H. R. 6 
One Hundred Fifteenth Congress 
of the 
United States of America 
AT THE SECOND SESSION 
Begun and held at the City of Washington on Wednesday, 
the third day of January, two thousand and eighteen 
An Act 
To provide for opioid use disorder prevention, recovery, and treatment, and for 
other purposes. 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the ‘‘Substance 
Use–Disorder Prevention that Promotes Opioid Recovery and Treat-
ment for Patients and Communities Act’’ or the ‘‘SUPPORT for 
Patients and Communities Act’’. 
(b) TABLE OF CONTENTS.—The table of contents of this Act 
is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—MEDICAID PROVISIONS TO ADDRESS THE OPIOID CRISIS 
Sec. 1001. At-risk youth Medicaid protection. 
Sec. 1002. Health insurance for former foster youth. 
Sec. 1003. Demonstration project to increase substance use provider capacity under 
the Medicaid program. 
Sec. 1004. Medicaid drug review and utilization. 
Sec. 1005. Guidance to improve care for infants with neonatal abstinence syndrome 
and their mothers; GAO study on gaps in Medicaid coverage for preg-
nant and postpartum women with substance use disorder. 
Sec. 1006. Medicaid health homes for substance-use-disorder Medicaid enrollees. 
Sec. 1007. Caring recovery for infants and babies. 
Sec. 1008. Peer support enhancement and evaluation review. 
Sec. 1009. Medicaid substance use disorder treatment via telehealth. 
Sec. 1010. Enhancing patient access to non-opioid treatment options. 
Sec. 1011. Assessing barriers to opioid use disorder treatment. 
Sec. 1012. Help for moms and babies. 
Sec. 1013. Securing flexibility to treat substance use disorders. 
Sec. 1014. MACPAC study and report on MAT utilization controls under State 
Medicaid programs. 
Sec. 1015. Opioid addiction treatment programs enhancement. 
Sec. 1016. Better data sharing to combat the opioid crisis. 
Sec. 1017. Report on innovative State initiatives and strategies to provide housing- 
related services and supports to individuals struggling with substance 
use disorders under Medicaid. 
Sec. 1018. Technical assistance and support for innovative State strategies to pro-
vide housing-related supports under Medicaid. 
TITLE II—MEDICARE PROVISIONS TO ADDRESS THE OPIOID CRISIS 
Sec. 2001. Expanding the use of telehealth services for the treatment of opioid use 
disorder and other substance use disorders. 
Sec. 2002. Comprehensive screenings for seniors. 
Sec. 2003. Every prescription conveyed securely. 
Sec. 2004. Requiring prescription drug plan sponsors under Medicare to establish 
drug management programs for at-risk beneficiaries. 
Sec. 2005. Medicare coverage of certain services furnished by opioid treatment pro-
grams. 
Sec. 2006. Encouraging appropriate prescribing under Medicare for victims of 
opioid overdose.
H. R. 6—2 
Sec. 2007. Automatic escalation to external review under a Medicare part D drug 
management program for at-risk beneficiaries. 
Sec. 2008. Suspension of payments by Medicare prescription drug plans and MA– 
PD plans pending investigations of credible allegations of fraud by phar-
macies. 
TITLE III—FDA AND CONTROLLED SUBSTANCE PROVISIONS 
Subtitle A—FDA Provisions 
CHAPTER 1—IN GENERAL 
Sec. 3001. Clarifying FDA regulation of non-addictive pain products. 
Sec. 3002. Evidence-based opioid analgesic prescribing guidelines and report. 
CHAPTER 2—STOP COUNTERFEIT DRUGS BY REGULATING AND ENHANCING 
ENFORCEMENT NOW 
Sec. 3011. Short title. 
Sec. 3012. Notification, nondistribution, and recall of controlled substances. 
Sec. 3013. Single source pattern of imported illegal drugs. 
Sec. 3014. Strengthening FDA and CBP coordination and capacity. 
CHAPTER 3—STOP ILLICIT DRUG IMPORTATION 
Sec. 3021. Short title. 
Sec. 3022. Restricting entrance of illicit drugs. 
CHAPTER 4—SECURING OPIOIDS AND UNUSED NARCOTICS WITH DELIBERATE 
DISPOSAL AND PACKAGING 
Sec. 3031. Short title. 
Sec. 3032. Safety-enhancing packaging and disposal features. 
CHAPTER 5—POSTAPPROVAL STUDY REQUIREMENTS 
Sec. 3041. Clarifying FDA postmarket authorities. 
Subtitle B—Controlled Substance Provisions 
CHAPTER 1—MORE FLEXIBILITY WITH RESPECT TO MEDICATION-ASSISTED 
TREATMENT FOR OPIOID USE DISORDERS 
Sec. 3201. Allowing for more flexibility with respect to medication-assisted treat-
ment for opioid use disorders. 
Sec. 3202. Medication-assisted treatment for recovery from substance use disorder. 
Sec. 3203. Grants to enhance access to substance use disorder treatment. 
Sec. 3204. Delivery of a controlled substance by a pharmacy to be administered by 
injection or implantation. 
CHAPTER 2—EMPOWERING PHARMACISTS IN THE FIGHT AGAINST OPIOID ABUSE 
Sec. 3211. Short title. 
Sec. 3212. Programs and materials for training on certain circumstances under 
which a pharmacist may decline to fill a prescription. 
CHAPTER 3—SAFE DISPOSAL OF UNUSED MEDICATION 
Sec. 3221. Short title. 
Sec. 3222. Disposal of controlled substances of a hospice patient by employees of a 
qualified hospice program. 
Sec. 3223. GAO study and report on hospice safe drug management. 
CHAPTER 4—SPECIAL REGISTRATION FOR TELEMEDICINE CLARIFICATION 
Sec. 3231. Short title. 
Sec. 3232. Regulations relating to a special registration for telemedicine. 
CHAPTER 5—SYNTHETIC ABUSE AND LABELING OF TOXIC SUBSTANCES 
Sec. 3241. Controlled substance analogues. 
CHAPTER 6—ACCESS TO INCREASED DRUG DISPOSAL 
Sec. 3251. Short title. 
Sec. 3252. Definitions. 
Sec. 3253. Authority to make grants. 
Sec. 3254. Application. 
Sec. 3255. Use of grant funds. 
Sec. 3256. Eligibility for grant.
H. R. 6—3 
Sec. 3257. Duration of grants. 
Sec. 3258. Accountability and oversight. 
Sec. 3259. Duration of program. 
Sec. 3260. Authorization of appropriations. 
CHAPTER 7—USING DATA TO PREVENT OPIOID DIVERSION 
Sec. 3271. Short title. 
Sec. 3272. Purpose. 
Sec. 3273. Amendments. 
Sec. 3274. Report. 
CHAPTER 8—OPIOID QUOTA REFORM 
Sec. 3281. Short title. 
Sec. 3282. Strengthening considerations for DEA opioid quotas. 
CHAPTER 9—PREVENTING DRUG DIVERSION 
Sec. 3291. Short title. 
Sec. 3292. Improvements to prevent drug diversion. 
TITLE IV—OFFSETS 
Sec. 4001. Promoting value in Medicaid managed care. 
Sec. 4002. Requiring reporting by group health plans of prescription drug coverage 
information for purposes of identifying primary payer situations under 
the Medicare program. 
Sec. 4003. Additional religious exemption from health coverage responsibility re-
quirement. 
Sec. 4004. Modernizing the reporting of biological and biosimilar products. 
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. 
Subtitle B—Medicaid IMD Additional Info 
Sec. 5011. Short title. 
Sec. 5012. MACPAC exploratory study and report on institutions for mental dis-
eases requirements and practices under Medicaid. 
Subtitle C—CHIP Mental Health and Substance Use Disorder Parity 
Sec. 5021. Short title. 
Sec. 5022. Ensuring access to mental health and substance use disorder services for 
children and pregnant women under the Children’s Health Insurance 
Program. 
Subtitle D—Medicaid Reentry 
Sec. 5031. Short title. 
Sec. 5032. Promoting State innovations to ease transitions integration to the com-
munity for certain individuals. 
Subtitle E—Medicaid Partnership 
Sec. 5041. Short title. 
Sec. 5042. Medicaid providers are required to note experiences in record systems to 
help in-need patients. 
Subtitle F—IMD CARE Act 
Sec. 5051. Short title. 
Sec. 5052. State option to provide Medicaid coverage for certain individuals with 
substance use disorders who are patients in certain institutions for men-
tal diseases. 
Subtitle G—Medicaid Improvement Fund 
Sec. 5061. Medicaid Improvement Fund. 
TITLE VI—OTHER MEDICARE PROVISIONS 
Subtitle A—Testing of Incentive Payments for Behavioral Health Providers for 
Adoption and Use of Certified Electronic Health Record Technology 
Sec. 6001. Testing of incentive payments for behavioral health providers for adop-
tion and use of certified electronic health record technology.
H. R. 6—4 
Subtitle B—Abuse Deterrent Access 
Sec. 6011. Short title. 
Sec. 6012. Study on abuse-deterrent opioid formulations access barriers under 
Medicare. 
Subtitle C—Medicare Opioid Safety Education 
Sec. 6021. Medicare opioid safety education. 
Subtitle D—Opioid Addiction Action Plan 
Sec. 6031. Short title. 
Sec. 6032. Action plan on recommendations for changes under Medicare and Med-
icaid to prevent opioids addictions and enhance access to medication-as-
sisted treatment. 
Subtitle E—Advancing High Quality Treatment for Opioid Use Disorders in 
Medicare 
Sec. 6041. Short title. 
Sec. 6042. Opioid use disorder treatment demonstration program. 
Subtitle F—Responsible Education Achieves Care and Healthy Outcomes for Users’ 
Treatment 
Sec. 6051. Short title. 
Sec. 6052. Grants to provide technical assistance to outlier prescribers of opioids. 
Subtitle G—Preventing Addiction for Susceptible Seniors 
Sec. 6061. Short title. 
Sec. 6062. Electronic prior authorization for covered part D drugs. 
Sec. 6063. Program integrity transparency measures under Medicare parts C and 
D. 
Sec. 6064. Expanding eligibility for medication therapy management programs 
under part D. 
Sec. 6065. Commit to opioid medical prescriber accountability and safety for sen-
iors. 
Sec. 6066. No additional funds authorized. 
Subtitle H—Expanding Oversight of Opioid Prescribing and Payment 
Sec. 6071. Short title. 
Sec. 6072. Medicare Payment Advisory Commission report on opioid payment, ad-
verse incentives, and data under the Medicare program. 
Sec. 6073. No additional funds authorized. 
Subtitle I—Dr. Todd Graham Pain Management, Treatment, and Recovery 
Sec. 6081. Short title. 
Sec. 6082. Review and adjustment of payments under the Medicare outpatient pro-
spective payment system to avoid financial incentives to use opioids in-
stead of non-opioid alternative treatments. 
Sec. 6083. Expanding access under the Medicare program to addiction treatment in 
Federally qualified health centers and rural health clinics. 
Sec. 6084. Studying the availability of supplemental benefits designed to treat or 
prevent substance use disorders under Medicare Advantage plans. 
Sec. 6085. Clinical psychologist services models under the Center for Medicare and 
Medicaid Innovation; GAO study and report. 
Sec. 6086. Dr. Todd Graham pain management study. 
Subtitle J—Combating Opioid Abuse for Care in Hospitals 
Sec. 6091. Short title. 
Sec. 6092. Developing guidance on pain management and opioid use disorder pre-
vention for hospitals receiving payment under part A of the Medicare 
program. 
Sec. 6093. Requiring the review of quality measures relating to opioids and opioid 
use disorder treatments furnished under the medicare program and 
other federal health care programs. 
Sec. 6094. Technical expert panel on reducing surgical setting opioid use; Data col-
lection on perioperative opioid use. 
Sec. 6095. Requiring the posting and periodic update of opioid prescribing guidance 
for Medicare beneficiaries. 
Subtitle K—Providing Reliable Options for Patients and Educational Resources 
Sec. 6101. Short title.
H. R. 6—5 
Sec. 6102. Requiring Medicare Advantage plans and part D prescription drug plans 
to include information on risks associated with opioids and coverage of 
nonpharmacological therapies and nonopioid medications or devices 
used to treat pain. 
Sec. 6103. Requiring Medicare Advantage plans and prescription drug plans to pro-
vide information on the safe disposal of prescription drugs. 
Sec. 6104. Revising measures used under the Hospital Consumer Assessment of 
Healthcare Providers and Systems survey relating to pain management. 
Subtitle L—Fighting the Opioid Epidemic With Sunshine 
Sec. 6111. Fighting the opioid epidemic with sunshine. 
TITLE VII—PUBLIC HEALTH PROVISIONS 
Subtitle A—Awareness and Training 
Sec. 7001. Report on effects on public health of synthetic drug use. 
Sec. 7002. First responder training. 
Subtitle B—Pilot Program for Public Health Laboratories To Detect Fentanyl and 
Other Synthetic Opioids 
Sec. 7011. Pilot program for public health laboratories to detect fentanyl and other 
synthetic opioids. 
Subtitle C—Indexing Narcotics, Fentanyl, and Opioids 
Sec. 7021. Establishment of substance use disorder information dashboard. 
Sec. 7022. Interdepartmental Substance Use Disorders Coordinating Committee. 
Sec. 7023. National milestones to measure success in curtailing the opioid crisis. 
Sec. 7024. Study on prescribing limits. 
Subtitle D—Ensuring Access to Quality Sober Living 
Sec. 7031. National recovery housing best practices. 
Subtitle E—Advancing Cutting Edge Research 
Sec. 7041. Unique research initiatives. 
Sec. 7042. Pain research. 
Subtitle F—Jessie’s Law 
Sec. 7051. Inclusion of opioid addiction history in patient records. 
Sec. 7052. Communication with families during emergencies. 
Sec. 7053. Development and dissemination of model training programs for sub-
stance use disorder patient records. 
Subtitle G—Protecting Pregnant Women and Infants 
Sec. 7061. Report on addressing maternal and infant health in the opioid crisis. 
Sec. 7062. Protecting moms and infants. 
Sec. 7063. Early interventions for pregnant women and infants. 
Sec. 7064. Prenatal and postnatal health. 
Sec. 7065. Plans of safe care. 
Subtitle H—Substance Use Disorder Treatment Workforce 
Sec. 7071. Loan repayment program for substance use disorder treatment work-
force. 
Sec. 7072. Clarification regarding service in schools and other community-based 
settings. 
Sec. 7073. Programs for health care workforce. 
Subtitle I—Preventing Overdoses While in Emergency Rooms 
Sec. 7081. Program to support coordination and continuation of care for drug over-
dose patients. 
Subtitle J—Alternatives to Opioids in the Emergency Department 
Sec. 7091. Emergency department alternatives to opioids demonstration program. 
Subtitle K—Treatment, Education, and Community Help To Combat Addiction 
Sec. 7101. Establishment of regional centers of excellence in substance use disorder 
education. 
Sec. 7102. Youth prevention and recovery. 
Subtitle L—Information From National Mental Health and Substance Use Policy 
Laboratory 
Sec. 7111. Information from National Mental Health and Substance Use Policy 
Laboratory.
H. R. 6—6 
Subtitle M—Comprehensive Opioid Recovery Centers 
Sec. 7121. Comprehensive opioid recovery centers. 
Subtitle N—Trauma-Informed Care 
Sec. 7131. CDC surveillance and data collection for child, youth, and adult trauma. 
Sec. 7132. Task force to develop best practices for trauma-informed identification, 
referral, and support. 
Sec. 7133. National Child Traumatic Stress Initiative. 
Sec. 7134. Grants to improve trauma support services and mental health care for 
children and youth in educational settings. 
Sec. 7135. Recognizing early childhood trauma related to substance abuse. 
Subtitle O—Eliminating Opioid Related Infectious Diseases 
Sec. 7141. Reauthorization and expansion of program of surveillance and education 
regarding infections associated with illicit drug use and other risk fac-
tors. 
Subtitle P—Peer Support Communities of Recovery 
Sec. 7151. Building communities of recovery. 
Sec. 7152. Peer support technical assistance center. 
Subtitle Q—Creating Opportunities That Necessitate New and Enhanced 
Connections That Improve Opioid Navigation Strategies 
Sec. 7161. Preventing overdoses of controlled substances. 
Sec. 7162. Prescription drug monitoring program. 
Subtitle R—Review of Substance Use Disorder Treatment Providers Receiving 
Federal Funding 
Sec. 7171. Review of substance use disorder treatment providers receiving Federal 
funding. 
Subtitle S—Other Health Provisions 
Sec. 7181. State response to the opioid abuse crisis. 
Sec. 7182. Report on investigations regarding parity in mental health and sub-
stance use disorder benefits. 
Sec. 7183. CAREER Act. 
TITLE VIII—MISCELLANEOUS 
Subtitle A—Synthetics Trafficking and Overdose Prevention 
Sec. 8001. Short title. 
Sec. 8002. Customs fees. 
Sec. 8003. Mandatory advance electronic information for postal shipments. 
Sec. 8004. International postal agreements. 
Sec. 8005. Cost recoupment. 
Sec. 8006. Development of technology to detect illicit narcotics. 
Sec. 8007. Civil penalties for postal shipments. 
Sec. 8008. Report on violations of arrival, reporting, entry, and clearance require-
ments and falsity or lack of manifest. 
Sec. 8009. Effective date; regulations. 
Subtitle B—Opioid Addiction Recovery Fraud Prevention 
Sec. 8021. Short title. 
Sec. 8022. Definitions. 
Sec. 8023. Unfair or deceptive acts or practices with respect to substance use dis-
order treatment service and products. 
Subtitle C—Addressing Economic and Workforce Impacts of the Opioid Crisis 
Sec. 8041. Addressing economic and workforce impacts of the opioid crisis. 
Subtitle D—Peer Support Counseling Program for Women Veterans 
Sec. 8051. Peer support counseling program for women veterans. 
Subtitle E—Treating Barriers to Prosperity 
Sec. 8061. Short title. 
Sec. 8062. Drug abuse mitigation initiative. 
Subtitle F—Pilot Program to Help Individuals in Recovery From a Substance Use 
Disorder Become Stably Housed 
Sec. 8071. Pilot program to help individuals in recovery from a substance use dis-
order become stably housed.
H. R. 6—7 
Subtitle G—Human Services 
Sec. 8081. Supporting family-focused residential treatment. 
Sec. 8082. Improving recovery and reunifying families. 
Sec. 8083. Building capacity for family-focused residential treatment. 
Subtitle H—Reauthorizing and Extending Grants for Recovery From Opioid Use 
Programs 
Sec. 8091. Short title. 
Sec. 8092. Reauthorization of the comprehensive opioid abuse grant program. 
Subtitle I—Fighting Opioid Abuse in Transportation 
Sec. 8101. Short title. 
Sec. 8102. Alcohol and controlled substance testing of mechanical employees. 
Sec. 8103. Department of Transportation public drug and alcohol testing database. 
Sec. 8104. GAO report on Department of Transportation’s collection and use of 
drug and alcohol testing data. 
Sec. 8105. Transportation Workplace Drug and Alcohol Testing Program; addition 
of fentanyl and other substances. 
Sec. 8106. Status reports on hair testing guidelines. 
Sec. 8107. Mandatory Guidelines for Federal Workplace Drug Testing Programs 
using Oral Fluid. 
Sec. 8108. Electronic recordkeeping. 
Sec. 8109. Status reports on Commercial Driver’s License Drug and Alcohol Clear-
inghouse. 
Subtitle J—Eliminating Kickbacks in Recovery 
Sec. 8121. Short title. 
Sec. 8122. Criminal penalties. 
Subtitle K—Substance Abuse Prevention 
Sec. 8201. Short title. 
Sec. 8202. Reauthorization of the Office of National Drug Control Policy. 
Sec. 8203. Reauthorization of the Drug-Free Communities Program. 
Sec. 8204. Reauthorization of the National Community Anti-Drug Coalition Insti-
tute. 
Sec. 8205. Reauthorization of the High-Intensity Drug Trafficking Area Program. 
Sec. 8206. Reauthorization of drug court program. 
Sec. 8207. Drug court training and technical assistance. 
Sec. 8208. Drug overdose response strategy. 
Sec. 8209. Protecting law enforcement officers from accidental exposure. 
Sec. 8210. COPS Anti-Meth Program. 
Sec. 8211. COPS anti-heroin task force program. 
Sec. 8212. Comprehensive Addiction and Recovery Act education and awareness. 
Sec. 8213. Reimbursement of substance use disorder treatment professionals. 
Sec. 8214. Sobriety Treatment and Recovery Teams (START). 
Sec. 8215. Provider education. 
Sec. 8216. Definitions. 
Sec. 8217. Amendments to administration of the Office. 
Sec. 8218. Emerging threats committee, plan, and media campaign. 
Sec. 8219. Drug interdiction. 
Sec. 8220. GAO Audit. 
Sec. 8221. National Drug Control Strategy. 
Sec. 8222. Technical and conforming amendments to the Office of National Drug 
Control Policy Reauthorization Act of 1998. 
Subtitle L—Budgetary Effects 
Sec. 8231. Budgetary effect. 
TITLE I—MEDICAID PROVISIONS TO 
ADDRESS THE OPIOID CRISIS 
SEC. 1001. AT-RISK YOUTH MEDICAID PROTECTION. 
(a) IN GENERAL.—Section 1902 of the Social Security Act (42 
U.S.C. 1396a) is amended— 
(1) in subsection (a)— 
(A) by striking ‘‘and’’ at the end of paragraph (82);
H. R. 6—8 
(B) by striking the period at the end of paragraph 
(83) and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (83) the following 
new paragraph: 
‘‘(84) provide that— 
‘‘(A) the State shall not terminate eligibility for medical 
assistance under the State plan for an individual who 
is an eligible juvenile (as defined in subsection (nn)(2)) 
because the juvenile is an inmate of a public institution 
(as defined in subsection (nn)(3)), but may suspend coverage 
during the period the juvenile is such an inmate; 
‘‘(B) in the case of an individual who is an eligible 
juvenile described in paragraph (2)(A) of subsection (nn), 
the State shall, prior to the individual’s release from such 
a public institution, conduct a redetermination of eligibility 
for such individual with respect to such medical assistance 
(without requiring a new application from the individual) 
and, if the State determines pursuant to such redetermina-
tion that the individual continues to meet the eligibility 
requirements for such medical assistance, the State shall 
restore coverage for such medical assistance to such an 
individual upon the individual’s release from such public 
institution; and 
‘‘(C) in the case of an individual who is an eligible 
juvenile described in paragraph (2)(B) of subsection (nn), 
the State shall process any application for medical assist-
ance submitted by, or on behalf of, such individual such 
that the State makes a determination of eligibility for 
such individual with respect to such medical assistance 
upon release of such individual from such public institu-
tion.’’; and 
(2) by adding at the end the following new subsection: 
‘‘(nn) JUVENILE; ELIGIBLE JUVENILE; PUBLIC INSTITUTION.—For 
purposes of subsection (a)(84) and this subsection: 
‘‘(1) JUVENILE.—The term ‘juvenile’ means an individual 
who is— 
‘‘(A) under 21 years of age; or 
‘‘(B) described in subsection (a)(10)(A)(i)(IX). 
‘‘(2) ELIGIBLE JUVENILE.—The term ‘eligible juvenile’ means 
a juvenile who is an inmate of a public institution and who— 
‘‘(A) was determined eligible for medical assistance 
under the State plan immediately before becoming an 
inmate of such a public institution; or 
‘‘(B) is determined eligible for such medical assistance 
while an inmate of a public institution. 
‘‘(3) INMATE OF A PUBLIC INSTITUTION.—The term ‘inmate 
of a public institution’ has the meaning given such term for 
purposes of applying the subdivision (A) following paragraph 
(30) of section 1905(a), taking into account the exception in 
such subdivision for a patient of a medical institution.’’. 
(b) NO CHANGE IN EXCLUSION FROM MEDICAL ASSISTANCE FOR 
INMATES OF PUBLIC INSTITUTIONS.—Nothing in this section shall 
be construed as changing the exclusion from medical assistance 
under the subdivision (A) following paragraph (30) of section 1905(a) 
of the Social Security Act (42 U.S.C. 1396d(a)), as redesignated
H. R. 6—9 
by section 1006(b)(2)(B) of this Act, including any applicable restric-
tions on a State submitting claims for Federal financial participation 
under title XIX of such Act for such assistance. 
(c) NO CHANGE IN CONTINUITY OF ELIGIBILITY BEFORE ADJU-
DICATION OR SENTENCING.—Nothing in this section shall be con-
strued to mandate, encourage, or suggest that a State suspend 
or terminate coverage for individuals before they have been adju-
dicated or sentenced. 
(d) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in paragraph (2), the 
amendments made by subsection (a) shall apply to eligibility 
of juveniles who become inmates of public institutions on or 
after the date that is 1 year after the date of the enactment 
of this Act. 
(2) RULE FOR CHANGES REQUIRING STATE LEGISLATION.— 
In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health 
and Human Services determines requires State legislation 
(other than legislation appropriating funds) in order for the 
plan to meet the additional requirements imposed by the 
amendments made by subsection (a), the State plan shall not 
be regarded as failing to comply with the requirements of 
such title solely on the basis of its failure to meet these addi-
tional requirements before the first day of the first calendar 
quarter beginning after the close of the first regular session 
of the State legislature that begins after the date of the enact-
ment of this Act. For purposes of the previous sentence, in 
the case of a State that has a 2-year legislative session, each 
year of such session shall be deemed to be a separate regular 
session of the State legislature. 
SEC. 1002. HEALTH INSURANCE FOR FORMER FOSTER YOUTH. 
(a) COVERAGE CONTINUITY FOR FORMER FOSTER CARE CHILDREN 
UP TO AGE 26.— 
(1) IN GENERAL.—Section 1902(a)(10)(A)(i)(IX) of the Social 
Security Act (42 U.S.C. 1396a(a)(10)(A)(i)(IX)) is amended— 
(A) in item (bb), by striking ‘‘are not described in 
or enrolled under’’ and inserting ‘‘are not described in and 
are not enrolled under’’; 
(B) in item (cc), by striking ‘‘responsibility of the State’’ 
and inserting ‘‘responsibility of a State’’; and 
(C) in item (dd), by striking ‘‘the State plan under 
this title or under a waiver of the’’ and inserting ‘‘a State 
plan under this title or under a waiver of such a’’. 
(2) EFFECTIVE DATE.—The amendments made by this sub-
section shall take effect with respect to foster youth who attain 
18 years of age on or after January 1, 2023. 
(b) GUIDANCE.—Not later than 1 year after the date of the 
enactment of this Act, the Secretary of Health and Human Services 
shall issue guidance to States, with respect to the State Medicaid 
programs of such States— 
(1) on best practices for— 
(A) removing barriers and ensuring streamlined, timely 
access to Medicaid coverage for former foster youth up 
to age 26; and
H. R. 6—10 
(B) conducting outreach and raising awareness among 
such youth regarding Medicaid coverage options for such 
youth; and 
(2) which shall include examples of States that have 
successfully extended Medicaid coverage to former foster youth 
up to age 26. 
SEC. 1003. DEMONSTRATION PROJECT TO INCREASE SUBSTANCE USE 
PROVIDER CAPACITY UNDER THE MEDICAID PROGRAM. 
Section 1903 of the Social Security Act (42 U.S.C. 1396b) is 
amended by adding at the end the following new subsection: 
‘‘(aa) DEMONSTRATION PROJECT TO INCREASE SUBSTANCE USE 
PROVIDER CAPACITY.— 
‘‘(1) IN
GENERAL.—Not later than the date that is 180 
days after the date of the enactment of this subsection, the 
Secretary shall, in consultation, as appropriate, with the 
Director of the Agency for Healthcare Research and Quality 
and the Assistant Secretary for Mental Health and Substance 
Use, conduct a 54-month demonstration project for the purpose 
described in paragraph (2) under which the Secretary shall— 
‘‘(A) for the first 18-month period of such project, award 
planning grants described in paragraph (3); and 
‘‘(B) for the remaining 36-month period of such project, 
provide to each State selected under paragraph (4) pay-
ments in accordance with paragraph (5). 
‘‘(2) PURPOSE.—The purpose described in this paragraph 
is for each State selected under paragraph (4) to increase the 
treatment capacity of providers participating under the State 
plan (or a waiver of such plan) to provide substance use disorder 
treatment or recovery services under such plan (or waiver) 
through the following activities: 
‘‘(A) For the purpose described in paragraph (3)(C)(i), 
activities that support an ongoing assessment of the behav-
ioral health treatment needs of the State, taking into 
account the matters described in subclauses (I) through 
(IV) of such paragraph. 
‘‘(B) Activities that, taking into account the results 
of the assessment described in subparagraph (A), support 
the recruitment, training, and provision of technical assist-
ance for providers participating under the State plan (or 
a waiver of such plan) that offer substance use disorder 
treatment or recovery services. 
‘‘(C) Improved reimbursement for and expansion of, 
through the provision of education, training, and technical 
assistance, the number or treatment capacity of providers 
participating under the State plan (or waiver) that— 
‘‘(i) are authorized to dispense drugs approved by 
the Food and Drug Administration for individuals with 
a substance use disorder who need withdrawal 
management or maintenance treatment for such dis-
order; 
‘‘(ii) have in effect a registration or waiver under 
section 303(g) of the Controlled Substances Act for 
purposes of dispensing narcotic drugs to individuals 
for maintenance treatment or detoxification treatment 
and are in compliance with any regulation promulgated
H. R. 6—11 
by the Assistant Secretary for Mental Health and Sub-
stance Use for purposes of carrying out the require-
ments of such section 303(g); and 
‘‘(iii) are qualified under applicable State law to 
provide substance use disorder treatment or recovery 
services. 
‘‘(D) Improved reimbursement for and expansion of, 
through the provision of education, training, and technical 
assistance, the number or treatment capacity of providers 
participating under the State plan (or waiver) that have 
the qualifications to address the treatment or recovery 
needs of— 
‘‘(i) individuals enrolled under the State plan (or 
a waiver of such plan) who have neonatal abstinence 
syndrome, in accordance with guidelines issued by the 
American Academy of Pediatrics and American College 
of Obstetricians and Gynecologists relating to maternal 
care and infant care with respect to neonatal 
abstinence syndrome; 
‘‘(ii) pregnant women, postpartum women, and 
infants, particularly the concurrent treatment, as 
appropriate, and comprehensive case management of 
pregnant women, postpartum women and infants, 
enrolled under the State plan (or a waiver of such 
plan); 
‘‘(iii) adolescents and young adults between the 
ages of 12 and 21 enrolled under the State plan (or 
a waiver of such plan); or 
‘‘(iv) American Indian and Alaska Native individ-
uals enrolled under the State plan (or a waiver of 
such plan). 
‘‘(3) PLANNING GRANTS.— 
‘‘(A) IN GENERAL.—The Secretary shall, with respect 
to the first 18-month period of the demonstration project 
conducted under paragraph (1), award planning grants to 
at least 10 States selected in accordance with subparagraph 
(B) for purposes of preparing an application described in 
paragraph (4)(C) and carrying out the activities described 
in subparagraph (C). 
‘‘(B) SELECTION.—In selecting States for purposes of 
this paragraph, the Secretary shall— 
‘‘(i) select States that have a State plan (or waiver 
of the State plan) approved under this title; 
‘‘(ii) select States in a manner that ensures 
geographic diversity; and 
‘‘(iii) give preference to States with a prevalence 
of substance use disorders (in particular opioid use 
disorders) that is comparable to or higher than the 
national average prevalence, as measured by aggregate 
per capita drug overdoses, or any other measure that 
the Secretary deems appropriate. 
‘‘(C) ACTIVITIES
DESCRIBED.—Activities described in 
this subparagraph are, with respect to a State, each of 
the following: 
‘‘(i) Activities that support the development of an 
initial assessment of the behavioral health treatment 
needs of the State to determine the extent to which
H. R. 6—12 
providers are needed (including the types of such pro-
viders and geographic area of need) to improve the 
network of providers that treat substance use disorders 
under the State plan (or waiver), including the fol-
lowing: 
‘‘(I) An estimate of the number of individuals 
enrolled under the State plan (or a waiver of such 
plan) who have a substance use disorder. 
‘‘(II) Information on the capacity of providers 
to provide substance use disorder treatment or 
recovery services to individuals enrolled under the 
State plan (or waiver), including information on 
providers who provide such services and their 
participation under the State plan (or waiver). 
‘‘(III) Information on the gap in substance use 
disorder treatment or recovery services under the 
State plan (or waiver) based on the information 
described in subclauses (I) and (II). 
‘‘(IV) Projections regarding the extent to which 
the State participating under the demonstration 
project would increase the number of providers 
offering substance use disorder treatment or 
recovery services under the State plan (or waiver) 
during the period of the demonstration project. 
‘‘(ii) Activities that, taking into account the results 
of the assessment described in clause (i), support the 
development of State infrastructure to, with respect 
to the provision of substance use disorder treatment 
or recovery services under the State plan (or a waiver 
of such plan), recruit prospective providers and provide 
training and technical assistance to such providers. 
‘‘(D) FUNDING.—For purposes of subparagraph (A), 
there is appropriated, out of any funds in the Treasury 
not otherwise appropriated, $50,000,000, to remain avail-
able until expended. 
‘‘(4) POST-PLANNING STATES.— 
‘‘(A) IN GENERAL.—The Secretary shall, with respect 
to the remaining 36-month period of the demonstration 
project conducted under paragraph (1), select not more 
than 5 States in accordance with subparagraph (B) for 
purposes of carrying out the activities described in para-
graph (2) and receiving payments in accordance with para-
graph (5). 
‘‘(B) SELECTION.—In selecting States for purposes of 
this paragraph, the Secretary shall— 
‘‘(i) select States that received a planning grant 
under paragraph (3); 
‘‘(ii) select States that submit to the Secretary 
an application in accordance with the requirements 
in subparagraph (C), taking into consideration the 
quality of each such application; 
‘‘(iii) select States in a manner that ensures 
geographic diversity; and 
‘‘(iv) give preference to States with a prevalence 
of substance use disorders (in particular opioid use 
disorders) that is comparable to or higher than the 
national average prevalence, as measured by aggregate
H. R. 6—13 
per capita drug overdoses, or any other measure that 
the Secretary deems appropriate. 
‘‘(C) APPLICATIONS.— 
‘‘(i) IN GENERAL.—A State seeking to be selected 
for purposes of this paragraph shall submit to the 
Secretary, at such time and in such form and manner 
as the Secretary requires, an application that includes 
such information, provisions, and assurances, as the 
Secretary may require, in addition to the following: 
‘‘(I) A proposed process for carrying out the 
ongoing assessment described in paragraph (2)(A), 
taking into account the results of the initial assess-
ment described in paragraph (3)(C)(i). 
‘‘(II) A review of reimbursement methodologies 
and other policies related to substance use disorder 
treatment or recovery services under the State 
plan (or waiver) that may create barriers to 
increasing the number of providers delivering such 
services. 
‘‘(III) The development of a plan, taking into 
account activities carried out under paragraph 
(3)(C)(ii), that will result in long-term and sustain-
able provider networks under the State plan (or 
waiver) that will offer a continuum of care for 
substance use disorders. Such plan shall include 
the following: 
‘‘(aa) Specific activities to increase the 
number of providers (including providers that 
specialize in providing substance use disorder 
treatment or recovery services, hospitals, 
health care systems, Federally qualified health 
centers, and, as applicable, certified commu-
nity behavioral health clinics) that offer sub-
stance use disorder treatment, recovery, or 
support services, including short-term detoxi-
fication services, outpatient substance use dis-
order 
services, 
and 
evidence-based 
peer 
recovery services. 
‘‘(bb) Strategies that will incentivize pro-
viders described in subparagraphs (C) and (D) 
of paragraph (2) to obtain the necessary 
training, education, and support to deliver 
substance use disorder treatment or recovery 
services in the State. 
‘‘(cc) Milestones and timeliness for imple-
menting activities set forth in the plan. 
‘‘(dd) Specific measurable targets for 
increasing the substance use disorder treat-
ment and recovery provider network under the 
State plan (or a waiver of such plan). 
‘‘(IV) A proposed process for reporting the 
information required under paragraph (6)(A), 
including information to assess the effectiveness 
of the efforts of the State to expand the capacity 
of providers to deliver substance use disorder treat-
ment or recovery services during the period of 
the demonstration project under this subsection.
H. R. 6—14 
‘‘(V) The expected financial impact of the dem-
onstration project under this subsection on the 
State. 
‘‘(VI) A description of all funding sources avail-
able to the State to provide substance use disorder 
treatment or recovery services in the State. 
‘‘(VII) A preliminary plan for how the State 
will sustain any increase in the capacity of pro-
viders to deliver substance use disorder treatment 
or recovery services resulting from the demonstra-
tion project under this subsection after the termi-
nation of such demonstration project. 
‘‘(VIII) A description of how the State will 
coordinate the goals of the demonstration project 
with any waiver granted (or submitted by the State 
and pending) pursuant to section 1115 for the 
delivery of substance use services under the State 
plan, as applicable. 
‘‘(ii) CONSULTATION.—In completing an application 
under clause (i), a State shall consult with relevant 
stakeholders, including Medicaid managed care plans, 
health care providers, and Medicaid beneficiary advo-
cates, and include in such application a description 
of such consultation. 
‘‘(5) PAYMENT.— 
‘‘(A) IN GENERAL.—For each quarter occurring during 
the period for which the demonstration project is conducted 
(after the first 18 months of such period), the Secretary 
shall pay under this subsection, subject to subparagraph 
(C), to each State selected under paragraph (4) an amount 
equal to 80 percent of so much of the qualified sums 
expended during such quarter. 
‘‘(B) QUALIFIED
SUMS
DEFINED.—For purposes of 
subparagraph (A), the term ‘qualified sums’ means, with 
respect to a State and a quarter, the amount equal to 
the amount (if any) by which the sums expended by the 
State during such quarter attributable to substance use 
disorder treatment or recovery services furnished by pro-
viders participating under the State plan (or a waiver 
of such plan) exceeds 1/4 of such sums expended by the 
State during fiscal year 2018 attributable to substance 
use disorder treatment or recovery services. 
‘‘(C) NON-DUPLICATION OF PAYMENT.—In the case that 
payment is made under subparagraph (A) with respect 
to expenditures for substance use disorder treatment or 
recovery services furnished by providers participating 
under the State plan (or a waiver of such plan), payment 
may not also be made under subsection (a) with respect 
to expenditures for the same services so furnished. 
‘‘(6) REPORTS.— 
‘‘(A) STATE
REPORTS.—A State receiving payments 
under paragraph (5) shall, for the period of the demonstra-
tion project under this subsection, submit to the Secretary 
a quarterly report, with respect to expenditures for sub-
stance use disorder treatment or recovery services for which 
payment is made to the State under this subsection, on 
the following:
H. R. 6—15 
‘‘(i) The specific activities with respect to which 
payment under this subsection was provided. 
‘‘(ii) The number of providers that delivered sub-
stance use disorder treatment or recovery services in 
the State under the demonstration project compared 
to the estimated number of providers that would have 
otherwise delivered such services in the absence of 
such demonstration project. 
‘‘(iii) The number of individuals enrolled under 
the State plan (or a waiver of such plan) who received 
substance use disorder treatment or recovery services 
under the demonstration project compared to the esti-
mated number of such individuals who would have 
otherwise received such services in the absence of such 
demonstration project. 
‘‘(iv) Other matters as determined by the Sec-
retary. 
‘‘(B) CMS REPORTS.— 
‘‘(i) INITIAL
REPORT.—Not later than October 1, 
2020, the Administrator of the Centers for Medicare 
& Medicaid Services shall, in consultation with the 
Director of the Agency for Healthcare Research and 
Quality and the Assistant Secretary for Mental Health 
and Substance Use, submit to Congress an initial 
report on— 
‘‘(I) the States awarded planning grants under 
paragraph (3); 
‘‘(II) the criteria used in such selection; and 
‘‘(III) the activities carried out by such States 
under such planning grants. 
‘‘(ii) INTERIM REPORT.—Not later than October 1, 
2022, the Administrator of the Centers for Medicare 
& Medicaid Services shall, in consultation with the 
Director of the Agency for Healthcare Research and 
Quality and the Assistant Secretary for Mental Health 
and Substance Use, submit to Congress an interim 
report— 
‘‘(I) on activities carried out under the dem-
onstration project under this subsection; 
‘‘(II) on the extent to which States selected 
under paragraph (4) have achieved the stated goals 
submitted in their applications under subpara-
graph (C) of such paragraph; 
‘‘(III) with a description of the strengths and 
limitations of such demonstration project; and 
‘‘(IV) with a plan for the sustainability of such 
project. 
‘‘(iii) FINAL
REPORT.—Not later than October 1, 
2024, the Administrator of the Centers for Medicare 
& Medicaid Services shall, in consultation with the 
Director of the Agency for Healthcare Research and 
Quality and the Assistant Secretary for Mental Health 
and Substance Use, submit to Congress a final report— 
‘‘(I) providing updates on the matters reported 
in the interim report under clause (ii); 
‘‘(II) including a description of any changes 
made with respect to the demonstration project
H. R. 6—16 
under this subsection after the submission of such 
interim report; and 
‘‘(III) evaluating such demonstration project. 
‘‘(C) AHRQ REPORT.—Not later than 3 years after the 
date of the enactment of this subsection, the Director of 
the Agency for Healthcare Research and Quality, in con-
sultation with the Administrator of the Centers for Medi-
care & Medicaid Services, shall submit to Congress a sum-
mary on the experiences of States awarded planning grants 
under paragraph (3) and States selected under paragraph 
(4). 
‘‘(7) DATA SHARING AND BEST PRACTICES.—During the period 
of the demonstration project under this subsection, the Sec-
retary shall, in collaboration with States selected under para-
graph (4), facilitate data sharing and the development of best 
practices between such States and States that were not so 
selected. 
‘‘(8) CMS FUNDING.—There is appropriated, out of any 
funds in the Treasury not otherwise appropriated, $5,000,000 
to the Centers for Medicare & Medicaid Services for purposes 
of implementing this subsection. Such amount shall remain 
available until expended.’’. 
SEC. 1004. MEDICAID DRUG REVIEW AND UTILIZATION. 
(a) MEDICAID DRUG UTILIZATION REVIEW.— 
(1) STATE
PLAN
REQUIREMENT.—Section 1902(a) of the 
Social Security Act (42 U.S.C. 1396a(a)), as amended by section 
1001, is further amended— 
(A) in paragraph (83), at the end, by striking ‘‘and’’; 
(B) in paragraph (84), at the end, by striking the 
period and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (84) the following 
new paragraph: 
‘‘(85) provide that the State is in compliance with the 
drug review and utilization requirements under subsection 
(oo)(1).’’. 
(2) DRUG REVIEW AND UTILIZATION REQUIREMENTS.—Section 
1902 of the Social Security Act (42 U.S.C. 1396a), as amended 
by section 1001, is further amended by adding at the end 
the following new subsection: 
‘‘(oo) DRUG REVIEW AND UTILIZATION REQUIREMENTS.— 
‘‘(1) IN GENERAL.—For purposes of subsection (a)(85), the 
drug review and utilization requirements under this subsection 
are, subject to paragraph (3) and beginning October 1, 2019, 
the following: 
‘‘(A) CLAIMS REVIEW LIMITATIONS.— 
‘‘(i) IN GENERAL.—The State has in place— 
‘‘(I) safety edits (as specified by the State) 
for subsequent fills for opioids and a claims review 
automated process (as designed and implemented 
by the State) that indicates when an individual 
enrolled under the State plan (or under a waiver 
of the State plan) is prescribed a subsequent fill 
of opioids in excess of any limitation that may 
be identified by the State; 
‘‘(II) safety edits (as specified by the State) 
on the maximum daily morphine equivalent that
H. R. 6—17 
can be prescribed to an individual enrolled under 
the State plan (or under a waiver of the State 
plan) for treatment of chronic pain and a claims 
review automated process (as designed and imple-
mented by the State) that indicates when an indi-
vidual enrolled under the plan (or waiver) is pre-
scribed the morphine equivalent for such treat-
ment in excess of any limitation that may be 
identified by the State; and 
‘‘(III) a claims review automated process (as 
designed and implemented by the State) that mon-
itors when an individual enrolled under the State 
plan (or under a waiver of the State plan) is 
concurrently prescribed opioids and— 
‘‘(aa) benzodiazepines; or 
‘‘(bb) antipsychotics. 
‘‘(ii) MANAGED CARE ENTITIES.—The State requires 
each managed care entity (as defined in section 
1932(a)(1)(B)) with respect to which the State has a 
contract under section 1903(m) or under section 
1905(t)(3) to have in place, subject to paragraph (3), 
with respect to individuals who are eligible for medical 
assistance under the State plan (or under a waiver 
of the State plan) and who are enrolled with the entity, 
the limitations described in subclauses (I) and (II) of 
clause (i) and a claims review automated process 
described in subclause (III) of such clause. 
‘‘(iii) RULES OF CONSTRUCTION.—Nothing in this 
subparagraph may be construed as prohibiting a State 
or managed care entity from designing and imple-
menting a claims review automated process under this 
subparagraph that provides for prospective or retro-
spective reviews of claims. Nothing in this subpara-
graph shall be understood as prohibiting the exercise 
of clinical judgment from a provider enrolled as a 
participating provider in a State plan (or waiver of 
the State plan) or contracting with a managed care 
entity regarding the best items and services for an 
individual enrolled under such State plan (or waiver). 
‘‘(B) PROGRAM
TO
MONITOR
ANTIPSYCHOTIC
MEDICA-
TIONS BY CHILDREN.—The State has in place a program 
(as designed and implemented by the State) to monitor 
and manage the appropriate use of antipsychotic medica-
tions by children enrolled under the State plan (or under 
a waiver of the State plan) and submits annually to the 
Secretary such information as the Secretary may require 
on activities carried out under such program for individuals 
not more than the age of 18 years generally and children 
in foster care specifically. 
‘‘(C) FRAUD AND ABUSE IDENTIFICATION.—The State has 
in place a process (as designed and implemented by the 
State) that identifies potential fraud or abuse of controlled 
substances by individuals enrolled under the State plan 
(or under a waiver of the State plan), health care providers 
prescribing drugs to individuals so enrolled, and phar-
macies dispensing drugs to individuals so enrolled.
H. R. 6—18 
‘‘(D) REPORTS.—The State shall include in the annual 
report 
submitted 
to 
the 
Secretary 
under 
section 
1927(g)(3)(D) information on the limitations, requirement, 
program, and processes applied by the State under subpara-
graphs (A) through (C) in accordance with such manner 
and time as specified by the Secretary. 
‘‘(E) CLARIFICATION.—Nothing shall prevent a State 
from satisfying the requirement— 
‘‘(i) described in subparagraph (A) by having safety 
edits or a claims review automated process described 
in such subparagraph that was in place before October 
1, 2019; 
‘‘(ii) described in subparagraph (B) by having a 
program described in such subparagraph that was in 
place before such date; or 
‘‘(iii) described in subparagraph (C) by having a 
process described in such subparagraph that was in 
place before such date. 
‘‘(2) ANNUAL REPORT BY SECRETARY.—For each fiscal year 
beginning with fiscal year 2020, the Secretary shall submit 
to Congress a report on the most recent information submitted 
by States under paragraph (1)(D). 
‘‘(3) EXCEPTIONS.— 
‘‘(A) 
CERTAIN
INDIVIDUALS
EXEMPTED.—The 
drug 
review and utilization requirements under this subsection 
shall not apply with respect to an individual who— 
‘‘(i) is receiving— 
‘‘(I) hospice or palliative care; or 
‘‘(II) treatment for cancer; 
‘‘(ii) is a resident of a long-term care facility, of 
a facility described in section 1905(d), or of another 
facility for which frequently abused drugs are dis-
pensed for residents through a contract with a single 
pharmacy; or 
‘‘(iii) the State elects to treat as exempted from 
such requirements. 
‘‘(B) EXCEPTION
RELATING
TO
ENSURING
ACCESS.—In 
order to ensure reasonable access to health care, the Sec-
retary shall waive the drug review and utilization require-
ments under this subsection, with respect to a State, in 
the case of natural disasters and similar situations, and 
in the case of the provision of emergency services (as 
defined for purposes of section 1860D–4(c)(5)(D)(ii)(II)).’’. 
(3) MANAGED CARE ENTITIES.—Section 1932 of the Social 
Security Act (42 U.S.C. 1396u–2) is amended by adding at 
the end the following new subsection: 
‘‘(i) DRUG
UTILIZATION
REVIEW
ACTIVITIES
AND
REQUIRE-
MENTS.—Beginning not later than October 1, 2019, each contract 
under a State plan with a managed care entity (other than a 
primary care case manager) under section 1903(m) shall provide 
that the entity is in compliance with the applicable provisions 
of section 438.3(s)(2) of title 42, Code of Federal Regulations, section 
483.3(s)(4)) of such title, and section 483.3(s)(5) of such title, as 
such provisions were in effect on March 31, 2018.’’. 
(b) IDENTIFYING AND ADDRESSING INAPPROPRIATE PRESCRIBING 
AND BILLING PRACTICES UNDER MEDICAID.—
H. R. 6—19 
(1) IN GENERAL.—Section 1927(g) of the Social Security 
Act (42 U.S.C. 1396r–8(g)) is amended— 
(A) in paragraph (1)(A)— 
(i) by striking ‘‘of section 1903(i)(10)(B)’’ and 
inserting ‘‘of section 1902(a)(54)’’; 
(ii) by striking ‘‘, by not later than January 1, 
1993,’’; 
(iii) by inserting after ‘‘gross overuse,’’ the fol-
lowing: ‘‘excessive utilization,’’; and 
(iv) by striking ‘‘or inappropriate or medically 
unnecessary care’’ and inserting ‘‘inappropriate or 
medically unnecessary care, or prescribing or billing 
practices that indicate abuse or excessive utilization’’; 
and 
(B) in paragraph (2)(B)— 
(i) by inserting after ‘‘gross overuse,’’ the following: 
‘‘excessive utilization,’’; and 
(ii) by striking ‘‘or inappropriate or medically 
unnecessary care’’ and inserting ‘‘inappropriate or 
medically unnecessary care, or prescribing or billing 
practices that indicate abuse or excessive utilization’’. 
(2) EFFECTIVE DATE.—The amendments made by paragraph 
(1) shall take effect with respect to retrospective drug use 
reviews conducted on or after October 1, 2020. 
SEC. 1005. GUIDANCE TO IMPROVE CARE FOR INFANTS WITH NEO-
NATAL ABSTINENCE SYNDROME AND THEIR MOTHERS; 
GAO STUDY ON GAPS IN MEDICAID COVERAGE FOR PREG-
NANT AND POSTPARTUM WOMEN WITH SUBSTANCE USE 
DISORDER. 
(a) GUIDANCE.—Not later than 1 year after the date of the 
enactment of this Act, the Secretary of Health and Human Services 
shall issue guidance to improve care for infants with neonatal 
abstinence syndrome and their families. Such guidance shall 
include— 
(1) best practices from States with respect to innovative 
or evidenced-based payment models that focus on prevention, 
screening, treatment, plans of safe care, and postdischarge 
services for mothers and fathers with substance use disorders 
and babies with neonatal abstinence syndrome that improve 
care and clinical outcomes; 
(2) recommendations for States on available financing 
options under the Medicaid program under title XIX of such 
Act and under the Children’s Health Insurance Program under 
title XXI of such Act for Children’s Health Insurance Program 
Health Services Initiative funds for parents with substance 
use disorders, infants with neonatal abstinence syndrome, and 
home-visiting services; 
(3) guidance and technical assistance to State Medicaid 
agencies regarding additional flexibilities and incentives related 
to screening, prevention, and postdischarge services, including 
parenting supports, and infant-caregiver bonding, including 
breastfeeding when it is appropriate; and 
(4) guidance regarding suggested terminology and ICD 
codes to identify infants with neonatal abstinence syndrome 
and neonatal opioid withdrawal syndrome, which could include 
opioid-exposure, 
opioid 
withdrawal 
not 
requiring
H. R. 6—20 
pharmacotherapy, 
and 
opioid 
withdrawal 
requiring 
pharmacotherapy. 
(b) GAO STUDY.—Not later than 1 year 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, addressing 
gaps in coverage for pregnant women with substance use disorder 
under the Medicaid program under title XIX of the Social Security 
Act, and gaps in coverage for postpartum women with substance 
use disorder who had coverage during their pregnancy under the 
Medicaid program under such title. 
SEC. 1006. MEDICAID HEALTH HOMES FOR SUBSTANCE-USE-DISORDER 
MEDICAID ENROLLEES. 
(a) EXTENSION
OF ENHANCED FMAP FOR CERTAIN HEALTH 
HOMES FOR INDIVIDUALS WITH SUBSTANCE USE DISORDERS.—Sec-
tion 1945(c) of the Social Security Act (42 U.S.C. 1396w–4(c)) is 
amended— 
(1) in paragraph (1), by inserting ‘‘subject to paragraph 
(4),’’ after ‘‘except that,’’; and 
(2) by adding at the end the following new paragraph: 
‘‘(4) SPECIAL RULE RELATING TO SUBSTANCE USE DISORDER 
HEALTH HOMES.— 
‘‘(A) IN GENERAL.—In the case of a State with an SUD- 
focused State plan amendment approved by the Secretary 
on or after October 1, 2018, the Secretary may, at the 
request of the State, extend the application of the Federal 
medical assistance percentage described in paragraph (1) 
to payments for the provision of health home services to 
SUD-eligible individuals under such State plan amend-
ment, in addition to the first 8 fiscal year quarters the 
State plan amendment is in effect, for the subsequent 
2 fiscal year quarters that the State plan amendment is 
in effect. Nothing in this section shall be construed as 
prohibiting a State with a State plan amendment that 
is approved under this section and that is not an SUD- 
focused State plan amendment from additionally having 
approved on or after such date an SUD-focused State plan 
amendment under this section, including for purposes of 
application of this paragraph. 
‘‘(B) REPORT REQUIREMENTS.—In the case of a State 
with an SUD-focused State plan amendment for which 
the application of the Federal medical assistance percent-
age has been extended under subparagraph (A), such State 
shall, at the end of the period of such State plan amend-
ment, submit to the Secretary a report on the following, 
with respect to SUD-eligible individuals provided health 
home services under such State plan amendment: 
‘‘(i) The quality of health care provided to such 
individuals, with a focus on outcomes relevant to the 
recovery of each such individual. 
‘‘(ii) The access of such individuals to health care. 
‘‘(iii) The total expenditures of such individuals 
for health care. 
For purposes of this subparagraph, the Secretary shall 
specify all applicable measures for determining quality, 
access, and expenditures.
H. R. 6—21 
‘‘(C) BEST PRACTICES.—Not later than October 1, 2020, 
the Secretary shall make publicly available on the internet 
website of the Centers for Medicare & Medicaid Services 
best practices for designing and implementing an SUD- 
focused State plan amendment, based on the experiences 
of States that have State plan amendments approved under 
this section that include SUD-eligible individuals. 
‘‘(D) DEFINITIONS.—For purposes of this paragraph: 
‘‘(i) SUD-ELIGIBLE INDIVIDUALS.—The term ‘SUD- 
eligible individual’ means, with respect to a State, an 
individual who satisfies all of the following: 
‘‘(I) The individual is an eligible individual 
with chronic conditions. 
‘‘(II) The individual is an individual with a 
substance use disorder. 
‘‘(III) The individual has not previously 
received health home services under any other 
State plan amendment approved for the State 
under this section by the Secretary. 
‘‘(ii) SUD-FOCUSED STATE PLAN AMENDMENT.—The 
term ‘SUD-focused State plan amendment’ means a 
State plan amendment under this section that is 
designed to provide health home services primarily 
to SUD-eligible individuals.’’. 
(b) REQUIREMENT FOR STATE MEDICAID PLANS TO PROVIDE COV-
ERAGE FOR MEDICATION-ASSISTED TREATMENT.— 
(1) REQUIREMENT FOR STATE MEDICAID PLANS TO PROVIDE 
COVERAGE
FOR
MEDICATION-ASSISTED
TREATMENT.—Section 
1902(a)(10)(A) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(10)(A)) is amended, in the matter preceding clause 
(i), by striking ‘‘and (28)’’ and inserting ‘‘(28), and (29)’’. 
(2) INCLUSION OF MEDICATION-ASSISTED TREATMENT AS MED-
ICAL ASSISTANCE.—Section 1905(a) of the Social Security Act 
(42 U.S.C. 1396d(a)) is amended— 
(A) in paragraph (28), by striking ‘‘and’’ at the end; 
(B) by redesignating paragraph (29) as paragraph (30); 
and 
(C) by inserting after paragraph (28) the following 
new paragraph: 
‘‘(29) subject to paragraph (2) of subsection (ee), for the 
period beginning October 1, 2020, and ending September 30, 
2025, medication-assisted treatment (as defined in paragraph 
(1) of such subsection); and’’. 
(3) MEDICATION-ASSISTED TREATMENT DEFINED; WAIVERS.— 
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is 
amended by adding at the end the following new subsection: 
‘‘(ee) MEDICATION-ASSISTED TREATMENT.— 
‘‘(1) DEFINITION.—For purposes of subsection (a)(29), the 
term ‘medication-assisted treatment’— 
‘‘(A) means all drugs approved under section 505 of 
the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355), 
including methadone, and all biological products licensed 
under section 351 of the Public Health Service Act (42 
U.S.C. 262) to treat opioid use disorders; and 
‘‘(B) includes, with respect to the provision of such 
drugs and biological products, counseling services and 
behavioral therapy.
H. R. 6—22 
‘‘(2) EXCEPTION.—The provisions of paragraph (29) of sub-
section (a) shall not apply with respect to a State for the 
period specified in such paragraph, if before the beginning 
of such period the State certifies to the satisfaction of the 
Secretary that implementing such provisions statewide for all 
individuals eligible to enroll in the State plan (or waiver of 
the State plan) would not be feasible by reason of a shortage 
of qualified providers of medication-assisted treatment, or facili-
ties providing such treatment, that will contract with the State 
or a managed care entity with which the State has a contract 
under section 1903(m) or under section 1905(t)(3).’’. 
(4) EFFECTIVE DATE.— 
(A) IN
GENERAL.—Subject to subparagraph (B), the 
amendments made by this subsection shall apply with 
respect to medical assistance provided on or after October 
1, 2020, and before October 1, 2025. 
(B) EXCEPTION FOR STATE LEGISLATION.—In the case 
of a State plan under title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.) that the Secretary of Health 
and Human Services determines requires State legislation 
in order for the respective plan to meet any requirement 
imposed by the amendments made by this subsection, the 
respective plan 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 legislature 
that begins after the date of the enactment of this Act. 
For purposes of the previous sentence, in the case of a 
State that has a 2-year legislative session, each year of 
the session shall be considered to be a separate regular 
session of the State legislature. 
SEC. 1007. CARING RECOVERY FOR INFANTS AND BABIES. 
(a) STATE PLAN AMENDMENT.—Section 1902(a) of the Social 
Security Act (42 U.S.C. 1396a(a)), as amended by sections 1001 
and 1004, is further amended— 
(1) in paragraph (84)(C), by striking ‘‘and’’ after the semi-
colon; 
(2) in paragraph (85), by striking the period at the end 
and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (85), the following new 
paragraph: 
‘‘(86) provide, at the option of the State, for making medical 
assistance available on an inpatient or outpatient basis at 
a residential pediatric recovery center (as defined in subsection 
(pp)) to infants with neonatal abstinence syndrome.’’. 
(b) RESIDENTIAL PEDIATRIC RECOVERY CENTER DEFINED.—Sec-
tion 1902 of such Act (42 U.S.C. 1396a), as amended by sections 
1001 and 1004, is further amended by adding at the end the 
following new subsection: 
‘‘(pp) RESIDENTIAL PEDIATRIC RECOVERY CENTER DEFINED.— 
‘‘(1) IN GENERAL.—For purposes of section 1902(a)(86), the 
term ‘residential pediatric recovery center’ means a center or 
facility that furnishes items and services for which medical 
assistance is available under the State plan to infants with
H. R. 6—23 
the diagnosis of neonatal abstinence syndrome without any 
other significant medical risk factors. 
‘‘(2) COUNSELING
AND
SERVICES.—A residential pediatric 
recovery center may offer counseling and other services to 
mothers (and other appropriate family members and care-
takers) of infants receiving treatment at such centers if such 
services are otherwise covered under the State plan under 
this title or under a waiver of such plan. Such other services 
may include the following: 
‘‘(A) Counseling or referrals for services. 
‘‘(B) Activities to encourage caregiver-infant bonding. 
‘‘(C) Training on caring for such infants.’’. 
(c) EFFECTIVE DATE.—The amendments made by this section 
take effect on the date of enactment of this Act and shall apply 
to medical assistance furnished on or after that date, without regard 
to final regulations to carry out such amendments being promul-
gated as of such date. 
SEC. 1008. PEER SUPPORT ENHANCEMENT AND EVALUATION REVIEW. 
(a) IN GENERAL.—Not later than 2 years after the date of 
the enactment of this Act, the Comptroller General of the United 
States shall submit to the Committee on Energy and Commerce 
of the House of Representatives, the Committee on Finance of 
the Senate, and the Committee on Health, Education, Labor and 
Pensions of the Senate a report on the provision of peer support 
services under the Medicaid program. 
(b) CONTENT OF REPORT.— 
(1) IN
GENERAL.—The report required under subsection 
(a) shall include the following information: 
(A) Information on State coverage of peer support serv-
ices under Medicaid, including— 
(i) the mechanisms through which States may pro-
vide such coverage, including through existing statu-
tory authority or through waivers; 
(ii) the populations to which States have provided 
such coverage; 
(iii) the payment models, including any alternative 
payment models, used by States to pay providers of 
such services; and 
(iv) where available, information on Federal and 
State spending under Medicaid for peer support serv-
ices. 
(B) Information on selected State experiences in pro-
viding medical assistance for peer support services under 
State Medicaid plans and whether States measure the 
effects of providing such assistance with respect to— 
(i) improving access to behavioral health services; 
(ii) improving early detection, and preventing wors-
ening, of behavioral health disorders; 
(iii) reducing chronic and comorbid conditions; and 
(iv) reducing overall health costs. 
(2) RECOMMENDATIONS.—The report required under sub-
section (a) shall include recommendations, including rec-
ommendations for such legislative and administrative actions 
related to improving services, including peer support services, 
and access to peer support services under Medicaid as the
H. R. 6—24 
Comptroller General of the United States determines appro-
priate. 
SEC. 1009. MEDICAID SUBSTANCE USE DISORDER TREATMENT VIA 
TELEHEALTH. 
(a) DEFINITIONS.—In this section: 
(1) COMPTROLLER GENERAL.—The term ‘‘Comptroller Gen-
eral’’ means the Comptroller General of the United States. 
(2) SCHOOL-BASED
HEALTH
CENTER.—The term ‘‘school- 
based health center’’ has the meaning given that term in section 
2110(c)(9) of the Social Security Act (42 U.S.C. 1397jj(c)(9)). 
(3) SECRETARY.—The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
(4) UNDERSERVED
AREA.—The term ‘‘underserved area’’ 
means a health professional shortage area (as defined in section 
332(a)(1)(A) of the Public Health Service Act (42 U.S.C. 
254e(a)(1)(A))) and a medically underserved area (according 
to a designation under section 330(b)(3)(A) of the Public Health 
Service Act (42 U.S.C. 254b(b)(3)(A))). 
(b) GUIDANCE TO STATES REGARDING FEDERAL REIMBURSEMENT 
FOR FURNISHING SERVICES AND TREATMENT FOR SUBSTANCE USE 
DISORDERS UNDER MEDICAID USING SERVICES DELIVERED VIA TELE-
HEALTH, INCLUDING IN SCHOOL-BASED HEALTH CENTERS.—Not later 
than 1 year after the date of enactment of this Act, the Secretary, 
acting through the Administrator of the Centers for Medicare & 
Medicaid Services, shall issue guidance to States on the following: 
(1) State options for Federal reimbursement of expenditures 
under Medicaid for furnishing services and treatment for sub-
stance use disorders, including assessment, medication-assisted 
treatment, counseling, medication management, and medication 
adherence with prescribed medication regimes, using services 
delivered via telehealth. Such guidance shall also include guid-
ance on furnishing services and treatments that address the 
needs of high-risk individuals, including at least the following 
groups: 
(A) American Indians and Alaska Natives. 
(B) Adults under the age of 40. 
(C) Individuals with a history of non-fatal overdose. 
(D) Individuals with a co-occurring serious mental ill-
ness and substance use disorder. 
(2) State options for Federal reimbursement of expenditures 
under Medicaid for education directed to providers serving Med-
icaid beneficiaries with substance use disorders using the hub 
and spoke model, through contracts with managed care entities, 
through administrative claiming for disease management activi-
ties, and under Delivery System Reform Incentive Payment 
(‘‘DSRIP’’) programs. 
(3) State options for Federal reimbursement of expenditures 
under Medicaid for furnishing services and treatment for sub-
stance use disorders for individuals enrolled in Medicaid in 
a school-based health center using services delivered via tele-
health. 
(c) GAO EVALUATION OF CHILDREN’S ACCESS TO SERVICES AND 
TREATMENT FOR SUBSTANCE USE DISORDERS UNDER MEDICAID.— 
(1) STUDY.—The Comptroller General shall evaluate chil-
dren’s access to services and treatment for substance use dis-
orders under Medicaid. The evaluation shall include an analysis
H. R. 6—25 
of State options for improving children’s access to such services 
and treatment and for improving outcomes, including by 
increasing the number of Medicaid providers who offer services 
or treatment for substance use disorders in a school-based 
health center using services delivered via telehealth, particu-
larly in rural and underserved areas. The evaluation shall 
include an analysis of Medicaid provider reimbursement rates 
for services and treatment for substance use disorders. 
(2) REPORT.—Not later than 1 year after the date of enact-
ment of this Act, the Comptroller General shall submit to 
Congress a report containing the results of the evaluation con-
ducted under paragraph (1), together with recommendations 
for such legislation and administrative action as the Comp-
troller General determines appropriate. 
(d) REPORT ON REDUCING BARRIERS TO USING SERVICES DELIV-
ERED VIA TELEHEALTH AND REMOTE PATIENT MONITORING FOR PEDI-
ATRIC POPULATIONS UNDER MEDICAID.— 
(1) IN
GENERAL.—Not later than 1 year after the date 
of enactment of this Act, the Secretary, acting through the 
Administrator of the Centers for Medicare & Medicaid Services, 
shall issue a report to the Committee on Finance of the Senate 
and the Committee on Energy and Commerce of the House 
of Representatives identifying best practices and potential solu-
tions for reducing barriers to using services delivered via tele-
health to furnish services and treatment for substance use 
disorders among pediatric populations under Medicaid. The 
report shall include— 
(A) analyses of the best practices, barriers, and poten-
tial solutions for using services delivered via telehealth 
to diagnose and provide services and treatment for children 
with substance use disorders, including opioid use disorder; 
and 
(B) identification and analysis of the differences, if 
any, in furnishing services and treatment for children with 
substance use disorders using services delivered via tele-
health and using services delivered in person, such as, 
and to the extent feasible, with respect to— 
(i) utilization rates; 
(ii) costs; 
(iii) avoidable inpatient admissions and readmis-
sions; 
(iv) quality of care; and 
(v) patient, family, and provider satisfaction. 
(2) PUBLICATION.—The Secretary shall publish the report 
required under paragraph (1) on a public internet website of 
the Department of Health and Human Services. 
SEC. 1010. ENHANCING PATIENT ACCESS TO NON-OPIOID TREATMENT 
OPTIONS. 
Not later than January 1, 2019, the Secretary of Health and 
Human Services, acting through the Administrator of the Centers 
for Medicare & Medicaid Services, shall issue 1 or more final 
guidance documents, or update existing guidance documents, to 
States regarding mandatory and optional items and services that 
may be provided under a State plan under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.), or under a waiver of such 
a plan, for non-opioid treatment and management of pain, including,
H. R. 6—26 
but not limited to, evidence-based, non-opioid pharmacological 
therapies and non-pharmacological therapies. 
SEC. 1011. ASSESSING BARRIERS TO OPIOID USE DISORDER TREAT-
MENT. 
(a) STUDY.— 
(1) IN GENERAL.—The Comptroller General of the United 
States (in this section referred to as the ‘‘Comptroller General’’) 
shall conduct a study regarding the barriers to providing medi-
cation used in the treatment of substance use disorders under 
Medicaid distribution models such as the ‘‘buy-and-bill’’ model, 
and options for State Medicaid programs to remove or reduce 
such barriers. The study shall include analyses of each of 
the following models of distribution of substance use disorder 
treatment medications, particularly buprenorphine, naltrexone, 
and buprenorphine-naloxone combinations: 
(A) The purchasing, storage, and administration of sub-
stance use disorder treatment medications by providers. 
(B) The dispensing of substance use disorder treatment 
medications by pharmacists. 
(C) The ordering, prescribing, and obtaining substance 
use disorder treatment medications on demand from spe-
cialty pharmacies by providers. 
(2) REQUIREMENTS.—For each model of distribution speci-
fied in paragraph (1), the Comptroller General shall evaluate 
how each model presents barriers or could be used by selected 
State Medicaid programs to reduce the barriers related to the 
provision of substance use disorder treatment by examining 
what is known about the effects of the model of distribution 
on— 
(A) Medicaid beneficiaries’ access to substance use dis-
order treatment medications; 
(B) the differential cost to the program between each 
distribution model for medication-assisted treatment; and 
(C) provider willingness to provide or prescribe sub-
stance use disorder treatment medications. 
(b) REPORT.—Not later than 15 months after the date of the 
enactment of this Act, the Comptroller General shall submit to 
Congress a report containing the results of the study conducted 
under subsection (a), together with recommendations for such legis-
lation and administrative action as the Comptroller General deter-
mines appropriate. 
SEC. 1012. HELP FOR MOMS AND BABIES. 
(a) MEDICAID STATE PLAN.—Section 1905(a) of the Social Secu-
rity Act (42 U.S.C. 1396d(a)), as amended by section 1006, is further 
amended by adding at the end the following new sentence: ‘‘In 
the case of a woman who is eligible for medical assistance on 
the basis of being pregnant (including through the end of the 
month in which the 60-day period beginning on the last day of 
her pregnancy ends), who is a patient in an institution for mental 
diseases for purposes of receiving treatment for a substance use 
disorder, and who was enrolled for medical assistance under the 
State plan immediately before becoming a patient in an institution 
for mental diseases or who becomes eligible to enroll for such 
medical assistance while such a patient, the exclusion from the 
definition of ‘medical assistance’ set forth in the subdivision (B) 
following paragraph (30) of the first sentence of this subsection
H. R. 6—27 
shall not be construed as prohibiting Federal financial participation 
for medical assistance for items or services that are provided to 
the woman outside of the institution.’’. 
(b) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in paragraph (2), the 
amendment made by subsection (a) shall take effect on the 
date of enactment of this Act. 
(2) RULE FOR CHANGES REQUIRING STATE LEGISLATION.— 
In the case of a State plan under title XIX of the Social 
Security Act which the Secretary of Health and Human Services 
determines requires State legislation (other than legislation 
appropriating funds) in order for the plan to meet the additional 
requirements imposed by the amendment made by subsection 
(a), the State plan shall not be regarded as failing to comply 
with the requirements of such title solely on the basis of its 
failure to meet these additional requirements before the first 
day of the first calendar quarter beginning after the close 
of the first regular session of the State legislature that begins 
after the date of the enactment of this Act. For purposes of 
the previous sentence, in the case of a State that has a 2- 
year legislative session, each year of such session shall be 
deemed to be a separate regular session of the State legislature. 
SEC. 1013. SECURING FLEXIBILITY TO TREAT SUBSTANCE USE DIS-
ORDERS. 
Section 1903(m) of the Social Security Act (42 U.S.C. 1396b(m)) 
is amended by adding at the end the following new paragraph: 
‘‘(7) Payment shall be made under this title to a State for 
expenditures for capitation payments described in section 438.6(e) 
of title 42, Code of Federal Regulations (or any successor regula-
tion).’’. 
SEC. 1014. MACPAC STUDY AND REPORT ON MAT UTILIZATION CON-
TROLS UNDER STATE MEDICAID PROGRAMS. 
(a) STUDY.—The Medicaid and CHIP Payment and Access 
Commission shall conduct a study and analysis of utilization control 
policies applied to medication-assisted treatment for substance use 
disorders under State Medicaid programs, including policies and 
procedures applied both in fee-for-service Medicaid and in risk- 
based managed care Medicaid, which shall— 
(1) include an inventory of such utilization control policies 
and related protocols for ensuring access to medically necessary 
treatment; 
(2) determine whether managed care utilization control 
policies and procedures for medication-assisted treatment for 
substance 
use 
disorders 
are 
consistent 
with 
section 
438.210(a)(4)(ii) of title 42, Code of Federal Regulations; and 
(3) identify policies that— 
(A) limit an individual’s access to medication-assisted 
treatment for a substance use disorder by limiting the 
quantity of medication-assisted treatment prescriptions, or 
the number of refills for such prescriptions, available to 
the individual as part of a prior authorization process 
or similar utilization protocols; and 
(B) apply without evaluating individual instances of 
fraud, waste, or abuse. 
(b) REPORT.—Not later than 1 year after the date of the enact-
ment of this Act, the Medicaid and CHIP Payment and Access
H. R. 6—49 
(21 U.S.C. 801 et seq.), are made available to the public and 
any barriers to the use of such disposal products; 
(4) identification of ways in which packaging technologies 
are made available to the public and any barriers to the use 
of such technologies; 
(5) a description of current Federal oversight, if any, of 
site-of-use, in-home controlled substance disposal products, 
including— 
(A) identification of the Federal agencies that oversee 
such products; 
(B) identification of the methods of disposal of con-
trolled substances recommended by such agencies for site- 
of-use, in-home disposal; and 
(C) a description of the effectiveness of such rec-
ommendations at preventing the diversion of legally pre-
scribed controlled substances; 
(6) a description of current Federal oversight, if any, of 
controlled substance packaging technologies, including— 
(A) identification of the Federal agencies that oversee 
such technologies; 
(B) identification of the technologies recommended by 
such agencies, including unit dose packaging, packaging 
that provides a set duration, and other packaging systems 
that may mitigate abuse or misuse; and 
(C) a description of the effectiveness of such rec-
ommendations at preventing the diversion of legally pre-
scribed controlled substances; and 
(7) recommendations, as appropriate, on— 
(A) whether site-of-use, in-home controlled substance 
disposal products and packaging technologies require Fed-
eral oversight and, if so, which agency or agencies should 
be responsible for such oversight and, as applicable, review 
of such products or technologies; and 
(B) whether there are applicable standards that should 
be considered to ensure the effectiveness of such products. 
CHAPTER 5—POSTAPPROVAL STUDY REQUIREMENTS 
SEC. 3041. CLARIFYING FDA POSTMARKET AUTHORITIES. 
(a) DEFINITION OF ADVERSE DRUG EXPERIENCE.—Section 505– 
1(b)(1)(E) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
355–1(b)(1)(E)) is amended by striking ‘‘of the drug’’ and inserting 
‘‘of the drug, which may include reduced effectiveness under the 
conditions of use prescribed in the labeling of such drug, but which 
may not include reduced effectiveness that is in accordance with 
such labeling’’. 
(b) SAFETY LABELING CHANGES.—Section 505(o)(4) of the Fed-
eral Food, Drug, and Cosmetic Act (21 U.S.C. 355(o)(4)) is 
amended— 
(1) in subparagraph (A) by— 
(A) striking ‘‘SAFETY
INFORMATION’’ and inserting 
‘‘SAFETY OR NEW EFFECTIVENESS INFORMATION’’; and 
(B) by striking ‘‘If the Secretary becomes’’ and all that 
follows through ‘‘in the labeling of the drug’’ and inserting 
‘‘If the Secretary becomes aware of new information, 
including any new safety information or information related
H. R. 6—68 
(B) in subsection (b)— 
(i) in the subsection heading, by inserting ‘‘OR BIO-
SIMILAR
BIOLOGICAL
PRODUCT
APPLICANT’’ 
after 
‘‘APPLICANT’’; 
(ii) in paragraph (1)(B), by striking the first sen-
tence and inserting the following: ‘‘A biosimilar 
biological product applicant that has submitted a bio-
similar biological product application that references 
a reference product and another biosimilar biological 
product applicant that has submitted a biosimilar 
biological product application that references the same 
reference product shall each file the agreement in 
accordance with subsection (c).’’; and 
(iii) in paragraph (2)— 
(I) by striking ‘‘2 generic drug applicants’’ and 
inserting ‘‘2 or more generic drug applicants’’; and 
(II) by striking ‘‘or an agreement between 2 
biosimilar biological product applicants regarding 
the 1-year period referred to in section 351(k)(6)(A) 
of the Public Health Service Act as it applies to 
the biosimilar biological product applications with 
which the agreement is concerned’’ and inserting 
‘‘, an agreement between 2 or more biosimilar 
biological product applicants regarding a time 
period 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 biosimilar biological product’’; and 
(C) in subsection (c)(2), by inserting ‘‘were entered 
into within 30 days of,’’ after ‘‘condition for,’’. 
TITLE V—OTHER MEDICAID 
PROVISIONS 
Subtitle A—Mandatory Reporting With Re-
spect to Adult Behavioral Health Meas-
ures 
SEC. 5001. MANDATORY REPORTING WITH RESPECT TO ADULT BEHAV-
IORAL HEALTH MEASURES. 
Section 1139B of the Social Security Act (42 U.S.C. 1320b– 
9b) is amended— 
(1) in subsection (b)— 
(A) in paragraph (3)— 
(i) by striking ‘‘Not later than 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 BEHAV-
IORAL HEALTH MEASURES.—Beginning with the State report 
required under subsection (d)(1) for 2024, the Secretary