IMPROVE Addiction Care Act
Bill: S.1575 | Sponsor: Sen. Toomey, Patrick (R-PA)
Policy area: Health

Summary:
Improving Medicaid Programs' Response to Overdose Victims and Enhancing Addiction Care Act or the IMPROVE Addiction Care Act
This bill establishes additional requirements for state Medicaid drug-use review programs with respect to individuals who experience opioid-related overdoses.
Specifically, programs must include protocols that (1) connect individuals who have experienced an opioid-related overdose within a certain period to appropriate treatment; (2) notify providers who prescribe opioids about subsequent fatal overdoses; (3) ensure providers are notified about an individual's history of opioid-use disorder, overdoses, or poisonings; and (4) educate providers about proper prescribing practices for these individuals.

To amend title XIX of the Social Security Act to encourage appropriate 
       prescribing under Medicaid for victims of opioid overdose.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Improving Medicaid Programs' 
Response to Overdose Victims and Enhancing Addiction Care Act'' or the 
``IMPROVE Addiction Care Act''.

SEC. 2. ENCOURAGING APPROPRIATE PRESCRIBING UNDER MEDICAID FOR VICTIMS 
              OF OPIOID OVERDOSE.

    (a) In General.--Section 1927(g)(2) of the Social Security Act (42 
U.S.C. 1396r-8(g)(2)) is amended by adding at the end the following new 
subparagraph:
                    ``(E) Additional drug use review requirements.--As 
                part of a State's prospective and retrospective drug 
                use review under subparagraphs (A) and (B), as 
                applicable, the State shall, not later than 24 months 
                after the date of enactment of this subparagraph, 
                develop and implement, or review and update, protocols 
                to, subject to any applicable State or Federal privacy 
                or confidentiality protections that could preclude such 
                protocols--
                            ``(i) identify individuals receiving 
                        benefits under this title who have experienced 
                        a nonfatal opioid-related overdose within a 
                        look-back period (to be determined by the 
                        Secretary except that such period shall not be 
                        less than 1 year and shall not exceed 5 years), 
                        to the extent that such data is available, and 
                        make a good faith effort to connect these 
                        individuals to treatment options and recovery 
                        support services that have been determined 
                        appropriate by the Secretary;
                            ``(ii) if an individual receiving benefits 
                        under this title experiences a fatal overdose 
                        that is opioid-related (without regard to 
                        whether such overdose was related to a covered 
                        outpatient drug), or, if specified by the 
                        Secretary, related to any other drug (including 
                        a drug that is not a covered outpatient drug), 
                        not later than 6 months after the date of such 
                        overdose--
                                    ``(I) provide notice of such 
                                overdose to each provider that, during 
                                the period (to be established by the 
                                Secretary) preceding such overdose, 
                                prescribed opioids (or such other 
                                specified drug, if applicable) to such 
                                individual, to the extent that such 
                                data is available; and
                                    ``(II) provide each such provider 
                                with educational materials on 
                                prescribing opioids (or such other 
                                specified drugs, if applicable);
                            ``(iii) ensure that a provider who is 
                        treating an individual receiving benefits under 
                        this title has notice of the individual's 
                        diagnosis or history of opioid use disorder, 
                        opioid poisoning diagnosis, history of nonfatal 
                        opioid-related overdose, or a diagnosis or 
                        history of a substance use disorder or overdose 
                        for such other specified drug, if applicable, 
                        to the extent such data is available; and
                            ``(iv) perform ongoing retrospective drug 
                        utilization reviews and offer provider 
                        education that is informed by such reviews 
                        (which may include education provided under an 
                        educational outreach program established under 
                        subparagraph (D) or through an intervention 
                        described in paragraph (3)(C)(iii)) regarding 
                        appropriate prescribing practices for 
                        individuals receiving benefits under this title 
                        with a diagnosis or history of opioid use 
                        disorder, a history of nonfatal opioid-related 
                        overdose, an opioid poisoning diagnosis, or a 
                        diagnosis or history of a substance use 
                        disorder or overdose for such other specified 
                        drug, if applicable.
                Nothing in this subparagraph shall be construed as 
                requiring a State to develop and implement additional 
                protocols if the State establishes to the satisfaction 
                of the Secretary that the State has in place existing 
                protocols meeting or exceeding the standards set forth 
                in this subparagraph.''.
    (b) Technical Amendments.--Section 1932(i) of the Social Security 
Act (42 U.S.C. 1396u-2(i)) is amended--
            (1) by striking ``section 483.3(s)(4)'' and inserting 
        ``section 438.3(s)(4)''; and
            (2) by striking ``483.3(s)(5)'' and inserting 
        ``438.3(s)(5)''.
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