H. R. 6—78 
(i) transition in and out of coverage under such 
title; 
(ii) may have sources of health care coverage in 
addition to coverage under such title; or 
(iii) pay for prescription drugs with cash. 
(C) Any other purposes specified by the Secretary. 
(2) ELEMENTS OF MODEL PRACTICES.—The model practices 
described in paragraph (1)— 
(A) shall include strategies for assisting States in 
allowing the medical director or pharmacy director (or des-
ignees of such a director) of managed care organizations 
or pharmaceutical benefit managers to access information 
with respect to all covered individuals served by such man-
aged care organizations or pharmaceutical benefit man-
agers to access as a single data set, in an electronic format; 
and 
(B) shall include any appropriate beneficiary protec-
tions and privacy guidelines. 
(3) CONSULTATION.—In developing model practices under 
this subsection, the Secretary shall consult with the National 
Association of Medicaid Directors, managed care entities (as 
defined in section 1932(a)(1)(B) of the Social Security Act) with 
contracts with States pursuant to section 1903(m) of such Act, 
pharmaceutical benefit managers, physicians and other health 
care providers, beneficiary advocates, and individuals with 
expertise in health care technology related to prescription drug 
monitoring programs and electronic health records. 
(d) REPORT BY COMPTROLLER GENERAL.—Not later than October 
1, 2020, the Comptroller General of the United States shall issue 
a report examining the operation of prescription drug monitoring 
programs administered by States, including data security and access 
standards used by such programs. 
Subtitle F—IMD CARE Act 
SEC. 5051. SHORT TITLE. 
This title may be cited as the ‘‘Individuals in Medicaid Deserve 
Care that is Appropriate and Responsible in its Execution Act’’ 
or the ‘‘IMD CARE Act’’. 
SEC. 5052. STATE OPTION TO PROVIDE MEDICAID COVERAGE FOR CER-
TAIN INDIVIDUALS WITH SUBSTANCE USE DISORDERS 
WHO ARE PATIENTS IN CERTAIN INSTITUTIONS FOR 
MENTAL DISEASES. 
(a) IN GENERAL.—Title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.), as amended by preceding sections of this Act, is 
further amended— 
(1) in section 1905(a), in the subdivision (B) that follows 
paragraph (30), by inserting ‘‘(except in the case of services 
provided under a State plan amendment described in section 
1915(l))’’ before the period; and 
(2) in section 1915, by adding at the end the following 
new subsection: 
‘‘(l) STATE PLAN AMENDMENT OPTION
TO PROVIDE MEDICAL 
ASSISTANCE FOR CERTAIN INDIVIDUALS WHO ARE PATIENTS IN CER-
TAIN INSTITUTIONS FOR MENTAL DISEASES.—
H. R. 6—79 
‘‘(1) IN GENERAL.—With respect to calendar quarters begin-
ning during the period beginning October 1, 2019, and ending 
September 30, 2023, a State may elect, through a State plan 
amendment, to provide medical assistance for items and serv-
ices furnished to an eligible individual who is a patient in 
an eligible institution for mental diseases in accordance with 
the requirements of this subsection. 
‘‘(2) PAYMENTS.—Subject to paragraphs (3) and (4), amounts 
expended under a State plan amendment under paragraph 
(1) for services described in such paragraph furnished, with 
respect to a 12-month period, to an eligible individual who 
is a patient in an eligible institution for mental diseases shall 
be treated as medical assistance for which payment is made 
under section 1903(a) but only to the extent that such services 
are furnished for not more than a period of 30 days (whether 
or not consecutive) during such 12-month period. 
‘‘(3) MAINTENANCE OF EFFORT.— 
‘‘(A) IN GENERAL.—As a condition for a State receiving 
payments under section 1903(a) for medical assistance pro-
vided in accordance with this subsection, the State shall 
(during the period in which it so furnished such medical 
assistance through a State plan amendment under this 
subsection) maintain on an annual basis a level of funding 
expended by the State (and political subdivisions thereof) 
other than under this title from non-Federal funds for— 
‘‘(i) items and services furnished to eligible individ-
uals who are patients in eligible institutions for mental 
diseases that is not less than the level of such funding 
for such items and services for the most recently ended 
fiscal year as of the date of enactment of this subsection 
or, if higher, for the most recently ended fiscal year 
as of the date the State submits a State plan amend-
ment to the Secretary to provide such medical assist-
ance in accordance with this subsection; and 
‘‘(ii) 
items 
and 
services 
(including 
services 
described in subparagraph (B)) furnished to eligible 
individuals in outpatient and community-based set-
tings that is not less than the level of such funding 
for such items and services for the most recently ended 
fiscal year as of the date of enactment of this subsection 
or, if higher, for the most recently ended fiscal year 
as of the date the State submits a State plan amend-
ment to the Secretary to provide such medical assist-
ance in accordance with this subsection. 
‘‘(B) SERVICES DESCRIBED.—For purposes of subpara-
graph (A)(ii), services described in this subparagraph are 
the following: 
‘‘(i) Outpatient and community-based substance 
use disorder treatment. 
‘‘(ii) Evidence-based recovery and support services. 
‘‘(iii) Clinically-directed therapeutic treatment to 
facilitate recovery skills, relapse prevention, and emo-
tional coping strategies. 
‘‘(iv) Outpatient medication-assisted treatment, 
related therapies, and pharmacology. 
‘‘(v) Counseling and clinical monitoring.
H. R. 6—80 
‘‘(vi) Outpatient withdrawal management and 
related treatment designed to alleviate acute emo-
tional, behavioral, cognitive, or biomedical distress 
resulting from, or occurring with, an individual’s use 
of alcohol and other drugs. 
‘‘(vii) Routine monitoring of medication adherence. 
‘‘(viii) Other outpatient and community-based serv-
ices for the treatment of substance use disorders, as 
designated by the Secretary. 
‘‘(C) STATE REPORTING REQUIREMENT.— 
‘‘(i) IN GENERAL.—Prior to approval of a State plan 
amendment under this subsection, as a condition for 
a State receiving payments under section 1903(a) for 
medical assistance provided in accordance with this 
subsection, the State shall report to the Secretary, 
in accordance with the process established by the Sec-
retary under clause (ii), the information deemed nec-
essary by the Secretary under such clause. 
‘‘(ii) PROCESS.—Not later than the date that is 
8 months after the date of enactment of this subsection, 
the Secretary shall establish a process for States to 
report to the Secretary, at such time and in such 
manner as the Secretary deems appropriate, such 
information as the Secretary deems necessary to verify 
a State’s compliance with subparagraph (A). 
‘‘(4) ENSURING A CONTINUUM OF SERVICES.— 
‘‘(A) IN GENERAL.—As a condition for a State receiving 
payments under section 1903(a) for medical assistance pro-
vided in accordance with this subsection, the State shall 
carry out each of the requirements described in subpara-
graphs (B) through (D). 
‘‘(B) NOTIFICATION.—Prior to approval of a State plan 
amendment under this subsection, the State shall notify 
the Secretary of how the State will ensure that eligible 
individuals receive appropriate evidence-based clinical 
screening prior to being furnished with items and services 
in an eligible institution for mental diseases, including 
initial and periodic assessments to determine the appro-
priate level of care, length of stay, and setting for such 
care for each individual. 
‘‘(C) OUTPATIENT SERVICES; INPATIENT AND RESIDENTIAL 
SERVICES.— 
‘‘(i) OUTPATIENT SERVICES.—The State shall, at a 
minimum, provide medical assistance for services that 
could otherwise be covered under the State plan, con-
sistent with each of the following outpatient levels 
of care: 
‘‘(I) Early intervention for individuals who, for 
a known reason, are at risk of developing sub-
stance-related problems and for individuals for 
whom there is not yet sufficient information to 
document a diagnosable substance use disorder. 
‘‘(II) Outpatient services for less than 9 hours 
per week for adults, and for less than 6 hours 
per week for adolescents, for recovery or motiva-
tional enhancement therapies and strategies.
H. R. 6—81 
‘‘(III) Intensive outpatient services for 9 hours 
or more per week for adults, and for 6 hours or 
more per week for adolescents, to treat multi-
dimensional instability. 
‘‘(IV) Partial hospitalization services for 20 
hours or more per week for adults and adolescents 
to treat multidimensional instability that does not 
require 24-hour care. 
‘‘(ii) INPATIENT AND RESIDENTIAL SERVICES.—The 
State shall provide medical assistance for services that 
could otherwise be covered under the State plan, con-
sistent with at least 2 of the following inpatient and 
residential levels of care: 
‘‘(I) Clinically managed, low-intensity residen-
tial services that provide adults and adolescents 
with 24-hour living support and structure with 
trained personnel and at least 5 hours of clinical 
service per week per individual. 
‘‘(II) Clinically managed, population-specific, 
high-intensity residential services that provide 
adults with 24-hour care with trained counselors 
to stabilize multidimensional imminent danger 
along with less intense milieu and group treatment 
for those with cognitive or other impairments 
unable to use full active milieu or therapeutic 
community. 
‘‘(III) Clinically managed, medium-intensity 
residential services for adolescents, and clinically 
managed, high-intensity residential services for 
adults, that provide 24-hour care with trained 
counselors to stabilize multidimensional imminent 
danger and preparation for outpatient treatment. 
‘‘(IV) 
Medically 
monitored, 
high-intensity 
inpatient services for adolescents, and medically 
monitored, intensive inpatient services withdrawal 
management for adults, that provide 24-hour 
nursing care, make physicians available for signifi-
cant problems in Dimensions 1, 2, or 3, and provide 
counseling services 16 hours per day. 
‘‘(V) Medically managed, intensive inpatient 
services for adolescents and adults that provide 
24-hour nursing care and daily physician care for 
severe, unstable problems in Dimensions 1, 2 or 
3. 
‘‘(D) TRANSITION
OF
CARE.—In order to ensure an 
appropriate transition for an eligible individual from 
receiving care in an eligible institution for mental diseases 
to receiving care at a lower level of clinical intensity within 
the continuum of care (including outpatient services), the 
State shall ensure that— 
‘‘(i) a placement in such eligible institution for 
mental diseases would allow for an eligible individual’s 
successful transition to the community, considering 
such factors as proximity to an individual’s support 
network (such as family members, employment, and 
counseling and other services near an individual’s resi-
dence); and
H. R. 6—82 
‘‘(ii) all eligible institutions for mental diseases 
that furnish items and services to individuals for which 
medical assistance is provided under the State plan— 
‘‘(I) are able to provide care at such lower 
level of clinical intensity; or 
‘‘(II) have an established relationship with 
another facility or provider that is able to provide 
care at such lower level of clinical intensity and 
accepts patients receiving medical assistance 
under this title under which the eligible institution 
for mental diseases may arrange for individuals 
to receive such care from such other facility or 
provider. 
‘‘(5) APPLICATION TO MANAGED CARE.—Payments for, and 
limitations to, medical assistance furnished in accordance with 
this subsection shall be in addition to and shall not be construed 
to limit or supersede the ability of States to make monthly 
capitation payments to managed care organizations for individ-
uals receiving treatment in institutions for mental diseases 
in accordance with section 438.6(e) of title 42, Code of Federal 
Regulations (or any successor regulation). 
‘‘(6) OTHER MEDICAL ASSISTANCE.—The provision of medical 
assistance for items and services furnished to an eligible indi-
vidual who is a patient in an eligible institution for mental 
diseases in accordance with the requirements of this subsection 
shall not prohibit Federal financial participation for medical 
assistance for items or services that are provided to such eligible 
individual in or away from the eligible institution for mental 
disease during any period in which the eligible individual is 
receiving items or services in accordance with this subsection. 
‘‘(7) DEFINITIONS.—In this subsection: 
‘‘(A) DIMENSIONS 1, 2, OR 3.—The term ‘Dimensions 
1, 2, or 3’ has the meaning given that term for purposes 
of the publication of the American Society of Addiction 
Medicine entitled ‘The ASAM Criteria: Treatment Criteria 
for Addictive Substance-Related, and Co-Occurring Condi-
tions, 2013’. 
‘‘(B) ELIGIBLE
INDIVIDUAL.—The term ‘eligible indi-
vidual’ means an individual who— 
‘‘(i) with respect to a State, is enrolled for medical 
assistance under the State plan or a waiver of such 
plan; 
‘‘(ii) is at least 21 years of age; 
‘‘(iii) has not attained 65 years of age; and 
‘‘(iv) has at least 1 substance use disorder. 
‘‘(C) ELIGIBLE
INSTITUTION
FOR
MENTAL
DISEASES.— 
The term ‘eligible institution for mental diseases’ means 
an institution for mental diseases that— 
‘‘(i) follows reliable, evidence-based practices; and 
‘‘(ii) offers at least 2 forms of medication-assisted 
treatment for substance use disorders on site, 
including, in the case of medication-assisted treatment 
for opioid use disorder, at least 1 antagonist and 1 
partial agonist. 
‘‘(D) INSTITUTION
FOR
MENTAL
DISEASES.—The term 
‘institution for mental diseases’ has the meaning given 
that term in section 1905(i).’’.
H. R. 6—83 
(b) RULE OF CONSTRUCTION.—Nothing in the amendments made 
by subsection (a) shall be construed as encouraging a State to 
place an individual in an inpatient or a residential care setting 
where a home or community-based care setting would be more 
appropriate for the individual, or as preventing a State from con-
ducting or pursuing a demonstration project under section 1115 
of the Social Security Act to improve access to, and the quality 
of, substance use disorder treatment for eligible populations. 
Subtitle G—Medicaid Improvement Fund 
SEC. 5061. MEDICAID IMPROVEMENT FUND. 
Section 1941(b)(1) of the Social Security Act (42 U.S.C. 1396w– 
1(b)(1)) is amended by striking ‘‘$0’’ and inserting ‘‘$31,000,000’’. 
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 ADOPTION AND USE OF CER-
TIFIED ELECTRONIC HEALTH RECORD TECHNOLOGY. 
Section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 
1315a(b)(2)(B)) is amended by adding at the end the following 
new clause: 
‘‘(xxv) Providing, for the adoption and use of cer-
tified EHR technology (as defined in section 1848(o)(4)) 
to improve the quality and coordination of care through 
the electronic documentation and exchange of health 
information, incentive payments to behavioral health 
providers (such as psychiatric hospitals (as defined 
in section 1861(f)), community mental health centers 
(as defined in section 1861(ff)(3)(B)), hospitals that 
participate in a State plan under title XIX or a waiver 
of such plan, treatment facilities that participate in 
such a State plan or such a waiver, mental health 
or substance use disorder providers that participate 
in such a State plan or such a waiver, clinical psycholo-
gists (as defined in section 1861(ii)), nurse practitioners 
(as defined in section 1861(aa)(5)) with respect to the 
provision of psychiatric services, and clinical social 
workers (as defined in section 1861(hh)(1))).’’. 
Subtitle B—Abuse Deterrent Access 
SEC. 6011. SHORT TITLE. 
This subtitle may be cited at the ‘‘Abuse Deterrent Access 
Act of 2018’’.
H. R. 6—84 
SEC. 6012. STUDY ON ABUSE-DETERRENT OPIOID FORMULATIONS 
ACCESS BARRIERS UNDER MEDICARE. 
(a) IN GENERAL.—Not later than 1 year after the date of the 
enactment of this Act, the Secretary of Health and Human Services 
shall conduct a study and submit to Congress a report on— 
(1) the adequacy of access to abuse-deterrent opioid formu-
lations for individuals with chronic pain enrolled in an MA– 
PD plan under part C of title XVIII of the Social Security 
Act or a prescription drug plan under part D of such title 
of such Act, taking into account any barriers preventing such 
individuals from accessing such formulations under such MA– 
PD or part D plans, such as cost-sharing tiers, fail-first require-
ments, the price of such formulations, and prior authorization 
requirements; and 
(2) the effectiveness of abuse-deterrent opioid formulations 
in preventing opioid abuse or misuse; the impact of the use 
of abuse-deterrent opioid formulations on the use or abuse 
of other prescription or illicit opioids (including changes in 
deaths from such opioids); and other public health consequences 
of the use of abuse-deterrent opioid formulations, such as an 
increase in rates of human immunodeficiency virus. 
(b) DEFINITION OF ABUSE-DETERRENT OPIOID FORMULATION.— 
In this section, the term ‘‘abuse-deterrent opioid formulation’’ means 
an opioid that is a prodrug or that has certain abuse-deterrent 
properties, such as physical or chemical barriers, agonist or antago-
nist combinations, aversion properties, delivery system mechanisms, 
or other features designed to prevent abuse of such opioid. 
Subtitle C—Medicare Opioid Safety 
Education 
SEC. 6021. MEDICARE OPIOID SAFETY EDUCATION. 
(a) IN GENERAL.—Section 1804 of the Social Security Act (42 
U.S.C. 1395b–2) is amended by adding at the end the following 
new subsection: 
‘‘(d) The notice provided under subsection (a) shall include— 
‘‘(1) references to educational resources regarding opioid 
use and pain management; 
‘‘(2) a description of categories of alternative, non-opioid 
pain management treatments covered under this title; and 
‘‘(3) a suggestion for the beneficiary to talk to a physician 
regarding opioid use and pain management.’’. 
(b) EFFECTIVE DATE.—The amendment made by subsection (a) 
shall apply to notices distributed prior to each Medicare open enroll-
ment period beginning after January 1, 2019. 
Subtitle D—Opioid Addiction Action Plan 
SEC. 6031. SHORT TITLE. 
This subtitle may be cited as the ‘‘Opioid Addiction Action 
Plan Act’’.
H. R. 6—85 
SEC. 6032. ACTION PLAN ON RECOMMENDATIONS FOR CHANGES 
UNDER MEDICARE AND MEDICAID TO PREVENT OPIOIDS 
ADDICTIONS AND ENHANCE ACCESS TO MEDICATION- 
ASSISTED TREATMENT. 
(a) IN GENERAL.—Not later than January 1, 2020, the Secretary 
of Health and Human Services (in this section referred to as the 
‘‘Secretary’’), in collaboration with the Pain Management Best Prac-
tices Inter-Agency Task Force convened under section 101(b) of 
the Comprehensive Addiction and Recovery Act of 2016 (Public 
Law 114–198), shall develop an action plan as described in sub-
section (b). 
(b) ACTION PLAN COMPONENTS.—The action plan shall include 
a review by the Secretary of Medicare and Medicaid payment and 
coverage policies that may be viewed as potential obstacles to 
an effective response to the opioid crisis, and recommendations, 
as determined appropriate by the Secretary, on the following: 
(1) A review of payment and coverage policies under the 
Medicare program under title XVIII of the Social Security Act 
and the Medicaid program under title XIX of such Act, including 
a review of coverage and payment under such programs of 
all medication-assisted treatment approved by the Food and 
Drug Administration related to the treatment of opioid use 
disorder and other therapies that manage chronic and acute 
pain and treat and minimize risk of opioid misuse and abuse, 
including in such review, payment under the Medicare prospec-
tive payment system for inpatient hospital services under sec-
tion 1886(d) of such Act (42 U.S.C. 1395ww(d)) and the Medi-
care prospective payment system for hospital outpatient depart-
ment services under section 1833(t) of such Act (42 U.S.C. 
1395I(t)), to determine whether those payment policies resulted 
in incentives or disincentives that have contributed to the opioid 
crisis. 
(2) Recommendations for payment and service delivery 
models to be tested as appropriate by the Center for Medicare 
and Medicaid Innovation and other federally authorized dem-
onstration projects, including value-based models, that may 
encourage the use of appropriate medication-assisted treatment 
approved by the Food and Drug Administration for the treat-
ment of opioid use disorder and other therapies that manage 
chronic and acute pain and treat and minimize risk of opioid 
misuse and abuse. 
(3) Recommendations for data collection that could facilitate 
research and policy-making regarding prevention of opioid use 
disorder as well as data that would aid the Secretary in making 
coverage and payment decisions under the Medicare and Med-
icaid programs related to the access to appropriate opioid 
dependence treatments. 
(4) A review of Medicare and Medicaid beneficiaries’ access 
to the full range of medication-assisted treatment approved 
by the Food and Drug Administration for the treatment of 
opioid use disorder and other therapies that manage chronic 
and acute pain and treat and minimize risk of opioid misuse 
and abuse, including access of beneficiaries residing in rural 
or medically underserved communities. 
(5) A review of payment and coverage policies under the 
Medicare program and the Medicaid program related to medical 
devices that are non-opioid based treatments approved by the
H. R. 6—86 
Food and Drug Administration for the management of acute 
pain and chronic pain, for monitoring substance use withdrawal 
and preventing overdoses of controlled substances, and for 
treating substance use disorder, including barriers to patient 
access. 
(c) STAKEHOLDER MEETINGS.— 
(1) IN GENERAL.—Beginning not later than 3 months after 
the date of the enactment of this section, the Secretary shall 
convene a public stakeholder meeting to solicit public comment 
on the components of the action plan described in subsection 
(b). 
(2) PARTICIPANTS.—Participants of meetings described in 
paragraph (1) shall include representatives from the Food and 
Drug Administration and National Institutes of Health, bio-
pharmaceutical industry members, medical researchers, health 
care providers, the medical device industry, the Medicare pro-
gram, the Medicaid program, and patient advocates. 
(d) REQUEST FOR INFORMATION.—Not later than 3 months after 
the date of the enactment of this section, the Secretary shall issue 
a request for information seeking public feedback regarding ways 
in which the Centers for Medicare & Medicaid Services can help 
address the opioid crisis through the development of and application 
of the action plan. 
(e) REPORT TO CONGRESS.—Not later than June 1, 2020, the 
Secretary shall submit to Congress, and make public, a report 
that includes— 
(1) a summary of the results of the Secretary’s review 
and any recommendations under the action plan; 
(2) the Secretary’s planned next steps with respect to the 
action plan; and 
(3) an evaluation of price trends for drugs used to reverse 
opioid overdoses (such as naloxone), including recommendations 
on ways to lower such prices for consumers. 
(f) DEFINITION OF MEDICATION-ASSISTED TREATMENT.—In this 
section, the term ‘‘medication-assisted treatment’’ includes opioid 
treatment programs, behavioral therapy, and medications to treat 
substance abuse disorder. 
Subtitle E—Advancing High Quality Treat-
ment for Opioid Use Disorders in Medi-
care 
SEC. 6041. SHORT TITLE. 
This subtitle may be cited as the ‘‘Advancing High Quality 
Treatment for Opioid Use Disorders in Medicare Act’’. 
SEC. 6042. OPIOID USE DISORDER TREATMENT DEMONSTRATION PRO-
GRAM. 
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) 
is amended by inserting after section 1866E (42 U.S.C. 1395cc– 
5) the following new section: 
‘‘SEC. 1866F. OPIOID USE DISORDER TREATMENT DEMONSTRATION 
PROGRAM. 
‘‘(a) IMPLEMENTATION OF 4-YEAR DEMONSTRATION PROGRAM.—