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title XI of the Social Security Act (42 U.S.C. 
1320c et seq.). 
(2) OUTLIER
PRESCRIBER
OF
OPIOIDS.—The 
term ‘‘outlier prescriber of opioids’’ means a pre-
scriber, identified by the Secretary of Health and 
Human Services (through use of prescriber informa-
tion provided by prescriber National Provider Identi-
fiers included pursuant to section 1860D–4(c)(4)(A) 
of the Social Security Act (42 U.S.C. 1395w– 
104(c)(4)(A)) on claims for covered part D drugs for 
part D eligible individuals enrolled in prescription 
drug plans under part D of title XVIII of such Act 
(42 U.S.C. 1395w–101 et seq.) and MA–PD plans 
under part C of such title (42 U.S.C. 1395w–21 et 
seq.)) as prescribing, as compared to other pre-
scribers in the specialty of the prescriber and geo-
graphic area, amounts of opioids in excess of a 
threshold (and other criteria) specified by the Sec-
retary, after consultation with stakeholders. 
(3) PRESCRIBERS.—The term ‘‘prescriber’’ 
means any health care professional, including a 
nurse practitioner or physician assistant, who is li-
censed to prescribe opioids by the State or territory 
in which such professional practices. 
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(f) FUNDING.—For purposes of implementing this 
section, $75 million shall be available from the Federal 
Supplementary Medical Insurance Trust Fund under sec-
tion 1841 of the Social Security Act (42 U.S.C. 1395t), 
to remain available until expended. 
SEC. 3. PROMOTING VALUE IN MEDICAID MANAGED CARE. 
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)(A) With respect to expenditures described in 
subparagraph (B) that are incurred by a State for any 
fiscal year after fiscal year 2025 (and before fiscal year 
2029), in determining the pro rata share to which the 
United States is equitably entitled under subsection 
(d)(3), the Secretary shall substitute the Federal medical 
assistance percentage that applies for such fiscal year to 
the State under section 1905(b) (without regard to any 
adjustments to such percentage applicable under such sec-
tion or any other provision of law) for the percentage that 
applies to such expenditures under section 1905(y). 
‘‘(B) Expenditures described in this subparagraph, 
with respect to a fiscal year to which subparagraph (A) 
applies, are expenditures incurred by a State for payment 
for medical assistance provided to individuals described in 
subclause (VIII) of section 1902(a)(10)(A)(i) by a man-
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aged care entity, or other specified entity (as defined in 
subparagraph (D)(iii)), that are treated as remittances be-
cause the State— 
‘‘(i) has satisfied the requirement of section 
438.8 of title 42, Code of Federal Regulations (or 
any successor regulation), by electing— 
‘‘(I) in the case of a State described in 
subparagraph (C), to apply a minimum medical 
loss ratio (as defined in subparagraph (D)(ii)) 
that is at least 85 percent but not greater than 
the minimum medical loss ratio (as so defined) 
that such State applied as of May 31, 2018; or 
‘‘(II) in the case of a State not described 
in subparagraph (C), to apply a minimum med-
ical loss ratio that is equal to 85 percent; and 
‘‘(ii) recovered all or a portion of the expendi-
tures as a result of the entity’s failure to meet such 
ratio. 
‘‘(C) For purposes of subparagraph (B), a State de-
scribed in this subparagraph is a State that as of May 
31, 2018, applied a minimum medical loss ratio (as cal-
culated under subsection (d) of section 438.8 of title 42, 
Code of Federal Regulations (as in effect on June 1, 
2018)) for payment for services provided by entities de-
scribed in such subparagraph under the State plan under 
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this title (or a waiver of the plan) that is equal to or great-
er than 85 percent. 
‘‘(D) For purposes of this paragraph: 
‘‘(i) The term ‘managed care entity’ means a 
medicaid managed care organization described in 
section 1932(a)(1)(B)(i). 
‘‘(ii) The term ‘minimum medical loss ratio’ 
means, with respect to a State, a minimum medical 
loss ratio (as calculated under subsection (d) of sec-
tion 438.8 of title 42, Code of Federal Regulations 
(as in effect on June 1, 2018)) for payment for serv-
ices provided by entities described in subparagraph 
(B) under the State plan under this title (or a waiv-
er of the plan). 
‘‘(iii) The term ‘other specified entity’ means— 
‘‘(I) a prepaid inpatient health plan, as de-
fined in section 438.2 of title 42, Code of Fed-
eral Regulations (or any successor regulation); 
and 
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‘‘(II) a prepaid ambulatory health plan, as 
defined in such section (or any successor regu-
lation).’’. 
Passed the House of Representatives June 19, 2018. 
Attest: 
KAREN L. HAAS, 
Clerk. 
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