IB 
Union Calendar No. 560 
115TH CONGRESS 
2D SESSION 
H. R. 5801 
[Report No. 115–725] 
To amend title XIX of the Social Security Act to provide for requirements 
under the Medicaid program relating to the use of qualified prescription 
drug monitoring programs and prescribing certain controlled substances. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 15, 2018 
Mr. GRIFFITH (for himself and Mr. FITZPATRICK) introduced the following 
bill; which was referred to the Committee on Energy and Commerce 
JUNE 12, 2018 
Additional sponsor: Mrs. BLACKBURN and Mr. WALDEN 
JUNE 12, 2018 
Reported with an amendment, committed to the Committee of the Whole 
House on the State of the Union, and ordered to be printed 
[Strike out all after the enacting clause and insert the part printed in italic] 
[For text of introduced bill, see copy of bill as introduced on May 15, 2018] 
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A BILL 
To amend title XIX of the Social Security Act to provide 
for requirements under the Medicaid program relating 
to the use of qualified prescription drug monitoring pro-
grams and prescribing certain controlled substances. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicaid Providers Are 
Required To Note Experiences in Record Systems to Help 
In-need Patients Act’’ or the ‘‘Medicaid PARTNERSHIP 
Act’’. 
SEC. 2. REQUIREMENTS UNDER THE MEDICAID PROGRAM 
RELATING 
TO 
QUALIFIED 
PRESCRIPTION 
DRUG MONITORING PROGRAMS AND PRE-
SCRIBING 
CERTAIN 
CONTROLLED 
SUB-
STANCES. 
Title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.) is amended by inserting after section 1943 the fol-
lowing new section: 
‘‘SEC. 1944. REQUIREMENTS RELATING TO QUALIFIED PRE-
SCRIPTION DRUG MONITORING PROGRAMS 
AND PRESCRIBING CERTAIN CONTROLLED 
SUBSTANCES. 
‘‘(a) IN GENERAL.—Beginning October 1, 2021, a 
State shall, subject to subsection (d), require each covered 
provider to check the prescription drug history of a covered 
individual being treated by the covered provider through a 
qualified prescription drug monitoring program described 
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in subsection (b) before prescribing to such individual a 
controlled substance. 
‘‘(b) QUALIFIED PRESCRIPTION DRUG MONITORING 
PROGRAM
DESCRIBED.—A qualified prescription drug 
monitoring program described in this subsection is, with 
respect to a State, a prescription drug monitoring program 
administered 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 
substances prescribed to and filled for the covered 
individual during at least the most recent 12- 
month period. 
‘‘(C) The name, location, and contact infor-
mation (or other identifying number selected by 
the State, such as a national provider identifier 
issued by the National Plan and Provider Enu-
meration System of the Centers for Medicare & 
Medicaid Services) of each covered provider who 
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prescribed a controlled substance to the covered 
individual during at least the most recent 12- 
month period. 
‘‘(2) The program facilitates the integration of 
information described in paragraph (1) into the 
workflow of a covered provider, which may include 
the electronic system the covered provider uses to pre-
scribe controlled substances. 
A qualified prescription drug monitoring program de-
scribed 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 pro-
gram that allows the medical director and pharmacy direc-
tor of such program (and any designee of such a director 
who reports directly to such director) to access the informa-
tion 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 medical director or pharmacy 
director of any managed care entity (as defined under sec-
tion 1932(a)(1)(B)) that has a contract with the State 
under section 1903(m) or under section 1905(t)(3), or the 
medical director or pharmacy director of any entity has 
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a contract to manage the pharmaceutical benefit with re-
spect to individuals enrolled in the State plan (or waiver 
of the State plan). All applicable 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, 
including requirements under the regulations promulgated 
pursuant to section 264(c) of the Health Insurance Port-
ability and Accountability Act of 1996 (42 U.S.C. 1320d– 
2 note), related to the sharing of data under subsection (b) 
in the same manner as the Secretary is required under sub-
paragraph (J) of section 1860D–4(c)(5) to clarify privacy 
requirements related to the sharing of data described in such 
subparagraph. 
‘‘(d) ENSURING ACCESS.—In order to ensure reason-
able access to health care, the Secretary may waive the ap-
plication of the requirement under subsection (a), with re-
spect 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)). 
‘‘(e) REPORTS.— 
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‘‘(1) STATE REPORTS.—Each State shall include 
in the annual report submitted to the Secretary under 
section 1927(g)(3)(D), beginning with such reports 
submitted for 2023, information including, at a min-
imum, the following information for the most recent 
12-month period: 
‘‘(A) The percentage of covered providers (as 
determined pursuant to a process established by 
the State) who checked the prescription drug his-
tory of a covered individual through a qualified 
prescription drug monitoring program described 
in subsection (b) before prescribing to such indi-
vidual a controlled substance. 
‘‘(B) Aggregate trends with respect to pre-
scribing controlled substances such as— 
‘‘(i) the number of pill counts and dos-
age for controlled substances; 
‘‘(ii) the number and dosage of con-
trolled substances prescribed per covered in-
dividual; and 
‘‘(iii) the types of controlled substances 
prescribed, including the dates of such pre-
scriptions, the supplies authorized (includ-
ing the duration of such supplies), and the 
period of validity of such prescriptions, in 
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different populations (such as individuals 
who are elderly, individuals with disabil-
ities, 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 
prescription drug history of a covered individual 
through a qualified drug management program 
before dispensing a controlled substance to such 
individual. 
‘‘(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 & Med-
icaid Services a report including the following infor-
mation: 
‘‘(A) Guidance for States on how States can 
increase the percentage of covered providers who 
use qualified prescription drug monitoring pro-
grams described in subsection (b). 
‘‘(B) Best practices for how States and cov-
ered providers should use such qualified prescrip-
tion drug monitoring programs to reduce the oc-
currence of abuse of controlled substances. 
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‘‘(f) INCREASE TO FEDERAL MATCHING RATE FOR 
CERTAIN EXPENDITURES RELATING TO QUALIFIED PRE-
SCRIPTION DRUG MANAGEMENT PROGRAMS.—The Sec-
retary shall increase the Federal medical assistance percent-
age or Federal matching rate that would otherwise apply 
to a State under section 1903(a) for a calendar quarter oc-
curring during the period beginning October 1, 2018, and 
ending September 30, 2021, for expenditures by the State 
for activities under the State plan (or waiver of the State 
plan) to implement a prescription drug management pro-
gram that satisfies the criteria described in paragraphs (1) 
and (2) of subsection (b) if the State (in this subsection 
referred to as the ‘administering State’) has in place agree-
ments with all States that are contiguous to such admin-
istering State that, when combined, enable covered pro-
viders in all such contiguous States to access, through the 
prescription drug management program, 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. In no case shall an increase under this subsection 
result in a Federal medical assistance percentage or Federal 
matching rate that exceeds 100 percent. 
‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec-
tion prevents a State from requiring pharmacists to check 
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the prescription drug history of covered individuals through 
a qualified drug management 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-
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 
individual’ means, with respect to a State, an indi-
vidual 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 facil-
ity, of a facility described in section 1905(d), or 
of another facility for which frequently abused 
drugs are dispensed for residents through a con-
tract with a single pharmacy; or 
‘‘(C) the State elects to treat as exempted 
from such term. 
‘‘(3) COVERED PROVIDER.— 
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‘‘(A) IN GENERAL.—The term ‘covered pro-
vider’ means, subject to subparagraph (B), with 
respect to a State, a health care provider who is 
participating under the State plan (or waiver of 
the State plan) and licensed, registered, or other-
wise permitted by the State to prescribe a con-
trolled substance (or the designee of such pro-
vider). 
‘‘(B) EXCEPTIONS.— 
‘‘(i) IN GENERAL.—Beginning October 
1, 2021, for purposes of this section, such 
term does not include a health care provider 
included in any type of health care provider 
determined by the Secretary to be exempt 
from application of this section under 
clause (ii). 
‘‘(ii) EXCEPTIONS PROCESS.—Not later 
than October 1, 2020, the Secretary, after 
consultation with the National Association 
of Medicaid Directors, national health care 
provider associations, Medicaid beneficiary 
advocates, and advocates for individuals 
with rare diseases, shall determine, based on 
such consultations, the types of health care 
providers (if any) that should be exempted 
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from the definition of the term ‘covered pro-
vider’ for purposes of this section.’’. 
SEC. 3. GUIDANCE. 
Not later than October 1, 2019, the Administrator of 
the Centers for Medicare & Medicaid Services, in consulta-
tion with the Director of the Centers for Disease Control 
and Prevention, shall issue guidance on best practices on 
the uses of prescription drug monitoring programs required 
of prescribers and on protecting the privacy of Medicaid 
beneficiary information maintained in and accessed 
through prescription drug monitoring programs. 
SEC. 4. DEVELOPMENT OF MODEL STATE PRACTICES. 
(a) IN GENERAL.—Not later than October 1, 2020, the 
Secretary of Health and Human Services shall develop and 
publish model practices to assist State Medicaid program 
operations in identifying and implementing strategies to 
utilize data sharing agreements described in the matter fol-
lowing paragraph (2) of section 1944(b) of the Social Secu-
rity Act, as added by section 2, for the following purposes: 
(1) Monitoring and preventing fraud, waste, and 
abuse. 
(2) Improving health care for individuals en-
rolled in a State plan under title XIX of such Act (or 
waiver of such plan) who— 
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(A) transition in and out of coverage under 
such title; 
(B) may have sources of health care cov-
erage in addition to coverage under such title; or 
(C) pay for prescription drugs with cash. 
(3) Any other purposes specified by the Sec-
retary. 
(b) ELEMENTS OF MODEL PRACTICES.—The model 
practices described in subsection (a)— 
(1) may include strategies for assisting States in 
allowing the medical director or pharmacy director 
(or designees of such a director) of managed care or-
ganizations or pharmaceutical benefit managers to 
access information with respect to all covered individ-
uals served by such managed care organizations or 
pharmaceutical benefit managers to access as a single 
data set, in an electronic format; and 
(2) shall include any appropriate beneficiary 
protections and privacy guidelines. 
(c) CONSULTATION.—In developing model practices 
under this section, the Secretary shall consult with the Na-
tional Association of Medicaid Directors, managed care en-
tities (as defined in section 1932(a)(1)(B) of the Social Se-
curity Act) with contracts with States pursuant to section 
1903(m) of such Act, pharmaceutical benefit managers, 
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physicians and other health care providers, beneficiary ad-
vocates, and individuals with expertise in health care tech-
nology related to prescription drug monitoring programs 
and electronic health records. 
SEC. 5. REPORT BY COMPTROLLER GENERAL. 
Not later than October 1, 2020, the Comptroller Gen-
eral of the United States shall issue a report examining 
the operation of prescription drug monitoring programs ad-
ministered by States, including data security and access 
standards used by such programs. 
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