IIB 
115TH CONGRESS 
2D SESSION 
H. R. 6110 
IN THE SENATE OF THE UNITED STATES 
JUNE 20, 2018 
Received; read twice and referred to the Committee on Finance 
AN ACT 
To amend title XVIII of the Social Security Act to provide 
for the review and adjustment of payments under the 
Medicare outpatient prospective payment system to avoid 
financial incentives to use opioids instead of non-opioid 
alternative treatments, and for other purposes. 
VerDate Sep 11 2014 
01:25 Jun 21, 2018
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6652
E:\BILLS\H6110.RFS
H6110
lotter on DSKBCFDHB2PROD with BILLS
HR 6110 RFS
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 ‘‘Dr. Todd Graham Pain 
Management, Treatment, and Recovery Act of 2018’’. 
SEC. 2. REVIEW AND ADJUSTMENT OF PAYMENTS UNDER 
THE MEDICARE OUTPATIENT PROSPECTIVE 
PAYMENT SYSTEM TO AVOID FINANCIAL IN-
CENTIVES TO USE OPIOIDS INSTEAD OF NON- 
OPIOID ALTERNATIVE TREATMENTS. 
(a) OUTPATIENT
PROSPECTIVE
PAYMENT
SYS-
TEM.—Section 1833(t) of the Social Security Act (42 
U.S.C. 1395l(t)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(22) REVIEW AND REVISIONS OF PAYMENTS 
FOR NON-OPIOID ALTERNATIVE TREATMENTS.— 
‘‘(A) IN GENERAL.—With respect to pay-
ments made under this subsection for covered 
OPD services (or groups of services), including 
covered OPD services assigned to a comprehen-
sive ambulatory payment classification, the Sec-
retary— 
‘‘(i) shall, as soon as practicable, con-
duct a review (part of which may include 
a request for information) of payments for 
VerDate Sep 11 2014 
01:25 Jun 21, 2018
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H6110.RFS
H6110
lotter on DSKBCFDHB2PROD with BILLS
HR 6110 RFS
opioids and evidence-based non-opioid al-
ternatives for pain management (including 
drugs and devices, nerve blocks, surgical 
injections, and neuromodulation) with a 
goal of ensuring that there are not finan-
cial incentives to use opioids instead of 
non-opioid alternatives; 
‘‘(ii) may, as the Secretary determines 
appropriate, conduct subsequent reviews of 
such payments; and 
‘‘(iii) shall consider the extent to 
which revisions under this subsection to 
such payments (such as the creation of ad-
ditional groups of covered OPD services to 
classify separately those procedures that 
utilize opioids and non-opioid alternatives 
for pain management) would reduce pay-
ment incentives to use opioids instead of 
non-opioid alternatives for pain manage-
ment. 
‘‘(B) PRIORITY.—In conducting the review 
under clause (i) of subparagraph (A) and con-
sidering revisions under clause (iii) of such sub-
paragraph, the Secretary shall focus on covered 
OPD services (or groups of services) assigned 
VerDate Sep 11 2014 
01:25 Jun 21, 2018
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H6110.RFS
H6110
lotter on DSKBCFDHB2PROD with BILLS
HR 6110 RFS
to a comprehensive ambulatory payment classi-
fication, ambulatory payment classifications 
that primarily include surgical services, and 
other services determined by the Secretary 
which generally involve treatment for pain man-
agement. 
‘‘(C) REVISIONS.—If the Secretary identi-
fies revisions to payments pursuant to subpara-
graph (A)(iii), the Secretary shall, as deter-
mined appropriate, begin making such revisions 
for services furnished on or after January 1, 
2020. Revisions under the previous sentence 
shall be treated as adjustments for purposes of 
application of paragraph (9)(B). 
‘‘(D) RULES OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed to preclude 
the Secretary— 
‘‘(i) from conducting a demonstration 
before making the revisions described in 
subparagraph (C); or 
‘‘(ii) prior to implementation of this 
paragraph, from changing payments under 
this subsection for covered OPD services 
(or groups of services) which include 
VerDate Sep 11 2014 
01:25 Jun 21, 2018
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H6110.RFS
H6110
lotter on DSKBCFDHB2PROD with BILLS
HR 6110 RFS
opioids or non-opioid alternatives for pain 
management.’’. 
(b) AMBULATORY
SURGICAL
CENTERS.—Section 
1833(i) of the Social Security Act (42 U.S.C. 1395l(i)) 
is amended by adding at the end the following new para-
graph: 
‘‘(8) The Secretary shall conduct a similar type of 
review as required under paragraph (22) of section 
1833(t)), including the second sentence of subparagraph 
(C) of such paragraph, to payment for services under this 
subsection, and make such revisions under this paragraph, 
in an appropriate manner (as determined by the Sec-
retary).’’. 
SEC. 3. EXPANDING ACCESS UNDER THE MEDICARE PRO-
GRAM TO ADDICTION TREATMENT IN FEDER-
ALLY QUALIFIED HEALTH CENTERS AND 
RURAL HEALTH CLINICS. 
(a) FEDERALLY QUALIFIED HEALTH CENTERS.— 
Section 1834(o) of the Social Security Act (42 U.S.C. 
1395m(o)) is amended by adding at the end the following 
new paragraph: 
‘‘(3) ADDITIONAL
PAYMENTS
FOR
CERTAIN 
FQHCS WITH PHYSICIANS OR OTHER PRACTITIONERS 
RECEIVING DATA 2000 WAIVERS.— 
VerDate Sep 11 2014 
01:25 Jun 21, 2018
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H6110.RFS
H6110
lotter on DSKBCFDHB2PROD with BILLS
HR 6110 RFS
‘‘(A) IN GENERAL.—In the case of a Fed-
erally qualified health center with respect to 
which, beginning on or after January 1, 2019, 
Federally-qualified health center services (as de-
fined in section 1861(aa)(3)) are furnished for 
the treatment of opioid use disorder by a physi-
cian or practitioner who meets the requirements 
described in subparagraph (C) the Secretary 
shall, subject to availability of funds under sub-
paragraph (D), make a payment (at such time 
and in such manner as specified by the Sec-
retary) to such Federally qualified health center 
after receiving and approving an application 
submitted by such Federally qualified health 
center under subparagraph (B). Such a pay-
ment shall be in an amount determined by the 
Secretary, based on an estimate of the average 
costs of training for purposes of receiving a 
waiver described in subparagraph (C)(ii). Such 
a payment may be made only one time with re-
spect to each such physician or practitioner. 
‘‘(B) APPLICATION.—In order to receive a 
payment described in subparagraph (A), a Fed-
erally-qualified health center shall submit to the 
Secretary an application for such a payment at 
VerDate Sep 11 2014 
01:25 Jun 21, 2018
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H6110.RFS
H6110
lotter on DSKBCFDHB2PROD with BILLS
HR 6110 RFS
such time, in such manner, and containing such 
information as specified by the Secretary. A 
Federally-qualified health center may apply for 
such a payment for each physician or practi-
tioner described in subparagraph (A) furnishing 
services described in such subparagraph at such 
center. 
‘‘(C) REQUIREMENTS.—For purposes of 
subparagraph (A), the requirements described 
in this subparagraph, with respect to a physi-
cian or practitioner, are the following: 
‘‘(i) The physician or practitioner is 
employed by or working under contract 
with a Federally qualified health center de-
scribed in subparagraph (A) that submits 
an application under subparagraph (B). 
‘‘(ii) The physician or practitioner 
first receives a waiver under section 303(g) 
of the Controlled Substances Act on or 
after January 1, 2019. 
‘‘(D) FUNDING.—For purposes of making 
payments under this paragraph, there are ap-
propriated, out of amounts in the Treasury not 
otherwise appropriated, $6 million, which shall 
remain available until expended.’’. 
VerDate Sep 11 2014 
01:25 Jun 21, 2018
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H6110.RFS
H6110
lotter on DSKBCFDHB2PROD with BILLS
HR 6110 RFS
(b) RURAL HEALTH CLINIC.—Section 1833 of the 
Social Security Act (42 U.S.C. 1395l) is amended— 
(1) by redesignating the subsection (z) relating 
to medical review of spinal subluxation services as 
subsection (aa); and 
(2) by adding at the end the following new sub-
section: 
‘‘(bb) ADDITIONAL PAYMENTS FOR CERTAIN RURAL 
HEALTH CLINICS WITH PHYSICIANS OR PRACTITIONERS 
RECEIVING DATA 2000 WAIVERS.— 
‘‘(1) IN
GENERAL.—In the case of a rural 
health clinic with respect to which, beginning on or 
after January 1, 2019, rural health clinic services 
(as defined in section 1861(aa)(1)) are furnished for 
the treatment of opioid use disorder by a physician 
or practitioner who meets the requirements de-
scribed in paragraph (3), the Secretary shall, subject 
to availability of funds under paragraph (4), make 
a payment (at such time and in such manner as 
specified by the Secretary) to such rural health clinic 
after receiving and approving an application de-
scribed in paragraph (2). Such payment shall be in 
an amount determined by the Secretary, based on an 
estimate of the average costs of training for pur-
poses of receiving a waiver described in paragraph 
VerDate Sep 11 2014 
01:25 Jun 21, 2018
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H6110.RFS
H6110
lotter on DSKBCFDHB2PROD with BILLS
HR 6110 RFS
(3)(B). Such payment may be made only one time 
with respect to each such physician or practitioner. 
‘‘(2) APPLICATION.—In order to receive a pay-
ment described in paragraph (1), a rural health clin-
ic shall submit to the Secretary an application for 
such a payment at such time, in such manner, and 
containing such information as specified by the Sec-
retary. A rural health clinic may apply for such a 
payment for each physician or practitioner described 
in paragraph (1) furnishing services described in 
such paragraph at such clinic. 
‘‘(3) REQUIREMENTS.—For purposes of para-
graph (1), the requirements described in this para-
graph, with respect to a physician or practitioner, 
are the following: 
‘‘(A) The physician or practitioner is em-
ployed by or working under contract with a 
rural health clinic described in paragraph (1) 
that submits an application under paragraph 
(2). 
‘‘(B) The physician or practitioner first re-
ceives a waiver under section 303(g) of the 
Controlled Substances Act on or after January 
1, 2019. 
VerDate Sep 11 2014 
01:25 Jun 21, 2018
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H6110.RFS
H6110
lotter on DSKBCFDHB2PROD with BILLS
HR 6110 RFS
‘‘(4) FUNDING.—For purposes of making pay-
ments under this subsection, there are appropriated, 
out of amounts in the Treasury not otherwise appro-
priated, $2 million, which shall remain available 
until expended.’’. 
SEC. 4. STUDYING THE AVAILABILITY OF SUPPLEMENTAL 
BENEFITS DESIGNED TO TREAT OR PREVENT 
SUBSTANCE USE DISORDERS UNDER MEDI-
CARE ADVANTAGE PLANS. 
(a) IN GENERAL.—Not later than 2 years after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services (in this section referred to as the 
‘‘Secretary’’) shall submit to Congress a report on the 
availability of supplemental health care benefits (as de-
scribed in section 1852(a)(3)(A) of the Social Security Act 
(42 U.S.C. 1395w–22(a)(3)(A))) designed to treat or pre-
vent substance use disorders under Medicare Advantage 
plans offered under part C of title XVIII of such Act. Such 
report shall include the analysis described in subsection 
(c) and any differences in the availability of such benefits 
under specialized MA plans for special needs individuals 
(as defined in section 1859(b)(6) of such Act (42 U.S.C. 
1395w–28(b)(6))) offered to individuals entitled to med-
ical assistance under title XIX of such Act and other such 
Medicare Advantage plans. 
VerDate Sep 11 2014 
01:25 Jun 21, 2018
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H6110.RFS
H6110
lotter on DSKBCFDHB2PROD with BILLS
HR 6110 RFS
(b) CONSULTATION.—The Secretary shall develop the 
report described in subsection (a) in consultation with rel-
evant stakeholders, including— 
(1) individuals entitled to benefits under part A 
or enrolled under part B of title XVIII of the Social 
Security Act; 
(2) entities who advocate on behalf of such indi-
viduals; 
(3) Medicare Advantage organizations; 
(4) pharmacy benefit managers; and 
(5) providers of services and suppliers (as such 
terms are defined in section 1861 of such Act (42 
U.S.C. 1395x)). 
(c) CONTENTS.—The report described in subsection 
(a) shall include an analysis on the following: 
(1) The extent to which plans described in such 
subsection offer supplemental health care benefits 
relating to coverage of— 
(A) medication-assisted treatments for 
opioid use, substance use disorder counseling, 
peer recovery support services, or other forms 
of substance use disorder treatments (whether 
furnished in an inpatient or outpatient setting); 
and 
VerDate Sep 11 2014 
01:25 Jun 21, 2018
Jkt 079200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H6110.RFS
H6110
lotter on DSKBCFDHB2PROD with BILLS
HR 6110 RFS
(B) non-opioid alternatives for the treat-
ment of pain. 
(2) Challenges associated with such plans offer-
ing supplemental health care benefits relating to cov-
erage of items and services described in subpara-
graph (A) or (B) of paragraph (1). 
(3) The impact, if any, of increasing the appli-
cable rebate percentage determined under section 
1854(b)(1)(C) of the Social Security Act (42 U.S.C. 
1395w–24(b)(1)(C)) for plans offering such benefits 
relating to such coverage would have on the avail-
ability of such benefits relating to such coverage of-
fered under Medicare Advantage plans. 
(4) Potential ways to improve upon such cov-
erage or to incentivize such plans to offer additional 
supplemental health care benefits relating to such 
coverage. 
SEC. 
5. 
CLINICAL 
PSYCHOLOGIST 
SERVICES 
MODELS 
UNDER THE CENTER FOR MEDICARE AND 
MEDICAID INNOVATION; GAO STUDY AND RE-
PORT. 
(a) CMI MODELS.—Section 1115A(b)(2)(B) of the 
Social Security Act (42 U.S.C. 1315a(b)(2)(B) is amend-
ed by adding at the end the following new clauses: 
VerDate Sep 11 2014 
01:25 Jun 21, 2018
Jkt 079200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H6110.RFS
H6110
lotter on DSKBCFDHB2PROD with BILLS