CLEARANCE 
REQUIRE-
MENTS AND FALSITY OR LACK OF MANIFEST. 
(a) IN GENERAL.—The Commissioner of U.S. Customs 
and Border Protection shall submit to the appropriate con-
gressional committees an annual report that contains the 
information described in subsection (b) with respect to each 
violation of section 436 of the Tariff Act of 1930 (19 U.S.C. 
1436), as amended by section 7, and section 584 of such 
Act (19 U.S.C. 1584) that occurred during the previous 
year. 
(b) INFORMATION DESCRIBED.—The information de-
scribed in this subsection is the following: 
(1) The name and address of the violator. 
(2) The specific violation that was committed. 
(3) The location or port of entry through which 
the items were transported.
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(4) An inventory of the items seized, including 
a description of the items and the quantity seized. 
(5) The location from which the items originated. 
(6) The entity responsible for the apprehension 
or seizure, organized by location or port of entry. 
(7) The amount of penalties assessed by U.S. 
Customs and Border Protection, organized by name of 
the violator and location or port of entry. 
(8) The amount of penalties that U.S. Customs 
and Border Protection could have levied, organized by 
name of the violator and location or port of entry. 
(9) The rationale for negotiating lower penalties, 
organized by name of the violator and location or 
port of entry. 
(c) APPROPRIATE CONGRESSIONAL COMMITTEES DE-
FINED.—In this section, the term ‘‘appropriate congres-
sional committees’’ means— 
(1) the Committee on Finance and the Com-
mittee on Homeland Security and Governmental Af-
fairs of the Senate; and 
(2) the Committee on Ways and Means, the Com-
mittee on Oversight and Government Reform, and the 
Committee on Homeland Security of the House of 
Representatives.
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SEC. 2409. EFFECTIVE DATE; REGULATIONS. 
(a) EFFECTIVE DATE.—This subtitle and the amend-
ments made by this subtitle (other than the amendments 
made by section 2402) shall take effect on the date of the 
enactment of this Act. 
(b) REGULATIONS.—Not later than one year after the 
date of the enactment of this Act, such regulations as are 
necessary to carry out this subtitle and the amendments 
made by this subtitle shall be prescribed. 
TITLE III—JUDICIARY 
Subtitle A—Access to Increased 
Drug Disposal 
SEC. 3101. SHORT TITLE. 
This subtitle may be cited as the ‘‘Access to Increased 
Drug Disposal Act of 2018’’. 
SEC. 3102. DEFINITIONS. 
In this subtitle— 
(1) the term ‘‘Attorney General’’ means the At-
torney General, acting through the Assistant Attorney 
General for the Office of Justice Programs; 
(2) the term ‘‘authorized collector’’ means a nar-
cotic treatment program, a hospital or clinic with an 
on-site pharmacy, a retail pharmacy, or a reverse dis-
tributor, that is authorized as a collector under sec-
tion 1317.40 of title 21, Code of Federal Regulations 
(or any successor regulation);
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(3) the term ‘‘covered grant’’ means a grant 
awarded under section 3003; and 
(4) the term ‘‘eligible collector’’ means a person 
who is eligible to be an authorized collector. 
SEC. 3103. AUTHORITY TO MAKE GRANTS. 
The Attorney General shall award grants to States to 
enable the States to increase the participation of eligible 
collectors as authorized collectors. 
SEC. 3104. APPLICATION. 
A State desiring a covered grant shall submit to the 
Attorney General an application that, at a minimum— 
(1) identifies the single State agency that over-
sees pharmaceutical care and will be responsible for 
complying with the requirements of the grant; 
(2) details a plan to increase participation rates 
of eligible collectors as authorized collectors; and 
(3) describes how the State will select eligible col-
lectors to be served under the grant. 
SEC. 3105. USE OF GRANT FUNDS. 
A State that receives a covered grant, and any sub-
recipient of the grant, may use the grant amounts only for 
the costs of installation, maintenance, training, purchasing, 
and disposal of controlled substances associated with the 
participation of eligible collectors as authorized collectors.
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SEC. 3106. ELIGIBILITY FOR GRANT. 
The Attorney General shall award a covered grant to 
5 States, not less than 3 of which shall be States in the 
lowest quartile of States based on the participation rate of 
eligible collectors as authorized collectors, as determined by 
the Attorney General. 
SEC. 3107. DURATION OF GRANTS. 
The Attorney General shall determine the period of 
years for which a covered grant is made to a State. 
SEC. 3108. ACCOUNTABILITY AND OVERSIGHT. 
A State that receives a covered grant shall submit to 
the Attorney General a report, at such time and in such 
manner as the Attorney General may reasonably require, 
that— 
(1) lists the ultimate recipients of the grant 
amounts; 
(2) describes the activities undertaken by the 
State using the grant amounts; and 
(3) contains performance measures relating to 
the effectiveness of the grant, including changes in the 
participation rate of eligible collectors as authorized 
collectors. 
SEC. 3109. DURATION OF PROGRAM. 
The Attorney General may award covered grants for 
each of the first 5 fiscal years beginning after the date of 
enactment of this Act.
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SEC. 3110. AUTHORIZATION OF APPROPRIATIONS. 
There is authorized to be appropriated to the Attorney 
General such sums as may be necessary to carry out this 
subtitle. 
Subtitle B—Using Data To Prevent 
Opioid Diversion 
SEC. 3201. SHORT TITLE. 
This subtitle may be cited as the ‘‘Using Data to Pre-
vent Opioid Diversion Act of 2018’’. 
SEC. 3202. PURPOSE. 
(a) IN GENERAL.—The purpose of this subtitle is to 
provide drug manufacturers and distributors with access to 
anonymized information through the Automated Reports 
and Consolidated Orders System to help drug manufactur-
ers and distributors identify, report, and stop suspicious 
orders of opioids and reduce diversion rates. 
(b) RULE OF CONSTRUCTION.—Nothing in this subtitle 
should be construed to absolve a drug manufacturer, drug 
distributor, or other Drug Enforcement Administration reg-
istrant from the responsibility of the manufacturer, dis-
tributor, or other registrant to— 
(1) identify, stop, and report suspicious orders; 
or 
(2) maintain effective controls against diversion 
in accordance with section 303 of the Controlled Sub-
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stances Act (21 U.S.C. 823) or any successor law or 
associated regulation. 
SEC. 3203. AMENDMENTS. 
(a) RECORDS AND REPORTS OF REGISTRANTS.—Sec-
tion 307 of the Controlled Substances Act (21 U.S.C. 827) 
is amended— 
(1) by redesignating subsections (f), (g), and (h) 
as subsections (g), (h), and (i), respectively; 
(2) by inserting after subsection (e) the following: 
‘‘(f)(1) The Attorney General shall, not less frequently 
than quarterly, make the following information available 
to manufacturer and distributor registrants through the 
Automated Reports and Consolidated Orders System, or 
any subsequent automated system developed by the Drug 
Enforcement Administration to monitor selected controlled 
substances: 
‘‘(A) The total number of distributor registrants 
that distribute controlled substances to a pharmacy or 
practitioner registrant, aggregated by the name and 
address of each pharmacy and practitioner registrant. 
‘‘(B) The total quantity and type of opioids dis-
tributed, listed by Administration Controlled Sub-
stances Code Number, to each pharmacy and practi-
tioner registrant described in subparagraph (A).
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‘‘(2) The information required to be made available 
under paragraph (1) shall be made available not later than 
the 15th day of the first month following the quarter to 
which the information relates. 
‘‘(3)(A) All registered manufacturers and distributors 
shall be responsible for reviewing the information made 
available by the Attorney General under this subsection. 
‘‘(B) In determining whether to initiate proceedings 
under this title against a registered manufacturer or dis-
tributor based on the failure of the registrant to maintain 
effective controls against diversion or otherwise comply with 
the requirements of this title or the regulations issued there-
under, the Attorney General may take into account that the 
information made available under this subsection was 
available to the registrant.’’; and 
(3) by inserting after subsection (i), as so redes-
ignated, the following: 
‘‘(j) All of the reports required under this section shall 
be provided in an electronic format.’’. 
(b) COOPERATIVE ARRANGEMENTS.—Section 503 of 
the Controlled Substances Act (21 U.S.C. 873) is amend-
ed— 
(1) by striking subsection (c) and inserting the 
following:
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‘‘(c)(1) The Attorney General shall, once every 6 
months, prepare and make available to regulatory, licens-
ing, attorneys general, and law enforcement agencies of 
States a standardized report containing descriptive and 
analytic information on the actual distribution patterns, 
as gathered through the Automated Reports and Consoli-
dated Orders System, or any subsequent automated system, 
pursuant to section 307 and which includes detailed 
amounts, outliers, and trends of distributor and pharmacy 
registrants, in such States for the controlled substances con-
tained in schedule II, which, in the discretion of the Attor-
ney General, are determined to have the highest abuse. 
‘‘(2) If the Attorney General publishes the report de-
scribed in paragraph (1) once every 6 months as required 
under paragraph (1), nothing in this subsection shall be 
construed to bring an action in any court to challenge the 
sufficiency of the information or to compel the Attorney 
General to produce any documents or reports referred to 
in this subsection.’’. 
(c) CIVIL AND CRIMINAL PENALTIES.—Section 402 of 
the Controlled Substances Act (21 U.S.C. 842) is amend-
ed— 
(1) in subsection (a)— 
(A) in paragraph (15), by striking ‘‘or’’ at 
the end;
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(B) in paragraph (16), by striking the pe-
riod at the end and inserting ‘‘; or’’; and 
(C) by inserting after paragraph (16) the 
following: 
‘‘(17) in the case of a registered manufacturer or 
distributor of opioids, to fail to review the most recent 
information, directly related to the customers of the 
manufacturer or distributor, made available by the 
Attorney General in accordance with section 307(f).’’; 
and 
(2) in subsection (c)— 
(A) in paragraph (1), by striking subpara-
graph (B) and inserting the following: 
‘‘(B)(i) Except as provided in clause (ii), in the case 
of a violation of paragraph (5), (10), or (17) of subsection 
(a), the penalty shall not exceed $10,000. 
‘‘(ii) In the case of a violation described in clause (i) 
committed by a registered manufacturer or distributor of 
opioids and related to the reporting of suspicious orders for 
opioids, failing to maintain effective controls against diver-
sion of opioids, or failing to review the most recent informa-
tion made available by the Attorney General in accordance 
with section 307(f), the penalty shall not exceed $100,000.’’; 
and 
(B) in paragraph (2)—
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(i) in subparagraph (A), by inserting 
‘‘or (D)’’ after ‘‘subparagraph (B)’’; and 
(ii) by adding at the end the following: 
‘‘(D) In the case of a violation described in subpara-
graph (A) that was a violation of paragraph (5), (10), or 
(17) of subsection (a) committed by a registered manufac-
turer or distributor of opioids that relates to the reporting 
of suspicious orders for opioids, failing to maintain effective 
controls against diversion of opioids, or failing to review 
the most recent information made available by the Attorney 
General in accordance with section 307(f), the criminal fine 
under title 18, United States Code, shall not exceed 
$500,000.’’. 
SEC. 3204. REPORT. 
Not later than 1 year after the date of enactment of 
this Act, the Attorney General shall submit to Congress a 
report that provides information about how the Attorney 
General is using data in the Automation of Reports and 
Consolidated Orders System to identify and stop suspicious 
activity, including whether the Attorney General is looking 
at aggregate orders from individual pharmacies to multiple 
distributors that in total are suspicious, even if no indi-
vidual order rises to the level of a suspicious order to a 
given distributor.
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Subtitle C—Substance Abuse 
Prevention 
SEC. 3301. SHORT TITLE. 
This subtitle may be cited as the ‘‘Substance Abuse 
Prevention Act of 2018’’. 
SEC. 3302. REAUTHORIZATION OF THE OFFICE OF NA-
TIONAL DRUG CONTROL POLICY. 
(a) OFFICE OF NATIONAL DRUG CONTROL POLICY RE-
AUTHORIZATION ACT OF 1998.— 
(1) IN GENERAL.—The Office of National Drug 
Control Policy Reauthorization Act of 1998 (21 
U.S.C. 1701 et seq.), as in effect on September 29, 
2003, and as amended by the laws described in para-
graph (2), is revived and restored. 
(2) LAWS DESCRIBED.—The laws described in 
this paragraph are: 
(A) The Office of National Drug Control 
Policy Reauthorization Act of 2006 (Public Law 
109–469; 120 Stat. 3502). 
(B) The Presidential Appointment Effi-
ciency and Streamlining Act of 2011 (Public 
Law 112–166; 126 Stat. 1283). 
(b) REAUTHORIZATION.—Section 715(a) of the Office 
of National Drug Control Policy Reauthorization Act of
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1998 (21 U.S.C. 1712(a)) is amended by striking ‘‘2010’’ 
and inserting ‘‘2022’’. 
SEC. 3303. REAUTHORIZATION OF THE DRUG-FREE COMMU-
NITIES PROGRAM. 
Section 1024 of the National Narcotics Leadership Act 
of 1988 (21 U.S.C. 1524(a)) is amended by striking sub-
sections (a) and (b) and inserting the following: 
‘‘(a) IN GENERAL.—There is authorized to be appro-
priated to the Office of National Drug Control Policy to 
carry out this chapter $99,000,000 for each of fiscal years 
2018 through 2022. 
‘‘(b) ADMINISTRATIVE COSTS.—Not more than 8 per-
cent of the funds appropriated to carry out this chapter 
may be used by the Office of National Drug Control Policy 
to pay administrative costs associated with the responsibil-
ities of the Office under this chapter.’’. 
SEC. 3304. REAUTHORIZATION OF THE NATIONAL COMMU-
NITY ANTI-DRUG COALITION INSTITUTE. 
Section 4(c)(4) of Public Law 107–82 (21 U.S.C. 1521 
note) is amended by striking ‘‘2008 through 2012’’ and in-
serting ‘‘2018 through 2022’’.
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‘‘(e) DRUG COURT TRAINING AND TECHNICAL ASSIST-
ANCE PROGRAM.—Using funds appropriated to carry out 
this title, the Director may make grants to nonprofit orga-
nizations for the purpose of providing training and tech-
nical assistance to drug courts.’’. 
SEC. 3308. DRUG OVERDOSE RESPONSE STRATEGY. 
Section 707 of the Office of National Drug Control Pol-
icy Reauthorization Act of 1998 (21 U.S.C. 1706) is amend-
ed by adding at the end the following: 
‘‘(r) DRUG OVERDOSE RESPONSE STRATEGY IMPLE-
MENTATION.—The Director may use funds appropriated to 
carry out this section to implement a drug overdose re-
sponse strategy in high intensity drug trafficking areas on 
a nationwide basis by— 
‘‘(1) coordinating multi-disciplinary efforts to 
prevent, reduce, and respond to drug overdoses, in-
cluding the uniform reporting of fatal and non-fatal 
overdoses to public health and safety officials; 
‘‘(2) increasing data sharing among public safe-
ty and public health officials concerning drug-related 
abuse trends, including new psychoactive substances, 
and related crime; and 
‘‘(3) enabling collaborative deployment of preven-
tion, intervention, and enforcement resources to ad-