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‘‘(3)(A) All registered manufacturers and distributors 
shall be responsible for reviewing the information made avail-
able 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 ef-
fective 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 avail-
able to the registrant.’’; and 
(3) by inserting after subsection (i), as so redesig-
nated, 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 amended by 
striking subsection (c) and inserting the following: 
‘‘(c)(1) The Attorney General shall, once every 6 
months, prepare and make available to regulatory, licensing, 
attorneys general, and law enforcement agencies of States a 
standardized report containing descriptive and analytic infor-
mation on the actual distribution patterns, as gathered 
through the Automated Reports and Consolidated Orders 
System, or any subsequent automated system, pursuant to
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section 307 and which includes detailed amounts, outliers, 
and trends of distributor and pharmacy registrants, in such 
States for the controlled substances contained in schedule II, 
which, in the discretion of the Attorney General, are deter-
mined 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 con-
strued to bring an action in any court to challenge the suffi-
ciency of the information or to compel the Attorney General 
to produce any documents or reports referred to in this sub-
section.’’. 
(c) CIVIL AND CRIMINAL PENALTIES.—Section 402 of 
the Controlled Substances Act (21 U.S.C. 842) is amended— 
(1) in subsection (a)— 
(A) in paragraph (15), by striking ‘‘or’’ at the 
end; 
(B) in paragraph (16), by striking the period 
at the end and inserting ‘‘; or’’; and 
(C) by inserting after paragraph (16) the fol-
lowing: 
‘‘(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
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manufacturer or distributor, made available by the At-
torney General in accordance with section 307(f).’’; and 
(2) in subsection (c)— 
(A) in paragraph (1), by striking subparagraph 
(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 civil 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 diversion 
of opioids, or failing to review the most recent information 
made available by the Attorney General in accordance with 
section 307(f), the penalty shall not exceed $100,000.’’; and 
(B) in paragraph (2)— 
(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 manufacturer or 
distributor of opioids that relates to the reporting of sus-
picious orders for opioids, failing to maintain effective con-
trols against diversion of opioids, or failing to review the most
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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. 3274. 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, includ-
ing whether the Attorney General is looking at aggregate or-
ders from individual pharmacies to multiple distributors that 
in total are suspicious, even if no individual order rises to the 
level of a suspicious order to a given distributor. 
CHAPTER 8—OPIOID QUOTA REFORM 
SEC. 3281. SHORT TITLE. 
This chapter may be cited as the ‘‘Opioid Quota Reform 
Act’’. 
SEC. 
3282. 
STRENGTHENING 
CONSIDERATIONS 
FOR 
DEA 
OPIOID QUOTAS. 
(a) IN GENERAL.—Section 306 of the Controlled Sub-
stances Act (21 U.S.C. 826) is amended— 
(1) in subsection (a)— 
(A) by inserting ‘‘(1)’’ after ‘‘(a)’’;
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(B) in the second sentence, by striking ‘‘Pro-
duction’’ and inserting ‘‘Except as provided in para-
graph (2), production’’; and 
(C) by adding at the end the following: 
‘‘(2) The Attorney General may, if the Attorney General 
determines it will assist in avoiding the overproduction, short-
ages, or diversion of a controlled substance, establish an ag-
gregate or individual production quota under this subsection, 
or a procurement quota established by the Attorney General 
by regulation, in terms of pharmaceutical dosage forms pre-
pared from or containing the controlled substance.’’; 
(2) in subsection (b), in the first sentence, by strik-
ing ‘‘production’’ and inserting ‘‘manufacturing’’; 
(3) in subsection (c), by striking ‘‘October’’ and in-
serting ‘‘December’’; and 
(4) by adding at the end the following: 
‘‘(i)(1)(A) In establishing any quota under this section, 
or any procurement quota established by the Attorney Gen-
eral by regulation, for fentanyl, oxycodone, hydrocodone, 
oxymorphone, or hydromorphone (in this subsection referred 
to as a ‘covered controlled substance’), the Attorney General 
shall estimate the amount of diversion of the covered con-
trolled substance that occurs in the United States. 
‘‘(B) In estimating diversion under this paragraph, the 
Attorney General—
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‘‘(i) shall consider information the Attorney Gen-
eral, in consultation with the Secretary of Health and 
Human Services, determines reliable on rates of overdose 
deaths and abuse and overall public health impact re-
lated to the covered controlled substance in the United 
States; and 
‘‘(ii) may take into consideration whatever other 
sources of information the Attorney General determines 
reliable. 
‘‘(C) After estimating the amount of diversion of a cov-
ered controlled substance, the Attorney General shall make 
appropriate quota reductions, as determined by the Attorney 
General, from the quota the Attorney General would have 
otherwise established had such diversion not been considered. 
‘‘(2)(A) For any year for which the approved aggregate 
production quota for a covered controlled substance is higher 
than the approved aggregate production quota for the covered 
controlled substance for the previous year, the Attorney Gen-
eral, in consultation with the Secretary of Health and Human 
Services, shall include in the final order an explanation of 
why the public health benefits of increasing the quota clearly 
outweigh the consequences of having an increased volume of 
the covered controlled substance available for sale, and poten-
tial diversion, in the United States.
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‘‘(B) Not later than 1 year after the date of enactment 
of this subsection, and every year thereafter, the Attorney 
General shall submit to the Committee on the Judiciary, the 
Committee on Health, Education, Labor, and Pensions, and 
the Committee on Appropriations of the Senate and the Com-
mittee on the Judiciary, the Committee on Energy and Com-
merce, and the Committee on Appropriations of the House of 
Representatives the following information with regard to each 
covered controlled substance: 
‘‘(i) An anonymized count of the total number of 
manufacturers issued individual manufacturing quotas 
that year for the covered controlled substance. 
‘‘(ii) An anonymized count of how many such man-
ufacturers were issued an approved manufacturing quota 
that was higher than the quota issued to that manufac-
turer for the covered controlled substance in the previous 
year. 
‘‘(3) Not later than 1 year after the date of enactment 
of this subsection, the Attorney General shall submit to Con-
gress a report on how the Attorney General, when fixing and 
adjusting production and manufacturing quotas under this 
section for covered controlled substances, will— 
‘‘(A) take into consideration changes in the accept-
ed medical use of the covered controlled substances; and
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‘‘(B) work with the Secretary of Health and Human 
Services on methods to appropriately and anonymously 
estimate the type and amount of covered controlled sub-
stances that are submitted for collection from approved 
drug collection receptacles, mail-back programs, and 
take-back events.’’. 
(b) CONFORMING CHANGE.—The Law Revision Counsel 
is directed to amend the heading for subsection (b) of section 
826 of title 21, United States Code, by striking ‘‘PRODUC-
TION’’ and inserting ‘‘MANUFACTURING’’. 
CHAPTER 9—PREVENTING DRUG DIVERSION 
SEC. 3291. SHORT TITLE. 
This chapter may be cited as the ‘‘Preventing Drug Di-
version Act of 2018’’. 
SEC. 3292. IMPROVEMENTS TO PREVENT DRUG DIVERSION. 
(a) DEFINITION.—Section 102 of the Controlled Sub-
stances Act (21 U.S.C. 802) is amended by adding at the end 
the following: 
‘‘(57) The term ‘suspicious order’ may include, but 
is not limited to— 
‘‘(A) an order of a controlled substance of un-
usual size; 
‘‘(B) an order of a controlled substance deviat-
ing substantially from a normal pattern; and
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‘‘(C) orders of controlled substances of unusual 
frequency.’’. 
(b) SUSPICIOUS ORDERS.—Part C of the Controlled 
Substances Act (21 U.S.C. 821 et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 312. SUSPICIOUS ORDERS. 
‘‘(a) REPORTING.—Each registrant shall— 
‘‘(1) design and operate a system to identify sus-
picious orders for the registrant; 
‘‘(2) ensure that the system designed and operated 
under paragraph (1) by the registrant complies with ap-
plicable Federal and State privacy laws; and 
‘‘(3) upon discovering a suspicious order or series of 
orders, notify the Administrator of the Drug Enforce-
ment Administration and the Special Agent in Charge of 
the Division Office of the Drug Enforcement Adminis-
tration for the area in which the registrant is located or 
conducts business. 
‘‘(b) SUSPICIOUS ORDER DATABASE.— 
‘‘(1) IN GENERAL.—Not later than 1 year after the 
date of enactment of this section, the Attorney General 
shall establish a centralized database for collecting re-
ports of suspicious orders. 
‘‘(2) SATISFACTION
OF
REPORTING
REQUIRE-
MENTS.—If a registrant reports a suspicious order to
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the centralized database established under paragraph 
(1), the registrant shall be considered to have complied 
with the requirement under subsection (a)(3) to notify 
the Administrator of the Drug Enforcement Administra-
tion and the Special Agent in Charge of the Division Of-
fice of the Drug Enforcement Administration for the 
area in which the registrant is located or conducts busi-
ness. 
‘‘(c) SHARING INFORMATION WITH THE STATES.— 
‘‘(1) IN
GENERAL.—The Attorney General shall 
prepare and make available information regarding sus-
picious orders in a State, including information in the 
database established under subsection (b)(1), to the 
point of contact for purposes of administrative, civil, and 
criminal oversight relating to the diversion of controlled 
substances for the State, as designated by the Governor 
or chief executive officer of the State. 
‘‘(2) TIMING.—The Attorney General shall provide 
information in accordance with paragraph (1) within a 
reasonable period of time after obtaining the informa-
tion. 
‘‘(3) COORDINATION.—In establishing the process 
for the provision of information under this subsection, 
the Attorney General shall coordinate with States to en-
sure that the Attorney General has access to informa-
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tion, as permitted under State law, possessed by the 
States relating to prescriptions for controlled substances 
that will assist in enforcing Federal law.’’. 
(c) REPORTS TO CONGRESS.— 
(1) DEFINITION.—In this subsection, the term 
‘‘suspicious order’’ has the meaning given that term in 
section 102 of the Controlled Substances Act, as amend-
ed by this chapter. 
(2) ONE-TIME
REPORT.—Not later than 1 year 
after the date of enactment of this Act, the Attorney 
General shall submit to Congress a report on the report-
ing of suspicious orders, which shall include— 
(A) a description of the centralized database 
established under section 312 of the Controlled 
Substances Act, as added by this section, to collect 
reports of suspicious orders; 
(B) a description of the system and reports es-
tablished under section 312 of the Controlled Sub-
stances Act, as added by this section, to share in-
formation with States; 
(C) information regarding how the Attorney 
General used reports of suspicious orders before the 
date of enactment of this Act and after the date of 
enactment of this Act, including how the Attorney
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•HRES 1099 EH 
General received the reports and what actions were 
taken in response to the reports; and 
(D) descriptions of the data analyses conducted 
on reports of suspicious orders to identify, analyze, 
and stop suspicious activity. 
(3) ADDITIONAL REPORTS.—Not later than 1 year 
after the date of enactment of this Act, and annually 
thereafter until the date that is 5 years after the date 
of enactment of this Act, the Attorney General shall sub-
mit to Congress a report providing, for the previous 
year— 
(A) the number of reports of suspicious orders; 
(B) a summary of actions taken in response to 
reports, in the aggregate, of suspicious orders; and 
(C) a description of the information shared 
with States based on reports of suspicious orders. 
(4) ONE-TIME GAO REPORT.—Not later than 1 year 
after the date of enactment of this Act, the Comptroller 
General of the United States, in consultation with the 
Administrator of the Drug Enforcement Administration, 
shall submit to Congress a report on the reporting of 
suspicious orders, which shall include an evaluation of 
the utility of real-time reporting of potential suspicious 
orders of opioids on a national level using computerized
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•HRES 1099 EH 
algorithms, including the extent to which such algo-
rithms— 
(A) would help ensure that potentially sus-
picious orders are more accurately captured, identi-
fied, and reported in real time to suppliers before 
orders are filled; 
(B) may produce false positives of suspicious 
order reports that could result in market disrup-
tions for legitimate orders of opioids; and 
(C) would reduce the overall length of an inves-
tigation that prevents the diversion of suspicious or-
ders of opioids. 
TITLE IV—OFFSETS 
SEC. 4001. PROMOTING VALUE IN MEDICAID MANAGED CARE. 
Section 1903(m) of the Social Security Act (42 U.S.C. 
1396b(m)), as amended by sections 1013 and 1016, is fur-
ther amended by adding at the end the following new para-
graph: 
‘‘(9)(A) With respect to expenditures described in sub-
paragraph (B) that are incurred by a State for any fiscal 
year after fiscal year 2020 (and before fiscal year 2024), in 
determining the pro rata share to which the United States is 
equitably entitled under subsection (d)(3), the Secretary shall 
substitute the Federal medical assistance percentage that ap-
plies for such fiscal year to the State under section 1905(b)
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(without regard to any adjustments to such percentage appli-
cable under such section or any other provision of law) for 
the percentage that applies to such expenditures under sec-
tion 1905(y). 
‘‘(B) Expenditures described in this subparagraph, with 
respect to a fiscal year to which subparagraph (A) applies, 
are expenditures incurred by a State for payment for medical 
assistance provided to individuals described in subclause 
(VIII) of section 1902(a)(10)(A)(i) by a managed care entity, 
or other specified entity (as defined in subparagraph (D)(iii)), 
that are treated as remittances because the State— 
‘‘(i) has satisfied the requirement of section 438.8 
of title 42, Code of Federal Regulations (or any suc-
cessor regulation), by electing— 
‘‘(I) in the case of a State described in sub-
paragraph (C), to apply a minimum medical loss 
ratio (as defined in subparagraph (D)(ii)) that is at 
least 85 percent but not greater than the minimum 
medical loss ratio (as so defined) that such State 
applied as of May 31, 2018; or 
‘‘(II) in the case of a State not described in 
subparagraph (C), to apply a minimum medical loss 
ratio that is equal to 85 percent; and 
‘‘(ii) recovered all or a portion of the expenditures 
as a result of the entity’s failure to meet such ratio.
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‘‘(C) For purposes of subparagraph (B), a State de-
scribed in this subparagraph is a State that as of May 31, 
2018, applied a minimum medical loss ratio (as calculated 
under subsection (d) of section 438.8 of title 42, Code of 
Federal Regulations (as in effect on June 1, 2018)) for pay-
ment for services provided by entities described in such sub-
paragraph under the State plan under this title (or a waiver 
of the plan) that is equal to or greater than 85 percent. 
‘‘(D) For purposes of this paragraph: 
‘‘(i) The term ‘managed care entity’ means a med-
icaid managed care organization described in section 
1932(a)(1)(B)(i). 
‘‘(ii) The term ‘minimum medical loss ratio’ means, 
with respect to a State, a minimum medical loss ratio 
(as calculated under subsection (d) of section 438.8 of 
title 42, Code of Federal Regulations (as in effect on 
June 1, 2018)) for payment for services provided by en-
tities described in subparagraph (B) under the State 
plan under this title (or a waiver of the plan). 
‘‘(iii) The term ‘other specified entity’ means— 
‘‘(I) a prepaid inpatient health plan, as defined 
in section 438.2 of title 42, Code of Federal Regu-
lations (or any successor regulation); and
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‘‘(II) a prepaid ambulatory health plan, as de-
fined in such section (or any successor regula-
tion).’’. 
SEC. 4002. REQUIRING REPORTING BY GROUP HEALTH PLANS 
OF PRESCRIPTION DRUG COVERAGE INFORMA-
TION FOR PURPOSES OF IDENTIFYING PRIMARY 
PAYER SITUATIONS UNDER THE MEDICARE PRO-
GRAM. 
Clause (i) of section 1862(b)(7)(A) of the Social Secu-
rity Act (42 U.S.C. 1395y(b)(7)(A)) is amended to read as 
follows: 
‘‘(i) secure from the plan sponsor and 
plan participants such information as the Sec-
retary shall specify for the purpose of identi-
fying situations where the group health plan is 
or has been— 
‘‘(I) a primary plan to the program 
under this title; or 
‘‘(II) for calendar quarters beginning 
on or after January 1, 2020, a primary 
payer with respect to benefits relating to 
prescription drug coverage under part D; 
and’’.
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SEC. 4003. ADDITIONAL RELIGIOUS EXEMPTION FROM HEALTH 
COVERAGE RESPONSIBILITY REQUIREMENT. 
(a) IN GENERAL.—Section 5000A(d)(2)(A) of the Inter-
nal Revenue Code of 1986 is amended to read as follows: 
‘‘(A) RELIGIOUS CONSCIENCE EXEMPTIONS.— 
‘‘(i) IN GENERAL.—Such term shall not 
include any individual for any month if such 
individual has in effect an exemption under 
section 1311(d)(4)(H) of the Patient Protec-
tion and Affordable Care Act which certifies 
that— 
‘‘(I) such individual is a member of a 
recognized religious sect or division there-
of 
which 
is 
described 
in 
section 
1402(g)(1), and is adherent of established 
tenets or teachings of such sect or division 
as described in such section; or 
‘‘(II) such individual is a member of 
a religious sect or division thereof which is 
not described in section 1402(g)(1), who 
relies solely on a religious method of heal-
ing, and for whom the acceptance of med-
ical health services would be inconsistent 
with the religious beliefs of the individual. 
‘‘(ii) SPECIAL RULES.—
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‘‘(I) MEDICAL HEALTH SERVICES DE-
FINED.—For purposes of this subpara-
graph, the term ‘medical health services’ 
does not include routine dental, vision and 
hearing services, midwifery services, vac-
cinations, necessary medical services pro-
vided to children, services required by law 
or by a third party, and such other serv-
ices as the Secretary of Health and 
Human Services may provide in imple-
menting section 1311(d)(4)(H) of the Pa-
tient Protection and Affordable Care Act. 
‘‘(II) 
ATTESTATION
REQUIRED.— 
Clause (i)(II) shall apply to an individual 
for months in a taxable year only if the 
information provided by the individual 
under section 1411(b)(5)(A) of such Act 
includes an attestation that the individual 
has not received medical health services 
during the preceding taxable year.’’. 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall apply to taxable years beginning after De-
cember 31, 2018. 
(c) CONSTRUCTION.—Nothing in the amendment made 
by subsection (a) shall preempt any State law requiring the
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provision of medical treatment for children, especially those 
who are seriously ill. 
SEC. 4004. MODERNIZING THE REPORTING OF BIOLOGICAL AND 
BIOSIMILAR PRODUCTS. 
Subtitle B of title XI of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Public Law 
108–173) is amended— 
(1) in section 1111, as amended by section 3(1) of 
the Patient Right to Know Drug Prices Act— 
(A) in the paragraph (3) inserted by such sec-
tion 3(1), by striking ‘‘an application’’ and inserting 
‘‘a biosimilar biological product application’’; 
(B) in the paragraph (4) inserted by such sec-
tion 3(1), by inserting ‘‘application’’ before ‘‘under 
section 351(k) of the Public Health Service Act’’; 
(C) in the paragraph (5) inserted by such sec-
tion 3(1), by striking ‘‘for licensure of a biological 
product under section 351(k) of the Public Health 
Service Act’’ and inserting ‘‘under section 351(k) of 
the Public Health Service Act for licensure of a bio-
logical product as biosimilar to, or interchangeable 
with, a reference product’’; 
(D) in paragraph (7), as redesignated and 
amended by such section 3(1), by striking ‘‘or 
under section 351(a) of the Public Health Service
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Act’’ and inserting ‘‘or the owner, or exclusive li-
censee, of a patent included in a list provided under 
section 351(l)(3) of the Public Health Service Act’’; 
and 
(E) in the paragraph (12) added by such sec-
tion 3(1), by striking ‘‘means a brand name drug 
for which a license is in effect under section 
351(a)’’ and inserting ‘‘has the meaning given such 
term in section 351(i)’’; and 
(2) in section 1112, as amended by section 3(2) of 
the Patient Right to Know Drug Prices Act— 
(A) in subsection (a)— 
(i) in paragraph (1), by striking ‘‘for 
which 
a 
statement 
under 
section 
351(l)(3)(B)(ii)(I) of the Public Health Service 
Act has been provided’’; 
(ii) in paragraph (2)— 
(I) in subparagraph (C)(i), by strik-
ing ‘‘brand name’’ and inserting ‘‘listed’’; 
and 
(II) by amending clause (ii) of sub-
paragraph (C) to read as follows: 
‘‘(ii) any of the time periods referred to in 
section 351(k)(6) of the Public Health Service 
Act as such period applies to such biosimilar
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biological product application or to any other 
biosimilar biological product application based 
on the same reference product.’’; 
(B) in subsection (b)— 
(i) in the subsection heading, by inserting 
‘‘OR BIOSIMILAR BIOLOGICAL PRODUCT AP-
PLICANT’’ after ‘‘APPLICANT’’; 
(ii) in paragraph (1)(B), by striking the 
first sentence and inserting the following: ‘‘A 
biosimilar biological product applicant that has 
submitted a biosimilar biological product appli-
cation that references a reference product and 
another biosimilar biological product applicant 
that has submitted a biosimilar biological prod-
uct application that references the same ref-
erence product shall each file the agreement in 
accordance with subsection (c).’’; and 
(iii) in paragraph (2)— 
(I) by striking ‘‘2 generic drug appli-
cants’’ and inserting ‘‘2 or more generic 
drug applicants’’; and 
(II) by striking ‘‘or an agreement be-
tween 2 biosimilar biological product ap-
plicants regarding the 1-year period re-
ferred to in section 351(k)(6)(A) of the
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Public Health Service Act as it applies to 
the biosimilar biological product applica-
tions with which the agreement is con-
cerned’’ and inserting ‘‘, an agreement be-
tween 2 or more biosimilar biological 
product applicants regarding a time pe-
riod referred to in section 351(k)(6) of the 
Public Health Service Act as it applies to 
the biosimilar biological product, or an 
agreement between 2 or more biosimilar 
biological product applicants regarding the 
manufacture, marketing, or sale of a bio-
similar biological product’’; and 
(C) in subsection (c)(2), by inserting ‘‘were en-
tered into within 30 days of,’’ after ‘‘condition 
for,’’. 
TITLE V—OTHER MEDICAID 
PROVISIONS 
Subtitle 
A—Mandatory 
Reporting 
With Respect to Adult Behavioral 
Health Measures 
SEC. 5001. MANDATORY REPORTING WITH RESPECT TO ADULT 
BEHAVIORAL HEALTH MEASURES. 
Section 1139B of the Social Security Act (42 U.S.C. 
1320b–9b) is amended—
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(1) in subsection (b)— 
(A) in paragraph (3)— 
(i) by striking ‘‘Not later than January 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 RESPECT 
TO
BEHAVIORAL
HEALTH
MEASURES.—Beginning 
with the State report required under subsection 
(d)(1) for 2024, the Secretary shall require States 
to use all behavioral health measures included in 
the core set of adult health quality measures and 
any updates or changes to such measures to report 
information, using the standardized format for re-
porting information and procedures developed under 
subparagraph (A), regarding the quality of behav-
ioral health care for Medicaid eligible adults.’’; and 
(B) in paragraph (5), by adding at the end the 
following new subparagraph: 
‘‘(C) BEHAVIORAL
HEALTH
MEASURES.—Be-
ginning 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
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•HRES 1099 EH 
measures) shall include behavioral health meas-
ures.’’; and 
(2) in subsection (d)(1)(A)— 
(A) by striking ‘‘the such plan’’ and inserting 
‘‘such plan’’; and 
(B) by striking ‘‘subsection (a)(5)’’ and insert-
ing ‘‘subsection (b)(5) and, beginning with the re-
port for 2024, all behavioral health measures in-
cluded in the core set of adult health quality meas-
ures maintained under such subsection (b)(5) and 
any updates or changes to such measures (as re-
quired under subsection (b)(3))’’. 
Subtitle B—Medicaid IMD Additional 
Info 
SEC. 5011. SHORT TITLE. 
This subtitle may be cited as the ‘‘Medicaid Institutes 
for Mental Disease Are Decisive in Delivering Inpatient 
Treatment for Individuals but Opportunities for Needed Ac-
cess are Limited without Information Needed about Facility 
Obligations Act’’ or the ‘‘Medicaid IMD ADDITIONAL 
INFO Act’’.
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SEC. 5012. MACPAC EXPLORATORY STUDY AND REPORT ON IN-
STITUTIONS FOR MENTAL DISEASES REQUIRE-
MENTS AND PRACTICES UNDER MEDICAID. 
(a) IN GENERAL.—Not later than January 1, 2020, the 
Medicaid and CHIP Payment and Access Commission estab-
lished under section 1900 of the Social Security Act (42 
U.S.C. 1396) shall conduct an exploratory study, using data 
from a representative sample of States, and submit to Con-
gress a report on at least the following information, with re-
spect to services furnished to individuals enrolled under State 
plans under the Medicaid program under title XIX of such 
Act (42 U.S.C. 1396 et seq.) (or waivers of such plans) who 
are patients in institutions for mental diseases and for which 
payment is made through fee-for-service or managed care ar-
rangements under such State plans (or waivers): 
(1) A description of such institutions for mental 
diseases in each such State, including at a minimum— 
(A) the number of such institutions in the 
State; 
(B) the facility type of such institutions in the 
State; and 
(C) any coverage limitations under each such 
State plan (or waiver) on scope, duration, or fre-
quency of such services. 
(2) With respect to each such institution for mental 
diseases in each such State, a description of—
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(A) such services provided at such institution; 
(B) the process, including any timeframe, used 
by such institution to clinically assess and reassess 
such individuals; and 
(C) the discharge process used by such institu-
tion, including any care continuum of relevant serv-
ices or facilities provided or used in such process. 
(3) A description of— 
(A) any Federal waiver that each such State 
has for such institutions and the Federal statutory 
authority for such waiver; and 
(B) any other Medicaid funding sources used 
by each such State for funding such institutions, 
such as supplemental payments. 
(4) A summary of State requirements (such as cer-
tification, licensure, and accreditation) applied by each 
such State to such institutions in order for such institu-
tions to receive payment under the State plan (or waiv-
er) and how each such State determines if such require-
ments have been met. 
(5) A summary of State standards (such as quality 
standards, clinical standards, and facility standards) 
that such institutions must meet to receive payment 
under such State plans (or waivers) and how each such 
State determines if such standards have been met.
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(6) If determined appropriate by the Commission, 
recommendations for policies and actions by Congress 
and the Centers for Medicare & Medicaid Services, such 
as on how State Medicaid programs may improve care 
and improve standards and including a recommendation 
for how the Centers for Medicare & Medicaid Services 
can improve data collection from such programs to ad-
dress any gaps in information. 
(b) STAKEHOLDER INPUT.—In carrying out subsection 
(a), the Medicaid and CHIP Payment and Access Commis-
sion shall seek input from State Medicaid directors and 
stakeholders, including at a minimum the Substance Abuse 
and Mental Health Services Administration, Centers for 
Medicare & Medicaid Services, State Medicaid officials, State 
mental health authorities, Medicaid beneficiary advocates, 
health care providers, and Medicaid managed care organiza-
tions. 
(c) DEFINITIONS.—In this section: 
(1) REPRESENTATIVE
SAMPLE
OF
STATES.—The 
term ‘‘representative sample of States’’ means a non- 
probability sample in which at least two States are se-
lected based on the knowledge and professional judgment 
of the selector.
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(2) STATE.—The term ‘‘State’’ means each of the 
50 States, the District of Columbia, and any common-
wealth or territory of the United States. 
(3) INSTITUTION
FOR
MENTAL
DISEASES.—The 
term ‘‘institution for mental diseases’’ has the meaning 
given such term in section 435.1010 of title 42, Code of 
Federal Regulations, or any successor regulation. 
Subtitle C—CHIP Mental Health and 
Substance Use Disorder Parity 
SEC. 5021. SHORT TITLE. 
This subtitle may be cited as the ‘‘CHIP Mental Health 
and Substance Use Disorder Parity Act’’. 
SEC. 5022. ENSURING ACCESS TO MENTAL HEALTH AND SUB-
STANCE USE DISORDER SERVICES FOR CHILDREN 
AND PREGNANT WOMEN UNDER THE CHILDREN’S 
HEALTH INSURANCE PROGRAM. 
(a) IN GENERAL.—Section 2103(c)(1) of the Social Se-
curity Act (42 U.S.C. 1397cc(c)(1)) is amended by adding at 
the end the following new subparagraph: 
‘‘(E) Mental health and substance use disorder 
services (as defined in paragraph (5)).’’. 
(b) MENTAL HEALTH AND SUBSTANCE USE DISORDER 
SERVICES.— 
(1) IN GENERAL.—Section 2103(c) of the Social Se-
curity Act (42 U.S.C. 1397cc(c)) is amended—
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(A) by redesignating paragraphs (5), (6), (7), 
and (8) as paragraphs (6), (7), (8), and (9), respec-
tively; and 
(B) by inserting after paragraph (4) the fol-
lowing new paragraph: 
‘‘(5) MENTAL HEALTH AND SUBSTANCE USE DIS-
ORDER SERVICES.—Regardless of the type of coverage 
elected by a State under subsection (a), child health as-
sistance provided under such coverage for targeted low- 
income children and, in the case that the State elects to 
provide pregnancy-related assistance under such cov-
erage pursuant to section 2112, such pregnancy-related 
assistance for targeted low-income pregnant women (as 
defined in section 2112(d)) shall— 
‘‘(A) include coverage of mental health services 
(including behavioral health treatment) necessary to 
prevent, diagnose, and treat a broad range of men-
tal health symptoms and disorders, including sub-
stance use disorders; and 
‘‘(B) be delivered in a culturally and linguis-
tically appropriate manner.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 2103(a) of the Social Security Act 
(42 U.S.C. 1397cc(a)) is amended, in the matter 
before paragraph (1), by striking ‘‘paragraphs (5),
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(6), and (7)’’ and inserting ‘‘paragraphs (5), (6), 
(7), and (8)’’. 
(B) Section 2110(a) of the Social Security Act 
(42 U.S.C. 1397jj(a)) is amended— 
(i) in paragraph (18), by striking ‘‘sub-
stance abuse’’ each place it appears and insert-
ing ‘‘substance use’’; and 
(ii) in paragraph (19), by striking ‘‘sub-
stance abuse’’ and inserting ‘‘substance use’’. 
(C) Section 2110(b)(5)(A)(i) of the Social Se-
curity Act (42 U.S.C. 1397jj(b)(5)(A)(i)) is amend-
ed by striking ‘‘subsection (c)(5)’’ and inserting 
‘‘subsection (c)(6)’’. 
(c) ASSURING ACCESS TO CARE.—Section 2102(a)(7)(B) 
of the Social Security Act (42 U.S.C. 1397bb(c)(2)) is 
amended by striking ‘‘section 2103(c)(5)’’ and inserting 
‘‘paragraphs (5) and (6) of section 2103(c)’’. 
(d) MENTAL
HEALTH
SERVICES
PARITY.—Subpara-
graph (A) of paragraph (7) of section 2103(c) of the Social 
Security Act (42 U.S.C. 1397cc(c)) (as redesignated by sub-
section (b)(1)) is amended to read as follows: 
‘‘(A) IN GENERAL.—A State child health plan 
shall ensure that the financial requirements and 
treatment limitations applicable to mental health 
and substance use disorder services (as described in
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paragraph (5)) provided under such plan comply 
with the requirements of section 2726(a) of the 
Public Health Service Act in the same manner as 
such requirements or limitations apply to a group 
health plan under such section.’’. 
(e) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), the 
amendments made by this section shall take effect with 
respect to child health assistance provided on or after 
the date that is 1 year after the date of the enactment 
of this Act. 
(2) EXCEPTION FOR STATE LEGISLATION.—In the 
case of a State child health plan under title XXI of the 
Social Security Act (or a waiver of such plan), which the 
Secretary of Health and Human Services determines re-
quires State legislation in order for the respective plan 
(or waiver) to meet any requirement imposed by the 
amendments made by this section, the respective plan 
(or waiver) shall not be regarded as failing to comply 
with the requirements of such title solely on the basis of 
its failure to meet such an additional requirement before 
the first day of the first calendar quarter beginning after 
the close of the first regular session of the State legisla-
ture that begins after the date of enactment of this sec-
tion. For purposes of the previous sentence, in the case
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of a State that has a 2-year legislative session, each year 
of the session shall be considered to be a separate reg-
ular session of the State legislature. 
Subtitle D—Medicaid Reentry 
SEC. 5031. SHORT TITLE. 
This subtitle may be cited as the ‘‘Medicaid Reentry 
Act’’. 
SEC. 5032. PROMOTING STATE INNOVATIONS TO EASE TRANSI-
TIONS INTEGRATION TO THE COMMUNITY FOR 
CERTAIN INDIVIDUALS. 
(a) STAKEHOLDER GROUP DEVELOPMENT
OF BEST 
PRACTICES; STATE MEDICAID PROGRAM INNOVATION.— 
(1) STAKEHOLDER GROUP BEST PRACTICES.—Not 
later than 6 months after the date of the enactment of 
this Act, the Secretary of Health and Human Services 
shall convene a stakeholder group of representatives of 
managed care organizations, Medicaid beneficiaries, 
health care providers, the National Association of Med-
icaid Directors, and other relevant representatives from 
local, State, and Federal jail and prison systems to de-
velop best practices (and submit to the Secretary and 
Congress a report on such best practices) for States— 
(A) to ease the health care-related transition of 
an individual who is an inmate of a public institu-
tion from the public institution to the community,
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including best practices for ensuring continuity of 
health insurance coverage or coverage under the 
State Medicaid plan under title XIX of the Social 
Security Act, as applicable, and relevant social serv-
ices; and 
(B) to carry out, with respect to such an indi-
vidual, such health care-related transition not later 
than 30 days after such individual is released from 
the public institution. 
(2) STATE MEDICAID PROGRAM INNOVATION.—The 
Secretary of Health and Human Services shall work with 
States on innovative strategies to help individuals who 
are inmates of public institutions and otherwise eligible 
for medical assistance under the Medicaid program 
under title XIX of the Social Security Act transition, 
with respect to enrollment for medical assistance under 
such program, seamlessly to the community. 
(b) GUIDANCE ON INNOVATIVE SERVICE DELIVERY SYS-
TEMS
DEMONSTRATION
PROJECT
OPPORTUNITIES.—Not 
later than 1 year after the date of the enactment of this Act, 
the Secretary of Health and Human Services, through the 
Administrator of the Centers for Medicare & Medicaid Serv-
ices, shall issue a State Medicaid Director letter, based on 
best practices developed under subsection (a)(1), regarding 
opportunities to design demonstration projects under section
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1115 of the Social Security Act (42 U.S.C. 1315) to improve 
care transitions for certain individuals who are soon-to-be 
former inmates of a public institution and who are otherwise 
eligible to receive medical assistance under title XIX of such 
Act, including systems for, with respect to a period (not to 
exceed 30 days) immediately prior to the day on which such 
individuals are expected to be released from such institu-
tion— 
(1) providing assistance and education for enroll-
ment under a State plan under the Medicaid program 
under title XIX of such Act for such individuals during 
such period; and 
(2) providing health care services for such individ-
uals during such period. 
(c) RULE OF CONSTRUCTION.—Nothing under title XIX 
of the Social Security Act or any other provision of law pre-
cludes a State from reclassifying or suspending (rather than 
terminating) eligibility of an individual for medical assistance 
under title XIX of the Social Security Act while such indi-
vidual is an inmate of a public institution. 
Subtitle E—Medicaid Partnership 
SEC. 5041. SHORT TITLE. 
This subtitle may be cited as the ‘‘Medicaid Providers 
Are Required To Note Experiences in Record Systems to
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Help In-need Patients Act’’ or the ‘‘Medicaid PARTNER-
SHIP Act’’. 
SEC. 5042. MEDICAID PROVIDERS ARE REQUIRED TO NOTE EX-
PERIENCES IN RECORD SYSTEMS TO HELP IN- 
NEED PATIENTS. 
(a) REQUIREMENTS UNDER THE MEDICAID PROGRAM 
RELATING TO QUALIFIED PRESCRIPTION DRUG MONITORING 
PROGRAMS AND PRESCRIBING CERTAIN CONTROLLED SUB-
STANCES.—Title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.) is amended by inserting after section 1943 the 
following new section: 
‘‘SEC. 1944. REQUIREMENTS RELATING TO QUALIFIED PRE-
SCRIPTION DRUG MONITORING PROGRAMS AND 
PRESCRIBING 
CERTAIN 
CONTROLLED 
SUB-
STANCES. 
‘‘(a) IN GENERAL.—Subject to subsection (d), beginning 
October 1, 2021, a State— 
‘‘(1) shall require each covered provider to check, in 
accordance with such timing, manner, and form as speci-
fied by the State, the prescription drug history of a cov-
ered individual being treated by the covered provider 
through a qualified prescription drug monitoring pro-
gram described in subsection (b) before prescribing to 
such individual a controlled substance; and
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‘‘(2) in the case that such a provider is not able to 
conduct such a check despite a good faith effort by such 
provider— 
‘‘(A) shall require the provider to document 
such good faith effort, including the reasons why 
the provider was not able to conduct the check; and 
‘‘(B) may require the provider to submit, upon 
request, such documentation to the State. 
‘‘(b) QUALIFIED
PRESCRIPTION
DRUG
MONITORING 
PROGRAM DESCRIBED.—A qualified prescription drug moni-
toring program described in this subsection is, with respect 
to a State, a prescription drug monitoring program adminis-
tered by the State that, at a minimum, satisfies each of the 
following criteria: 
‘‘(1) The program facilitates access by a covered 
provider to, at a minimum, the following information 
with respect to a covered individual, in as close to real- 
time as possible: 
‘‘(A) Information regarding the prescription 
drug history of a covered individual with respect to 
controlled substances. 
‘‘(B) The number and type of controlled sub-
stances prescribed to and filled for the covered indi-
vidual during at least the most recent 12-month pe-
riod.
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‘‘(C) The name, location, and contact informa-
tion (or other identifying number selected by the 
State, such as a national provider identifier issued 
by the National Plan and Provider Enumeration 
System of the Centers for Medicare & Medicaid 
Services) of each covered provider who prescribed a 
controlled substance to the covered individual dur-
ing at least the most recent 12-month period. 
‘‘(2) The program facilitates the integration of in-
formation described in paragraph (1) into the workflow 
of a covered provider, which may include the electronic 
system the covered provider uses to prescribe controlled 
substances. 
A qualified prescription drug monitoring program described 
in this subsection, with respect to a State, may have in place, 
in accordance with applicable State and Federal law, a data- 
sharing agreement with the State Medicaid program that al-
lows the medical director and pharmacy director of such pro-
gram (and any designee of such a director who reports di-
rectly to such director) to access the information described in 
paragraph (1) in an electronic format. The State Medicaid 
program under this title may facilitate reasonable and limited 
access, as determined by the State and ensuring documented 
beneficiary protections regarding the use of such data, to 
such qualified prescription drug monitoring program for the
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medical director or pharmacy director of any managed care 
entity (as defined under section 1932(a)(1)(B)) that has a 
contract with the State under section 1903(m) or under sec-
tion 1905(t)(3), or the medical director or pharmacy director 
of any entity that has a contract to manage the pharma-
ceutical benefit with respect to individuals enrolled in the 
State plan (or under a waiver of the State plan). All applica-
ble State and Federal security and privacy laws shall apply 
to the directors or designees of such directors of any State 
Medicaid program or entity accessing a qualified prescription 
drug monitoring program under this section. 
‘‘(c) APPLICATION
OF
PRIVACY
RULES
CLARIFICA-
TION.—The Secretary shall clarify privacy requirements, in-
cluding requirements under the regulations promulgated pur-
suant to section 264(c) of the Health Insurance Portability 
and Accountability Act of 1996 (42 U.S.C. 1320d–2 note), 
related to the sharing of data under subsection (b) in the 
same manner as the Secretary is required under subpara-
graph (J) of section 1860D–4(c)(5) to clarify privacy require-
ments related to the sharing of data described in such sub-
paragraph. 
‘‘(d) ENSURING ACCESS.—In order to ensure reasonable 
access to health care, the Secretary shall waive the applica-
tion of the requirement under subsection (a), with respect to 
a State, in the case of natural disasters and similar situa-
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‘‘(iii) the types of controlled substances 
prescribed, including the dates of such pre-
scriptions, the supplies authorized (including 
the duration of such supplies), and the period 
of validity of such prescriptions, in different 
populations (such as individuals who are elder-
ly, individuals with disabilities, and individuals 
who are enrolled under both this title and title 
XVIII). 
‘‘(C) Whether or not the State requires (and a 
detailed explanation as to why the State does or 
does not require) pharmacists to check the prescrip-
tion drug history of a covered individual through a 
qualified prescription drug monitoring program de-
scribed in subsection (b) before dispensing a con-
trolled substance to such individual. 
‘‘(D) An accounting of any data or privacy 
breach of a qualified prescription drug monitoring 
program described in subsection (b), the number of 
covered individuals impacted by each such breach, 
and a description of the steps the State has taken 
to address each such breach, including, to the ex-
tent required by State or Federal law or otherwise 
determined appropriate by the State, alerting any
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such impacted individual and law enforcement of 
the breach. 
‘‘(2) REPORT BY CMS.—Not later than October 1, 
2023, the Administrator of the Centers for Medicare & 
Medicaid Services shall publish on the publicly available 
website of the Centers for Medicare & Medicaid Services 
a report including the following information: 
‘‘(A) Guidance for States on how States can 
increase the percentage of covered providers who 
use qualified prescription drug monitoring programs 
described in subsection (b). 
‘‘(B) Best practices for how States and covered 
providers should use such qualified prescription 
drug monitoring programs to reduce the occurrence 
of abuse of controlled substances. 
‘‘(f) INCREASE
TO FMAP AND FEDERAL MATCHING 
RATES FOR CERTAIN EXPENDITURES RELATING TO QUALI-
FIED PRESCRIPTION DRUG MONITORING PROGRAMS.— 
‘‘(1) IN GENERAL.—With respect to a State that 
meets the condition described in paragraph (2) and any 
quarter occurring during fiscal year 2019 or fiscal year 
2020, the Federal medical assistance percentage or Fed-
eral matching rate that would otherwise apply to such 
State under section 1903(a) for such quarter, with re-
spect to expenditures by the State for activities under
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the State plan (or a waiver of such plan) to design, de-
velop, or implement a prescription drug monitoring pro-
gram (and to make connections to such program) that 
satisfies the criteria described in paragraphs (1) and (2) 
of subsection (b), shall be equal to 100 percent. 
‘‘(2) CONDITION.—The condition described in this 
paragraph, with respect to a State, is that the State (in 
this paragraph referred to as the ‘administering State’) 
has in place agreements with all States that are contig-
uous to such administering State that, when combined, 
enable covered providers in all such contiguous States to 
access, through the prescription drug monitoring pro-
gram, the information that is described in subsection 
(b)(1) of covered individuals of such administering State 
and that covered providers in such administering State 
are able to access through such program. 
‘‘(g) RULE OF CONSTRUCTION.—Nothing in this section 
prevents a State from requiring pharmacists to check the pre-
scription drug history of covered individuals through a quali-
fied prescription drug monitoring program before dispensing 
controlled substances to such individuals. 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) CONTROLLED
SUBSTANCE.—The term ‘con-
trolled substance’ means a drug that is included in 
schedule II of section 202(c) of the Controlled Sub-
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stances Act and, at the option of the State involved, a 
drug included in schedule III or IV of such section. 
‘‘(2) COVERED INDIVIDUAL.—The term ‘covered in-
dividual’ means, with respect to a State, an individual 
who is enrolled in the State plan (or under a waiver of 
such plan). Such term does not include an individual 
who— 
‘‘(A) is receiving— 
‘‘(i) hospice or palliative care; or 
‘‘(ii) treatment for cancer; 
‘‘(B) is a resident of a long-term care facility, 
of a facility described in section 1905(d), or of an-
other facility for which frequently abused drugs are 
dispensed for residents through a contract with a 
single pharmacy; or 
‘‘(C) the State elects to treat as exempted from 
such term. 
‘‘(3) COVERED PROVIDER.— 
‘‘(A) IN
GENERAL.—The term ‘covered pro-
vider’ means, subject to subparagraph (B), with re-
spect to a State, a health care provider who is par-
ticipating under the State plan (or waiver of the 
State plan) and licensed, registered, or otherwise 
permitted by the State to prescribe a controlled sub-
stance (or the designee of such provider).
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‘‘(B) EXCEPTIONS.— 
‘‘(i) IN GENERAL.—Beginning October 1, 
2021, for purposes of this section, such term 
does not include a health care provider in-
cluded in any type of health care provider de-
termined by the Secretary to be exempt from 
application of this section under clause (ii). 
‘‘(ii) EXCEPTIONS
PROCESS.—Not later 
than October 1, 2020, the Secretary, after con-
sultation with the National Association of Med-
icaid Directors, national health care provider 
associations, Medicaid beneficiary advocates, 
and advocates for individuals with rare dis-
eases, shall determine, based on such consulta-
tions, the types of health care providers (if 
any) that should be exempted from the defini-
tion of the term ‘covered provider’ for purposes 
of this section.’’. 
(b) GUIDANCE.—Not later than October 1, 2019, the 
Administrator of the Centers for Medicare & Medicaid Serv-
ices, in consultation with the Director of the Centers for Dis-
ease Control and Prevention, shall issue guidance on best 
practices on the uses of prescription drug monitoring pro-
grams required of prescribers and on protecting the privacy
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of Medicaid beneficiary information maintained in and 
accessed through prescription drug monitoring programs. 
(c) DEVELOPMENT OF MODEL STATE PRACTICES.— 
(1) IN GENERAL.—Not later than October 1, 2020, 
the Secretary of Health and Human Services shall de-
velop and publish model practices to assist State Med-
icaid program operations in identifying and imple-
menting strategies to utilize data-sharing agreements de-
scribed in the matter following paragraph (2) of section 
1944(b) of the Social Security Act, as added by sub-
section (a), for the following purposes: 
(A) Monitoring and preventing fraud, waste, 
and abuse. 
(B) Improving health care for individuals en-
rolled in a State plan under title XIX of such Act 
(or under a waiver of such plan) who— 
(i) transition in and out of coverage under 
such title; 
(ii) may have sources of health care cov-
erage in addition to coverage under such title; 
or 
(iii) pay for prescription drugs with cash. 
(C) Any other purposes specified by the Sec-
retary.
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(2) ELEMENTS OF MODEL PRACTICES.—The model 
practices described in paragraph (1)— 
(A) shall include strategies for assisting States 
in allowing the medical director or pharmacy direc-
tor (or designees of such a director) of managed 
care organizations or pharmaceutical benefit man-
agers to access information with respect to all cov-
ered individuals served by such managed care orga-
nizations or pharmaceutical benefit managers to ac-
cess as a single data set, in an electronic format; 
and 
(B) shall include any appropriate beneficiary 
protections and privacy guidelines. 
(3) CONSULTATION.—In developing model practices 
under this subsection, the Secretary shall consult with 
the National Association of Medicaid Directors, managed 
care entities (as defined in section 1932(a)(1)(B) of the 
Social Security Act) with contracts with States pursuant 
to section 1903(m) of such Act, pharmaceutical benefit 
managers, physicians and other health care providers, 
beneficiary advocates, and individuals with expertise in 
health care technology related to prescription drug moni-
toring programs and electronic health records. 
(d) REPORT
BY COMPTROLLER GENERAL.—Not later 
than October 1, 2020, the Comptroller General of the United
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•HRES 1099 EH 
States shall issue a report examining the operation of pre-
scription drug monitoring programs administered by States, 
including data security and access standards used by such 
programs. 
Subtitle F—IMD CARE Act 
SEC. 5051. SHORT TITLE. 
This title may be cited as the ‘‘Individuals in Medicaid 
Deserve Care that is Appropriate and Responsible in its Exe-
cution Act’’ or the ‘‘IMD CARE Act’’. 
SEC. 5052. STATE OPTION TO PROVIDE MEDICAID COVERAGE 
FOR CERTAIN INDIVIDUALS WITH SUBSTANCE USE 
DISORDERS WHO ARE PATIENTS IN CERTAIN IN-
STITUTIONS FOR MENTAL DISEASES. 
(a) IN GENERAL.—Title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.), as amended by preceding sections 
of this Act, is further amended— 
(1) in section 1905(a), in the subdivision (B) that 
follows paragraph (30), by inserting ‘‘(except in the case 
of services provided under a State plan amendment de-
scribed in section 1915(l))’’ before the period; and 
(2) in section 1915, by adding at the end the fol-
lowing new subsection: 
‘‘(l) STATE PLAN AMENDMENT OPTION
TO PROVIDE 
MEDICAL ASSISTANCE FOR CERTAIN INDIVIDUALS WHO ARE
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PATIENTS
IN CERTAIN INSTITUTIONS
FOR MENTAL DIS-
EASES.— 
‘‘(1) IN GENERAL.—With respect to calendar quar-
ters beginning during the period beginning October 1, 
2019, and ending September 30, 2023, a State may 
elect, through a State plan amendment, to provide med-
ical assistance for items and services furnished to an eli-
gible individual who is a patient in an eligible institution 
for mental diseases in accordance with the requirements 
of this subsection. 
‘‘(2) PAYMENTS.—Subject to paragraphs (3) and 
(4), amounts expended under a State plan amendment 
under paragraph (1) for services described in such para-
graph furnished, with respect to a 12-month period, to 
an eligible individual who is a patient in an eligible insti-
tution for mental diseases shall be treated as medical as-
sistance for which payment is made under section 
1903(a) but only to the extent that such services are 
furnished for not more than a period of 30 days (wheth-
er or not consecutive) during such 12-month period. 
‘‘(3) MAINTENANCE OF EFFORT.— 
‘‘(A) IN GENERAL.—As a condition for a State 
receiving payments under section 1903(a) for med-
ical assistance provided in accordance with this sub-
section, the State shall (during the period in which
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it so furnished such medical assistance through a 
State plan amendment under this subsection) main-
tain on an annual basis a level of funding expended 
by the State (and political subdivisions thereof) 
other than under this title from non-Federal funds 
for— 
‘‘(i) items and services furnished to eligi-
ble individuals who are patients in eligible in-
stitutions for mental diseases that is not less 
than the level of such funding for such items 
and services for the most recently ended fiscal 
year as of the date of enactment of this sub-
section or, if higher, for the most recently 
ended fiscal year as of the date the State sub-
mits a State plan amendment to the Secretary 
to provide such medical assistance in accord-
ance with this subsection; and 
‘‘(ii) items and services (including services 
described in subparagraph (B)) furnished to el-
igible individuals in outpatient and community- 
based settings that is not less than the level of 
such funding for such items and services for 
the most recently ended fiscal year as of the 
date of enactment of this subsection or, if 
higher, for the most recently ended fiscal year
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as of the date the State submits a State plan 
amendment to the Secretary to provide such 
medical assistance in accordance with this sub-
section. 
‘‘(B) SERVICES DESCRIBED.—For purposes of 
subparagraph (A)(ii), services described in this sub-
paragraph are the following: 
‘‘(i) Outpatient and community-based sub-
stance use disorder treatment. 
‘‘(ii) Evidence-based recovery and support 
services. 
‘‘(iii) Clinically-directed therapeutic treat-
ment to facilitate recovery skills, relapse pre-
vention, and emotional coping strategies. 
‘‘(iv) Outpatient medication-assisted treat-
ment, related therapies, and pharmacology. 
‘‘(v) Counseling and clinical monitoring. 
‘‘(vi) Outpatient withdrawal management 
and related treatment designed to alleviate 
acute emotional, behavioral, cognitive, or bio-
medical distress resulting from, or occurring 
with, an individual’s use of alcohol and other 
drugs. 
‘‘(vii) Routine monitoring of medication 
adherence.
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‘‘(viii) Other outpatient and community- 
based services for the treatment of substance 
use disorders, as designated by the Secretary. 
‘‘(C) STATE REPORTING REQUIREMENT.— 
‘‘(i) IN GENERAL.—Prior to approval of a 
State plan amendment under this subsection, 
as a condition for a State receiving payments 
under section 1903(a) for medical assistance 
provided in accordance with this subsection, 
the State shall report to the Secretary, in ac-
cordance with the process established by the 
Secretary under clause (ii), the information 
deemed necessary by the Secretary under such 
clause. 
‘‘(ii) PROCESS.—Not later than the date 
that is 8 months after the date of enactment 
of this subsection, the Secretary shall establish 
a process for States to report to the Secretary, 
at such time and in such manner as the Sec-
retary deems appropriate, such information as 
the Secretary deems necessary to verify a 
State’s compliance with subparagraph (A). 
‘‘(4) ENSURING A CONTINUUM OF SERVICES.— 
‘‘(A) IN GENERAL.—As a condition for a State 
receiving payments under section 1903(a) for med-
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ical assistance provided in accordance with this sub-
section, the State shall carry out each of the re-
quirements described in subparagraphs (B) through 
(D). 
‘‘(B) NOTIFICATION.—Prior to approval of a 
State plan amendment under this subsection, the 
State shall notify the Secretary of how the State 
will ensure that eligible individuals receive appro-
priate evidence-based clinical screening prior to 
being furnished with items and services in an eligi-
ble institution for mental diseases, including initial 
and periodic assessments to determine the appro-
priate level of care, length of stay, and setting for 
such care for each individual. 
‘‘(C) OUTPATIENT SERVICES; INPATIENT AND 
RESIDENTIAL SERVICES.— 
‘‘(i) OUTPATIENT
SERVICES.—The State 
shall, at a minimum, provide medical assist-
ance for services that could otherwise be cov-
ered under the State plan, consistent with each 
of the following outpatient levels of care: 
‘‘(I) Early intervention for individuals 
who, for a known reason, are at risk of 
developing substance-related problems and 
for individuals for whom there is not yet
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sufficient information to document a 
diagnosable substance use disorder. 
‘‘(II) Outpatient services for less 
than 9 hours per week for adults, and for 
less than 6 hours per week for adoles-
cents, for recovery or motivational en-
hancement therapies and strategies. 
‘‘(III) Intensive outpatient services 
for 9 hours or more per week for adults, 
and for 6 hours or more per week for ado-
lescents, to treat multidimensional insta-
bility. 
‘‘(IV) Partial hospitalization services 
for 20 hours or more per week for adults 
and adolescents to treat multidimensional 
instability that does not require 24-hour 
care. 
‘‘(ii) INPATIENT AND RESIDENTIAL SERV-
ICES.—The State shall provide medical assist-
ance for services that could otherwise be cov-
ered under the State plan, consistent with at 
least 2 of the following inpatient and residen-
tial levels of care: 
‘‘(I) Clinically managed, low-intensity 
residential services that provide adults
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and adolescents with 24-hour living sup-
port and structure with trained personnel 
and at least 5 hours of clinical service per 
week per individual. 
‘‘(II) Clinically managed, population- 
specific, high-intensity residential services 
that provide adults with 24-hour care with 
trained counselors to stabilize multidimen-
sional imminent danger along with less in-
tense milieu and group treatment for 
those with cognitive or other impairments 
unable to use full active milieu or thera-
peutic community. 
‘‘(III) Clinically managed, medium- 
intensity residential services for adoles-
cents, and clinically managed, high-inten-
sity residential services for adults, that 
provide 24-hour care with trained coun-
selors to stabilize multidimensional immi-
nent danger and preparation for out-
patient treatment. 
‘‘(IV) Medically monitored, high-in-
tensity inpatient services for adolescents, 
and medically monitored, intensive inpa-
tient services withdrawal management for
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adults, that provide 24-hour nursing care, 
make physicians available for significant 
problems in Dimensions 1, 2, or 3, and 
provide counseling services 16 hours per 
day. 
‘‘(V) Medically managed, intensive in-
patient services for adolescents and adults 
that provide 24-hour nursing care and 
daily physician care for severe, unstable 
problems in Dimensions 1, 2 or 3. 
‘‘(D) TRANSITION OF CARE.—In order to en-
sure an appropriate transition for an eligible indi-
vidual from receiving care in an eligible institution 
for mental diseases to receiving care at a lower level 
of clinical intensity within the continuum of care 
(including outpatient services), the State shall en-
sure that— 
‘‘(i) a placement in such eligible institu-
tion for mental diseases would allow for an eli-
gible individual’s successful transition to the 
community, considering such factors as prox-
imity to an individual’s support network (such 
as family members, employment, and coun-
seling and other services near an individual’s 
residence); and
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‘‘(ii) all eligible institutions for mental dis-
eases that furnish items and services to indi-
viduals for which medical assistance is provided 
under the State plan— 
‘‘(I) are able to provide care at such 
lower level of clinical intensity; or 
‘‘(II) have an established relationship 
with another facility or provider that is 
able to provide care at such lower level of 
clinical intensity and accepts patients re-
ceiving medical assistance under this title 
under which the eligible institution for 
mental diseases may arrange for individ-
uals to receive such care from such other 
facility or provider. 
‘‘(5) APPLICATION TO MANAGED CARE.—Payments 
for, and limitations to, medical assistance furnished in 
accordance with this subsection shall be in addition to 
and shall not be construed to limit or supersede the abil-
ity of States to make monthly capitation payments to 
managed care organizations for individuals receiving 
treatment in institutions for mental diseases in accord-
ance with section 438.6(e) of title 42, Code of Federal 
Regulations (or any successor regulation).
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‘‘(6) OTHER MEDICAL ASSISTANCE.—The provision 
of medical assistance for items and services furnished to 
an eligible individual who is a patient in an eligible insti-
tution for mental diseases in accordance with the re-
quirements of this subsection shall not prohibit Federal 
financial participation for medical assistance for items or 
services that are provided to such eligible individual in 
or away from the eligible institution for mental disease 
during any period in which the eligible individual is re-
ceiving items or services in accordance with this sub-
section. 
‘‘(7) DEFINITIONS.—In this subsection: 
‘‘(A) DIMENSIONS 1, 2, OR 3.—The term ‘Di-
mensions 1, 2, or 3’ has the meaning given that 
term for purposes of the publication of the Amer-
ican Society of Addiction Medicine entitled ‘The 
ASAM Criteria: Treatment Criteria for Addictive 
Substance-Related, and Co-Occurring Conditions, 
2013’. 
‘‘(B) ELIGIBLE INDIVIDUAL.—The term ‘eligi-
ble individual’ means an individual who— 
‘‘(i) with respect to a State, is enrolled for 
medical assistance under the State plan or a 
waiver of such plan; 
‘‘(ii) is at least 21 years of age;
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‘‘(iii) has not attained 65 years of age; 
and 
‘‘(iv) has at least 1 substance use dis-
order. 
‘‘(C) ELIGIBLE INSTITUTION FOR MENTAL DIS-
EASES.—The term ‘eligible institution for mental 
diseases’ means an institution for mental diseases 
that— 
‘‘(i) follows reliable, evidence-based prac-
tices; and 
‘‘(ii) offers at least 2 forms of medication- 
assisted treatment for substance use disorders 
on site, including, in the case of medication-as-
sisted treatment for opioid use disorder, at 
least 1 antagonist and 1 partial agonist. 
‘‘(D) INSTITUTION FOR MENTAL DISEASES.— 
The term ‘institution for mental diseases’ has the 
meaning given that term in section 1905(i).’’. 
(b) RULE OF CONSTRUCTION.—Nothing in the amend-
ments made by subsection (a) shall be construed as encour-
aging a State to place an individual in an inpatient or a resi-
dential care setting where a home or community-based care 
setting would be more appropriate for the individual, or as 
preventing a State from conducting or pursuing a demonstra-
tion project under section 1115 of the Social Security Act to
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improve access to, and the quality of, substance use disorder 
treatment for eligible populations. 
Subtitle G—Medicaid Improvement 
Fund 
SEC. 5061. MEDICAID IMPROVEMENT FUND. 
Section 1941(b)(1) of the Social Security Act (42 U.S.C. 
1396w–1(b)(1)) is amended by striking ‘‘$0’’ and inserting 
‘‘$31,000,000’’. 
TITLE VI—OTHER MEDICARE 
PROVISIONS 
Subtitle A—Testing of Incentive Pay-
ments for Behavioral Health Pro-
viders for Adoption and Use of 
Certified Electronic Health Record 
Technology 
SEC. 6001. 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, for the adoption and use 
of certified EHR technology (as defined in sec-
tion 1848(o)(4)) to improve the quality and co-
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ordination of care through the electronic docu-
mentation and exchange of health information, 
incentive payments to behavioral health pro-
viders (such as psychiatric hospitals (as de-
fined in section 1861(f)), community mental 
health 
centers 
(as 
defined 
in 
section 
1861(ff)(3)(B)), hospitals that participate in a 
State plan under title XIX or a waiver of such 
plan, treatment facilities that participate in 
such a State plan or such a waiver, mental 
health or substance use disorder providers that 
participate in such a State plan or such a 
waiver, clinical psychologists (as defined in sec-
tion 1861(ii)), nurse practitioners (as defined 
in section 1861(aa)(5)) with respect to the pro-
vision of psychiatric services, and clinical social 
workers (as defined in section 1861(hh)(1))).’’. 
Subtitle B—Abuse Deterrent Access 
SEC. 6011. SHORT TITLE. 
This subtitle may be cited at the ‘‘Abuse Deterrent Ac-
cess Act of 2018’’. 
SEC. 6012. STUDY ON ABUSE-DETERRENT OPIOID FORMULA-
TIONS ACCESS BARRIERS UNDER MEDICARE. 
(a) IN GENERAL.—Not later than 1 year after the date 
of the enactment of this Act, the Secretary of Health and
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Human Services shall conduct a study and submit to Con-
gress a report on— 
(1) the adequacy of access to abuse-deterrent opioid 
formulations for individuals with chronic pain enrolled in 
an MA–PD plan under part C of title XVIII of the So-
cial Security Act or a prescription drug plan under part 
D of such title of such Act, taking into account any bar-
riers preventing such individuals from accessing such 
formulations under such MA–PD or part D plans, such 
as cost-sharing tiers, fail-first requirements, the price of 
such formulations, and prior authorization requirements; 
and 
(2) the effectiveness of abuse-deterrent opioid for-
mulations in preventing opioid abuse or misuse; the im-
pact of the use of abuse-deterrent opioid formulations on 
the use or abuse of other prescription or illicit opioids 
(including changes in deaths from such opioids); and 
other public health consequences of the use of abuse-de-
terrent opioid formulations, such as an increase in rates 
of human immunodeficiency virus. 
(b) DEFINITION OF ABUSE-DETERRENT OPIOID FORMU-
LATION.—In this section, the term ‘‘abuse-deterrent opioid 
formulation’’ means an opioid that is a prodrug or that has 
certain abuse-deterrent properties, such as physical or chem-
ical barriers, agonist or antagonist combinations, aversion
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properties, delivery system mechanisms, or other features de-
signed to prevent abuse of such opioid. 
Subtitle C—Medicare Opioid Safety 
Education 
SEC. 6021. 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 management.’’. 
(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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Subtitle D—Opioid Addiction Action 
Plan 
SEC. 6031. SHORT TITLE. 
This subtitle may be cited as the ‘‘Opioid Addiction Ac-
tion Plan Act’’. 
SEC. 
6032. 
ACTION 
PLAN 
ON 
RECOMMENDATIONS 
FOR 
CHANGES UNDER MEDICARE AND MEDICAID TO 
PREVENT OPIOIDS ADDICTIONS AND ENHANCE 
ACCESS TO MEDICATION-ASSISTED TREATMENT. 
(a) IN GENERAL.—Not later than January 1, 2020, the 
Secretary of Health and Human Services (in this section re-
ferred to as the ‘‘Secretary’’), in collaboration with the Pain 
Management Best Practices Inter-Agency Task Force con-
vened under section 101(b) of the Comprehensive Addiction 
and Recovery Act of 2016 (Public Law 114–198), shall de-
velop an action plan as described in subsection (b). 
(b) ACTION PLAN COMPONENTS.—The action plan shall 
include a review by the Secretary of Medicare and Medicaid 
payment and coverage policies that may be viewed as poten-
tial obstacles to an effective response to the opioid crisis, and 
recommendations, as determined appropriate by the Sec-
retary, on the following: 
(1) A review of payment and coverage policies 
under the Medicare program under title XVIII of the 
Social Security Act and the Medicaid program under
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title XIX of such Act, including a review of coverage and 
payment under such programs of all medication-assisted 
treatment approved by the Food and Drug Administra-
tion related to the treatment of opioid use disorder and 
other therapies that manage chronic and acute pain and 
treat and minimize risk of opioid misuse and abuse, in-
cluding in such review, payment under the Medicare pro-
spective payment system for inpatient hospital services 
under section 1886(d) of such Act (42 U.S.C. 
1395ww(d)) and the Medicare prospective payment sys-
tem for hospital outpatient department services under 
section 1833(t) of such Act (42 U.S.C. 1395I(t)), to de-
termine whether those payment policies resulted in in-
centives or disincentives that have contributed to the 
opioid crisis. 
(2) Recommendations for payment and service de-
livery models to be tested as appropriate by the Center 
for Medicare and Medicaid Innovation and other feder-
ally authorized demonstration projects, including value- 
based models, that may encourage the use of appropriate 
medication-assisted treatment approved by the Food and 
Drug Administration for the treatment of opioid use dis-
order and other therapies that manage chronic and acute 
pain and treat and minimize risk of opioid misuse and 
abuse.
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(3) Recommendations for data collection that could 
facilitate research and policy-making regarding preven-
tion of opioid use disorder as well as data that would aid 
the Secretary in making coverage and payment decisions 
under the Medicare and Medicaid programs related to 
the access to appropriate opioid dependence treatments. 
(4) A review of Medicare and Medicaid bene-
ficiaries’ access to the full range of medication-assisted 
treatment approved by the Food and Drug Administra-
tion for the treatment of opioid use disorder and other 
therapies that manage chronic and acute pain and treat 
and minimize risk of opioid misuse and abuse, including 
access of beneficiaries residing in rural or medically un-
derserved communities. 
(5) A review of payment and coverage policies 
under the Medicare program and the Medicaid program 
related to medical devices that are non-opioid based 
treatments approved by the Food and Drug Administra-
tion for the management of acute pain and chronic pain, 
for monitoring substance use withdrawal and preventing 
overdoses of controlled substances, and for treating sub-
stance use disorder, including barriers to patient access. 
(c) STAKEHOLDER MEETINGS.— 
(1) IN
GENERAL.—Beginning not later than 3 
months after the date of the enactment of this section,
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the Secretary shall convene a public stakeholder meeting 
to solicit public comment on the components of the ac-
tion plan described in subsection (b). 
(2) PARTICIPANTS.—Participants of meetings de-
scribed in paragraph (1) shall include representatives 
from the Food and Drug Administration and National 
Institutes of Health, biopharmaceutical industry mem-
bers, medical researchers, health care providers, the 
medical device industry, the Medicare program, the Med-
icaid program, and patient advocates. 
(d) REQUEST
FOR INFORMATION.—Not later than 3 
months after the date of the enactment of this section, the 
Secretary shall issue a request for information seeking public 
feedback regarding ways in which the Centers for Medicare 
& Medicaid Services can help address the opioid crisis 
through the development of and application of the action 
plan. 
(e) REPORT TO CONGRESS.—Not later than June 1, 
2020, the Secretary shall submit to Congress, and make pub-
lic, a report that includes— 
(1) a summary of the results of the Secretary’s re-
view and any recommendations under the action plan; 
(2) the Secretary’s planned next steps with respect 
to the action plan; and
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(3) an evaluation of price trends for drugs used to 
reverse opioid overdoses (such as naloxone), including 
recommendations on ways to lower such prices for con-
sumers. 
(f) DEFINITION
OF
MEDICATION-ASSISTED
TREAT-
MENT.—In this section, the term ‘‘medication-assisted treat-
ment’’ includes opioid treatment programs, behavioral ther-
apy, and medications to treat substance abuse disorder. 
Subtitle E—Advancing High Quality 
Treatment for Opioid Use Dis-
orders in Medicare 
SEC. 6041. SHORT TITLE. 
This subtitle may be cited as the ‘‘Advancing High Qual-
ity Treatment for Opioid Use Disorders in Medicare Act’’. 
SEC. 6042. OPIOID USE DISORDER TREATMENT DEMONSTRA-
TION PROGRAM. 
Title XVIII of the Social Security Act (42 U.S.C. 1395 
et seq.) is amended by inserting after section 1866E (42 
U.S.C. 1395cc–5) the following new section: 
‘‘SEC. 1866F. OPIOID USE DISORDER TREATMENT DEMONSTRA-
TION PROGRAM. 
‘‘(a) IMPLEMENTATION
OF 4-YEAR DEMONSTRATION 
PROGRAM.— 
‘‘(1) IN
GENERAL.—Not later than January 1, 
2021, the Secretary shall implement a 4-year demonstra-
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tion program under this title (in this section referred to 
as the ‘Program’) to increase access of applicable bene-
ficiaries to opioid use disorder treatment services, im-
prove physical and mental health outcomes for such 
beneficiaries, and to the extent possible, reduce expendi-
tures under this title. Under the Program, the Secretary 
shall make payments under subsection (e) to partici-
pants (as defined in subsection (c)(1)(A)) for furnishing 
opioid use disorder treatment services delivered through 
opioid use disorder care teams, or arranging for such 
services to be furnished, to applicable beneficiaries par-
ticipating in the Program. 
‘‘(2) OPIOID
USE
DISORDER
TREATMENT
SERV-
ICES.—For purposes of this section, the term ‘opioid use 
disorder treatment services’— 
‘‘(A) means, with respect to an applicable ben-
eficiary, services that are furnished for the treat-
ment of opioid use disorders and that utilize drugs 
approved under section 505 of the Federal Food, 
Drug, and Cosmetic Act for the treatment of opioid 
use disorders in an outpatient setting; and 
‘‘(B) includes— 
‘‘(i) medication-assisted treatment; 
‘‘(ii) treatment planning;
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‘‘(iii) psychiatric, psychological, or coun-
seling services (or any combination of such 
services), as appropriate; 
‘‘(iv) social support services, as appro-
priate; and 
‘‘(v) care management and care coordina-
tion services, including coordination with other 
providers of services and suppliers not on an 
opioid use disorder care team. 
‘‘(b) PROGRAM DESIGN.— 
‘‘(1) IN GENERAL.—The Secretary shall design the 
Program in such a manner to allow for the evaluation 
of the extent to which the Program accomplishes the fol-
lowing purposes: 
‘‘(A) Reduces hospitalizations and emergency 
department visits. 
‘‘(B) Increases use of medication-assisted 
treatment for opioid use disorders. 
‘‘(C) Improves health outcomes of individuals 
with opioid use disorders, including by reducing the 
incidence of infectious diseases (such as hepatitis C 
and HIV). 
‘‘(D) Does not increase the total spending on 
items and services under this title. 
‘‘(E) Reduces deaths from opioid overdose.
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‘‘(F) Reduces the utilization of inpatient resi-
dential treatment. 
‘‘(2) CONSULTATION.—In designing the Program, 
including the criteria under subsection (e)(2)(A), the 
Secretary shall, not later than 3 months after the date 
of the enactment of this section, consult with specialists 
in the field of addiction, clinicians in the primary care 
community, and beneficiary groups. 
‘‘(c) PARTICIPANTS; OPIOID
USE
DISORDER
CARE 
TEAMS.— 
‘‘(1) PARTICIPANTS.— 
‘‘(A) DEFINITION.—In this section, the term 
‘participant’ means an entity or individual— 
‘‘(i) that is otherwise enrolled under this 
title and that is— 
‘‘(I) a physician (as defined in section 
1861(r)(1)); 
‘‘(II) a group practice comprised of 
at least one physician described in sub-
clause (I); 
‘‘(III) a hospital outpatient depart-
ment; 
‘‘(IV) a federally qualified health cen-
ter (as defined in section 1861(aa)(4));
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‘‘(V) a rural health clinic (as defined 
in section 1861(aa)(2)); 
‘‘(VI) a community mental health 
center 
(as 
defined 
in 
section 
1861(ff)(3)(B)); 
‘‘(VII) a clinic certified as a certified 
community behavioral health clinic pursu-
ant to section 223 of the Protecting Ac-
cess to Medicare Act of 2014; or 
‘‘(VIII) any other individual or entity 
specified by the Secretary; 
‘‘(ii) that applied for and was selected to 
participate in the Program pursuant to an ap-
plication and selection process established by 
the Secretary; and 
‘‘(iii) that establishes an opioid use dis-
order care team (as defined in paragraph (2)) 
through employing or contracting with health 
care practitioners described in paragraph 
(2)(A), and uses such team to furnish or ar-
range for opioid use disorder treatment serv-
ices in the outpatient setting under the Pro-
gram. 
‘‘(B) PREFERENCE.—In selecting participants 
for the Program, the Secretary shall give preference
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to individuals and entities that are located in areas 
with a prevalence of opioid use disorders that is 
higher than the national average prevalence. 
‘‘(2) OPIOID USE DISORDER CARE TEAMS.— 
‘‘(A) IN GENERAL.—For purposes of this sec-
tion, the term ‘opioid use disorder care team’ means 
a team of health care practitioners established by a 
participant described in paragraph (1)(A) that— 
‘‘(i) shall include— 
‘‘(I) at least one physician (as de-
fined in section 1861(r)(1)) furnishing 
primary care services or addiction treat-
ment services to an applicable beneficiary; 
and 
‘‘(II) at least one eligible practitioner 
(as defined in paragraph (3)), who may be 
a physician who meets the criterion in 
subclause (I); and 
‘‘(ii) may include other practitioners li-
censed under State law to furnish psychiatric, 
psychological, counseling, and social services to 
applicable beneficiaries. 
‘‘(B) REQUIREMENTS FOR RECEIPT OF PAY-
MENT UNDER PROGRAM.—In order to receive pay-
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ments under subsection (e), each participant in the 
Program shall— 
‘‘(i) furnish opioid use disorder treatment 
services through opioid use disorder care teams 
to applicable beneficiaries who agree to receive 
the services; 
‘‘(ii) meet minimum criteria, as estab-
lished by the Secretary; and 
‘‘(iii) submit to the Secretary, in such 
form, manner, and frequency as specified by 
the Secretary, with respect to each applicable 
beneficiary for whom opioid use disorder treat-
ment services are furnished by the opioid use 
disorder care team, data and such other infor-
mation as the Secretary determines appro-
priate to— 
‘‘(I) monitor and evaluate the Pro-
gram; 
‘‘(II) determine if minimum criteria 
are met under clause (ii); and 
‘‘(III) determine the incentive pay-
ment under subsection (e). 
‘‘(3) ELIGIBLE PRACTITIONER DEFINED.—For pur-
poses of this section, the term ‘eligible practitioner’
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means a physician or other health care practitioner, such 
as a nurse practitioner, that— 
‘‘(A) is enrolled under section 1866(j)(1); 
‘‘(B) is authorized to prescribe or dispense nar-
cotic drugs to individuals for maintenance treat-
ment or detoxification treatment; and 
‘‘(C) has in effect a waiver in accordance with 
section 303(g) of the Controlled Substances Act for 
such purpose and is otherwise in compliance with 
regulations promulgated by the Substance Abuse 
and Mental Health Services Administration to carry 
out such section. 
‘‘(d) PARTICIPATION OF APPLICABLE BENEFICIARIES.— 
‘‘(1) APPLICABLE BENEFICIARY DEFINED.—In this 
section, the term ‘applicable beneficiary’ means an indi-
vidual who— 
‘‘(A) is entitled to, or enrolled for, benefits 
under part A and enrolled for benefits under part 
B; 
‘‘(B) is not enrolled in a Medicare Advantage 
plan under part C; 
‘‘(C) has a current diagnosis for an opioid use 
disorder; and 
‘‘(D) meets such other criteria as the Secretary 
determines appropriate.
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Such term shall include an individual who is dually eligi-
ble for benefits under this title and title XIX if such in-
dividual satisfies the criteria described in subparagraphs 
(A) through (D). 
‘‘(2) VOLUNTARY
BENEFICIARY
PARTICIPATION; 
LIMITATION ON NUMBER OF BENEFICIARIES.—An appli-
cable beneficiary may participate in the Program on a 
voluntary basis and may terminate participation in the 
Program at any time. Not more than 20,000 applicable 
beneficiaries may participate in the Program at any 
time. 
‘‘(3) SERVICES.—In order to participate in the Pro-
gram, an applicable beneficiary shall agree to receive 
opioid use disorder treatment services from a partici-
pant. Participation under the Program shall not affect 
coverage of or payment for any other item or service 
under this title for the applicable beneficiary. 
‘‘(4) BENEFICIARY ACCESS TO SERVICES.—Nothing 
in this section shall be construed as encouraging pro-
viders to limit applicable beneficiary access to services 
covered under this title, and applicable beneficiaries shall 
not be required to relinquish access to any benefit under 
this title as a condition of receiving services from a par-
ticipant in the Program. 
‘‘(e) PAYMENTS.—
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‘‘(1) PER APPLICABLE BENEFICIARY PER MONTH 
CARE MANAGEMENT FEE.— 
‘‘(A) IN GENERAL.—The Secretary shall estab-
lish a schedule of per applicable beneficiary per 
month care management fees. Such a per applicable 
beneficiary per month care management fee shall be 
paid to a participant in addition to any other 
amount otherwise payable under this title to the 
health care practitioners in the participant’s opioid 
use disorder care team or, if applicable, to the par-
ticipant. A participant may use such per applicable 
beneficiary per month care management fee to de-
liver additional services to applicable beneficiaries, 
including services not otherwise eligible for payment 
under this title. 
‘‘(B) PAYMENT
AMOUNTS.—In carrying out 
subparagraph (A), the Secretary may— 
‘‘(i) consider payments otherwise payable 
under this title for opioid use disorder treat-
ment services and the needs of applicable bene-
ficiaries; 
‘‘(ii) pay a higher per applicable bene-
ficiary per month care management fee for an 
applicable beneficiary who receives more inten-
sive treatment services from a participant and
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for whom those services are appropriate based 
on clinical guidelines for opioid use disorder 
care; 
‘‘(iii) pay a higher per applicable bene-
ficiary per month care management fee for the 
month in which the applicable beneficiary be-
gins treatment with a participant than in sub-
sequent months, to reflect the greater time and 
costs required for the planning and initiation 
of treatment, as compared to maintenance of 
treatment; and 
‘‘(iv) take into account whether a partici-
pant’s opioid use disorder care team refers ap-
plicable beneficiaries to other suppliers or pro-
viders for any opioid use disorder treatment 
services. 
‘‘(C) NO
DUPLICATE
PAYMENT.—The Sec-
retary shall make payments under this paragraph to 
only one participant for services furnished to an ap-
plicable beneficiary during a calendar month. 
‘‘(2) INCENTIVE PAYMENTS.— 
‘‘(A) IN GENERAL.—Under the Program, the 
Secretary shall establish a performance-based incen-
tive payment, which shall be paid (using a method-
ology established and at a time determined appro-
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priate by the Secretary) to participants based on 
the performance of participants with respect to cri-
teria, as determined appropriate by the Secretary, 
in accordance with subparagraph (B). 
‘‘(B) CRITERIA.— 
‘‘(i) IN GENERAL.—Criteria described in 
subparagraph (A) may include consideration of 
the following: 
‘‘(I) Patient engagement and reten-
tion in treatment. 
‘‘(II) Evidence-based medication-as-
sisted treatment. 
‘‘(III) Other criteria established by 
the Secretary. 
‘‘(ii) REQUIRED CONSULTATION AND CON-
SIDERATION.—In 
determining 
criteria 
de-
scribed in subparagraph (A), the Secretary 
shall— 
‘‘(I) consult with stakeholders, in-
cluding clinicians in the primary care com-
munity and in the field of addiction medi-
cine; and 
‘‘(II) consider existing clinical guide-
lines for the treatment of opioid use dis-
orders.
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‘‘(C) NO
DUPLICATE
PAYMENT.—The Sec-
retary shall ensure that no duplicate payments 
under this paragraph are made with respect to an 
applicable beneficiary. 
‘‘(f) MULTIPAYER STRATEGY.—In carrying out the Pro-
gram, the Secretary shall encourage other payers to provide 
similar payments and to use similar criteria as applied under 
the Program under subsection (e)(2)(C). The Secretary may 
enter into a memorandum of understanding with other payers 
to align the methodology for payment provided by such a 
payer related to opioid use disorder treatment services with 
such methodology for payment under the Program. 
‘‘(g) EVALUATION.— 
‘‘(1) IN GENERAL.—The Secretary shall conduct an 
intermediate and final evaluation of the program. Each 
such evaluation shall determine the extent to which each 
of the purposes described in subsection (b) have been ac-
complished under the Program. 
‘‘(2) REPORTS.—The Secretary shall submit to 
Congress— 
‘‘(A) a report with respect to the intermediate 
evaluation under paragraph (1) not later than 3 
years after the date of the implementation of the 
Program; and
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‘‘(B) a report with respect to the final evalua-
tion under paragraph (1) not later than 6 years 
after such date. 
‘‘(h) FUNDING.— 
‘‘(1) ADMINISTRATIVE FUNDING.—For the purposes 
of implementing, administering, and carrying out the 
Program (other than for purposes described in para-
graph (2)), $5,000,000 shall be available from the Fed-
eral Supplementary Medical Insurance Trust Fund 
under section 1841. 
‘‘(2) CARE MANAGEMENT FEES AND INCENTIVES.— 
For the purposes of making payments under subsection 
(e), $10,000,000 shall be available from the Federal 
Supplementary Medical Insurance Trust Fund under 
section 1841 for each of fiscal years 2021 through 2024. 
‘‘(3) AVAILABILITY.—Amounts transferred under 
this subsection for a fiscal year shall be available until 
expended. 
‘‘(i) WAIVERS.—The Secretary may waive any provision 
of this title as may be necessary to carry out the Program 
under this section.’’.
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Subtitle 
F—Responsible 
Education 
Achieves Care and Healthy Out-
comes for Users’ Treatment 
SEC. 6051. SHORT TITLE. 
This subtitle may be cited as the ‘‘Responsible Edu-
cation Achieves Care and Healthy Outcomes for Users’ 
Treatment Act of 2018’’ or the ‘‘REACH OUT Act of 2018’’. 
SEC. 6052. GRANTS TO PROVIDE TECHNICAL ASSISTANCE TO 
OUTLIER PRESCRIBERS OF OPIOIDS. 
(a) GRANTS AUTHORIZED.—The Secretary of Health 
and Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall, through the Centers for Medicare & Medicaid 
Services, award grants, contracts, or cooperative agreements 
to eligible entities for the purposes described in subsection 
(b). 
(b) USE OF FUNDS.—Grants, contracts, and cooperative 
agreements awarded under subsection (a) shall be used to 
support eligible entities through technical assistance— 
(1) to educate and provide outreach to outlier pre-
scribers of opioids about best practices for prescribing 
opioids; 
(2) to educate and provide outreach to outlier pre-
scribers of opioids about non-opioid pain management 
therapies; and
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(3) to reduce the amount of opioid prescriptions 
prescribed by outlier prescribers of opioids. 
(c) APPLICATION.—Each eligible entity seeking to re-
ceive a grant, contract, or cooperative agreement under sub-
section (a) shall submit to the Secretary an application, at 
such time, in such manner, and containing such information 
as the Secretary may require. 
(d) GEOGRAPHIC DISTRIBUTION.—In awarding grants, 
contracts, and cooperative agreements under this section, the 
Secretary shall prioritize establishing technical assistance re-
sources in each State. 
(e) DEFINITIONS.—In this section: 
(1) ELIGIBLE ENTITY.—The term ‘‘eligible entity’’ 
means— 
(A) an organization— 
(i) that has demonstrated experience pro-
viding technical assistance to health care pro-
fessionals on a State or regional basis; and 
(ii) that has at least— 
(I) one individual who is a represent-
ative of consumers on its governing body; 
and 
(II) one individual who is a rep-
resentative of health care providers on its 
governing body; or
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(B) an entity that is a quality improvement en-
tity with a contract under part B of title XI of the 
Social Security Act (42 U.S.C. 1320c et seq.). 
(2) OUTLIER PRESCRIBER OF OPIOIDS.—The term 
‘‘outlier prescriber of opioids’’ means, with respect to a 
period, a prescriber identified by the Secretary under 
subparagraph (D)(ii) of section 1860D–4(c)(4) of the 
Social Security Act (42 U.S.C. 1395w–104(c)(4)), as 
added by section 6065 of this Act, to be an outlier pre-
scriber of opioids for such period. 
(3) PRESCRIBERS.—The term ‘‘prescriber’’ means 
any health care professional, including a nurse practi-
tioner or physician assistant, who is licensed to prescribe 
opioids by the State or territory in which such profes-
sional practices. 
(f) FUNDING.—For purposes of implementing this sec-
tion, $75,000,000 shall be available from the Federal Supple-
mentary Medical Insurance Trust Fund under section 1841 
of the Social Security Act (42 U.S.C. 1395t), to remain avail-
able until expended.
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Subtitle G—Preventing Addiction for 
Susceptible Seniors 
SEC. 6061. SHORT TITLE. 
This subtitle may be cited as the ‘‘Preventing Addiction 
for Susceptible Seniors Act of 2018’’ or the ‘‘PASS Act of 
2018’’. 
SEC. 6062. ELECTRONIC PRIOR AUTHORIZATION FOR COVERED 
PART D DRUGS. 
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 AUTHORIZATION.— 
‘‘(i) IN GENERAL.—Not later than Janu-
ary 1, 2021, the program shall provide for the 
secure electronic transmission 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 en-
rolled in a part D plan (as defined in sec-
tion 1860D–23(a)(5)) to the PDP sponsor 
or Medicare Advantage organization offer-
ing such plan; and 
‘‘(II) a response, in accordance with 
this subparagraph, from such PDP spon-
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sor or Medicare Advantage organization, 
respectively, to such professional. 
‘‘(ii) ELECTRONIC TRANSMISSION.— 
‘‘(I) EXCLUSIONS.—For purposes of 
this subparagraph, a facsimile, a propri-
etary payer portal that does not meet 
standards specified by the Secretary, or 
an electronic form shall not be treated as 
an electronic transmission described in 
clause (i). 
‘‘(II) STANDARDS.—In order to be 
treated, for purposes of this subpara-
graph, as an electronic transmission de-
scribed in clause (i), such transmission 
shall comply with technical standards 
adopted by the Secretary in consultation 
with the National Council for Prescription 
Drug Programs, other standard setting 
organizations determined appropriate by 
the Secretary, and stakeholders including 
PDP sponsors, Medicare Advantage orga-
nizations, health care professionals, and 
health information technology software 
vendors.
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•HRES 1099 EH 
‘‘(III) 
APPLICATION.—Notwith-
standing any other provision of law, for 
purposes of this subparagraph, the Sec-
retary may require the use of such stand-
ards adopted under subclause (II) in lieu 
of any other applicable standards for an 
electronic transmission described in clause 
(i) for a covered part D drug for a part 
D eligible individual.’’. 
SEC. 6063. PROGRAM INTEGRITY TRANSPARENCY MEASURES 
UNDER MEDICARE PARTS C AND D. 
(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 
(or other successor technology) that would allow a 
secure path for communication between the Sec-
retary, MA plans under this part, prescription drug 
plans under part D, and an eligible entity with a
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•HRES 1099 EH 
contract under section 1893 (such as a Medicare 
drug integrity contractor or an entity responsible 
for carrying out program integrity activities under 
this part and part D) for the purpose of enabling 
through such portal (or other successor tech-
nology)— 
‘‘(i) the referral by such plans of substan-
tiated or suspicious activities, as defined by the 
Secretary, of a provider of services (including 
a prescriber) or supplier related to fraud, 
waste, and abuse for initiating or assisting in-
vestigations conducted by the eligible entity; 
and 
‘‘(ii) data sharing among such MA plans, 
prescription drug plans, and the Secretary. 
‘‘(B) REQUIRED USES OF PORTAL.—The Sec-
retary shall disseminate the following information to 
MA plans under this part and prescription drug 
plans under part D through the secure internet 
website portal (or other successor technology) estab-
lished under subparagraph (A): 
‘‘(i) Providers of services and suppliers 
that have been referred pursuant to subpara-
graph (A)(i) during the previous 12-month pe-
riod.
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‘‘(ii) Providers of services and suppliers 
who are the subject of an active exclusion 
under section 1128 or who are subject to a 
suspension of payment under this title pursu-
ant to section 1862(o) or otherwise. 
‘‘(iii) Providers of services and suppliers 
who are the subject of an active revocation of 
participation under this title, including for not 
satisfying conditions of participation. 
‘‘(iv) In the case of such a plan that 
makes a referral under subparagraph (A)(i) 
through the portal (or other successor tech-
nology) with respect to activities of substan-
tiated or suspicious activities of fraud, waste, 
or abuse of a provider of services (including a 
prescriber) or supplier, if such provider (in-
cluding a prescriber) or supplier has been the 
subject of an administrative action under this 
title or title XI with respect to similar activi-
ties, a notification to such plan of such action 
so taken. 
‘‘(C) RULEMAKING.—For purposes of this 
paragraph, the Secretary shall, through rulemaking, 
specify what constitutes substantiated or suspicious 
activities of fraud, waste, and abuse, using guidance
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•HRES 1099 EH 
such as what is provided in the Medicare Program 
Integrity Manual 4.8. In carrying out this sub-
section, a fraud hotline tip (as defined by the Sec-
retary) without further evidence shall not be treated 
as sufficient evidence for substantiated fraud, 
waste, or abuse. 
‘‘(D) 
HIPAA 
COMPLIANT
INFORMATION 
ONLY.—For purposes of this subsection, commu-
nications may only occur if the communications are 
permitted under the Federal regulations (con-
cerning the privacy of individually identifiable 
health information) promulgated under section 
264(c) of the Health Insurance Portability and Ac-
countability Act of 1996. 
‘‘(2) QUARTERLY
REPORTS.—Beginning not later 
than 2 years after the date of the enactment of this sub-
section, 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 quar-
terly) and using information submitted to an entity de-
scribed in paragraph (1) through the portal (or other 
successor technology) described in such paragraph or 
pursuant to section 1893, information on fraud, waste, 
and abuse schemes and trends in identifying suspicious
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•HRES 1099 EH 
activity. Information included in each such report 
shall— 
‘‘(A) include administrative actions, pertinent 
information related to opioid overprescribing, and 
other data determined appropriate by the Secretary 
in consultation with stakeholders; and 
‘‘(B) be anonymized information submitted by 
plans without identifying the source of such infor-
mation. 
‘‘(3) CLARIFICATION.—Nothing in this subsection 
shall preclude or otherwise affect referrals to the Inspec-
tor 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) of the Social Security Act (42 
U.S.C. 1395w–27(e)) is amended by adding at the end the 
following new paragraph: 
‘‘(5) COMMUNICATING PLAN CORRECTIVE ACTIONS 
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 organization shall re-
quire the organization to submit to the Secretary, 
through the process established under subparagraph
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(B), information on the investigations, credible evi-
dence of suspicious activities of a provider of serv-
ices (including a prescriber) or supplier related 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 to 
the Secretary information described in subpara-
graph (A). 
‘‘(C) REGULATIONS.—For purposes of this 
paragraph, including as applied under section 
1860D–12(b)(3)(D), the Secretary shall, pursuant 
to rulemaking— 
‘‘(i) specify a definition for the term ‘inap-
propriate prescribing’ and a method for deter-
mining if a provider of services prescribes inap-
propriate prescribing; and 
‘‘(ii) establish the process described in 
subparagraph (B) and the types of information 
that shall be submitted through such process.’’. 
(c) REFERENCE UNDER PART D TO PROGRAM INTEG-
RITY TRANSPARENCY MEASURES.—Section 1860D–4 of the
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•HRES 1099 EH 
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 applied 
with respect to prescription drug plan and MA plans, see sec-
tion 1859(i).’’. 
SEC. 6064. EXPANDING ELIGIBILITY FOR MEDICATION THER-
APY MANAGEMENT PROGRAMS UNDER PART D. 
Section 1860D–4(c)(2)(A)(ii) of the Social Security Act 
(42 U.S.C. 1395w–104(c)(2)(A)(ii)) is amended— 
(1) by redesignating subclauses (I) through (III) as 
items (aa) through (cc), respectively, and adjusting the 
margins accordingly; 
(2) by striking ‘‘are part D eligible individuals 
who—’’ and inserting ‘‘are the following: 
‘‘(I) Part D eligible individuals 
who—’’; and 
(3) by adding at the end the following new sub-
clause: 
‘‘(II) Beginning January 1, 2021, at- 
risk beneficiaries for prescription drug 
abuse (as defined in paragraph (5)(C)).’’.
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SEC. 6065. 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
OUTLIER
PRE-
SCRIBERS OF OPIOIDS.— 
‘‘(i) NOTIFICATION.—Not later than Jan-
uary 1, 2021, the Secretary shall, in the case 
of a prescriber identified by the Secretary 
under clause (ii) to be an outlier prescriber of 
opioids, provide, subject to clause (iv), an an-
nual notification to such prescriber that such 
prescriber has been so identified and that in-
cludes resources on proper prescribing methods 
and other information as specified in accord-
ance with clause (iii). 
‘‘(ii) IDENTIFICATION OF OUTLIER PRE-
SCRIBERS OF OPIOIDS.— 
‘‘(I) IN
GENERAL.—The Secretary 
shall, subject to subclause (III), using the 
valid prescriber National Provider Identi-
fiers included pursuant to subparagraph 
(A) on claims for covered part D drugs 
for part D eligible individuals enrolled in
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•HRES 1099 EH 
prescription drug plans under this part or 
MA–PD plans under part C and based on 
the thresholds established under subclause 
(II), identify prescribers that are outlier 
opioids prescribers for a period of time 
specified by the Secretary. 
‘‘(II) ESTABLISHMENT OF THRESH-
OLDS.—For purposes of subclause (I) and 
subject to subclause (III), the Secretary 
shall, after consultation with stakeholders, 
establish thresholds, based on prescriber 
specialty and geographic area, for identi-
fying whether a prescriber in a specialty 
and geographic area is an outlier pre-
scriber of opioids as compared to other 
prescribers of opioids within such specialty 
and area. 
‘‘(III) EXCLUSIONS.—The following 
shall not be included in the analysis for 
identifying outlier prescribers of opioids 
under this clause: 
‘‘(aa) Claims for covered part D 
drugs for part D eligible individuals 
who are receiving hospice care under 
this title.
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•HRES 1099 EH 
‘‘(bb) Claims for covered part D 
drugs for part D eligible individuals 
who are receiving oncology 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 informa-
tion in the notifications provided under clause 
(i): 
‘‘(I) Information on how such pre-
scriber compares to other prescribers 
within the same specialty and geographic 
area. 
‘‘(II) Information on opioid pre-
scribing guidelines, based on input from 
stakeholders, that may include the Centers 
for Disease Control and Prevention guide-
lines for prescribing opioids for chronic 
pain and guidelines developed by physician 
organizations.
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‘‘(III) Other information determined 
appropriate by the Secretary. 
‘‘(iv) MODIFICATIONS AND EXPANSIONS.— 
‘‘(I) 
FREQUENCY.—Beginning 
years after the date of the enactment of 
this subparagraph, the Secretary may 
change the frequency of the notifications 
described in clause (i) based on stake-
holder input and changes in opioid pre-
scribing utilization and trends. 
‘‘(II) EXPANSION
TO
OTHER
PRE-
SCRIPTIONS.—The Secretary may expand 
notifications under this subparagraph to 
include identifications and notifications 
with respect to concurrent prescriptions of 
covered Part D drugs used in combination 
with opioids that are considered to have 
adverse side effects when so used in such 
combination, as determined by the Sec-
retary. 
‘‘(v) ADDITIONAL
REQUIREMENTS
FOR 
PERSISTENT
OUTLIER
PRESCRIBERS.—In the 
case of a prescriber who the Secretary deter-
mines is persistently identified under clause (ii)
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as an outlier prescriber of opioids, the fol-
lowing shall apply: 
‘‘(I) Such prescriber may be required 
to enroll in the program under this title 
under section 1866(j) if such prescriber is 
not otherwise required to enroll, but only 
after other appropriate remedies have 
been provided, such as the provision of 
education funded through section 6052 of 
the SUPPORT for Patients and Commu-
nities Act, for a period determined by the 
Secretary as sufficient to correct the pre-
scribing patterns that lead to identifica-
tion of such prescriber as a persistent 
outlier prescriber of opioids. The Sec-
retary shall determine the length of the 
period for which such prescriber is re-
quired to maintain such enrollment, which 
shall be the minimum period necessary to 
correct such prescribing patterns. 
‘‘(II) Not less frequently than annu-
ally (and in a form and manner deter-
mined appropriate by the Secretary), the 
Secretary, consistent with clause(iv)(I), 
shall communicate information on such
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prescribers to sponsors of a prescription 
drug plan and Medicare Advantage orga-
nizations offering an MA–PD plan. 
‘‘(vi) PUBLIC AVAILABILITY OF INFORMA-
TION.—The Secretary shall make aggregate in-
formation under this subparagraph available 
on the internet website of the Centers for 
Medicare & Medicaid Services. Such informa-
tion shall be in a form and manner determined 
appropriate by the Secretary and shall not 
identify any specific prescriber. In carrying out 
this clause, the Secretary shall consult with in-
terested stakeholders. 
‘‘(vii) OPIOIDS
DEFINED.—For purposes 
of this subparagraph, the term ‘opioids’ has 
such meaning as specified by the Secretary. 
‘‘(viii) OTHER
ACTIVITIES.—Nothing in 
this subparagraph shall preclude the Secretary 
from conducting activities that provide pre-
scribers with information as to how they com-
pare to other prescribers that are in addition 
to the activities under this subparagraph, in-
cluding activities that were being conducted as 
of the date of the enactment of this subpara-
graph.’’.
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SEC. 6066. NO ADDITIONAL FUNDS AUTHORIZED. 
No additional funds are authorized to be appropriated to 
carry out the requirements of this subtitle and the amend-
ments made by this subtitle. Such requirements shall be car-
ried out using amounts otherwise authorized to be appro-
priated. 
Subtitle H—Expanding Oversight of 
Opioid Prescribing and Payment 
SEC. 6071. SHORT TITLE. 
This subtitle may be cited as the ‘‘Expanding Oversight 
of Opioid Prescribing and Payment Act of 2018’’. 
SEC. 6072. MEDICARE PAYMENT ADVISORY COMMISSION RE-
PORT ON OPIOID PAYMENT, ADVERSE INCEN-
TIVES, AND DATA UNDER THE MEDICARE PRO-
GRAM. 
Not later than March 15, 2019, the Medicare Payment 
Advisory Commission shall submit to Congress a report on, 
with respect to the Medicare program under title XVIII of 
the Social Security Act, the following: 
(1) A description of how the Medicare program 
pays for pain management treatments (both opioid and 
non-opioid pain management alternatives) in both inpa-
tient and outpatient hospital settings. 
(2) The identification of incentives under the hos-
pital inpatient prospective payment system under section 
1886 of the Social Security Act (42 U.S.C. 1395ww) and
242 
•HRES 1099 EH 
incentives under the hospital outpatient prospective pay-
ment system under section 1833(t) of such Act (42 
U.S.C. 1395l(t)) for prescribing opioids and incentives 
under each such system for prescribing non-opioid treat-
ments, and recommendations as the Commission deems 
appropriate for addressing any of such incentives that 
are adverse incentives. 
(3) A description of how opioid use is tracked and 
monitored through Medicare claims data and other 
mechanisms and the identification of any areas in which 
further data and methods are needed for improving data 
and understanding of opioid use. 
SEC. 6073. NO ADDITIONAL FUNDS AUTHORIZED. 
No additional funds are authorized to be appropriated to 
carry out the requirements of this subtitle. Such require-
ments shall be carried out using amounts otherwise author-
ized to be appropriated. 
Subtitle I—Dr. Todd Graham Pain 
Management, Treatment, and Re-
covery 
SEC. 6081. SHORT TITLE. 
This subtitle may be cited as the ‘‘Dr. Todd Graham 
Pain Management, Treatment, and Recovery Act of 2018’’.
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SEC. 6082. REVIEW AND ADJUSTMENT OF PAYMENTS UNDER 
THE MEDICARE OUTPATIENT PROSPECTIVE PAY-
MENT SYSTEM TO AVOID FINANCIAL INCENTIVES 
TO USE OPIOIDS INSTEAD OF NON-OPIOID ALTER-
NATIVE TREATMENTS. 
(a) OUTPATIENT PROSPECTIVE PAYMENT SYSTEM.— 
Section 1833(t) of the Social Security Act (42 U.S.C. 
1395l(t)) is amended by adding at the end the following new 
paragraph: 
‘‘(22) REVIEW AND REVISIONS OF PAYMENTS FOR 
NON-OPIOID ALTERNATIVE TREATMENTS.— 
‘‘(A) IN GENERAL.—With respect to payments 
made under this subsection for covered OPD serv-
ices (or groups of services), including covered OPD 
services assigned to a comprehensive ambulatory 
payment classification, the Secretary— 
‘‘(i) shall, as soon as practicable, conduct 
a review (part of which may include a request 
for information) of payments for opioids and 
evidence-based non-opioid alternatives for pain 
management (including drugs and devices, 
nerve 
blocks, 
surgical 
injections, 
and 
neuromodulation) with a goal of ensuring that 
there are not financial incentives to use opioids 
instead of non-opioid alternatives;
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•HRES 1099 EH 
‘‘(ii) may, as the Secretary determines ap-
propriate, conduct subsequent reviews of such 
payments; and 
‘‘(iii) shall consider the extent to which re-
visions under this subsection to such payments 
(such as the creation of additional groups of 
covered OPD services to classify separately 
those procedures that utilize opioids and non- 
opioid alternatives for pain management) 
would reduce payment incentives to use opioids 
instead of non-opioid alternatives for pain 
management. 
‘‘(B) PRIORITY.—In conducting the review 
under clause (i) of subparagraph (A) and consid-
ering revisions under clause (iii) of such subpara-
graph, the Secretary shall focus on covered OPD 
services (or groups of services) assigned to a com-
prehensive ambulatory payment classification, am-
bulatory payment classifications that primarily in-
clude surgical services, and other services deter-
mined by the Secretary which generally involve 
treatment for pain management. 
‘‘(C) REVISIONS.—If the Secretary identifies 
revisions to payments pursuant to subparagraph 
(A)(iii), the Secretary shall, as determined appro-
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•HRES 1099 EH 
priate, begin making such revisions for services fur-
nished on or after January 1, 2020. Revisions 
under the previous sentence shall be treated as ad-
justments for purposes of application of paragraph 
(9)(B). 
‘‘(D) RULES OF CONSTRUCTION.—Nothing in 
this paragraph shall be construed to preclude the 
Secretary— 
‘‘(i) from conducting a demonstration be-
fore making the revisions described in subpara-
graph (C); or 
‘‘(ii) prior to implementation of this para-
graph, from changing payments under this 
subsection for covered OPD services (or groups 
of services) which include opioids or non-opioid 
alternatives for pain management.’’. 
(b) AMBULATORY SURGICAL CENTERS.—Section 1833(i) 
of the Social Security Act (42 U.S.C. 1395l(i)) is amended 
by adding at the end the following new paragraph: 
‘‘(8) The Secretary shall conduct a similar type of review 
as required under paragraph (22) of section 1833(t)), includ-
ing the second sentence of subparagraph (C) of such para-
graph, to payment for services under this subsection, and 
make such revisions under this paragraph, in an appropriate 
manner (as determined by the Secretary).’’.
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SEC. 6083. EXPANDING ACCESS UNDER THE MEDICARE PRO-
GRAM TO ADDICTION TREATMENT IN FEDERALLY 
QUALIFIED 
HEALTH 
CENTERS 
AND 
RURAL 
HEALTH CLINICS. 
(a) FEDERALLY QUALIFIED HEALTH CENTERS.—Sec-
tion 1834(o) of the Social Security Act (42 U.S.C. 1395m(o)) 
is amended by adding at the end the following new para-
graph: 
‘‘(3) ADDITIONAL PAYMENTS FOR CERTAIN FQHCS 
WITH PHYSICIANS OR OTHER PRACTITIONERS RECEIVING 
DATA 2000 WAIVERS.— 
‘‘(A) IN GENERAL.—In the case of a Federally 
qualified health center with respect to which, begin-
ning on or after January 1, 2019, Federally quali-
fied health center services (as defined in section 
1861(aa)(3)) are furnished for the treatment of 
opioid use disorder by a physician or practitioner 
who meets the requirements described in subpara-
graph (C), the Secretary shall, subject to avail-
ability of funds under subparagraph (D), make a 
payment (at such time and in such manner as spec-
ified by the Secretary) to such Federally qualified 
health center after receiving and approving an ap-
plication submitted by such Federally qualified 
health center under subparagraph (B). Such a pay-
ment shall be in an amount determined by the Sec-
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retary, based on an estimate of the average costs of 
training for purposes of receiving a waiver described 
in subparagraph (C)(ii). Such a payment may be 
made only one time with respect to each such physi-
cian or practitioner. 
‘‘(B) APPLICATION.—In order to receive a pay-
ment described in subparagraph (A), a Federally 
qualified health center shall submit to the Secretary 
an application for such a payment at such time, in 
such manner, and containing such information as 
specified by the Secretary. A Federally qualified 
health center may apply for such a payment for 
each physician or practitioner described in subpara-
graph (A) furnishing services described in such sub-
paragraph at such center. 
‘‘(C) REQUIREMENTS.—For purposes of sub-
paragraph (A), the requirements described in this 
subparagraph, with respect to a physician or practi-
tioner, are the following: 
‘‘(i) The physician or practitioner is em-
ployed by or working under contract with a 
Federally qualified health center described in 
subparagraph (A) that submits an application 
under subparagraph (B).
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‘‘(ii) The physician or practitioner first re-
ceives a waiver under section 303(g) of the 
Controlled Substances Act on or after January 
1, 2019. 
‘‘(D) FUNDING.—For purposes of making pay-
ments under this paragraph, there are appropriated, 
out of amounts in the Treasury not otherwise ap-
propriated, $6,000,000, which shall remain avail-
able until expended.’’. 
(b) RURAL HEALTH CLINIC.—Section 1833 of the Social 
Security Act (42 U.S.C. 1395l) is amended— 
(1) by redesignating the subsection (z) relating to 
medical review of spinal subluxation services as sub-
section (aa); and 
(2) by adding at the end the following new sub-
section: 
‘‘(bb) ADDITIONAL PAYMENTS
FOR CERTAIN RURAL 
HEALTH CLINICS WITH PHYSICIANS OR PRACTITIONERS RE-
CEIVING DATA 2000 WAIVERS.— 
‘‘(1) IN GENERAL.—In the case of a rural health 
clinic with respect to which, beginning on or after Janu-
ary 1, 2019, rural health clinic services (as defined in 
section 1861(aa)(1)) are furnished for the treatment of 
opioid use disorder by a physician or practitioner who 
meets the requirements described in paragraph (3), the
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Secretary shall, subject to availability of funds under 
paragraph (4), make a payment (at such time and in 
such manner as specified by the Secretary) to such rural 
health clinic after receiving and approving an application 
described in paragraph (2). Such payment shall be in an 
amount determined by the Secretary, based on an esti-
mate of the average costs of training for purposes of re-
ceiving a waiver described in paragraph (3)(B). Such 
payment may be made only one time with respect to 
each such physician or practitioner. 
‘‘(2) APPLICATION.—In order to receive a payment 
described in paragraph (1), a rural health clinic shall 
submit to the Secretary an application for such a pay-
ment at such time, in such manner, and containing such 
information as specified by the Secretary. A rural health 
clinic may apply for such a payment for each physician 
or practitioner described in paragraph (1) furnishing 
services described in such paragraph at such clinic. 
‘‘(3) REQUIREMENTS.—For purposes of paragraph 
(1), the requirements described in this paragraph, with 
respect to a physician or practitioner, are the following: 
‘‘(A) The physician or practitioner is employed 
by or working under contract with a rural health 
clinic described in paragraph (1) that submits an 
application under paragraph (2).
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‘‘(B) The physician or practitioner first re-
ceives a waiver under section 303(g) of the Con-
trolled Substances Act on or after January 1, 2019. 
‘‘(4) FUNDING.—For purposes of making payments 
under this subsection, there are appropriated, out of 
amounts in the Treasury not otherwise appropriated, 
$2,000,000, which shall remain available until ex-
pended.’’. 
SEC. 6084. STUDYING THE AVAILABILITY OF SUPPLEMENTAL 
BENEFITS DESIGNED TO TREAT OR PREVENT SUB-
STANCE USE DISORDERS UNDER MEDICARE AD-
VANTAGE PLANS. 
(a) IN GENERAL.—Not later than 2 years after the date 
of the enactment of this Act, the Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall submit to Congress a report on the availability 
of supplemental health care benefits (as described in section 
1852(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w– 
22(a)(3)(A))) designed to treat or prevent substance use dis-
orders under Medicare Advantage plans offered under part C 
of title XVIII of such Act. Such report shall include the anal-
ysis described in subsection (c) and any differences in the 
availability of such benefits under specialized MA plans for 
special needs individuals (as defined in section 1859(b)(6) of 
such Act (42 U.S.C. 1395w–28(b)(6))) offered to individuals
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entitled to medical assistance under title XIX of such Act 
and other such Medicare Advantage plans. 
(b) CONSULTATION.—The Secretary shall develop the re-
port described in subsection (a) in consultation with relevant 
stakeholders, including— 
(1) individuals entitled to benefits under part A or 
enrolled under part B of title XVIII of the Social Secu-
rity Act; 
(2) entities who advocate on behalf of such individ-
uals; 
(3) Medicare Advantage organizations; 
(4) pharmacy benefit managers; and 
(5) providers of services and suppliers (as such 
terms are defined in section 1861 of such Act (42 
U.S.C. 1395x)). 
(c) CONTENTS.—The report described in subsection (a) 
shall include an analysis on the following: 
(1) The extent to which plans described in such 
subsection offer supplemental health care benefits relat-
ing to coverage of— 
(A) medication-assisted treatments for opioid 
use, substance use disorder counseling, peer recov-
ery support services, or other forms of substance 
use disorder treatments (whether furnished in an 
inpatient or outpatient setting); and
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(B) non-opioid alternatives for the treatment of 
pain. 
(2) Challenges associated with such plans offering 
supplemental health care benefits relating to coverage of 
items and services described in subparagraph (A) or (B) 
of paragraph (1). 
(3) The impact, if any, of increasing the applicable 
rebate 
percentage 
determined 
under 
section 
1854(b)(1)(C) of the Social Security Act (42 U.S.C. 
1395w–24(b)(1)(C)) for plans offering such benefits re-
lating to such coverage would have on the availability of 
such benefits relating to such coverage offered under 
Medicare Advantage plans. 
(4) Potential ways to improve upon such coverage 
or to incentivize such plans to offer additional supple-
mental health care benefits relating to such coverage. 
SEC. 6085. CLINICAL PSYCHOLOGIST SERVICES MODELS UNDER 
THE CENTER FOR MEDICARE AND MEDICAID IN-
NOVATION; GAO STUDY AND REPORT. 
(a) CMI MODELS.—Section 1115A(b)(2)(B) of the So-
cial Security Act (42 U.S.C. 1315a(b)(2)(B)), as amended by 
section 6001, is further amended by adding at the end the 
following new clauses: 
‘‘(xxvi) Supporting ways to familiarize in-
dividuals with the availability of coverage
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under part B of title XVIII for qualified psy-
chologist services (as defined in section 
1861(ii)). 
‘‘(xxvii) Exploring ways to avoid unneces-
sary hospitalizations or emergency department 
visits for mental and behavioral health services 
(such as for treating depression) through use 
of a 24-hour, 7-day a week help line that may 
inform individuals about the availability of 
treatment options, including the availability of 
qualified psychologist services (as defined in 
section 1861(ii)).’’. 
(b) GAO STUDY
AND REPORT.—Not later than 18 
months after the date of the enactment of this Act, the 
Comptroller General of the United States shall conduct a 
study, and submit to Congress a report, on mental and be-
havioral health services under the Medicare program under 
title XVIII of the Social Security Act, including an examina-
tion of the following: 
(1) Information about services furnished by psychi-
atrists, clinical psychologists, and other professionals. 
(2) Information about ways that Medicare bene-
ficiaries familiarize themselves about the availability of 
Medicare payment for qualified psychologist services (as 
defined in section 1861(ii) of the Social Security Act (42
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U.S.C. 1395x(ii)) and ways that the provision of such in-
formation could be improved. 
SEC. 6086. DR. TODD GRAHAM PAIN MANAGEMENT STUDY. 
(a) IN GENERAL.—Not later than 1 year after the date 
of enactment of this Act, the Secretary of Health and Human 
Services (referred to in this section as the ‘‘Secretary’’) shall 
conduct a study analyzing best practices as well as payment 
and coverage for pain management services under title XVIII 
of the Social Security Act and submit to the Committee on 
Ways and Means and the Committee on Energy and Com-
merce of the House of Representatives and the Committee on 
Finance of the Senate a report containing options for revising 
payment to providers and suppliers of services and coverage 
related to the use of multi-disciplinary, evidence-based, non- 
opioid treatments for acute and chronic pain management for 
individuals entitled to benefits under part A or enrolled under 
part B of title XVIII of the Social Security Act. The Sec-
retary shall make such report available on the public website 
of the Centers for Medicare & Medicaid Services. 
(b) CONSULTATION.—In developing the report described 
in subsection (a), the Secretary shall consult with— 
(1) relevant agencies within the Department of 
Health and Human Services; 
(2) 
licensed 
and 
practicing 
osteopathic 
and 
allopathic physicians, behavioral health practitioners,
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•HRES 1099 EH 
physician assistants, nurse practitioners, dentists, phar-
macists, and other providers of health services; 
(3) providers and suppliers of services (as such 
terms are defined in section 1861 of the Social Security 
Act (42 U.S.C. 1395x)); 
(4) substance abuse and mental health professional 
organizations; 
(5) pain management professional organizations 
and advocacy entities, including individuals who person-
ally suffer chronic pain; 
(6) medical professional organizations and medical 
specialty organizations; 
(7) licensed health care providers who furnish alter-
native pain management services; 
(8) organizations with expertise in the development 
of innovative medical technologies for pain management; 
(9) beneficiary advocacy organizations; and 
(10) other organizations with expertise in the as-
sessment, diagnosis, treatment, and management of 
pain, as determined appropriate by the Secretary. 
(c) CONTENTS.—The report described in subsection (a) 
shall include the following: 
(1) An analysis of payment and coverage under title 
XVIII of the Social Security Act with respect to the fol-
lowing:
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(A) Evidence-based treatments and tech-
nologies for chronic or acute pain, including such 
treatments that are covered, not covered, or have 
limited coverage under such title. 
(B) Evidence-based treatments and tech-
nologies that monitor substance use withdrawal and 
prevent overdoses of opioids. 
(C) Evidence-based treatments and tech-
nologies that treat substance use disorders. 
(D) Items and services furnished by practi-
tioners through a multi-disciplinary treatment 
model for pain management, including the patient- 
centered medical home. 
(E) Items and services furnished to bene-
ficiaries with psychiatric disorders, substance use 
disorders, or who are at risk of suicide, or have 
comorbidities and require consultation or manage-
ment of pain with one or more specialists in pain 
management, mental health, or addiction treatment. 
(2) An evaluation of the following: 
(A) Barriers inhibiting individuals entitled to 
benefits under part A or enrolled under part B of 
such title from accessing treatments and tech-
nologies described in subparagraphs (A) through 
(E) of paragraph (1).
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(B) Costs and benefits associated with poten-
tial expansion of coverage under such title to in-
clude items and services not covered under such 
title that may be used for the treatment of pain, 
such as acupuncture, therapeutic massage, and 
items and services furnished by integrated pain 
management programs. 
(C) Pain management guidance published by 
the Federal Government that may be relevant to 
coverage determinations or other coverage require-
ments under title XVIII of the Social Security Act. 
(3) An assessment of all guidance published by the 
Department of Health and Human Services on or after 
January 1, 2016, relating to the prescribing of opioids. 
Such assessment shall consider incorporating into such 
guidance relevant elements of the ‘‘Va/DoD Clinical 
Practice Guideline for Opioid Therapy for Chronic Pain’’ 
published in February 2017 by the Department of Vet-
erans Affairs and Department of Defense, including 
adoption of elements of the Department of Defense and 
Department of Veterans Affairs pain rating scale. 
(4) The options described in subsection (d). 
(5) The impact analysis described in subsection (e). 
(d) OPTIONS.—The options described in this subsection 
are, with respect to individuals entitled to benefits under part
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•HRES 1099 EH 
A or enrolled under part B of title XVIII of the Social Secu-
rity Act, legislative and administrative options for accom-
plishing the following: 
(1) Improving coverage of and payment for pain 
management therapies without the use of opioids, includ-
ing interventional pain therapies, and options to aug-
ment opioid therapy with other clinical and complemen-
tary, integrative health services to minimize the risk of 
substance use disorder, including in a hospital setting. 
(2) Improving coverage of and payment for medical 
devices and non-opioid based pharmacological and non- 
pharmacological therapies approved or cleared by the 
Food and Drug Administration for the treatment of pain 
as an alternative or augment to opioid therapy. 
(3) Improving and disseminating treatment strate-
gies for beneficiaries with psychiatric disorders, sub-
stance use disorders, or who are at risk of suicide, and 
treatment strategies to address health disparities related 
to opioid use and opioid abuse treatment. 
(4) Improving and disseminating treatment strate-
gies for beneficiaries with comorbidities who require a 
consultation or comanagement of pain with one or more 
specialists in pain management, mental health, or addic-
tion treatment, including in a hospital setting.
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Subtitle J—Combating Opioid Abuse 
for Care in Hospitals 
SEC. 6091. SHORT TITLE. 
This subtitle may be cited as the ‘‘Combating Opioid 
Abuse for Care in Hospitals Act of 2018’’ or the ‘‘COACH 
Act of 2018’’. 
SEC. 6092. DEVELOPING GUIDANCE ON PAIN MANAGEMENT 
AND OPIOID USE DISORDER PREVENTION FOR 
HOSPITALS RECEIVING PAYMENT UNDER PART A 
OF THE MEDICARE PROGRAM. 
(a) IN GENERAL.—Not later than July 1, 2019, the Sec-
retary of Health and Human Services (in this section referred 
to as the ‘‘Secretary’’) shall develop and publish on the public 
website of the Centers for Medicare & Medicaid Services 
guidance for hospitals receiving payment under part A of title 
XVIII of the Social Security Act (42 U.S.C. 1395c et seq.) 
on pain management strategies and opioid use disorder pre-
vention strategies with respect to individuals entitled to bene-
fits under such part. 
(b) CONSULTATION.—In developing the guidance de-
scribed in subsection (a), the Secretary shall consult with rel-
evant stakeholders, including— 
(1) medical professional organizations;
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(2) providers and suppliers of services (as such 
terms are defined in section 1861 of the Social Security 
Act (42 U.S.C. 1395x)); 
(3) health care consumers or groups representing 
such consumers; and 
(4) other entities determined appropriate by the 
Secretary. 
(c) CONTENTS.—The guidance described in subsection 
(a) shall include, with respect to hospitals and individuals de-
scribed in such subsection, the following: 
(1) Best practices regarding evidence-based screen-
ing and practitioner education initiatives relating to 
screening and treatment protocols for opioid use dis-
order, including— 
(A) methods to identify such individuals at-risk 
of opioid use disorder, including risk stratification; 
(B) ways to prevent, recognize, and treat 
opioid overdoses; and 
(C) resources available to such individuals, 
such as opioid treatment programs, peer support 
groups, and other recovery programs. 
(2) Best practices for such hospitals to educate 
practitioners furnishing items and services at such hos-
pital with respect to pain management and substance 
use disorders, including education on—
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(A) the adverse effects of prolonged opioid use; 
(B) non-opioid, evidence-based, non-pharma-
cological pain management treatments; 
(C) monitoring programs for individuals who 
have been prescribed opioids; and 
(D) the prescribing of naloxone along with an 
initial opioid prescription. 
(3) Best practices for such hospitals to make such 
individuals aware of the risks associated with opioid use 
(which may include use of the notification template de-
scribed in paragraph (4)). 
(4) A notification template developed by the Sec-
retary, for use as appropriate, for such individuals who 
are prescribed an opioid that— 
(A) explains the risks and side effects associ-
ated with opioid use (including the risks of addic-
tion and overdose) and the importance of adhering 
to the prescribed treatment regimen, avoiding medi-
cations that may have an adverse interaction with 
such opioid, and storing such opioid safely and se-
curely; 
(B) highlights multimodal and evidence-based 
non-opioid alternatives for pain management; 
(C) encourages such individuals to talk to their 
health care providers about such alternatives;
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•HRES 1099 EH 
(D) provides for a method (through signature 
or otherwise) for such an individual, or person act-
ing on such individual’s behalf, to acknowledge re-
ceipt of such notification template; 
(E) is worded in an easily understandable man-
ner and made available in multiple languages deter-
mined appropriate by the Secretary; and 
(F) includes any other information determined 
appropriate by the Secretary. 
(5) Best practices for such hospital to track opioid 
prescribing trends by practitioners furnishing items and 
services at such hospital, including— 
(A) ways for such hospital to establish target 
levels, taking into account the specialties of such 
practitioners and the geographic area in which such 
hospital is located, with respect to opioids pre-
scribed by such practitioners; 
(B) guidance on checking the medical records 
of such individuals against information included in 
prescription drug monitoring programs; 
(C) strategies to reduce long-term opioid pre-
scriptions; and 
(D) methods to identify such practitioners who 
may be over-prescribing opioids.
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(6) Other information the Secretary determines ap-
propriate, including any such information from the 
Opioid Safety Initiative established by the Department 
of Veterans Affairs or the Opioid Overdose Prevention 
Toolkit published by the Substance Abuse and Mental 
Health Services Administration. 
SEC. 6093. REQUIRING THE REVIEW OF QUALITY MEASURES RE-
LATING TO OPIOIDS AND OPIOID USE DISORDER 
TREATMENTS FURNISHED UNDER THE MEDICARE 
PROGRAM AND OTHER FEDERAL HEALTH CARE 
PROGRAMS. 
Section 1890A of the Social Security Act (42 U.S.C. 
1395aaa–1) is amended by adding at the end the following 
new subsection: 
‘‘(g) TECHNICAL EXPERT PANEL REVIEW OF OPIOID 
AND OPIOID USE DISORDER QUALITY MEASURES.— 
‘‘(1) IN GENERAL.—Not later than 180 days after 
the date of the enactment of this subsection, the Sec-
retary shall establish a technical expert panel for pur-
poses of reviewing quality measures relating to opioids 
and opioid use disorders, including care, prevention, di-
agnosis, health outcomes, and treatment furnished to in-
dividuals with opioid use disorders. The Secretary may 
use the entity with a contract under section 1890(a) and
265 
•HRES 1099 EH 
amend such contract as necessary to provide for the es-
tablishment of such technical expert panel. 
‘‘(2) REVIEW AND ASSESSMENT.—Not later than 1 
year after the date the technical expert panel described 
in paragraph (1) is established (and periodically there-
after as the Secretary determines appropriate), the tech-
nical expert panel shall— 
‘‘(A) review quality measures that relate to 
opioids and opioid use disorders, including existing 
measures and those under development; 
‘‘(B) identify gaps in areas of quality measure-
ment that relate to opioids and opioid use disorders, 
and identify measure development priorities for 
such measure gaps; and 
‘‘(C) make recommendations to the Secretary 
on quality measures with respect to opioids and 
opioid use disorders for purposes of improving care, 
prevention, diagnosis, health outcomes, and treat-
ment, including recommendations for revisions of 
such measures, need for development of new meas-
ures, and recommendations for including such 
measures in the Merit-Based Incentive Payment 
System under section 1848(q), the alternative pay-
ment models under section 1833(z)(3)(C), the 
shared savings program under section 1899, the
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quality reporting requirements for inpatient hos-
pitals under section 1886(b)(3)(B)(viii), and the 
hospital value-based purchasing program under sec-
tion 1886(o). 
‘‘(3) CONSIDERATION
OF
MEASURES
BY
SEC-
RETARY.—The Secretary shall consider— 
‘‘(A) using opioid and opioid use disorder 
measures (including measures used under the 
Merit-Based Incentive Payment System under sec-
tion 1848(q), measures recommended under para-
graph (2)(C), and other such measures identified by 
the Secretary) in alternative payment models under 
section 1833(z)(3)(C) and in the shared savings 
program under section 1899; and 
‘‘(B) using opioid measures described in sub-
paragraph (A), as applicable, in the quality report-
ing requirements for inpatient hospitals under sec-
tion 1886(b)(3)(B)(viii), and in the hospital value- 
based purchasing program under section 1886(o). 
‘‘(4) PRIORITIZATION
OF
MEASURE
DEVELOP-
MENT.—The Secretary shall prioritize for measure devel-
opment the gaps in quality measures identified under 
paragraph (2)(B). 
‘‘(5) PRIORITIZATION
OF
MEASURE
ENDORSE-
MENT.—The Secretary—
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‘‘(A) during the period beginning on the date 
of the enactment of this subsection and ending on 
December 31, 2023, shall prioritize the endorse-
ment of measures relating to opioids and opioid use 
disorders by the entity with a contract under sub-
section (a) of section 1890 in connection with en-
dorsement of measures described in subsection 
(b)(2) of such section; and 
‘‘(B) on and after January 1, 2024, may 
prioritize the endorsement of such measures by such 
entity.’’. 
SEC. 6094. TECHNICAL EXPERT PANEL ON REDUCING SUR-
GICAL SETTING OPIOID USE; DATA COLLECTION 
ON PERIOPERATIVE OPIOID USE. 
(a) TECHNICAL EXPERT PANEL
ON REDUCING SUR-
GICAL SETTING OPIOID USE.— 
(1) IN GENERAL.—Not later than 6 months after 
the date of the enactment of this Act, the Secretary of 
Health and Human Services shall convene a technical 
expert panel, including medical and surgical specialty so-
cieties and hospital organizations, to provide rec-
ommendations on reducing opioid use in the inpatient 
and outpatient surgical settings and on best practices for 
pain management, including with respect to the fol-
lowing:
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(A) Approaches that limit patient exposure to 
opioids during the perioperative period, including 
pre-surgical and post-surgical injections, and that 
identify such patients at risk of opioid use disorder 
pre-operation. 
(B) Shared decision making with patients and 
families on pain management, including a review of 
payment to ensure payment under the Medicare 
program under title XVIII of the Social Security 
Act accounts for time spent on shared decision 
making. 
(C) Education on the safe use, storage, and 
disposal of opioids. 
(D) Prevention of opioid misuse and abuse 
after discharge. 
(E) Development of a clinical algorithm to 
identify and treat at-risk, opiate-tolerant patients 
and reduce reliance on opioids for acute pain during 
the perioperative period. 
(2) REPORT.—Not later than 1 year after the date 
of the enactment of this Act, the Secretary shall submit 
to Congress and make public a report containing the rec-
ommendations developed under paragraph (1) and an ac-
tion plan for broader implementation of pain manage-
ment protocols that limit the use of opioids in the
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•HRES 1099 EH 
perioperative setting and upon discharge from such set-
ting. 
(b) DATA
COLLECTION
ON
PERIOPERATIVE
OPIOID 
USE.—Not later than 1 year after the date of the enactment 
of this Act, the Secretary of Health and Human Services 
shall submit to Congress a report that contains the following: 
(1) The diagnosis-related group codes identified by 
the Secretary as having the highest volume of surgeries. 
(2) With respect to each of such diagnosis-related 
group codes so identified, a determination by the Sec-
retary of the data that is both available and reported on 
opioid use following such surgeries, such as with respect 
to— 
(A) surgical volumes, practices, and opioid pre-
scribing patterns; 
(B) opioid consumption, including— 
(i) perioperative days of therapy; 
(ii) average daily dose at the hospital, in-
cluding dosage greater than 90 milligram mor-
phine equivalent; 
(iii) post-discharge prescriptions and other 
combination drugs that are used before inter-
vention and after intervention; 
(iv) quantity and duration of opioid pre-
scription at discharge; and
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•HRES 1099 EH 
(v) quantity consumed and number of re-
fills; 
(C) regional anesthesia and analgesia practices, 
including pre-surgical and post-surgical injections; 
(D) naloxone reversal; 
(E) post-operative respiratory failure; 
(F) information about storage and disposal; 
and 
(G) such other information as the Secretary 
may specify. 
(3) Recommendations for improving data collection 
on perioperative opioid use, including an analysis to 
identify and reduce barriers to collecting, reporting, and 
analyzing the data described in paragraph (2), including 
barriers related to technological availability. 
SEC. 6095. REQUIRING THE POSTING AND PERIODIC UPDATE 
OF OPIOID PRESCRIBING GUIDANCE FOR MEDI-
CARE BENEFICIARIES. 
(a) IN GENERAL.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall post on the public website of the Centers for 
Medicare & Medicaid Services all guidance published by the 
Department of Health and Human Services on or after Janu-
ary 1, 2016, relating to the prescribing of opioids and appli-
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•HRES 1099 EH 
cable to opioid prescriptions for individuals entitled to bene-
fits under part A of title XVIII of the Social Security Act 
(42 U.S.C. 1395c et seq.) or enrolled under part B of such 
title of such Act (42 U.S.C. 1395j et seq.). 
(b) UPDATE OF GUIDANCE.— 
(1) PERIODIC
UPDATE.—The Secretary shall, in 
consultation with the entities specified in paragraph (2), 
periodically (as determined appropriate by the Secretary) 
update guidance described in subsection (a) and revise 
the posting of such guidance on the website described in 
such subsection. 
(2) CONSULTATION.—The entities specified in this 
paragraph are the following: 
(A) Medical professional organizations. 
(B) Providers and suppliers of services (as 
such terms are defined in section 1861 of the Social 
Security Act (42 U.S.C. 1395x)). 
(C) Health care consumers or groups rep-
resenting such consumers. 
(D) Other entities determined appropriate by 
the Secretary.
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Subtitle K—Providing Reliable Op-
tions for Patients and Educational 
Resources 
SEC. 6101. SHORT TITLE. 
This subtitle may be cited as the ‘‘Providing Reliable 
Options for Patients and Educational Resources Act of 
2018’’ or the ‘‘PROPER Act of 2018’’. 
SEC. 6102. REQUIRING MEDICARE ADVANTAGE PLANS AND 
PART D PRESCRIPTION DRUG PLANS TO INCLUDE 
INFORMATION 
ON 
RISKS 
ASSOCIATED 
WITH 
OPIOIDS 
AND 
COVERAGE 
OF 
NONPHARMA-
COLOGICAL THERAPIES AND NONOPIOID MEDICA-
TIONS OR DEVICES USED TO TREAT PAIN. 
Section 1860D–4(a)(1) of the Social Security Act (42 
U.S.C. 1395w–104(a)(1)) is amended— 
(1) in subparagraph (A), by inserting ‘‘, subject to 
subparagraph (C),’’ before ‘‘including’’; 
(2) in subparagraph (B), by adding at the end the 
following new clause: 
‘‘(vi) For plan year 2021 and each subse-
quent plan year, subject to subparagraph (C), 
with respect to the treatment of pain— 
‘‘(I) the risks associated with pro-
longed opioid use; and
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‘‘(II) coverage of nonpharmacological 
therapies, devices, and nonopioid medica-
tions— 
‘‘(aa) in the case of an MA–PD 
plan under part C, under such plan; 
and 
‘‘(bb) in the case of a prescrip-
tion drug plan, under such plan and 
under parts A and B.’’; and 
(3) by adding at the end the following new subpara-
graph: 
‘‘(C) TARGETED
PROVISION
OF
INFORMA-
TION.—A PDP sponsor of a prescription drug plan 
may, in lieu of disclosing the information described 
in subparagraph (B)(vi) to each enrollee under the 
plan, disclose such information through mail or 
electronic communications to a subset of enrollees 
under the plan, such as enrollees who have been 
prescribed an opioid in the previous 2-year period.’’.
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SEC. 6103. REQUIRING MEDICARE ADVANTAGE PLANS AND PRE-
SCRIPTION DRUG PLANS TO PROVIDE INFORMA-
TION ON THE SAFE DISPOSAL OF PRESCRIPTION 
DRUGS. 
(a) MEDICARE ADVANTAGE.—Section 1852 of the Social 
Security Act (42 U.S.C. 1395w–22) is amended by adding at 
the end the following new subsection: 
‘‘(n) PROVISION OF INFORMATION RELATING TO THE 
SAFE DISPOSAL OF CERTAIN PRESCRIPTION DRUGS.— 
‘‘(1) IN GENERAL.—In the case of an individual en-
rolled under an MA or MA–PD plan who is furnished an 
in-home health risk assessment on or after January 1, 
2021, such plan shall ensure that such assessment in-
cludes information on the safe disposal of prescription 
drugs that are controlled substances that meets the cri-
teria established under paragraph (2). Such information 
shall include information on drug takeback programs 
that meet such requirements determined appropriate by 
the Secretary and information on in-home disposal. 
‘‘(2) CRITERIA.—The Secretary shall, through rule-
making, establish criteria the Secretary determines ap-
propriate with respect to information provided to an in-
dividual to ensure that such information sufficiently edu-
cates such individual on the safe disposal of prescription 
drugs that are controlled substances.’’.
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(b) PRESCRIPTION
DRUG
PLANS.—Section 1860D– 
4(c)(2)(B) of the Social Security Act (42 U.S.C. 1395w– 
104(c)(2)(B)) is amended— 
(1) by striking ‘‘may include elements that pro-
mote’’; 
(2) by redesignating clauses (i) through (iii) as sub-
clauses (I) through (III) and adjusting the margins ac-
cordingly; 
(3) by inserting before subclause (I), as so redesig-
nated, the following new clause: 
‘‘(i) may include elements that promote— 
’’; 
(4) in subclause (III), as so redesignated, by strik-
ing the period at the end and inserting ‘‘; and’’; and 
(5) by adding at the end the following new clause: 
‘‘(ii) with respect to plan years beginning 
on or after January 1, 2021, shall provide 
for— 
‘‘(I) the provision of information to 
the enrollee on the safe disposal of pre-
scription drugs that are controlled sub-
stances that meets the criteria established 
under section 1852(n)(2), including infor-
mation on drug takeback programs that 
meet such requirements determined appro-
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priate by the Secretary and information 
on in-home disposal; and 
‘‘(II) cost-effective means by which 
an enrollee may so safely dispose of such 
drugs.’’. 
SEC. 6104. REVISING MEASURES USED UNDER THE HOSPITAL 
CONSUMER ASSESSMENT OF HEALTHCARE PRO-
VIDERS AND SYSTEMS SURVEY RELATING TO PAIN 
MANAGEMENT. 
(a) RESTRICTION ON THE USE OF PAIN QUESTIONS IN 
HCAHPS.—Section 1886(b)(3)(B)(viii) of the Social Secu-
rity Act (42 U.S.C. 1395ww(b)(3)(B)(viii)) is amended by 
adding at the end the following new subclause: 
‘‘(XII)(aa) With respect to a Hospital Consumer Assess-
ment of Healthcare Providers and Systems survey (or a suc-
cessor survey) conducted on or after January 1, 2020, such 
survey may not include questions about communication by 
hospital staff with an individual about such individual’s pain 
unless such questions take into account, as applicable, wheth-
er an individual experiencing pain was informed about risks 
associated with the use of opioids and about non-opioid alter-
natives for the treatment of pain. 
‘‘(bb) The Secretary shall not include on the Hospital 
Compare internet website any measures based on the ques-
tions appearing on the Hospital Consumer Assessment of
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Healthcare Providers and Systems survey in 2018 or 2019 
about communication by hospital staff with an individual 
about such individual’s pain.’’. 
(b) RESTRICTION ON USE OF 2018 AND 2019 PAIN 
QUESTIONS IN THE HOSPITAL VALUE-BASED PURCHASING 
PROGRAM.—Section 1886(o)(2)(B) of the Social Security Act 
(42 U.S.C. 1395ww(o)(2)(B)) is amended by adding at the 
end the following new clause: 
‘‘(iii) HCAHPS PAIN
QUESTIONS.—The 
Secretary may not include under subparagraph 
(A) a measure that is based on the questions 
appearing on the Hospital Consumer Assess-
ment of Healthcare Providers and Systems 
survey in 2018 or 2019 about communication 
by hospital staff with an individual about the 
individual’s pain.’’. 
Subtitle L—Fighting the Opioid 
Epidemic With Sunshine 
SEC. 6111. FIGHTING THE OPIOID EPIDEMIC WITH SUNSHINE. 
(a) INCLUSION
OF
INFORMATION
REGARDING
PAY-
MENTS TO ADDITIONAL PRACTITIONERS.— 
(1) IN GENERAL.—Section 1128G(e)(6) of the So-
cial Security Act (42 U.S.C. 1320a–7h(e)(6)) is amend-
ed—
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(A) in subparagraph (A), by adding at the end 
the following new clauses: 
‘‘(iii) A physician assistant, nurse practi-
tioner, or clinical nurse specialist (as 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 defined 
in section 1861(gg)(2)).’’; and 
(B) in subparagraph (B), by inserting ‘‘, physi-
cian assistant, nurse practitioner, clinical nurse spe-
cialist, certified nurse anesthetist, or certified 
nurse-midwife’’ after ‘‘physician’’. 
(2) EFFECTIVE DATE.—The amendments made by 
this subsection shall apply with respect to information 
required to be submitted under section 1128G of the So-
cial Security Act (42 U.S.C. 1320a–7h) on or after Jan-
uary 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
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under this subparagraph prior to January 1, 2022, does not 
contain’’. 
(c) ADMINISTRATION.—Chapter 35 of title 44, United 
States Code, shall not apply to this section or the amend-
ments made by this section. 
TITLE VII—PUBLIC HEALTH 
PROVISIONS 
Subtitle A—Awareness and Training 
SEC. 7001. REPORT ON EFFECTS ON PUBLIC HEALTH OF SYN-
THETIC DRUG USE. 
(a) IN GENERAL.—Not later than 3 years after the date 
of the enactment of this Act, the Secretary of Health and 
Human Services, in coordination with the Surgeon General of 
the Public Health Service, shall submit to the Committee on 
Energy and Commerce of the House of Representatives and 
the Committee on Health, Education, Labor, and Pensions of 
the Senate a report on the health effects of new psychoactive 
substances, including synthetic drugs, used by adolescents 
and young adults. 
(b) NEW PSYCHOACTIVE SUBSTANCE DEFINED.—For 
purposes of subsection (a), the term ‘‘new psychoactive sub-
stance’’ means a controlled substance analogue (as defined in 
section 102(32) of the Controlled Substances Act (21 U.S.C. 
802(32)).
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SEC. 7002. FIRST RESPONDER TRAINING. 
Section 546 of the Public Health Service Act (42 U.S.C. 
290ee–1) is amended— 
(1) in subsection (c)— 
(A) in paragraph (2), by striking ‘‘and’’ at the 
end; 
(B) in paragraph (3), by striking the period 
and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(4) train and provide resources for first responders 
and members of other key community sectors on safety 
around fentanyl, carfentanil, and other dangerous licit 
and illicit drugs to protect themselves from exposure to 
such drugs and respond appropriately when exposure oc-
curs.’’; 
(2) in subsection (d), by striking ‘‘and mechanisms 
for referral to appropriate treatment for an entity receiv-
ing a grant under this section’’ and inserting ‘‘mecha-
nisms for referral to appropriate treatment, and safety 
around fentanyl, carfentanil, and other dangerous licit 
and illicit drugs’’; 
(3) in subsection (f)— 
(A) in paragraph (3), by striking ‘‘and’’ at the 
end; 
(B) in paragraph (4), by striking the period 
and inserting ‘‘; and’’; and
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(C) by adding at the end the following: 
‘‘(5) the number of first responders and members of 
other key community sectors trained on safety around 
fentanyl, carfentanil, and other dangerous licit and illicit 
drugs.’’; 
(4) by redesignating subsection (g) as subsection 
(h); 
(5) by inserting after subsection (f) the following: 
‘‘(g) OTHER KEY COMMUNITY SECTORS.—In this sec-
tion, the term ‘other key community sectors’ includes sub-
stance use disorder treatment providers, emergency medical 
services agencies, agencies and organizations working with 
prison and jail populations and offender reentry programs, 
health care providers, harm reduction groups, pharmacies, 
community health centers, tribal health facilities, and mental 
health providers.’’; and 
(6) in subsection (h), as so redesignated, by striking 
‘‘$12,000,000 for each of fiscal years 2017 through 
2021’’ and inserting ‘‘$36,000,000 for each of fiscal 
years 2019 through 2023’’.
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Subtitle B—Pilot Program for Public 
Health 
Laboratories 
To 
Detect 
Fentanyl 
and 
Other 
Synthetic 
Opioids 
SEC. 7011. PILOT PROGRAM FOR PUBLIC HEALTH LABORA-
TORIES TO DETECT FENTANYL AND OTHER SYN-
THETIC OPIOIDS. 
(a) GRANTS.—The Secretary of Health and Human 
Services (referred to in this section as the ‘‘Secretary’’) shall 
award grants to, or enter into cooperative agreements with, 
Federal, State, and local agencies to improve coordination be-
tween public health laboratories and laboratories operated by 
law enforcement agencies, such as Customs and Border Pro-
tection and the Drug Enforcement Administration, to im-
prove detection of synthetic opioids, including fentanyl and its 
analogues, as described in subsection (b). 
(b) DETECTION ACTIVITIES.—The Secretary, in con-
sultation with the Director of the National Institute of Stand-
ards and Technology, the Director of the Centers for Disease 
Control and Prevention, the Attorney General of the United 
States, and the Administrator of the Drug Enforcement Ad-
ministration, shall, for purposes of this section, develop or 
identify— 
(1) best practices for safely handling and testing 
synthetic opioids, including fentanyl and its analogues,
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including with respect to reference materials, instrument 
calibration, and quality control protocols; 
(2) reference materials and quality control stand-
ards related to synthetic opioids, including fentanyl and 
its analogues, to enhance— 
(A) clinical diagnostics; 
(B) postmortem data collection; and 
(C) portable testing equipment utilized by law 
enforcement and public health officials; and 
(3) procedures for the identification of new and 
emerging synthetic opioid formulations and procedures 
for reporting those findings to appropriate law enforce-
ment agencies and Federal, State, and local public 
health laboratories and health departments, as appro-
priate. 
(c) LABORATORIES.—The Secretary shall require recipi-
ents of grants or cooperative agreements under subsection (a) 
to— 
(1) follow the best practices established under sub-
section (b) and have the appropriate capabilities to pro-
vide laboratory testing of controlled substances, such as 
synthetic fentanyl, and biospecimens for the purposes of 
aggregating and reporting public health information to 
Federal, State, and local public health officials, labora-
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tories, and other entities the Secretary deems appro-
priate; 
(2) work with law enforcement agencies and public 
health authorities, as practicable; 
(3) provide early warning information to Federal, 
State, and local law enforcement agencies and public 
health authorities regarding trends or other data related 
to the supply of synthetic opioids, including fentanyl and 
its analogues; 
(4) provide biosurveillance capabilities with respect 
to identifying trends in adverse health outcomes associ-
ated with non-fatal exposures; and 
(5) provide diagnostic testing, as appropriate and 
practicable, for non-fatal exposures of emergency per-
sonnel, first responders, and other individuals. 
(d) AUTHORIZATION
OF APPROPRIATIONS.—To carry 
out this section, there is authorized to be appropriated 
$15,000,000 for each of fiscal years 2019 through 2023. 
Subtitle C—Indexing Narcotics, 
Fentanyl, and Opioids 
SEC. 7021. ESTABLISHMENT OF SUBSTANCE USE DISORDER IN-
FORMATION DASHBOARD. 
Title XVII of the Public Health Service Act (42 U.S.C. 
300u et seq.) is amended by adding at the end the following 
new section:
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‘‘SEC. 1711. ESTABLISHMENT OF SUBSTANCE USE DISORDER IN-
FORMATION DASHBOARD. 
‘‘(a) IN GENERAL.—Not later than 6 months after the 
date of the enactment of this section, the Secretary of Health 
and Human Services shall, in consultation with the Director 
of National Drug Control Policy, establish and periodically 
update, on the Internet website of the Department of Health 
and Human Services, a public information dashboard that— 
‘‘(1) provides links to information on programs 
within the Department of Health and Human Services 
related to the reduction of opioid and other substance 
use disorders; 
‘‘(2) provides access, to the extent practicable and 
appropriate, to publicly available data, which may in-
clude data from agencies within the Department of 
Health and Human Services and— 
‘‘(A) other Federal agencies; 
‘‘(B) State, local, and Tribal governments; 
‘‘(C) nonprofit organizations; 
‘‘(D) law enforcement; 
‘‘(E) medical experts; 
‘‘(F) public health educators; and 
‘‘(G) research institutions regarding preven-
tion, treatment, recovery, and other services for 
opioid and other substance use disorders;
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‘‘(3) provides data on substance use disorder pre-
vention and treatment strategies in different regions of 
and populations in the United States; 
‘‘(4) identifies information on alternatives to con-
trolled substances for pain management, such as ap-
proaches studied by the National Institutes of Health 
Pain Consortium, the National Center for Complimen-
tary and Integrative Health, and other institutes and 
centers at the National Institutes of Health, as appro-
priate; and 
‘‘(5) identifies guidelines and best practices for 
health care providers regarding treatment of substance 
use disorders. 
‘‘(b) CONTROLLED SUBSTANCE DEFINED.—In this sec-
tion, the term ‘controlled substance’ has the meaning given 
that term in section 102 of the Controlled Substances Act 
(21 U.S.C. 802).’’. 
SEC. 7022. INTERDEPARTMENTAL SUBSTANCE USE DISORDERS 
COORDINATING COMMITTEE. 
(a) ESTABLISHMENT.—Not later than 3 months after 
the date of the enactment of this Act, the Secretary of Health 
and Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall, in coordination with the Director of National 
Drug Control Policy, establish a committee, to be known as 
the Interdepartmental Substance Use Disorders Coordinating
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Committee (in this section referred to as the ‘‘Committee’’), 
to coordinate Federal activities related to substance use dis-
orders. 
(b) MEMBERSHIP.— 
(1) FEDERAL MEMBERS.—The Committee shall be 
composed of the following Federal representatives, or the 
designees of such representatives: 
(A) The Secretary, who shall serve as the 
Chair of the Committee. 
(B) The Attorney General of the United 
States. 
(C) The Secretary of Labor. 
(D) The Secretary of Housing and Urban De-
velopment. 
(E) The Secretary of Education. 
(F) The Secretary of Veterans Affairs. 
(G) The Commissioner of Social Security. 
(H) The Assistant Secretary for Mental Health 
and Substance Use. 
(I) The Director of National Drug Control Pol-
icy. 
(J) Representatives of other Federal agencies 
that support or conduct activities or programs re-
lated to substance use disorders, as determined ap-
propriate by the Secretary.
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(2) NON-FEDERAL
MEMBERS.—The Committee 
shall include a minimum of 15 non-Federal members ap-
pointed by the Secretary, of which— 
(A) at least two such members shall be an indi-
vidual who has received treatment for a diagnosis of 
a substance use disorder; 
(B) at least two such members shall be a direc-
tor of a State substance abuse agency; 
(C) at least two such members shall be a rep-
resentative of a leading research, advocacy, or serv-
ice organization for adults with substance use dis-
order; 
(D) at least two such members shall— 
(i) be a physician, licensed mental health 
professional, advance practice registered nurse, 
or physician assistant; and 
(ii) have experience in treating individuals 
with substance use disorders; 
(E) at least one such member shall be a sub-
stance use disorder treatment professional who pro-
vides treatment services at a certified opioid treat-
ment program; 
(F) at least one such member shall be a sub-
stance use disorder treatment professional who has
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research or clinical experience in working with ra-
cial and ethnic minority populations; 
(G) at least one such member shall be a sub-
stance use disorder treatment professional who has 
research or clinical mental health experience in 
working with medically underserved populations; 
(H) at least one such member shall be a State- 
certified substance use disorder peer support spe-
cialist; 
(I) at least one such member shall be a drug 
court judge or a judge with experience in adjudi-
cating cases related to substance use disorder; 
(J) at least one such member shall be a public 
safety officer with extensive experience in inter-
acting with adults with a substance use disorder; 
and 
(K) at least one such member shall be an indi-
vidual with experience providing services for home-
less individuals with a substance use disorder. 
(c) TERMS.— 
(1) IN GENERAL.—A member of the Committee ap-
pointed under subsection (b)(2) shall be appointed for a 
term of 3 years and may be reappointed for one or more 
3-year terms.
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(2) VACANCIES.—A vacancy on the Committee shall 
be filled in the same manner in which the original ap-
pointment was made. Any individual appointed to fill a 
vacancy for an unexpired term shall be appointed for the 
remainder of such term and may serve after the expira-
tion of such term until a successor has been appointed. 
(d) MEETINGS.—The Committee shall meet not fewer 
than two times each year. 
(e) DUTIES.—The Committee shall— 
(1) identify areas for improved coordination of ac-
tivities, if any, related to substance use disorders, includ-
ing research, services, supports, and prevention activities 
across all relevant Federal agencies; 
(2) identify and provide to the Secretary rec-
ommendations for improving Federal programs for the 
prevention and treatment of, and recovery from, sub-
stance use disorders, including by expanding access to 
prevention, treatment, and recovery services; 
(3) analyze substance use disorder prevention and 
treatment strategies in different regions of and popu-
lations in the United States and evaluate the extent to 
which Federal substance use disorder prevention and 
treatment strategies are aligned with State and local 
substance use disorder prevention and treatment strate-
gies;
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(4) make recommendations to the Secretary regard-
ing any appropriate changes with respect to the activities 
and strategies described in paragraphs (1) through (3); 
(5) make recommendations to the Secretary regard-
ing public participation in decisions relating to substance 
use disorders and the process by which public feedback 
can be better integrated into such decisions; and 
(6) make recommendations to ensure that substance 
use disorder research, services, supports, and prevention 
activities of the Department of Health and Human Serv-
ices and other Federal agencies are not unnecessarily 
duplicative. 
(f) ANNUAL REPORT.—Not later than 1 year after the 
date of the enactment of this Act, and annually thereafter for 
the life of the Committee, the Committee shall publish on the 
Internet website of the Department of Health and Human 
Services, which may include the public information dashboard 
established under section 1711 of the Public Health Service 
Act, as added by section 7021, a report summarizing the ac-
tivities carried out by the Committee pursuant to subsection 
(e), including any findings resulting from such activities. 
(g) WORKING GROUPS.—The Committee may establish 
working groups for purposes of carrying out the duties de-
scribed in subsection (e). Any such working group shall be 
composed of members of the Committee (or the designees of
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such members) and may hold such meetings as are necessary 
to enable the working group to carry out the duties delegated 
to the working group. 
(h) FEDERAL ADVISORY COMMITTEE ACT.—The Fed-
eral Advisory Committee Act (5 U.S.C. App.) shall apply to 
the Committee only to the extent that the provisions of such 
Act do not conflict with the requirements of this section. 
(i) SUNSET.—The Committee shall terminate on the 
date that is 6 years after the date on which the Committee 
is established under subsection (a). 
SEC. 7023. 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 of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’), in coordination with the Administrator of the Drug 
Enforcement Administration and the Director of the Office of 
National Drug Control Policy, shall develop or identify exist-
ing national indicators (referred to in this section as the ‘‘na-
tional milestones’’) 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.
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(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 accu-
rately and expediently measure progress in meeting the 
goal described in subsection (a), which shall, as appro-
priate, 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 re-
covery from opioid use disorder; 
(D) the number of infections associated with il-
licit drug use, such as HIV, viral hepatitis, and in-
fective endocarditis, and available capacity for treat-
ing such infections; 
(E) the number of providers prescribing medi-
cation-assisted treatment for opioid use disorders, 
including in primary care settings, community 
health centers, jails, and prisons; 
(F) the number of individuals receiving treat-
ment for opioid use disorder; and 
(G) additional indicators or metrics, as appro-
priate, such as metrics pertaining to specific popu-
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•HRES 1099 EH 
lations, including women and children, American In-
dians and Alaskan Natives, individuals living in 
rural and non-urban areas, and justice-involved 
populations, that would further clarify the progress 
made in addressing the opioid 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 an-
nual 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 disorder. 
(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 ration-
ale 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 date of enactment of this Act, the Secretary shall
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make available on the Internet website of the Department of 
Health and Human Services, and submit to the Committee 
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, including ex-
pected progress in the subsequent year, in achieving the goals 
detailed in the national milestones. Each such update shall 
include the progress made in the first year or since the pre-
vious report, as applicable, in meeting each indicator or met-
ric in the national milestones. 
SEC. 7024. STUDY ON PRESCRIBING LIMITS. 
Not later than 2 years after the date of enactment of 
this Act, the Secretary of Health and Human Services, in 
consultation with the Attorney General of the United States, 
shall submit to the Committee on Health, Education, Labor, 
and Pensions of the Senate and the Committee on Energy 
and Commerce of the House of Representatives 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;
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(C) the prevalence of opioid use disorders; 
(D) medically appropriate use of, and access 
to, opioids, including any impact on travel expenses 
and pain management outcomes for patients, 
whether such limits are associated with significantly 
higher rates of negative health outcomes, including 
suicide, and whether the impact of such limits dif-
fers based on the clinical indication for which 
opioids are prescribed; 
(2) whether such limits lead to a significant in-
crease in burden for prescribers of opioids or prescribers 
of treatments for opioid use disorder, including any im-
pact on patient access to treatment, and whether any 
such burden is mitigated by any factors such as elec-
tronic 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)). 
Subtitle D—Ensuring Access to 
Quality Sober Living 
SEC. 7031. NATIONAL RECOVERY HOUSING BEST PRACTICES. 
Part D of title V of the Public Health Service Act (42 
U.S.C. 290dd et seq.) is amended by adding at the end the 
following new section:
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‘‘SEC. 550. NATIONAL RECOVERY HOUSING BEST PRACTICES. 
‘‘(a) BEST
PRACTICES
FOR
OPERATING
RECOVERY 
HOUSING.— 
‘‘(1) IN GENERAL.—The Secretary, in consultation 
with the individuals and entities specified in paragraph 
(2), shall identify or facilitate the development of best 
practices, which may include model laws for imple-
menting suggested minimum standards, for operating re-
covery housing. 
‘‘(2) CONSULTATION.—In carrying out the activities 
described in paragraph (1), the Secretary shall consult 
with, as appropriate— 
‘‘(A) relevant divisions of the Department of 
Health and Human Services, including the Sub-
stance Abuse and Mental Health Services Adminis-
tration, the Office of Inspector General, the Indian 
Health Service, and the Centers for Medicare & 
Medicaid Services; 
‘‘(B) the Secretary of Housing and Urban De-
velopment; 
‘‘(C) directors or commissioners, as applicable, 
of State health departments, tribal health depart-
ments, State Medicaid programs, and State insur-
ance agencies; 
‘‘(D) 
representatives 
of 
health 
insurance 
issuers;
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‘‘(E) national accrediting entities and rep-
utable providers of, and analysts of, recovery hous-
ing services, including Indian tribes, tribal organiza-
tions, and tribally designated housing entities that 
provide recovery housing services, as applicable; 
‘‘(F) individuals with a history of substance 
use disorder; and 
‘‘(G) other stakeholders identified by the Sec-
retary. 
‘‘(b) IDENTIFICATION
OF
FRAUDULENT
RECOVERY 
HOUSING OPERATORS.— 
‘‘(1) IN GENERAL.—The Secretary, in consultation 
with the individuals and entities described in paragraph 
(2), shall identify or facilitate the development of com-
mon indicators that could be used to identify potentially 
fraudulent recovery housing operators. 
‘‘(2) CONSULTATION.—In carrying out the activities 
described in paragraph (1), the Secretary shall consult 
with, as appropriate, the individuals and entities speci-
fied in subsection (a)(2) and the Attorney General of the 
United States. 
‘‘(3) REQUIREMENTS.— 
‘‘(A) PRACTICES FOR IDENTIFICATION AND RE-
PORTING.—In carrying out the activities described 
in paragraph (1), the Secretary shall consider how
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law enforcement, public and private payers, and the 
public can best identify and report fraudulent recov-
ery housing operators. 
‘‘(B) FACTORS TO BE CONSIDERED.—In car-
rying out the activities described in paragraph (1), 
the Secretary shall identify or develop indicators, 
which may include indicators related to— 
‘‘(i) unusual billing practices; 
‘‘(ii) average lengths of stays; 
‘‘(iii) excessive levels of drug testing (in 
terms of cost or frequency); and 
‘‘(iv) unusually high levels of recidivism. 
‘‘(c) DISSEMINATION.—The Secretary shall, as appro-
priate, disseminate the best practices identified or developed 
under subsection (a) and the common indicators identified or 
developed under subsection (b) to— 
‘‘(1) State agencies, which may include the provi-
sion of technical assistance to State agencies seeking to 
adopt or implement such best practices; 
‘‘(2) Indian tribes, tribal organizations, and tribally 
designated housing entities; 
‘‘(3) the Attorney General of the United States; 
‘‘(4) the Secretary of Labor; 
‘‘(5) the Secretary of Housing and Urban Develop-
ment;
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‘‘(6) State and local law enforcement agencies; 
‘‘(7) health insurance issuers; 
‘‘(8) recovery housing entities; and 
‘‘(9) the public. 
‘‘(d) REQUIREMENTS.—In carrying out the activities de-
scribed in subsections (a) and (b), the Secretary, in consulta-
tion with appropriate individuals and entities described in 
subsections (a)(2) and (b)(2), shall consider how recovery 
housing is able to support recovery and prevent relapse, re-
cidivism, or overdose (including overdose death), including by 
improving access and adherence to treatment, including medi-
cation-assisted treatment. 
‘‘(e) RULE OF CONSTRUCTION.—Nothing in this section 
shall be construed to provide the Secretary with the authority 
to require States to adhere to minimum standards in the 
State oversight of recovery housing. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) The term ‘recovery housing’ means a shared 
living environment free from alcohol and illicit drug use 
and centered on peer support and connection to services 
that promote sustained recovery from substance use dis-
orders. 
‘‘(2) The terms ‘Indian tribe’ and ‘tribal organiza-
tion’ have the meanings given those terms in section 4
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of the Indian Self-Determination and Education Assist-
ance Act (25 U.S.C. 5304). 
‘‘(3) The term ‘tribally designated housing entity’ 
has the meaning given that term in section 4 of the Na-
tive American Housing Assistance and Self-Determina-
tion Act of 1996 (25 U.S.C. 4103). 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there is authorized to be appropriated 
$3,000,000 for the period of fiscal years 2019 through 
2021.’’. 
Subtitle E—Advancing Cutting Edge 
Research 
SEC. 7041. UNIQUE RESEARCH INITIATIVES. 
Section 402(n)(1) of the Public Health Service Act (42 
U.S.C. 282(n)(1)) is amended— 
(1) in subparagraph (A), by striking ‘‘or’’; 
(2) in subparagraph (B), by striking the period and 
inserting ‘‘; or’’; and 
(3) by adding at the end the following: 
‘‘(C) high impact cutting-edge research that 
fosters scientific creativity and increases funda-
mental biological understanding leading to the pre-
vention, diagnosis, or treatment of diseases and dis-
orders, or research urgently required to respond to 
a public health threat.’’.
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SEC. 7042. PAIN RESEARCH. 
Section 409J(b) of the Public Health Service Act (42 
U.S.C. 284q(b)) is amended— 
(1) in paragraph (5)— 
(A) in subparagraph (A), by striking ‘‘and 
treatment of pain and diseases and disorders associ-
ated with pain’’ and inserting ‘‘treatment, and man-
agement of pain and diseases and disorders associ-
ated with pain, including information on best prac-
tices for the utilization of non-pharmacologic treat-
ments, non-addictive medical products, and other 
drugs or devices approved or cleared by the Food 
and Drug Administration’’; 
(B) in subparagraph (B), by striking ‘‘on the 
symptoms and causes of pain;’’ and inserting the 
following: ‘‘on— 
‘‘(i) the symptoms and causes of pain, in-
cluding the identification of relevant biomark-
ers and screening models and the epidemiology 
of acute and chronic pain; 
‘‘(ii) the diagnosis, prevention, treatment, 
and management of acute and chronic pain, in-
cluding with respect to non-pharmacologic 
treatments, non-addictive medical products, 
and other drugs or devices approved or cleared 
by the Food and Drug Administration; and
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‘‘(iii) risk factors for, and early warning 
signs of, substance use disorders in populations 
with acute and chronic pain; and’’; and 
(C) by striking subparagraphs (C) through (E) 
and inserting the following: 
‘‘(C) make recommendations to the Director of 
NIH— 
‘‘(i) to ensure that the activities of the 
National Institutes of Health and other Fed-
eral agencies are free of unnecessary duplica-
tion of effort; 
‘‘(ii) on how best to disseminate informa-
tion on pain care and epidemiological data re-
lated to acute and chronic pain; and 
‘‘(iii) on how to expand partnerships be-
tween public entities and private entities to ex-
pand collaborative, cross-cutting research.’’; 
(2) by redesignating paragraph (6) as paragraph 
(7); and 
(3) by inserting after paragraph (5) the following: 
‘‘(6) REPORT.—The Secretary shall ensure that rec-
ommendations and actions taken by the Director with 
respect to the topics discussed at the meetings described 
in paragraph (4) are included in appropriate reports to 
Congress.’’.
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Subtitle F—Jessie’s Law 
SEC. 7051. INCLUSION OF OPIOID ADDICTION HISTORY IN PA-
TIENT RECORDS. 
(a) BEST PRACTICES.— 
(1) IN GENERAL.—Not later than 1 year after the 
date of enactment of this Act, the Secretary of Health 
and Human Services (in this section referred to as the 
‘‘Secretary’’), in consultation with appropriate stake-
holders, including a patient with a history of opioid use 
disorder, an expert in electronic health records, an ex-
pert in the confidentiality 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 information 
that a patient has provided to a health care pro-
vider regarding such patient’s history of opioid use 
disorder should, only at the patient’s request, be 
prominently displayed in the medical records (in-
cluding 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 in-
formation should be so displayed.
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(2) DISSEMINATION.—The Secretary shall dissemi-
nate the best practices developed under paragraph (1) to 
health care providers and State agencies. 
(b) REQUIREMENTS.—In identifying or facilitating the 
development of best practices under subsection (a), as appli-
cable, the Secretary, in consultation with appropriate stake-
holders, shall consider the following: 
(1) The potential for addiction relapse or overdose, 
including overdose death, when opioid medications are 
prescribed to a patient recovering from opioid use dis-
order. 
(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 infor-
mation about a patient’s opioid use disorder when a phy-
sician or medical professional is prescribing medication, 
including methods for avoiding alert fatigue in providers. 
(4) The importance of a variety of appropriate med-
ical professionals, including physicians, nurses, and 
pharmacists, having access to information described in 
this section when prescribing or dispensing opioid medi-
cation, consistent with Federal and State laws and regu-
lations.
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(5) The importance of protecting patient privacy, 
including the requirements related to consent for disclo-
sure of substance use disorder information under all ap-
plicable laws and regulations. 
(6) All applicable Federal and State laws and regu-
lations. 
SEC. 7052. COMMUNICATION WITH FAMILIES DURING EMER-
GENCIES. 
(a) PROMOTING AWARENESS OF AUTHORIZED DISCLO-
SURES DURING EMERGENCIES.—The Secretary of Health 
and Human Services shall annually notify health care pro-
viders regarding permitted disclosures under Federal health 
care privacy law during emergencies, including overdoses, of 
certain health information to families, caregivers, and health 
care providers. 
(b) USE OF MATERIAL.—For the purposes of carrying 
out subsection (a), the Secretary of Health and Human Serv-
ices may use material produced under section 7053 of this 
Act or section 11004 of the 21st Century Cures Act (42 
U.S.C. 1320d–2 note). 
SEC. 7053. DEVELOPMENT AND DISSEMINATION OF MODEL 
TRAINING PROGRAMS FOR SUBSTANCE USE DIS-
ORDER PATIENT RECORDS. 
(a) INITIAL PROGRAMS
AND MATERIALS.—Not later 
than 1 year after the date of the enactment of this Act, the
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Secretary of Health and Human Services (in this section re-
ferred to as the ‘‘Secretary’’), in consultation with appro-
priate experts, shall identify the following model programs 
and materials (or if no such programs or materials exist, rec-
ognize private or public entities to develop and disseminate 
such programs and materials): 
(1) Model programs and materials for training 
health care providers (including physicians, emergency 
medical personnel, psychiatrists, psychologists, coun-
selors, therapists, nurse practitioners, physician assist-
ants, behavioral health facilities and clinics, care man-
agers, and hospitals, including individuals such as gen-
eral counsels or regulatory compliance staff who are re-
sponsible for establishing provider privacy policies) con-
cerning the permitted uses and disclosures, consistent 
with the standards and regulations governing the privacy 
and security of substance use disorder patient records 
promulgated by the Secretary under section 543 of the 
Public Health Service Act (42 U.S.C. 290dd–2) for the 
confidentiality of patient records. 
(2) Model programs and materials for training pa-
tients and their families regarding their rights to protect 
and obtain information under the standards and regula-
tions described in paragraph (1).
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(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 pro-
viders to promote and provide the best possible inte-
grated care; 
(2) avoid inappropriate prescribing that can lead to 
dangerous drug interactions, overdose, or relapse; 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 pro-
gram and materials identified or developed under sub-
section (a); and 
(2) disseminate such updated programs and mate-
rials 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 au-
thorized to be appropriated to carry out this section— 
(1) $4,000,000 for fiscal year 2019;
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(2) $2,000,000 for each of fiscal years 2020 and 
2021; and 
(3) $1,000,000 for each of fiscal years 2022 and 
2023. 
Subtitle G—Protecting Pregnant 
Women and Infants 
SEC. 7061. REPORT ON ADDRESSING MATERNAL AND INFANT 
HEALTH IN THE OPIOID CRISIS. 
(a) IN GENERAL.—Not later than 18 months after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services, in coordination with the Centers for 
Disease Control and Prevention, the National Institutes of 
Health, the Indian Health Service, and the Substance Abuse 
and Mental Health Services Administration, shall develop and 
submit to the Committee on Health, Education, Labor, and 
Pensions of the Senate and the Committee on Energy and 
Commerce of the House of Representatives a report that in-
cludes— 
(1) information on opioid, non-opioid, and non- 
pharmacologic pain management practices during preg-
nancy and after pregnancy; 
(2) recommendations for increasing public aware-
ness and education about substance use disorders, in-
cluding opioid use disorders, during and after pregnancy,
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including available treatment resources in urban and 
rural areas; 
(3) recommendations to prevent, identify, and re-
duce substance use disorders, including opioid use dis-
orders, during pregnancy to improve care for pregnant 
women with substance use disorders and their infants; 
and 
(4) an identification of areas in need of further re-
search with respect to acute and chronic pain manage-
ment during and after pregnancy. 
(b) NO ADDITIONAL FUNDS.—No additional funds are 
authorized to be appropriated for purposes of carrying out 
subsection (a). 
SEC. 7062. PROTECTING MOMS AND INFANTS. 
(a) REPORT.— 
(1) IN GENERAL.—Not later than 60 days after the 
date of enactment of this Act, the Secretary of Health 
and Human Services (referred to in this section as the 
‘‘Secretary’’) shall submit to the Committee on Health, 
Education, Labor, and Pensions of the Senate and the 
Committee on Energy and Commerce of the House of 
Representatives, 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 recommendations in the strategy relating to pre-
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natal opioid use, including neonatal abstinence syn-
drome, 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 informa-
tion regarding the agencies involved in the imple-
mentation; and 
(B) information on additional funding or au-
thority the Secretary requires, if any, to implement 
the strategy, which may include authorities needed 
to coordinate implementation of such strategy 
across the Department of Health and Human Serv-
ices. 
(2) PERIODIC UPDATES.—The Secretary shall peri-
odically 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’’.
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SEC. 7063. 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 consultation with relevant stakeholders and 
in collaboration with the Director of the Centers for Dis-
ease Control and Prevention, develop educational mate-
rials for clinicians to use with pregnant women for 
shared decision making regarding pain management and 
the prevention of substance use disorders 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 amend-
ed— 
(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
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(3) by adding at the end the following: 
‘‘(15) in cooperation with the Secretary, implement 
and disseminate, as appropriate, the recommendations in 
the report entitled ‘Protecting Our Infants Act: Final 
Strategy’ issued by the Department 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, and 
through public-private partnerships, encourage education 
about substance use disorders for pregnant women and 
health care providers who treat pregnant women and ba-
bies.’’. 
SEC. 7064. 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 fol-
lows: 
‘‘(1) to collect, analyze, and make available data on 
prenatal smoking and alcohol and other substance abuse 
and misuse, including—
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‘‘(A) data on— 
‘‘(i) the incidence, prevalence, and implica-
tions of such activities; and 
‘‘(ii) the incidence and prevalence of impli-
cations and outcomes, including neonatal absti-
nence syndrome and other maternal and child 
health outcomes associated with such activities; 
and 
‘‘(B) additional information or data, as appro-
priate, on family health history, medication expo-
sures during pregnancy, demographic information, 
such as race, ethnicity, geographic location, and 
family history, and other relevant information, to 
inform such analysis;’’; 
(B) in paragraph (2)— 
(i) by striking ‘‘prevention of’’ and insert-
ing ‘‘prevention and long-term outcomes associ-
ated with’’; and 
(ii) by striking ‘‘illegal drug use’’ and in-
serting ‘‘other substance abuse and misuse’’; 
(C) in paragraph (3), by striking ‘‘and ces-
sation programs; and’’ and inserting ‘‘, treatment, 
and cessation programs;’’;
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(D) in paragraph (4), by striking ‘‘illegal drug 
use.’’ and inserting ‘‘other 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 prenatal 
smoking, alcohol, and substance abuse and misuse; 
and 
‘‘(C) relevant studies, evaluations, or informa-
tion the Secretary determines to be appropriate.’’; 
(2) in subsection (b), by inserting ‘‘tribal entities,’’ 
after ‘‘local governments,’’; 
(3) by redesignating subsection (c) as subsection 
(d); 
(4) by inserting after subsection (b) the following: 
‘‘(c) COORDINATING ACTIVITIES.—To carry out this sec-
tion, the Secretary may— 
‘‘(1) provide technical and consultative assistance to 
entities receiving grants under subsection (b); 
‘‘(2) ensure a pathway for data sharing between 
States, tribal entities, and the Centers for Disease Con-
trol and Prevention;
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‘‘(3) ensure data collection under this section is 
consistent with applicable State, Federal, and Tribal pri-
vacy 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 Coordinator, as 
such recognized standards are available, in order to fa-
cilitate interoperability between such systems and health 
information technology systems, including certified 
health information technology.’’; and 
(5) in subsection (d), as so redesignated, by striking 
‘‘2001 through 2005’’ and inserting ‘‘2019 through 
2023’’. 
SEC. 7065. PLANS OF SAFE CARE. 
(a) IN GENERAL.—Section 105(a) of the Child Abuse 
Prevention and Treatment Act (42 U.S.C. 5106(a)) is 
amended by adding at the end the following: 
‘‘(7) GRANTS TO STATES TO IMPROVE AND COORDI-
NATE THEIR RESPONSE TO ENSURE THE SAFETY, PER-
MANENCY, AND WELL-BEING OF INFANTS AFFECTED BY 
SUBSTANCE USE.— 
‘‘(A) PROGRAM AUTHORIZED.—The Secretary 
is authorized to make grants to States for the pur-
pose of assisting child welfare agencies, social serv-
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ices agencies, substance use disorder treatment 
agencies, hospitals with labor and delivery units, 
medical staff, public health and mental health agen-
cies, and maternal and child health agencies to fa-
cilitate collaboration in developing, updating, imple-
menting, and monitoring plans of safe care de-
scribed 
in 
section 
106(b)(2)(B)(iii). 
Section 
112(a)(2) shall not apply to the program authorized 
under this paragraph. 
‘‘(B) DISTRIBUTION OF FUNDS.— 
‘‘(i) RESERVATIONS.—Of the amounts 
made available to carry out subparagraph (A), 
the Secretary shall reserve— 
‘‘(I) no more than 3 percent for the 
purposes described in subparagraph (G); 
and 
‘‘(II) up to 3 percent for grants to 
Indian Tribes and tribal organizations to 
address the needs of infants born with, 
and identified as being affected by, sub-
stance abuse or withdrawal symptoms re-
sulting from prenatal drug exposure or a 
fetal alcohol spectrum disorder and their 
families or caregivers, which to the extent 
practicable, shall be consistent with the
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uses of funds described under subpara-
graph (D). 
‘‘(ii) ALLOTMENTS TO STATES AND TERRI-
TORIES.—The Secretary shall allot the amount 
made available to carry out subparagraph (A) 
that remains after application of clause (i) to 
each State that applies for such a grant, in an 
amount equal to the sum of— 
‘‘(I) $500,000; and 
‘‘(II) an amount that bears the same 
relationship to any funds made available 
to carry out subparagraph (A) and re-
maining 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 made available to carry out subpara-
graph (A) is insufficient to satisfy the require-
ments of clause (ii), the Secretary shall ratably 
reduce each allotment to a State. 
‘‘(C) APPLICATION.—A State desiring a grant 
under this paragraph shall submit an application to 
the Secretary at such time and in such manner as
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the Secretary may require. Such application shall 
include— 
‘‘(i) a description of— 
‘‘(I) the impact of substance use dis-
order in such State, including with respect 
to the substance or class of substances 
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; 
‘‘(bb) the aggregate rate of 
births in the State of infants affected 
by substance abuse or withdrawal 
symptoms or a fetal alcohol spectrum 
disorder (as determined by hospitals, 
insurance claims, claims submitted to 
the State Medicaid program, or other 
records), if available and to the ex-
tent 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 appropriate 
services, as reported under section 
106(d)(18);
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‘‘(II) the challenges the State faces in 
developing, implementing, and monitoring 
plans of safe care in accordance with sec-
tion 106(b)(2)(B)(iii); 
‘‘(III) the State’s lead agency for the 
grant program and how that agency will 
coordinate with relevant State entities and 
programs, including the child welfare 
agency, the substance use disorder treat-
ment agency, hospitals with labor and de-
livery units, health care providers, the 
public health and mental health agencies, 
programs funded by the Substance Abuse 
and Mental Health Services Administra-
tion that provide substance use disorder 
treatment for women, the State Medicaid 
program, the State agency administering 
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 In-
dividuals 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