datamatters24/research-document-archive huggingface dataset:
‘‘(i) individuals enrolled under the 
State plan (or a waiver of such plan) who 
have neonatal abstinence syndrome, in ac-
cordance 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 con-
current treatment, as appropriate, and 
comprehensive case management of preg-
nant women, postpartum women and in-
fants, enrolled under the State plan (or a 
waiver of such plan); 
‘‘(iii) adolescents and young adults be-
tween the ages of 12 and 21 enrolled 
under the State plan (or a waiver of such 
plan); or 
‘‘(iv) American Indian and Alaska Na-
tive individuals enrolled under the State 
plan (or a waiver of such plan). 
‘‘(3) PLANNING GRANTS.— 
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‘‘(A) IN GENERAL.—The Secretary shall, 
with respect to the first 18-month period of the 
demonstration project conducted under para-
graph (1), award planning grants to at least 10 
States selected in accordance with subpara-
graph (B) for purposes of preparing an applica-
tion 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 aggre-
gate per capita drug overdoses, or any 
other measure that the Secretary deems 
appropriate. 
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‘‘(C) ACTIVITIES
DESCRIBED.—Activities 
described in this subparagraph are, with respect 
to a State, each of the following: 
‘‘(i) Activities that support the devel-
opment of an initial assessment of the be-
havioral health treatment needs of the 
State to determine the extent to which pro-
viders are needed (including the types of 
such providers and geographic area of 
need) to improve the network of providers 
that treat substance use disorders under 
the State plan (or waiver), including the 
following: 
‘‘(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 serv-
ices to individuals enrolled under the 
State plan (or waiver), including in-
formation on providers who provide 
such services and their participation 
under the State plan (or waiver). 
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‘‘(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 partici-
pating 
under 
the 
demonstration 
project would increase the number of 
providers offering substance use dis-
order treatment or recovery services 
under the State plan (or waiver) dur-
ing the period of the demonstration 
project. 
‘‘(ii) Activities that, taking into ac-
count the results of the assessment de-
scribed in clause (i), support the develop-
ment of State infrastructure to, with re-
spect to the provision of substance use dis-
order 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. 
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‘‘(D) FUNDING.—For purposes of subpara-
graph (A), there is appropriated, out of any 
funds in the Treasury not otherwise appro-
priated, $50,000,000, to remain available 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 paragraph (5). 
‘‘(B) SELECTION.—In selecting States for 
purposes of this paragraph, the Secretary 
shall— 
‘‘(i) select States that received a plan-
ning 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; 
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‘‘(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 aggre-
gate 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 Sec-
retary requires, an application that in-
cludes such information, provisions, and 
assurances, as the Secretary may require, 
in addition to the following: 
‘‘(I) A proposed process for car-
rying out the ongoing assessment de-
scribed in paragraph (2)(A), taking 
into account the results of the initial 
assessment described in paragraph 
(3)(C)(i). 
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‘‘(II) A review of reimbursement 
methodologies and other policies re-
lated to substance use disorder treat-
ment 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 spe-
cialize in providing substance use 
disorder treatment or recovery 
services, hospitals, health care 
systems, 
Federally 
qualified 
health centers, and, as applicable, 
certified community behavioral 
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health clinics) that offer sub-
stance use disorder treatment, re-
covery, or support services, in-
cluding short-term detoxification 
services, outpatient substance use 
disorder services, and evidence- 
based peer recovery services. 
‘‘(bb) Strategies that will 
incentivize providers described in 
subparagraphs (C) and (D) of 
paragraph (2) to obtain the nec-
essary training, education, and 
support to deliver substance use 
disorder treatment or recovery 
services in the State. 
‘‘(cc) Milestones and timeli-
ness for implementing activities 
set forth in the plan. 
‘‘(dd) Specific measurable 
targets for increasing the sub-
stance use disorder treatment 
and recovery provider network 
under the State plan (or a waiver 
of such plan). 
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‘‘(IV) A proposed process for re-
porting 
the 
information 
required 
under paragraph (6)(A), including in-
formation to assess the effectiveness 
of the efforts of the State to expand 
the capacity of providers to deliver 
substance use disorder treatment or 
recovery services during the period of 
the demonstration project under this 
subsection. 
‘‘(V) The expected financial im-
pact of the demonstration project 
under this subsection on the State. 
‘‘(VI) A description of all funding 
sources available to the State to pro-
vide substance use disorder treatment 
or recovery services in the State. 
‘‘(VII) A preliminary plan for 
how the State will sustain any in-
crease in the capacity of providers to 
deliver substance use disorder treat-
ment or recovery services resulting 
from the demonstration project under 
this subsection after the termination 
of such demonstration project. 
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‘‘(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 ap-
plicable. 
‘‘(ii) CONSULTATION.—In completing 
an application under clause (i), a State 
shall consult with relevant stakeholders, in-
cluding Medicaid managed care plans, 
health care providers, and Medicaid bene-
ficiary advocates, and include in such ap-
plication a description of such consultation. 
‘‘(5) PAYMENT.— 
‘‘(A) IN GENERAL.—For each quarter oc-
curring during the period for which the dem-
onstration project is conducted (after the first 
18 months of such period), the Secretary shall 
pay under this subsection, subject to subpara-
graph (C), to each State selected under para-
graph (4) an amount equal to 80 percent of so 
much of the qualified sums expended during 
such quarter. 
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‘‘(B) QUALIFIED
SUMS
DEFINED.—For 
purposes of subparagraph (A), the term ‘quali-
fied 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 treatment or recovery services furnished by 
providers 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 treatment or re-
covery services. 
‘‘(C) NON-DUPLICATION OF PAYMENT.—In 
the case that payment is made under subpara-
graph (A) with respect to expenditures for sub-
stance use treatment or recovery services fur-
nished 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 pe-
riod of the demonstration project under this 
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subsection, submit to the Secretary a quarterly 
report, with respect to expenditures for sub-
stance use treatment or recovery services for 
which payment is made to the State under this 
subsection, on the following: 
‘‘(i) The specific activities with re-
spect to which payment under this sub-
section was provided. 
‘‘(ii) The number of providers that de-
livered substance use disorder treatment or 
recovery services in the State under the 
demonstration project compared to the es-
timated number of providers that would 
have otherwise delivered such services in 
the absence of such demonstration project. 
‘‘(iii) The number of individuals en-
rolled under the State plan (or a waiver of 
such plan) who received substance use dis-
order treatment or recovery services under 
the demonstration project compared to the 
estimated number of such individuals who 
would have otherwise received such services 
in the absence of such demonstration 
project. 
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‘‘(iv) Other matters as determined by 
the Secretary. 
‘‘(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 se-
lection; 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 Di-
rector of the Agency for Healthcare Re-
search and Quality and the Assistant Sec-
retary for Mental Health and Substance 
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Use, submit to Congress an interim re-
port— 
‘‘(I) on activities carried out 
under 
the 
demonstration 
project 
under this subsection; 
‘‘(II) on the extent to which 
States selected under paragraph (4) 
have achieved the stated goals sub-
mitted in their applications under sub-
paragraph (C) of such paragraph; 
‘‘(III) with a description of the 
strengths and limitations of such dem-
onstration project; and 
‘‘(IV) with a plan for the sustain-
ability 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— 
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‘‘(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 under this sub-
section after the submission of such 
interim report; and 
‘‘(III) 
evaluating 
such 
dem-
onstration project. 
‘‘(C) AHRQ REPORT.—Not later than 
three years after the date of the enactment of 
this subsection, the Director of the Agency for 
Healthcare Research and Quality, on consulta-
tion with the Administrator of the Centers for 
Medicare & Medicaid Services, shall submit to 
Congress a summary on the experiences of 
States awarded planning grants under para-
graph (3) and States selected under paragraph 
(4). 
‘‘(7) DATA SHARING AND BEST PRACTICES.— 
During the period of the demonstration project 
under this subsection, the Secretary shall, in collabo-
ration with States selected under paragraph (4), fa-
cilitate data sharing and the development of best 
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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 ap-
propriated, $5,000,000 to the Centers for Medicare 
& Medicaid Services for purposes of implementing 
this subsection. Such amount shall remain available 
until expended.’’. 
SEC. 104. DRUG MANAGEMENT PROGRAM FOR AT-RISK 
BENEFICIARIES. 
(a) IN GENERAL.—Title XIX of the Social Security 
Act is amended by inserting after section 1927 (42 U.S.C. 
1396r–8) the following new section: 
‘‘SEC. 1927A. DRUG MANAGEMENT PROGRAM FOR AT-RISK 
BENEFICIARIES. 
‘‘(a) IN GENERAL.—Beginning January 1, 2020, a 
State shall operate a qualified drug management program 
under which a State may enroll certain at-risk bene-
ficiaries identified by the State under the program. 
‘‘(b) QUALIFIED DRUG MANAGEMENT PROGRAM.— 
For purposes of this section, the term ‘qualified drug man-
agement program’ means, with respect to a State, a pro-
gram carried out by the State (including through a con-
tract with a pharmacy benefit manager) that provides at 
least for the following: 
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‘‘(1) IDENTIFICATION
OF
AT-RISK
INDIVID-
UALS.—Under the program, the State identifies, in 
accordance with subsection (c), individuals enrolled 
under the State plan (or waiver of the State plan) 
who are at-risk beneficiaries. 
‘‘(2) ELEMENTS OF PROGRAM.— 
‘‘(A) IN GENERAL.—Under the program, 
the State, with respect to each individual identi-
fied under paragraph (1) and enrolled under 
the program under paragraph (5)— 
‘‘(i) subject to subparagraphs (B) and 
(C), selects at least one, but not more than 
three, health care providers and at least 
one, but not more than three, pharmacies 
for each such individual for purposes of 
clause (ii), in accordance with a selection 
process that takes into account reasonable 
factors such as the individual’s previous 
utilization of items and services from 
health care providers and pharmacies, geo-
graphic proximity of the individual to such 
health care providers and pharmacies, ac-
cess of the individual to health care, rea-
sonable travel time, information regarding 
housing status, and any known preference 
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of the individual for a certain health care 
provider or pharmacy; and 
‘‘(ii) requires that any controlled sub-
stance furnished to such individual during 
the period for which such individual is en-
rolled under the program be prescribed by 
a health care provider selected under 
clause (i) for such individual and dispensed 
by a pharmacy selected under clause (i) for 
such individual in order for such controlled 
substance to be covered under the State 
plan (or waiver). 
‘‘(B) BENEFICIARY PREFERENCE.—In the 
case of an individual receiving a notice under 
paragraph (3)(A) of being identified as poten-
tially being an at-risk beneficiary described in 
such paragraph, such individual may submit, 
during the 30-day period following receipt of 
such notice, preferences for which health care 
providers and pharmacies the individual would 
prefer the State to select under subparagraph 
(A). The State shall select or change the selec-
tion of health care providers and pharmacies 
under subparagraph (A) for the individuals 
based on such preferences, except that in the 
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case that State determines that such selection 
(or change of selection) of a health care pro-
vider or pharmacy under subparagraph (A) is 
contributing or would contribute to prescription 
drug abuse or drug diversion by the individual, 
the State may select or change the selection of 
health care provider or pharmacy for the indi-
vidual without regard to the preferences of the 
individual described in this subparagraph. If the 
State selects or changes the selection pursuant 
to the preceding sentence without regard to the 
preferences of the individual, the State shall 
provide the individual with at least 30 days 
written notice of the selection or change of se-
lection and a rationale for the selection or 
change. 
‘‘(C) TREATMENT
OF
PHARMACY
WITH 
MULTIPLE LOCATIONS.—For purposes of sub-
paragraph (A)(i), in the case of a pharmacy 
that has multiple locations that share real-time 
electronic prescription data, all such locations 
of the pharmacy shall collectively be treated as 
one pharmacy. 
‘‘(D) TREATMENT OF EXISTING FFS DRUG 
MANAGEMENT PROGRAMS.—In the case of a pa-
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tient review and restriction program (as identi-
fied in the annual report submitted to the Sec-
retary under section 1927(g)(3)(D)) operated 
by a State pursuant to section 1915(a)(2) be-
fore the date of the enactment of this section, 
such program shall be treated as a qualified 
drug management program. 
‘‘(E) REASONABLE ACCESS.—The program 
shall ensure, including through waiver of ele-
ments of the program (including under sub-
paragraph (A)(ii)), reasonable access to health 
care (including access to health care providers 
and pharmacies with respect to prescription 
drugs described in subparagraph (A)) in the 
case of individuals with multiple residences, in 
the case of natural disasters and similar situa-
tions, and in the case of the provision of emer-
gency services (as defined for purposes of sec-
tion 1860D–4(c)(5)(D)(ii)(II)). 
‘‘(3) NOTIFICATION
TO
IDENTIFIED
INDIVID-
UALS.—Under the program, the State provides each 
individual who is identified under paragraph (1), 
prior to enrolling such individual under the program, 
at least one notification of each of the following: 
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‘‘(A) Notice that the State has identified 
the individual as potentially being an at-risk 
beneficiary for abuse or misuse of a controlled 
substance. 
‘‘(B) The name, address, and contact in-
formation of each health care provider and 
pharmacy that may be selected for the indi-
vidual under paragraph (2)(A). 
‘‘(C) Information describing all State and 
Federal public health resources that are de-
signed to address such abuse or misuse to 
which the individual has access, including men-
tal health services, substance use disorder and 
recovery services, and other counseling services. 
‘‘(D) Notice of, and information about, the 
right of the individual to— 
‘‘(i) submit preferences of the indi-
vidual for health care providers and phar-
macies to be selected under paragraph 
(2)(A), including as described in paragraph 
(2)(B); 
‘‘(ii) appeal under paragraph (4)— 
‘‘(I) such identification described 
in subparagraph (A); and 
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‘‘(II) the selection of health care 
providers and pharmacies under para-
graph (2)(A). 
‘‘(E) An explanation of the meaning and 
consequences of the identification of the indi-
vidual as potentially being an at-risk beneficiary 
for abuse or misuse of a controlled substance, 
including an explanation of the program. 
‘‘(F) Information, including a contact list 
and clear instructions, that explain how the in-
dividual can contact the appropriate entities ad-
ministering the program in order to submit 
preferences described in paragraph (2)(B) and 
any other communications relating to the pro-
gram. 
‘‘(4) APPEALS PROCESS.—Under the program, 
the State provides for an appeals process under 
which, with respect to an individual identified under 
paragraph (1)— 
‘‘(A) such individual may appeal— 
‘‘(i) such identification; and 
‘‘(ii) the selection of a health care pro-
vider or pharmacy under paragraph (2)(A); 
‘‘(B) in the case of an appeal described in 
subparagraph (A)(ii), the State shall accommo-
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