Title: Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act
Policy area: Congress

Summary:
Sets forth the rule for consideration of the Senate amendment to H.R. 6 (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act or the SUPPORT for Patients and Communities Act).

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H. Res. 1099 Engrossed in House (EH)]

<DOC>
H. Res. 1099

                In the House of Representatives, U. S.,

                                                    September 28, 2018.
    Resolved, That upon the adoption of this resolution the House shall be 
considered to have taken from the Speaker's table the bill, H.R. 6, with the 
Senate amendment thereto, and to have concurred in the Senate amendment with the 
following amendment:
            In lieu of the matter proposed to be inserted by the amendment of 
        the Senate to the text of the bill, insert the following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Substance Use-Disorder 
Prevention that Promotes Opioid Recovery and Treatment for Patients and 
Communities Act'' or the ``SUPPORT for Patients and Communities Act''.
    (b) Table of Contents.--The table of contents of this Act is as follows:

Sec. 1. Short title; table of contents.
       TITLE I--MEDICAID PROVISIONS TO ADDRESS THE OPIOID CRISIS

Sec. 1001. At-risk youth Medicaid protection.
Sec. 1002. Health insurance for former foster youth.
Sec. 1003. Demonstration project to increase substance use provider 
                            capacity under the Medicaid program.
Sec. 1004. Medicaid drug review and utilization.
Sec. 1005. Guidance to improve care for infants with neonatal 
                            abstinence syndrome and their mothers; GAO 
                            study on gaps in Medicaid coverage for 
                            pregnant and postpartum women with 
                            substance use disorder.
Sec. 1006. Medicaid health homes for substance-use-disorder Medicaid 
                            enrollees.
Sec. 1007. Caring recovery for infants and babies.
Sec. 1008. Peer support enhancement and evaluation review.
Sec. 1009. Medicaid substance use disorder treatment via telehealth.
Sec. 1010. Enhancing patient access to non-opioid treatment options.
Sec. 1011. Assessing barriers to opioid use disorder treatment.
Sec. 1012. Help for moms and babies.
Sec. 1013. Securing flexibility to treat substance use disorders.
Sec. 1014. MACPAC study and report on MAT utilization controls under 
                            State Medicaid programs.
Sec. 1015. Opioid addiction treatment programs enhancement.
Sec. 1016. Better data sharing to combat the opioid crisis.
Sec. 1017. Report on innovative State initiatives and strategies to 
                            provide housing-related services and 
                            supports to individuals struggling with 
                            substance use disorders under Medicaid.
Sec. 1018. Technical assistance and support for innovative State 
                            strategies to provide housing-related 
                            supports under Medicaid.
       TITLE II--MEDICARE PROVISIONS TO ADDRESS THE OPIOID CRISIS

Sec. 2001. Expanding the use of telehealth services for the treatment 
                            of opioid use disorder and other substance 
                            use disorders.
Sec. 2002. Comprehensive screenings for seniors.
Sec. 2003. Every prescription conveyed securely.
Sec. 2004. Requiring prescription drug plan sponsors under Medicare to 
                            establish drug management programs for at-
                            risk beneficiaries.
Sec. 2005. Medicare coverage of certain services furnished by opioid 
                            treatment programs.
Sec. 2006. Encouraging appropriate prescribing under Medicare for 
                            victims of opioid overdose.
Sec. 2007. Automatic escalation to external review under a Medicare 
                            part D drug management program for at-risk 
                            beneficiaries.
Sec. 2008. Suspension of payments by Medicare prescription drug plans 
                            and MA-PD plans pending investigations of 
                            credible allegations of fraud by 
                            pharmacies.
           TITLE III--FDA AND CONTROLLED SUBSTANCE PROVISIONS

                       Subtitle A--FDA Provisions

                         Chapter 1--In General

Sec. 3001. Clarifying FDA regulation of non-addictive pain products.
Sec. 3002. Evidence-based opioid analgesic prescribing guidelines and 
                            report.
     Chapter 2--Stop Counterfeit Drugs by Regulating and Enhancing 
                            Enforcement Now

Sec. 3011. Short title.
Sec. 3012. Notification, nondistribution, and recall of controlled 
                            substances.
Sec. 3013. Single source pattern of imported illegal drugs.
Sec. 3014. Strengthening FDA and CBP coordination and capacity.
                Chapter 3--Stop Illicit Drug Importation

Sec. 3021. Short title.
Sec. 3022. Restricting entrance of illicit drugs.
   Chapter 4--Securing Opioids and Unused Narcotics With Deliberate 
                         Disposal and Packaging

Sec. 3031. Short title.
Sec. 3032. Safety-enhancing packaging and disposal features.
               Chapter 5--Postapproval Study Requirements

Sec. 3041. Clarifying FDA postmarket authorities.
              Subtitle B--Controlled Substance Provisions

    Chapter 1--More Flexibility With Respect to Medication-Assisted 
                   Treatment for Opioid Use Disorders

Sec. 3201. Allowing for more flexibility with respect to medication-
                            assisted treatment for opioid use 
                            disorders.
Sec. 3202. Medication-assisted treatment for recovery from substance 
                            use disorder.
Sec. 3203. Grants to enhance access to substance use disorder 
                            treatment.
Sec. 3204. Delivery of a controlled substance by a pharmacy to be 
                            administered by injection or implantation.
  Chapter 2--Empowering Pharmacists in the Fight Against Opioid Abuse

Sec. 3211. Short title.
Sec. 3212. Programs and materials for training on certain circumstances 
                            under which a pharmacist may decline to 
                            fill a prescription.
             Chapter 3--Safe Disposal of Unused Medication

Sec. 3221. Short title.
Sec. 3222. Disposal of controlled substances of a hospice patient by 
                            employees of a qualified hospice program.
Sec. 3223. GAO study and report on hospice safe drug management.
     Chapter 4--Special Registration for Telemedicine Clarification

Sec. 3231. Short title.
Sec. 3232. Regulations relating to a special registration for 
                            telemedicine.
      Chapter 5--Synthetic Abuse and Labeling of Toxic Substances

Sec. 3241. Controlled substance analogues.
              Chapter 6--Access to Increased Drug Disposal

Sec. 3251. Short title.
Sec. 3252. Definitions.
Sec. 3253. Authority to make grants.
Sec. 3254. Application.
Sec. 3255. Use of grant funds.
Sec. 3256. Eligibility for grant.
Sec. 3257. Duration of grants.
Sec. 3258. Accountability and oversight.
Sec. 3259. Duration of program.
Sec. 3260. Authorization of appropriations.
           Chapter 7--Using Data To Prevent Opioid Diversion

Sec. 3271. Short title.
Sec. 3272. Purpose.
Sec. 3273. Amendments.
Sec. 3274. Report.
                     Chapter 8--Opioid Quota Reform

Sec. 3281. Short title.
Sec. 3282. Strengthening considerations for DEA opioid quotas.
                  Chapter 9--Preventing Drug Diversion

Sec. 3291. Short title.
Sec. 3292. Improvements to prevent drug diversion.
                           TITLE IV--OFFSETS

Sec. 4001. Promoting value in Medicaid managed care.
Sec. 4002. Requiring reporting by group health plans of prescription 
                            drug coverage information for purposes of 
                            identifying primary payer situations under 
                            the Medicare program.
Sec. 4003. Additional religious exemption from health coverage 
                            responsibility requirement.
Sec. 4004. Modernizing the reporting of biological and biosimilar 
                            products.
                   TITLE V--OTHER MEDICAID PROVISIONS

Subtitle A--Mandatory Reporting With Respect to Adult Behavioral Health 
                                Measures

Sec. 5001. Mandatory reporting with respect to adult behavioral health 
                            measures.
                Subtitle B--Medicaid IMD Additional Info

Sec. 5011. Short title.
Sec. 5012. MACPAC exploratory study and report on institutions for 
                            mental diseases requirements and practices 
                            under Medicaid.
    Subtitle C--CHIP Mental Health and Substance Use Disorder Parity

Sec. 5021. Short title.
Sec. 5022. Ensuring access to mental health and substance use disorder 
                            services for children and pregnant women 
                            under the Children's Health Insurance 
                            Program.
                      Subtitle D--Medicaid Reentry

Sec. 5031. Short title.
Sec. 5032. Promoting State innovations to ease transitions integration 
                            to the community for certain individuals.
                    Subtitle E--Medicaid Partnership

Sec. 5041. Short title.
Sec. 5042. Medicaid providers are required to note experiences in 
                            record systems to help in-need patients.
                        Subtitle F--IMD CARE Act

Sec. 5051. Short title.
Sec. 5052. State option to provide Medicaid coverage for certain 
                            individuals with substance use disorders 
                            who are patients in certain institutions 
                            for mental diseases.
                 Subtitle G--Medicaid Improvement Fund

Sec. 5061. Medicaid Improvement Fund.
                  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 certified 
                            electronic health record technology.
                   Subtitle B--Abuse Deterrent Access

Sec. 6011. Short title.
Sec. 6012. Study on abuse-deterrent opioid formulations access barriers 
                            under Medicare.
              Subtitle C--Medicare Opioid Safety Education

Sec. 6021. Medicare opioid safety education.
                Subtitle D--Opioid Addiction Action Plan

Sec. 6031. Short title.
Sec. 6032. Action plan on recommendations for changes under Medicare 
                            and Medicaid to prevent opioids addictions 
                            and enhance access to medication-assisted 
                            treatment.
 Subtitle E--Advancing High Quality Treatment for Opioid Use Disorders 
                              in Medicare

Sec. 6041. Short title.
Sec. 6042. Opioid use disorder treatment demonstration program.
 Subtitle F--Responsible Education Achieves Care and Healthy Outcomes 
                          for Users' Treatment

Sec. 6051. Short title.
Sec. 6052. Grants to provide technical assistance to outlier 
                            prescribers of opioids.
        Subtitle G--Preventing Addiction for Susceptible Seniors

Sec. 6061. Short title.
Sec. 6062. Electronic prior authorization for covered part D drugs.
Sec. 6063. Program integrity transparency measures under Medicare parts 
                            C and D.
Sec. 6064. Expanding eligibility for medication therapy management 
                            programs under part D.
Sec. 6065. Commit to opioid medical prescriber accountability and 
                            safety for seniors.
Sec. 6066. No additional funds authorized.
   Subtitle H--Expanding Oversight of Opioid Prescribing and Payment

Sec. 6071. Short title.
Sec. 6072. Medicare Payment Advisory Commission report on opioid 
                            payment, adverse incentives, and data under 
                            the Medicare program.
Sec. 6073. No additional funds authorized.
  Subtitle I--Dr. Todd Graham Pain Management, Treatment, and Recovery

Sec. 6081. Short title.
Sec. 6082. 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.
Sec. 6083. Expanding access under the Medicare program to addiction 
                            treatment in Federally qualified health 
                            centers and rural health clinics.
Sec. 6084. Studying the availability of supplemental benefits designed 
                            to treat or prevent substance use disorders 
                            under Medicare Advantage plans.
Sec. 6085. Clinical psychologist services models under the Center for 
                            Medicare and Medicaid Innovation; GAO study 
                            and report.
Sec. 6086. Dr. Todd Graham pain management study.
        Subtitle J--Combating Opioid Abuse for Care in Hospitals

Sec. 6091. Short title.
Sec. 6092. Developing guidance on pain management and opioid use 
                            disorder prevention for hospitals receiving 
                            payment under part A of the Medicare 
                            program.
Sec. 6093. Requiring the review of quality measures relating to opioids 
                            and opioid use disorder treatments 
                            furnished under the medicare program and 
                            other federal health care programs.
Sec. 6094. Technical expert panel on reducing surgical setting opioid 
                            use; Data collection on perioperative 
                            opioid use.
Sec. 6095. Requiring the posting and periodic update of opioid 
                            prescribing guidance for Medicare 
                            beneficiaries.
  Subtitle K--Providing Reliable Options for Patients and Educational 
                               Resources

Sec. 6101. Short title.
Sec. 6102. Requiring Medicare Advantage plans and part D prescription 
                            drug plans to include information on risks 
                            associated with opioids and coverage of 
                            nonpharmacological therapies and nonopioid 
                            medications or devices used to treat pain.
Sec. 6103. Requiring Medicare Advantage plans and prescription drug 
                            plans to provide information on the safe 
                            disposal of prescription drugs.
Sec. 6104. Revising measures used under the Hospital Consumer 
                            Assessment of Healthcare Providers and 
                            Systems survey relating to pain management.
         Subtitle L--Fighting the Opioid Epidemic With Sunshine

Sec. 6111. Fighting the opioid epidemic with sunshine.
                  TITLE VII--PUBLIC HEALTH PROVISIONS

                   Subtitle A--Awareness and Training

Sec. 7001. Report on effects on public health of synthetic drug use.
Sec. 7002. First responder training.
  Subtitle B--Pilot Program for Public Health Laboratories To Detect 
                  Fentanyl and Other Synthetic Opioids

Sec. 7011. Pilot program for public health laboratories to detect 
                            fentanyl and other synthetic opioids.
         Subtitle C--Indexing Narcotics, Fentanyl, and Opioids

Sec. 7021. Establishment of substance use disorder information 
                            dashboard.
Sec. 7022. Interdepartmental Substance Use Disorders Coordinating 
                            Committee.
Sec. 7023. National milestones to measure success in curtailing the 
                            opioid crisis.
Sec. 7024. Study on prescribing limits.
          Subtitle D--Ensuring Access to Quality Sober Living

Sec. 7031. National recovery housing best practices.
              Subtitle E--Advancing Cutting Edge Research

Sec. 7041. Unique research initiatives.
Sec. 7042. Pain research.
                        Subtitle F--Jessie's Law

Sec. 7051. Inclusion of opioid addiction history in patient records.
Sec. 7052. Communication with families during emergencies.
Sec. 7053. Development and dissemination of model training programs for 
                            substance use disorder patient records.
           Subtitle G--Protecting Pregnant Women and Infants

Sec. 7061. Report on addressing maternal and infant health in the 
                            opioid crisis.
Sec. 7062. Protecting moms and infants.
Sec. 7063. Early interventions for pregnant women and infants.
Sec. 7064. Prenatal and postnatal health.
Sec. 7065. Plans of safe care.
         Subtitle H--Substance Use Disorder Treatment Workforce

Sec. 7071. Loan repayment program for substance use disorder treatment 
                            workforce.
Sec. 7072. Clarification regarding service in schools and other 
                            community-based settings.
Sec. 7073. Programs for health care workforce.
       Subtitle I--Preventing Overdoses While in Emergency Rooms

Sec. 7081. Program to support coordination and continuation of care for 
                            drug overdose patients.
    Subtitle J--Alternatives to Opioids in the Emergency Department

Sec. 7091. Emergency department alternatives to opioids demonstration 
                            program.
    Subtitle K--Treatment, Education, and Community Help To Combat 
                               Addiction

Sec. 7101. Establishment of regional centers of excellence in substance 
                            use disorder education.
Sec. 7102. Youth prevention and recovery.
 Subtitle L--Information From National Mental Health and Substance Use 
                           Policy Laboratory

Sec. 7111. Information from National Mental Health and Substance Use 
                            Policy Laboratory.
           Subtitle M--Comprehensive Opioid Recovery Centers

Sec. 7121. Comprehensive opioid recovery centers.
                    Subtitle N--Trauma-Informed Care

Sec. 7131. CDC surveillance and data collection for child, youth, and 
                            adult trauma.
Sec. 7132. Task force to develop best practices for trauma-informed 
                            identification, referral, and support.
Sec. 7133. National Child Traumatic Stress Initiative.
Sec. 7134. Grants to improve trauma support services and mental health 
                            care for children and youth in educational 
                            settings.
Sec. 7135. Recognizing early childhood trauma related to substance 
                            abuse.
       Subtitle O--Eliminating Opioid Related Infectious Diseases

Sec. 7141. Reauthorization and expansion of program of surveillance and 
                            education regarding infections associated 
                            with illicit drug use and other risk 
                            factors.
            Subtitle P--Peer Support Communities of Recovery

Sec. 7151. Building communities of recovery.
Sec. 7152. Peer support technical assistance center.
 Subtitle Q--Creating Opportunities That Necessitate New and Enhanced 
         Connections That Improve Opioid Navigation Strategies

Sec. 7161. Preventing overdoses of controlled substances.
Sec. 7162. Prescription drug monitoring program.
   Subtitle R--Review of Substance Use Disorder Treatment Providers 
                       Receiving Federal Funding

Sec. 7171. Review of substance use disorder treatment providers 
                            receiving Federal funding.
                  Subtitle S--Other Health Provisions

Sec. 7181. State response to the opioid abuse crisis.
Sec. 7182. Report on investigations regarding parity in mental health 
                            and substance use disorder benefits.
Sec. 7183. CAREER Act.
                       TITLE VIII--MISCELLANEOUS

       Subtitle A--Synthetics Trafficking and Overdose Prevention

Sec. 8001. Short title.
Sec. 8002. Customs fees.
Sec. 8003. Mandatory advance electronic information for postal 
                            shipments.
Sec. 8004. International postal agreements.
Sec. 8005. Cost recoupment.
Sec. 8006. Development of technology to detect illicit narcotics.
Sec. 8007. Civil penalties for postal shipments.
Sec. 8008. Report on violations of arrival, reporting, entry, and 
                            clearance requirements and falsity or lack 
                            of manifest.
Sec. 8009. Effective date; regulations.
         Subtitle B--Opioid Addiction Recovery Fraud Prevention

Sec. 8021. Short title.
Sec. 8022. Definitions.
Sec. 8023. Unfair or deceptive acts or practices with respect to 
                            substance use disorder treatment service 
                            and products.
  Subtitle C--Addressing Economic and Workforce Impacts of the Opioid 
                                 Crisis

Sec. 8041. Addressing economic and workforce impacts of the opioid 
                            crisis.
     Subtitle D--Peer Support Counseling Program for Women Veterans

Sec. 8051. Peer support counseling program for women veterans.
              Subtitle E--Treating Barriers to Prosperity

Sec. 8061. Short title.
Sec. 8062. Drug abuse mitigation initiative.
   Subtitle F--Pilot Program to Help Individuals in Recovery From a 
              Substance Use Disorder Become Stably Housed

Sec. 8071. Pilot program to help individuals in recovery from a 
                            substance use disorder become stably 
                            housed.
                       Subtitle G--Human Services

Sec. 8081. Supporting family-focused residential treatment.
Sec. 8082. Improving recovery and reunifying families.
Sec. 8083. Building capacity for family-focused residential treatment.
Subtitle H--Reauthorizing and Extending Grants for Recovery From Opioid 
                              Use Programs

Sec. 8091. Short title.
Sec. 8092. Reauthorization of the comprehensive opioid abuse grant 
                            program.
          Subtitle I--Fighting Opioid Abuse in Transportation

Sec. 8101. Short title.
Sec. 8102. Alcohol and controlled substance testing of mechanical 
                            employees.
Sec. 8103. Department of Transportation public drug and alcohol testing 
                            database.
Sec. 8104. GAO report on Department of Transportation's collection and 
                            use of drug and alcohol testing data.
Sec. 8105. Transportation Workplace Drug and Alcohol Testing Program; 
                            addition of fentanyl and other substances.
Sec. 8106. Status reports on hair testing guidelines.
Sec. 8107. Mandatory Guidelines for Federal Workplace Drug Testing 
                            Programs using Oral Fluid.
Sec. 8108. Electronic recordkeeping.
Sec. 8109. Status reports on Commercial Driver's License Drug and 
                            Alcohol Clearinghouse.
             Subtitle J--Eliminating Kickbacks in Recovery

Sec. 8121. Short title.
Sec. 8122. Criminal penalties.
                 Subtitle K--Substance Abuse Prevention

Sec. 8201. Short title.
Sec. 8202. Reauthorization of the Office of National Drug Control 
                            Policy.
Sec. 8203. Reauthorization of the Drug-Free Communities Program.
Sec. 8204. Reauthorization of the National Community Anti-Drug 
                            Coalition Institute.
Sec. 8205. Reauthorization of the High-Intensity Drug Trafficking Area 
                            Program.
Sec. 8206. Reauthorization of drug court program.
Sec. 8207. Drug court training and technical assistance.
Sec. 8208. Drug overdose response strategy.
Sec. 8209. Protecting law enforcement officers from accidental 
                            exposure.
Sec. 8210. COPS Anti-Meth Program.
Sec. 8211. COPS anti-heroin task force program.
Sec. 8212. Comprehensive Addiction and Recovery Act education and 
                            awareness.
Sec. 8213. Reimbursement of substance use disorder treatment 
                            professionals.
Sec. 8214. Sobriety Treatment and Recovery Teams (START).
Sec. 8215. Provider education.
Sec. 8216. Definitions.
Sec. 8217. Amendments to administration of the Office.
Sec. 8218. Emerging threats committee, plan, and media campaign.
Sec. 8219. Drug interdiction.
Sec. 8220. GAO Audit.
Sec. 8221. National Drug Control Strategy.
Sec. 8222. Technical and conforming amendments to the Office of 
                            National Drug Control Policy 
                            Reauthorization Act of 1998.
                     Subtitle L--Budgetary Effects

Sec. 8231. Budgetary effect.

            TITLE I--MEDICAID PROVISIONS TO ADDRESS THE OPIOID CRISIS

SEC. 1001. AT-RISK YOUTH MEDICAID PROTECTION.

    (a) In General.--Section 1902 of the Social Security Act (42 U.S.C. 1396a) 
is amended--
            (1) in subsection (a)--
                    (A) by striking ``and'' at the end of paragraph (82);
                    (B) by striking the period at the end of paragraph (83) and 
                inserting ``; and''; and
                    (C) by inserting after paragraph (83) the following new 
                paragraph:
            ``(84) provide that--
                    ``(A) the State shall not terminate eligibility for medical 
                assistance under the State plan for an individual who is an 
                eligible juvenile (as defined in subsection (nn)(2)) because the 
                juvenile is an inmate of a public institution (as defined in 
                subsection (nn)(3)), but may suspend coverage during the period 
                the juvenile is such an inmate;
                    ``(B) in the case of an individual who is an eligible 
                juvenile described in paragraph (2)(A) of subsection (nn), the 
                State shall, prior to the individual's release from such a 
                public institution, conduct a redetermination of eligibility for 
                such individual with respect to such medical assistance (without 
                requiring a new application from the individual) and, if the 
                State determines pursuant to such redetermination that the 
                individual continues to meet the eligibility requirements for 
                such medical assistance, the State shall restore coverage for 
                such medical assistance to such an individual upon the 
                individual's release from such public institution; and
                    ``(C) in the case of an individual who is an eligible 
                juvenile described in paragraph (2)(B) of subsection (nn), the 
                State shall process any application for medical assistance 
                submitted by, or on behalf of, such individual such that the 
                State makes a determination of eligibility for such individual 
                with respect to such medical assistance upon release of such 
                individual from such public institution.''; and
            (2) by adding at the end the following new subsection:
    ``(nn) Juvenile; Eligible Juvenile; Public Institution.--For purposes of 
subsection (a)(84) and this subsection:
            ``(1) Juvenile.--The term `juvenile' means an individual who is--
                    ``(A) under 21 years of age; or
                    ``(B) described in subsection (a)(10)(A)(i)(IX).
            ``(2) Eligible juvenile.--The term `eligible juvenile' means a 
        juvenile who is an inmate of a public institution and who--
                    ``(A) was determined eligible for medical assistance under 
                the State plan immediately before becoming an inmate of such a 
                public institution; or
                    ``(B) is determined eligible for such medical assistance 
                while an inmate of a public institution.
            ``(3) Inmate of a public institution.--The term `inmate of a public 
        institution' has the meaning given such term for purposes of applying 
        the subdivision (A) following paragraph (30) of section 1905(a), taking 
        into account the exception in such subdivision for a patient of a 
        medical institution.''.
    (b) No Change in Exclusion From Medical Assistance for Inmates of Public 
Institutions.--Nothing in this section shall be construed as changing the 
exclusion from medical assistance under the subdivision (A) following paragraph 
(30) of section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)), as 
redesignated by section 1006(b)(2)(B) of this Act, including any applicable 
restrictions on a State submitting claims for Federal financial participation 
under title XIX of such Act for such assistance.
    (c) No Change in Continuity of Eligibility Before Adjudication or 
Sentencing.--Nothing in this section shall be construed to mandate, encourage, 
or suggest that a State suspend or terminate coverage for individuals before 
they have been adjudicated or sentenced.
    (d) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the amendments 
        made by subsection (a) shall apply to eligibility of juveniles who 
        become inmates of public institutions on or after the date that is 1 
        year after the date of the enactment of this Act.
            (2) Rule for changes requiring state legislation.--In the case of a 
        State plan for medical assistance under title XIX of the Social Security 
        Act which the Secretary of Health and Human Services determines requires 
        State legislation (other than legislation appropriating funds) in order 
        for the plan to meet the additional requirements imposed by the 
        amendments made by subsection (a), the State plan shall not be regarded 
        as failing to comply with the requirements of such title solely on the 
        basis of its failure to meet these additional requirements before the 
        first day of the first calendar quarter beginning after the close of the 
        first regular session of the State legislature that begins after the 
        date of the enactment of this Act. For purposes of the previous 
        sentence, in the case of a State that has a 2-year legislative session, 
        each year of such session shall be deemed to be a separate regular 
        session of the State legislature.

SEC. 1002. HEALTH INSURANCE FOR FORMER FOSTER YOUTH.

    (a) Coverage Continuity for Former Foster Care Children up to Age 26.--
            (1) In general.--Section 1902(a)(10)(A)(i)(IX) of the Social 
        Security Act (42 U.S.C. 1396a(a)(10)(A)(i)(IX)) is amended--
                    (A) in item (bb), by striking ``are not described in or 
                enrolled under'' and inserting ``are not described in and are 
                not enrolled under'';
                    (B) in item (cc), by striking ``responsibility of the 
                State'' and inserting ``responsibility of a State''; and
                    (C) in item (dd), by striking ``the State plan under this 
                title or under a waiver of the'' and inserting ``a State plan 
                under this title or under a waiver of such a''.
            (2) Effective date.--The amendments made by this subsection shall 
        take effect with respect to foster youth who attain 18 years of age on 
        or after January 1, 2023.
    (b) Guidance.--Not later than 1 year after the date of the enactment of this 
Act, the Secretary of Health and Human Services shall issue guidance to States, 
with respect to the State Medicaid programs of such States--
            (1) on best practices for--
                    (A) removing barriers and ensuring streamlined, timely 
                access to Medicaid coverage for former foster youth up to age 
                26; and
                    (B) conducting outreach and raising awareness among such 
                youth regarding Medicaid coverage options for such youth; and
            (2) which shall include examples of States that have successfully 
        extended Medicaid coverage to former foster youth up to age 26.

SEC. 1003. DEMONSTRATION PROJECT TO INCREASE SUBSTANCE USE PROVIDER CAPACITY 
              UNDER THE MEDICAID PROGRAM.

    Section 1903 of the Social Security Act (42 U.S.C. 1396b) is amended by 
adding at the end the following new subsection:
    ``(aa) Demonstration Project To Increase Substance Use Provider Capacity.--
            ``(1) In general.--Not later than the date that is 180 days after 
        the date of the enactment of this subsection, the Secretary shall, in 
        consultation, as appropriate, with the Director of the Agency for 
        Healthcare Research and Quality and the Assistant Secretary for Mental 
        Health and Substance Use, conduct a 54-month demonstration project for 
        the purpose described in paragraph (2) under which the Secretary shall--
                    ``(A) for the first 18-month period of such project, award 
                planning grants described in paragraph (3); and
                    ``(B) for the remaining 36-month period of such project, 
                provide to each State selected under paragraph (4) payments in 
                accordance with paragraph (5).
            ``(2) Purpose.--The purpose described in this paragraph is for each 
        State selected under paragraph (4) to increase the treatment capacity of 
        providers participating under the State plan (or a waiver of such plan) 
        to provide substance use disorder treatment or recovery services under 
        such plan (or waiver) through the following activities:
                    ``(A) For the purpose described in paragraph (3)(C)(i), 
                activities that support an ongoing assessment of the behavioral 
                health treatment needs of the State, taking into account the 
                matters described in subclauses (I) through (IV) of such 
                paragraph.
                    ``(B) Activities that, taking into account the results of 
                the assessment described in subparagraph (A), support the 
                recruitment, training, and provision of technical assistance for 
                providers participating under the State plan (or a waiver of 
                such plan) that offer substance use disorder treatment or 
                recovery services.
                    ``(C) Improved reimbursement for and expansion of, through 
                the provision of education, training, and technical assistance, 
                the number or treatment capacity of providers participating 
                under the State plan (or waiver) that--
                            ``(i) are authorized to dispense drugs approved by 
                        the Food and Drug Administration for individuals with a 
                        substance use disorder who need withdrawal management or 
                        maintenance treatment for such disorder;
                            ``(ii) have in effect a registration or waiver under 
                        section 303(g) of the Controlled Substances Act for 
                        purposes of dispensing narcotic drugs to individuals for 
                        maintenance treatment or detoxification treatment and 
                        are in compliance with any regulation promulgated by the 
                        Assistant Secretary for Mental Health and Substance Use 
                        for purposes of carrying out the requirements of such 
                        section 303(g); and
                            ``(iii) are qualified under applicable State law to 
                        provide substance use disorder treatment or recovery 
                        services.
                    ``(D) Improved reimbursement for and expansion of, through 
                the provision of education, training, and technical assistance, 
                the number or treatment capacity of providers participating 
                under the State plan (or waiver) that have the qualifications to 
                address the treatment or recovery needs of--
                            ``(i) individuals enrolled under the State plan (or 
                        a waiver of such plan) who have neonatal abstinence 
                        syndrome, in accordance 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 concurrent treatment, as 
                        appropriate, and comprehensive case management of 
                        pregnant women, postpartum women and infants, enrolled 
                        under the State plan (or a waiver of such plan);
                            ``(iii) adolescents and young adults between the 
                        ages of 12 and 21 enrolled under the State plan (or a 
                        waiver of such plan); or
                            ``(iv) American Indian and Alaska Native individuals 
                        enrolled under the State plan (or a waiver of such 
                        plan).
            ``(3) Planning grants.--
                    ``(A) In general.--The Secretary shall, with respect to the 
                first 18-month period of the demonstration project conducted 
                under paragraph (1), award planning grants to at least 10 States 
                selected in accordance with subparagraph (B) for purposes of 
                preparing an application 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 aggregate 
                        per capita drug overdoses, or any other measure that the 
                        Secretary deems appropriate.
                    ``(C) Activities described.--Activities described in this 
                subparagraph are, with respect to a State, each of the 
                following:
                            ``(i) Activities that support the development of an 
                        initial assessment of the behavioral health treatment 
                        needs of the State to determine the extent to which 
                        providers 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 services to individuals 
                                enrolled under the State plan (or waiver), 
                                including information on providers who provide 
                                such services and their participation under the 
                                State plan (or waiver).
                                    ``(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 participating under the 
                                demonstration project would increase the number 
                                of providers offering substance use disorder 
                                treatment or recovery services under the State 
                                plan (or waiver) during the period of the 
                                demonstration project.
                            ``(ii) Activities that, taking into account the 
                        results of the assessment described in clause (i), 
                        support the development of State infrastructure to, with 
                        respect to the provision of substance use disorder 
                        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.
                    ``(D) Funding.--For purposes of subparagraph (A), there is 
                appropriated, out of any funds in the Treasury not otherwise 
                appropriated, $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 paragraph (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 planning 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;
                            ``(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 aggregate 
                        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 Secretary requires, an application that includes 
                        such information, provisions, and assurances, as the 
                        Secretary may require, in addition to the following:
                                    ``(I) A proposed process for carrying out 
                                the ongoing assessment described in paragraph 
                                (2)(A), taking into account the results of the 
                                initial assessment described in paragraph 
                                (3)(C)(i).
                                    ``(II) A review of reimbursement 
                                methodologies and other policies related to 
                                substance use disorder treatment 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 sustainable 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 specialize in 
                                        providing substance use disorder 
                                        treatment or recovery services, 
                                        hospitals, health care systems, 
                                        Federally qualified health centers, and, 
                                        as applicable, certified community 
                                        behavioral health clinics) that offer 
                                        substance use disorder treatment, 
                                        recovery, or support services, including 
                                        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 necessary training, 
                                        education, and support to deliver 
                                        substance use disorder treatment or 
                                        recovery services in the State.
                                            ``(cc) Milestones and timeliness for 
                                        implementing activities set forth in the 
                                        plan.
                                            ``(dd) Specific measurable targets 
                                        for increasing the substance use 
                                        disorder treatment and recovery provider 
                                        network under the State plan (or a 
                                        waiver of such plan).
                                    ``(IV) A proposed process for reporting the 
                                information required under paragraph (6)(A), 
                                including information 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 impact of the 
                                demonstration project under this subsection on 
                                the State.
                                    ``(VI) A description of all funding sources 
                                available to the State to provide substance use 
                                disorder treatment or recovery services in the 
                                State.
                                    ``(VII) A preliminary plan for how the State 
                                will sustain any increase in the capacity of 
                                providers to deliver substance use disorder 
                                treatment or recovery services resulting from 
                                the demonstration project under this subsection 
                                after the termination of such demonstration 
                                project.
                                    ``(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 applicable.
                            ``(ii) Consultation.--In completing an application 
                        under clause (i), a State shall consult with relevant 
                        stakeholders, including Medicaid managed care plans, 
                        health care providers, and Medicaid beneficiary 
                        advocates, and include in such application a description 
                        of such consultation.
            ``(5) Payment.--
                    ``(A) In general.--For each quarter occurring during the 
                period for which the demonstration project is conducted (after 
                the first 18 months of such period), the Secretary shall pay 
                under this subsection, subject to subparagraph (C), to each 
                State selected under paragraph (4) an amount equal to 80 percent 
                of so much of the qualified sums expended during such quarter.
                    ``(B) Qualified sums defined.--For purposes of subparagraph 
                (A), the term `qualified 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 disorder 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 
                disorder treatment or recovery services.
                    ``(C) Non-duplication of payment.--In the case that payment 
                is made under subparagraph (A) with respect to expenditures for 
                substance use disorder treatment or recovery services furnished 
                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 period of the demonstration project 
                under this subsection, submit to the Secretary a quarterly 
                report, with respect to expenditures for substance use disorder 
                treatment or recovery services for which payment is made to the 
                State under this subsection, on the following:
                            ``(i) The specific activities with respect to which 
                        payment under this subsection was provided.
                            ``(ii) The number of providers that delivered 
                        substance use disorder treatment or recovery services in 
                        the State under the demonstration project compared to 
                        the estimated number of providers that would have 
                        otherwise delivered such services in the absence of such 
                        demonstration project.
                            ``(iii) The number of individuals enrolled under the 
                        State plan (or a waiver of such plan) who received 
                        substance use disorder 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.
                            ``(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 selection; 
                                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 
                        Director of the Agency for Healthcare Research and 
                        Quality and the Assistant Secretary for Mental Health 
                        and Substance Use, submit to Congress an interim 
                        report--
                                    ``(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 submitted in their applications 
                                under subparagraph (C) of such paragraph;
                                    ``(III) with a description of the strengths 
                                and limitations of such demonstration project; 
                                and
                                    ``(IV) with a plan for the sustainability 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--
                                    ``(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 subsection after the 
                                submission of such interim report; and
                                    ``(III) evaluating such demonstration 
                                project.
                    ``(C) AHRQ report.--Not later than 3 years after the date of 
                the enactment of this subsection, the Director of the Agency for 
                Healthcare Research and Quality, in consultation 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 paragraph (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 
        collaboration with States selected under paragraph (4), facilitate data 
        sharing and the development of best 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 appropriated, $5,000,000 to the Centers for 
        Medicare & Medicaid Services for purposes of implementing this 
        subsection. Such amount shall remain available until expended.''.

SEC. 1004. MEDICAID DRUG REVIEW AND UTILIZATION.

    (a) Medicaid Drug Utilization Review.--
            (1) State plan requirement.--Section 1902(a) of the Social Security 
        Act (42 U.S.C. 1396a(a)), as amended by section 1001, is further 
        amended--
                    (A) in paragraph (83), at the end, by striking ``and'';
                    (B) in paragraph (84), at the end, by striking the period 
                and inserting ``; and''; and
                    (C) by inserting after paragraph (84) the following new 
                paragraph:
            ``(85) provide that the State is in compliance with the drug review 
        and utilization requirements under subsection (oo)(1).''.
            (2) Drug review and utilization requirements.--Section 1902 of the 
        Social Security Act (42 U.S.C. 1396a), as amended by section 1001, is 
        further amended by adding at the end the following new subsection:
    ``(oo) Drug Review and Utilization Requirements.--
            ``(1) In general.--For purposes of subsection (a)(85), the drug 
        review and utilization requirements under this subsection are, subject 
        to paragraph (3) and beginning October 1, 2019, the following:
                    ``(A) Claims review limitations.--
                            ``(i) In general.--The State has in place--
                                    ``(I) safety edits (as specified by the 
                                State) for subsequent fills for opioids and a 
                                claims review automated process (as designed and 
                                implemented by the State) that indicates when an 
                                individual enrolled under the State plan (or 
                                under a waiver of the State plan) is prescribed 
                                a subsequent fill of opioids in excess of any 
                                limitation that may be identified by the State;
                                    ``(II) safety edits (as specified by the 
                                State) on the maximum daily morphine equivalent 
                                that can be prescribed to an individual enrolled 
                                under the State plan (or under a waiver of the 
                                State plan) for treatment of chronic pain and a 
                                claims review automated process (as designed and 
                                implemented by the State) that indicates when an 
                                individual enrolled under the plan (or waiver) 
                                is prescribed the morphine equivalent for such 
                                treatment in excess of any limitation that may 
                                be identified by the State; and
                                    ``(III) a claims review automated process 
                                (as designed and implemented by the State) that 
                                monitors when an individual enrolled under the 
                                State plan (or under a waiver of the State plan) 
                                is concurrently prescribed opioids and--
                                            ``(aa) benzodiazepines; or
                                            ``(bb) antipsychotics.
                            ``(ii) Managed care entities.--The State requires 
                        each managed care entity (as defined in section 
                        1932(a)(1)(B)) with respect to which the State has a 
                        contract under section 1903(m) or under section 
                        1905(t)(3) to have in place, subject to paragraph (3), 
                        with respect to individuals who are eligible for medical 
                        assistance under the State plan (or under a waiver of 
                        the State plan) and who are enrolled with the entity, 
                        the limitations described in subclauses (I) and (II) of 
                        clause (i) and a claims review automated process 
                        described in subclause (III) of such clause.
                            ``(iii) Rules of construction.--Nothing in this 
                        subparagraph may be construed as prohibiting a State or 
                        managed care entity from designing and implementing a 
                        claims review automated process under this subparagraph 
                        that provides for prospective or retrospective reviews 
                        of claims. Nothing in this subparagraph shall be 
                        understood as prohibiting the exercise of clinical 
                        judgment from a provider enrolled as a participating 
                        provider in a State plan (or waiver of the State plan) 
                        or contracting with a managed care entity regarding the 
                        best items and services for an individual enrolled under 
                        such State plan (or waiver).
                    ``(B) Program to monitor antipsychotic medications by 
                children.--The State has in place a program (as designed and 
                implemented by the State) to monitor and manage the appropriate 
                use of antipsychotic medications by children enrolled under the 
                State plan (or under a waiver of the State plan) and submits 
                annually to the Secretary such information as the Secretary may 
                require on activities carried out under such program for 
                individuals not more than the age of 18 years generally and 
                children in foster care specifically.
                    ``(C) Fraud and abuse identification.--The State has in 
                place a process (as designed and implemented by the State) that 
                identifies potential fraud or abuse of controlled substances by 
                individuals enrolled under the State plan (or under a waiver of 
                the State plan), health care providers prescribing drugs to 
                individuals so enrolled, and pharmacies dispensing drugs to 
                individuals so enrolled.
                    ``(D) Reports.--The State shall include in the annual report 
                submitted to the Secretary under section 1927(g)(3)(D) 
                information on the limitations, requirement, program, and 
                processes applied by the State under subparagraphs (A) through 
                (C) in accordance with such manner and time as specified by the 
                Secretary.
                    ``(E) Clarification.--Nothing shall prevent a State from 
                satisfying the requirement--
                            ``(i) described in subparagraph (A) by having safety 
                        edits or a claims review automated process described in 
                        such subparagraph that was in place before October 1, 
                        2019;
                            ``(ii) described in subparagraph (B) by having a 
                        program described in such subparagraph that was in place 
                        before such date; or
                            ``(iii) described in subparagraph (C) by having a 
                        process described in such subparagraph that was in place 
                        before such date.
            ``(2) Annual report by secretary.--For each fiscal year beginning 
        with fiscal year 2020, the Secretary shall submit to Congress a report 
        on the most recent information submitted by States under paragraph 
        (1)(D).
            ``(3) Exceptions.--
                    ``(A) Certain individuals exempted.--The drug review and 
                utilization requirements under this subsection shall not apply 
                with respect to an individual who--
                            ``(i) is receiving--
                                    ``(I) hospice or palliative care; or
                                    ``(II) treatment for cancer;
                            ``(ii) is a resident of a long-term care facility, 
                        of a facility described in section 1905(d), or of 
                        another facility for which frequently abused drugs are 
                        dispensed for residents through a contract with a single 
                        pharmacy; or
                            ``(iii) the State elects to treat as exempted from 
                        such requirements.
                    ``(B)  Exception relating to ensuring access.--In order to 
                ensure reasonable access to health care, the Secretary shall 
                waive the drug review and utilization requirements under this 
                subsection, with respect to a State, in the case of natural 
                disasters and similar situations, and in the case of the 
                provision of emergency services (as defined for purposes of 
                section 1860D-4(c)(5)(D)(ii)(II)).''.
            (3) Managed care entities.--Section 1932 of the Social Security Act 
        (42 U.S.C. 1396u-2) is amended by adding at the end the following new 
        subsection:
    ``(i) Drug Utilization Review Activities and Requirements.--Beginning not 
later than October 1, 2019, each contract under a State plan with a managed care 
entity (other than a primary care case manager) under section 1903(m) shall 
provide that the entity is in compliance with the applicable provisions of 
section 438.3(s)(2) of title 42, Code of Federal Regulations, section 
483.3(s)(4)) of such title, and section 483.3(s)(5) of such title, as such 
provisions were in effect on March 31, 2018.''.
    (b) Identifying and Addressing Inappropriate Prescribing and Billing 
Practices Under Medicaid.--
            (1) In general.--Section 1927(g) of the Social Security Act (42 
        U.S.C. 1396r-8(g)) is amended--
                    (A) in paragraph (1)(A)--
                            (i) by striking ``of section 1903(i)(10)(B)'' and 
                        inserting ``of section 1902(a)(54)'';
                            (ii) by striking ``, by not later than January 1, 
                        1993,'';
                            (iii) by inserting after ``gross overuse,'' the 
                        following: ``excessive utilization,''; and
                            (iv) by striking ``or inappropriate or medically 
                        unnecessary care'' and inserting ``inappropriate or 
                        medically unnecessary care, or prescribing or billing 
                        practices that indicate abuse or excessive 
                        utilization''; and
                    (B) in paragraph (2)(B)--
                            (i) by inserting after ``gross overuse,'' the 
                        following: ``excessive utilization,''; and
                            (ii) by striking ``or inappropriate or medically 
                        unnecessary care'' and inserting ``inappropriate or 
                        medically unnecessary care, or prescribing or billing 
                        practices that indicate abuse or excessive 
                        utilization''.
            (2) Effective date.--The amendments made by paragraph (1) shall take 
        effect with respect to retrospective drug use reviews conducted on or 
        after October 1, 2020.

SEC. 1005. GUIDANCE TO IMPROVE CARE FOR INFANTS WITH NEONATAL ABSTINENCE 
              SYNDROME AND THEIR MOTHERS; GAO STUDY ON GAPS IN MEDICAID COVERAGE 
              FOR PREGNANT AND POSTPARTUM WOMEN WITH SUBSTANCE USE DISORDER.

    (a) Guidance.--Not later than 1 year after the date of the enactment of this 
Act, the Secretary of Health and Human Services shall issue guidance to improve 
care for infants with neonatal abstinence syndrome and their families. Such 
guidance shall include--
            (1) best practices from States with respect to innovative or 
        evidenced-based payment models that focus on prevention, screening, 
        treatment, plans of safe care, and postdischarge services for mothers 
        and fathers with substance use disorders and babies with neonatal 
        abstinence syndrome that improve care and clinical outcomes;
            (2) recommendations for States on available financing options under 
        the Medicaid program under title XIX of such Act and under the 
        Children's Health Insurance Program under title XXI of such Act for 
        Children's Health Insurance Program Health Services Initiative funds for 
        parents with substance use disorders, infants with neonatal abstinence 
        syndrome, and home-visiting services;
            (3) guidance and technical assistance to State Medicaid agencies 
        regarding additional flexibilities and incentives related to screening, 
        prevention, and postdischarge services, including parenting supports, 
        and infant-caregiver bonding, including breastfeeding when it is 
        appropriate; and
            (4) guidance regarding suggested terminology and ICD codes to 
        identify infants with neonatal abstinence syndrome and neonatal opioid 
        withdrawal syndrome, which could include opioid-exposure, opioid 
        withdrawal not requiring pharmacotherapy, and opioid withdrawal 
        requiring pharmacotherapy.
    (b) GAO Study.--Not later than 1 year after the date of the enactment of 
this Act, the Comptroller General of the United States shall conduct a study, 
and submit to Congress a report, addressing gaps in coverage for pregnant women 
with substance use disorder under the Medicaid program under title XIX of the 
Social Security Act, and gaps in coverage for postpartum women with substance 
use disorder who had coverage during their pregnancy under the Medicaid program 
under such title.

SEC. 1006. MEDICAID HEALTH HOMES FOR SUBSTANCE-USE-DISORDER MEDICAID ENROLLEES.

    (a) Extension of Enhanced FMAP for Certain Health Homes for Individuals With 
Substance Use Disorders.--Section 1945(c) of the Social Security Act (42 U.S.C. 
1396w-4(c)) is amended--
            (1) in paragraph (1), by inserting ``subject to paragraph (4),'' 
        after ``except that,''; and
            (2) by adding at the end the following new paragraph:
            ``(4) Special rule relating to substance use disorder health 
        homes.--
                    ``(A) In general.--In the case of a State with an SUD-
                focused State plan amendment approved by the Secretary on or 
                after October 1, 2018, the Secretary may, at the request of the 
                State, extend the application of the Federal medical assistance 
                percentage described in paragraph (1) to payments for the 
                provision of health home services to SUD-eligible individuals 
                under such State plan amendment, in addition to the first 8 
                fiscal year quarters the State plan amendment is in effect, for 
                the subsequent 2 fiscal year quarters that the State plan 
                amendment is in effect. Nothing in this section shall be 
                construed as prohibiting a State with a State plan amendment 
                that is approved under this section and that is not an SUD-
                focused State plan amendment from additionally having approved 
                on or after such date an SUD-focused State plan amendment under 
                this section, including for purposes of application of this 
                paragraph.
                    ``(B) Report requirements.--In the case of a State with an 
                SUD-focused State plan amendment for which the application of 
                the Federal medical assistance percentage has been extended 
                under subparagraph (A), such State shall, at the end of the 
                period of such State plan amendment, submit to the Secretary a 
                report on the following, with respect to SUD-eligible 
                individuals provided health home services under such State plan 
                amendment:
                            ``(i) The quality of health care provided to such 
                        individuals, with a focus on outcomes relevant to the 
                        recovery of each such individual.
                            ``(ii) The access of such individuals to health 
                        care.
                            ``(iii) The total expenditures of such individuals 
                        for health care.
                For purposes of this subparagraph, the Secretary shall specify 
                all applicable measures for determining quality, access, and 
                expenditures.
                    ``(C) Best practices.--Not later than October 1, 2020, the 
                Secretary shall make publicly available on the internet website 
                of the Centers for Medicare & Medicaid Services best practices 
                for designing and implementing an SUD-focused State plan 
                amendment, based on the experiences of States that have State 
                plan amendments approved under this section that include SUD-
                eligible individuals.
                    ``(D) Definitions.--For purposes of this paragraph:
                            ``(i) SUD-eligible individuals.--The term `SUD-
                        eligible individual' means, with respect to a State, an 
                        individual who satisfies all of the following:
                                    ``(I) The individual is an eligible 
                                individual with chronic conditions.
                                    ``(II) The individual is an individual with 
                                a substance use disorder.
                                    ``(III) The individual has not previously 
                                received health home services under any other 
                                State plan amendment approved for the State 
                                under this section by the Secretary.
                            ``(ii) SUD-focused state plan amendment.--The term 
                        `SUD-focused State plan amendment' means a State plan 
                        amendment under this section that is designed to provide 
                        health home services primarily to SUD-eligible 
                        individuals.''.
    (b) Requirement for State Medicaid Plans To Provide Coverage for Medication-
Assisted Treatment.--
            (1) Requirement for state medicaid plans to provide coverage for 
        medication-assisted treatment.--Section 1902(a)(10)(A) of the Social 
        Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in the matter 
        preceding clause (i), by striking ``and (28)'' and inserting ``(28), and 
        (29)''.
            (2) Inclusion of medication-assisted treatment as medical 
        assistance.--Section 1905(a) of the Social Security Act (42 U.S.C. 
        1396d(a)) is amended--
                    (A) in paragraph (28), by striking ``and'' at the end;
                    (B) by redesignating paragraph (29) as paragraph (30); and
                    (C) by inserting after paragraph (28) the following new 
                paragraph:
            ``(29) subject to paragraph (2) of subsection (ee), for the period 
        beginning October 1, 2020, and ending September 30, 2025, medication-
        assisted treatment (as defined in paragraph (1) of such subsection); 
        and''.
            (3) Medication-assisted treatment defined; waivers.--Section 1905 of 
        the Social Security Act (42 U.S.C. 1396d) is amended by adding at the 
        end the following new subsection:
    ``(ee) Medication-Assisted Treatment.--
            ``(1) Definition.--For purposes of subsection (a)(29), the term 
        `medication-assisted treatment'--
                    ``(A) means all drugs approved under section 505 of the 
                Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355), including 
                methadone, and all biological products licensed under section 
                351 of the Public Health Service Act (42 U.S.C. 262) to treat 
                opioid use disorders; and
                    ``(B) includes, with respect to the provision of such drugs 
                and biological products, counseling services and behavioral 
                therapy.
            ``(2) Exception.--The provisions of paragraph (29) of subsection (a) 
        shall not apply with respect to a State for the period specified in such 
        paragraph, if before the beginning of such period the State certifies to 
        the satisfaction of the Secretary that implementing such provisions 
        statewide for all individuals eligible to enroll in the State plan (or 
        waiver of the State plan) would not be feasible by reason of a shortage 
        of qualified providers of medication-assisted treatment, or facilities 
        providing such treatment, that will contract with the State or a managed 
        care entity with which the State has a contract under section 1903(m) or 
        under section 1905(t)(3).''.
            (4) Effective date.--
                    (A) In general.--Subject to subparagraph (B), the amendments 
                made by this subsection shall apply with respect to medical 
                assistance provided on or after October 1, 2020, and before 
                October 1, 2025.
                    (B) Exception for state legislation.--In the case of a State 
                plan under title XIX of the Social Security Act (42 U.S.C. 1396 
                et seq.) that the Secretary of Health and Human Services 
                determines requires State legislation in order for the 
                respective plan to meet any requirement imposed by the 
                amendments made by this subsection, the respective plan shall 
                not be regarded as failing to comply with the requirements of 
                such title solely on the basis of its failure to meet such an 
                additional requirement before the first day of the first 
                calendar quarter beginning after the close of the first regular 
                session of the State legislature that begins after the date of 
                the enactment of this Act. For purposes of the previous 
                sentence, in the case of a State that has a 2-year legislative 
                session, each year of the session shall be considered to be a 
                separate regular session of the State legislature.

SEC. 1007. CARING RECOVERY FOR INFANTS AND BABIES.

    (a) State Plan Amendment.--Section 1902(a) of the Social Security Act (42 
U.S.C. 1396a(a)), as amended by sections 1001 and 1004, is further amended--
            (1) in paragraph (84)(C), by striking ``and'' after the semicolon;
            (2) in paragraph (85), by striking the period at the end and 
        inserting ``; and''; and
            (3) by inserting after paragraph (85), the following new paragraph:
            ``(86) provide, at the option of the State, for making medical 
        assistance available on an inpatient or outpatient basis at a 
        residential pediatric recovery center (as defined in subsection (pp)) to 
        infants with neonatal abstinence syndrome.''.
    (b) Residential Pediatric Recovery Center Defined.--Section 1902 of such Act 
(42 U.S.C. 1396a), as amended by sections 1001 and 1004, is further amended by 
adding at the end the following new subsection:
    ``(pp) Residential Pediatric Recovery Center Defined.--
            ``(1) In general.--For purposes of section 1902(a)(86), the term 
        `residential pediatric recovery center' means a center or facility that 
        furnishes items and services for which medical assistance is available 
        under the State plan to infants with the diagnosis of neonatal 
        abstinence syndrome without any other significant medical risk factors.
            ``(2) Counseling and services.--A residential pediatric recovery 
        center may offer counseling and other services to mothers (and other 
        appropriate family members and caretakers) of infants receiving 
        treatment at such centers if such services are otherwise covered under 
        the State plan under this title or under a waiver of such plan. Such 
        other services may include the following:
                    ``(A) Counseling or referrals for services.
                    ``(B) Activities to encourage caregiver-infant bonding.
                    ``(C) Training on caring for such infants.''.
    (c) Effective Date.--The amendments made by this section take effect on the 
date of enactment of this Act and shall apply to medical assistance furnished on 
or after that date, without regard to final regulations to carry out such 
amendments being promulgated as of such date.

SEC. 1008. PEER SUPPORT ENHANCEMENT AND EVALUATION REVIEW.

    (a) In General.--Not later than 2 years after the date of the enactment of 
this Act, the Comptroller General of the United States shall submit to the 
Committee on Energy and Commerce of the House of Representatives, the Committee 
on Finance of the Senate, and the Committee on Health, Education, Labor and 
Pensions of the Senate a report on the provision of peer support services under 
the Medicaid program.
    (b) Content of Report.--
            (1) In general.--The report required under subsection (a) shall 
        include the following information:
                    (A) Information on State coverage of peer support services 
                under Medicaid, including--
                            (i) the mechanisms through which States may provide 
                        such coverage, including through existing statutory 
                        authority or through waivers;
                            (ii) the populations to which States have provided 
                        such coverage;
                            (iii) the payment models, including any alternative 
                        payment models, used by States to pay providers of such 
                        services; and
                            (iv) where available, information on Federal and 
                        State spending under Medicaid for peer support services.
                    (B) Information on selected State experiences in providing 
                medical assistance for peer support services under State 
                Medicaid plans and whether States measure the effects of 
                providing such assistance with respect to--
                            (i) improving access to behavioral health services;
                            (ii) improving early detection, and preventing 
                        worsening, of behavioral health disorders;
                            (iii) reducing chronic and comorbid conditions; and
                            (iv) reducing overall health costs.
            (2) Recommendations.--The report required under subsection (a) shall 
        include recommendations, including recommendations for such legislative 
        and administrative actions related to improving services, including peer 
        support services, and access to peer support services under Medicaid as 
        the Comptroller General of the United States determines appropriate.

SEC. 1009. MEDICAID SUBSTANCE USE DISORDER TREATMENT VIA TELEHEALTH.

    (a) Definitions.--In this section:
            (1) Comptroller general.--The term ``Comptroller General'' means the 
        Comptroller General of the United States.
            (2) School-based health center.--The term ``school-based health 
        center'' has the meaning given that term in section 2110(c)(9) of the 
        Social Security Act (42 U.S.C. 1397jj(c)(9)).
            (3) Secretary.--The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (4) Underserved area.--The term ``underserved area'' means a health 
        professional shortage area (as defined in section 332(a)(1)(A) of the 
        Public Health Service Act (42 U.S.C. 254e(a)(1)(A))) and a medically 
        underserved area (according to a designation under section 330(b)(3)(A) 
        of the Public Health Service Act (42 U.S.C. 254b(b)(3)(A))).
    (b) Guidance to States Regarding Federal Reimbursement for Furnishing 
Services and Treatment for Substance Use Disorders Under Medicaid Using Services 
Delivered Via Telehealth, Including in School-Based Health Centers.--Not later 
than 1 year after the date of enactment of this Act, the Secretary, acting 
through the Administrator of the Centers for Medicare & Medicaid Services, shall 
issue guidance to States on the following:
            (1) State options for Federal reimbursement of expenditures under 
        Medicaid for furnishing services and treatment for substance use 
        disorders, including assessment, medication-assisted treatment, 
        counseling, medication management, and medication adherence with 
        prescribed medication regimes, using services delivered via telehealth. 
        Such guidance shall also include guidance on furnishing services and 
        treatments that address the needs of high-risk individuals, including at 
        least the following groups:
                    (A) American Indians and Alaska Natives.
                    (B) Adults under the age of 40.
                    (C) Individuals with a history of non-fatal overdose.
                    (D) Individuals with a co-occurring serious mental illness 
                and substance use disorder.
            (2) State options for Federal reimbursement of expenditures under 
        Medicaid for education directed to providers serving Medicaid 
        beneficiaries with substance use disorders using the hub and spoke 
        model, through contracts with managed care entities, through 
        administrative claiming for disease management activities, and under 
        Delivery System Reform Incentive Payment (``DSRIP'') programs.
            (3) State options for Federal reimbursement of expenditures under 
        Medicaid for furnishing services and treatment for substance use 
        disorders for individuals enrolled in Medicaid in a school-based health 
        center using services delivered via telehealth.
    (c) GAO Evaluation of Children's Access to Services and Treatment for 
Substance Use Disorders Under Medicaid.--
            (1) Study.--The Comptroller General shall evaluate children's access 
        to services and treatment for substance use disorders under Medicaid. 
        The evaluation shall include an analysis of State options for improving 
        children's access to such services and treatment and for improving 
        outcomes, including by increasing the number of Medicaid providers who 
        offer services or treatment for substance use disorders in a school-
        based health center using services delivered via telehealth, 
        particularly in rural and underserved areas. The evaluation shall 
        include an analysis of Medicaid provider reimbursement rates for 
        services and treatment for substance use disorders.
            (2) Report.--Not later than 1 year after the date of enactment of 
        this Act, the Comptroller General shall submit to Congress a report 
        containing the results of the evaluation conducted under paragraph (1), 
        together with recommendations for such legislation and administrative 
        action as the Comptroller General determines appropriate.
    (d) Report on Reducing Barriers to Using Services Delivered Via Telehealth 
and Remote Patient Monitoring for Pediatric Populations Under Medicaid.--
            (1) In general.--Not later than 1 year after the date of enactment 
        of this Act, the Secretary, acting through the Administrator of the 
        Centers for Medicare & Medicaid Services, shall issue a report to the 
        Committee on Finance of the Senate and the Committee on Energy and 
        Commerce of the House of Representatives identifying best practices and 
        potential solutions for reducing barriers to using services delivered 
        via telehealth to furnish services and treatment for substance use 
        disorders among pediatric populations under Medicaid. The report shall 
        include--
                    (A) analyses of the best practices, barriers, and potential 
                solutions for using services delivered via telehealth to 
                diagnose and provide services and treatment for children with 
                substance use disorders, including opioid use disorder; and
                    (B) identification and analysis of the differences, if any, 
                in furnishing services and treatment for children with substance 
                use disorders using services delivered via telehealth and using 
                services delivered in person, such as, and to the extent 
                feasible, with respect to--
                            (i) utilization rates;
                            (ii) costs;
                            (iii) avoidable inpatient admissions and 
                        readmissions;
                            (iv) quality of care; and
                            (v) patient, family, and provider satisfaction.
            (2) Publication.--The Secretary shall publish the report required 
        under paragraph (1) on a public internet website of the Department of 
        Health and Human Services.

SEC. 1010. ENHANCING PATIENT ACCESS TO NON-OPIOID TREATMENT OPTIONS.

    Not later than January 1, 2019, the Secretary of Health and Human Services, 
acting through the Administrator of the Centers for Medicare & Medicaid 
Services, shall issue 1 or more final guidance documents, or update existing 
guidance documents, to States regarding mandatory and optional items and 
services that may be provided under a State plan under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.), or under a waiver of such a plan, for 
non-opioid treatment and management of pain, including, but not limited to, 
evidence-based, non-opioid pharmacological therapies and non-pharmacological 
therapies.

SEC. 1011. ASSESSING BARRIERS TO OPIOID USE DISORDER TREATMENT.

    (a) Study.--
            (1) In general.--The Comptroller General of the United States (in 
        this section referred to as the ``Comptroller General'') shall conduct a 
        study regarding the barriers to providing medication used in the 
        treatment of substance use disorders under Medicaid distribution models 
        such as the ``buy-and-bill'' model, and options for State Medicaid 
        programs to remove or reduce such barriers. The study shall include 
        analyses of each of the following models of distribution of substance 
        use disorder treatment medications, particularly buprenorphine, 
        naltrexone, and buprenorphine-naloxone combinations:
                    (A) The purchasing, storage, and administration of substance 
                use disorder treatment medications by providers.
                    (B) The dispensing of substance use disorder treatment 
                medications by pharmacists.
                    (C) The ordering, prescribing, and obtaining substance use 
                disorder treatment medications on demand from specialty 
                pharmacies by providers.
            (2) Requirements.--For each model of distribution specified in 
        paragraph (1), the Comptroller General shall evaluate how each model 
        presents barriers or could be used by selected State Medicaid programs 
        to reduce the barriers related to the provision of substance use 
        disorder treatment by examining what is known about the effects of the 
        model of distribution on--
                    (A) Medicaid beneficiaries' access to substance use disorder 
                treatment medications;
                    (B) the differential cost to the program between each 
                distribution model for medication-assisted treatment; and
                    (C) provider willingness to provide or prescribe substance 
                use disorder treatment medications.
    (b) Report.--Not later than 15 months after the date of the enactment of 
this Act, the Comptroller General shall submit to Congress a report containing 
the results of the study conducted under subsection (a), together with 
recommendations for such legislation and administrative action as the 
Comptroller General determines appropriate.

SEC. 1012. HELP FOR MOMS AND BABIES.

    (a) Medicaid State Plan.--Section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)), as amended by section 1006, is further amended by adding at 
the end the following new sentence: ``In the case of a woman who is eligible for 
medical assistance on the basis of being pregnant (including through the end of 
the month in which the 60-day period beginning on the last day of her pregnancy 
ends), who is a patient in an institution for mental diseases for purposes of 
receiving treatment for a substance use disorder, and who was enrolled for 
medical assistance under the State plan immediately before becoming a patient in 
an institution for mental diseases or who becomes eligible to enroll for such 
medical assistance while such a patient, the exclusion from the definition of 
`medical assistance' set forth in the subdivision (B) following paragraph (30) 
of the first sentence of this subsection shall not be construed as prohibiting 
Federal financial participation for medical assistance for items or services 
that are provided to the woman outside of the institution.''.
    (b) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the amendment 
        made by subsection (a) shall take effect on the date of enactment of 
        this Act.
            (2) Rule for changes requiring state legislation.--In the case of a 
        State plan under title XIX of the Social Security Act which the 
        Secretary of Health and Human Services determines requires State 
        legislation (other than legislation appropriating funds) in order for 
        the plan to meet the additional requirements imposed by the amendment 
        made by subsection (a), the State plan shall not be regarded as failing 
        to comply with the requirements of such title solely on the basis of its 
        failure to meet these additional requirements before the first day of 
        the first calendar quarter beginning after the close of the first 
        regular session of the State legislature that begins after the date of 
        the enactment of this Act. For purposes of the previous sentence, in the 
        case of a State that has a 2-year legislative session, each year of such 
        session shall be deemed to be a separate regular session of the State 
        legislature.

SEC. 1013. SECURING FLEXIBILITY TO TREAT SUBSTANCE USE DISORDERS.

    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) Payment shall be made under this title to a State for expenditures for 
capitation payments described in section 438.6(e) of title 42, Code of Federal 
Regulations (or any successor regulation).''.

SEC. 1014. MACPAC STUDY AND REPORT ON MAT UTILIZATION CONTROLS UNDER STATE 
              MEDICAID PROGRAMS.

    (a) Study.--The Medicaid and CHIP Payment and Access Commission shall 
conduct a study and analysis of utilization control policies applied to 
medication-assisted treatment for substance use disorders under State Medicaid 
programs, including policies and procedures applied both in fee-for-service 
Medicaid and in risk-based managed care Medicaid, which shall--
            (1) include an inventory of such utilization control policies and 
        related protocols for ensuring access to medically necessary treatment;
            (2) determine whether managed care utilization control policies and 
        procedures for medication-assisted treatment for substance use disorders 
        are consistent with section 438.210(a)(4)(ii) of title 42, Code of 
        Federal Regulations; and
            (3) identify policies that--
                    (A) limit an individual's access to medication-assisted 
                treatment for a substance use disorder by limiting the quantity 
                of medication-assisted treatment prescriptions, or the number of 
                refills for such prescriptions, available to the individual as 
                part of a prior authorization process or similar utilization 
                protocols; and
                    (B) apply without evaluating individual instances of fraud, 
                waste, or abuse.
    (b) Report.--Not later than 1 year after the date of the enactment of this 
Act, the Medicaid and CHIP Payment and Access Commission shall make publicly 
available a report containing the results of the study conducted under 
subsection (a).

SEC. 1015. OPIOID ADDICTION TREATMENT PROGRAMS ENHANCEMENT.

    (a) T-MSIS Substance Use Disorder Data Book.--
            (1) In general.--Not later than the date that is 12 months after the 
        date of enactment of this Act, the Secretary of Health and Human 
        Services (in this section referred to as the ``Secretary'') shall 
        publish on the public website of the Centers for Medicare & Medicaid 
        Services a report with comprehensive data on the prevalence of substance 
        use disorders in the Medicaid beneficiary population and services 
        provided for the treatment of substance use disorders under Medicaid.
            (2) Content of report.--The report required under paragraph (1) 
        shall include, at a minimum, the following data for each State 
        (including, to the extent available, for the District of Columbia, 
        Puerto Rico, the United States Virgin Islands, Guam, the Northern 
        Mariana Islands, and American Samoa):
                    (A) The number and percentage of individuals enrolled in the 
                State Medicaid plan or waiver of such plan in each of the major 
                enrollment categories (as defined in a public letter from the 
                Medicaid and CHIP Payment and Access Commission to the 
                Secretary) who have been diagnosed with a substance use disorder 
                and whether such individuals are enrolled under the State 
                Medicaid plan or a waiver of such plan, including the specific 
                waiver authority under which they are enrolled, to the extent 
                available.
                    (B) A list of the substance use disorder treatment services 
                by each major type of service, such as counseling, medication-
                assisted treatment, peer support, residential treatment, and 
                inpatient care, for which beneficiaries in each State received 
                at least 1 service under the State Medicaid plan or a waiver of 
                such plan.
                    (C) The number and percentage of individuals with a 
                substance use disorder diagnosis enrolled in the State Medicaid 
                plan or waiver of such plan who received substance use disorder 
                treatment services under such plan or waiver by each major type 
                of service under subparagraph (B) within each major setting 
                type, such as outpatient, inpatient, residential, and other 
                home-based and community-based settings.
                    (D) The number of services provided under the State Medicaid 
                plan or waiver of such plan per individual with a substance use 
                disorder diagnosis enrolled in such plan or waiver for each 
                major type of service under subparagraph (B).
                    (E) The number and percentage of individuals enrolled in the 
                State Medicaid plan or waiver, by major enrollment category, who 
                received substance use disorder treatment through--
                            (i) a medicaid managed care entity (as defined in 
                        section 1932(a)(1)(B) of the Social Security Act (42 
                        U.S.C. 1396u-2(a)(1)(B))), including the number of such 
                        individuals who received such assistance through a 
                        prepaid inpatient health plan or a prepaid ambulatory 
                        health plan;
                            (ii) a fee-for-service payment model; or
                            (iii) an alternative payment model, to the extent 
                        available.
                    (F) The number and percentage of individuals with a 
                substance use disorder who receive substance use disorder 
                treatment services in an outpatient or home-based and community-
                based setting after receiving treatment in an inpatient or 
                residential setting, and the number of services received by such 
                individuals in the outpatient or home-based and community-based 
                setting.
            (3) Annual updates.--The Secretary shall issue an updated version of 
        the report required under paragraph (1) not later than January 1 of each 
        calendar year through 2024.
            (4) Use of t-msis data.--The report required under paragraph (1) and 
        updates required under paragraph (3) shall--
                    (A) use data and definitions from the Transformed Medicaid 
                Statistical Information System (``T-MSIS'') data set that is no 
                more than 12 months old on the date that the report or update is 
                published; and
                    (B) as appropriate, include a description with respect to 
                each State of the quality and completeness of the data and 
                caveats describing the limitations of the data reported to the 
                Secretary by the State that is sufficient to communicate the 
                appropriate uses for the information.
    (b) Making T-MSIS Data on Substance Use Disorders Available to 
Researchers.--
            (1) In general.--The Secretary shall publish in the Federal Register 
        a system of records notice for the data specified in paragraph (2) for 
        the Transformed Medicaid Statistical Information System, in accordance 
        with section 552a(e)(4) of title 5, United States Code. The notice shall 
        outline policies that protect the security and privacy of the data that, 
        at a minimum, meet the security and privacy policies of SORN 09-70-0541 
        for the Medicaid Statistical Information System.
            (2) Required data.--The data covered by the systems of records 
        notice required under paragraph (1) shall be sufficient for researchers 
        and States to analyze the prevalence of substance use disorders in the 
        Medicaid beneficiary population and the treatment of substance use 
        disorders under Medicaid across all States (including the District of 
        Columbia, Puerto Rico, the United States Virgin Islands, Guam, the 
        Northern Mariana Islands, and American Samoa), forms of treatment, and 
        treatment settings.
            (3) Initiation of data-sharing activities.--Not later than January 
        1, 2019, the Secretary shall initiate the data-sharing activities 
        outlined in the notice required under paragraph (1).

SEC. 1016. BETTER DATA SHARING TO COMBAT THE OPIOID CRISIS.

    (a) In General.--Section 1903(m) of the Social Security Act (42 U.S.C. 
1396b(m)), as amended by section 1013, is further amended by adding at the end 
the following new paragraph:
    ``(8)(A) The State agency administering the State plan under this title may 
have reasonable access, as determined by the State, to 1 or more prescription 
drug monitoring program databases administered or accessed by the State to the 
extent the State agency is permitted to access such databases under State law.
    ``(B) Such State agency may facilitate reasonable access, as determined by 
the State, to 1 or more prescription drug monitoring program databases 
administered or accessed by the State, to same extent that the State agency is 
permitted under State law to access such databases, for--
            ``(i) any provider enrolled under the State plan to provide services 
        to Medicaid beneficiaries; and
            ``(ii) any managed care entity (as defined under section 
        1932(a)(1)(B)) that has a contract with the State under this subsection 
        or under section 1905(t)(3).
    ``(C) Such State agency may share information in such databases, to the same 
extent that the State agency is permitted under State law to share information 
in such databases, with--
            ``(i) any provider enrolled under the State plan to provide services 
        to Medicaid beneficiaries; and
            ``(ii) any managed care entity (as defined under section 
        1932(a)(1)(B)) that has a contract with the State under this subsection 
        or under section 1905(t)(3).''.
    (b) Security and Privacy.--All applicable State and Federal security and 
privacy protections and laws shall apply to any State agency, individual, or 
entity accessing 1 or more prescription drug monitoring program databases or 
obtaining information in such databases in accordance with section 1903(m)(8) of 
the Social Security Act (as added by subsection (a)).
    (c) Effective Date.--The amendment made by subsection (a) shall take effect 
on the date of enactment of this Act.

SEC. 1017. REPORT ON INNOVATIVE STATE INITIATIVES AND STRATEGIES TO PROVIDE 
              HOUSING-RELATED SERVICES AND SUPPORTS TO INDIVIDUALS STRUGGLING 
              WITH SUBSTANCE USE DISORDERS UNDER MEDICAID.

    (a) In General.--Not later than 1 year after the date of enactment of this 
Act, the Secretary of Health and Human Services shall issue a report to Congress 
describing innovative State initiatives and strategies for providing housing-
related services and supports under a State Medicaid program to individuals with 
substance use disorders who are experiencing or at risk of experiencing 
homelessness.
    (b) Content of Report.--The report required under subsection (a) shall 
describe the following:
            (1) Existing methods and innovative strategies developed and adopted 
        by State Medicaid programs that have achieved positive outcomes in 
        increasing housing stability among Medicaid beneficiaries with substance 
        use disorders who are experiencing or at risk of experiencing 
        homelessness, including Medicaid beneficiaries with substance use 
        disorders who are--
                    (A) receiving treatment for substance use disorders in 
                inpatient, residential, outpatient, or home-based and community-
                based settings;
                    (B) transitioning between substance use disorder treatment 
                settings; or
                    (C) living in supportive housing or another model of 
                affordable housing.
            (2) Strategies employed by Medicaid managed care organizations, 
        primary care case managers, hospitals, accountable care organizations, 
        and other care coordination providers to deliver housing-related 
        services and supports and to coordinate services provided under State 
        Medicaid programs across different treatment settings.
            (3) Innovative strategies and lessons learned by States with 
        Medicaid waivers approved under section 1115 or 1915 of the Social 
        Security Act (42 U.S.C. 1315, 1396n), including--
                    (A) challenges experienced by States in designing, securing, 
                and implementing such waivers or plan amendments;
                    (B) how States developed partnerships with other 
                organizations such as behavioral health agencies, State housing 
                agencies, housing providers, health care services agencies and 
                providers, community-based organizations, and health insurance 
                plans to implement waivers or State plan amendments; and
                    (C) how and whether States plan to provide Medicaid coverage 
                for housing-related services and supports in the future, 
                including by covering such services and supports under State 
                Medicaid plans or waivers.
            (4) Existing opportunities for States to provide housing-related 
        services and supports through a Medicaid waiver under sections 1115 or 
        1915 of the Social Security Act (42 U.S.C. 1315, 1396n) or through a 
        State Medicaid plan amendment, such as the Assistance in Community 
        Integration Service pilot program, which promotes supportive housing and 
        other housing-related supports under Medicaid for individuals with 
        substance use disorders and for which Maryland has a waiver approved 
        under such section 1115 to conduct the program.
            (5) Innovative strategies and partnerships developed and implemented 
        by State Medicaid programs or other entities to identify and enroll 
        eligible individuals with substance use disorders who are experiencing 
        or at risk of experiencing homelessness in State Medicaid programs.

SEC. 1018. TECHNICAL ASSISTANCE AND SUPPORT FOR INNOVATIVE STATE STRATEGIES TO 
              PROVIDE HOUSING-RELATED SUPPORTS UNDER MEDICAID.

    (a) In General.--The Secretary of Health and Human Services shall provide 
technical assistance and support to States regarding the development and 
expansion of innovative State strategies (including through State Medicaid 
demonstration projects) to provide housing-related supports and services and 
care coordination services under Medicaid to individuals with substance use 
disorders.
    (b) Report.--Not later than 180 days after the date of enactment of this 
Act, the Secretary shall issue a report to Congress detailing a plan of action 
to carry out the requirements of subsection (a).

           TITLE II--MEDICARE PROVISIONS TO ADDRESS THE OPIOID CRISIS

SEC. 2001. EXPANDING THE USE OF TELEHEALTH SERVICES FOR THE TREATMENT OF OPIOID 
              USE DISORDER AND OTHER SUBSTANCE USE DISORDERS.

    (a) In General.--Section 1834(m) of the Social Security Act (42 U.S.C. 
1395m(m)) is amended--
            (1) in paragraph (2)(B)--
                    (A) in clause (i), in the matter preceding subclause (I), by 
                striking ``clause (ii)'' and inserting ``clause (ii) and 
                paragraph (6)(C)''; and
                    (B) in clause (ii), in the heading, by striking ``for home 
                dialysis therapy'';
            (2) in paragraph (4)(C)--
                    (A) in clause (i), by striking ``paragraph (6)'' and 
                inserting ``paragraphs (5), (6), and (7)''; and
                    (B) in clause (ii)(X), by inserting ``or telehealth services 
                described in paragraph (7)'' before the period at the end; and
            (3) by adding at the end the following new paragraph:
            ``(7) Treatment of substance use disorder services furnished through 
        telehealth.--The geographic requirements described in paragraph 
        (4)(C)(i) shall not apply with respect to telehealth services furnished 
        on or after July 1, 2019, to an eligible telehealth individual with a 
        substance use disorder diagnosis for purposes of treatment of such 
        disorder or co-occurring mental health disorder, as determined by the 
        Secretary, at an originating site described in paragraph (4)(C)(ii) 
        (other than an originating site described in subclause (IX) of such 
        paragraph).''.
    (b) Implementation.--The Secretary of Health and Human Services (in this 
section referred to as the ``Secretary'') may implement the amendments made by 
this section by interim final rule.
    (c) Report.--
            (1) In general.--Not later than 5 years after the date of the 
        enactment of this Act, the Secretary shall submit to Congress a report 
        on the impact of the implementation of the amendments made by this 
        section with respect to telehealth services under section 1834(m) of the 
        Social Security Act (42 U.S.C. 1395m(m)) on--
                    (A) the utilization of health care items and services under 
                title XVIII of such Act (42 U.S.C. 1395 et seq.) related to 
                substance use disorders, including emergency department visits; 
                and
                    (B) health outcomes related to substance use disorders, such 
                as opioid overdose deaths.
            (2) Funding.--For purposes of carrying out paragraph (1), in 
        addition to funds otherwise available, the Secretary shall provide for 
        the transfer, from the Federal Supplementary Medical Insurance Trust 
        Fund under section 1841, of $3,000,000 to the Centers for Medicare & 
        Medicaid Services Program Management Account to remain available until 
        expended.

SEC. 2002. COMPREHENSIVE SCREENINGS FOR SENIORS.

    (a) Initial Preventive Physical Examination.--Section 1861(ww) of the Social 
Security Act (42 U.S.C. 1395x(ww)) is amended--
            (1) in paragraph (1)--
                    (A) by striking ``paragraph (2) and'' and inserting 
                ``paragraph (2),''; and
                    (B) by inserting ``and the furnishing of a review of any 
                current opioid prescriptions (as defined in paragraph (4)),'' 
                after ``upon the agreement with the individual,''; and
            (2) in paragraph (2)--
                    (A) by redesignating subparagraph (N) as subparagraph (O); 
                and
                    (B) by inserting after subparagraph (M) the following new 
                subparagraph:
                    ``(N) Screening for potential substance use disorders.''; 
                and
            (3) by adding at the end the following new paragraph:
    ``(4) For purposes of paragraph (1), the term `a review of any current 
opioid prescriptions' means, with respect to an individual determined to have a 
current prescription for opioids--
            ``(A) a review of the potential risk factors to the individual for 
        opioid use disorder;
            ``(B) an evaluation of the individual's severity of pain and current 
        treatment plan;
            ``(C) the provision of information on non-opioid treatment options; 
        and
            ``(D) a referral to a specialist, as appropriate.''.
    (b) Annual Wellness Visit.--Section 1861(hhh)(2) of the Social Security Act 
(42 U.S.C. 1395x(hhh)(2)) is amended--
            (1) by redesignating subparagraph (G) as subparagraph (I); and
            (2) by inserting after subparagraph (F) the following new 
        subparagraphs:
                    ``(G) Screening for potential substance use disorders and 
                referral for treatment as appropriate.
                    ``(H) The furnishing of a review of any current opioid 
                prescriptions (as defined in subsection (ww)(4)).''.
    (c) Rule of Construction.--Nothing in the amendments made by subsection (a) 
or (b) shall be construed to prohibit separate payment for structured assessment 
and intervention services for substance abuse furnished to an individual on the 
same day as an initial preventive physical examination or an annual wellness 
visit.
    (d) Effective Date.--The amendments made by this section shall apply to 
examinations and visits furnished on or after January 1, 2020.

SEC. 2003. EVERY PRESCRIPTION CONVEYED SECURELY.

    (a) In General.--Section 1860D-4(e) of the Social Security Act (42 U.S.C. 
1395w-104(e)) is amended by adding at the end the following:
            ``(7) Requirement of e-prescribing for controlled substances.--
                    ``(A) In general.--Subject to subparagraph (B), a 
                prescription for a covered part D drug under a prescription drug 
                plan (or under an MA-PD plan) for a schedule II, III, IV, or V 
                controlled substance shall be transmitted by a health care 
                practitioner electronically in accordance with an electronic 
                prescription drug program that meets the requirements of 
                paragraph (2).
                    ``(B) Exception for certain circumstances.--The Secretary 
                shall, through rulemaking, specify circumstances and processes 
                by which the Secretary may waive the requirement under 
                subparagraph (A), with respect to a covered part D drug, 
                including in the case of--
                            ``(i) a prescription issued when the practitioner 
                        and dispensing pharmacy are the same entity;
                            ``(ii) a prescription issued that cannot be 
                        transmitted electronically under the most recently 
                        implemented version of the National Council for 
                        Prescription Drug Programs SCRIPT Standard;
                            ``(iii) a prescription issued by a practitioner who 
                        received a waiver or a renewal thereof for a period of 
                        time as determined by the Secretary, not to exceed one 
                        year, from the requirement to use electronic prescribing 
                        due to demonstrated economic hardship, technological 
                        limitations that are not reasonably within the control 
                        of the practitioner, or other exceptional circumstance 
                        demonstrated by the practitioner;
                            ``(iv) a prescription issued by a practitioner under 
                        circumstances in which, notwithstanding the 
                        practitioner's ability to submit a prescription 
                        electronically as required by this subsection, such 
                        practitioner reasonably determines that it would be 
                        impractical for the individual involved to obtain 
                        substances prescribed by electronic prescription in a 
                        timely manner, and such delay would adversely impact the 
                        individual's medical condition involved;
                            ``(v) a prescription issued by a practitioner 
                        prescribing a drug under a research protocol;
                            ``(vi) a prescription issued by a practitioner for a 
                        drug for which the Food and Drug Administration requires 
                        a prescription to contain elements that are not able to 
                        be included in electronic prescribing, such as a drug 
                        with risk evaluation and mitigation strategies that 
                        include elements to assure safe use;
                            ``(vii) a prescription issued by a practitioner--
                                    ``(I) for an individual who receives hospice 
                                care under this title; and
                                    ``(II) that is not covered under the hospice 
                                benefit under this title; and
                            ``(viii) a prescription issued by a practitioner for 
                        an individual who is--
                                    ``(I) a resident of a nursing facility (as 
                                defined in section 1919(a)); and
                                    ``(II) dually eligible for benefits under 
                                this title and title XIX.
                    ``(C) Dispensing.--(i) Nothing in this paragraph shall be 
                construed as requiring a sponsor of a prescription drug plan 
                under this part, MA organization offering an MA-PD plan under 
                part C, or a pharmacist to verify that a practitioner, with 
                respect to a prescription for a covered part D drug, has a 
                waiver (or is otherwise exempt) under subparagraph (B) from the 
                requirement under subparagraph (A).
                    ``(ii) Nothing in this paragraph shall be construed as 
                affecting the ability of the plan to cover or the pharmacists' 
                ability to continue to dispense covered part D drugs from 
                otherwise valid written, oral, or fax prescriptions that are 
                consistent with laws and regulations.
                    ``(iii) Nothing in this paragraph shall be construed as 
                affecting the ability of an individual who is being prescribed a 
                covered part D drug to designate a particular pharmacy to 
                dispense the covered part D drug to the extent consistent with 
                the requirements under subsection (b)(1) and under this 
                paragraph.
                    ``(D) Enforcement.--The Secretary shall, through rulemaking, 
                have authority to enforce and specify appropriate penalties for 
                non-compliance with the requirement under subparagraph (A).''.
    (b) Effective Date.--The amendment made by subsection (a) shall apply to 
coverage of drugs prescribed on or after January 1, 2021.
    (c) Update of Biometric Component of Multifactor Authentication.--Not later 
than 1 year after the date of enactment of this Act, the Attorney General shall 
update the requirements for the biometric component of multifactor 
authentication with respect to electronic prescriptions of controlled 
substances.

SEC. 2004. REQUIRING PRESCRIPTION DRUG PLAN SPONSORS UNDER MEDICARE TO ESTABLISH 
              DRUG MANAGEMENT PROGRAMS FOR AT-RISK BENEFICIARIES.

    Section 1860D-4(c) of the Social Security Act (42 U.S.C. 1395w-104(c)) is 
amended--
            (1) in paragraph (1), by inserting after subparagraph (E) the 
        following new subparagraph:
                    ``(F) With respect to plan years beginning on or after 
                January 1, 2022, a drug management program for at-risk 
                beneficiaries described in paragraph (5).''; and
            (2) in paragraph (5)(A), by inserting ``(and for plan years 
        beginning on or after January 1, 2022, a PDP sponsor shall)'' after ``A 
        PDP sponsor may''.

SEC. 2005. MEDICARE COVERAGE OF CERTAIN SERVICES FURNISHED BY OPIOID TREATMENT 
              PROGRAMS.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 U.S.C. 
1395x(s)(2)) is amended--
            (1) in subparagraph (FF), by striking at the end ``and'';
            (2) in subparagraph (GG), by inserting at the end ``and''; and
            (3) by adding at the end the following new subparagraph:
            ``(HH) opioid use disorder treatment services (as defined in 
        subsection (jjj)).''.
    (b) Opioid Use Disorder Treatment Services and Opioid Treatment Program 
Defined.--Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended 
by adding at the end the following new subsection:
    ``(jjj) Opioid Use Disorder Treatment Services; Opioid Treatment Program.--
            ``(1) Opioid use disorder treatment services.--The term `opioid use 
        disorder treatment services' means items and services that are furnished 
        by an opioid treatment program for the treatment of opioid use disorder, 
        including--
                    ``(A) opioid agonist and antagonist treatment medications 
                (including oral, injected, or implanted versions) that are 
                approved by the Food and Drug Administration under section 505 
                of the Federal Food, Drug, and Cosmetic Act for use in the 
                treatment of opioid use disorder;
                    ``(B) dispensing and administration of such medications, if 
                applicable;
                    ``(C) substance use counseling by a professional to the 
                extent authorized under State law to furnish such services;
                    ``(D) individual and group therapy with a physician or 
                psychologist (or other mental health professional to the extent 
                authorized under State law);
                    ``(E) toxicology testing, and
                    ``(F) other items and services that the Secretary determines 
                are appropriate (but in no event to include meals or 
                transportation).
            ``(2) Opioid treatment program.--The term `opioid treatment program' 
        means an entity that is an opioid treatment program (as defined in 
        section 8.2 of title 42 of the Code of Federal Regulations, or any 
        successor regulation) that--
                    ``(A) is enrolled under section 1866(j);
                    ``(B) has in effect a certification by the Substance Abuse 
                and Mental Health Services Administration for such a program;
                    ``(C) is accredited by an accrediting body approved by the 
                Substance Abuse and Mental Health Services Administration; and
                    ``(D) meets such additional conditions as the Secretary may 
                find necessary to ensure--
                            ``(i) the health and safety of individuals being 
                        furnished services under such program; and
                            ``(ii) the effective and efficient furnishing of 
                        such services.''.
    (c) Payment.--
            (1) In general.--Section 1833(a)(1) of the Social Security Act (42 
        U.S.C. 1395l(a)(1)) is amended--
                    (A) by striking ``and (bb)'' and inserting ``(bb)''; and
                    (B) by inserting before the semicolon at the end the 
                following ``, and (cc) with respect to opioid use disorder 
                treatment services furnished during an episode of care, the 
                amount paid shall be equal to the amount payable under section 
                1834(w) less any copayment required as specified by the 
                Secretary''.
            (2) Payment determination.--Section 1834 of the Social Security Act 
        (42 U.S.C. 1395m) is amended by adding at the end the following new 
        subsection:
    ``(w) Opioid Use Disorder Treatment Services.--
            ``(1) In general.--The Secretary shall pay to an opioid treatment 
        program (as defined in paragraph (2) of section 1861(jjj)) an amount 
        that is equal to 100 percent of a bundled payment under this part for 
        opioid use disorder treatment services (as defined in paragraph (1) of 
        such section) that are furnished by such program to an individual during 
        an episode of care (as defined by the Secretary) beginning on or after 
        January 1, 2020. The Secretary shall ensure, as determined appropriate 
        by the Secretary, that no duplicative payments are made under this part 
        or part D for items and services furnished by an opioid treatment 
        program.
            ``(2) Considerations.--The Secretary may implement this subsection 
        through one or more bundles based on the type of medication provided 
        (such as buprenorphine, methadone, naltrexone, or a new innovative 
        drug), the frequency of services, the scope of services furnished, 
        characteristics of the individuals furnished such services, or other 
        factors as the Secretary determine appropriate. In developing such 
        bundles, the Secretary may consider payment rates paid to opioid 
        treatment programs for comparable services under State plans under title 
        XIX or under the TRICARE program under chapter 55 of title 10 of the 
        United States Code.
            ``(3) Annual updates.--The Secretary shall provide an update each 
        year to the bundled payment amounts under this subsection.''.
    (d) Including Opioid Treatment Programs as Medicare Providers.--Section 
1866(e) of the Social Security Act (42 U.S.C. 1395cc(e)) is amended--
            (1) in paragraph (1), by striking at the end ``and'';
            (2) in paragraph (2), by striking the period at the end and 
        inserting ``; and''; and
            (3) by adding at the end the following new paragraph:
            ``(3) opioid treatment programs (as defined in paragraph (2) of 
        section 1861(jjj)), but only with respect to the furnishing of opioid 
        use disorder treatment services (as defined in paragraph (1) of such 
        section).''.

SEC. 2006. ENCOURAGING APPROPRIATE PRESCRIBING UNDER MEDICARE FOR VICTIMS OF 
              OPIOID OVERDOSE.

    Section 1860D-4(c)(5)(C) of the Social Security Act (42 U.S.C. 1395w-
104(c)(5)(C)) is amended--
            (1) in clause (i), in the matter preceding subclause (I), by 
        striking ``For purposes'' and inserting ``Except as provided in clause 
        (v), for purposes''; and
            (2) by adding at the end the following new clause:
                            ``(v) Treatment of enrollees with a history of 
                        opioid-related overdose.--
                                    ``(I) In general.--For plan years beginning 
                                not later than January 1, 2021, a part D 
                                eligible individual who is not an exempted 
                                individual described in clause (ii) and who is 
                                identified under this clause as a part D 
                                eligible individual with a history of opioid-
                                related overdose (as defined by the Secretary) 
                                shall be included as a potentially at-risk 
                                beneficiary for prescription drug abuse under 
                                the drug management program under this 
                                paragraph.
                                    ``(II) Identification and notice.--For 
                                purposes of this clause, the Secretary shall--
                                            ``(aa) identify part D eligible 
                                        individuals with a history of opioid-
                                        related overdose (as so defined); and
                                            ``(bb) notify the PDP sponsor of the 
                                        prescription drug plan in which such an 
                                        individual is enrolled of such 
                                        identification.''.

SEC. 2007. AUTOMATIC ESCALATION TO EXTERNAL REVIEW UNDER A MEDICARE PART D DRUG 
              MANAGEMENT PROGRAM FOR AT-RISK BENEFICIARIES.

    (a) In General.--Section 1860D-4(c)(5) of the Social Security Act (42 U.S.C. 
1395ww-10(c)(5)) is amended--
            (1) in subparagraph (B), in each of clauses (ii)(III) and (iii)(IV), 
        by striking ``and the option of an automatic escalation to external 
        review'' and inserting ``, including notice that if on reconsideration a 
        PDP sponsor affirms its denial, in whole or in part, the case shall be 
        automatically forwarded to the independent, outside entity contracted 
        with the Secretary for review and resolution''; and
            (2) in subparagraph (E), by striking ``and the option'' and all that 
        follows and inserting the following: ``and if on reconsideration a PDP 
        sponsor affirms its denial, in whole or in part, the case shall be 
        automatically forwarded to the independent, outside entity contracted 
        with the Secretary for review and resolution.''.
    (b) Effective Date.--The amendments made by subsection (a) shall apply 
beginning not later January 1, 2021.

SEC. 2008. SUSPENSION OF PAYMENTS BY MEDICARE PRESCRIPTION DRUG PLANS AND MA-PD 
              PLANS PENDING INVESTIGATIONS OF CREDIBLE ALLEGATIONS OF FRAUD BY 
              PHARMACIES.

    (a) In General.--Section 1860D-12(b) of the Social Security Act (42 U.S.C. 
1395w-112(b)) is amended by adding at the end the following new paragraph:
            ``(7) Suspension of payments pending investigation of credible 
        allegations of fraud by pharmacies.--
                    ``(A) In general.--Section 1862(o)(1) shall apply with 
                respect to a PDP sponsor with a contract under this part, a 
                pharmacy, and payments to such pharmacy under this part in the 
                same manner as such section applies with respect to the 
                Secretary, a provider of services or supplier, and payments to 
                such provider of services or supplier under this title. A PDP 
                sponsor shall notify the Secretary regarding the imposition of 
                any payment suspension pursuant to the previous sentence, such 
                as through the secure internet website portal (or other 
                successor technology) established under section 1859(i).
                    ``(B) Rule of construction.--Nothing in this paragraph shall 
                be construed as limiting the authority of a PDP sponsor to 
                conduct postpayment review.''.
    (b) Application to MA-PD Plans.--Section 1857(f)(3) of the Social Security 
Act (42 U.S.C. 1395w-27(f)(3)) is amended by adding at the end the following new 
subparagraph:
                    ``(D) Suspension of payments pending investigation of 
                credible allegations of fraud by pharmacies.--Section 1860D-
                12(b)(7).''.
    (c) Conforming Amendment.--Section 1862(o)(3) of the Social Security Act (42 
U.S.C. 1395y(o)(3)) is amended by inserting ``, section 1860D-12(b)(7) 
(including as applied pursuant to section 1857(f)(3)(D)),'' after ``this 
subsection''.
    (d) Clarification Relating to Credible Allegation of Fraud.--Section 1862(o) 
of the Social Security Act (42 U.S.C. 1395y(o)) is amended by adding at the end 
the following new paragraph:
            ``(4) Credible allegation of fraud.--In carrying out this 
        subsection, section 1860D-12(b)(7) (including as applied pursuant to 
        section 1857(f)(3)(D)), and section 1903(i)(2)(C), a fraud hotline tip 
        (as defined by the Secretary) without further evidence shall not be 
        treated as sufficient evidence for a credible allegation of fraud.''.
    (e) Effective Date.--The amendments made by this section shall apply with 
respect to plan years beginning on or after January 1, 2020.

               TITLE III--FDA AND CONTROLLED SUBSTANCE PROVISIONS

                           Subtitle A--FDA Provisions

                              CHAPTER 1--IN GENERAL

SEC. 3001. CLARIFYING FDA REGULATION OF NON-ADDICTIVE PAIN PRODUCTS.

    (a) Public Meetings.--Not later than one year after the date of enactment of 
this Act, the Secretary of Health and Human Services (referred to in this 
section as the ``Secretary''), acting through the Commissioner of Food and 
Drugs, shall hold not less than one public meeting to address the challenges and 
barriers of developing non-addictive medical products intended to treat acute or 
chronic pain or addiction, which may include--
            (1) the manner by which the Secretary may incorporate the risks of 
        misuse and abuse of a controlled substance (as defined in section 102 of 
        the Controlled Substances Act (21 U.S.C. 802)) into the risk benefit 
        assessments under subsections (d) and (e) of section 505 of the Federal 
        Food, Drug, and Cosmetic Act (21 U.S.C. 355), section 510(k) of such Act 
        (21 U.S.C. 360(k)), or section 515(c) of such Act (21 U.S.C. 360e(c)), 
        as applicable;
            (2) the application of novel clinical trial designs (consistent with 
        section 3021 of the 21st Century Cures Act (Public Law 114-255)), use of 
        real world evidence (consistent with section 505F of the Federal Food, 
        Drug, and Cosmetic Act (21 U.S.C. 355g)), and use of patient experience 
        data (consistent with section 569C of the Federal Food, Drug, and 
        Cosmetic Act (21 U.S.C. 360bbb-8c)) for the development of non-addictive 
        medical products intended to treat pain or addiction;
            (3) the evidentiary standards and the development of opioid-sparing 
        data for inclusion in the labeling of medical products intended to treat 
        acute or chronic pain; and
            (4) the application of eligibility criteria under sections 506 and 
        515B of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 356, 360e-3) 
        for non-addictive medical products intended to treat pain or addiction.
    (b) Guidance.--Not less than one year after the public meetings are 
conducted under subsection (a) the Secretary shall issue one or more final 
guidance documents, or update existing guidance documents, to help address 
challenges to developing non-addictive medical products to treat pain or 
addiction. Such guidance documents shall include information regarding--
            (1) how the Food and Drug Administration may apply sections 506 and 
        515B of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 356, 360e-3) 
        to non-addictive medical products intended to treat pain or addiction, 
        including the circumstances under which the Secretary--
                    (A) may apply the eligibility criteria under such sections 
                506 and 515B to non-addictive medical products intended to treat 
                pain or addiction;
                    (B) considers the risk of addiction of controlled substances 
                approved to treat pain when establishing unmet medical need; and
                    (C) considers pain, pain control, or pain management in 
                assessing whether a disease or condition is a serious or life-
                threatening disease or condition;
            (2) the methods by which sponsors may evaluate acute and chronic 
        pain, endpoints for non-addictive medical products intended to treat 
        pain, the manner in which endpoints and evaluations of efficacy will be 
        applied across and within review divisions, taking into consideration 
        the etiology of the underlying disease, and the manner in which sponsors 
        may use surrogate endpoints, intermediate endpoints, and real world 
        evidence;
            (3) the manner in which the Food and Drug Administration will assess 
        evidence to support the inclusion of opioid-sparing data in the labeling 
        of non-addictive medical products intended to treat acute or chronic 
        pain, including--
                    (A) alternative data collection methodologies, including the 
                use of novel clinical trial designs (consistent with section 
                3021 of the 21st Century Cures Act (Public Law 114-255)) and 
                real world evidence (consistent with section 505F of the Federal 
                Food, Drug, and Cosmetic Act (21 U.S.C. 355g)), including 
                patient registries and patient reported outcomes, as 
                appropriate, to support product labeling;
                    (B) ethical considerations of exposing subjects to 
                controlled substances in clinical trials to develop opioid-
                sparing data and considerations on data collection methods that 
                reduce harm, which may include the reduction of opioid use as a 
                clinical benefit;
                    (C) endpoints, including primary, secondary, and surrogate 
                endpoints, to evaluate the reduction of opioid use;
                    (D) best practices for communication between sponsors and 
                the agency on the development of data collection methods, 
                including the initiation of data collection; and
                    (E) the appropriate format in which to submit such data 
                results to the Secretary; and
            (4) the circumstances under which the Food and Drug Administration 
        considers misuse and abuse of a controlled substance (as defined in 
        section 102 of the Controlled Substances Act (21 U.S.C. 802)) in making 
        the risk benefit assessment under paragraphs (2) and (4) of subsection 
        (d) of section 505 of the Federal Food, Drug, and Cosmetic Act (21 
        U.S.C. 355) and in finding that a drug is unsafe under paragraph (1) or 
        (2) of subsection (e) of such section.
    (c) Definitions.--In this section--
            (1) the term ``medical product'' means a drug (as defined in section 
        201(g)(1) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
        321(g)(1))), biological product (as defined in section 351(i) of the 
        Public Health Service Act (42 U.S.C. 262(i))), or device (as defined in 
        section 201(h) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
        321(h))); and
            (2) the term ``opioid-sparing'' means reducing, replacing, or 
        avoiding the use of opioids or other controlled substances intended to 
        treat acute or chronic pain.

SEC. 3002. EVIDENCE-BASED OPIOID ANALGESIC PRESCRIBING GUIDELINES AND REPORT.

    (a) Guidelines.--The Commissioner of Food and Drugs shall develop evidence-
based opioid analgesic prescribing guidelines for the indication-specific 
treatment of acute pain only for the relevant therapeutic areas where such 
guidelines do not exist.
    (b) Public Input.--In developing the guidelines under subsection (a), the 
Commissioner of Food and Drugs shall--
            (1) consult with stakeholders, which may include conducting a public 
        meeting of medical professional societies (including any State-based 
        societies), health care providers, State medical boards, medical 
        specialties including pain medicine specialty societies, patient groups, 
        pharmacists, academic or medical research entities, and other entities 
        with experience in health care, as appropriate;
            (2) collaborate with the Director of the Centers for Disease Control 
        and Prevention, as applicable and appropriate, and other Federal 
        agencies with relevant expertise as appropriate; and
            (3) provide for a notice and comment period consistent with section 
        701(h) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 371(h)) 
        for the submission of comments by the public.
    (c) Report.--Not later than 1 year after the date of enactment of this Act, 
or, if earlier, at the time the guidelines under subsection (a) are finalized, 
the Commissioner of Food and Drugs shall submit to the Committee on Energy and 
Commerce of the House of Representatives and the Committee on Health, Education, 
Labor, and Pensions of the Senate, and post on the public website of the Food 
and Drug Administration, a report on how the Food and Drug Administration will 
utilize the guidelines under subsection (a) to protect the public health and a 
description of the public health need with respect to each such indication-
specific treatment guideline.
    (d) Updates.--The Commissioner of Food and Drugs shall periodically--
            (1) update the guidelines under subsection (a), informed by public 
        input described in subsection (b); and
            (2) submit to the committees specified in subsection (c) and post on 
        the public website of the Food and Drug Administration an updated report 
        under such subsection.
    (e) Statement To Accompany Guidelines and Recommendations.--The Commissioner 
of Food and Drugs shall ensure that opioid analgesic prescribing guidelines and 
other recommendations developed under this section are accompanied by a clear 
statement that such guidelines or recommendations, as applicable--
            (1) are intended to help inform clinical decisionmaking by 
        prescribers and patients; and
            (2) are not intended to be used for the purposes of restricting, 
        limiting, delaying, or denying coverage for, or access to, a 
        prescription issued for a legitimate medical purpose by an individual 
        practitioner acting in the usual course of professional practice.

  CHAPTER 2--STOP COUNTERFEIT DRUGS BY REGULATING AND ENHANCING ENFORCEMENT NOW

SEC. 3011. SHORT TITLE.

    This chapter may be cited as the ``Stop Counterfeit Drugs by Regulating and 
Enhancing Enforcement Now Act'' or the ``SCREEN Act''.

SEC. 3012. NOTIFICATION, NONDISTRIBUTION, AND RECALL OF CONTROLLED SUBSTANCES.

    (a) Prohibited Acts.--Section 301 of the Federal Food, Drug, and Cosmetic 
Act (21 U.S.C. 331) is amended by adding at the end the following:
    ``(eee) The failure to comply with any order issued under section 569D.''.
    (b) Notification, Nondistribution, and Recall of Controlled Substances.--
Subchapter E of chapter V of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
360bbb et seq.) is amended by adding at the end the following:

``SEC. 569D. NOTIFICATION, NONDISTRIBUTION, AND RECALL OF CONTROLLED SUBSTANCES.

    ``(a) Order To Cease Distribution and Recall.--
            ``(1) In general.--If the Secretary determines there is a reasonable 
        probability that a controlled substance would cause serious adverse 
        health consequences or death, the Secretary may, after providing the 
        appropriate person with an opportunity to consult with the agency, issue 
        an order requiring manufacturers, importers, distributors, or 
        pharmacists, who distribute such controlled substance to immediately 
        cease distribution of such controlled substance.
            ``(2) Hearing.--An order under paragraph (1) shall provide the 
        person subject to the order with an opportunity for an informal hearing, 
        to be held not later than 10 days after the date of issuance of the 
        order, on whether adequate evidence exists to justify an amendment to 
        the order, and what actions are required by such amended order pursuant 
        to subparagraph (3).
            ``(3) Order resolution.--After an order is issued according to the 
        process under paragraphs (1) and (2), the Secretary shall, except as 
        provided in paragraph (4)--
                    ``(A) vacate the order, if the Secretary determines that 
                inadequate grounds exist to support the actions required by the 
                order;
                    ``(B) continue the order ceasing distribution of the 
                controlled substance until a date specified in such order; or
                    ``(C) amend the order to require a recall of the controlled 
                substance, including any requirements to notify appropriate 
                persons, a timetable for the recall to occur, and a schedule for 
                updates to be provided to the Secretary regarding such recall.
            ``(4) Risk assessment.--If the Secretary determines that the risk of 
        recalling a controlled substance presents a greater health risk than the 
        health risk of not recalling such controlled substance from use, an 
        amended order under subparagraph (B) or (C) of paragraph (3) shall not 
        include either a recall order for, or an order to cease distribution of, 
        such controlled substance, as applicable.
            ``(5) Action following order.--Any person who is subject to an order 
        pursuant to subparagraph (B) or (C) of paragraph (3) shall immediately 
        cease distribution of or recall, as applicable, the controlled substance 
        and provide notification as required by such order.
    ``(b) Notice to Persons Affected.--If the Secretary determines necessary, 
the Secretary may require the person subject to an order pursuant to paragraph 
(1) or an amended order pursuant to subparagraph (B) or (C) of paragraph (3) to 
provide either a notice of a recall order for, or an order to cease distribution 
of, such controlled substance, as applicable, under this section to appropriate 
persons, including persons who manufacture, distribute, import, or offer for 
sale such product that is the subject of an order and to the public. In 
providing such notice, the Secretary may use the assistance of health 
professionals who prescribed or dispensed such controlled substances.
    ``(c) Nondelegation.--An order described in subsection (a)(3) shall be 
ordered by the Secretary or an official designated by the Secretary. An official 
may not be so designated under this section unless the official is the Director 
of the Center for Drug Evaluation and Research or an official senior to such 
Director.
    ``(d) Savings Clause.--Nothing contained in this section shall be construed 
as limiting--
            ``(1) the authority of the Secretary to issue an order to cease 
        distribution of, or to recall, any drug under any other provision of 
        this Act or the Public Health Service Act; or
            ``(2) the ability of the Secretary to request any person to perform 
        a voluntary activity related to any drug subject to this Act or the 
        Public Health Service Act.''.
    (c) Controlled Substances Subject to Refusal.--The third sentence of section 
801(a) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 381(a)) is amended 
by inserting ``, or is a controlled substance subject to an order under section 
569D'' before ``, or (4)''.
    (d) Effective Date.--Sections 301(eee) and 569D of the Federal Food, Drug, 
and Cosmetic Act, as added by subsections (a) and (b), shall be effective 
beginning on the date of enactment of this Act.

SEC. 3013. SINGLE SOURCE PATTERN OF IMPORTED ILLEGAL DRUGS.

    Section 801 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 381), as 
amended by section 3012, is further amended by adding at the end the following:
    ``(t) Single Source Pattern of Imported Illegal Drugs.--If the Secretary 
determines that a person subject to debarment as a result of engaging in a 
pattern of importing or offering for import controlled substances or drugs as 
described in section 306(b)(3)(D), and such pattern is identified by the 
Secretary as being offered for import from the same manufacturer, distributor, 
or importer, the Secretary may by order determine all drugs being offered for 
import from such person as adulterated or misbranded, unless such person can 
provide evidence otherwise.''.

SEC. 3014. STRENGTHENING FDA AND CBP COORDINATION AND CAPACITY.

    (a) In General.--The Secretary of Health and Human Services (referred to in 
this section as the ``Secretary''), acting through the Commissioner of Food and 
Drugs, shall coordinate with the Secretary of Homeland Security to carry out 
activities related to customs and border protection and in response to illegal 
controlled substances and drug imports, including at sites of import (such as 
international mail facilities), that will provide improvements to such 
facilities, technologies, and inspection capacity. Such Secretaries may carry 
out such activities through a memorandum of understanding between the Food and 
Drug Administration and the U.S. Customs and Border Protection.
    (b) FDA Import Facilities and Inspection Capacity.--
            (1) In general.--In carrying out this section, the Secretary shall, 
        in collaboration with the Secretary of Homeland Security and the 
        Postmaster General of the United States Postal Service, provide that 
        import facilities in which the Food and Drug Administration operates or 
        carries out activities related to drug imports within the international 
        mail facilities include--
                    (A) facility upgrades and improved capacity in order to 
                increase and improve inspection and detection capabilities, 
                which may include, as the Secretary determines appropriate--
                            (i) improvements to facilities, such as upgrades or 
                        renovations, and support for the maintenance of existing 
                        import facilities and sites to improve coordination 
                        between Federal agencies;
                            (ii) improvements in equipment and information 
                        technology enhancement to identify unapproved, 
                        counterfeit, or other unlawful controlled substances for 
                        destruction;
                            (iii) the construction of, or upgrades to, 
                        laboratory capacity for purposes of detection and 
                        testing of imported goods;
                            (iv) upgrades to the security of import facilities; 
                        and
                            (v) innovative technology and equipment to 
                        facilitate improved and near-real-time information 
                        sharing between the Food and Drug Administration, the 
                        Department of Homeland Security, and the United States 
                        Postal Service; and
                    (B) innovative technology, including controlled substance 
                detection and testing equipment and other applicable technology, 
                in order to collaborate with the U.S. Customs and Border 
                Protection to share near-real-time information, including 
                information about test results, as appropriate.
            (2) Innovative technology.--Any technology used in accordance with 
        paragraph (1)(B) shall be interoperable with technology used by other 
        relevant Federal agencies, including the U.S. Customs and Border 
        Protection, as the Secretary determines appropriate and practicable.
    (c) Report.--Not later than 6 months after the date of enactment of this 
Act, the Secretary, in consultation with the Secretary of Homeland Security and 
the Postmaster General of the United States Postal Service, shall report to the 
Committee on Energy and Commerce and the Committee on Homeland Security of the 
House of Representatives and the Committee on Health, Education, Labor, and 
Pensions and the Committee on Homeland Security and Governmental Affairs of the 
Senate on the implementation of this section, including a summary of progress 
made toward near-real-time information sharing and the interoperability of such 
technologies.

                    CHAPTER 3--STOP ILLICIT DRUG IMPORTATION

SEC. 3021. SHORT TITLE.

    This chapter may be cited as the ``Stop Illicit Drug Importation Act of 
2018''.

SEC. 3022. RESTRICTING ENTRANCE OF ILLICIT DRUGS.

    (a) Food and Drug Administration and U.S. Customs and Border Protection 
Cooperation.--
            (1) In general.--The Secretary of Health and Human Services 
        (referred to in this section as the ``Secretary''), acting through the 
        Commissioner of Food and Drugs and in consultation with the U.S. Customs 
        and Border Protection, shall develop and periodically update a mutually 
        agreed upon list of the controlled substances that the Secretary will 
        refer to U.S. Customs and Border Protection, unless the Secretary and 
        U.S. Customs and Border Protection agree otherwise, when such substances 
        are offered for import via international mail and appear to violate the 
        Controlled Substances Act (21 U.S.C. 801 et seq.), the Controlled 
        Substances Import and Export Act (21 U.S.C. 951 et seq.), the Federal 
        Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.), or any other 
        applicable law. The Secretary shall transfer controlled substances on 
        such list to the U.S. Customs and Border Protection. If the Secretary 
        identifies additional packages that appear to be the same as such 
        package containing a controlled substance, such additional packages may 
        also be transferred to U.S. Customs and Border Protection. The U.S. 
        Customs and Border Protection shall receive such packages consistent 
        with the requirements of the Controlled Substances Act (21 U.S.C. 801 et 
        seq.).
            (2) Report.--Not later than 9 months after the date of enactment of 
        this Act, the Secretary, acting through the Commissioner of Food and 
        Drugs and in consultation with the Secretary of Homeland Security, shall 
        report to the Committee on Energy and Commerce of the House of 
        Representatives and the Committee on Health, Education, Labor, and 
        Pensions of the Senate on the implementation of this section.
    (b) Debarment, Temporary Denial of Approval, and Suspension.--
            (1) Prohibited act.--Section 301(cc) of the Federal Food, Drug, and 
        Cosmetic Act (21 U.S.C. 331(cc)) is amended--
                    (A) by inserting ``or a drug'' after ``food''; and
                    (B) by inserting ``from such activity'' after ``person 
                debarred''.
            (2) Debarment.--Section 306(b) of the Federal Food, Drug, and 
        Cosmetic Act (21 U.S.C. 335a(b)) is amended--
                    (A) in paragraph (1)--
                            (i) in the matter preceding subparagraph (A), by 
                        inserting ``or (3)'' after ``paragraph (2)'';
                            (ii) in subparagraph (A), by striking the comma at 
                        the end and inserting a semicolon;
                            (iii) in subparagraph (B), by striking ``, or'' and 
                        inserting a semicolon;
                            (iv) in subparagraph (C), by striking the period and 
                        inserting ``; or''; and
                            (v) by adding at the end the following:
                    ``(D) a person from importing or offering for import into 
                the United States a drug.'';
                    (B) in paragraph (3)--
                            (i) in the heading, by inserting ``or drug'' after 
                        ``Food'';
                            (ii) in subparagraph (A), by striking ``; or'' and 
                        inserting a semicolon;
                            (iii) in subparagraph (B), by striking the period 
                        and inserting a semicolon; and
                            (iv) by adding at the end the following:
                    ``(C) the person has been convicted of a felony for conduct 
                relating to the importation into the United States of any drug 
                or controlled substance (as defined in section 102 of the 
                Controlled Substances Act);
                    ``(D) the person has engaged in a pattern of importing or 
                offering for import--
                            ``(i) controlled substances that are prohibited from 
                        importation under section 401(m) of the Tariff Act of 
                        1930 (19 U.S.C. 1401(m)); or
                            ``(ii) adulterated or misbranded drugs that are--
                                    ``(I) not designated in an authorized 
                                electronic data interchange system as a product 
                                that is regulated by the Secretary; or
                                    ``(II) knowingly or intentionally falsely 
                                designated in an authorized electronic data 
                                interchange system as a product that is 
                                regulated by the Secretary.''; and
                    (C) by adding at the end the following:
            ``(5) Definition.--For purposes of paragraph (3)(D), the term 
        `pattern of importing or offering for import' means importing or 
        offering for import a drug described in clause (i) or (ii) of paragraph 
        (3)(D) in an amount, frequency, or dosage that is inconsistent with 
        personal or household use by the importer.''.
    (c) Imports and Exports.--Section 801(a) of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 381(a)), as amended, is further amended--
            (1) by striking ``, then such article shall be refused admission'' 
        inserting ``or (5) such article is being imported or offered for import 
        in violation of section 301(cc), then any such article described in any 
        of clauses (1) through (5) shall be refused admission'';
            (2) by inserting ``If it appears from the examination of such 
        samples or otherwise that the article is a counterfeit drug, such 
        article shall be refused admission.'' before ``With respect to an 
        article of food, if importation''; and
            (3) by striking ``Clause (2) of the third sentence'' and all that 
        follows through the period at the end and inserting the following: 
        ``Neither clause (2) nor clause (5) of the third sentence of this 
        subsection shall be construed to prohibit the admission of narcotic 
        drugs, the importation of which is permitted under the Controlled 
        Substances Import and Export Act.''.
    (d) Certain Illicit Articles.--Section 801 of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 381), as amended, is amended by adding at the end the 
following--
    ``(u) Illicit Articles Containing Active Pharmaceutical Ingredients.--
            ``(1) In general.--For purposes of this section, an article that is 
        being imported or offered for import into the United States may be 
        treated by the Secretary as a drug if the article--
                    ``(A) is not--
                            ``(i) accompanied by an electronic import entry for 
                        such article submitted using an authorized electronic 
                        data interchange system; and
                            ``(ii) designated in such a system as an article 
                        regulated by the Secretary (which may include regulation 
                        as a drug, a device, a dietary supplement, or other 
                        product that is regulated under this Act); and
                    ``(B) is an ingredient that presents significant public 
                health concern and is, or contains--
                            ``(i) an active ingredient in a drug--
                                    ``(I) that is approved under section 505 or 
                                licensed under section 351 of the Public Health 
                                Service Act; or
                                    ``(II) for which--
                                            ``(aa) an investigational use 
                                        exemption has been authorized under 
                                        section 505(i) of this Act or section 
                                        351(a) of the Public Health Service Act; 
                                        and
                                            ``(bb) a substantial clinical 
                                        investigation has been instituted, and 
                                        such investigation has been made public; 
                                        or
                            ``(ii) a substance that has a chemical structure 
                        that is substantially similar to the chemical structure 
                        of an active ingredient in a drug or biological product 
                        described in subclause (I) or (II) of clause (i).
            ``(2) Effect.--This subsection shall not be construed to bear upon 
        any determination of whether an article is a drug within the meaning of 
        section 201(g), other than for the purposes described in paragraph 
        (1).''.

 CHAPTER 4--SECURING OPIOIDS AND UNUSED NARCOTICS WITH DELIBERATE DISPOSAL AND 
                                    PACKAGING

SEC. 3031. SHORT TITLE.

    This chapter may be cited as the ``Securing Opioids and Unused Narcotics 
with Deliberate Disposal and Packaging Act of 2018'' or the ``SOUND Disposal and 
Packaging Act''.

SEC. 3032. SAFETY-ENHANCING PACKAGING AND DISPOSAL FEATURES.

     (a) Deliberate Disposal and Packaging Elements of Strategy.--Section 505-
1(e) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355-1(e)) is amended 
by adding at the end the following:
            ``(4) Packaging and disposal.--The Secretary may require a risk 
        evaluation mitigation strategy for a drug for which there is a serious 
        risk of an adverse drug experience described in subparagraph (B) or (C) 
        of subsection (b)(1), taking into consideration the factors described in 
        subparagraphs (C) and (D) of subsection (f)(2) and in consultation with 
        other relevant Federal agencies with authorities over drug disposal 
        packaging, which may include requiring that--
                    ``(A) the drug be made available for dispensing to certain 
                patients in unit dose packaging, packaging that provides a set 
                duration, or another packaging system that the Secretary 
                determines may mitigate such serious risk; or
                    ``(B) the drug be dispensed to certain patients with a safe 
                disposal packaging or safe disposal system for purposes of 
                rendering drugs nonretrievable (as defined in section 1300.05 of 
                title 21, Code of Federal Regulations (or any successor 
                regulation)) if the Secretary determines that such safe disposal 
                packaging or system may mitigate such serious risk and is 
                sufficiently available.''.
    (b) Assuring Access and Minimizing Burden.--Section 505-1(f)(2)(C) of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355-1(f)(2)(C)) is amended--
            (1) in clause (i) by striking ``and'' at the end; and
            (2) by adding at the end the following:
                            ``(iii) patients with functional limitations; and''.
    (c) Application to Abbreviated New Drug Applications.--Section 505-1(i) of 
the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355-1(i)) is amended--
            (1) in paragraph (1)--
                    (A) by redesignating subparagraph (B) as subparagraph (C); 
                and
                    (B) inserting after subparagraph (A) the following:
                    ``(B) A packaging or disposal requirement, if required under 
                subsection (e)(4) for the applicable listed drug.''; and
            (2) in paragraph (2)--
                    (A) in subparagraph (A), by striking ``and'' at the end;
                    (B) by redesignating subparagraph (B) as subparagraph (C); 
                and
                    (C) by inserting after subparagraph (A) the following:
                    ``(B) shall permit packaging systems and safe disposal 
                packaging or safe disposal systems that are different from those 
                required for the applicable listed drug under subsection (e)(4); 
                and''.
    (d) GAO Report.--Not later than 12 months after the date of enactment of 
this Act, the Comptroller General of the United States shall prepare and submit 
to Congress a report containing--
            (1) a description of available evidence, if any, on the 
        effectiveness of site-of-use, in-home controlled substance disposal 
        products and packaging technologies;
            (2) an evaluation of existing reference standards with respect to 
        controlled substance disposal products and packaging technologies, 
        including any such standards established by a standards development 
        organization, and how such standards should be considered in ensuring 
        effectiveness of such products and technologies;
            (3) identification of ways in which such disposal products intended 
        for use by patients, consumers, and other end users that are not 
        registrants under the Controlled Substances Act (21 U.S.C. 801 et seq.), 
        are made available to the public and any barriers to the use of such 
        disposal products;
            (4) identification of ways in which packaging technologies are made 
        available to the public and any barriers to the use of such 
        technologies;
            (5) a description of current Federal oversight, if any, of site-of-
        use, in-home controlled substance disposal products, including--
                    (A) identification of the Federal agencies that oversee such 
                products;
                    (B) identification of the methods of disposal of controlled 
                substances recommended by such agencies for site-of-use, in-home 
                disposal; and
                    (C) a description of the effectiveness of such 
                recommendations at preventing the diversion of legally 
                prescribed controlled substances;
            (6) a description of current Federal oversight, if any, of 
        controlled substance packaging technologies, including--
                    (A) identification of the Federal agencies that oversee such 
                technologies;
                    (B) identification of the technologies recommended by such 
                agencies, including unit dose packaging, packaging that provides 
                a set duration, and other packaging systems that may mitigate 
                abuse or misuse; and
                    (C) a description of the effectiveness of such 
                recommendations at preventing the diversion of legally 
                prescribed controlled substances; and
            (7) recommendations, as appropriate, on--
                    (A) whether site-of-use, in-home controlled substance 
                disposal products and packaging technologies require Federal 
                oversight and, if so, which agency or agencies should be 
                responsible for such oversight and, as applicable, review of 
                such products or technologies; and
                    (B) whether there are applicable standards that should be 
                considered to ensure the effectiveness of such products.

                   CHAPTER 5--POSTAPPROVAL STUDY REQUIREMENTS

SEC. 3041. CLARIFYING FDA POSTMARKET AUTHORITIES.

    (a) Definition of Adverse Drug Experience.--Section 505-1(b)(1)(E) of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355-1(b)(1)(E)) is amended by 
striking ``of the drug'' and inserting ``of the drug, which may include reduced 
effectiveness under the conditions of use prescribed in the labeling of such 
drug, but which may not include reduced effectiveness that is in accordance with 
such labeling''.
    (b) Safety Labeling Changes.--Section 505(o)(4) of the Federal Food, Drug, 
and Cosmetic Act (21 U.S.C. 355(o)(4)) is amended--
            (1) in subparagraph (A) by--
                    (A) striking ``Safety information'' and inserting ``Safety 
                or new effectiveness information''; and
                    (B) by striking ``If the Secretary becomes'' and all that 
                follows through ``in the labeling of the drug'' and inserting 
                ``If the Secretary becomes aware of new information, including 
                any new safety information or information related to reduced 
                effectiveness, that the Secretary determines should be included 
                in the labeling of the drug'';
            (2) in clause (i) of subparagraph (B), by inserting before the 
        semicolon ``, or new effectiveness information'';
            (3) in subparagraph (C) by striking ``safety information'' and 
        inserting ``safety or new effectiveness information''; and
            (4) in subparagraph (E) by striking ``safety information'' and 
        inserting ``safety or new effectiveness information''.
    (c) Guidance.--Not less than one year after the date of enactment of this 
Act, the Secretary of Health and Human Services shall issue guidance regarding 
the circumstances under which the Food and Drug Administration may require 
postmarket studies or clinical trials to assess the potential reduction in 
effectiveness of a drug and how such reduction in effectiveness could result in 
a change to the benefits of the drug and the risks to the patient. Such guidance 
shall also address how the Food and Drug Administration may apply this section 
and the amendments made thereby with respect to circumstances under which the 
Food and Drug Administration may require postmarket studies or clinical trials 
and safety labeling changes related to the use of controlled substances for 
acute or chronic pain.

                   Subtitle B--Controlled Substance Provisions

 CHAPTER 1--MORE FLEXIBILITY WITH RESPECT TO MEDICATION-ASSISTED TREATMENT FOR 
                              OPIOID USE DISORDERS

SEC. 3201. ALLOWING FOR MORE FLEXIBILITY WITH RESPECT TO MEDICATION-ASSISTED 
              TREATMENT FOR OPIOID USE DISORDERS.

    (a) Conforming Applicable Number.--Subclause (II) of section 
303(g)(2)(B)(iii) of the Controlled Substances Act (21 U.S.C. 823(g)(2)(B)(iii)) 
is amended to read as follows:
            ``(II) The applicable number is--
                    ``(aa) 100 if, not sooner than 1 year after the date on 
                which the practitioner submitted the initial notification, the 
                practitioner submits a second notification to the Secretary of 
                the need and intent of the practitioner to treat up to 100 
                patients;
                    ``(bb) 100 if the practitioner holds additional 
                credentialing, as defined in section 8.2 of title 42, Code of 
                Federal Regulations (or successor regulations);
                    ``(cc) 100 if the practitioner provides medication-assisted 
                treatment (MAT) using covered medications (as such terms are 
                defined in section 8.2 of title 42, Code of Federal Regulations 
                (or successor regulations)) in a qualified practice setting (as 
                described in section 8.615 of title 42, Code of Federal 
                Regulations (or successor regulations)); or
                    ``(dd) 275 if the practitioner meets the requirements 
                specified in sections 8.610 through 8.655 of title 42, Code of 
                Federal Regulations (or successor regulations).''.
    (b) Eliminating Any Time Limitation for Nurse Practitioners and Physician 
Assistants To Become Qualifying Practitioners.--Clause (iii) of section 
303(g)(2)(G) of the Controlled Substances Act (21 U.S.C. 823(g)(2)(G)) is 
amended--
            (1) in subclause (I), by striking ``or'' at the end; and
            (2) by amending subclause (II) to read as follows:
                    ``(II) a qualifying other practitioner, as defined in clause 
                (iv), who is a nurse practitioner or physician assistant; or''.
    (c) Imposing a Time Limitation for Clinical Nurse Specialists, Certified 
Registered Nurse Anesthetists, and Certified Nurse Midwifes To Become Qualifying 
Practitioners.--Clause (iii) of section 303(g)(2)(G) of the Controlled 
Substances Act (21 U.S.C. 823(g)(2)(G)), as amended by subsection (b), is 
further amended by adding at the end the following:
                    ``(III) for the period beginning on October 1, 2018, and 
                ending on October 1, 2023, a qualifying other practitioner, as 
                defined in clause (iv), who is a clinical nurse specialist, 
                certified registered nurse anesthetist, or certified nurse 
                midwife.''.
    (d) Definition of Qualifying Other Practitioner.--Section 303(g)(2)(G)(iv) 
of the Controlled Substances Act (21 U.S.C. 823(g)(2)(G)(iv)) is amended by 
striking ``nurse practitioner or physician assistant'' each place it appears and 
inserting ``nurse practitioner, clinical nurse specialist, certified registered 
nurse anesthetist, certified nurse midwife, or physician assistant''.
    (e) Report by Secretary.--Not later than 2 years after the date of the 
enactment of this Act, the Secretary of Health and Human Services, in 
consultation with the Drug Enforcement Administration, shall submit to Congress 
a report that assesses the care provided by qualifying practitioners (as defined 
in section 303(g)(2)(G)(iii) of the Controlled Substances Act (21 U.S.C. 
823(g)(2)(G)(iii))) who are treating, in the case of physicians, more than 100 
patients, and in the case of qualifying practitioners who are not physicians, 
more than 30 patients. Such report shall include recommendations on future 
applicable patient number levels and limits. In preparing such report, the 
Secretary shall study, with respect to opioid use disorder treatment--
            (1) the average frequency with which qualifying practitioners see 
        their patients;
            (2) the average frequency with which patients receive counseling, 
        including the rates by which such counseling is provided by such a 
        qualifying practitioner directly, or by referral;
            (3) the frequency of toxicology testing, including the average 
        frequency with which random toxicology testing is administered;
            (4) the average monthly patient caseload for each type of qualifying 
        practitioner;
            (5) the treatment retention rates for patients;
            (6) overdose and mortality rates; and
            (7) any available information regarding the diversion of drugs by 
        patients receiving such treatment from such a qualifying practitioner.

SEC. 3202. MEDICATION-ASSISTED TREATMENT FOR RECOVERY FROM SUBSTANCE USE 
              DISORDER.

    (a) Waivers for Maintenance Treatment or Detoxification.--Section 
303(g)(2)(G)(ii) of the Controlled Substances Act (21 U.S.C. 823(g)(2)(G)(ii)) 
is amended by adding at the end the following:
            ``(VIII) The physician graduated in good standing from an accredited 
        school of allopathic medicine or osteopathic medicine in the United 
        States during the 5-year period immediately preceding the date on which 
        the physician submits to the Secretary a written notification under 
        subparagraph (B) and successfully completed a comprehensive allopathic 
        or osteopathic medicine curriculum or accredited medical residency 
        that--
                    ``(aa) included not less than 8 hours of training on 
                treating and managing opioid-dependent patients; and
                    ``(bb) included, at a minimum--
                            ``(AA) the training described in items (aa) through 
                        (gg) of subclause (IV); and
                            ``(BB) training with respect to any other best 
                        practice the Secretary determines should be included in 
                        the curriculum, which may include training on pain 
                        management, including assessment and appropriate use of 
                        opioid and non-opioid alternatives.''.
    (b) Treatment for Children.--The Secretary of Health and Human Services 
shall consider ways to ensure that an adequate number of qualified 
practitioners, as defined in subparagraph (G)(ii) of section 303(g)(2) of the 
Controlled Substances Act (21 U.S.C. 823(g)(2)), who have a specialty in 
pediatrics or the treatment of children or adolescents, are granted a waiver 
under such section 303(g)(2) to treat children and adolescents with substance 
use disorders.
    (c) Technical Amendment.--Section 102(24) of the Controlled Substances Act 
(21 U.S.C. 802(24)) is amended by striking ``Health, Education, and Welfare'' 
and inserting ``Health and Human Services''.

SEC. 3203. GRANTS TO ENHANCE ACCESS TO SUBSTANCE USE DISORDER TREATMENT.

    (a) In General.--The Secretary of Health and Human Services shall establish 
a grant program under which the Secretary may make grants to accredited schools 
of allopathic medicine or osteopathic medicine and teaching hospitals located in 
the United States to support the development of curricula that meet the 
requirements under subclause (VIII) of section 303(g)(2)(G)(ii) of the 
Controlled Substances Act, as added by section 3202(a) of this Act.
    (b) Authorization of Appropriations.--There is authorized to be 
appropriated, for grants under subsection (a), $4,000,000 for each of fiscal 
years 2019 through 2023.

SEC. 3204. DELIVERY OF A CONTROLLED SUBSTANCE BY A PHARMACY TO BE ADMINISTERED 
              BY INJECTION OR IMPLANTATION.

    (a) In General.--The Controlled Substances Act is amended by inserting after 
section 309 (21 U.S.C. 829) the following:

     ``delivery of a controlled substance by a pharmacy to an administering 
                                  practitioner

    ``Sec. 309A.  (a) In General.--Notwithstanding section 102(10), a pharmacy 
may deliver a controlled substance to a practitioner in accordance with a 
prescription that meets the requirements of this title and the regulations 
issued by the Attorney General under this title, for the purpose of 
administering the controlled substance by the practitioner if--
            ``(1) the controlled substance is delivered by the pharmacy to the 
        prescribing practitioner or the practitioner administering the 
        controlled substance, as applicable, at the location listed on the 
        practitioner's certificate of registration issued under this title;
            ``(2) the controlled substance is to be administered for the purpose 
        of maintenance or detoxification treatment under section 303(g)(2) and--
                    ``(A) the practitioner who issued the prescription is a 
                qualifying practitioner authorized under, and acting within the 
                scope of that section; and
                    ``(B) the controlled substance is to be administered by 
                injection or implantation;
            ``(3) the pharmacy and the practitioner are authorized to conduct 
        the activities specified in this section under the law of the State in 
        which such activities take place;
            ``(4) the prescription is not issued to supply any practitioner with 
        a stock of controlled substances for the purpose of general dispensing 
        to patients;
            ``(5) except as provided in subsection (b), the controlled substance 
        is to be administered only to the patient named on the prescription not 
        later than 14 days after the date of receipt of the controlled substance 
        by the practitioner; and
            ``(6) notwithstanding any exceptions under section 307, the 
        prescribing practitioner, and the practitioner administering the 
        controlled substance, as applicable, maintain complete and accurate 
        records of all controlled substances delivered, received, administered, 
        or otherwise disposed of under this section, including the persons to 
        whom controlled substances were delivered and such other information as 
        may be required by regulations of the Attorney General.
    ``(b) Modification of Number of Days Before Which Controlled Substance Shall 
Be Administered.--
            ``(1) Initial 2-year period.--During the 2-year period beginning on 
        the date of enactment of this section, the Attorney General, in 
        coordination with the Secretary, may reduce the number of days described 
        in subsection (a)(5) if the Attorney General determines that such 
        reduction will--
                    ``(A) reduce the risk of diversion; or
                    ``(B) protect the public health.
            ``(2) Modifications after submission of report.--After the date on 
        which the report described in section 3204(b) of the SUPPORT for 
        Patients and Communities Act is submitted, the Attorney General, in 
        coordination with the Secretary, may modify the number of days described 
        in subsection (a)(5).
            ``(3) Minimum number of days.--Any modification under this 
        subsection shall be for a period of not less than 7 days.''.
    (b) Study and Report.--Not later than 2 years after the date of enactment of 
this section, the Comptroller General of the United States shall conduct a study 
and submit to Congress a report on access to and potential diversion of 
controlled substances administered by injection or implantation.
    (c) Technical and Conforming Amendment.--The table of contents for the 
Comprehensive Drug Abuse Prevention and Control Act of 1970 is amended by 
inserting after the item relating to section 309 the following:

``Sec. 309A. Delivery of a controlled substance by a pharmacy to an 
                            administering practitioner.''.

       CHAPTER 2--EMPOWERING PHARMACISTS IN THE FIGHT AGAINST OPIOID ABUSE

SEC. 3211. SHORT TITLE.

    This chapter may be cited as the ``Empowering Pharmacists in the Fight 
Against Opioid Abuse Act''.

SEC. 3212. PROGRAMS AND MATERIALS FOR TRAINING ON CERTAIN CIRCUMSTANCES UNDER 
              WHICH A PHARMACIST MAY DECLINE TO FILL A PRESCRIPTION.

    (a) In General.--Not later than 1 year after the date of enactment of this 
Act, the Secretary of Health and Human Services, in consultation with the 
Administrator of the Drug Enforcement Administration, Commissioner of Food and 
Drugs, Director of the Centers for Disease Control and Prevention, and Assistant 
Secretary for Mental Health and Substance Use, shall develop and disseminate, as 
appropriate, materials for pharmacists, health care providers, and patients on--
            (1) circumstances under which a pharmacist may, consistent with 
        section 309 of the Controlled Substances Act (21 U.S.C. 829) and 
        regulations thereunder, including section 1306.04 of title 21, Code of 
        Federal Regulations, decline to fill a prescription for a controlled 
        substance because the pharmacist suspects the prescription is 
        fraudulent, forged, or of doubtful, questionable, or suspicious origin; 
        and
            (2) other Federal requirements pertaining to declining to fill a 
        prescription under such circumstances, including the partial fill of 
        prescriptions for certain controlled substances.
    (b) Materials Included.--In developing materials under subsection (a), the 
Secretary of Health and Human Services shall include information for--
            (1) pharmacists on how to decline to fill a prescription and actions 
        to take after declining to fill a prescription; and
            (2) other health care practitioners and the public on a pharmacist's 
        ability to decline to fill prescriptions in certain circumstances and a 
        description of those circumstances (as described in the materials 
        developed under subsection (a)(1)).
    (c) Stakeholder Input.--In developing the programs and materials required 
under subsection (a), the Secretary of Health and Human Services shall seek 
input from relevant national, State, and local associations, boards of pharmacy, 
medical societies, licensing boards, health care practitioners, and patients, 
including individuals with chronic pain.

                  CHAPTER 3--SAFE DISPOSAL OF UNUSED MEDICATION

SEC. 3221. SHORT TITLE.

    This chapter may be cited as the ``Safe Disposal of Unused Medication Act''.

SEC. 3222. DISPOSAL OF CONTROLLED SUBSTANCES OF A HOSPICE PATIENT BY EMPLOYEES 
              OF A QUALIFIED HOSPICE PROGRAM.

    (a) In General.--Subsection (g) of section 302 of the Controlled Substances 
Act (21 U.S.C. 822) is amended by adding at the end the following:
    ``(5)(A) In the case of a person receiving hospice care, an employee of a 
qualified hospice program, acting within the scope of employment, may handle, 
without being registered under this section, any controlled substance that was 
lawfully dispensed to the person receiving hospice care, for the purpose of 
disposal of the controlled substance so long as such disposal occurs onsite in 
accordance with all applicable Federal, State, Tribal, and local law and--
            ``(i) the disposal occurs after the death of a person receiving 
        hospice care;
            ``(ii) the controlled substance is expired; or
            ``(iii)(I) the employee is--
                            ``(aa) the physician of the person receiving hospice 
                        care; and
                            ``(bb) registered under section 303(f); and
                    ``(II) the hospice patient no longer requires the controlled 
                substance because the plan of care of the hospice patient has 
                been modified.
    ``(B) For the purposes of this paragraph:
            ``(i) The terms `hospice care' and `hospice program' have the 
        meanings given to those terms in section 1861(dd) of the Social Security 
        Act.
            ``(ii) The term `employee of a qualified hospice program' means a 
        physician, physician assistant, nurse, or other person who--
                    ``(I) is employed by, or pursuant to arrangements made by, a 
                qualified hospice program;
                    ``(II)(aa) is licensed to perform medical or nursing 
                services by the jurisdiction in which the person receiving 
                hospice care was located; and
                    ``(bb) is acting within the scope of such employment in 
                accordance with applicable State law; and
                    ``(III) has completed training through the qualified hospice 
                program regarding the disposal of controlled substances in a 
                secure and responsible manner so as to discourage abuse, misuse, 
                or diversion.
            ``(iii) The term `qualified hospice program' means a hospice program 
        that--
                    ``(I) has written policies and procedures for assisting in 
                the disposal of the controlled substances of a person receiving 
                hospice care after the person's death;
                    ``(II) at the time when the controlled substances are first 
                ordered--
                            ``(aa) provides a copy of the written policies and 
                        procedures to the patient or patient representative and 
                        family;
                            ``(bb) discusses the policies and procedures with 
                        the patient or representative and the family in a 
                        language and manner that they understand to ensure that 
                        these parties are educated regarding the safe disposal 
                        of controlled substances; and
                            ``(cc) documents in the patient's clinical record 
                        that the written policies and procedures were provided 
                        and discussed; and
                    ``(III) at the time following the disposal of the controlled 
                substances--
                            ``(aa) documents in the patient's clinical record 
                        the type of controlled substance, dosage, route of 
                        administration, and quantity so disposed; and
                            ``(bb) the time, date, and manner in which that 
                        disposal occurred.''.
    (b) Guidance.--The Attorney General may issue guidance to hospice programs 
(as defined in paragraph (5) of section 302(g) of the Controlled Substances Act 
(21 U.S.C. 822(g)), as added by subsection (a)) to assist the programs in 
satisfying the requirements under such paragraph (5).
    (c) Rule of Construction Relating to State and Local Law.--Nothing in this 
section or the amendments made by this section shall be construed to prevent a 
State or local government from imposing additional controls or restrictions 
relating to the regulation of the disposal of controlled substances in hospice 
care or hospice programs.

SEC. 3223. GAO STUDY AND REPORT ON HOSPICE SAFE DRUG MANAGEMENT.

    (a) Study.--
            (1) In general.--The Comptroller General of the United States (in 
        this section referred to as the ``Comptroller General'') shall conduct a 
        study on the requirements applicable to, and challenges of, hospice 
        programs with regard to the management and disposal of controlled 
        substances in the home of an individual.
            (2) Contents.--In conducting the study under paragraph (1), the 
        Comptroller General shall include--
                    (A) an overview of any challenges encountered by selected 
                hospice programs regarding the disposal of controlled 
                substances, such as opioids, in a home setting, including any 
                key changes in policies, procedures, or best practices for the 
                disposal of controlled substances over time; and
                    (B) a description of Federal requirements, including 
                requirements under the Medicare program, for hospice programs 
                regarding the disposal of controlled substances in a home 
                setting, and oversight of compliance with those requirements.
    (b) Report.--Not later than 18 months after the date of enactment of this 
Act, the Comptroller General shall submit to Congress a report containing the 
results of the study conducted under subsection (a), together with 
recommendations, if any, for such legislation and administrative action as the 
Comptroller General determines appropriate.

         CHAPTER 4--SPECIAL REGISTRATION FOR TELEMEDICINE CLARIFICATION

SEC. 3231. SHORT TITLE.

    This chapter may be cited as the ``Special Registration for Telemedicine 
Clarification Act of 2018''.

SEC. 3232. REGULATIONS RELATING TO A SPECIAL REGISTRATION FOR TELEMEDICINE.

    Section 311(h)(2) of the Controlled Substances Act (21 U.S.C. 831(h)(2)) is 
amended to read as follows:
            ``(2) Regulations.--Not later than 1 year after the date of 
        enactment of the SUPPORT for Patients and Communities Act, in 
        consultation with the Secretary, the Attorney General shall promulgate 
        final regulations specifying--
                    ``(A) the limited circumstances in which a special 
                registration under this subsection may be issued; and
                    ``(B) the procedure for obtaining a special registration 
                under this subsection.''.

           CHAPTER 5--SYNTHETIC ABUSE AND LABELING OF TOXIC SUBSTANCES

SEC. 3241. CONTROLLED SUBSTANCE ANALOGUES.

    Section 203 of the Controlled Substances Act (21 U.S.C. 813) is amended--
            (1) by striking ``A controlled'' and inserting ``(a) In General.--A 
        controlled''; and
            (2) by adding at the end the following:
    ``(b) Determination.--In determining whether a controlled substance analogue 
was intended for human consumption under subsection (a), the following factors 
may be considered, along with any other relevant factors:
            ``(1) The marketing, advertising, and labeling of the substance.
            ``(2) The known efficacy or usefulness of the substance for the 
        marketed, advertised, or labeled purpose.
            ``(3) The difference between the price at which the substance is 
        sold and the price at which the substance it is purported to be or 
        advertised as is normally sold.
            ``(4) The diversion of the substance from legitimate channels and 
        the clandestine importation, manufacture, or distribution of the 
        substance.
            ``(5) Whether the defendant knew or should have known the substance 
        was intended to be consumed by injection, inhalation, ingestion, or any 
        other immediate means.
            ``(6) Any controlled substance analogue that is manufactured, 
        formulated, sold, distributed, or marketed with the intent to avoid the 
        provisions of existing drug laws.
    ``(c) Limitation.--For purposes of this section, evidence that a substance 
was not marketed, advertised, or labeled for human consumption, by itself, shall 
not be sufficient to establish that the substance was not intended for human 
consumption.''.

                  CHAPTER 6--ACCESS TO INCREASED DRUG DISPOSAL

SEC. 3251. SHORT TITLE.

    This chapter may be cited as the ``Access to Increased Drug Disposal Act of 
2018''.

SEC. 3252. DEFINITIONS.

    In this chapter--
            (1) the term ``Attorney General'' means the Attorney General, acting 
        through the Assistant Attorney General for the Office of Justice 
        Programs;
            (2) the term ``authorized collector'' means a narcotic treatment 
        program, a hospital or clinic with an on-site pharmacy, a retail 
        pharmacy, or a reverse distributor, that is authorized as a collector 
        under section 1317.40 of title 21, Code of Federal Regulations (or any 
        successor regulation);
            (3) the term ``covered grant'' means a grant awarded under section 
        3003; and
            (4) the term ``eligible collector'' means a person who is eligible 
        to be an authorized collector.

SEC. 3253. AUTHORITY TO MAKE GRANTS.

    The Attorney General shall award grants to States to enable the States to 
increase the participation of eligible collectors as authorized collectors.

SEC. 3254. APPLICATION.

    A State desiring a covered grant shall submit to the Attorney General an 
application that, at a minimum--
            (1) identifies the single State agency that oversees pharmaceutical 
        care and will be responsible for complying with the requirements of the 
        grant;
            (2) details a plan to increase participation rates of eligible 
        collectors as authorized collectors; and
            (3) describes how the State will select eligible collectors to be 
        served under the grant.

SEC. 3255. USE OF GRANT FUNDS.

    A State that receives a covered grant, and any subrecipient of the grant, 
may use the grant amounts only for the costs of installation, maintenance, 
training, purchasing, and disposal of controlled substances associated with the 
participation of eligible collectors as authorized collectors.

SEC. 3256. ELIGIBILITY FOR GRANT.

    The Attorney General shall award a covered grant to 5 States, not less than 
3 of which shall be States in the lowest quartile of States based on the 
participation rate of eligible collectors as authorized collectors, as 
determined by the Attorney General.

SEC. 3257. DURATION OF GRANTS.

    The Attorney General shall determine the period of years for which a covered 
grant is made to a State.

SEC. 3258. ACCOUNTABILITY AND OVERSIGHT.

    A State that receives a covered grant shall submit to the Attorney General a 
report, at such time and in such manner as the Attorney General may reasonably 
require, that--
            (1) lists the ultimate recipients of the grant amounts;
            (2) describes the activities undertaken by the State using the grant 
        amounts; and
            (3) contains performance measures relating to the effectiveness of 
        the grant, including changes in the participation rate of eligible 
        collectors as authorized collectors.

SEC. 3259. DURATION OF PROGRAM.

    The Attorney General may award covered grants for each of the first 5 fiscal 
years beginning after the date of enactment of this Act.

SEC. 3260. AUTHORIZATION OF APPROPRIATIONS.

    There is authorized to be appropriated to the Attorney General such sums as 
may be necessary to carry out this chapter.

                CHAPTER 7--USING DATA TO PREVENT OPIOID DIVERSION

SEC. 3271. SHORT TITLE.

    This chapter may be cited as the ``Using Data To Prevent Opioid Diversion 
Act of 2018''.

SEC. 3272. PURPOSE.

    (a) In General.--The purpose of this chapter is to provide drug 
manufacturers and distributors with access to anonymized information through the 
Automated Reports and Consolidated Orders System to help drug manufacturers and 
distributors identify, report, and stop suspicious orders of opioids and reduce 
diversion rates.
    (b) Rule of Construction.--Nothing in this chapter should be construed to 
absolve a drug manufacturer, drug distributor, or other Drug Enforcement 
Administration registrant from the responsibility of the manufacturer, 
distributor, or other registrant to--
            (1) identify, stop, and report suspicious orders; or
            (2) maintain effective controls against diversion in accordance with 
        section 303 of the Controlled Substances Act (21 U.S.C. 823) or any 
        successor law or associated regulation.

SEC. 3273. AMENDMENTS.

    (a) Records and Reports of Registrants.--Section 307 of the Controlled 
Substances Act (21 U.S.C. 827) is amended--
            (1) by redesignating subsections (f), (g), and (h) as subsections 
        (g), (h), and (i), respectively;
            (2) by inserting after subsection (e) the following:
    ``(f)(1) The Attorney General shall, not less frequently than quarterly, 
make the following information available to manufacturer and distributor 
registrants through the Automated Reports and Consolidated Orders System, or any 
subsequent automated system developed by the Drug Enforcement Administration to 
monitor selected controlled substances:
            ``(A) The total number of distributor registrants that distribute 
        controlled substances to a pharmacy or practitioner registrant, 
        aggregated by the name and address of each pharmacy and practitioner 
        registrant.
            ``(B) The total quantity and type of opioids distributed, listed by 
        Administration Controlled Substances Code Number, to each pharmacy and 
        practitioner registrant described in subparagraph (A).
    ``(2) The information required to be made available under paragraph (1) 
shall be made available not later than the 30th day of the first month following 
the quarter to which the information relates.
    ``(3)(A) All registered manufacturers and distributors shall be responsible 
for reviewing the information made available by the Attorney General under this 
subsection.
    ``(B) In determining whether to initiate proceedings under this title 
against a registered manufacturer or distributor based on the failure of the 
registrant to maintain effective controls against diversion or otherwise comply 
with the requirements of this title or the regulations issued thereunder, the 
Attorney General may take into account that the information made available under 
this subsection was available to the registrant.''; and
            (3) by inserting after subsection (i), as so redesignated, the 
        following:
    ``(j) All of the reports required under this section shall be provided in an 
electronic format.''.
    (b) Cooperative Arrangements.--Section 503 of the Controlled Substances Act 
(21 U.S.C. 873) is amended by striking subsection (c) and inserting the 
following:
    ``(c)(1) The Attorney General shall, once every 6 months, prepare and make 
available to regulatory, licensing, attorneys general, and law enforcement 
agencies of States a standardized report containing descriptive and analytic 
information on the actual distribution patterns, as gathered through the 
Automated Reports and Consolidated Orders System, or any subsequent automated 
system, pursuant to section 307 and which includes detailed amounts, outliers, 
and trends of distributor and pharmacy registrants, in such States for the 
controlled substances contained in schedule II, which, in the discretion of the 
Attorney General, are determined to have the highest abuse.
    ``(2) If the Attorney General publishes the report described in paragraph 
(1) once every 6 months as required under paragraph (1), nothing in this 
subsection shall be construed to bring an action in any court to challenge the 
sufficiency of the information or to compel the Attorney General to produce any 
documents or reports referred to in this subsection.''.
    (c) Civil and Criminal Penalties.--Section 402 of the Controlled Substances 
Act (21 U.S.C. 842) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (15), by striking ``or'' at the end;
                    (B) in paragraph (16), by striking the period at the end and 
                inserting ``; or''; and
                    (C) by inserting after paragraph (16) the following:
            ``(17) in the case of a registered manufacturer or distributor of 
        opioids, to fail to review the most recent information, directly related 
        to the customers of the manufacturer or distributor, made available by 
        the Attorney General in accordance with section 307(f).''; and
            (2) in subsection (c)--
                    (A) in paragraph (1), by striking subparagraph (B) and 
                inserting the following:
    ``(B)(i) Except as provided in clause (ii), in the case of a violation of 
paragraph (5), (10), or (17) of subsection (a), the civil penalty shall not 
exceed $10,000.
    ``(ii) In the case of a violation described in clause (i) committed by a 
registered manufacturer or distributor of opioids and related to the reporting 
of suspicious orders for opioids, failing to maintain effective controls against 
diversion of opioids, or failing to review the most recent information made 
available by the Attorney General in accordance with section 307(f), the penalty 
shall not exceed $100,000.''; and
                    (B) in paragraph (2)--
                            (i) in subparagraph (A), by inserting ``or (D)'' 
                        after ``subparagraph (B)''; and
                            (ii) by adding at the end the following:
    ``(D) In the case of a violation described in subparagraph (A) that was a 
violation of paragraph (5), (10), or (17) of subsection (a) committed by a 
registered manufacturer or distributor of opioids that relates to the reporting 
of suspicious orders for opioids, failing to maintain effective controls against 
diversion of opioids, or failing to review the most recent information made 
available by the Attorney General in accordance with section 307(f), the 
criminal fine under title 18, United States Code, shall not exceed $500,000.''.

SEC. 3274. REPORT.

    Not later than 1 year after the date of enactment of this Act, the Attorney 
General shall submit to Congress a report that provides information about how 
the Attorney General is using data in the Automation of Reports and Consolidated 
Orders System to identify and stop suspicious activity, including whether the 
Attorney General is looking at aggregate orders from individual pharmacies to 
multiple distributors that in total are suspicious, even if no individual order 
rises to the level of a suspicious order to a given distributor.

                         CHAPTER 8--OPIOID QUOTA REFORM

SEC. 3281. SHORT TITLE.

    This chapter may be cited as the ``Opioid Quota Reform Act''.

SEC. 3282. STRENGTHENING CONSIDERATIONS FOR DEA OPIOID QUOTAS.

    (a) In General.--Section 306 of the Controlled Substances Act (21 U.S.C. 
826) is amended--
            (1) in subsection (a)--
                    (A) by inserting ``(1)'' after ``(a)'';
                    (B) in the second sentence, by striking ``Production'' and 
                inserting ``Except as provided in paragraph (2), production''; 
                and
                    (C) by adding at the end the following:
    ``(2) The Attorney General may, if the Attorney General determines it will 
assist in avoiding the overproduction, shortages, or diversion of a controlled 
substance, establish an aggregate or individual production quota under this 
subsection, or a procurement quota established by the Attorney General by 
regulation, in terms of pharmaceutical dosage forms prepared from or containing 
the controlled substance.'';
            (2) in subsection (b), in the first sentence, by striking 
        ``production'' and inserting ``manufacturing'';
            (3) in subsection (c), by striking ``October'' and inserting 
        ``December''; and
            (4) by adding at the end the following:
    ``(i)(1)(A) In establishing any quota under this section, or any procurement 
quota established by the Attorney General by regulation, for fentanyl, 
oxycodone, hydrocodone, oxymorphone, or hydromorphone (in this subsection 
referred to as a `covered controlled substance'), the Attorney General shall 
estimate the amount of diversion of the covered controlled substance that occurs 
in the United States.
    ``(B) In estimating diversion under this paragraph, the Attorney General--
            ``(i) shall consider information the Attorney General, in 
        consultation with the Secretary of Health and Human Services, determines 
        reliable on rates of overdose deaths and abuse and overall public health 
        impact related to the covered controlled substance in the United States; 
        and
            ``(ii) may take into consideration whatever other sources of 
        information the Attorney General determines reliable.
    ``(C) After estimating the amount of diversion of a covered controlled 
substance, the Attorney General shall make appropriate quota reductions, as 
determined by the Attorney General, from the quota the Attorney General would 
have otherwise established had such diversion not been considered.
    ``(2)(A) For any year for which the approved aggregate production quota for 
a covered controlled substance is higher than the approved aggregate production 
quota for the covered controlled substance for the previous year, the Attorney 
General, in consultation with the Secretary of Health and Human Services, shall 
include in the final order an explanation of why the public health benefits of 
increasing the quota clearly outweigh the consequences of having an increased 
volume of the covered controlled substance available for sale, and potential 
diversion, in the United States.
    ``(B) Not later than 1 year after the date of enactment of this subsection, 
and every year thereafter, the Attorney General shall submit to the Committee on 
the Judiciary, the Committee on Health, Education, Labor, and Pensions, and the 
Committee on Appropriations of the Senate and the Committee on the Judiciary, 
the Committee on Energy and Commerce, and the Committee on Appropriations of the 
House of Representatives the following information with regard to each covered 
controlled substance:
            ``(i) An anonymized count of the total number of manufacturers 
        issued individual manufacturing quotas that year for the covered 
        controlled substance.
            ``(ii) An anonymized count of how many such manufacturers were 
        issued an approved manufacturing quota that was higher than the quota 
        issued to that manufacturer for the covered controlled substance in the 
        previous year.
    ``(3) Not later than 1 year after the date of enactment of this subsection, 
the Attorney General shall submit to Congress a report on how the Attorney 
General, when fixing and adjusting production and manufacturing quotas under 
this section for covered controlled substances, will--
            ``(A) take into consideration changes in the accepted medical use of 
        the covered controlled substances; and
            ``(B) work with the Secretary of Health and Human Services on 
        methods to appropriately and anonymously estimate the type and amount of 
        covered controlled substances that are submitted for collection from 
        approved drug collection receptacles, mail-back programs, and take-back 
        events.''.
    (b) Conforming Change.--The Law Revision Counsel is directed to amend the 
heading for subsection (b) of section 826 of title 21, United States Code, by 
striking ``Production'' and inserting ``Manufacturing''.

                      CHAPTER 9--PREVENTING DRUG DIVERSION

SEC. 3291. SHORT TITLE.

    This chapter may be cited as the ``Preventing Drug Diversion Act of 2018''.

SEC. 3292. IMPROVEMENTS TO PREVENT DRUG DIVERSION.

    (a) Definition.--Section 102 of the Controlled Substances Act (21 U.S.C. 
802) is amended by adding at the end the following:
            ``(57) The term `suspicious order' may include, but is not limited 
        to--
                    ``(A) an order of a controlled substance of unusual size;
                    ``(B) an order of a controlled substance deviating 
                substantially from a normal pattern; and
                    ``(C) orders of controlled substances of unusual 
                frequency.''.
    (b) Suspicious Orders.--Part C of the Controlled Substances Act (21 U.S.C. 
821 et seq.) is amended by adding at the end the following:

``SEC. 312. SUSPICIOUS ORDERS.

    ``(a) Reporting.--Each registrant shall--
            ``(1) design and operate a system to identify suspicious orders for 
        the registrant;
            ``(2) ensure that the system designed and operated under paragraph 
        (1) by the registrant complies with applicable Federal and State privacy 
        laws; and
            ``(3) upon discovering a suspicious order or series of orders, 
        notify the Administrator of the Drug Enforcement Administration and the 
        Special Agent in Charge of the Division Office of the Drug Enforcement 
        Administration for the area in which the registrant is located or 
        conducts business.
    ``(b) Suspicious Order Database.--
            ``(1) In general.--Not later than 1 year after the date of enactment 
        of this section, the Attorney General shall establish a centralized 
        database for collecting reports of suspicious orders.
            ``(2) Satisfaction of reporting requirements.--If a registrant 
        reports a suspicious order to the centralized database established under 
        paragraph (1), the registrant shall be considered to have complied with 
        the requirement under subsection (a)(3) to notify the Administrator of 
        the Drug Enforcement Administration and the Special Agent in Charge of 
        the Division Office of the Drug Enforcement Administration for the area 
        in which the registrant is located or conducts business.
    ``(c) Sharing Information With the States.--
            ``(1) In general.--The Attorney General shall prepare and make 
        available information regarding suspicious orders in a State, including 
        information in the database established under subsection (b)(1), to the 
        point of contact for purposes of administrative, civil, and criminal 
        oversight relating to the diversion of controlled substances for the 
        State, as designated by the Governor or chief executive officer of the 
        State.
            ``(2) Timing.--The Attorney General shall provide information in 
        accordance with paragraph (1) within a reasonable period of time after 
        obtaining the information.
            ``(3) Coordination.--In establishing the process for the provision 
        of information under this subsection, the Attorney General shall 
        coordinate with States to ensure that the Attorney General has access to 
        information, as permitted under State law, possessed by the States 
        relating to prescriptions for controlled substances that will assist in 
        enforcing Federal law.''.
    (c) Reports to Congress.--
            (1) Definition.--In this subsection, the term ``suspicious order'' 
        has the meaning given that term in section 102 of the Controlled 
        Substances Act, as amended by this chapter.
            (2) One-time report.--Not later than 1 year after the date of 
        enactment of this Act, the Attorney General shall submit to Congress a 
        report on the reporting of suspicious orders, which shall include--
                    (A) a description of the centralized database established 
                under section 312 of the Controlled Substances Act, as added by 
                this section, to collect reports of suspicious orders;
                    (B) a description of the system and reports established 
                under section 312 of the Controlled Substances Act, as added by 
                this section, to share information with States;
                    (C) information regarding how the Attorney General used 
                reports of suspicious orders before the date of enactment of 
                this Act and after the date of enactment of this Act, including 
                how the Attorney General received the reports and what actions 
                were taken in response to the reports; and
                    (D) descriptions of the data analyses conducted on reports 
                of suspicious orders to identify, analyze, and stop suspicious 
                activity.
            (3) Additional reports.--Not later than 1 year after the date of 
        enactment of this Act, and annually thereafter until the date that is 5 
        years after the date of enactment of this Act, the Attorney General 
        shall submit to Congress a report providing, for the previous year--
                    (A) the number of reports of suspicious orders;
                    (B) a summary of actions taken in response to reports, in 
                the aggregate, of suspicious orders; and
                    (C) a description of the information shared with States 
                based on reports of suspicious orders.
            (4) One-time gao report.--Not later than 1 year after the date of 
        enactment of this Act, the Comptroller General of the United States, in 
        consultation with the Administrator of the Drug Enforcement 
        Administration, shall submit to Congress a report on the reporting of 
        suspicious orders, which shall include an evaluation of the utility of 
        real-time reporting of potential suspicious orders of opioids on a 
        national level using computerized algorithms, including the extent to 
        which such algorithms--
                    (A) would help ensure that potentially suspicious orders are 
                more accurately captured, identified, and reported in real time 
                to suppliers before orders are filled;
                    (B) may produce false positives of suspicious order reports 
                that could result in market disruptions for legitimate orders of 
                opioids; and
                    (C) would reduce the overall length of an investigation that 
                prevents the diversion of suspicious orders of opioids.

                                TITLE IV--OFFSETS

SEC. 4001. PROMOTING VALUE IN MEDICAID MANAGED CARE.

    Section 1903(m) of the Social Security Act (42 U.S.C. 1396b(m)), as amended 
by sections 1013 and 1016, is further amended by adding at the end the following 
new paragraph:
    ``(9)(A) With respect to expenditures described in subparagraph (B) that are 
incurred by a State for any fiscal year after fiscal year 2020 (and before 
fiscal year 2024), 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 section 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 managed care entity, or other specified 
entity (as defined in subparagraph (D)(iii)), that are treated as remittances 
because 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 medical loss ratio that is equal to 85 
                percent; and
            ``(ii) recovered all or a portion of the expenditures as a result of 
        the entity's failure to meet such ratio.
    ``(C) For purposes of subparagraph (B), a State described in this 
subparagraph is a State that as of May 31, 2018, applied a minimum medical loss 
ratio (as calculated 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 described in such subparagraph under the State plan under 
this title (or a waiver of the plan) that is equal to or greater 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 section 438.8 of title 42, Code of Federal Regulations (as in 
        effect on June 1, 2018)) for payment for services provided by entities 
        described in subparagraph (B) under the State plan under this title (or 
        a waiver of the plan).
            ``(iii) The term `other specified entity' means--
                    ``(I) a prepaid inpatient health plan, as defined in section 
                438.2 of title 42, Code of Federal Regulations (or any successor 
                regulation); and
                    ``(II) a prepaid ambulatory health plan, as defined in such 
                section (or any successor regulation).''.

SEC. 4002. REQUIRING REPORTING BY GROUP HEALTH PLANS OF PRESCRIPTION DRUG 
              COVERAGE INFORMATION FOR PURPOSES OF IDENTIFYING PRIMARY PAYER 
              SITUATIONS UNDER THE MEDICARE PROGRAM.

    Clause (i) of section 1862(b)(7)(A) of the Social Security Act (42 U.S.C. 
1395y(b)(7)(A)) is amended to read as follows:
                            ``(i) secure from the plan sponsor and plan 
                        participants such information as the Secretary shall 
                        specify for the purpose of identifying situations where 
                        the group health plan is or has been--
                                    ``(I) a primary plan to the program under 
                                this title; or
                                    ``(II) for calendar quarters beginning on or 
                                after January 1, 2020, a primary payer with 
                                respect to benefits relating to prescription 
                                drug coverage under part D; and''.

SEC. 4003. ADDITIONAL RELIGIOUS EXEMPTION FROM HEALTH COVERAGE RESPONSIBILITY 
              REQUIREMENT.

    (a) In General.--Section 5000A(d)(2)(A) of the Internal Revenue Code of 1986 
is amended to read as follows:
                    ``(A) Religious conscience exemptions.--
                            ``(i) In general.--Such term shall not include any 
                        individual for any month if such individual has in 
                        effect an exemption under section 1311(d)(4)(H) of the 
                        Patient Protection and Affordable Care Act which 
                        certifies that--
                                    ``(I) such individual is a member of a 
                                recognized religious sect or division thereof 
                                which is described in section 1402(g)(1), and is 
                                adherent of established tenets or teachings of 
                                such sect or division as described in such 
                                section; or
                                    ``(II) such individual is a member of a 
                                religious sect or division thereof which is not 
                                described in section 1402(g)(1), who relies 
                                solely on a religious method of healing, and for 
                                whom the acceptance of medical health services 
                                would be inconsistent with the religious beliefs 
                                of the individual.
                            ``(ii) Special rules.--
                                    ``(I) Medical health services defined.--For 
                                purposes of this subparagraph, the term `medical 
                                health services' does not include routine 
                                dental, vision and hearing services, midwifery 
                                services, vaccinations, necessary medical 
                                services provided to children, services required 
                                by law or by a third party, and such other 
                                services as the Secretary of Health and Human 
                                Services may provide in implementing section 
                                1311(d)(4)(H) of the Patient Protection and 
                                Affordable Care Act.
                                    ``(II) Attestation required.--Clause (i)(II) 
                                shall apply to an individual for months in a 
                                taxable year only if the information provided by 
                                the individual under section 1411(b)(5)(A) of 
                                such Act includes an attestation that the 
                                individual has not received medical health 
                                services during the preceding taxable year.''.
    (b) Effective Date.--The amendment made by subsection (a) shall apply to 
taxable years beginning after December 31, 2018.
    (c) Construction.--Nothing in the amendment made by subsection (a) shall 
preempt any State law requiring the provision of medical treatment for children, 
especially those who are seriously ill.

SEC. 4004. MODERNIZING THE REPORTING OF BIOLOGICAL AND BIOSIMILAR PRODUCTS.

    Subtitle B of title XI of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 108-173) is amended--
            (1) in section 1111, as amended by section 3(1) of the Patient Right 
        to Know Drug Prices Act--
                    (A) in the paragraph (3) inserted by such section 3(1), by 
                striking ``an application'' and inserting ``a biosimilar 
                biological product application'';
                    (B) in the paragraph (4) inserted by such section 3(1), by 
                inserting ``application'' before ``under section 351(k) of the 
                Public Health Service Act'';
                    (C) in the paragraph (5) inserted by such section 3(1), by 
                striking ``for licensure of a biological product under section 
                351(k) of the Public Health Service Act'' and inserting ``under 
                section 351(k) of the Public Health Service Act for licensure of 
                a biological product as biosimilar to, or interchangeable with, 
                a reference product'';
                    (D) in paragraph (7), as redesignated and amended by such 
                section 3(1), by striking ``or under section 351(a) of the 
                Public Health Service Act'' and inserting ``or the owner, or 
                exclusive licensee, of a patent included in a list provided 
                under section 351(l)(3) of the Public Health Service Act''; and
                    (E) in the paragraph (12) added by such section 3(1), by 
                striking ``means a brand name drug for which a license is in 
                effect under section 351(a)'' and inserting ``has the meaning 
                given such term in section 351(i)''; and
            (2) in section 1112, as amended by section 3(2) of the Patient Right 
        to Know Drug Prices Act--
                    (A) in subsection (a)--
                            (i) in paragraph (1), by striking ``for which a 
                        statement under section 351(l)(3)(B)(ii)(I) of the 
                        Public Health Service Act has been provided'';
                            (ii) in paragraph (2)--
                                    (I) in subparagraph (C)(i), by striking 
                                ``brand name'' and inserting ``listed''; and
                                    (II) by amending clause (ii) of subparagraph 
                                (C) to read as follows:
                            ``(ii) any of the time periods referred to in 
                        section 351(k)(6) of the Public Health Service Act as 
                        such period applies to such biosimilar biological 
                        product application or to any other biosimilar 
                        biological product application based on the same 
                        reference product.'';
                    (B) in subsection (b)--
                            (i) in the subsection heading, by inserting ``or 
                        Biosimilar Biological Product Applicant'' after 
                        ``Applicant'';
                            (ii) in paragraph (1)(B), by striking the first 
                        sentence and inserting the following: ``A biosimilar 
                        biological product applicant that has submitted a 
                        biosimilar biological product application that 
                        references a reference product and another biosimilar 
                        biological product applicant that has submitted a 
                        biosimilar biological product application that 
                        references the same reference product shall each file 
                        the agreement in accordance with subsection (c).''; and
                            (iii) in paragraph (2)--
                                    (I) by striking ``2 generic drug 
                                applicants'' and inserting ``2 or more generic 
                                drug applicants''; and
                                    (II) by striking ``or an agreement between 2 
                                biosimilar biological product applicants 
                                regarding the 1-year period referred to in 
                                section 351(k)(6)(A) of the Public Health 
                                Service Act as it applies to the biosimilar 
                                biological product applications with which the 
                                agreement is concerned'' and inserting ``, an 
                                agreement between 2 or more biosimilar 
                                biological product applicants regarding a time 
                                period referred to in section 351(k)(6) of the 
                                Public Health Service Act as it applies to the 
                                biosimilar biological product, or an agreement 
                                between 2 or more biosimilar biological product 
                                applicants regarding the manufacture, marketing, 
                                or sale of a biosimilar biological product''; 
                                and
                    (C) in subsection (c)(2), by inserting ``were entered into 
                within 30 days of,'' after ``condition for,''.

                       TITLE V--OTHER MEDICAID PROVISIONS

Subtitle A--Mandatory Reporting With Respect to Adult Behavioral Health Measures

SEC. 5001. MANDATORY REPORTING WITH RESPECT TO ADULT BEHAVIORAL HEALTH MEASURES.

    Section 1139B of the Social Security Act (42 U.S.C. 1320b-9b) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (3)--
                            (i) by striking ``Not later than January 1, 2013'' 
                        and inserting the following:
                    ``(A) Voluntary reporting.--Not later than January 1, 
                2013''; and
                            (ii) by adding at the end the following:
                    ``(B) Mandatory reporting with respect to behavioral health 
                measures.--Beginning with the State report required under 
                subsection (d)(1) for 2024, the Secretary shall require States 
                to use all behavioral health measures included in the core set 
                of adult health quality measures and any updates or changes to 
                such measures to report information, using the standardized 
                format for reporting information and procedures developed under 
                subparagraph (A), regarding the quality of behavioral health 
                care for Medicaid eligible adults.''; and
                    (B) in paragraph (5), by adding at the end the following new 
                subparagraph:
                    ``(C) Behavioral health measures.--Beginning with respect to 
                State reports required under subsection (d)(1) for 2024, the 
                core set of adult health quality measures maintained under this 
                paragraph (and any updates or changes to such measures) shall 
                include behavioral health measures.''; and
            (2) in subsection (d)(1)(A)--
                    (A) by striking ``the such plan'' and inserting ``such 
                plan''; and
                    (B) by striking ``subsection (a)(5)'' and inserting 
                ``subsection (b)(5) and, beginning with the report for 2024, all 
                behavioral health measures included in the core set of adult 
                health quality measures maintained under such subsection (b)(5) 
                and any updates or changes to such measures (as required under 
                subsection (b)(3))''.

                    Subtitle B--Medicaid IMD Additional Info

SEC. 5011. SHORT TITLE.

    This subtitle may be cited as the ``Medicaid Institutes for Mental Disease 
Are Decisive in Delivering Inpatient Treatment for Individuals but Opportunities 
for Needed Access are Limited without Information Needed about Facility 
Obligations Act'' or the ``Medicaid IMD ADDITIONAL INFO Act''.

SEC. 5012. MACPAC EXPLORATORY STUDY AND REPORT ON INSTITUTIONS FOR MENTAL 
              DISEASES REQUIREMENTS AND PRACTICES UNDER MEDICAID.

    (a) In General.--Not later than January 1, 2020, the Medicaid and CHIP 
Payment and Access Commission established under section 1900 of the Social 
Security Act (42 U.S.C. 1396) shall conduct an exploratory study, using data 
from a representative sample of States, and submit to Congress a report on at 
least the following information, with respect to services furnished to 
individuals enrolled under State plans under the Medicaid program under title 
XIX of such Act (42 U.S.C. 1396 et seq.) (or waivers of such plans) who are 
patients in institutions for mental diseases and for which payment is made 
through fee-for-service or managed care arrangements under such State plans (or 
waivers):
            (1) A description of such institutions for mental diseases in each 
        such State, including at a minimum--
                    (A) the number of such institutions in the State;
                    (B) the facility type of such institutions in the State; and
                    (C) any coverage limitations under each such State plan (or 
                waiver) on scope, duration, or frequency of such services.
            (2) With respect to each such institution for mental diseases in 
        each such State, a description of--
                    (A) such services provided at such institution;
                    (B) the process, including any timeframe, used by such 
                institution to clinically assess and reassess such individuals; 
                and
                    (C) the discharge process used by such institution, 
                including any care continuum of relevant services or facilities 
                provided or used in such process.
            (3) A description of--
                    (A) any Federal waiver that each such State has for such 
                institutions and the Federal statutory authority for such 
                waiver; and
                    (B) any other Medicaid funding sources used by each such 
                State for funding such institutions, such as supplemental 
                payments.
            (4) A summary of State requirements (such as certification, 
        licensure, and accreditation) applied by each such State to such 
        institutions in order for such institutions to receive payment under the 
        State plan (or waiver) and how each such State determines if such 
        requirements have been met.
            (5) A summary of State standards (such as quality standards, 
        clinical standards, and facility standards) that such institutions must 
        meet to receive payment under such State plans (or waivers) and how each 
        such State determines if such standards have been met.
            (6) If determined appropriate by the Commission, recommendations for 
        policies and actions by Congress and the Centers for Medicare & Medicaid 
        Services, such as on how State Medicaid programs may improve care and 
        improve standards and including a recommendation for how the Centers for 
        Medicare & Medicaid Services can improve data collection from such 
        programs to address any gaps in information.
    (b) Stakeholder Input.--In carrying out subsection (a), the Medicaid and 
CHIP Payment and Access Commission shall seek input from State Medicaid 
directors and stakeholders, including at a minimum the Substance Abuse and 
Mental Health Services Administration, Centers for Medicare & Medicaid Services, 
State Medicaid officials, State mental health authorities, Medicaid beneficiary 
advocates, health care providers, and Medicaid managed care organizations.
    (c) Definitions.--In this section:
            (1) Representative sample of states.--The term ``representative 
        sample of States'' means a non-probability sample in which at least two 
        States are selected based on the knowledge and professional judgment of 
        the selector.
            (2) State.--The term ``State'' means each of the 50 States, the 
        District of Columbia, and any commonwealth or territory of the United 
        States.
            (3) Institution for mental diseases.--The term ``institution for 
        mental diseases'' has the meaning given such term in section 435.1010 of 
        title 42, Code of Federal Regulations, or any successor regulation.

        Subtitle C--CHIP Mental Health and Substance Use Disorder Parity

SEC. 5021. SHORT TITLE.

    This subtitle may be cited as the ``CHIP Mental Health and Substance Use 
Disorder Parity Act''.

SEC. 5022. ENSURING ACCESS TO MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES 
              FOR CHILDREN AND PREGNANT WOMEN UNDER THE CHILDREN'S HEALTH 
              INSURANCE PROGRAM.

    (a) In General.--Section 2103(c)(1) of the Social Security Act (42 U.S.C. 
1397cc(c)(1)) is amended by adding at the end the following new subparagraph:
                    ``(E) Mental health and substance use disorder services (as 
                defined in paragraph (5)).''.
    (b) Mental Health and Substance Use Disorder Services.--
            (1) In general.--Section 2103(c) of the Social Security Act (42 
        U.S.C. 1397cc(c)) is amended--
                    (A) by redesignating paragraphs (5), (6), (7), and (8) as 
                paragraphs (6), (7), (8), and (9), respectively; and
                    (B) by inserting after paragraph (4) the following new 
                paragraph:
            ``(5) Mental health and substance use disorder services.--Regardless 
        of the type of coverage elected by a State under subsection (a), child 
        health assistance provided under such coverage for targeted low-income 
        children and, in the case that the State elects to provide pregnancy-
        related assistance under such coverage pursuant to section 2112, such 
        pregnancy-related assistance for targeted low-income pregnant women (as 
        defined in section 2112(d)) shall--
                    ``(A) include coverage of mental health services (including 
                behavioral health treatment) necessary to prevent, diagnose, and 
                treat a broad range of mental health symptoms and disorders, 
                including substance use disorders; and
                    ``(B) be delivered in a culturally and linguistically 
                appropriate manner.''.
            (2) Conforming amendments.--
                    (A) Section 2103(a) of the Social Security Act (42 U.S.C. 
                1397cc(a)) is amended, in the matter before paragraph (1), by 
                striking ``paragraphs (5), (6), and (7)'' and inserting 
                ``paragraphs (5), (6), (7), and (8)''.
                    (B) Section 2110(a) of the Social Security Act (42 U.S.C. 
                1397jj(a)) is amended--
                            (i) in paragraph (18), by striking ``substance 
                        abuse'' each place it appears and inserting ``substance 
                        use''; and
                            (ii) in paragraph (19), by striking ``substance 
                        abuse'' and inserting ``substance use''.
                    (C) Section 2110(b)(5)(A)(i) of the Social Security Act (42 
                U.S.C. 1397jj(b)(5)(A)(i)) is amended by striking ``subsection 
                (c)(5)'' and inserting ``subsection (c)(6)''.
    (c) Assuring Access to Care.--Section 2102(a)(7)(B) of the Social Security 
Act (42 U.S.C. 1397bb(c)(2)) is amended by striking ``section 2103(c)(5)'' and 
inserting ``paragraphs (5) and (6) of section 2103(c)''.
    (d) Mental Health Services Parity.--Subparagraph (A) of paragraph (7) of 
section 2103(c) of the Social Security Act (42 U.S.C. 1397cc(c)) (as 
redesignated by subsection (b)(1)) is amended to read as follows:
                    ``(A) In general.--A State child health plan shall ensure 
                that the financial requirements and treatment limitations 
                applicable to mental health and substance use disorder services 
                (as described in paragraph (5)) provided under such plan comply 
                with the requirements of section 2726(a) of the Public Health 
                Service Act in the same manner as such requirements or 
                limitations apply to a group health plan under such section.''.
    (e) Effective Date.--
            (1) In general.--Subject to paragraph (2), the amendments made by 
        this section shall take effect with respect to child health assistance 
        provided on or after the date that is 1 year after the date of the 
        enactment of this Act.
            (2) Exception for state legislation.--In the case of a State child 
        health plan under title XXI of the Social Security Act (or a waiver of 
        such plan), which the Secretary of Health and Human Services determines 
        requires State legislation in order for the respective plan (or waiver) 
        to meet any requirement imposed by the amendments made by this section, 
        the respective plan (or waiver) shall not be regarded as failing to 
        comply with the requirements of such title solely on the basis of its 
        failure to meet such an additional requirement before the first day of 
        the first calendar quarter beginning after the close of the first 
        regular session of the State legislature that begins after the date of 
        enactment of this section. For purposes of the previous sentence, in the 
        case of a State that has a 2-year legislative session, each year of the 
        session shall be considered to be a separate regular session of the 
        State legislature.

                          Subtitle D--Medicaid Reentry

SEC. 5031. SHORT TITLE.

    This subtitle may be cited as the ``Medicaid Reentry Act''.

SEC. 5032. PROMOTING STATE INNOVATIONS TO EASE TRANSITIONS INTEGRATION TO THE 
              COMMUNITY FOR CERTAIN INDIVIDUALS.

    (a) Stakeholder Group Development of Best Practices; State Medicaid Program 
Innovation.--
            (1) Stakeholder group best practices.--Not later than 6 months after 
        the date of the enactment of this Act, the Secretary of Health and Human 
        Services shall convene a stakeholder group of representatives of managed 
        care organizations, Medicaid beneficiaries, health care providers, the 
        National Association of Medicaid Directors, and other relevant 
        representatives from local, State, and Federal jail and prison systems 
        to develop best practices (and submit to the Secretary and Congress a 
        report on such best practices) for States--
                    (A) to ease the health care-related transition of an 
                individual who is an inmate of a public institution from the 
                public institution to the community, including best practices 
                for ensuring continuity of health insurance coverage or coverage 
                under the State Medicaid plan under title XIX of the Social 
                Security Act, as applicable, and relevant social services; and
                    (B) to carry out, with respect to such an individual, such 
                health care-related transition not later than 30 days after such 
                individual is released from the public institution.
            (2) State medicaid program innovation.--The Secretary of Health and 
        Human Services shall work with States on innovative strategies to help 
        individuals who are inmates of public institutions and otherwise 
        eligible for medical assistance under the Medicaid program under title 
        XIX of the Social Security Act transition, with respect to enrollment 
        for medical assistance under such program, seamlessly to the community.
    (b) Guidance on Innovative Service Delivery Systems Demonstration Project 
Opportunities.--Not later than 1 year after the date of the enactment of this 
Act, the Secretary of Health and Human Services, through the Administrator of 
the Centers for Medicare & Medicaid Services, shall issue a State Medicaid 
Director letter, based on best practices developed under subsection (a)(1), 
regarding opportunities to design demonstration projects under section 1115 of 
the Social Security Act (42 U.S.C. 1315) to improve care transitions for certain 
individuals who are soon-to-be former inmates of a public institution and who 
are otherwise eligible to receive medical assistance under title XIX of such 
Act, including systems for, with respect to a period (not to exceed 30 days) 
immediately prior to the day on which such individuals are expected to be 
released from such institution--
            (1) providing assistance and education for enrollment under a State 
        plan under the Medicaid program under title XIX of such Act for such 
        individuals during such period; and
            (2) providing health care services for such individuals during such 
        period.
    (c) Rule of Construction.--Nothing under title XIX of the Social Security 
Act or any other provision of law precludes a State from reclassifying or 
suspending (rather than terminating) eligibility of an individual for medical 
assistance under title XIX of the Social Security Act while such individual is 
an inmate of a public institution.

                        Subtitle E--Medicaid Partnership

SEC. 5041. SHORT TITLE.

    This subtitle may be cited as the ``Medicaid Providers Are Required To Note 
Experiences in Record Systems to Help In-need Patients Act'' or the ``Medicaid 
PARTNERSHIP Act''.

SEC. 5042. MEDICAID PROVIDERS ARE REQUIRED TO NOTE EXPERIENCES IN RECORD SYSTEMS 
              TO HELP IN-NEED PATIENTS.

    (a) Requirements Under the Medicaid Program Relating to Qualified 
Prescription Drug Monitoring Programs and Prescribing Certain Controlled 
Substances.--Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is 
amended by inserting after section 1943 the following new section:

``SEC. 1944. REQUIREMENTS RELATING TO QUALIFIED PRESCRIPTION DRUG MONITORING 
              PROGRAMS AND PRESCRIBING CERTAIN CONTROLLED SUBSTANCES.

    ``(a) In General.--Subject to subsection (d), beginning October 1, 2021, a 
State--
            ``(1) shall require each covered provider to check, in accordance 
        with such timing, manner, and form as specified by the State, the 
        prescription drug history of a covered individual being treated by the 
        covered provider through a qualified prescription drug monitoring 
        program described in subsection (b) before prescribing to such 
        individual a controlled substance; and
            ``(2) in the case that such a provider is not able to conduct such a 
        check despite a good faith effort by such provider--
                    ``(A) shall require the provider to document such good faith 
                effort, including the reasons why the provider was not able to 
                conduct the check; and
                    ``(B) may require the provider to submit, upon request, such 
                documentation to the State.
    ``(b) Qualified Prescription Drug Monitoring Program Described.--A qualified 
prescription drug monitoring program described in this subsection is, with 
respect to a State, a prescription drug monitoring program administered by the 
State that, at a minimum, satisfies each of the following criteria:
            ``(1) The program facilitates access by a covered provider to, at a 
        minimum, the following information with respect to a covered individual, 
        in as close to real-time as possible:
                    ``(A) Information regarding the prescription drug history of 
                a covered individual with respect to controlled substances.
                    ``(B) The number and type of controlled substances 
                prescribed to and filled for the covered individual during at 
                least the most recent 12-month period.
                    ``(C) The name, location, and contact information (or other 
                identifying number selected by the State, such as a national 
                provider identifier issued by the National Plan and Provider 
                Enumeration System of the Centers for Medicare & Medicaid 
                Services) of each covered provider who prescribed a controlled 
                substance to the covered individual during at least the most 
                recent 12-month period.
            ``(2) The program facilitates the integration of information 
        described in paragraph (1) into the workflow of a covered provider, 
        which may include the electronic system the covered provider uses to 
        prescribe controlled substances.
A qualified prescription drug monitoring program described in this subsection, 
with respect to a State, may have in place, in accordance with applicable State 
and Federal law, a data-sharing agreement with the State Medicaid program that 
allows the medical director and pharmacy director of such program (and any 
designee of such a director who reports directly to such director) to access the 
information described in paragraph (1) in an electronic format. The State 
Medicaid program under this title may facilitate reasonable and limited access, 
as determined by the State and ensuring documented beneficiary protections 
regarding the use of such data, to such qualified prescription drug monitoring 
program for the medical director or pharmacy director of any managed care entity 
(as defined under section 1932(a)(1)(B)) that has a contract with the State 
under section 1903(m) or under section 1905(t)(3), or the medical director or 
pharmacy director of any entity that has a contract to manage the pharmaceutical 
benefit with respect to individuals enrolled in the State plan (or under a 
waiver of the State plan). All applicable State and Federal security and privacy 
laws shall apply to the directors or designees of such directors of any State 
Medicaid program or entity accessing a qualified prescription drug monitoring 
program under this section.
    ``(c) Application of Privacy Rules Clarification.--The Secretary shall 
clarify privacy requirements, including requirements under the regulations 
promulgated pursuant to section 264(c) of the Health Insurance Portability and 
Accountability Act of 1996 (42 U.S.C. 1320d-2 note), related to the sharing of 
data under subsection (b) in the same manner as the Secretary is required under 
subparagraph (J) of section 1860D-4(c)(5) to clarify privacy requirements 
related to the sharing of data described in such subparagraph.
    ``(d) Ensuring Access.--In order to ensure reasonable access to health care, 
the Secretary shall waive the application of the requirement under subsection 
(a), with respect to a State, in the case of natural disasters and similar 
situations, and in the case of the provision of emergency services (as defined 
for purposes of section 1860D-4(c)(5)(D)(ii)(II)).
    ``(e) Reports.--
            ``(1) State reports.--Each State shall include in the annual report 
        submitted to the Secretary under section 1927(g)(3)(D), beginning with 
        such reports submitted for 2023, information including, at a minimum, 
        the following information for the most recent 12-month period:
                    ``(A) The percentage of covered providers (as determined 
                pursuant to a process established by the State) who checked the 
                prescription drug history of a covered individual through a 
                qualified prescription drug monitoring program described in 
                subsection (b) before prescribing to such individual a 
                controlled substance.
                    ``(B) Aggregate trends with respect to prescribing 
                controlled substances such as--
                            ``(i) the quantity of daily morphine milligram 
                        equivalents prescribed for controlled substances;
                            ``(ii) the number and quantity of daily morphine 
                        milligram equivalents prescribed for controlled 
                        substances per covered individual; and
                            ``(iii) the types of controlled substances 
                        prescribed, including the dates of such prescriptions, 
                        the supplies authorized (including the duration of such 
                        supplies), and the period of validity of such 
                        prescriptions, in different populations (such as 
                        individuals who are elderly, individuals with 
                        disabilities, and individuals who are enrolled under 
                        both this title and title XVIII).
                    ``(C) Whether or not the State requires (and a detailed 
                explanation as to why the State does or does not require) 
                pharmacists to check the prescription drug history of a covered 
                individual through a qualified prescription drug monitoring 
                program described in subsection (b) before dispensing a 
                controlled substance to such individual.
                    ``(D) An accounting of any data or privacy breach of a 
                qualified prescription drug monitoring program described in 
                subsection (b), the number of covered individuals impacted by 
                each such breach, and a description of the steps the State has 
                taken to address each such breach, including, to the extent 
                required by State or Federal law or otherwise determined 
                appropriate by the State, alerting any such impacted individual 
                and law enforcement of the breach.
            ``(2) Report by cms.--Not later than October 1, 2023, the 
        Administrator of the Centers for Medicare & Medicaid Services shall 
        publish on the publicly available website of the Centers for Medicare & 
        Medicaid Services a report including the following information:
                    ``(A) Guidance for States on how States can increase the 
                percentage of covered providers who use qualified prescription 
                drug monitoring programs described in subsection (b).
                    ``(B) Best practices for how States and covered providers 
                should use such qualified prescription drug monitoring programs 
                to reduce the occurrence of abuse of controlled substances.
    ``(f) Increase to FMAP and Federal Matching Rates for Certain Expenditures 
Relating to Qualified Prescription Drug Monitoring Programs.--
            ``(1) In general.--With respect to a State that meets the condition 
        described in paragraph (2) and any quarter occurring during fiscal year 
        2019 or fiscal year 2020, the Federal medical assistance percentage or 
        Federal matching rate that would otherwise apply to such State under 
        section 1903(a) for such quarter, with respect to expenditures by the 
        State for activities under the State plan (or a waiver of such plan) to 
        design, develop, or implement a prescription drug monitoring program 
        (and to make connections to such program) that satisfies the criteria 
        described in paragraphs (1) and (2) of subsection (b), shall be equal to 
        100 percent.
            ``(2) Condition.--The condition described in this paragraph, with 
        respect to a State, is that the State (in this paragraph referred to as 
        the `administering State') has in place agreements with all States that 
        are contiguous to such administering State that, when combined, enable 
        covered providers in all such contiguous States to access, through the 
        prescription drug monitoring program, the information that is described 
        in subsection (b)(1) of covered individuals of such administering State 
        and that covered providers in such administering State are able to 
        access through such program.
    ``(g) Rule of Construction.--Nothing in this section prevents a State from 
requiring pharmacists to check the prescription drug history of covered 
individuals through a qualified prescription drug monitoring program before 
dispensing controlled substances to such individuals.
    ``(h) Definitions.--In this section:
            ``(1) Controlled substance.--The term `controlled substance' means a 
        drug that is included in schedule II of section 202(c) of the Controlled 
        Substances Act and, at the option of the State involved, a drug included 
        in schedule III or IV of such section.
            ``(2) Covered individual.--The term `covered individual' means, with 
        respect to a State, an individual who is enrolled in the State plan (or 
        under a waiver of such plan). Such term does not include an individual 
        who--
                    ``(A) is receiving--
                            ``(i) hospice or palliative care; or
                            ``(ii) treatment for cancer;
                    ``(B) is a resident of a long-term care facility, of a 
                facility described in section 1905(d), or of another facility 
                for which frequently abused drugs are dispensed for residents 
                through a contract with a single pharmacy; or
                    ``(C) the State elects to treat as exempted from such term.
            ``(3) Covered provider.--
                    ``(A) In general.--The term `covered provider' means, 
                subject to subparagraph (B), with respect to a State, a health 
                care provider who is participating under the State plan (or 
                waiver of the State plan) and licensed, registered, or otherwise 
                permitted by the State to prescribe a controlled substance (or 
                the designee of such provider).
                    ``(B) Exceptions.--
                            ``(i) In general.--Beginning October 1, 2021, for 
                        purposes of this section, such term does not include a 
                        health care provider included in any type of health care 
                        provider determined by the Secretary to be exempt from 
                        application of this section under clause (ii).
                            ``(ii) Exceptions process.--Not later than October 
                        1, 2020, the Secretary, after consultation with the 
                        National Association of Medicaid Directors, national 
                        health care provider associations, Medicaid beneficiary 
                        advocates, and advocates for individuals with rare 
                        diseases, shall determine, based on such consultations, 
                        the types of health care providers (if any) that should 
                        be exempted from the definition of the term `covered 
                        provider' for purposes of this section.''.
    (b) Guidance.--Not later than October 1, 2019, the Administrator of the 
Centers for Medicare & Medicaid Services, in consultation with the Director of 
the Centers for Disease Control and Prevention, shall issue guidance on best 
practices on the uses of prescription drug monitoring programs required of 
prescribers and on protecting the privacy of Medicaid beneficiary information 
maintained in and accessed through prescription drug monitoring programs.
    (c) Development of Model State Practices.--
            (1) In general.--Not later than October 1, 2020, the Secretary of 
        Health and Human Services shall develop and publish model practices to 
        assist State Medicaid program operations in identifying and implementing 
        strategies to utilize data-sharing agreements described in the matter 
        following paragraph (2) of section 1944(b) of the Social Security Act, 
        as added by subsection (a), for the following purposes:
                    (A) Monitoring and preventing fraud, waste, and abuse.
                    (B) Improving health care for individuals enrolled in a 
                State plan under title XIX of such Act (or under a waiver of 
                such plan) who--
                            (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 designees 
                of such a director) of managed care organizations or 
                pharmaceutical benefit managers to access information with 
                respect to all covered individuals served by such managed care 
                organizations or pharmaceutical benefit managers to access as a 
                single data set, in an electronic format; and
                    (B) shall include any appropriate beneficiary protections 
                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 CERTAIN 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 Certain Institutions for Mental Diseases.--
            ``(1) In general.--With respect to calendar quarters beginning 
        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 services 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 provided 
                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 
                        individuals 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 amendment to the Secretary to provide such 
                        medical assistance 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 settings 
                        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 amendment to the 
                        Secretary to provide such medical assistance in 
                        accordance with this subsection.
                    ``(B) Services described.--For purposes of subparagraph 
                (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 
                        emotional coping strategies.
                            ``(iv) Outpatient medication-assisted treatment, 
                        related therapies, and pharmacology.
                            ``(v) Counseling and clinical monitoring.
                            ``(vi) Outpatient withdrawal management and related 
                        treatment designed to alleviate acute emotional, 
                        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 
                        services 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 Secretary 
                        under clause (ii), the information deemed necessary 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 provided 
                in accordance with this subsection, the State shall carry out 
                each of the requirements described in subparagraphs (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 appropriate 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, 
                        consistent with each of the following outpatient levels 
                        of care:
                                    ``(I) Early intervention for individuals 
                                who, for a known reason, are at risk of 
                                developing substance-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 
                                motivational enhancement therapies and 
                                strategies.
                                    ``(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 
                                multidimensional 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, 
                        consistent with at least 2 of the following inpatient 
                        and residential levels of care:
                                    ``(I) Clinically managed, low-intensity 
                                residential 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 significant 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 residence); and
                            ``(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 individuals 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 individual 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 Conditions, 2013'.
                    ``(B) Eligible individual.--The term `eligible individual' 
                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).''.
    (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 conducting 
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 CERTIFIED 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 
                        certified 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 psychologists (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''.

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 formulations 
        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 
        requirements, 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 antagonist 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 enrollment 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''.

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 Practices 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 
subsection (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 prospective payment system 
        for inpatient hospital services under section 1886(d) of such Act (42 
        U.S.C. 1395ww(d)) and the Medicare prospective payment system for 
        hospital outpatient department 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 demonstration projects, including value-
        based models, that may encourage the use of appropriate 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.
            (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 Medicaid 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 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, biopharmaceutical industry members, 
        medical researchers, health care providers, the medical device industry, 
        the Medicare program, 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 Treatment for Opioid Use Disorders in 
                                    Medicare

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 PROGRAM.

    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.--
            ``(1) In general.--Not later than January 1, 2021, the Secretary 
        shall implement a 4-year demonstration program under this title (in this 
        section referred to as the `Program') to increase access of applicable 
        beneficiaries to opioid use disorder treatment services, improve 
        physical and mental health outcomes for such beneficiaries, and to the 
        extent possible, reduce expenditures under this title. Under the 
        Program, the Secretary shall make payments under subsection (e) to 
        participants (as defined in subsection (c)(1)(A)) for furnishing opioid 
        use disorder treatment services delivered through opioid use disorder 
        care teams, or arranging for such services to be furnished, to 
        applicable beneficiaries participating in the Program.
            ``(2) Opioid use disorder treatment services.--For purposes of this 
        section, the term `opioid use disorder treatment services'--
                    ``(A) means, with respect to an applicable beneficiary, 
                services that are furnished for the treatment of opioid use 
                disorders and that utilize drugs approved under section 505 of 
                the Federal Food, Drug, and Cosmetic Act for the treatment of 
                opioid use disorders in an outpatient setting; and
                    ``(B) includes--
                            ``(i) medication-assisted treatment;
                            ``(ii) treatment planning;
                            ``(iii) psychiatric, psychological, or counseling 
                        services (or any combination of such services), as 
                        appropriate;
                            ``(iv) social support services, as appropriate; and
                            ``(v) care management and care coordination 
                        services, including coordination with other providers of 
                        services and suppliers not on an opioid use disorder 
                        care team.
    ``(b) Program Design.--
            ``(1) In general.--The Secretary shall design the Program in such a 
        manner to allow for the evaluation of the extent to which the Program 
        accomplishes the following purposes:
                    ``(A) Reduces hospitalizations and emergency department 
                visits.
                    ``(B) Increases use of medication-assisted treatment for 
                opioid use disorders.
                    ``(C) Improves health outcomes of individuals with opioid 
                use disorders, including by reducing the incidence of infectious 
                diseases (such as hepatitis C and HIV).
                    ``(D) Does not increase the total spending on items and 
                services under this title.
                    ``(E) Reduces deaths from opioid overdose.
                    ``(F) Reduces the utilization of inpatient residential 
                treatment.
            ``(2) Consultation.--In designing the Program, including the 
        criteria under subsection (e)(2)(A), the Secretary shall, not later than 
        3 months after the date of the enactment of this section, consult with 
        specialists in the field of addiction, clinicians in the primary care 
        community, and beneficiary groups.
    ``(c) Participants; Opioid Use Disorder Care Teams.--
            ``(1) Participants.--
                    ``(A) Definition.--In this section, the term `participant' 
                means an entity or individual--
                            ``(i) that is otherwise enrolled under this title 
                        and that is--
                                    ``(I) a physician (as defined in section 
                                1861(r)(1));
                                    ``(II) a group practice comprised of at 
                                least one physician described in subclause (I);
                                    ``(III) a hospital outpatient department;
                                    ``(IV) a federally qualified health center 
                                (as defined in section 1861(aa)(4));
                                    ``(V) a rural health clinic (as defined in 
                                section 1861(aa)(2));
                                    ``(VI) a community mental health center (as 
                                defined in section 1861(ff)(3)(B));
                                    ``(VII) a clinic certified as a certified 
                                community behavioral health clinic pursuant to 
                                section 223 of the Protecting Access to Medicare 
                                Act of 2014; or
                                    ``(VIII) any other individual or entity 
                                specified by the Secretary;
                            ``(ii) that applied for and was selected to 
                        participate in the Program pursuant to an application 
                        and selection process established by the Secretary; and
                            ``(iii) that establishes an opioid use disorder care 
                        team (as defined in paragraph (2)) through employing or 
                        contracting with health care practitioners described in 
                        paragraph (2)(A), and uses such team to furnish or 
                        arrange for opioid use disorder treatment services in 
                        the outpatient setting under the Program.
                    ``(B) Preference.--In selecting participants for the 
                Program, the Secretary shall give preference to individuals and 
                entities that are located in areas with a prevalence of opioid 
                use disorders that is higher than the national average 
                prevalence.
            ``(2) Opioid use disorder care teams.--
                    ``(A) In general.--For purposes of this section, the term 
                `opioid use disorder care team' means a team of health care 
                practitioners established by a participant described in 
                paragraph (1)(A) that--
                            ``(i) shall include--
                                    ``(I) at least one physician (as defined in 
                                section 1861(r)(1)) furnishing primary care 
                                services or addiction treatment services to an 
                                applicable beneficiary; and
                                    ``(II) at least one eligible practitioner 
                                (as defined in paragraph (3)), who may be a 
                                physician who meets the criterion in subclause 
                                (I); and
                            ``(ii) may include other practitioners licensed 
                        under State law to furnish psychiatric, psychological, 
                        counseling, and social services to applicable 
                        beneficiaries.
                    ``(B) Requirements for receipt of payment under program.--In 
                order to receive payments under subsection (e), each participant 
                in the Program shall--
                            ``(i) furnish opioid use disorder treatment services 
                        through opioid use disorder care teams to applicable 
                        beneficiaries who agree to receive the services;
                            ``(ii) meet minimum criteria, as established by the 
                        Secretary; and
                            ``(iii) submit to the Secretary, in such form, 
                        manner, and frequency as specified by the Secretary, 
                        with respect to each applicable beneficiary for whom 
                        opioid use disorder treatment services are furnished by 
                        the opioid use disorder care team, data and such other 
                        information as the Secretary determines appropriate to--
                                    ``(I) monitor and evaluate the Program;
                                    ``(II) determine if minimum criteria are met 
                                under clause (ii); and
                                    ``(III) determine the incentive payment 
                                under subsection (e).
            ``(3) Eligible practitioner defined.--For purposes of this section, 
        the term `eligible practitioner' means a physician or other health care 
        practitioner, such as a nurse practitioner, that--
                    ``(A) is enrolled under section 1866(j)(1);
                    ``(B) is authorized to prescribe or dispense narcotic drugs 
                to individuals for maintenance treatment or detoxification 
                treatment; and
                    ``(C) has in effect a waiver in accordance with section 
                303(g) of the Controlled Substances Act for such purpose and is 
                otherwise in compliance with regulations promulgated by the 
                Substance Abuse and Mental Health Services Administration to 
                carry out such section.
    ``(d) Participation of Applicable Beneficiaries.--
            ``(1) Applicable beneficiary defined.--In this section, the term 
        `applicable beneficiary' means an individual who--
                    ``(A) is entitled to, or enrolled for, benefits under part A 
                and enrolled for benefits under part B;
                    ``(B) is not enrolled in a Medicare Advantage plan under 
                part C;
                    ``(C) has a current diagnosis for an opioid use disorder; 
                and
                    ``(D) meets such other criteria as the Secretary determines 
                appropriate.
        Such term shall include an individual who is dually eligible for 
        benefits under this title and title XIX if such individual satisfies the 
        criteria described in subparagraphs (A) through (D).
            ``(2) Voluntary beneficiary participation; limitation on number of 
        beneficiaries.--An applicable beneficiary may participate in the Program 
        on a voluntary basis and may terminate participation in the Program at 
        any time. Not more than 20,000 applicable beneficiaries may participate 
        in the Program at any time.
            ``(3) Services.--In order to participate in the Program, an 
        applicable beneficiary shall agree to receive opioid use disorder 
        treatment services from a participant. Participation under the Program 
        shall not affect coverage of or payment for any other item or service 
        under this title for the applicable beneficiary.
            ``(4) Beneficiary access to services.--Nothing in this section shall 
        be construed as encouraging providers to limit applicable beneficiary 
        access to services covered under this title, and applicable 
        beneficiaries shall not be required to relinquish access to any benefit 
        under this title as a condition of receiving services from a participant 
        in the Program.
    ``(e) Payments.--
            ``(1) Per applicable beneficiary per month care management fee.--
                    ``(A) In general.--The Secretary shall establish a schedule 
                of per applicable beneficiary per month care management fees. 
                Such a per applicable beneficiary per month care management fee 
                shall be paid to a participant in addition to any other amount 
                otherwise payable under this title to the health care 
                practitioners in the participant's opioid use disorder care team 
                or, if applicable, to the participant. A participant may use 
                such per applicable beneficiary per month care management fee to 
                deliver additional services to applicable beneficiaries, 
                including services not otherwise eligible for payment under this 
                title.
                    ``(B) Payment amounts.--In carrying out subparagraph (A), 
                the Secretary may--
                            ``(i) consider payments otherwise payable under this 
                        title for opioid use disorder treatment services and the 
                        needs of applicable beneficiaries;
                            ``(ii) pay a higher per applicable beneficiary per 
                        month care management fee for an applicable beneficiary 
                        who receives more intensive treatment services from a 
                        participant and for whom those services are appropriate 
                        based on clinical guidelines for opioid use disorder 
                        care;
                            ``(iii) pay a higher per applicable beneficiary per 
                        month care management fee for the month in which the 
                        applicable beneficiary begins treatment with a 
                        participant than in subsequent months, to reflect the 
                        greater time and costs required for the planning and 
                        initiation of treatment, as compared to maintenance of 
                        treatment; and
                            ``(iv) take into account whether a participant's 
                        opioid use disorder care team refers applicable 
                        beneficiaries to other suppliers or providers for any 
                        opioid use disorder treatment services.
                    ``(C) No duplicate payment.--The Secretary shall make 
                payments under this paragraph to only one participant for 
                services furnished to an applicable beneficiary during a 
                calendar month.
            ``(2) Incentive payments.--
                    ``(A) In general.--Under the Program, the Secretary shall 
                establish a performance-based incentive payment, which shall be 
                paid (using a methodology established and at a time determined 
                appropriate by the Secretary) to participants based on the 
                performance of participants with respect to criteria, as 
                determined appropriate by the Secretary, in accordance with 
                subparagraph (B).
                    ``(B) Criteria.--
                            ``(i) In general.--Criteria described in 
                        subparagraph (A) may include consideration of the 
                        following:
                                    ``(I) Patient engagement and retention in 
                                treatment.
                                    ``(II) Evidence-based medication-assisted 
                                treatment.
                                    ``(III) Other criteria established by the 
                                Secretary.
                            ``(ii) Required consultation and consideration.--In 
                        determining criteria described in subparagraph (A), the 
                        Secretary shall--
                                    ``(I) consult with stakeholders, including 
                                clinicians in the primary care community and in 
                                the field of addiction medicine; and
                                    ``(II) consider existing clinical guidelines 
                                for the treatment of opioid use disorders.
                    ``(C) No duplicate payment.--The Secretary shall ensure that 
                no duplicate payments under this paragraph are made with respect 
                to an applicable beneficiary.
    ``(f) Multipayer Strategy.--In carrying out the Program, the Secretary shall 
encourage other payers to provide similar payments and to use similar criteria 
as applied under the Program under subsection (e)(2)(C). The Secretary may enter 
into a memorandum of understanding with other payers to align the methodology 
for payment provided by such a payer related to opioid use disorder treatment 
services with such methodology for payment under the Program.
    ``(g) Evaluation.--
            ``(1) In general.--The Secretary shall conduct an intermediate and 
        final evaluation of the program. Each such evaluation shall determine 
        the extent to which each of the purposes described in subsection (b) 
        have been accomplished under the Program.
            ``(2) Reports.--The Secretary shall submit to Congress--
                    ``(A) a report with respect to the intermediate evaluation 
                under paragraph (1) not later than 3 years after the date of the 
                implementation of the Program; and
                    ``(B) a report with respect to the final evaluation under 
                paragraph (1) not later than 6 years after such date.
    ``(h) Funding.--
            ``(1) Administrative funding.--For the purposes of implementing, 
        administering, and carrying out the Program (other than for purposes 
        described in paragraph (2)), $5,000,000 shall be available from the 
        Federal Supplementary Medical Insurance Trust Fund under section 1841.
            ``(2) Care management fees and incentives.--For the purposes of 
        making payments under subsection (e), $10,000,000 shall be available 
        from the Federal Supplementary Medical Insurance Trust Fund under 
        section 1841 for each of fiscal years 2021 through 2024.
            ``(3) Availability.--Amounts transferred under this subsection for a 
        fiscal year shall be available until expended.
    ``(i) Waivers.--The Secretary may waive any provision of this title as may 
be necessary to carry out the Program under this section.''.

Subtitle F--Responsible Education Achieves Care and Healthy Outcomes for Users' 
                                    Treatment

SEC. 6051. SHORT TITLE.

    This subtitle may be cited as the ``Responsible Education Achieves Care and 
Healthy Outcomes for Users' Treatment Act of 2018'' or the ``REACH OUT Act of 
2018''.

SEC. 6052. GRANTS TO PROVIDE TECHNICAL ASSISTANCE TO OUTLIER PRESCRIBERS OF 
              OPIOIDS.

    (a) Grants Authorized.--The Secretary of Health and Human Services (in this 
section referred to as the ``Secretary'') shall, through the Centers for 
Medicare & Medicaid Services, award grants, contracts, or cooperative agreements 
to eligible entities for the purposes described in subsection (b).
    (b) Use of Funds.--Grants, contracts, and cooperative agreements awarded 
under subsection (a) shall be used to support eligible entities through 
technical assistance--
            (1) to educate and provide outreach to outlier prescribers of 
        opioids about best practices for prescribing opioids;
            (2) to educate and provide outreach to outlier prescribers of 
        opioids about non-opioid pain management therapies; and
            (3) to reduce the amount of opioid prescriptions prescribed by 
        outlier prescribers of opioids.
    (c) Application.--Each eligible entity seeking to receive a grant, contract, 
or cooperative agreement under subsection (a) shall submit to the Secretary an 
application, at such time, in such manner, and containing such information as 
the Secretary may require.
    (d) Geographic Distribution.--In awarding grants, contracts, and cooperative 
agreements under this section, the Secretary shall prioritize establishing 
technical assistance resources in each State.
    (e) Definitions.--In this section:
            (1) Eligible entity.--The term ``eligible entity'' means--
                    (A) an organization--
                            (i) that has demonstrated experience providing 
                        technical assistance to health care professionals on a 
                        State or regional basis; and
                            (ii) that has at least--
                                    (I) one individual who is a representative 
                                of consumers on its governing body; and
                                    (II) one individual who is a representative 
                                of health care providers on its governing body; 
                                or
                    (B) an entity that is a quality improvement entity with a 
                contract under part B of 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, with respect to a period, a prescriber identified by 
        the Secretary under subparagraph (D)(ii) of section 1860D-4(c)(4) of the 
        Social Security Act (42 U.S.C. 1395w-104(c)(4)), as added by section 
        6065 of this Act, to be an outlier prescriber of opioids for such 
        period.
            (3) Prescribers.--The term ``prescriber'' means any health care 
        professional, including a nurse practitioner or physician assistant, who 
        is licensed to prescribe opioids by the State or territory in which such 
        professional practices.
    (f) Funding.--For purposes of implementing this section, $75,000,000 shall 
be available from the Federal Supplementary Medical Insurance Trust Fund under 
section 1841 of the Social Security Act (42 U.S.C. 1395t), to remain available 
until expended.

            Subtitle G--Preventing Addiction for Susceptible Seniors

SEC. 6061. SHORT TITLE.

    This subtitle may be cited as the ``Preventing Addiction for Susceptible 
Seniors Act of 2018'' or the ``PASS Act of 2018''.

SEC. 6062. ELECTRONIC PRIOR AUTHORIZATION FOR COVERED PART D DRUGS.

    Section 1860D-4(e)(2) of the Social Security Act (42 U.S.C. 1395w-104(e)(2)) 
is amended by adding at the end the following new subparagraph:
                    ``(E) Electronic prior authorization.--
                            ``(i) In general.--Not later than January 1, 2021, 
                        the program shall provide for the secure electronic 
                        transmission of--
                                    ``(I) a prior authorization request from the 
                                prescribing health care professional for 
                                coverage of a covered part D drug for a part D 
                                eligible individual enrolled in a part D plan 
                                (as defined in section 1860D-23(a)(5)) to the 
                                PDP sponsor or Medicare Advantage organization 
                                offering such plan; and
                                    ``(II) a response, in accordance with this 
                                subparagraph, from such PDP sponsor or Medicare 
                                Advantage organization, respectively, to such 
                                professional.
                            ``(ii) Electronic transmission.--
                                    ``(I) Exclusions.--For purposes of this 
                                subparagraph, a facsimile, a proprietary payer 
                                portal that does not meet standards specified by 
                                the Secretary, or an electronic form shall not 
                                be treated as an electronic transmission 
                                described in clause (i).
                                    ``(II) Standards.--In order to be treated, 
                                for purposes of this subparagraph, as an 
                                electronic transmission described in clause (i), 
                                such transmission shall comply with technical 
                                standards adopted by the Secretary in 
                                consultation with the National Council for 
                                Prescription Drug Programs, other standard 
                                setting organizations determined appropriate by 
                                the Secretary, and stakeholders including PDP 
                                sponsors, Medicare Advantage organizations, 
                                health care professionals, and health 
                                information technology software vendors.
                                    ``(III) Application.--Notwithstanding any 
                                other provision of law, for purposes of this 
                                subparagraph, the Secretary may require the use 
                                of such standards adopted under subclause (II) 
                                in lieu of any other applicable standards for an 
                                electronic transmission described in clause (i) 
                                for a covered part D drug for a part D eligible 
                                individual.''.

SEC. 6063. PROGRAM INTEGRITY TRANSPARENCY MEASURES UNDER MEDICARE PARTS C AND D.

    (a) In General.--Section 1859 of the Social Security Act (42 U.S.C. 1395w-
28) is amended by adding at the end the following new subsection:
    ``(i) Program Integrity Transparency Measures.--
            ``(1) Program integrity portal.--
                    ``(A) In general.--Not later than 2 years after the date of 
                the enactment of this subsection, the Secretary shall, after 
                consultation with stakeholders, establish a secure internet 
                website portal (or other successor technology) that would allow 
                a secure path for communication between the Secretary, MA plans 
                under this part, prescription drug plans under part D, and an 
                eligible entity with a contract under section 1893 (such as a 
                Medicare drug integrity contractor or an entity responsible for 
                carrying out program integrity activities under this part and 
                part D) for the purpose of enabling through such portal (or 
                other successor technology)--
                            ``(i) the referral by such plans of substantiated or 
                        suspicious activities, as defined by the Secretary, of a 
                        provider of services (including a prescriber) or 
                        supplier related to fraud, waste, and abuse for 
                        initiating or assisting investigations conducted by the 
                        eligible entity; and
                            ``(ii) data sharing among such MA plans, 
                        prescription drug plans, and the Secretary.
                    ``(B) Required uses of portal.--The Secretary shall 
                disseminate the following information to MA plans under this 
                part and prescription drug plans under part D through the secure 
                internet website portal (or other successor technology) 
                established under subparagraph (A):
                            ``(i) Providers of services and suppliers that have 
                        been referred pursuant to subparagraph (A)(i) during the 
                        previous 12-month period.
                            ``(ii) Providers of services and suppliers who are 
                        the subject of an active exclusion under section 1128 or 
                        who are subject to a suspension of payment under this 
                        title pursuant to section 1862(o) or otherwise.
                            ``(iii) Providers of services and suppliers who are 
                        the subject of an active revocation of participation 
                        under this title, including for not satisfying 
                        conditions of participation.
                            ``(iv) In the case of such a plan that makes a 
                        referral under subparagraph (A)(i) through the portal 
                        (or other successor technology) with respect to 
                        activities of substantiated or suspicious activities of 
                        fraud, waste, or abuse of a provider of services 
                        (including a prescriber) or supplier, if such provider 
                        (including a prescriber) or supplier has been the 
                        subject of an administrative action under this title or 
                        title XI with respect to similar activities, a 
                        notification to such plan of such action so taken.
                    ``(C) Rulemaking.--For purposes of this paragraph, the 
                Secretary shall, through rulemaking, specify what constitutes 
                substantiated or suspicious activities of fraud, waste, and 
                abuse, using guidance such as what is provided in the Medicare 
                Program Integrity Manual 4.8. In carrying out this subsection, a 
                fraud hotline tip (as defined by the Secretary) without further 
                evidence shall not be treated as sufficient evidence for 
                substantiated fraud, waste, or abuse.
                    ``(D) HIPAA compliant information only.--For purposes of 
                this subsection, communications may only occur if the 
                communications are permitted under the Federal regulations 
                (concerning the privacy of individually identifiable health 
                information) promulgated under section 264(c) of the Health 
                Insurance Portability and Accountability Act of 1996.
            ``(2) Quarterly reports.--Beginning not later than 2 years after the 
        date of the enactment of this subsection, the Secretary shall make 
        available to MA plans under this part and prescription drug plans under 
        part D in a timely manner (but no less frequently than quarterly) and 
        using information submitted to an entity described in paragraph (1) 
        through the portal (or other successor technology) described in such 
        paragraph or pursuant to section 1893, information on fraud, waste, and 
        abuse schemes and trends in identifying suspicious activity. Information 
        included in each such report shall--
                    ``(A) include administrative actions, pertinent information 
                related to opioid overprescribing, and other data determined 
                appropriate by the Secretary in consultation with stakeholders; 
                and
                    ``(B) be anonymized information submitted by plans without 
                identifying the source of such information.
            ``(3) Clarification.--Nothing in this subsection shall preclude or 
        otherwise affect referrals to the Inspector General of the Department of 
        Health and Human Services or other law enforcement entities.''.
    (b) Contract Requirement to Communicate Plan Corrective Actions Against 
Opioids Over-prescribers.--Section 1857(e) of the Social Security Act (42 U.S.C. 
1395w-27(e)) is amended by adding at the end the following new paragraph:
            ``(5) Communicating plan corrective actions against opioids over-
        prescribers.--
                    ``(A) In general.--Beginning with plan years beginning on or 
                after January 1, 2021, a contract under this section with an MA 
                organization shall require the organization to submit to the 
                Secretary, through the process established under subparagraph 
                (B), information on the investigations, credible evidence of 
                suspicious activities of a provider of services (including a 
                prescriber) or supplier related to fraud, and other actions 
                taken by such plans related to inappropriate prescribing of 
                opioids.
                    ``(B) Process.--Not later than January 1, 2021, the 
                Secretary shall, in consultation with stakeholders, establish a 
                process under which MA plans and prescription drug plans shall 
                submit to the Secretary information described in subparagraph 
                (A).
                    ``(C) Regulations.--For purposes of this paragraph, 
                including as applied under section 1860D-12(b)(3)(D), the 
                Secretary shall, pursuant to rulemaking--
                            ``(i) specify a definition for the term 
                        `inappropriate prescribing' and a method for determining 
                        if a provider of services prescribes inappropriate 
                        prescribing; and
                            ``(ii) establish the process described in 
                        subparagraph (B) and the types of information that shall 
                        be submitted through such process.''.
    (c) Reference Under Part D to Program Integrity Transparency Measures.--
Section 1860D-4 of the Social Security Act (42 U.S.C. 1395w-104) is amended by 
adding at the end the following new subsection:
    ``(m) Program Integrity Transparency Measures.--For program integrity 
transparency measures applied with respect to prescription drug plan and MA 
plans, see section 1859(i).''.

SEC. 6064. EXPANDING ELIGIBILITY FOR MEDICATION THERAPY MANAGEMENT PROGRAMS 
              UNDER PART D.

    Section 1860D-4(c)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395w-
104(c)(2)(A)(ii)) is amended--
            (1) by redesignating subclauses (I) through (III) as items (aa) 
        through (cc), respectively, and adjusting the margins accordingly;
            (2) by striking ``are part D eligible individuals who--'' and 
        inserting ``are the following:
                                    ``(I) Part D eligible individuals who--''; 
                                and
            (3) by adding at the end the following new subclause:
                                    ``(II) Beginning January 1, 2021, at-risk 
                                beneficiaries for prescription drug abuse (as 
                                defined in paragraph (5)(C)).''.

SEC. 6065. COMMIT TO OPIOID MEDICAL PRESCRIBER ACCOUNTABILITY AND SAFETY FOR 
              SENIORS.

    Section 1860D-4(c)(4) of the Social Security Act (42 U.S.C. 1395w-104(c)(4)) 
is amended by adding at the end the following new subparagraph:
                    ``(D) Notification and additional requirements with respect 
                to outlier prescribers of opioids.--
                            ``(i) Notification.--Not later than January 1, 2021, 
                        the Secretary shall, in the case of a prescriber 
                        identified by the Secretary under clause (ii) to be an 
                        outlier prescriber of opioids, provide, subject to 
                        clause (iv), an annual notification to such prescriber 
                        that such prescriber has been so identified and that 
                        includes resources on proper prescribing methods and 
                        other information as specified in accordance with clause 
                        (iii).
                            ``(ii) Identification of outlier prescribers of 
                        opioids.--
                                    ``(I) In general.--The Secretary shall, 
                                subject to subclause (III), using the valid 
                                prescriber National Provider Identifiers 
                                included pursuant to subparagraph (A) on claims 
                                for covered part D drugs for part D eligible 
                                individuals enrolled in prescription drug plans 
                                under this part or MA-PD plans under part C and 
                                based on the thresholds established under 
                                subclause (II), identify prescribers that are 
                                outlier opioids prescribers for a period of time 
                                specified by the Secretary.
                                    ``(II) Establishment of thresholds.--For 
                                purposes of subclause (I) and subject to 
                                subclause (III), the Secretary shall, after 
                                consultation with stakeholders, establish 
                                thresholds, based on prescriber specialty and 
                                geographic area, for identifying whether a 
                                prescriber in a specialty and geographic area is 
                                an outlier prescriber of opioids as compared to 
                                other prescribers of opioids within such 
                                specialty and area.
                                    ``(III) Exclusions.--The following shall not 
                                be included in the analysis for identifying 
                                outlier prescribers of opioids under this 
                                clause:
                                            ``(aa) Claims for covered part D 
                                        drugs for part D eligible individuals 
                                        who are receiving hospice care under 
                                        this title.
                                            ``(bb) Claims for covered part D 
                                        drugs for part D eligible individuals 
                                        who are receiving oncology services 
                                        under this title.
                                            ``(cc) Prescribers who are the 
                                        subject of an investigation by the 
                                        Centers for Medicare & Medicaid Services 
                                        or the Inspector General of the 
                                        Department of Health and Human Services.
                            ``(iii) Contents of notification.--The Secretary 
                        shall include the following information in the 
                        notifications provided under clause (i):
                                    ``(I) Information on how such prescriber 
                                compares to other prescribers within the same 
                                specialty and geographic area.
                                    ``(II) Information on opioid prescribing 
                                guidelines, based on input from stakeholders, 
                                that may include the Centers for Disease Control 
                                and Prevention guidelines for prescribing 
                                opioids for chronic pain and guidelines 
                                developed by physician organizations.
                                    ``(III) Other information determined 
                                appropriate by the Secretary.
                            ``(iv) Modifications and expansions.--
                                    ``(I) Frequency.--Beginning 5 years after 
                                the date of the enactment of this subparagraph, 
                                the Secretary may change the frequency of the 
                                notifications described in clause (i) based on 
                                stakeholder input and changes in opioid 
                                prescribing utilization and trends.
                                    ``(II) Expansion to other prescriptions.--
                                The Secretary may expand notifications under 
                                this subparagraph to include identifications and 
                                notifications with respect to concurrent 
                                prescriptions of covered Part D drugs used in 
                                combination with opioids that are considered to 
                                have adverse side effects when so used in such 
                                combination, as determined by the Secretary.
                            ``(v) Additional requirements for persistent outlier 
                        prescribers.--In the case of a prescriber who the 
                        Secretary determines is persistently identified under 
                        clause (ii) as an outlier prescriber of opioids, the 
                        following shall apply:
                                    ``(I) Such prescriber may be required to 
                                enroll in the program under this title under 
                                section 1866(j) if such prescriber is not 
                                otherwise required to enroll, but only after 
                                other appropriate remedies have been provided, 
                                such as the provision of education funded 
                                through section 6052 of the SUPPORT for Patients 
                                and Communities Act, for a period determined by 
                                the Secretary as sufficient to correct the 
                                prescribing patterns that lead to identification 
                                of such prescriber as a persistent outlier 
                                prescriber of opioids. The Secretary shall 
                                determine the length of the period for which 
                                such prescriber is required to maintain such 
                                enrollment, which shall be the minimum period 
                                necessary to correct such prescribing patterns.
                                    ``(II) Not less frequently than annually 
                                (and in a form and manner determined appropriate 
                                by the Secretary), the Secretary, consistent 
                                with clause(iv)(I), shall communicate 
                                information on such prescribers to sponsors of a 
                                prescription drug plan and Medicare Advantage 
                                organizations offering an MA-PD plan.
                            ``(vi) Public availability of information.--The 
                        Secretary shall make aggregate information under this 
                        subparagraph available on the internet website of the 
                        Centers for Medicare & Medicaid Services. Such 
                        information shall be in a form and manner determined 
                        appropriate by the Secretary and shall not identify any 
                        specific prescriber. In carrying out this clause, the 
                        Secretary shall consult with interested stakeholders.
                            ``(vii) Opioids defined.--For purposes of this 
                        subparagraph, the term `opioids' has such meaning as 
                        specified by the Secretary.
                            ``(viii) Other activities.--Nothing in this 
                        subparagraph shall preclude the Secretary from 
                        conducting activities that provide prescribers with 
                        information as to how they compare to other prescribers 
                        that are in addition to the activities under this 
                        subparagraph, including activities that were being 
                        conducted as of the date of the enactment of this 
                        subparagraph.''.

SEC. 6066. NO ADDITIONAL FUNDS AUTHORIZED.

    No additional funds are authorized to be appropriated to carry out the 
requirements of this subtitle and the amendments made by this subtitle. Such 
requirements shall be carried out using amounts otherwise authorized to be 
appropriated.

        Subtitle H--Expanding Oversight of Opioid Prescribing and Payment

SEC. 6071. SHORT TITLE.

    This subtitle may be cited as the ``Expanding Oversight of Opioid 
Prescribing and Payment Act of 2018''.

SEC. 6072. MEDICARE PAYMENT ADVISORY COMMISSION REPORT ON OPIOID PAYMENT, 
              ADVERSE INCENTIVES, AND DATA UNDER THE MEDICARE PROGRAM.

    Not later than March 15, 2019, the Medicare Payment Advisory Commission 
shall submit to Congress a report on, with respect to the Medicare program under 
title XVIII of the Social Security Act, the following:
            (1) A description of how the Medicare program pays for pain 
        management treatments (both opioid and non-opioid pain management 
        alternatives) in both inpatient and outpatient hospital settings.
            (2) The identification of incentives under the hospital inpatient 
        prospective payment system under section 1886 of the Social Security Act 
        (42 U.S.C. 1395ww) and incentives under the hospital outpatient 
        prospective payment system under section 1833(t) of such Act (42 U.S.C. 
        1395l(t)) for prescribing opioids and incentives under each such system 
        for prescribing non-opioid treatments, and recommendations as the 
        Commission deems appropriate for addressing any of such incentives that 
        are adverse incentives.
            (3) A description of how opioid use is tracked and monitored through 
        Medicare claims data and other mechanisms and the identification of any 
        areas in which further data and methods are needed for improving data 
        and understanding of opioid use.

SEC. 6073. NO ADDITIONAL FUNDS AUTHORIZED.

    No additional funds are authorized to be appropriated to carry out the 
requirements of this subtitle. Such requirements shall be carried out using 
amounts otherwise authorized to be appropriated.

      Subtitle I--Dr. Todd Graham Pain Management, Treatment, and Recovery

SEC. 6081. SHORT TITLE.

    This subtitle may be cited as the ``Dr. Todd Graham Pain Management, 
Treatment, and Recovery Act of 2018''.

SEC. 6082. 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.

    (a) Outpatient Prospective Payment System.--Section 1833(t) of the Social 
Security Act (42 U.S.C. 1395l(t)) is amended by adding at the end the following 
new paragraph:
            ``(22) Review and revisions of payments for non-opioid alternative 
        treatments.--
                    ``(A) In general.--With respect to payments made under this 
                subsection for covered OPD services (or groups of services), 
                including covered OPD services assigned to a comprehensive 
                ambulatory payment classification, the Secretary--
                            ``(i) shall, as soon as practicable, conduct a 
                        review (part of which may include a request for 
                        information) of payments for opioids and evidence-based 
                        non-opioid alternatives for pain management (including 
                        drugs and devices, nerve blocks, surgical injections, 
                        and neuromodulation) with a goal of ensuring that there 
                        are not financial 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 additional groups of covered OPD services to 
                        classify separately those procedures that utilize 
                        opioids and non-opioid alternatives for pain management) 
                        would reduce payment incentives to use opioids instead 
                        of non-opioid alternatives for pain management.
                    ``(B) Priority.--In conducting the review under clause (i) 
                of subparagraph (A) and considering revisions under clause (iii) 
                of such subparagraph, the Secretary shall focus on covered OPD 
                services (or groups of services) assigned to a comprehensive 
                ambulatory payment classification, ambulatory payment 
                classifications that primarily include surgical services, and 
                other services determined by the Secretary which generally 
                involve treatment for pain management.
                    ``(C) Revisions.--If the Secretary identifies revisions to 
                payments pursuant to subparagraph (A)(iii), the Secretary shall, 
                as determined 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 
                        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 
paragraph:
    ``(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 Secretary).''.

SEC. 6083. EXPANDING ACCESS UNDER THE MEDICARE PROGRAM TO ADDICTION TREATMENT IN 
              FEDERALLY 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.--
                    ``(A) In general.--In the case of a Federally qualified 
                health center with respect to which, beginning on or after 
                January 1, 2019, Federally qualified health center services (as 
                defined in section 1861(aa)(3)) are furnished for the treatment 
                of opioid use disorder by a physician or practitioner who meets 
                the requirements described in subparagraph (C), the Secretary 
                shall, subject to availability of funds under subparagraph (D), 
                make a payment (at such time and in such manner as specified by 
                the Secretary) to such Federally qualified health center after 
                receiving and approving an application submitted by such 
                Federally qualified health center under subparagraph (B). Such a 
                payment 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 respect to each such 
                physician or practitioner.
                    ``(B) Application.--In order to receive a payment described 
                in subparagraph (A), a Federally qualified health center 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 Secretary. A Federally qualified health center 
                may apply for such a payment for each physician or practitioner 
                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 
                physician or practitioner, are the following:
                            ``(i) The physician or practitioner is employed by 
                        or working under contract with a Federally qualified 
                        health center described 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 appropriated, out of amounts in the 
                Treasury not otherwise appropriated, $6,000,000, which shall 
                remain available until expended.''.
    (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 subsection:
    ``(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 described 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 
        described 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 purposes of receiving a waiver described in paragraph 
        (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 payment described in 
        paragraph (1), a rural health clinic 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 Secretary. 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 paragraph (1), the requirements 
        described in this paragraph, with respect to a physician or 
        practitioner, are the following:
                    ``(A) The physician or practitioner is employed 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 receives a waiver 
                under section 303(g) of the Controlled Substances Act on or 
                after January 1, 2019.
            ``(4) Funding.--For purposes of making payments under this 
        subsection, there are appropriated, out of amounts in the Treasury not 
        otherwise appropriated, $2,000,000, which shall remain available until 
        expended.''.

SEC. 6084. STUDYING THE AVAILABILITY OF SUPPLEMENTAL BENEFITS DESIGNED TO TREAT 
              OR PREVENT SUBSTANCE USE DISORDERS UNDER MEDICARE 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 described in section 1852(a)(3)(A) of 
the Social Security Act (42 U.S.C. 1395w-22(a)(3)(A))) designed to treat or 
prevent 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 medical assistance under title XIX of such Act and other 
such Medicare Advantage plans.
    (b) Consultation.--The Secretary shall develop the report described in 
subsection (a) in consultation with relevant 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 individuals;
            (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
                    (B) non-opioid alternatives for the treatment of pain.
            (2) Challenges associated with such plans offering supplemental 
        health care benefits relating to coverage of items and services 
        described in subparagraph (A) or (B) of paragraph (1).
            (3) The impact, if any, of increasing the applicable 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 availability of such 
        benefits relating to such coverage offered under Medicare Advantage 
        plans.
            (4) Potential ways to improve upon such coverage or to incentivize 
        such plans to offer additional supplemental health care benefits 
        relating to such coverage.

SEC. 6085. CLINICAL PSYCHOLOGIST SERVICES MODELS UNDER THE CENTER FOR MEDICARE 
              AND MEDICAID INNOVATION; GAO STUDY AND REPORT.

    (a) CMI Models.--Section 1115A(b)(2)(B) of the Social Security Act (42 
U.S.C. 1315a(b)(2)(B)), as amended by section 6001, is further amended by adding 
at the end the following new clauses:
                            ``(xxvi) Supporting ways to familiarize individuals 
                        with the availability of coverage under part B of title 
                        XVIII for qualified psychologist services (as defined in 
                        section 1861(ii)).
                            ``(xxvii) Exploring ways to avoid unnecessary 
                        hospitalizations or emergency department visits for 
                        mental and behavioral health services (such as for 
                        treating depression) through use of a 24-hour, 7-day a 
                        week help line that may inform individuals about the 
                        availability of treatment options, including the 
                        availability of qualified psychologist services (as 
                        defined in section 1861(ii)).''.
    (b) GAO Study and Report.--Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General of the United States shall 
conduct a study, and submit to Congress a report, on mental and behavioral 
health services under the Medicare program under title XVIII of the Social 
Security Act, including an examination of the following:
            (1) Information about services furnished by psychiatrists, clinical 
        psychologists, and other professionals.
            (2) Information about ways that Medicare beneficiaries familiarize 
        themselves about the availability of Medicare payment for qualified 
        psychologist services (as defined in section 1861(ii) of the Social 
        Security Act (42 U.S.C. 1395x(ii)) and ways that the provision of such 
        information could be improved.

SEC. 6086. DR. TODD GRAHAM PAIN MANAGEMENT STUDY.

    (a) In General.--Not later than 1 year after the date of enactment of this 
Act, the Secretary of Health and Human Services (referred to in this section as 
the ``Secretary'') shall conduct a study analyzing best practices as well as 
payment and coverage for pain management services under title XVIII of the 
Social Security Act and submit to the Committee on Ways and Means and the 
Committee on Energy and Commerce of the House of Representatives and the 
Committee on Finance of the Senate a report containing options for revising 
payment to providers and suppliers of services and coverage related to the use 
of multi-disciplinary, evidence-based, non-opioid treatments for acute and 
chronic pain management for individuals entitled to benefits under part A or 
enrolled under part B of title XVIII of the Social Security Act. The Secretary 
shall make such report available on the public website of the Centers for 
Medicare & Medicaid Services.
    (b) Consultation.--In developing the report described in subsection (a), the 
Secretary shall consult with--
            (1) relevant agencies within the Department of Health and Human 
        Services;
            (2) licensed and practicing osteopathic and allopathic physicians, 
        behavioral health practitioners, physician assistants, nurse 
        practitioners, dentists, pharmacists, and other providers of health 
        services;
            (3) providers and suppliers of services (as such terms are defined 
        in section 1861 of the Social Security Act (42 U.S.C. 1395x));
            (4) substance abuse and mental health professional organizations;
            (5) pain management professional organizations and advocacy 
        entities, including individuals who personally suffer chronic pain;
            (6) medical professional organizations and medical specialty 
        organizations;
            (7) licensed health care providers who furnish alternative pain 
        management services;
            (8) organizations with expertise in the development of innovative 
        medical technologies for pain management;
            (9) beneficiary advocacy organizations; and
            (10) other organizations with expertise in the assessment, 
        diagnosis, treatment, and management of pain, as determined appropriate 
        by the Secretary.
    (c) Contents.--The report described in subsection (a) shall include the 
following:
            (1) An analysis of payment and coverage under title XVIII of the 
        Social Security Act with respect to the following:
                    (A) Evidence-based treatments and technologies for chronic 
                or acute pain, including such treatments that are covered, not 
                covered, or have limited coverage under such title.
                    (B) Evidence-based treatments and technologies that monitor 
                substance use withdrawal and prevent overdoses of opioids.
                    (C) Evidence-based treatments and technologies that treat 
                substance use disorders.
                    (D) Items and services furnished by practitioners through a 
                multi-disciplinary treatment model for pain management, 
                including the patient-centered medical home.
                    (E) Items and services furnished to beneficiaries with 
                psychiatric disorders, substance use disorders, or who are at 
                risk of suicide, or have comorbidities and require consultation 
                or management of pain with one or more specialists in pain 
                management, mental health, or addiction treatment.
            (2) An evaluation of the following:
                    (A) Barriers inhibiting individuals entitled to benefits 
                under part A or enrolled under part B of such title from 
                accessing treatments and technologies described in subparagraphs 
                (A) through (E) of paragraph (1).
                    (B) Costs and benefits associated with potential expansion 
                of coverage under such title to include items and services not 
                covered under such title that may be used for the treatment of 
                pain, such as acupuncture, therapeutic massage, and items and 
                services furnished by integrated pain management programs.
                    (C) Pain management guidance published by the Federal 
                Government that may be relevant to coverage determinations or 
                other coverage requirements under title XVIII of the Social 
                Security Act.
            (3) An assessment of all guidance published by the Department of 
        Health and Human Services on or after January 1, 2016, relating to the 
        prescribing of opioids. Such assessment shall consider incorporating 
        into such guidance relevant elements of the ``Va/DoD Clinical Practice 
        Guideline for Opioid Therapy for Chronic Pain'' published in February 
        2017 by the Department of Veterans Affairs and Department of Defense, 
        including adoption of elements of the Department of Defense and 
        Department of Veterans Affairs pain rating scale.
            (4) The options described in subsection (d).
            (5) The impact analysis described in subsection (e).
    (d) Options.--The options described in this subsection are, with respect to 
individuals entitled to benefits under part A or enrolled under part B of title 
XVIII of the Social Security Act, legislative and administrative options for 
accomplishing the following:
            (1) Improving coverage of and payment for pain management therapies 
        without the use of opioids, including interventional pain therapies, and 
        options to augment opioid therapy with other clinical and complementary, 
        integrative health services to minimize the risk of substance use 
        disorder, including in a hospital setting.
            (2) Improving coverage of and payment for medical devices and non-
        opioid based pharmacological and non-pharmacological therapies approved 
        or cleared by the Food and Drug Administration for the treatment of pain 
        as an alternative or augment to opioid therapy.
            (3) Improving and disseminating treatment strategies for 
        beneficiaries with psychiatric disorders, substance use disorders, or 
        who are at risk of suicide, and treatment strategies to address health 
        disparities related to opioid use and opioid abuse treatment.
            (4) Improving and disseminating treatment strategies for 
        beneficiaries with comorbidities who require a consultation or 
        comanagement of pain with one or more specialists in pain management, 
        mental health, or addiction treatment, including in a hospital setting.
            (5) Educating providers on risks of coadministration of opioids and 
        other drugs, particularly benzodiazepines.
            (6) Ensuring appropriate case management for beneficiaries who 
        transition between inpatient and outpatient hospital settings, or 
        between opioid therapy to non-opioid therapy, which may include the use 
        of care transition plans.
            (7) Expanding outreach activities designed to educate providers of 
        services and suppliers under the Medicare program and individuals 
        entitled to benefits under part A or under part B of such title on 
        alternative, non-opioid therapies to manage and treat acute and chronic 
        pain.
            (8) Creating a beneficiary education tool on alternatives to opioids 
        for chronic pain management.
    (e) Impact Analysis.--The impact analysis described in this subsection 
consists of an analysis of any potential effects implementing the options 
described in subsection (d) would have--
            (1) on expenditures under the Medicare program; and
            (2) on preventing or reducing opioid addiction for individuals 
        receiving benefits under the Medicare program.

            Subtitle J--Combating Opioid Abuse for Care in Hospitals

SEC. 6091. SHORT TITLE.

    This subtitle may be cited as the ``Combating Opioid Abuse for Care in 
Hospitals Act of 2018'' or the ``COACH Act of 2018''.

SEC. 6092. DEVELOPING GUIDANCE ON PAIN MANAGEMENT AND OPIOID USE DISORDER 
              PREVENTION FOR HOSPITALS RECEIVING PAYMENT UNDER PART A OF THE 
              MEDICARE PROGRAM.

    (a) In General.--Not later than July 1, 2019, the Secretary of Health and 
Human Services (in this section referred to as the ``Secretary'') shall develop 
and publish on the public website of the Centers for Medicare & Medicaid 
Services guidance for hospitals receiving payment under part A of title XVIII of 
the Social Security Act (42 U.S.C. 1395c et seq.) on pain management strategies 
and opioid use disorder prevention strategies with respect to individuals 
entitled to benefits under such part.
    (b) Consultation.--In developing the guidance described in subsection (a), 
the Secretary shall consult with relevant stakeholders, including--
            (1) medical professional organizations;
            (2) providers and suppliers of services (as such terms are defined 
        in section 1861 of the Social Security Act (42 U.S.C. 1395x));
            (3) health care consumers or groups representing such consumers; and
            (4) other entities determined appropriate by the Secretary.
    (c) Contents.--The guidance described in subsection (a) shall include, with 
respect to hospitals and individuals described in such subsection, the 
following:
            (1) Best practices regarding evidence-based screening and 
        practitioner education initiatives relating to screening and treatment 
        protocols for opioid use disorder, including--
                    (A) methods to identify such individuals at-risk of opioid 
                use disorder, including risk stratification;
                    (B) ways to prevent, recognize, and treat opioid overdoses; 
                and
                    (C) resources available to such individuals, such as opioid 
                treatment programs, peer support groups, and other recovery 
                programs.
            (2) Best practices for such hospitals to educate practitioners 
        furnishing items and services at such hospital with respect to pain 
        management and substance use disorders, including education on--
                    (A) the adverse effects of prolonged opioid use;
                    (B) non-opioid, evidence-based, non-pharmacological pain 
                management treatments;
                    (C) monitoring programs for individuals who have been 
                prescribed opioids; and
                    (D) the prescribing of naloxone along with an initial opioid 
                prescription.
            (3) Best practices for such hospitals to make such individuals aware 
        of the risks associated with opioid use (which may include use of the 
        notification template described in paragraph (4)).
            (4) A notification template developed by the Secretary, for use as 
        appropriate, for such individuals who are prescribed an opioid that--
                    (A) explains the risks and side effects associated with 
                opioid use (including the risks of addiction and overdose) and 
                the importance of adhering to the prescribed treatment regimen, 
                avoiding medications that may have an adverse interaction with 
                such opioid, and storing such opioid safely and securely;
                    (B) highlights multimodal and evidence-based non-opioid 
                alternatives for pain management;
                    (C) encourages such individuals to talk to their health care 
                providers about such alternatives;
                    (D) provides for a method (through signature or otherwise) 
                for such an individual, or person acting on such individual's 
                behalf, to acknowledge receipt of such notification template;
                    (E) is worded in an easily understandable manner and made 
                available in multiple languages determined appropriate by the 
                Secretary; and
                    (F) includes any other information determined appropriate by 
                the Secretary.
            (5) Best practices for such hospital to track opioid prescribing 
        trends by practitioners furnishing items and services at such hospital, 
        including--
                    (A) ways for such hospital to establish target levels, 
                taking into account the specialties of such practitioners and 
                the geographic area in which such hospital is located, with 
                respect to opioids prescribed by such practitioners;
                    (B) guidance on checking the medical records of such 
                individuals against information included in prescription drug 
                monitoring programs;
                    (C) strategies to reduce long-term opioid prescriptions; and
                    (D) methods to identify such practitioners who may be over-
                prescribing opioids.
            (6) Other information the Secretary determines appropriate, 
        including any such information from the Opioid Safety Initiative 
        established by the Department of Veterans Affairs or the Opioid Overdose 
        Prevention Toolkit published by the Substance Abuse and Mental Health 
        Services Administration.

SEC. 6093. REQUIRING THE REVIEW OF QUALITY MEASURES RELATING TO OPIOIDS AND 
              OPIOID USE DISORDER TREATMENTS FURNISHED UNDER THE MEDICARE 
              PROGRAM AND OTHER FEDERAL HEALTH CARE PROGRAMS.

    Section 1890A of the Social Security Act (42 U.S.C. 1395aaa-1) is amended by 
adding at the end the following new subsection:
    ``(g) Technical Expert Panel Review of Opioid and Opioid Use Disorder 
Quality Measures.--
            ``(1) In general.--Not later than 180 days after the date of the 
        enactment of this subsection, the Secretary shall establish a technical 
        expert panel for purposes of reviewing quality measures relating to 
        opioids and opioid use disorders, including care, prevention, diagnosis, 
        health outcomes, and treatment furnished to individuals with opioid use 
        disorders. The Secretary may use the entity with a contract under 
        section 1890(a) and amend such contract as necessary to provide for the 
        establishment of such technical expert panel.
            ``(2) Review and assessment.--Not later than 1 year after the date 
        the technical expert panel described in paragraph (1) is established 
        (and periodically thereafter as the Secretary determines appropriate), 
        the technical expert panel shall--
                    ``(A) review quality measures that relate to opioids and 
                opioid use disorders, including existing measures and those 
                under development;
                    ``(B) identify gaps in areas of quality measurement that 
                relate to opioids and opioid use disorders, and identify measure 
                development priorities for such measure gaps; and
                    ``(C) make recommendations to the Secretary on quality 
                measures with respect to opioids and opioid use disorders for 
                purposes of improving care, prevention, diagnosis, health 
                outcomes, and treatment, including recommendations for revisions 
                of such measures, need for development of new measures, and 
                recommendations for including such measures in the Merit-Based 
                Incentive Payment System under section 1848(q), the alternative 
                payment models under section 1833(z)(3)(C), the shared savings 
                program under section 1899, the quality reporting requirements 
                for inpatient hospitals under section 1886(b)(3)(B)(viii), and 
                the hospital value-based purchasing program under section 
                1886(o).
            ``(3) Consideration of measures by secretary.--The Secretary shall 
        consider--
                    ``(A) using opioid and opioid use disorder measures 
                (including measures used under the Merit-Based Incentive Payment 
                System under section 1848(q), measures recommended under 
                paragraph (2)(C), and other such measures identified by the 
                Secretary) in alternative payment models under section 
                1833(z)(3)(C) and in the shared savings program under section 
                1899; and
                    ``(B) using opioid measures described in subparagraph (A), 
                as applicable, in the quality reporting requirements for 
                inpatient hospitals under section 1886(b)(3)(B)(viii), and in 
                the hospital value-based purchasing program under section 
                1886(o).
            ``(4) Prioritization of measure development.--The Secretary shall 
        prioritize for measure development the gaps in quality measures 
        identified under paragraph (2)(B).
            ``(5) Prioritization of measure endorsement.--The Secretary--
                    ``(A) during the period beginning on the date of the 
                enactment of this subsection and ending on December 31, 2023, 
                shall prioritize the endorsement of measures relating to opioids 
                and opioid use disorders by the entity with a contract under 
                subsection (a) of section 1890 in connection with endorsement of 
                measures described in subsection (b)(2) of such section; and
                    ``(B) on and after January 1, 2024, may prioritize the 
                endorsement of such measures by such entity.''.

SEC. 6094. TECHNICAL EXPERT PANEL ON REDUCING SURGICAL SETTING OPIOID USE; DATA 
              COLLECTION ON PERIOPERATIVE OPIOID USE.

    (a) Technical Expert Panel on Reducing Surgical Setting Opioid Use.--
            (1) In general.--Not later than 6 months after the date of the 
        enactment of this Act, the Secretary of Health and Human Services shall 
        convene a technical expert panel, including medical and surgical 
        specialty societies and hospital organizations, to provide 
        recommendations on reducing opioid use in the inpatient and outpatient 
        surgical settings and on best practices for pain management, including 
        with respect to the following:
                    (A) Approaches that limit patient exposure to opioids during 
                the perioperative period, including pre-surgical and post-
                surgical injections, and that identify such patients at risk of 
                opioid use disorder pre-operation.
                    (B) Shared decision making with patients and families on 
                pain management, including a review of payment to ensure payment 
                under the Medicare program under title XVIII of the Social 
                Security Act accounts for time spent on shared decision making.
                    (C) Education on the safe use, storage, and disposal of 
                opioids.
                    (D) Prevention of opioid misuse and abuse after discharge.
                    (E) Development of a clinical algorithm to identify and 
                treat at-risk, opiate-tolerant patients and reduce reliance on 
                opioids for acute pain during the perioperative period.
            (2) Report.--Not later than 1 year after the date of the enactment 
        of this Act, the Secretary shall submit to Congress and make public a 
        report containing the recommendations developed under paragraph (1) and 
        an action plan for broader implementation of pain management protocols 
        that limit the use of opioids in the perioperative setting and upon 
        discharge from such setting.
    (b) Data Collection on Perioperative Opioid Use.--Not later than 1 year 
after the date of the enactment of this Act, the Secretary of Health and Human 
Services shall submit to Congress a report that contains the following:
            (1) The diagnosis-related group codes identified by the Secretary as 
        having the highest volume of surgeries.
            (2) With respect to each of such diagnosis-related group codes so 
        identified, a determination by the Secretary of the data that is both 
        available and reported on opioid use following such surgeries, such as 
        with respect to--
                    (A) surgical volumes, practices, and opioid prescribing 
                patterns;
                    (B) opioid consumption, including--
                            (i) perioperative days of therapy;
                            (ii) average daily dose at the hospital, including 
                        dosage greater than 90 milligram morphine equivalent;
                            (iii) post-discharge prescriptions and other 
                        combination drugs that are used before intervention and 
                        after intervention;
                            (iv) quantity and duration of opioid prescription at 
                        discharge; and
                            (v) quantity consumed and number of refills;
                    (C) regional anesthesia and analgesia practices, including 
                pre-surgical and post-surgical injections;
                    (D) naloxone reversal;
                    (E) post-operative respiratory failure;
                    (F) information about storage and disposal; and
                    (G) such other information as the Secretary may specify.
            (3) Recommendations for improving data collection on perioperative 
        opioid use, including an analysis to identify and reduce barriers to 
        collecting, reporting, and analyzing the data described in paragraph 
        (2), including barriers related to technological availability.

SEC. 6095. REQUIRING THE POSTING AND PERIODIC UPDATE OF OPIOID PRESCRIBING 
              GUIDANCE FOR MEDICARE BENEFICIARIES.

    (a) In General.--Not later than 180 days 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 post on the public website of the Centers for 
Medicare & Medicaid Services all guidance published by the Department of Health 
and Human Services on or after January 1, 2016, relating to the prescribing of 
opioids and applicable to opioid prescriptions for individuals entitled to 
benefits under part A of title XVIII of the Social Security Act (42 U.S.C. 1395c 
et seq.) or enrolled under part B of such title of such Act (42 U.S.C. 1395j et 
seq.).
    (b) Update of Guidance.--
            (1) Periodic update.--The Secretary shall, in consultation with the 
        entities specified in paragraph (2), periodically (as determined 
        appropriate by the Secretary) update guidance described in subsection 
        (a) and revise the posting of such guidance on the website described in 
        such subsection.
            (2) Consultation.--The entities specified in this paragraph are the 
        following:
                    (A) Medical professional organizations.
                    (B) Providers and suppliers of services (as such terms are 
                defined in section 1861 of the Social Security Act (42 U.S.C. 
                1395x)).
                    (C) Health care consumers or groups representing such 
                consumers.
                    (D) Other entities determined appropriate by the Secretary.

  Subtitle K--Providing Reliable Options for Patients and Educational Resources

SEC. 6101. SHORT TITLE.

    This subtitle may be cited as the ``Providing Reliable Options for Patients 
and Educational Resources Act of 2018'' or the ``PROPER Act of 2018''.

SEC. 6102. REQUIRING MEDICARE ADVANTAGE PLANS AND PART D PRESCRIPTION DRUG PLANS 
              TO INCLUDE INFORMATION ON RISKS ASSOCIATED WITH OPIOIDS AND 
              COVERAGE OF NONPHARMACOLOGICAL THERAPIES AND NONOPIOID MEDICATIONS 
              OR DEVICES USED TO TREAT PAIN.

    Section 1860D-4(a)(1) of the Social Security Act (42 U.S.C. 1395w-104(a)(1)) 
is amended--
            (1) in subparagraph (A), by inserting ``, subject to subparagraph 
        (C),'' before ``including'';
            (2) in subparagraph (B), by adding at the end the following new 
        clause:
                            ``(vi) For plan year 2021 and each subsequent plan 
                        year, subject to subparagraph (C), with respect to the 
                        treatment of pain--
                                    ``(I) the risks associated with prolonged 
                                opioid use; and
                                    ``(II) coverage of nonpharmacological 
                                therapies, devices, and nonopioid medications--
                                            ``(aa) in the case of an MA-PD plan 
                                        under part C, under such plan; and
                                            ``(bb) in the case of a prescription 
                                        drug plan, under such plan and under 
                                        parts A and B.''; and
            (3) by adding at the end the following new subparagraph:
                    ``(C) Targeted provision of information.--A PDP sponsor of a 
                prescription drug plan may, in lieu of disclosing the 
                information described in subparagraph (B)(vi) to each enrollee 
                under the plan, disclose such information through mail or 
                electronic communications to a subset of enrollees under the 
                plan, such as enrollees who have been prescribed an opioid in 
                the previous 2-year period.''.

SEC. 6103. REQUIRING MEDICARE ADVANTAGE PLANS AND PRESCRIPTION DRUG PLANS TO 
              PROVIDE INFORMATION ON THE SAFE DISPOSAL OF PRESCRIPTION DRUGS.

    (a) Medicare Advantage.--Section 1852 of the Social Security Act (42 U.S.C. 
1395w-22) is amended by adding at the end the following new subsection:
    ``(n) Provision of Information Relating to the Safe Disposal of Certain 
Prescription Drugs.--
            ``(1) In general.--In the case of an individual enrolled under an MA 
        or MA-PD plan who is furnished an in-home health risk assessment on or 
        after January 1, 2021, such plan shall ensure that such assessment 
        includes information on the safe disposal of prescription drugs that are 
        controlled substances that meets the criteria established under 
        paragraph (2). Such information shall include information on drug 
        takeback programs that meet such requirements determined appropriate by 
        the Secretary and information on in-home disposal.
            ``(2) Criteria.--The Secretary shall, through rulemaking, establish 
        criteria the Secretary determines appropriate with respect to 
        information provided to an individual to ensure that such information 
        sufficiently educates such individual on the safe disposal of 
        prescription drugs that are controlled substances.''.
    (b) Prescription Drug Plans.--Section 1860D-4(c)(2)(B) of the Social 
Security Act (42 U.S.C. 1395w-104(c)(2)(B)) is amended--
            (1) by striking ``may include elements that promote'';
            (2) by redesignating clauses (i) through (iii) as subclauses (I) 
        through (III) and adjusting the margins accordingly;
            (3) by inserting before subclause (I), as so redesignated, the 
        following new clause:
                            ``(i) may include elements that promote--'';
            (4) in subclause (III), as so redesignated, by striking the period 
        at the end and inserting ``; and''; and
            (5) by adding at the end the following new clause:
                            ``(ii) with respect to plan years beginning on or 
                        after January 1, 2021, shall provide for--
                                    ``(I) the provision of information to the 
                                enrollee on the safe disposal of prescription 
                                drugs that are controlled substances that meets 
                                the criteria established under section 
                                1852(n)(2), including information on drug 
                                takeback programs that meet such requirements 
                                determined appropriate by the Secretary and 
                                information on in-home disposal; and
                                    ``(II) cost-effective means by which an 
                                enrollee may so safely dispose of such drugs.''.

SEC. 6104. REVISING MEASURES USED UNDER THE HOSPITAL CONSUMER ASSESSMENT OF 
              HEALTHCARE PROVIDERS AND SYSTEMS SURVEY RELATING TO PAIN 
              MANAGEMENT.

    (a) Restriction on the Use of Pain Questions in HCAHPS.--Section 
1886(b)(3)(B)(viii) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(viii)) 
is amended by adding at the end the following new subclause:
    ``(XII)(aa) With respect to a Hospital Consumer Assessment of Healthcare 
Providers and Systems survey (or a successor survey) conducted on or after 
January 1, 2020, such survey may not include questions about communication by 
hospital staff with an individual about such individual's pain unless such 
questions take into account, as applicable, whether an individual experiencing 
pain was informed about risks associated with the use of opioids and about non-
opioid alternatives for the treatment of pain.
    ``(bb) The Secretary shall not include on the Hospital Compare internet 
website any measures based on the questions appearing on the Hospital Consumer 
Assessment of Healthcare Providers and Systems survey in 2018 or 2019 about 
communication by hospital staff with an individual about such individual's 
pain.''.
    (b) Restriction on Use of 2018 and 2019 Pain Questions in the Hospital 
Value-based Purchasing Program.--Section 1886(o)(2)(B) of the Social Security 
Act (42 U.S.C. 1395ww(o)(2)(B)) is amended by adding at the end the following 
new clause:
                            ``(iii) HCAHPS pain questions.--The Secretary may 
                        not include under subparagraph (A) a measure that is 
                        based on the questions appearing on the Hospital 
                        Consumer Assessment of Healthcare Providers and Systems 
                        survey in 2018 or 2019 about communication by hospital 
                        staff with an individual about the individual's pain.''.

             Subtitle L--Fighting the Opioid Epidemic With Sunshine

SEC. 6111. FIGHTING THE OPIOID EPIDEMIC WITH SUNSHINE.

    (a) Inclusion of Information Regarding Payments to Additional 
Practitioners.--
            (1) In general.--Section 1128G(e)(6) of the Social Security Act (42 
        U.S.C. 1320a-7h(e)(6)) is amended--
                    (A) in subparagraph (A), by adding at the end the following 
                new clauses:
                            ``(iii) A physician assistant, nurse practitioner, 
                        or clinical nurse specialist (as such terms are defined 
                        in section 1861(aa)(5)).
                            ``(iv) A certified registered nurse anesthetist (as 
                        defined in section 1861(bb)(2)).
                            ``(v) A certified nurse-midwife (as defined in 
                        section 1861(gg)(2)).''; and
                    (B) in subparagraph (B), by inserting ``, physician 
                assistant, nurse practitioner, clinical nurse specialist, 
                certified nurse anesthetist, or certified nurse-midwife'' after 
                ``physician''.
            (2) Effective date.--The amendments made by this subsection shall 
        apply with respect to information required to be submitted under section 
        1128G of the Social Security Act (42 U.S.C. 1320a-7h) on or after 
        January 1, 2022.
    (b) Sunset of Exclusion of National Provider Identifier of Covered Recipient 
in Information Made Publicly Available.--Section 1128G(c)(1)(C)(viii) of the 
Social Security Act (42 U.S.C. 1320a-7h(c)(1)(C)(viii)) is amended by striking 
``does not contain'' and inserting ``in the case of information made available 
under this subparagraph prior to January 1, 2022, does not contain''.
    (c) Administration.--Chapter 35 of title 44, United States Code, shall not 
apply to this section or the amendments made by this section.

                       TITLE VII--PUBLIC HEALTH PROVISIONS

                       Subtitle A--Awareness and Training

SEC. 7001. REPORT ON EFFECTS ON PUBLIC HEALTH OF SYNTHETIC DRUG USE.

    (a) In General.--Not later than 3 years after the date of the enactment of 
this Act, the Secretary of Health and Human Services, in coordination with the 
Surgeon General of the Public Health Service, shall submit to the Committee on 
Energy and Commerce of the House of Representatives and the Committee on Health, 
Education, Labor, and Pensions of the Senate a report on the health effects of 
new psychoactive substances, including synthetic drugs, used by adolescents and 
young adults.
    (b) New Psychoactive Substance Defined.--For purposes of subsection (a), the 
term ``new psychoactive substance'' means a controlled substance analogue (as 
defined in section 102(32) of the Controlled Substances Act (21 U.S.C. 802(32)).

SEC. 7002. FIRST RESPONDER TRAINING.

    Section 546 of the Public Health Service Act (42 U.S.C. 290ee-1) is 
amended--
            (1) in subsection (c)--
                    (A) in paragraph (2), by striking ``and'' at the end;
                    (B) in paragraph (3), by striking the period and inserting 
                ``; and''; and
                    (C) by adding at the end the following:
            ``(4) train and provide resources for first responders and members 
        of other key community sectors on safety around fentanyl, carfentanil, 
        and other dangerous licit and illicit drugs to protect themselves from 
        exposure to such drugs and respond appropriately when exposure 
        occurs.'';
            (2) in subsection (d), by striking ``and mechanisms for referral to 
        appropriate treatment for an entity receiving a grant under this 
        section'' and inserting ``mechanisms for referral to appropriate 
        treatment, and safety around fentanyl, carfentanil, and other dangerous 
        licit and illicit drugs'';
            (3) in subsection (f)--
                    (A) in paragraph (3), by striking ``and'' at the end;
                    (B) in paragraph (4), by striking the period and inserting 
                ``; and''; and
                    (C) by adding at the end the following:
            ``(5) the number of first responders and members of other key 
        community sectors trained on safety around fentanyl, carfentanil, and 
        other dangerous licit and illicit drugs.'';
            (4) by redesignating subsection (g) as subsection (h);
            (5) by inserting after subsection (f) the following:
    ``(g) Other Key Community Sectors.--In this section, the term `other key 
community sectors' includes substance use disorder treatment providers, 
emergency medical services agencies, agencies and organizations working with 
prison and jail populations and offender reentry programs, health care 
providers, harm reduction groups, pharmacies, community health centers, tribal 
health facilities, and mental health providers.''; and
            (6) in subsection (h), as so redesignated, by striking ``$12,000,000 
        for each of fiscal years 2017 through 2021'' and inserting ``$36,000,000 
        for each of fiscal years 2019 through 2023''.

Subtitle B--Pilot Program for Public Health Laboratories To Detect Fentanyl and 
                             Other Synthetic Opioids

SEC. 7011. PILOT PROGRAM FOR PUBLIC HEALTH LABORATORIES TO DETECT FENTANYL AND 
              OTHER SYNTHETIC OPIOIDS.

    (a) Grants.--The Secretary of Health and Human Services (referred to in this 
section as the ``Secretary'') shall award grants to, or enter into cooperative 
agreements with, Federal, State, and local agencies to improve coordination 
between public health laboratories and laboratories operated by law enforcement 
agencies, such as Customs and Border Protection and the Drug Enforcement 
Administration, to improve detection of synthetic opioids, including fentanyl 
and its analogues, as described in subsection (b).
    (b) Detection Activities.--The Secretary, in consultation with the Director 
of the National Institute of Standards and Technology, the Director of the 
Centers for Disease Control and Prevention, the Attorney General of the United 
States, and the Administrator of the Drug Enforcement Administration, shall, for 
purposes of this section, develop or identify--
            (1) best practices for safely handling and testing synthetic 
        opioids, including fentanyl and its analogues, including with respect to 
        reference materials, instrument calibration, and quality control 
        protocols;
            (2) reference materials and quality control standards related to 
        synthetic opioids, including fentanyl and its analogues, to enhance--
                    (A) clinical diagnostics;
                    (B) postmortem data collection; and
                    (C) portable testing equipment utilized by law enforcement 
                and public health officials; and
            (3) procedures for the identification of new and emerging synthetic 
        opioid formulations and procedures for reporting those findings to 
        appropriate law enforcement agencies and Federal, State, and local 
        public health laboratories and health departments, as appropriate.
    (c) Laboratories.--The Secretary shall require recipients of grants or 
cooperative agreements under subsection (a) to--
            (1) follow the best practices established under subsection (b) and 
        have the appropriate capabilities to provide laboratory testing of 
        controlled substances, such as synthetic fentanyl, and biospecimens for 
        the purposes of aggregating and reporting public health information to 
        Federal, State, and local public health officials, laboratories, and 
        other entities the Secretary deems appropriate;
            (2) work with law enforcement agencies and public health 
        authorities, as practicable;
            (3) provide early warning information to Federal, State, and local 
        law enforcement agencies and public health authorities regarding trends 
        or other data related to the supply of synthetic opioids, including 
        fentanyl and its analogues;
            (4) provide biosurveillance capabilities with respect to identifying 
        trends in adverse health outcomes associated with non-fatal exposures; 
        and
            (5) provide diagnostic testing, as appropriate and practicable, for 
        non-fatal exposures of emergency personnel, first responders, and other 
        individuals.
    (d) Authorization of Appropriations.--To carry out this section, there is 
authorized to be appropriated $15,000,000 for each of fiscal years 2019 through 
2023.

              Subtitle C--Indexing Narcotics, Fentanyl, and Opioids

SEC. 7021. ESTABLISHMENT OF SUBSTANCE USE DISORDER INFORMATION DASHBOARD.

    Title XVII of the Public Health Service Act (42 U.S.C. 300u et seq.) is 
amended by adding at the end the following new section:

``SEC. 1711. ESTABLISHMENT OF SUBSTANCE USE DISORDER INFORMATION DASHBOARD.

    ``(a) In General.--Not later than 6 months after the date of the enactment 
of this section, the Secretary of Health and Human Services shall, in 
consultation with the Director of National Drug Control Policy, establish and 
periodically update, on the Internet website of the Department of Health and 
Human Services, a public information dashboard that--
            ``(1) provides links to information on programs within the 
        Department of Health and Human Services related to the reduction of 
        opioid and other substance use disorders;
            ``(2) provides access, to the extent practicable and appropriate, to 
        publicly available data, which may include data from agencies within the 
        Department of Health and Human Services and--
                    ``(A) other Federal agencies;
                    ``(B) State, local, and Tribal governments;
                    ``(C) nonprofit organizations;
                    ``(D) law enforcement;
                    ``(E) medical experts;
                    ``(F) public health educators; and
                    ``(G) research institutions regarding prevention, treatment, 
                recovery, and other services for opioid and other substance use 
                disorders;
            ``(3) provides data on substance use disorder prevention and 
        treatment strategies in different regions of and populations in the 
        United States;
            ``(4) identifies information on alternatives to controlled 
        substances for pain management, such as approaches studied by the 
        National Institutes of Health Pain Consortium, the National Center for 
        Complimentary and Integrative Health, and other institutes and centers 
        at the National Institutes of Health, as appropriate; and
            ``(5) identifies guidelines and best practices for health care 
        providers regarding treatment of substance use disorders.
    ``(b) Controlled Substance Defined.--In this section, the term `controlled 
substance' has the meaning given that term in section 102 of the Controlled 
Substances Act (21 U.S.C. 802).''.

SEC. 7022. INTERDEPARTMENTAL SUBSTANCE USE DISORDERS COORDINATING COMMITTEE.

    (a) Establishment.--Not later than 3 months 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, in coordination with the Director of 
National Drug Control Policy, establish a committee, to be known as the 
Interdepartmental Substance Use Disorders Coordinating Committee (in this 
section referred to as the ``Committee''), to coordinate Federal activities 
related to substance use disorders.
    (b) Membership.--
            (1) Federal members.--The Committee shall be composed of the 
        following Federal representatives, or the designees of such 
        representatives:
                    (A) The Secretary, who shall serve as the Chair of the 
                Committee.
                    (B) The Attorney General of the United States.
                    (C) The Secretary of Labor.
                    (D) The Secretary of Housing and Urban Development.
                    (E) The Secretary of Education.
                    (F) The Secretary of Veterans Affairs.
                    (G) The Commissioner of Social Security.
                    (H) The Assistant Secretary for Mental Health and Substance 
                Use.
                    (I) The Director of National Drug Control Policy.
                    (J) Representatives of other Federal agencies that support 
                or conduct activities or programs related to substance use 
                disorders, as determined appropriate by the Secretary.
            (2) Non-federal members.--The Committee shall include a minimum of 
        15 non-Federal members appointed by the Secretary, of which--
                    (A) at least two such members shall be an individual who has 
                received treatment for a diagnosis of a substance use disorder;
                    (B) at least two such members shall be a director of a State 
                substance abuse agency;
                    (C) at least two such members shall be a representative of a 
                leading research, advocacy, or service organization for adults 
                with substance use disorder;
                    (D) at least two such members shall--
                            (i) be a physician, licensed mental health 
                        professional, advance practice registered nurse, or 
                        physician assistant; and
                            (ii) have experience in treating individuals with 
                        substance use disorders;
                    (E) at least one such member shall be a substance use 
                disorder treatment professional who provides treatment services 
                at a certified opioid treatment program;
                    (F) at least one such member shall be a substance use 
                disorder treatment professional who has research or clinical 
                experience in working with racial and ethnic minority 
                populations;
                    (G) at least one such member shall be a substance use 
                disorder treatment professional who has research or clinical 
                mental health experience in working with medically underserved 
                populations;
                    (H) at least one such member shall be a State-certified 
                substance use disorder peer support specialist;
                    (I) at least one such member shall be a drug court judge or 
                a judge with experience in adjudicating cases related to 
                substance use disorder;
                    (J) at least one such member shall be a public safety 
                officer with extensive experience in interacting with adults 
                with a substance use disorder; and
                    (K) at least one such member shall be an individual with 
                experience providing services for homeless individuals with a 
                substance use disorder.
    (c) Terms.--
            (1) In general.--A member of the Committee appointed under 
        subsection (b)(2) shall be appointed for a term of 3 years and may be 
        reappointed for one or more 3-year terms.
            (2) Vacancies.--A vacancy on the Committee shall be filled in the 
        same manner in which the original appointment was made. Any individual 
        appointed to fill a vacancy for an unexpired term shall be appointed for 
        the remainder of such term and may serve after the expiration of such 
        term until a successor has been appointed.
    (d) Meetings.--The Committee shall meet not fewer than two times each year.
    (e) Duties.--The Committee shall--
            (1) identify areas for improved coordination of activities, if any, 
        related to substance use disorders, including research, services, 
        supports, and prevention activities across all relevant Federal 
        agencies;
            (2) identify and provide to the Secretary recommendations for 
        improving Federal programs for the prevention and treatment of, and 
        recovery from, substance use disorders, including by expanding access to 
        prevention, treatment, and recovery services;
            (3) analyze substance use disorder prevention and treatment 
        strategies in different regions of and populations in the United States 
        and evaluate the extent to which Federal substance use disorder 
        prevention and treatment strategies are aligned with State and local 
        substance use disorder prevention and treatment strategies;
            (4) make recommendations to the Secretary regarding any appropriate 
        changes with respect to the activities and strategies described in 
        paragraphs (1) through (3);
            (5) make recommendations to the Secretary regarding public 
        participation in decisions relating to substance use disorders and the 
        process by which public feedback can be better integrated into such 
        decisions; and
            (6) make recommendations to ensure that substance use disorder 
        research, services, supports, and prevention activities of the 
        Department of Health and Human Services and other Federal agencies are 
        not unnecessarily duplicative.
    (f) Annual Report.--Not later than 1 year after the date of the enactment of 
this Act, and annually thereafter for the life of the Committee, the Committee 
shall publish on the Internet website of the Department of Health and Human 
Services, which may include the public information dashboard established under 
section 1711 of the Public Health Service Act, as added by section 7021, a 
report summarizing the activities carried out by the Committee pursuant to 
subsection (e), including any findings resulting from such activities.
    (g) Working Groups.--The Committee may establish working groups for purposes 
of carrying out the duties described in subsection (e). Any such working group 
shall be composed of members of the Committee (or the designees of such members) 
and may hold such meetings as are necessary to enable the working group to carry 
out the duties delegated to the working group.
    (h) Federal Advisory Committee Act.--The Federal Advisory Committee Act (5 
U.S.C. App.) shall apply to the Committee only to the extent that the provisions 
of such Act do not conflict with the requirements of this section.
    (i) Sunset.--The Committee shall terminate on the date that is 6 years after 
the date on which the Committee is established under subsection (a).

SEC. 7023. NATIONAL MILESTONES TO MEASURE SUCCESS IN CURTAILING THE OPIOID 
              CRISIS.

    (a) In General.--Not later than 180 days after the date of enactment of this 
Act, the Secretary of Health and Human Services (referred to in this section as 
the ``Secretary''), in coordination with the Administrator of the Drug 
Enforcement Administration and the Director of the Office of National Drug 
Control Policy, shall develop or identify existing national indicators (referred 
to in this section as the ``national milestones'') to measure success in 
curtailing the opioid crisis, with the goal of significantly reversing the 
incidence and prevalence of opioid misuse and abuse, and opioid-related 
morbidity and mortality in the United States within 5 years of such date of 
enactment.
    (b) National Milestones to End the Opioid Crisis.--The national milestones 
under subsection (a) shall include the following:
            (1) Not fewer than 10 indicators or metrics to accurately and 
        expediently measure progress in meeting the goal described in subsection 
        (a), which shall, as appropriate, include, indicators or metrics related 
        to--
                    (A) the number of fatal and non-fatal opioid overdoses;
                    (B) the number of emergency room visits related to opioid 
                misuse and abuse;
                    (C) the number of individuals in sustained recovery from 
                opioid use disorder;
                    (D) the number of infections associated with illicit drug 
                use, such as HIV, viral hepatitis, and infective endocarditis, 
                and available capacity for treating such infections;
                    (E) the number of providers prescribing medication-assisted 
                treatment for opioid use disorders, including in primary care 
                settings, community health centers, jails, and prisons;
                    (F) the number of individuals receiving treatment for opioid 
                use disorder; and
                    (G) additional indicators or metrics, as appropriate, such 
                as metrics pertaining to specific populations, including women 
                and children, American Indians and Alaskan Natives, individuals 
                living in rural and non-urban areas, and justice-involved 
                populations, that would further clarify the progress made in 
                addressing the opioid crisis.
            (2) A reasonable goal, such as a percentage decrease or other 
        specified metric, that signifies progress in meeting the goal described 
        in subsection (a), and annual targets to help achieve that goal.
    (c) Consideration of Other Substance Use Disorders.--In developing the 
national milestones under subsection (b), the Secretary shall, as appropriate, 
consider other substance use disorders in addition to opioid use disorder.
    (d) Extension of Period.--If the Secretary determines that the goal 
described in subsection (a) will not be achieved with respect to any indicator 
or metric established under subsection (b)(2) within 5 years of the date of 
enactment of this Act, the Secretary may extend the timeline for meeting such 
goal with respect to that indicator or metric. The Secretary shall include with 
any such extension a rationale for why additional time is needed and information 
on whether significant changes are needed in order to achieve such goal with 
respect to the indicator or metric.
    (e) Annual Status Update.--Not later than one year after the date of 
enactment of this Act, the Secretary shall make available on the Internet 
website of the Department of Health and Human Services, and submit to the 
Committee on Health, Education, Labor, and Pensions of the Senate and the 
Committee on Energy and Commerce of the House of Representatives, an update on 
the progress, including expected progress in the subsequent year, in achieving 
the goals detailed in the national milestones. Each such update shall include 
the progress made in the first year or since the previous report, as applicable, 
in meeting each indicator or metric in the national milestones.

SEC. 7024. STUDY ON PRESCRIBING LIMITS.

    Not later than 2 years after the date of enactment of this Act, the 
Secretary of Health and Human Services, in consultation with the Attorney 
General of the United States, shall submit to the Committee on Health, 
Education, Labor, and Pensions of the Senate and the Committee on Energy and 
Commerce of the House of Representatives a report on the impact of Federal and 
State laws and regulations that limit the length, quantity, or dosage of opioid 
prescriptions. Such report shall address--
            (1) the impact of such limits on--
                    (A) the incidence and prevalence of overdose related to 
                prescription opioids;
                    (B) the incidence and prevalence of overdose related to 
                illicit opioids;
                    (C) the prevalence of opioid use disorders;
                    (D) medically appropriate use of, and access to, opioids, 
                including any impact on travel expenses and pain management 
                outcomes for patients, whether such limits are associated with 
                significantly higher rates of negative health outcomes, 
                including suicide, and whether the impact of such limits differs 
                based on the clinical indication for which opioids are 
                prescribed;
            (2) whether such limits lead to a significant increase in burden for 
        prescribers of opioids or prescribers of treatments for opioid use 
        disorder, including any impact on patient access to treatment, and 
        whether any such burden is mitigated by any factors such as electronic 
        prescribing or telemedicine; and
            (3) the impact of such limits on diversion or misuse of any 
        controlled substance in schedule II, III, or IV of section 202(c) of the 
        Controlled Substances Act (21 U.S.C. 812(c)).

               Subtitle D--Ensuring Access to Quality Sober Living

SEC. 7031. NATIONAL RECOVERY HOUSING BEST PRACTICES.

    Part D of title V of the Public Health Service Act (42 U.S.C. 290dd et seq.) 
is amended by adding at the end the following new section:

``SEC. 550. NATIONAL RECOVERY HOUSING BEST PRACTICES.

    ``(a) Best Practices for Operating Recovery Housing.--
            ``(1) In general.--The Secretary, in consultation with the 
        individuals and entities specified in paragraph (2), shall identify or 
        facilitate the development of best practices, which may include model 
        laws for implementing suggested minimum standards, for operating 
        recovery housing.
            ``(2) Consultation.--In carrying out the activities described in 
        paragraph (1), the Secretary shall consult with, as appropriate--
                    ``(A) relevant divisions of the Department of Health and 
                Human Services, including the Substance Abuse and Mental Health 
                Services Administration, the Office of Inspector General, the 
                Indian Health Service, and the Centers for Medicare & Medicaid 
                Services;
                    ``(B) the Secretary of Housing and Urban Development;
                    ``(C) directors or commissioners, as applicable, of State 
                health departments, tribal health departments, State Medicaid 
                programs, and State insurance agencies;
                    ``(D) representatives of health insurance issuers;
                    ``(E) national accrediting entities and reputable providers 
                of, and analysts of, recovery housing services, including Indian 
                tribes, tribal organizations, and tribally designated housing 
                entities that provide recovery housing services, as applicable;
                    ``(F) individuals with a history of substance use disorder; 
                and
                    ``(G) other stakeholders identified by the Secretary.
    ``(b) Identification of Fraudulent Recovery Housing Operators.--
            ``(1) In general.--The Secretary, in consultation with the 
        individuals and entities described in paragraph (2), shall identify or 
        facilitate the development of common indicators that could be used to 
        identify potentially fraudulent recovery housing operators.
            ``(2) Consultation.--In carrying out the activities described in 
        paragraph (1), the Secretary shall consult with, as appropriate, the 
        individuals and entities specified in subsection (a)(2) and the Attorney 
        General of the United States.
            ``(3) Requirements.--
                    ``(A) Practices for identification and reporting.--In 
                carrying out the activities described in paragraph (1), the 
                Secretary shall consider how law enforcement, public and private 
                payers, and the public can best identify and report fraudulent 
                recovery housing operators.
                    ``(B) Factors to be considered.--In carrying out the 
                activities described in paragraph (1), the Secretary shall 
                identify or develop indicators, which may include indicators 
                related to--
                            ``(i) unusual billing practices;
                            ``(ii) average lengths of stays;
                            ``(iii) excessive levels of drug testing (in terms 
                        of cost or frequency); and
                            ``(iv) unusually high levels of recidivism.
    ``(c) Dissemination.--The Secretary shall, as appropriate, disseminate the 
best practices identified or developed under subsection (a) and the common 
indicators identified or developed under subsection (b) to--
            ``(1) State agencies, which may include the provision of technical 
        assistance to State agencies seeking to adopt or implement such best 
        practices;
            ``(2) Indian tribes, tribal organizations, and tribally designated 
        housing entities;
            ``(3) the Attorney General of the United States;
            ``(4) the Secretary of Labor;
            ``(5) the Secretary of Housing and Urban Development;
            ``(6) State and local law enforcement agencies;
            ``(7) health insurance issuers;
            ``(8) recovery housing entities; and
            ``(9) the public.
    ``(d) Requirements.--In carrying out the activities described in subsections 
(a) and (b), the Secretary, in consultation with appropriate individuals and 
entities described in subsections (a)(2) and (b)(2), shall consider how recovery 
housing is able to support recovery and prevent relapse, recidivism, or overdose 
(including overdose death), including by improving access and adherence to 
treatment, including medication-assisted treatment.
    ``(e) Rule of Construction.--Nothing in this section shall be construed to 
provide the Secretary with the authority to require States to adhere to minimum 
standards in the State oversight of recovery housing.
    ``(f) Definitions.--In this section:
            ``(1) The term `recovery housing' means a shared living environment 
        free from alcohol and illicit drug use and centered on peer support and 
        connection to services that promote sustained recovery from substance 
        use disorders.
            ``(2) The terms `Indian tribe' and `tribal organization' have the 
        meanings given those terms in section 4 of the Indian Self-Determination 
        and Education Assistance Act (25 U.S.C. 5304).
            ``(3) The term `tribally designated housing entity' has the meaning 
        given that term in section 4 of the Native American Housing Assistance 
        and Self-Determination Act of 1996 (25 U.S.C. 4103).
    ``(g) Authorization of Appropriations.--To carry out this section, there is 
authorized to be appropriated $3,000,000 for the period of fiscal years 2019 
through 2021.''.

                   Subtitle E--Advancing Cutting Edge Research

SEC. 7041. UNIQUE RESEARCH INITIATIVES.

    Section 402(n)(1) of the Public Health Service Act (42 U.S.C. 282(n)(1)) is 
amended--
            (1) in subparagraph (A), by striking ``or'';
            (2) in subparagraph (B), by striking the period and inserting ``; 
        or''; and
            (3) by adding at the end the following:
                    ``(C) high impact cutting-edge research that fosters 
                scientific creativity and increases fundamental biological 
                understanding leading to the prevention, diagnosis, or treatment 
                of diseases and disorders, or research urgently required to 
                respond to a public health threat.''.

SEC. 7042. PAIN RESEARCH.

    Section 409J(b) of the Public Health Service Act (42 U.S.C. 284q(b)) is 
amended--
            (1) in paragraph (5)--
                    (A) in subparagraph (A), by striking ``and treatment of pain 
                and diseases and disorders associated with pain'' and inserting 
                ``treatment, and management of pain and diseases and disorders 
                associated with pain, including information on best practices 
                for the utilization of non-pharmacologic treatments, non-
                addictive medical products, and other drugs or devices approved 
                or cleared by the Food and Drug Administration'';
                    (B) in subparagraph (B), by striking ``on the symptoms and 
                causes of pain;'' and inserting the following: ``on--
                            ``(i) the symptoms and causes of pain, including the 
                        identification of relevant biomarkers and screening 
                        models and the epidemiology of acute and chronic pain;
                            ``(ii) the diagnosis, prevention, treatment, and 
                        management of acute and chronic pain, including with 
                        respect to non-pharmacologic treatments, non-addictive 
                        medical products, and other drugs or devices approved or 
                        cleared by the Food and Drug Administration; and
                            ``(iii) risk factors for, and early warning signs 
                        of, substance use disorders in populations with acute 
                        and chronic pain; and''; and
                    (C) by striking subparagraphs (C) through (E) and inserting 
                the following:
                    ``(C) make recommendations to the Director of NIH--
                            ``(i) to ensure that the activities of the National 
                        Institutes of Health and other Federal agencies are free 
                        of unnecessary duplication of effort;
                            ``(ii) on how best to disseminate information on 
                        pain care and epidemiological data related to acute and 
                        chronic pain; and
                            ``(iii) on how to expand partnerships between public 
                        entities and private entities to expand collaborative, 
                        cross-cutting research.'';
            (2) by redesignating paragraph (6) as paragraph (7); and
            (3) by inserting after paragraph (5) the following:
            ``(6) Report.--The Secretary shall ensure that recommendations and 
        actions taken by the Director with respect to the topics discussed at 
        the meetings described in paragraph (4) are included in appropriate 
        reports to Congress.''.

                            Subtitle F--Jessie's Law

SEC. 7051. INCLUSION OF OPIOID ADDICTION HISTORY IN PATIENT RECORDS.

    (a) Best Practices.--
            (1) In general.--Not later than 1 year after the date of enactment 
        of this Act, the Secretary of Health and Human Services (in this section 
        referred to as the ``Secretary''), in consultation with appropriate 
        stakeholders, including a patient with a history of opioid use disorder, 
        an expert in electronic health records, an expert in the confidentiality 
        of patient health information and records, and a health care provider, 
        shall identify or facilitate the development of best practices 
        regarding--
                    (A) the circumstances under which information that a patient 
                has provided to a health care provider regarding such patient's 
                history of opioid use disorder should, only at the patient's 
                request, be prominently displayed in the medical records 
                (including electronic health records) of such patient;
                    (B) what constitutes the patient's request for the purpose 
                described in subparagraph (A); and
                    (C) the process and methods by which the information should 
                be so displayed.
            (2) Dissemination.--The Secretary shall disseminate the best 
        practices developed under paragraph (1) to health care providers and 
        State agencies.
    (b) Requirements.--In identifying or facilitating the development of best 
practices under subsection (a), as applicable, the Secretary, in consultation 
with appropriate stakeholders, shall consider the following:
            (1) The potential for addiction relapse or overdose, including 
        overdose death, when opioid medications are prescribed to a patient 
        recovering from opioid use disorder.
            (2) The benefits of displaying information about a patient's opioid 
        use disorder history in a manner similar to other potentially lethal 
        medical concerns, including drug allergies and contraindications.
            (3) The importance of prominently displaying information about a 
        patient's opioid use disorder when a physician or medical professional 
        is prescribing medication, including methods for avoiding alert fatigue 
        in providers.
            (4) The importance of a variety of appropriate medical 
        professionals, including physicians, nurses, and pharmacists, having 
        access to information described in this section when prescribing or 
        dispensing opioid medication, consistent with Federal and State laws and 
        regulations.
            (5) The importance of protecting patient privacy, including the 
        requirements related to consent for disclosure of substance use disorder 
        information under all applicable laws and regulations.
            (6) All applicable Federal and State laws and regulations.

SEC. 7052. COMMUNICATION WITH FAMILIES DURING EMERGENCIES.

    (a)  Promoting Awareness of Authorized Disclosures During Emergencies.--The 
Secretary of Health and Human Services shall annually notify health care 
providers regarding permitted disclosures under Federal health care privacy law 
during emergencies, including overdoses, of certain health information to 
families, caregivers, and health care providers.
    (b) Use of Material.--For the purposes of carrying out subsection (a), the 
Secretary of Health and Human Services may use material produced under section 
7053 of this Act or section 11004 of the 21st Century Cures Act (42 U.S.C. 
1320d-2 note).

SEC. 7053. DEVELOPMENT AND DISSEMINATION OF MODEL TRAINING PROGRAMS FOR 
              SUBSTANCE USE DISORDER PATIENT RECORDS.

    (a) Initial Programs and Materials.--Not later than 1 year after the date of 
the enactment of this Act, the Secretary of Health and Human Services (in this 
section referred to as the ``Secretary''), in consultation with appropriate 
experts, shall identify the following model programs and materials (or if no 
such programs or materials exist, recognize private or public entities to 
develop and disseminate such programs and materials):
            (1) Model programs and materials for training health care providers 
        (including physicians, emergency medical personnel, psychiatrists, 
        psychologists, counselors, therapists, nurse practitioners, physician 
        assistants, behavioral health facilities and clinics, care managers, and 
        hospitals, including individuals such as general counsels or regulatory 
        compliance staff who are responsible for establishing provider privacy 
        policies) concerning the permitted uses and disclosures, consistent with 
        the standards and regulations governing the privacy and security of 
        substance use disorder patient records promulgated by the Secretary 
        under section 543 of the Public Health Service Act (42 U.S.C. 290dd-2) 
        for the confidentiality of patient records.
            (2) Model programs and materials for training patients and their 
        families regarding their rights to protect and obtain information under 
        the standards and regulations described in paragraph (1).
    (b) Requirements.--The model programs and materials described in paragraphs 
(1) and (2) of subsection (a) shall address circumstances under which disclosure 
of substance use disorder patient records is needed to--
            (1) facilitate communication between substance use disorder 
        treatment providers and other health care providers to promote and 
        provide the best possible integrated care;
            (2) avoid inappropriate prescribing that can lead to dangerous drug 
        interactions, overdose, or relapse; and
            (3) notify and involve families and caregivers when individuals 
        experience an overdose.
    (c) Periodic Updates.--The Secretary shall--
            (1) periodically review and update the model program and materials 
        identified or developed under subsection (a); and
            (2) disseminate such updated programs and materials to the 
        individuals described in subsection (a)(1).
    (d) Input of Certain Entities.--In identifying, reviewing, or updating the 
model programs and materials under this section, the Secretary shall solicit the 
input of relevant stakeholders.
    (e) Authorization of Appropriations.--There is authorized to be appropriated 
to carry out this section--
            (1) $4,000,000 for fiscal year 2019;
            (2) $2,000,000 for each of fiscal years 2020 and 2021; and
            (3) $1,000,000 for each of fiscal years 2022 and 2023.

                Subtitle G--Protecting Pregnant Women and Infants

SEC. 7061. REPORT ON ADDRESSING MATERNAL AND INFANT HEALTH IN THE OPIOID CRISIS.

    (a) In General.--Not later than 18 months after the date of the enactment of 
this Act, the Secretary of Health and Human Services, in coordination with the 
Centers for Disease Control and Prevention, the National Institutes of Health, 
the Indian Health Service, and the Substance Abuse and Mental Health Services 
Administration, shall develop and submit to the Committee on Health, Education, 
Labor, and Pensions of the Senate and the Committee on Energy and Commerce of 
the House of Representatives a report that includes--
            (1) information on opioid, non-opioid, and non-pharmacologic pain 
        management practices during pregnancy and after pregnancy;
            (2) recommendations for increasing public awareness and education 
        about substance use disorders, including opioid use disorders, during 
        and after pregnancy, including available treatment resources in urban 
        and rural areas;
            (3) recommendations to prevent, identify, and reduce substance use 
        disorders, including opioid use disorders, during pregnancy to improve 
        care for pregnant women with substance use disorders and their infants; 
        and
            (4) an identification of areas in need of further research with 
        respect to acute and chronic pain management during and after pregnancy.
    (b) No Additional Funds.--No additional funds are authorized to be 
appropriated for purposes of carrying out subsection (a).

SEC. 7062. PROTECTING MOMS AND INFANTS.

    (a) Report.--
            (1) In general.--Not later than 60 days after the date of enactment 
        of this Act, the Secretary of Health and Human Services (referred to in 
        this section as the ``Secretary'') shall submit to the Committee on 
        Health, Education, Labor, and Pensions of the Senate and the Committee 
        on Energy and Commerce of the House of Representatives, and make 
        available to the public on the Internet website of the Department of 
        Health and Human Services, a report regarding the implementation of the 
        recommendations in the strategy relating to prenatal opioid use, 
        including neonatal abstinence syndrome, developed pursuant to section 2 
        of the Protecting Our Infants Act of 2015 (Public Law 114-91). Such 
        report shall include--
                    (A) an update on the implementation of the recommendations 
                in the strategy, including information regarding the agencies 
                involved in the implementation; and
                    (B) information on additional funding or authority the 
                Secretary requires, if any, to implement the strategy, which may 
                include authorities needed to coordinate implementation of such 
                strategy across the Department of Health and Human Services.
            (2) Periodic updates.--The Secretary shall periodically update the 
        report under paragraph (1).
    (b) Residential Treatment Programs for Pregnant and Postpartum Women.--
Section 508(s) of the Public Health Service Act (42 U.S.C. 290bb-1(s)) is 
amended by striking ``$16,900,000 for each of fiscal years 2017 through 2021'' 
and inserting ``$29,931,000 for each of fiscal years 2019 through 2023''.

SEC. 7063. EARLY INTERVENTIONS FOR PREGNANT WOMEN AND INFANTS.

    (a) Development of Educational Materials by Center for Substance Abuse 
Prevention.--Section 515(b) of the Public Health Service Act (42 U.S.C. 290bb-
21(b)) is amended--
            (1) in paragraph (13), by striking ``and'' at the end;
            (2) in paragraph (14), by striking the period at the end and 
        inserting ``; and''; and
            (3) by adding at the end the following:
            ``(15) in consultation with relevant stakeholders and in 
        collaboration with the Director of the Centers for Disease Control and 
        Prevention, develop educational materials for clinicians to use with 
        pregnant women for shared decision making regarding pain management and 
        the prevention of substance use disorders during pregnancy.''.
    (b) Guidelines and Recommendations by Center for Substance Abuse 
Treatment.--Section 507(b) of the Public Health Service Act (42 U.S.C. 290bb(b)) 
is amended--
            (1) in paragraph (13), by striking ``and'' at the end;
            (2) in paragraph (14), by striking the period at the end and 
        inserting a semicolon; and
            (3) by adding at the end the following:
            ``(15) in cooperation with the Secretary, implement and disseminate, 
        as appropriate, the recommendations in the report entitled `Protecting 
        Our Infants Act: Final Strategy' issued by the Department of Health and 
        Human Services in 2017; and''.
    (c) Support of Partnerships by Center for Substance Abuse Treatment.--
Section 507(b) of the Public Health Service Act (42 U.S.C. 290bb(b)), as amended 
by subsection (b), is further amended by adding at the end the following:
            ``(16) in cooperation with relevant stakeholders, and through 
        public-private partnerships, encourage education about substance use 
        disorders for pregnant women and health care providers who treat 
        pregnant women and babies.''.

SEC. 7064. PRENATAL AND POSTNATAL HEALTH.

    Section 317L of the Public Health Service Act (42 U.S.C. 247b-13) is 
amended--
            (1) in subsection (a)--
                    (A) by amending paragraph (1) to read as follows:
            ``(1) to collect, analyze, and make available data on prenatal 
        smoking and alcohol and other substance abuse and misuse, including--
                    ``(A) data on--
                            ``(i) the incidence, prevalence, and implications of 
                        such activities; and
                            ``(ii) the incidence and prevalence of implications 
                        and outcomes, including neonatal abstinence syndrome and 
                        other maternal and child health outcomes associated with 
                        such activities; and
                    ``(B) additional information or data, as appropriate, on 
                family health history, medication exposures during pregnancy, 
                demographic information, such as race, ethnicity, geographic 
                location, and family history, and other relevant information, to 
                inform such analysis;'';
                    (B) in paragraph (2)--
                            (i) by striking ``prevention of'' and inserting 
                        ``prevention and long-term outcomes associated with''; 
                        and
                            (ii) by striking ``illegal drug use'' and inserting 
                        ``other substance abuse and misuse'';
                    (C) in paragraph (3), by striking ``and cessation programs; 
                and'' and inserting ``, treatment, and cessation programs;'';
                    (D) in paragraph (4), by striking ``illegal drug use.'' and 
                inserting ``other substance abuse and misuse; and''; and
                    (E) by adding at the end the following:
            ``(5) to issue public reports on the analysis of data described in 
        paragraph (1), including analysis of--
                    ``(A) long-term outcomes of children affected by neonatal 
                abstinence syndrome;
                    ``(B) health outcomes associated with prenatal smoking, 
                alcohol, and substance abuse and misuse; and
                    ``(C) relevant studies, evaluations, or information the 
                Secretary determines to be appropriate.'';
            (2) in subsection (b), by inserting ``tribal entities,'' after 
        ``local governments,'';
            (3) by redesignating subsection (c) as subsection (d);
            (4) by inserting after subsection (b) the following:
    ``(c) Coordinating Activities.--To carry out this section, the Secretary 
may--
            ``(1) provide technical and consultative assistance to entities 
        receiving grants under subsection (b);
            ``(2) ensure a pathway for data sharing between States, tribal 
        entities, and the Centers for Disease Control and Prevention;
            ``(3) ensure data collection under this section is consistent with 
        applicable State, Federal, and Tribal privacy laws; and
            ``(4) coordinate with the National Coordinator for Health 
        Information Technology, as appropriate, to assist States and Tribes in 
        implementing systems that use standards recognized by such National 
        Coordinator, as such recognized standards are available, in order to 
        facilitate interoperability between such systems and health information 
        technology systems, including certified health information 
        technology.''; and
            (5) in subsection (d), as so redesignated, by striking ``2001 
        through 2005'' and inserting ``2019 through 2023''.

SEC. 7065. PLANS OF SAFE CARE.

    (a) In General.--Section 105(a) of the Child Abuse Prevention and Treatment 
Act (42 U.S.C. 5106(a)) is amended by adding at the end the following:
            ``(7) Grants to states to improve and coordinate their response to 
        ensure the safety, permanency, and well-being of infants affected by 
        substance use.--
                    ``(A) Program authorized.--The Secretary is authorized to 
                make grants to States for the purpose of assisting child welfare 
                agencies, social services agencies, substance use disorder 
                treatment agencies, hospitals with labor and delivery units, 
                medical staff, public health and mental health agencies, and 
                maternal and child health agencies to facilitate collaboration 
                in developing, updating, implementing, and monitoring plans of 
                safe care described in section 106(b)(2)(B)(iii). Section 
                112(a)(2) shall not apply to the program authorized under this 
                paragraph.
                    ``(B) Distribution of funds.--
                            ``(i) Reservations.--Of the amounts made available 
                        to carry out subparagraph (A), the Secretary shall 
                        reserve--
                                    ``(I) no more than 3 percent for the 
                                purposes described in subparagraph (G); and
                                    ``(II) up to 3 percent for grants to Indian 
                                Tribes and tribal organizations to address the 
                                needs of infants born with, and identified as 
                                being affected by, substance abuse or withdrawal 
                                symptoms resulting from prenatal drug exposure 
                                or a fetal alcohol spectrum disorder and their 
                                families or caregivers, which to the extent 
                                practicable, shall be consistent with the uses 
                                of funds described under subparagraph (D).
                            ``(ii) Allotments to states and territories.--The 
                        Secretary shall allot the amount made available to carry 
                        out subparagraph (A) that remains after application of 
                        clause (i) to each State that applies for such a grant, 
                        in an amount equal to the sum of--
                                    ``(I) $500,000; and
                                    ``(II) an amount that bears the same 
                                relationship to any funds made available to 
                                carry out subparagraph (A) and remaining after 
                                application of clause (i), as the number of live 
                                births in the State in the previous calendar 
                                year bears to the number of live births in all 
                                States in such year.
                            ``(iii) Ratable reduction.--If the amount made 
                        available to carry out subparagraph (A) is insufficient 
                        to satisfy the requirements of clause (ii), the 
                        Secretary shall ratably reduce each allotment to a 
                        State.
                    ``(C) Application.--A State desiring a grant under this 
                paragraph shall submit an application to the Secretary at such 
                time and in such manner as the Secretary may require. Such 
                application shall include--
                            ``(i) a description of--
                                    ``(I) the impact of substance use disorder 
                                in such State, including with respect to the 
                                substance or class of substances with the 
                                highest incidence of abuse in the previous year 
                                in such State, including--
                                            ``(aa) the prevalence of substance 
                                        use disorder in such State;
                                            ``(bb) the aggregate rate of births 
                                        in the State of infants affected by 
                                        substance abuse or withdrawal symptoms 
                                        or a fetal alcohol spectrum disorder (as 
                                        determined by hospitals, insurance 
                                        claims, claims submitted to the State 
                                        Medicaid program, or other records), if 
                                        available and to the extent practicable; 
                                        and
                                            ``(cc) the number of infants 
                                        identified, for whom a plan of safe care 
                                        was developed, and for whom a referral 
                                        was made for appropriate services, as 
                                        reported under section 106(d)(18);
                                    ``(II) the challenges the State faces in 
                                developing, implementing, and monitoring plans 
                                of safe care in accordance with section 
                                106(b)(2)(B)(iii);
                                    ``(III) the State's lead agency for the 
                                grant program and how that agency will 
                                coordinate with relevant State entities and 
                                programs, including the child welfare agency, 
                                the substance use disorder treatment agency, 
                                hospitals with labor and delivery units, health 
                                care providers, the public health and mental 
                                health agencies, programs funded by the 
                                Substance Abuse and Mental Health Services 
                                Administration that provide substance use 
                                disorder treatment for women, the State Medicaid 
                                program, the State agency administering the 
                                block grant program under title V of the Social 
                                Security Act (42 U.S.C. 701 et seq.), the State 
                                agency administering the programs funded under 
                                part C of the Individuals with Disabilities 
                                Education Act (20 U.S.C. 1431 et seq.), the 
                                maternal, infant, and early childhood home 
                                visiting program under section 511 of the Social 
                                Security Act (42 U.S.C. 711), the State judicial 
                                system, and other agencies, as determined by the 
                                Secretary, and Indian Tribes and tribal 
                                organizations, as appropriate, to implement the 
                                activities under this paragraph;
                                    ``(IV) how the State will monitor local 
                                development and implementation of plans of safe 
                                care, in accordance with section 
                                106(b)(2)(B)(iii)(II), including how the State 
                                will monitor to ensure plans of safe care 
                                address differences between substance use 
                                disorder and medically supervised substance use, 
                                including for the treatment of a substance use 
                                disorder;
                                    ``(V) if applicable, how the State plans to 
                                utilize funding authorized under part E of title 
                                IV of the Social Security Act (42 U.S.C. 670 et 
                                seq.) to assist in carrying out any plan of safe 
                                care, including such funding authorized under 
                                section 471(e) of such Act (as in effect on 
                                October 1, 2018) for mental health and substance 
                                abuse prevention and treatment services and in-
                                home parent skill-based programs and funding 
                                authorized under such section 472(j) (as in 
                                effect on October 1, 2018) for children with a 
                                parent in a licensed residential family-based 
                                treatment facility for substance abuse; and
                                    ``(VI) an assessment of the treatment and 
                                other services and programs available in the 
                                State to effectively carry out any plan of safe 
                                care developed, including identification of 
                                needed treatment, and other services and 
                                programs to ensure the well-being of young 
                                children and their families affected by 
                                substance use disorder, such as programs carried 
                                out under part C of the Individuals with 
                                Disabilities Education Act (20 U.S.C. 1431 et 
                                seq.) and comprehensive early childhood 
                                development services and programs such as Head 
                                Start programs;
                            ``(ii) a description of how the State plans to use 
                        funds for activities described in subparagraph (D) for 
                        the purposes of ensuring State compliance with 
                        requirements under clauses (ii) and (iii) of section 
                        106(b)(2)(B); and
                            ``(iii) an assurance that the State will comply with 
                        requirements to refer a child identified as substance-
                        exposed to early intervention services as required 
                        pursuant to a grant under part C of the Individuals with 
                        Disabilities Education Act (20 U.S.C. 1431 et seq.).
                    ``(D) Uses of funds.--Funds awarded to a State under this 
                paragraph may be used for the following activities, which may be 
                carried out by the State directly, or through grants or 
                subgrants, contracts, or cooperative agreements:
                            ``(i) Improving State and local systems with respect 
                        to the development and implementation of plans of safe 
                        care, which--
                                    ``(I) shall include parent and caregiver 
                                engagement, as required under section 
                                106(b)(2)(B)(iii)(I), regarding available 
                                treatment and service options, which may include 
                                resources available for pregnant, perinatal, and 
                                postnatal women; and
                                    ``(II) may include activities such as--
                                            ``(aa) developing policies, 
                                        procedures, or protocols for the 
                                        administration or development of 
                                        evidence-based and validated screening 
                                        tools for infants who may be affected by 
                                        substance use withdrawal symptoms or a 
                                        fetal alcohol spectrum disorder and 
                                        pregnant, perinatal, and postnatal women 
                                        whose infants may be affected by 
                                        substance use withdrawal symptoms or a 
                                        fetal alcohol spectrum disorder;
                                            ``(bb) improving assessments used to 
                                        determine the needs of the infant and 
                                        family;
                                            ``(cc) improving ongoing case 
                                        management services;
                                            ``(dd) improving access to treatment 
                                        services, which may be prior to the 
                                        pregnant woman's delivery date; and
                                            ``(ee) keeping families safely 
                                        together when it is in the best interest 
                                        of the child.
                            ``(ii) Developing policies, procedures, or protocols 
                        in consultation and coordination with health 
                        professionals, public and private health facilities, and 
                        substance use disorder treatment agencies to ensure 
                        that--
                                    ``(I) appropriate notification to child 
                                protective services is made in a timely manner, 
                                as required under section 106(b)(2)(B)(ii);
                                    ``(II) a plan of safe care is in place, in 
                                accordance with section 106(b)(2)(B)(iii), 
                                before the infant is discharged from the birth 
                                or health care facility; and
                                    ``(III) such health and related agency 
                                professionals are trained on how to follow such 
                                protocols and are aware of the supports that may 
                                be provided under a plan of safe care.
                            ``(iii) Training health professionals and health 
                        system leaders, child welfare workers, substance use 
                        disorder treatment agencies, and other related 
                        professionals such as home visiting agency staff and law 
                        enforcement in relevant topics including--
                                    ``(I) State mandatory reporting laws 
                                established under section 106(b)(2)(B)(i) and 
                                the referral and process requirements for 
                                notification to child protective services when 
                                child abuse or neglect reporting is not 
                                mandated;
                                    ``(II) the co-occurrence of pregnancy and 
                                substance use disorder, and implications of 
                                prenatal exposure;
                                    ``(III) the clinical guidance about treating 
                                substance use disorder in pregnant and 
                                postpartum women;
                                    ``(IV) appropriate screening and 
                                interventions for infants affected by substance 
                                use disorder, withdrawal symptoms, or a fetal 
                                alcohol spectrum disorder and the requirements 
                                under section 106(b)(2)(B)(iii); and
                                    ``(V) appropriate multigenerational 
                                strategies to address the mental health needs of 
                                the parent and child together.
                            ``(iv) Establishing partnerships, agreements, or 
                        memoranda of understanding between the lead agency and 
                        other entities (including health professionals, health 
                        facilities, child welfare professionals, juvenile and 
                        family court judges, substance use and mental disorder 
                        treatment programs, early childhood education programs, 
                        maternal and child health and early intervention 
                        professionals (including home visiting providers), peer-
                        to-peer recovery programs such as parent mentoring 
                        programs, and housing agencies) to facilitate the 
                        implementation of, and compliance with, section 
                        106(b)(2) and clause (ii) of this subparagraph, in areas 
                        which may include--
                                    ``(I) developing a comprehensive, multi-
                                disciplinary assessment and intervention process 
                                for infants, pregnant women, and their families 
                                who are affected by substance use disorder, 
                                withdrawal symptoms, or a fetal alcohol spectrum 
                                disorder, that includes meaningful engagement 
                                with and takes into account the unique needs of 
                                each family and addresses differences between 
                                medically supervised substance use, including 
                                for the treatment of substance use disorder, and 
                                substance use disorder;
                                    ``(II) ensuring that treatment approaches 
                                for serving infants, pregnant women, and 
                                perinatal and postnatal women whose infants may 
                                be affected by substance use, withdrawal 
                                symptoms, or a fetal alcohol spectrum disorder, 
                                are designed to, where appropriate, keep infants 
                                with their mothers during both inpatient and 
                                outpatient treatment; and
                                    ``(III) increasing access to all evidence-
                                based medication-assisted treatment approved by 
                                the Food and Drug Administration, behavioral 
                                therapy, and counseling services for the 
                                treatment of substance use disorders, as 
                                appropriate.
                            ``(v) Developing and updating systems of technology 
                        for improved data collection and monitoring under 
                        section 106(b)(2)(B)(iii), including existing electronic 
                        medical records, to measure the outcomes achieved 
                        through the plans of safe care, including monitoring 
                        systems to meet the requirements of this Act and 
                        submission of performance measures.
                    ``(E) Reporting.--Each State that receives funds under this 
                paragraph, for each year such funds are received, shall submit a 
                report to the Secretary, disaggregated by geographic location, 
                economic status, and major racial and ethnic groups, except that 
                such disaggregation shall not be required if the results would 
                reveal personally identifiable information on, with respect to 
                infants identified under section 106(b)(2)(B)(ii)--
                            ``(i) the number who experienced removal associated 
                        with parental substance use;
                            ``(ii) the number who experienced removal and 
                        subsequently are reunified with parents, and the length 
                        of time between such removal and reunification;
                            ``(iii) the number who are referred to community 
                        providers without a child protection case;
                            ``(iv) the number who receive services while in the 
                        care of their birth parents;
                            ``(v) the number who receive post-reunification 
                        services within 1 year after a reunification has 
                        occurred; and
                            ``(vi) the number who experienced a return to out-
                        of-home care within 1 year after reunification.
                    ``(F) Secretary's report to congress.--The Secretary shall 
                submit an annual report to the Committee on Health, Education, 
                Labor, and Pensions and the Committee on Appropriations of the 
                Senate and the Committee on Education and the Workforce and the 
                Committee on Appropriations of the House of Representatives that 
                includes the information described in subparagraph (E) and 
                recommendations or observations on the challenges, successes, 
                and lessons derived from implementation of the grant program.
                    ``(G) Assisting states' implementation.--The Secretary shall 
                use the amount reserved under subparagraph (B)(i)(I) to provide 
                written guidance and technical assistance to support States in 
                complying with and implementing this paragraph, which shall 
                include--
                            ``(i) technical assistance, including programs of 
                        in-depth technical assistance, to additional States, 
                        territories, and Indian Tribes and tribal organizations 
                        in accordance with the substance-exposed infant 
                        initiative developed by the National Center on Substance 
                        Abuse and Child Welfare;
                            ``(ii) guidance on the requirements of this Act with 
                        respect to infants born with and identified as being 
                        affected by substance use or withdrawal symptoms or 
                        fetal alcohol spectrum disorder, as described in clauses 
                        (ii) and (iii) of section 106(b)(2)(B), including by--
                                    ``(I) enhancing States' understanding of 
                                requirements and flexibilities under the law, 
                                including by clarifying key terms;
                                    ``(II) addressing state-identified 
                                challenges with developing, implementing, and 
                                monitoring plans of safe care, including those 
                                reported under subparagraph (C)(i)(II);
                                    ``(III) disseminating best practices on 
                                implementation of plans of safe care, on such 
                                topics as differential response, collaboration 
                                and coordination, and identification and 
                                delivery of services for different populations, 
                                while recognizing needs of different populations 
                                and varying community approaches across States; 
                                and
                                    ``(IV) helping States improve the long-term 
                                safety and well-being of young children and 
                                their families;
                            ``(iii) supporting State efforts to develop 
                        information technology systems to manage plans of safe 
                        care; and
                            ``(iv) preparing the Secretary's report to Congress 
                        described in subparagraph (F).
                    ``(H) Sunset.--The authority under this paragraph shall 
                sunset on September 30, 2023.''.
    (b) Repeal.--The Abandoned Infants Assistance Act of 1988 (42 U.S.C. 5117aa 
et seq.) is repealed.

             Subtitle H--Substance Use Disorder Treatment Workforce

SEC. 7071. LOAN REPAYMENT PROGRAM FOR SUBSTANCE USE DISORDER TREATMENT 
              WORKFORCE.

    Title VII of the Public Health Service Act is amended--
            (1) by redesignating part F as part G; and
            (2) by inserting after part E (42 U.S.C. 294n et seq.) the 
        following:

              ``PART F--SUBSTANCE USE DISORDER TREATMENT WORKFORCE

``SEC. 781. LOAN REPAYMENT PROGRAM FOR SUBSTANCE USE DISORDER TREATMENT 
              WORKFORCE.

    ``(a) In General.--The Secretary, acting through the Administrator of the 
Health Resources and Services Administration, shall carry out a program under 
which--
            ``(1) the Secretary enters into agreements with individuals to make 
        payments in accordance with subsection (b) on the principal of and 
        interest on any eligible loan; and
            ``(2) the individuals each agree to the requirements of service in 
        substance use disorder treatment employment, as described in subsection 
        (d).
    ``(b) Payments.--For each year of obligated service by an individual 
pursuant to an agreement under subsection (a), the Secretary shall make a 
payment to such individual as follows:
            ``(1) Service in a shortage area.--The Secretary shall pay--
                    ``(A) for each year of obligated service by an individual 
                pursuant to an agreement under subsection (a), \1/6\ of the 
                principal of and interest on each eligible loan of the 
                individual which is outstanding on the date the individual began 
                service pursuant to the agreement; and
                    ``(B) for completion of the sixth and final year of such 
                service, the remainder of such principal and interest.
            ``(2) Maximum amount.--The total amount of payments under this 
        section to any individual shall not exceed $250,000.
    ``(c) Eligible Loans.--The loans eligible for repayment under this section 
are each of the following:
            ``(1) Any loan for education or training for a substance use 
        disorder treatment employment.
            ``(2) Any loan under part E of title VIII (relating to nursing 
        student loans).
            ``(3) Any Federal Direct Stafford Loan, Federal Direct PLUS Loan, 
        Federal Direct Unsubsidized Stafford Loan, or Federal Direct 
        Consolidation Loan (as such terms are used in section 455 of the Higher 
        Education Act of 1965).
            ``(4) Any Federal Perkins Loan under part E of title I of the Higher 
        Education Act of 1965.
            ``(5) Any other Federal loan as determined appropriate by the 
        Secretary.
    ``(d) Requirements of Service.--Any individual receiving payments under this 
program as required by an agreement under subsection (a) shall agree to an 
annual commitment to full-time employment, with no more than 1 year passing 
between any 2 years of covered employment, in substance use disorder treatment 
employment in the United States in--
            ``(1) a Mental Health Professional Shortage Area, as designated 
        under section 332; or
            ``(2) a county (or a municipality, if not contained within any 
        county) where the mean drug overdose death rate per 100,000 people over 
        the past 3 years for which official data is available from the State, is 
        higher than the most recent available national average overdose death 
        rate per 100,000 people, as reported by the Centers for Disease Control 
        and Prevention.
    ``(e) Ineligibility for Double Benefits.--No borrower may, for the same 
service, receive a reduction of loan obligations or a loan repayment under 
both--
            ``(1) this section; and
            ``(2) any Federally supported loan forgiveness program, including 
        under section 338B, 338I, or 846 of this Act, or section 428J, 428L, 
        455(m), or 460 of the Higher Education Act of 1965.
    ``(f) Breach.--
            ``(1) Liquidated damages formula.--The Secretary may establish a 
        liquidated damages formula to be used in the event of a breach of an 
        agreement entered into under subsection (a).
            ``(2) Limitation.--The failure by an individual to complete the full 
        period of service obligated pursuant to such an agreement, taken alone, 
        shall not constitute a breach of the agreement, so long as the 
        individual completed in good faith the years of service for which 
        payments were made to the individual under this section.
    ``(g) Additional Criteria.--The Secretary--
            ``(1) may establish such criteria and rules to carry out this 
        section as the Secretary determines are needed and in addition to the 
        criteria and rules specified in this section; and
            ``(2) shall give notice to the committees specified in subsection 
        (h) of any criteria and rules so established.
    ``(h) Report to Congress.--Not later than 5 years after the date of 
enactment of this section, and every other year thereafter, the Secretary shall 
prepare and submit to the Committee on Energy and Commerce of the House of 
Representatives and the Committee on Health, Education, Labor, and Pensions of 
the Senate a report on--
            ``(1) the number and location of borrowers who have qualified for 
        loan repayments under this section; and
            ``(2) the impact of this section on the availability of substance 
        use disorder treatment employees nationally and in shortage areas and 
        counties described in subsection (d).
    ``(i) Definition.--In this section:
            ``(1) The terms `Indian tribe' and `tribal organization' have the 
        meanings given those terms in section 4 of the Indian Self-Determination 
        and Education Assistance Act.
            ``(2) The term `municipality' means a city, town, or other public 
        body created by or pursuant to State law, or an Indian tribe.
            ``(3) The term `substance use disorder treatment employment' means 
        full-time employment (including a fellowship)--
                    ``(A) where the primary intent and function of the position 
                is the direct treatment or recovery support of patients with or 
                in recovery from a substance use disorder, including master's 
                level social workers, psychologists, counselors, marriage and 
                family therapists, psychiatric mental health practitioners, 
                occupational therapists, psychology doctoral interns, and 
                behavioral health paraprofessionals and physicians, physician 
                assistants, and nurses, who are licensed or certified in 
                accordance with applicable State and Federal laws; and
                    ``(B) which is located at a substance use disorder treatment 
                program, private physician practice, hospital or health system-
                affiliated inpatient treatment center or outpatient clinic 
                (including an academic medical center-affiliated treatment 
                program), correctional facility or program, youth detention 
                center or program, inpatient psychiatric facility, crisis 
                stabilization unit, community health center, community mental 
                health or other specialty community behavioral health center, 
                recovery center, school, community-based organization, 
                telehealth platform, migrant health center, health program or 
                facility operated by an Indian tribe or tribal organization, 
                Federal medical facility, or any other facility as determined 
                appropriate for purposes of this section by the Secretary.
    ``(j) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $25,000,000 for each of fiscal years 2019 
through 2023.''.

SEC. 7072. CLARIFICATION REGARDING SERVICE IN SCHOOLS AND OTHER COMMUNITY-BASED 
              SETTINGS.

    Subpart III of part D of title III of the Public Health Service Act (42 
U.S.C. 254l et seq.) is amended by adding at the end the following:

``SEC. 338N. CLARIFICATION REGARDING SERVICE IN SCHOOLS AND OTHER COMMUNITY-
              BASED SETTINGS.

    ``(a) Schools and Community-based Settings.--An entity to which a 
participant in the Scholarship Program or the Loan Repayment Program (referred 
to in this section as a `participant') is assigned under section 333 may direct 
such participant to provide service as a behavioral or mental health 
professional at a school or other community-based setting located in a health 
professional shortage area.
    ``(b) Obligated Service.--
            ``(1) In general.--Any service described in subsection (a) that a 
        participant provides may count towards such participant's completion of 
        any obligated service requirements under the Scholarship Program or the 
        Loan Repayment Program, subject to any limitation imposed under 
        paragraph (2).
            ``(2) Limitation.--The Secretary may impose a limitation on the 
        number of hours of service described in subsection (a) that a 
        participant may credit towards completing obligated service 
        requirements, provided that the limitation allows a member to credit 
        service described in subsection (a) for not less than 50 percent of the 
        total hours required to complete such obligated service requirements.
    ``(c) Rule of Construction.--The authorization under subsection (a) shall be 
notwithstanding any other provision of this subpart or subpart II.''.

SEC. 7073. PROGRAMS FOR HEALTH CARE WORKFORCE.

    (a) Program for Education and Training in Pain Care.--Section 759 of the 
Public Health Service Act (42 U.S.C. 294i) is amended--
            (1) in subsection (a), by striking ``hospices, and other public and 
        private entities'' and inserting ``hospices, tribal health programs (as 
        defined in section 4 of the Indian Health Care Improvement Act), and 
        other public and nonprofit private entities'';
            (2) in subsection (b)--
                    (A) in the matter preceding paragraph (1), by striking 
                ``award may be made under subsection (a) only if the applicant 
                for the award agrees that the program carried out with the award 
                will include'' and inserting ``entity receiving an award under 
                this section shall develop a comprehensive education and 
                training plan that includes'';
                    (B) in paragraph (1)--
                            (i) by inserting ``preventing,'' after 
                        ``diagnosing,''; and
                            (ii) by inserting ``non-addictive medical products 
                        and non-pharmacologic treatments and'' after 
                        ``including'';
                    (C) in paragraph (2)--
                            (i) by inserting ``Federal, State, and local'' after 
                        ``applicable''; and
                            (ii) by striking ``the degree to which'' and all 
                        that follows through ``effective pain care'' and 
                        inserting ``opioids'';
                    (D) in paragraph (3), by inserting ``, integrated, evidence-
                based pain management, and, as appropriate, non-
                pharmacotherapy'' before the semicolon;
                    (E) in paragraph (4), by striking ``; and'' and inserting 
                ``;''; and
                    (F) by striking paragraph (5) and inserting the following:
            ``(5) recent findings, developments, and advancements in pain care 
        research and the provision of pain care, which may include non-addictive 
        medical products and non-pharmacologic treatments intended to treat 
        pain; and
            ``(6) the dangers of opioid abuse and misuse, detection of early 
        warning signs of opioid use disorders (which may include best practices 
        related to screening for opioid use disorders, training on screening, 
        brief intervention, and referral to treatment), and safe disposal 
        options for prescription medications (including such options provided by 
        law enforcement or other innovative deactivation mechanisms).'';
            (3) in subsection (d), by inserting ``prevention,'' after 
        ``diagnosis,''; and
            (4) in subsection (e), by striking ``2010 through 2012'' and 
        inserting ``2019 through 2023''.
    (b) Mental and Behavioral Health Education and Training Program.--Section 
756 of the Public Health Service Act (42 U.S.C. 294e-1) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by inserting ``, trauma,'' after 
                ``focus on child and adolescent mental health''; and
                    (B) in paragraphs (2) and (3), by inserting ``trauma-
                informed care and'' before ``substance use disorder prevention 
                and treatment services''; and
            (2) in subsection (f), by striking ``2018 through 2022'' and 
        inserting ``2019 through 2023''.

            Subtitle I--Preventing Overdoses While in Emergency Rooms

SEC. 7081. PROGRAM TO SUPPORT COORDINATION AND CONTINUATION OF CARE FOR DRUG 
              OVERDOSE PATIENTS.

    (a) In General.--The Secretary of Health and Human Services (referred to in 
this section as the ``Secretary'') shall identify or facilitate the development 
of best practices for--
            (1) emergency treatment of known or suspected drug overdose;
            (2) the use of recovery coaches, as appropriate, to encourage 
        individuals who experience a non-fatal overdose to seek treatment for 
        substance use disorder and to support coordination and continuation of 
        care;
            (3) coordination and continuation of care and treatment, including, 
        as appropriate, through referrals, of individuals after a drug overdose; 
        and
            (4) the provision or prescribing of overdose reversal medication, as 
        appropriate.
    (b) Grant Establishment and Participation.--
            (1) In general.--The Secretary shall award grants on a competitive 
        basis to eligible entities to support implementation of voluntary 
        programs for care and treatment of individuals after a drug overdose, as 
        appropriate, which may include implementation of the best practices 
        described in subsection (a).
            (2) Eligible entity.--In this section, the term ``eligible entity'' 
        means--
                    (A) a State substance abuse agency;
                    (B) an Indian Tribe or tribal organization; or
                    (C) an entity that offers treatment or other services for 
                individuals in response to, or following, drug overdoses or a 
                drug overdose, such as an emergency department, in consultation 
                with a State substance abuse agency.
            (3) Application.--An eligible entity desiring a grant under this 
        section shall submit an application to the Secretary, at such time and 
        in such manner as the Secretary may require, that includes--
                    (A) evidence that such eligible entity carries out, or is 
                capable of contracting and coordinating with other community 
                entities to carry out, the activities described in paragraph 
                (4);
                    (B) evidence that such eligible entity will work with a 
                recovery community organization to recruit, train, hire, mentor, 
                and supervise recovery coaches and fulfill the requirements 
                described in paragraph (4)(A); and
                    (C) such additional information as the Secretary may 
                require.
            (4) Use of grant funds.--An eligible entity awarded a grant under 
        this section shall use such grant funds to--
                    (A) hire or utilize recovery coaches to help support 
                recovery, including by--
                            (i) connecting patients to a continuum of care 
                        services, such as--
                                    (I) treatment and recovery support programs;
                                    (II) programs that provide non-clinical 
                                recovery support services;
                                    (III) peer support networks;
                                    (IV) recovery community organizations;
                                    (V) health care providers, including 
                                physicians and other providers of behavioral 
                                health and primary care;
                                    (VI) education and training providers;
                                    (VII) employers;
                                    (VIII) housing services; and
                                    (IX) child welfare agencies;
                            (ii) providing education on overdose prevention and 
                        overdose reversal to patients and families, as 
                        appropriate;
                            (iii) providing follow-up services for patients 
                        after an overdose to ensure continued recovery and 
                        connection to support services;
                            (iv) collecting and evaluating outcome data for 
                        patients receiving recovery coaching services; and
                            (v) providing other services the Secretary 
                        determines necessary to help ensure continued connection 
                        with recovery support services, including culturally 
                        appropriate services, as applicable;
                    (B) establish policies and procedures, pursuant to Federal 
                and State law, that address the provision of overdose reversal 
                medication, the administration of all drugs or devices approved 
                or cleared under the Federal Food, Drug, and Cosmetic Act (21 
                U.S.C. 301 et seq.) and all biological products licensed under 
                section 351 of the Public Health Service Act (42 U.S.C. 262) to 
                treat substance use disorder, and subsequent continuation of, or 
                referral to, evidence-based treatment for patients with a 
                substance use disorder who have experienced a non-fatal drug 
                overdose, in order to support long-term treatment, prevent 
                relapse, and reduce recidivism and future overdose; and
                    (C) establish integrated models of care for individuals who 
                have experienced a non-fatal drug overdose which may include 
                patient assessment, follow up, and transportation to and from 
                treatment facilities.
            (5) Additional permissible uses.--In addition to the uses described 
        in paragraph (4), a grant awarded under this section may be used, 
        directly or through contractual arrangements, to provide--
                    (A) all drugs or devices approved or cleared under the 
                Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) and 
                all biological products licensed under section 351 of the Public 
                Health Service Act (42 U.S.C. 262) to treat substance use 
                disorders or reverse overdose, pursuant to Federal and State 
                law;
                    (B) withdrawal and detoxification services that include 
                patient evaluation, stabilization, and preparation for treatment 
                of substance use disorder, including treatment described in 
                subparagraph (A), as appropriate; or
                    (C) mental health services provided by a certified 
                professional who is licensed and qualified by education, 
                training, or experience to assess the psychosocial background of 
                patients, to contribute to the appropriate treatment plan for 
                patients with substance use disorder, and to monitor patient 
                progress.
            (6) Preference.--In awarding grants under this section, the 
        Secretary shall give preference to eligible entities that meet any or 
        all of the following criteria:
                    (A) The eligible entity is a critical access hospital (as 
                defined in section 1861(mm)(1) of the Social Security Act (42 
                U.S.C. 1395x(mm)(1))), a low volume hospital (as defined in 
                section 1886(d)(12)(C)(i) of such Act (42 U.S.C. 
                1395ww(d)(12)(C)(i))), a sole community hospital (as defined in 
                section 1886(d)(5)(D)(iii) of such Act (42 U.S.C. 
                1395ww(d)(5)(D)(iii))), or a hospital that receives 
                disproportionate share hospital payments under section 
                1886(d)(5)(F) of the Social Security Act (42 U.S.C. 
                1395ww(d)(5)(F)).
                    (B) The eligible entity is located in a State with an age-
                adjusted rate of drug overdose deaths that is above the national 
                overdose mortality rate, as determined by the Director of the 
                Centers for Disease Control and Prevention, or under the 
                jurisdiction of an Indian Tribe with an age-adjusted rate of 
                drug overdose deaths that is above the national overdose 
                mortality rate, as determined through appropriate mechanisms as 
                determined by the Secretary in consultation with Indian Tribes.
                    (C) The eligible entity demonstrates that recovery coaches 
                will be placed in both health care settings and community 
                settings.
            (7) Period of grant.--A grant awarded to an eligible entity under 
        this section shall be for a period of not more than 5 years.
    (c) Definitions.--In this section:
            (1) Indian tribe; tribal organization.--The terms ``Indian Tribe'' 
        and ``tribal organization'' have the meanings given the terms ``Indian 
        tribe'' and ``tribal organization'' in section 4 of the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 5304).
            (2) Recovery coach.--the term ``recovery coach'' means an 
        individual--
                    (A) with knowledge of, or experience with, recovery from a 
                substance use disorder; and
                    (B) who has completed training from, and is determined to be 
                in good standing by, a recovery services organization capable of 
                conducting such training and making such determination.
            (3) Recovery community organization.--The term ``recovery community 
        organization'' has the meaning given such term in section 547(a) of the 
        Public Health Service Act (42 U.S.C. 290ee-2(a)).
    (d) Reporting Requirements.--
            (1) Reports by grantees.--Each eligible entity awarded a grant under 
        this section shall submit to the Secretary an annual report for each 
        year for which the entity has received such grant that includes 
        information on--
                    (A) the number of individuals treated by the entity for non-
                fatal overdoses, including the number of non-fatal overdoses 
                where overdose reversal medication was administered;
                    (B) the number of individuals administered medication-
                assisted treatment by the entity;
                    (C) the number of individuals referred by the entity to 
                other treatment facilities after a non-fatal overdose, the types 
                of such other facilities, and the number of such individuals 
                admitted to such other facilities pursuant to such referrals; 
                and
                    (D) the frequency and number of patients with reoccurrences, 
                including readmissions for non-fatal overdoses and evidence of 
                relapse related to substance use disorder.
            (2) Report by secretary.--Not later than 5 years after the date of 
        enactment of this Act, the Secretary shall submit to Congress a report 
        that includes an evaluation of the effectiveness of the grant program 
        carried out under this section with respect to long term health outcomes 
        of the population of individuals who have experienced a drug overdose, 
        the percentage of patients treated or referred to treatment by grantees, 
        and the frequency and number of patients who experienced relapse, were 
        readmitted for treatment, or experienced another overdose.
    (e) Privacy.--The requirements of this section, including with respect to 
data reporting and program oversight, shall be subject to all applicable Federal 
and State privacy laws.
    (f) Authorization of Appropriations.--There is authorized to be appropriated 
to carry out this section $10,000,000 for each of fiscal years 2019 through 
2023.

         Subtitle J--Alternatives to Opioids in the Emergency Department

SEC. 7091. EMERGENCY DEPARTMENT ALTERNATIVES TO OPIOIDS DEMONSTRATION PROGRAM.

    (a) Demonstration Program Grants.--
            (1) In general.--The Secretary of Health and Human Services (in this 
        section referred to as the ``Secretary'') shall carry out a 
        demonstration program for purposes of awarding grants to hospitals and 
        emergency departments, including freestanding emergency departments, to 
        develop, implement, enhance, or study alternatives to opioids for pain 
        management in such settings.
            (2) Eligibility.--To be eligible to receive a grant under paragraph 
        (1), a hospital or emergency department shall submit an application to 
        the Secretary at such time, in such manner, and containing such 
        information as the Secretary may require.
            (3) Geographic distribution.--In awarding grants under this section, 
        the Secretary shall seek to ensure geographical distribution among grant 
        recipients.
            (4) Use of funds.--Grants under paragraph (1) shall be used to--
                    (A) target treatment approaches for painful conditions 
                frequently treated in such settings;
                    (B) train providers and other hospital personnel on 
                protocols or best practices related to the use and prescription 
                of opioids and alternatives to opioids for pain management in 
                the emergency department; and
                    (C) develop or continue strategies to provide alternatives 
                to opioids, as appropriate.
    (b) Additional Demonstration Program.--The Secretary may carry out a 
demonstration program similar to the program under subsection (a) for other 
acute care settings.
    (c) Consultation.--The Secretary shall implement a process for recipients of 
grants under subsection (a) or (b) to share evidence-based and best practices 
and promote consultation with persons having robust knowledge, including 
emergency departments and physicians that have successfully implemented programs 
that use alternatives to opioids for pain management, as appropriate, such as 
approaches studied through the National Center for Complimentary and Integrative 
Health or other institutes and centers at the National Institutes of Health, as 
appropriate. The Secretary shall offer to each recipient of a grant under 
subsection (a) or (b) technical assistance as necessary.
    (d) Technical Assistance.--The Secretary shall identify or facilitate the 
development of best practices on alternatives to opioids for pain management and 
provide technical assistance to hospitals and other acute care settings on 
alternatives to opioids for pain management. The technical assistance provided 
shall be for the purpose of--
            (1) utilizing information from recipients of a grant under 
        subsection (a) or (b) that have successfully implemented alternatives to 
        opioids programs;
            (2) identifying or facilitating the development of best practices on 
        the use of alternatives to opioids, which may include pain-management 
        strategies that involve non-addictive medical products, non-
        pharmacologic treatments, and technologies or techniques to identify 
        patients at risk for opioid use disorder;
            (3) identifying or facilitating the development of best practices on 
        the use of alternatives to opioids that target common painful conditions 
        and include certain patient populations, such as geriatric patients, 
        pregnant women, and children; and
            (4) disseminating information on the use of alternatives to opioids 
        to providers in acute care settings, which may include emergency 
        departments, outpatient clinics, critical access hospitals, Federally 
        qualified health centers, Indian Health Service health facilities, and 
        tribal hospitals.
    (e) Report to the Secretary.--Each recipient of a grant under this section 
shall submit to the Secretary (during the period of such grant) annual reports 
on the progress of the program funded through the grant. These reports shall 
include, in accordance with all applicable State and Federal privacy laws--
            (1) a description of and specific information about the opioid 
        alternative pain management programs, including the demographic 
        characteristics of patients who were treated with an alternative pain 
        management protocol, implemented in hospitals, emergency departments, 
        and other acute care settings;
            (2) data on the opioid alternative pain management strategies used, 
        including the number of opioid prescriptions written--
                    (A) during a baseline period before the program began; or
                    (B) at various stages of the program; and
            (3) data on patients who were eventually prescribed opioids after 
        alternative pain management protocols and treatments were utilized; and
            (4) any other information the Secretary determines appropriate.
    (f) Report to Congress.--Not later than 1 year after completion of the 
demonstration program under this section, the Secretary shall submit a report to 
the Congress on the results of the demonstration program and include in the 
report--
            (1) the number of applications received and the number funded;
            (2) a summary of the reports described in subsection (e), including 
        data that allows for comparison of programs; and
            (3) recommendations for broader implementation of pain management 
        strategies that encourage the use of alternatives to opioids in 
        hospitals, emergency departments, or other acute care settings.
    (g) Authorization of Appropriations.--To carry out this section, there is 
authorized to be appropriated $10,000,000 for each of fiscal years 2019 through 
2021.

    Subtitle K--Treatment, Education, and Community Help To Combat Addiction

SEC. 7101. ESTABLISHMENT OF REGIONAL CENTERS OF EXCELLENCE IN SUBSTANCE USE 
              DISORDER EDUCATION.

    Part D of title V of the Public Health Service Act, as amended by section 
7031, is further amended by adding at the end the following new section:

``SEC. 551. REGIONAL CENTERS OF EXCELLENCE IN SUBSTANCE USE DISORDER EDUCATION.

    ``(a) In General.--The Secretary, in consultation with appropriate agencies, 
shall award cooperative agreements to eligible entities for the designation of 
such entities as Regional Centers of Excellence in Substance Use Disorder 
Education for purposes of improving health professional training resources with 
respect to substance use disorder prevention, treatment, and recovery.
    ``(b) Eligibility.--To be eligible to receive a cooperative agreement under 
subsection (a), an entity shall--
            ``(1) be an accredited entity that offers education to students in 
        various health professions, which may include--
                    ``(A) a teaching hospital;
                    ``(B) a medical school;
                    ``(C) a certified behavioral health clinic; or
                    ``(D) any other health professions school, school of public 
                health, or Cooperative Extension Program at institutions of 
                higher education, as defined in section 101 of the Higher 
                Education Act of 1965, engaged in the prevention, treatment, or 
                recovery of substance use disorders;
            ``(2) demonstrate community engagement and partnerships with 
        community stakeholders, including entities that train health 
        professionals, mental health counselors, social workers, peer recovery 
        specialists, substance use treatment programs, community health centers, 
        physician offices, certified behavioral health clinics, research 
        institutions, and law enforcement; and
            ``(3) submit to the Secretary an application containing such 
        information, at such time, and in such manner, as the Secretary may 
        require.
    ``(c) Activities.--An entity receiving an award under this section shall 
develop, evaluate, and distribute evidence-based resources regarding the 
prevention and treatment of, and recovery from, substance use disorders. Such 
resources may include information on--
            ``(1) the neurology and pathology of substance use disorders;
            ``(2) advancements in the treatment of substance use disorders;
            ``(3) techniques and best practices to support recovery from 
        substance use disorders;
            ``(4) strategies for the prevention and treatment of, and recovery 
        from substance use disorders across patient populations; and
            ``(5) other topic areas that are relevant to the objectives 
        described in subsection (a).
    ``(d) Geographic Distribution.--In awarding cooperative agreements under 
subsection (a), the Secretary shall take into account regional differences among 
eligible entities and shall make an effort to ensure geographic distribution.
    ``(e) Evaluation.--The Secretary shall evaluate each project carried out by 
an entity receiving an award under this section and shall disseminate the 
findings with respect to each such evaluation to appropriate public and private 
entities.
    ``(f) Funding.--There is authorized to be appropriated to carry out this 
section, $4,000,000 for each of fiscal years 2019 through 2023.''.

SEC. 7102. YOUTH PREVENTION AND RECOVERY.

    (a)  Substance Abuse Treatment Services for Children, Adolescents, and Young 
Adults.--Section 514 of the Public Health Service Act (42 U.S.C. 290bb-7) is 
amended--
            (1) in the section heading, by striking ``children and adolescents'' 
        and inserting ``children, adolescents, and young adults'';
            (2) in subsection (a)(2), by striking ``children, including'' and 
        inserting ``children, adolescents, and young adults, including''; and
            (3) by striking ``children and adolescents'' each place it appears 
        and inserting ``children, adolescents, and young adults''.
    (b) Resource Center.--The Secretary of Health and Human Services (referred 
to in this section as the ``Secretary'', except as otherwise provided), in 
consultation with the Secretary of Education and other heads of agencies, 
including the Assistant Secretary for Mental Health and Substance Use and the 
Administrator of the Health Resources and Services Administration, as 
appropriate, shall establish a resource center to provide technical support to 
recipients of grants under subsection (c).
    (c) Youth Prevention and Recovery Initiative.--
            (1) In general.--The Secretary, in consultation with the Secretary 
        of Education, shall administer a program to provide support for 
        communities to support the prevention of, treatment of, and recovery 
        from, substance use disorders for children, adolescents, and young 
        adults.
            (2) Definitions.--In this subsection:
                    (A) Eligible entity.--The term ``eligible entity'' means--
                            (i) a local educational agency that is seeking to 
                        establish or expand substance use prevention or recovery 
                        support services at one or more high schools;
                            (ii) a State educational agency;
                            (iii) an institution of higher education (or 
                        consortia of such institutions), which may include a 
                        recovery program at an institution of higher education;
                            (iv) a local board or one-stop operator;
                            (v) a nonprofit organization with appropriate 
                        expertise in providing services or programs for 
                        children, adolescents, or young adults, excluding a 
                        school;
                            (vi) a State, political subdivision of a State, 
                        Indian tribe, or tribal organization; or
                            (vii) a high school or dormitory serving high school 
                        students that receives funding from the Bureau of Indian 
                        Education.
                    (B) Foster care.--The term ``foster care'' has the meaning 
                given such term in section 1355.20(a) of title 45, Code of 
                Federal Regulations (or any successor regulations).
                    (C) High school.--The term ``high school'' has the meaning 
                given such term in section 8101 of the Elementary and Secondary 
                Education Act of 1965 (20 U.S.C. 7801).
                    (D) Homeless youth.--The term ``homeless youth'' has the 
                meaning given the term ``homeless children or youths'' in 
                section 725 of the McKinney-Vento Homeless Assistance Act (42 
                U.S.C. 11434a).
                    (E) Indian tribe; tribal organization.--The terms ``Indian 
                tribe'' and ``tribal organization'' have the meanings given such 
                terms in section 4 of the Indian Self-Determination and 
                Education Assistance Act (25 U.S.C. 5304).
                    (F) Institution of higher education.--The term ``institution 
                of higher education'' has the meaning given such term in section 
                101 of the Higher Education Act of 1965 (20 U.S.C. 1001) and 
                includes a ``postsecondary vocational institution'' as defined 
                in section 102(c) of such Act (20 U.S.C. 1002(c)).
                    (G) Local educational agency.--The term ``local educational 
                agency'' has the meaning given such term in section 8101 of the 
                Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).
                    (H) Local board; one-stop operator.--The terms ``local 
                board'' and ``one-stop operator'' have the meanings given such 
                terms in section 3 of the Workforce Innovation and Opportunity 
                Act (29 U.S.C. 3102).
                    (I) Out-of-school youth.--The term ``out-of-school youth'' 
                has the meaning given such term in section 129(a)(1)(B) of the 
                Workforce Innovation and Opportunity Act (29 U.S.C. 
                3164(a)(1)(B)).
                    (J) Recovery program.--The term ``recovery program'' means a 
                program--
                            (i) to help children, adolescents, or young adults 
                        who are recovering from substance use disorders to 
                        initiate, stabilize, and maintain healthy and productive 
                        lives in the community; and
                            (ii) that includes peer-to-peer support delivered by 
                        individuals with lived experience in recovery, and 
                        communal activities to build recovery skills and 
                        supportive social networks.
                    (K) State educational agency.--The term ``State educational 
                agency'' has the meaning given such term in section 8101 of the 
                Elementary and Secondary Education Act (20 U.S.C. 7801).
            (3) Best practices.--The Secretary, in consultation with the 
        Secretary of Education, shall--
                    (A) identify or facilitate the development of evidence-based 
                best practices for prevention of substance misuse and abuse by 
                children, adolescents, and young adults, including for specific 
                populations such as youth in foster care, homeless youth, out-
                of-school youth, and youth who are at risk of or have 
                experienced trafficking that address--
                            (i) primary prevention;
                            (ii) appropriate recovery support services;
                            (iii) appropriate use of medication-assisted 
                        treatment for such individuals, if applicable, and ways 
                        of overcoming barriers to the use of medication-assisted 
                        treatment in such population; and
                            (iv) efficient and effective communication, which 
                        may include the use of social media, to maximize 
                        outreach efforts;
                    (B) disseminate such best practices to State educational 
                agencies, local educational agencies, schools and dormitories 
                funded by the Bureau of Indian Education, institutions of higher 
                education, recovery programs at institutions of higher 
                education, local boards, one-stop operators, family and youth 
                homeless providers, and nonprofit organizations, as appropriate;
                    (C) conduct a rigorous evaluation of each grant funded under 
                this subsection, particularly its impact on the indicators 
                described in paragraph (7)(B); and
                    (D) provide technical assistance for grantees under this 
                subsection.
            (4) Grants authorized.--The Secretary, in consultation with the 
        Secretary of Education, shall award 3-year grants, on a competitive 
        basis, to eligible entities to enable such entities, in coordination 
        with Indian tribes, if applicable, and State agencies responsible for 
        carrying out substance use disorder prevention and treatment programs, 
        to carry out evidence-based programs for--
                    (A) prevention of substance misuse and abuse by children, 
                adolescents, and young adults, which may include primary 
                prevention;
                    (B) recovery support services for children, adolescents, and 
                young adults, which may include counseling, job training, 
                linkages to community-based services, family support groups, 
                peer mentoring, and recovery coaching; or
                    (C) treatment or referrals for treatment of substance use 
                disorders, which may include the use of medication-assisted 
                treatment, as appropriate.
            (5) Special consideration.--In awarding grants under this 
        subsection, the Secretary shall give special consideration to the unique 
        needs of tribal, urban, suburban, and rural populations.
            (6) Application.--To be eligible for a grant under this subsection, 
        an entity shall submit to the Secretary an application at such time, in 
        such manner, and containing such information as the Secretary may 
        require. Such application shall include--
                    (A) a description of--
                            (i) the impact of substance use disorders in the 
                        population that will be served by the grant program;
                            (ii) how the eligible entity has solicited input 
                        from relevant stakeholders, which may include faculty, 
                        teachers, staff, families, students, and experts in 
                        substance use disorder prevention, treatment, and 
                        recovery in developing such application;
                            (iii) the goals of the proposed project, including 
                        the intended outcomes;
                            (iv) how the eligible entity plans to use grant 
                        funds for evidence-based activities, in accordance with 
                        this subsection to prevent, provide recovery support 
                        for, or treat substance use disorders amongst such 
                        individuals, or a combination of such activities; and
                            (v) how the eligible entity will collaborate with 
                        relevant partners, which may include State educational 
                        agencies, local educational agencies, institutions of 
                        higher education, juvenile justice agencies, prevention 
                        and recovery support providers, local service providers, 
                        including substance use disorder treatment programs, 
                        providers of mental health services, youth serving 
                        organizations, family and youth homeless providers, 
                        child welfare agencies, and primary care providers, in 
                        carrying out the grant program; and
                    (B) an assurance that the eligible entity will participate 
                in the evaluation described in paragraph (3)(C).
            (7) Reports to the secretary.--Each eligible entity awarded a grant 
        under this subsection shall submit to the Secretary a report at such 
        time and in such manner as the Secretary may require. Such report shall 
        include--
                    (A) a description of how the eligible entity used grant 
                funds, in accordance with this subsection, including the number 
                of children, adolescents, and young adults reached through 
                programming; and
                    (B) a description, including relevant data, of how the grant 
                program has made an impact on the intended outcomes described in 
                paragraph (6)(A)(iii), including--
                            (i) indicators of student success, which, if the 
                        eligible entity is an educational institution, shall 
                        include student well-being and academic achievement;
                            (ii) substance use disorders amongst children, 
                        adolescents, and young adults, including the number of 
                        overdoses and deaths amongst children, adolescents, and 
                        young adults served by the grant during the grant 
                        period; and
                            (iii) other indicators, as the Secretary determines 
                        appropriate.
            (8) Report to congress.--The Secretary shall, not later than October 
        1, 2022, submit a report to the Committee on Health, Education, Labor, 
        and Pensions of the Senate and the Committee on Energy and Commerce and 
        the Committee on Education and the Workforce of the House of 
        Representatives a report summarizing the effectiveness of the grant 
        program under this subsection, based on the information submitted in 
        reports required under paragraph (7).
            (9) Authorization of appropriations.--There is authorized to be 
        appropriated $10,000,000 to carry out this subsection for each of fiscal 
        years 2019 through 2023.

  Subtitle L--Information From National Mental Health and Substance Use Policy 
                                   Laboratory

SEC. 7111. INFORMATION FROM NATIONAL MENTAL HEALTH AND SUBSTANCE USE POLICY 
              LABORATORY.

    Section 501A(b) of the Public Health Service Act (42 U.S.C. 290aa-0(b)) is 
amended--
            (1) in paragraph (5)(C), by striking ``; and'' at the end and 
        inserting a semicolon;
            (2) by redesignating paragraph (6) as paragraph (7); and
            (3) by inserting after paragraph (5) the following:
            ``(6) issue and periodically update information for entities 
        applying for grants or cooperative agreements from the Substance Abuse 
        and Mental Health Services Administration in order to--
                    ``(A) encourage the implementation and replication of 
                evidence-based practices; and
                    ``(B) provide technical assistance to applicants for 
                funding, including with respect to justifications for such 
                programs and activities; and''.

                Subtitle M--Comprehensive Opioid Recovery Centers

SEC. 7121. COMPREHENSIVE OPIOID RECOVERY CENTERS.

    (a) In General.--Part D of title V of the Public Health Service Act (42 
U.S.C. 290dd et seq.), as amended by sections 7031 and 7101, is further amended 
by adding at the end the following new section:

``SEC. 552. COMPREHENSIVE OPIOID RECOVERY CENTERS.

    ``(a) In General.--The Secretary shall award grants on a competitive basis 
to eligible entities to establish or operate a comprehensive opioid recovery 
center (referred to in this section as a `Center'). A Center may be a single 
entity or an integrated delivery network.
    ``(b) Grant Period.--
            ``(1) In general.--A grant awarded under subsection (a) shall be for 
        a period of not less than 3 years and not more than 5 years.
            ``(2) Renewal.--A grant awarded under subsection (a) may be renewed, 
        on a competitive basis, for additional periods of time, as determined by 
        the Secretary. In determining whether to renew a grant under this 
        paragraph, the Secretary shall consider the data submitted under 
        subsection (h).
    ``(c) Minimum Number of Centers.--The Secretary shall allocate the amounts 
made available under subsection (j) such that not fewer than 10 grants may be 
awarded. Not more than one grant shall be made to entities in a single State for 
any one period.
    ``(d) Application.--
            ``(1) Eligible entity.--An entity is eligible for a grant under this 
        section if the entity offers treatment and other services for 
        individuals with a substance use disorder.
            ``(2) Submission of application.--In order to be eligible for a 
        grant under subsection (a), an entity shall submit an application to the 
        Secretary at such time and in such manner as the Secretary may require. 
        Such application shall include--
                    ``(A) evidence that such entity carries out, or is capable 
                of coordinating with other entities to carry out, the activities 
                described in subsection (g); and
                    ``(B) such other information as the Secretary may require.
    ``(e) Priority.--In awarding grants under subsection (a), the Secretary 
shall give priority to eligible entities--
            ``(1) located in a State with an age-adjusted rate of drug overdose 
        deaths that is above the national overdose mortality rate, as determined 
        by the Director of the Centers for Disease Control and Prevention; or
            ``(2) serving an Indian Tribe (as defined in section 4 of the Indian 
        Self-Determination and Education Assistance Act) with an age-adjusted 
        rate of drug overdose deaths that is above the national overdose 
        mortality rate, as determined through appropriate mechanisms determined 
        by the Secretary in consultation with Indian Tribes.
    ``(f) Preference.--In awarding grants under subsection (a), the Secretary 
may give preference to eligible entities utilizing technology-enabled 
collaborative learning and capacity building models, including such models as 
defined in section 2 of the Expanding Capacity for Health Outcomes Act (Public 
Law 114-270; 130 Stat. 1395), to conduct the activities described in this 
section.
    ``(g) Center Activities.--Each Center shall, at a minimum, carry out the 
following activities directly, through referral, or through contractual 
arrangements, which may include carrying out such activities through technology-
enabled collaborative learning and capacity building models described in 
subsection (f):
            ``(1) Treatment and recovery services.--Each Center shall--
                    ``(A) Ensure that intake, evaluations, and periodic patient 
                assessments meet the individualized clinical needs of patients, 
                including by reviewing patient placement in treatment settings 
                to support meaningful recovery.
                    ``(B) Provide the full continuum of treatment services, 
                including--
                            ``(i) all drugs and devices approved or cleared 
                        under the Federal Food, Drug, and Cosmetic Act and all 
                        biological products licensed under section 351 of this 
                        Act to treat substance use disorders or reverse 
                        overdoses, pursuant to Federal and State law;
                            ``(ii) medically supervised withdrawal management, 
                        that includes patient evaluation, stabilization, and 
                        readiness for and entry into treatment;
                            ``(iii) counseling provided by a program counselor 
                        or other certified professional who is licensed and 
                        qualified by education, training, or experience to 
                        assess the psychological and sociological background of 
                        patients, to contribute to the appropriate treatment 
                        plan for the patient, and to monitor patient progress;
                            ``(iv) treatment, as appropriate, for patients with 
                        co-occurring substance use and mental disorders;
                            ``(v) testing, as appropriate, for infections 
                        commonly associated with illicit drug use;
                            ``(vi) residential rehabilitation, and outpatient 
                        and intensive outpatient programs;
                            ``(vii) recovery housing;
                            ``(viii) community-based and peer recovery support 
                        services;
                            ``(ix) job training, job placement assistance, and 
                        continuing education assistance to support reintegration 
                        into the workforce; and
                            ``(x) other best practices to provide the full 
                        continuum of treatment and services, as determined by 
                        the Secretary.
                    ``(C) Ensure that all programs covered by the Center include 
                medication-assisted treatment, as appropriate, and do not 
                exclude individuals receiving medication-assisted treatment from 
                any service.
                    ``(D) Periodically conduct patient assessments to support 
                sustained and clinically significant recovery, as defined by the 
                Assistant Secretary for Mental Health and Substance Use.
                    ``(E) Provide onsite access to medication, as appropriate, 
                and toxicology services; for purposes of carrying out this 
                section.
                    ``(F) Operate a secure, confidential, and interoperable 
                electronic health information system.
                    ``(G) Offer family support services such as child care, 
                family counseling, and parenting interventions to help stabilize 
                families impacted by substance use disorder, as appropriate.
            ``(2) Outreach.--Each Center shall carry out outreach activities 
        regarding the services offered through the Centers, which may include--
                    ``(A) training and supervising outreach staff, as 
                appropriate, to work with State and local health departments, 
                health care providers, the Indian Health Service, State and 
                local educational agencies, schools funded by the Indian Bureau 
                of Education, institutions of higher education, State and local 
                workforce development boards, State and local community action 
                agencies, public safety officials, first responders, Indian 
                Tribes, child welfare agencies, as appropriate, and other 
                community partners and the public, including patients, to 
                identify and respond to community needs;
                    ``(B) ensuring that the entities described in subparagraph 
                (A) are aware of the services of the Center; and
                    ``(C) disseminating and making publicly available, including 
                through the internet, evidence-based resources that educate 
                professionals and the public on opioid use disorder and other 
                substance use disorders, including co-occurring substance use 
                and mental disorders.
    ``(h) Data Reporting and Program Oversight.--With respect to a grant awarded 
under subsection (a), not later than 90 days after the end of the first year of 
the grant period, and annually thereafter for the duration of the grant period 
(including the duration of any renewal period for such grant), the entity shall 
submit data, as appropriate, to the Secretary regarding--
            ``(1) the programs and activities funded by the grant;
            ``(2) health outcomes of the population of individuals with a 
        substance use disorder who received services from the Center, evaluated 
        by an independent program evaluator through the use of outcomes 
        measures, as determined by the Secretary;
            ``(3) the retention rate of program participants; and
            ``(4) any other information that the Secretary may require for the 
        purpose of--ensuring that the Center is complying with all the 
        requirements of the grant, including providing the full continuum of 
        services described in subsection (g)(1)(B).
    ``(i) Privacy.--The provisions of this section, including with respect to 
data reporting and program oversight, shall be subject to all applicable Federal 
and State privacy laws.
    ``(j) Authorization of Appropriations.--There is authorized to be 
appropriated $10,000,000 for each of fiscal years 2019 through 2023 for purposes 
of carrying out this section.''.
    (b) Reports to Congress.--
            (1) Preliminary report.--Not later than 3 years after the date of 
        the enactment of this Act, the Secretary of Health and Human Services 
        shall submit to Congress a preliminary report that analyzes data 
        submitted under section 552(h) of the Public Health Service Act, as 
        added by subsection (a).
            (2) Final report.--Not later than 2 years after submitting the 
        preliminary report required under paragraph (1), the Secretary of Health 
        and Human Services shall submit to Congress a final report that 
        includes--
                    (A) an evaluation of the effectiveness of the comprehensive 
                services provided by the Centers established or operated 
                pursuant to section 552 of the Public Health Service Act, as 
                added by subsection (a), with respect to health outcomes of the 
                population of individuals with substance use disorder who 
                receive services from the Center, which shall include an 
                evaluation of the effectiveness of services for treatment and 
                recovery support and to reduce relapse, recidivism, and 
                overdose; and
                    (B) recommendations, as appropriate, regarding ways to 
                improve Federal programs related to substance use disorders, 
                which may include dissemination of best practices for the 
                treatment of substance use disorders to health care 
                professionals.

                        Subtitle N--Trauma-Informed Care

SEC. 7131. CDC SURVEILLANCE AND DATA COLLECTION FOR CHILD, YOUTH, AND ADULT 
              TRAUMA.

    (a) Data Collection.--The Director of the Centers for Disease Control and 
Prevention (referred to in this section as the ``Director'') may, in cooperation 
with the States, collect and report data on adverse childhood experiences 
through the Behavioral Risk Factor Surveillance System, the Youth Risk Behavior 
Surveillance System, and other relevant public health surveys or questionnaires.
    (b) Timing.--The collection of data under subsection (a) may occur 
biennially.
    (c) Data From Rural Areas.--The Director shall encourage each State that 
participates in collecting and reporting data under subsection (a) to collect 
and report data from rural areas within such State, in order to generate a 
statistically reliable representation of such areas.
    (d) Data From Tribal Areas.--The Director may, in cooperation with Indian 
Tribes (as defined in section 4 of the Indian Self-Determination and Education 
Assistance Act) and pursuant to a written request from an Indian Tribe, provide 
technical assistance to such Indian Tribe to collect and report data on adverse 
childhood experiences through the Behavioral Risk Factor Surveillance System, 
the Youth Risk Behavior Surveillance System, or another relevant public health 
survey or questionnaire.
    (e) Authorization of Appropriations.--To carry out this section, there is 
authorized to be appropriated $2,000,000 for each of fiscal years 2019 through 
2023.

SEC. 7132. TASK FORCE TO DEVELOP BEST PRACTICES FOR TRAUMA-INFORMED 
              IDENTIFICATION, REFERRAL, AND SUPPORT.

    (a) Establishment.--There is established a task force, to be known as the 
Interagency Task Force on Trauma-Informed Care (in this section referred to as 
the ``task force'') that shall identify, evaluate, and make recommendations 
regarding--
            (1) best practices with respect to children and youth, and their 
        families as appropriate, who have experienced or are at risk of 
        experiencing trauma; and
            (2) ways in which Federal agencies can better coordinate to improve 
        the Federal response to families impacted by substance use disorders and 
        other forms of trauma.
    (b) Membership.--
            (1) Composition.--The task force shall be composed of the heads of 
        the following Federal departments and agencies, or their designees:
                    (A) The Centers for Medicare & Medicaid Services.
                    (B) The Substance Abuse and Mental Health Services 
                Administration.
                    (C) The Agency for Healthcare Research and Quality.
                    (D) The Centers for Disease Control and Prevention.
                    (E) The Indian Health Service.
                    (F) The Department of Veterans Affairs.
                    (G) The National Institutes of Health.
                    (H) The Food and Drug Administration.
                    (I) The Health Resources and Services Administration.
                    (J) The Department of Defense.
                    (K) The Office of Minority Health of the Department of 
                Health and Human Services.
                    (L) The Administration for Children and Families.
                    (M) The Office of the Assistant Secretary for Planning and 
                Evaluation of the Department of Health and Human Services.
                    (N) The Office for Civil Rights of the Department of Health 
                and Human Services.
                    (O) The Office of Juvenile Justice and Delinquency 
                Prevention of the Department of Justice.
                    (P) The Office of Community Oriented Policing Services of 
                the Department of Justice.
                    (Q) The Office on Violence Against Women of the Department 
                of Justice.
                    (R) The National Center for Education Evaluation and 
                Regional Assistance of the Department of Education.
                    (S) The National Center for Special Education Research of 
                the Institute of Education Science.
                    (T) The Office of Elementary and Secondary Education of the 
                Department of Education.
                    (U) The Office for Civil Rights of the Department of 
                Education.
                    (V) The Office of Special Education and Rehabilitative 
                Services of the Department of Education.
                    (W) The Bureau of Indian Affairs of the Department of the 
                Interior.
                    (X) The Veterans Health Administration of the Department of 
                Veterans Affairs.
                    (Y) The Office of Special Needs Assistance Programs of the 
                Department of Housing and Urban Development.
                    (Z) The Office of Head Start of the Administration for 
                Children and Families.
                    (AA) The Children's Bureau of the Administration for 
                Children and Families.
                    (BB) The Bureau of Indian Education of the Department of the 
                Interior.
                    (CC) Such other Federal agencies as the Secretaries 
                determine to be appropriate.
            (2) Date of appointments.--The heads of Federal departments and 
        agencies shall appoint the corresponding members of the task force not 
        later than 60 days after the date of enactment of this Act.
            (3) Chairperson.--The task force shall be chaired by the Assistant 
        Secretary for Mental Health and Substance Use, or the Assistant 
        Secretary's designee.
    (c) Task Force Duties.--The task force shall--
            (1) solicit input from stakeholders, including frontline service 
        providers, educators, mental health professionals, researchers, experts 
        in infant, child, and youth trauma, child welfare professionals, and the 
        public, in order to inform the activities under paragraph (2); and
            (2) identify, evaluate, make recommendations, and update such 
        recommendations not less than annually, to the general public, the 
        Secretary of Education, the Secretary of Health and Human Services, the 
        Secretary of Labor, the Secretary of the Interior, the Attorney General, 
        and other relevant cabinet Secretaries, and Congress regarding--
                    (A) a set of evidence-based, evidence-informed, and 
                promising best practices with respect to--
                            (i) prevention strategies for individuals at risk of 
                        experiencing or being exposed to trauma, including 
                        trauma as a result of exposure to substance use;
                            (ii) the identification of infants, children and 
                        youth, and their families as appropriate, who have 
                        experienced or are at risk of experiencing trauma;
                            (iii) the expeditious referral to and implementation 
                        of trauma-informed practices and supports that prevent 
                        and mitigate the effects of trauma, which may include 
                        whole-family and multi-generational approaches; and
                            (iv) community based or multi-generational practices 
                        that support children and their families;
                    (B) a national strategy on how the task force and member 
                agencies will collaborate, prioritize options for, and implement 
                a coordinated approach, which may include--
                            (i) data sharing;
                            (ii) providing support to infants, children, and 
                        youth, and their families as appropriate, who have 
                        experienced or are at risk of experiencing trauma;
                            (iii) identifying options for coordinating existing 
                        grants that support infants, children, and youth, and 
                        their families as appropriate, who have experienced, or 
                        are at risk of experiencing, exposure to substance use 
                        or other trauma, including trauma related to substance 
                        use; and
                            (iv) other ways to improve coordination, planning, 
                        and communication within and across Federal agencies, 
                        offices, and programs, to better serve children and 
                        families impacted by substance use disorders; and
                    (C) existing Federal authorities at the Department of 
                Education, Department of Health and Human Services, Department 
                of Justice, Department of Labor, Department of the Interior, and 
                other relevant agencies, and specific Federal grant programs to 
                disseminate best practices on, provide training in, or deliver 
                services through, trauma-informed practices, and disseminate 
                such information--
                            (i) in writing to relevant program offices at such 
                        agencies to encourage grant applicants in writing to use 
                        such funds, where appropriate, for trauma-informed 
                        practices; and
                            (ii) to the general public through the internet 
                        website of the task force.
    (d) Best Practices.--In identifying, evaluating, and recommending the set of 
best practices under subsection (c), the task force shall--
            (1) include guidelines for providing professional development and 
        education for front-line services providers, including school personnel, 
        early childhood education program providers, providers from child- or 
        youth-serving organizations, housing and homeless providers, primary and 
        behavioral health care providers, child welfare and social services 
        providers, juvenile and family court personnel, health care providers, 
        individuals who are mandatory reporters of child abuse or neglect, 
        trained nonclinical providers (including peer mentors and clergy), and 
        first responders, in--
                    (A) understanding and identifying early signs and risk 
                factors of trauma in infants, children, and youth, and their 
                families as appropriate, including through screening processes 
                and services;
                    (B) providing practices to prevent and mitigate the impact 
                of trauma, including by fostering safe and stable environments 
                and relationships; and
                    (C) developing and implementing policies, procedures, or 
                systems that--
                            (i) are designed to quickly refer infants, children, 
                        youth, and their families as appropriate, who have 
                        experienced or are at risk of experiencing trauma to the 
                        appropriate trauma-informed screening and support and 
                        age-appropriate treatment, and to ensure such infants, 
                        children, youth, and family members receive such 
                        support;
                            (ii) utilize and develop partnerships with early 
                        childhood education programs, local social services 
                        organizations, such as organizations serving youth, and 
                        clinical mental health or other health care providers 
                        with expertise in providing support services and age-
                        appropriate trauma-informed and evidence-based treatment 
                        aimed at preventing or mitigating the effects of trauma;
                            (iii) educate children and youth to--
                                    (I) understand and identify the signs, 
                                effects, or symptoms of trauma; and
                                    (II) build the resilience and coping skills 
                                to mitigate the effects of experiencing trauma;
                            (iv) promote and support multi-generational 
                        practices that assist parents, foster parents, and 
                        kinship and other caregivers in accessing resources 
                        related to, and developing environments conducive to, 
                        the prevention and mitigation of trauma; and
                            (v) collect and utilize data from screenings, 
                        referrals, or the provision of services and supports to 
                        evaluate outcomes and improve processes for trauma-
                        informed services and supports that are culturally 
                        sensitive, linguistically appropriate, and specific to 
                        age ranges and sex, as applicable;
            (2) recommend best practices that are designed to avoid unwarranted 
        custody loss or criminal penalties for parents or guardians in 
        connection with infants, children, and youth who have experienced or are 
        at risk of experiencing trauma; and
            (3) recommend opportunities for local- and State-level partnerships 
        that--
                    (A) are designed to quickly identify and refer children and 
                families, as appropriate, who have experienced or are at risk of 
                experiencing exposure to trauma, including related to substance 
                use;
                    (B) utilize and develop partnerships with early childhood 
                education programs, local social services organizations, and 
                health care services aimed at preventing or mitigating the 
                effects of exposure to trauma, including related to substance 
                use;
                    (C) offer community-based prevention activities, including 
                educating families and children on the effects of exposure to 
                trauma, such as trauma related to substance use, and how to 
                build resilience and coping skills to mitigate those effects;
                    (D) in accordance with Federal privacy protections, utilize 
                non-personally-identifiable data from screenings, referrals, or 
                the provision of services and supports to evaluate and improve 
                processes addressing exposure to trauma, including related to 
                substance use; and
                    (E) are designed to prevent separation and support 
                reunification of families if in the best interest of the child.
    (e) Operating Plan.--Not later than 120 days after the date of enactment of 
this Act, the task force shall hold the first meeting. Not later than 2 years 
after such date of enactment, the task force shall submit to the Secretary of 
Education, Secretary of Health and Human Services, Secretary of Labor, Secretary 
of the Interior, the Attorney General, and Congress an operating plan for 
carrying out the activities of the task force described in subsection (c)(2). 
Such operating plan shall include--
            (1) a list of specific activities that the task force plans to carry 
        out for purposes of carrying out duties described in subsection (c)(2), 
        which may include public engagement;
            (2) a plan for carrying out the activities under subsection (c)(2);
            (3) a list of members of the task force and other individuals who 
        are not members of the task force that may be consulted to carry out 
        such activities;
            (4) an explanation of Federal agency involvement and coordination 
        needed to carry out such activities, including any statutory or 
        regulatory barriers to such coordination;
            (5) a budget for carrying out such activities;
            (6) a proposed timeline for implementing recommendations and efforts 
        identified under subsection (c); and
            (7) other information that the task force determines appropriate as 
        related to its duties.
    (f) Final Report.--Not later than 3 years after the date of the first 
meeting of the task force, the task force shall submit to the general public, 
Secretary of Education, Secretary of Health and Human Services, Secretary of 
Labor, Secretary of the Interior, the Attorney General, other relevant cabinet 
Secretaries, the Committee on Energy and Commerce and the Committee on Education 
and the Workforce of the House of Representatives and the Committee on Health, 
Education, Labor, and Pensions of the Senate, and Congress, a final report 
containing all of the findings and recommendations required under this section, 
and shall make such report available online in an accessible format.
    (g) Additional Reports.--In addition to the final report under subsection 
(f). the task force shall submit--
            (1) a report to Congress identifying any recommendations identified 
        under subsection (c) that require additional legislative authority to 
        implement; and
            (2) a report to the Governors describing the opportunities for 
        local- and State-level partnerships, professional development, or best 
        practices recommended under subsection (d)(3).
    (h) Definitions.--In this section--
            (1) the term ``early childhood education program'' has the meaning 
        given such term in section 103 of the Higher Education Act of 1965 (20 
        U.S.C. 1003);
            (2) The term ``Governor'' means the chief executive officer of a 
        State; and
            (3) the term ``State'' means each of the several States, the 
        District of Columbia, the Commonwealth of Puerto Rico, the Virgin 
        Islands, Guam, American Samoa, and the Commonwealth of the Northern 
        Mariana Islands.
    (i) Sunset.--The task force shall sunset on the date that is 60 days after 
the submission of the final report under subsection (f), but not later than 
September 30, 2023.

SEC. 7133. NATIONAL CHILD TRAUMATIC STRESS INITIATIVE.

    Section 582(j) of the Public Health Service Act (42 U.S.C. 290hh-1(j)) 
(relating to grants to address the problems of persons who experience violence-
related stress) is amended by striking ``$46,887,000 for each of fiscal years 
2018 through 2022'' and inserting ``$63,887,000 for each of fiscal years 2019 
through 2023''.

SEC. 7134. GRANTS TO IMPROVE TRAUMA SUPPORT SERVICES AND MENTAL HEALTH CARE FOR 
              CHILDREN AND YOUTH IN EDUCATIONAL SETTINGS.

    (a) Grants, Contracts, and Cooperative Agreements Authorized.--The 
Secretary, in coordination with the Assistant Secretary for Mental Health and 
Substance Use, is authorized to award grants to, or enter into contracts or 
cooperative agreements with, State educational agencies, local educational 
agencies, Indian Tribes (as defined in section 4 of the Indian Self-
Determination and Education Assistance Act) or their tribal educational 
agencies, a school operated by the Bureau of Indian Education, a Regional 
Corporation, or a Native Hawaiian educational organization, for the purpose of 
increasing student access to evidence-based trauma support services and mental 
health care by developing innovative initiatives, activities, or programs to 
link local school systems with local trauma-informed support and mental health 
systems, including those under the Indian Health Service.
    (b) Duration.--With respect to a grant, contract, or cooperative agreement 
awarded or entered into under this section, the period during which payments 
under such grant, contract or agreement are made to the recipient may not exceed 
4 years.
    (c) Use of Funds.--An entity that receives a grant, contract, or cooperative 
agreement under this section shall use amounts made available through such 
grant, contract, or cooperative agreement for evidence-based activities, which 
shall include any of the following:
            (1) Collaborative efforts between school-based service systems and 
        trauma-informed support and mental health service systems to provide, 
        develop, or improve prevention, screening, referral, and treatment and 
        support services to students, such as providing trauma screenings to 
        identify students in need of specialized support.
            (2) To implement schoolwide positive behavioral interventions and 
        supports, or other trauma-informed models of support.
            (3) To provide professional development to teachers, teacher 
        assistants, school leaders, specialized instructional support personnel, 
        and mental health professionals that--
                    (A) fosters safe and stable learning environments that 
                prevent and mitigate the effects of trauma, including through 
                social and emotional learning;
                    (B) improves school capacity to identify, refer, and provide 
                services to students in need of trauma support or behavioral 
                health services; or
                    (C) reflects the best practices for trauma-informed 
                identification, referral, and support developed by the Task 
                Force under section 7132.
            (4) Services at a full-service community school that focuses on 
        trauma-informed supports, which may include a full-time site 
        coordinator, or other activities consistent with section 4625 of the 
        Elementary and Secondary Education Act of 1965 (20 U.S.C. 7275).
            (5) Engaging families and communities in efforts to increase 
        awareness of child and youth trauma, which may include sharing best 
        practices with law enforcement regarding trauma-informed care and 
        working with mental health professionals to provide interventions, as 
        well as longer term coordinated care within the community for children 
        and youth who have experienced trauma and their families.
            (6) To provide technical assistance to school systems and mental 
        health agencies.
            (7) To evaluate the effectiveness of the program carried out under 
        this section in increasing student access to evidence-based trauma 
        support services and mental health care.
            (8) To establish partnerships with or provide subgrants to Head 
        Start agencies (including Early Head Start agencies), public and private 
        preschool programs, child care programs (including home-based 
        providers), or other entities described in subsection (a), to include 
        such entities described in this paragraph in the evidence-based trauma 
        initiatives, activities, support services, and mental health systems 
        established under this section in order to provide, develop, or improve 
        prevention, screening, referral, and treatment and support services to 
        young children and their families.
    (d) Applications.--To be eligible to receive a grant, contract, or 
cooperative agreement under this section, an entity described in subsection (a) 
shall submit an application to the Secretary at such time, in such manner, and 
containing such information as the Secretary may reasonably require, which shall 
include the following:
            (1) A description of the innovative initiatives, activities, or 
        programs to be funded under the grant, contract, or cooperative 
        agreement, including how such program will increase access to evidence-
        based trauma support services and mental health care for students, and, 
        as applicable, the families of such students.
            (2) A description of how the program will provide linguistically 
        appropriate and culturally competent services.
            (3) A description of how the program will support students and the 
        school in improving the school climate in order to support an 
        environment conducive to learning.
            (4) An assurance that--
                    (A) persons providing services under the grant, contract, or 
                cooperative agreement are adequately trained to provide such 
                services; and
                    (B) teachers, school leaders, administrators, specialized 
                instructional support personnel, representatives of local Indian 
                Tribes or tribal organizations as appropriate, other school 
                personnel, and parents or guardians of students participating in 
                services under this section will be engaged and involved in the 
                design and implementation of the services.
            (5) A description of how the applicant will support and integrate 
        existing school-based services with the program in order to provide 
        mental health services for students, as appropriate.
            (6) A description of the entities in the community with which the 
        applicant will partner or to which the applicant will provide subgrants 
        in accordance with subsection (c)(8).
    (e) Interagency Agreements.--
            (1) Local interagency agreements.--To ensure the provision of the 
        services described in subsection (c), a recipient of a grant, contract, 
        or cooperative agreement under this section, or their designee, shall 
        establish a local interagency agreement among local educational 
        agencies, agencies responsible for early childhood education programs, 
        Head Start agencies (including Early Head Start agencies), juvenile 
        justice authorities, mental health agencies, child welfare agencies, and 
        other relevant agencies, authorities, or entities in the community that 
        will be involved in the provision of such services.
            (2) Contents.--In ensuring the provision of the services described 
        in subsection (c), the local interagency agreement shall specify with 
        respect to each agency, authority, or entity that is a party to such 
        agreement--
                    (A) the financial responsibility for the services;
                    (B) the conditions and terms of responsibility for the 
                services, including quality, accountability, and coordination of 
                the services; and
                    (C) the conditions and terms of reimbursement among such 
                agencies, authorities, or entities, including procedures for 
                dispute resolution.
    (f) Evaluation.--The Secretary shall reserve not more than 3 percent of the 
funds made available under subsection (l) for each fiscal year to--
            (1) conduct a rigorous, independent evaluation of the activities 
        funded under this section; and
            (2) disseminate and promote the utilization of evidence-based 
        practices regarding trauma support services and mental health care.
    (g) Distribution of Awards.--The Secretary shall ensure that grants, 
contracts, and cooperative agreements awarded or entered into under this section 
are equitably distributed among the geographical regions of the United States 
and among tribal, urban, suburban, and rural populations.
    (h) Rule of Construction.--Nothing in this section shall be construed--
            (1) to prohibit an entity involved with a program carried out under 
        this section from reporting a crime that is committed by a student to 
        appropriate authorities; or
            (2) to prevent Federal, State, and tribal law enforcement and 
        judicial authorities from exercising their responsibilities with regard 
        to the application of Federal, tribal, and State law to crimes committed 
        by a student.
    (i) Supplement, Not Supplant.--Any services provided through programs 
carried out under this section shall supplement, and not supplant, existing 
mental health services, including any special education and related services 
provided under the Individuals with Disabilities Education Act (20 U.S.C. 1400 
et seq.).
    (j) Consultation With Indian Tribes.--In carrying out subsection (a), the 
Secretary shall, in a timely manner, meaningfully consult with Indian Tribes and 
their representatives to ensure notice of eligibility.
    (k) Definitions.--In this section:
            (1) Elementary school.--The term ``elementary school'' has the 
        meaning given such term in section 8101 of the Elementary and Secondary 
        Education Act of 1965 (20 U.S.C. 7801).
            (2) Evidence-based.--The term ``evidence-based'' has the meaning 
        given such term in section 8101(21)(A)(i) of the Elementary and 
        Secondary Education Act of 1965 (20 U.S.C. 7801(21)(A)(i)).
            (3) Native hawaiian educational organization.--The term ``Native 
        Hawaiian educational organization'' has the meaning given such term in 
        section 6207 of the Elementary and Secondary Education Act of 1965 (20 
        U.S.C. 7517).
            (4) Local educational agency.--The term ``local educational agency'' 
        has the meaning given such term in section 8101 of the Elementary and 
        Secondary Education Act of 1965 (20 U.S.C. 7801).
            (5) Regional corporation.--The term ``Regional Corporation'' has the 
        meaning given the term in section 3 of the Alaska Native Claims 
        Settlement Act (43 U.S.C. 1602)).
            (6) School.--The term ``school'' means a public elementary school or 
        public secondary school.
            (7) School leader.--The term ``school leader'' has the meaning given 
        such term in section 8101 of the Elementary and Secondary Education Act 
        of 1965 (20 U.S.C. 7801).
            (8) Secondary school.--The term ``secondary school'' has the meaning 
        given such term in section 8101 of the Elementary and Secondary 
        Education Act of 1965 (20 U.S.C. 7801).
            (9) Secretary.--The term ``Secretary'' means the Secretary of 
        Education.
            (10) Specialized instructional support personnel.--The term 
        ``specialized instructional support personnel'' has the meaning given 
        such term in section 8101 of the Elementary and Secondary Education Act 
        of 1965 (20 U.S.C. 7801).
            (11) State educational agency.--The term ``State educational 
        agency'' has the meaning given such term in section 8101 of the 
        Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).
    (l) Authorization of Appropriations.--There is authorized to be appropriated 
to carry out this section, $50,000,000 for each of fiscal years 2019 through 
2023.

SEC. 7135. RECOGNIZING EARLY CHILDHOOD TRAUMA RELATED TO SUBSTANCE ABUSE.

    (a) Dissemination of Information.--The Secretary of Health and Human 
Services shall disseminate information, resources, and, if requested, technical 
assistance to early childhood care and education providers and professionals 
working with young children on--
            (1) ways to properly recognize children who may be impacted by 
        trauma, including trauma related to substance use by a family member or 
        other adult; and
            (2) how to respond appropriately in order to provide for the safety 
        and well-being of young children and their families.
    (b) Goals.--The information, resources, and technical assistance provided 
under subsection (a) shall--
            (1) educate early childhood care and education providers and 
        professionals working with young children on understanding and 
        identifying the early signs and risk factors of children who might be 
        impacted by trauma, including trauma due to exposure to substance use;
            (2) suggest age-appropriate communication tools, procedures, and 
        practices for trauma-informed care, including ways to prevent or 
        mitigate the effects of trauma;
            (3) provide options for responding to children impacted by trauma, 
        including due to exposure to substance use, that consider the needs of 
        the child and family, including recommending resources and referrals for 
        evidence-based services to support such family; and
            (4) promote whole-family and multi-generational approaches to keep 
        families safely together when it is in the best interest of the child.
    (c) Coordination.--The Secretary of Health and Human Services shall 
coordinate with the task force to develop best practices for trauma-informed 
identification, referral, and support authorized under section 7132 in 
disseminating the information, resources, and technical assistance described 
under subsection (b).
    (d) Rule of Construction.--Such information, resources, and if applicable, 
technical assistance, shall not be construed to amend the requirements under--
            (1) the Child Care and Development Block Grant Act of 1990 (42 
        U.S.C. 9858 et seq.);
            (2) the Head Start Act (42 U.S.C. 9831 et seq.); or
            (3) the Individuals with Disabilities Education Act (20 U.S.C. 1400 
        et seq.).

           Subtitle O--Eliminating Opioid Related Infectious Diseases

SEC. 7141. REAUTHORIZATION AND EXPANSION OF PROGRAM OF SURVEILLANCE AND 
              EDUCATION REGARDING INFECTIONS ASSOCIATED WITH ILLICIT DRUG USE 
              AND OTHER RISK FACTORS.

    Section 317N of the Public Health Service Act (42 U.S.C. 247b-15) is amended 
to read as follows:

``SEC. 317N. SURVEILLANCE AND EDUCATION REGARDING INFECTIONS ASSOCIATED WITH 
              ILLICIT DRUG USE AND OTHER RISK FACTORS.

    ``(a) In General.--The Secretary, acting through the Director of the Centers 
for Disease Control and Prevention, may (directly or through grants to public 
and nonprofit private entities) provide for programs for the following:
            ``(1) To cooperate with States and Indian tribes in implementing or 
        maintaining a national system to determine the incidence of infections 
        commonly associated with illicit drug use, such as viral hepatitis, 
        human immunodeficiency virus, and infective endocarditis, and to assist 
        the States in determining the prevalence of such infections, which may 
        include the reporting of cases of such infections.
            ``(2) To identify, counsel, and offer testing to individuals who are 
        at risk of infections described in paragraph (1) resulting from illicit 
        drug use, receiving blood transfusions prior to July 1992, or other risk 
        factors.
            ``(3) To provide appropriate referrals for counseling, testing, and 
        medical treatment of individuals identified under paragraph (2) and to 
        ensure, to the extent practicable, the provision of appropriate follow-
        up services.
            ``(4) To develop and disseminate public information and education 
        programs for the detection and control of infections described in 
        paragraph (1), with priority given to high-risk populations as 
        determined by the Secretary.
            ``(5) To improve the education, training, and skills of health 
        professionals in the detection and control of infections described in 
        paragraph (1), including to improve coordination of treatment of 
        substance use disorders and infectious diseases, with priority given to 
        substance use disorder treatment providers, pediatricians and other 
        primary care providers, obstetrician-gynecologists, and infectious 
        disease clinicians, including HIV clinicians.
    ``(b) Laboratory Procedures.--The Secretary may (directly or through grants 
to public and nonprofit private entities) carry out programs to provide for 
improvements in the quality of clinical-laboratory procedures regarding 
infections described in subsection (a)(1).
    ``(c) Definition.--In this section, the term `Indian tribe' has the meaning 
given that term in section 4 of the Indian Self-Determination and Education 
Assistance Act.
    ``(d) Authorization of Appropriations.--For the purpose of carrying out this 
section, there are authorized to be appropriated $40,000,000 for each of the 
fiscal years 2019 through 2023.''.

                Subtitle P--Peer Support Communities of Recovery

SEC. 7151. BUILDING COMMUNITIES OF RECOVERY.

    Section 547 of the Public Health Service Act (42 U.S.C. 290ee-2) is amended 
to read as follows:

``SEC. 547. BUILDING COMMUNITIES OF RECOVERY.

    ``(a) Definition.--In this section, the term `recovery community 
organization' means an independent nonprofit organization that--
            ``(1) mobilizes resources within and outside of the recovery 
        community, which may include through a peer support network, to increase 
        the prevalence and quality of long-term recovery from substance use 
        disorders; and
            ``(2) is wholly or principally governed by people in recovery for 
        substance use disorders who reflect the community served.
    ``(b) Grants Authorized.--The Secretary shall award grants to recovery 
community organizations to enable such organizations to develop, expand, and 
enhance recovery services.
    ``(c) Federal Share.--The Federal share of the costs of a program funded by 
a grant under this section may not exceed 85 percent.
    ``(d) Use of Funds.--Grants awarded under subsection (b)--
            ``(1) shall be used to develop, expand, and enhance community and 
        statewide recovery support services; and
            ``(2) may be used to--
                    ``(A) build connections between recovery networks, including 
                between recovery community organizations and peer support 
                networks, and with other recovery support services, including--
                            ``(i) behavioral health providers;
                            ``(ii) primary care providers and physicians;
                            ``(iii) educational and vocational schools;
                            ``(iv) employers;
                            ``(v) housing services;
                            ``(vi) child welfare agencies; and
                            ``(vii) other recovery support services that 
                        facilitate recovery from substance use disorders, 
                        including non-clinical community services;
                    ``(B) reduce stigma associated with substance use disorders; 
                and
                    ``(C) conduct outreach on issues relating to substance use 
                disorders and recovery, including--
                            ``(i) identifying the signs of substance use 
                        disorder;
                            ``(ii) the resources available to individuals with 
                        substance use disorder and to families of an individual 
                        with a substance use disorder, including programs that 
                        mentor and provide support services to children;
                            ``(iii) the resources available to help support 
                        individuals in recovery; and
                            ``(iv) related medical outcomes of substance use 
                        disorders, the potential of acquiring an infection 
                        commonly associated with illicit drug use, and neonatal 
                        abstinence syndrome among infants exposed to opioids 
                        during pregnancy.
    ``(e) Special Consideration.--In carrying out this section, the Secretary 
shall give special consideration to the unique needs of rural areas, including 
areas with an age-adjusted rate of drug overdose deaths that is above the 
national average and areas with a shortage of prevention and treatment services.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $5,000,000 for each of fiscal years 2019 
through 2023.''.

SEC. 7152. PEER SUPPORT TECHNICAL ASSISTANCE CENTER.

    Title V of the Public Health Service Act (42 U.S.C. 290dd et seq.) is 
amended by inserting after section 547 the following:

``SEC. 547A. PEER SUPPORT TECHNICAL ASSISTANCE CENTER.

    ``(a) Establishment.--The Secretary, acting through the Assistant Secretary, 
shall establish or operate a National Peer-Run Training and Technical Assistance 
Center for Addiction Recovery Support (referred to in this section as the 
`Center').
    ``(b) Functions.--The Center established under subsection (a) shall provide 
technical assistance and support to recovery community organizations and peer 
support networks, including such assistance and support related to--
            ``(1) training on identifying--
                    ``(A) signs of substance use disorder;
                    ``(B) resources to assist individuals with a substance use 
                disorder, or resources for families of an individual with a 
                substance use disorder; and
                    ``(C) best practices for the delivery of recovery support 
                services;
            ``(2) the provision of translation services, interpretation, or 
        other such services for clients with limited English speaking 
        proficiency;
            ``(3) data collection to support research, including for 
        translational research;
            ``(4) capacity building; and
            ``(5) evaluation and improvement, as necessary, of the effectiveness 
        of such services provided by recovery community organizations.
    ``(c) Best Practices.--The Center established under subsection (a) shall 
periodically issue best practices for use by recovery community organizations 
and peer support networks.
    ``(d) Recovery Community Organization.--In this section, the term `recovery 
community organization' has the meaning given such term in section 547.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $1,000,000 for each of fiscal years 2019 
through 2023.''.

Subtitle Q--Creating Opportunities That Necessitate New and Enhanced Connections 
                    That Improve Opioid Navigation Strategies

SEC. 7161. PREVENTING OVERDOSES OF CONTROLLED SUBSTANCES.

    (a) In General.--Part J of title III of the Public Health Service Act (42 
U.S.C. 280b et seq.) is amended by inserting after section 392 (42 U.S.C. 280b-
1) the following:

``SEC. 392A. PREVENTING OVERDOSES OF CONTROLLED SUBSTANCES.

    ``(a) Evidence-Based Prevention Grants.--
            ``(1) In general.--The Director of the Centers for Disease Control 
        and Prevention may--
                    ``(A) to the extent practicable, carry out and expand any 
                evidence-based prevention activities described in paragraph (2);
                    ``(B) provide training and technical assistance to States, 
                localities, and Indian tribes for purposes of carrying out such 
                activity; and
                    ``(C) award grants to States, localities, and Indian tribes 
                for purposes of carrying out such activity.
            ``(2) Evidence-based prevention activities.--An evidence-based 
        prevention activity described in this paragraph is any of the following 
        activities:
                    ``(A) Improving the efficiency and use of a new or currently 
                operating prescription drug monitoring program, including by--
                            ``(i) encouraging all authorized users (as specified 
                        by the State or other entity) to register with and use 
                        the program;
                            ``(ii) enabling such users to access any updates to 
                        information collected by the program in as close to 
                        real-time as possible;
                            ``(iii) improving the ease of use of such program;
                            ``(iv) providing for a mechanism for the program to 
                        notify authorized users of any potential misuse or abuse 
                        of controlled substances and any detection of 
                        inappropriate prescribing or dispensing practices 
                        relating to such substances;
                            ``(v) encouraging the analysis of prescription drug 
                        monitoring data for purposes of providing de-identified, 
                        aggregate reports based on such analysis to State public 
                        health agencies, State substance abuse agencies, State 
                        licensing boards, and other appropriate State agencies, 
                        as permitted under applicable Federal and State law and 
                        the policies of the prescription drug monitoring program 
                        and not containing any protected health information, to 
                        prevent inappropriate prescribing, drug diversion, or 
                        abuse and misuse of controlled substances, and to 
                        facilitate better coordination among agencies;
                            ``(vi) enhancing interoperability between the 
                        program and any health information technology (including 
                        certified health information technology), including by 
                        integrating program data into such technology;
                            ``(vii) updating program capabilities to respond to 
                        technological innovation for purposes of appropriately 
                        addressing the occurrence and evolution of controlled 
                        substance overdoses;
                            ``(viii) facilitating and encouraging data exchange 
                        between the program and the prescription drug monitoring 
                        programs of other States;
                            ``(ix) enhancing data collection and quality, 
                        including improving patient matching and proactively 
                        monitoring data quality;
                            ``(x) providing prescriber and dispenser practice 
                        tools, including prescriber practice insight reports for 
                        practitioners to review their prescribing patterns in 
                        comparison to such patterns of other practitioners in 
                        the specialty; and
                            ``(xi) meeting the purpose of the program 
                        established under section 399O, as described in section 
                        399O(a).
                    ``(B) Promoting community or health system interventions.
                    ``(C) Evaluating interventions to prevent controlled 
                substance overdoses.
                    ``(D) Implementing projects to advance an innovative 
                prevention approach with respect to new and emerging public 
                health crises and opportunities to address such crises, such as 
                enhancing public education and awareness on the risks associated 
                with opioids.
            ``(3) Additional grants.--The Director may award grants to States, 
        localities, and Indian Tribes--
                    ``(A) to carry out innovative projects for grantees to 
                rapidly respond to controlled substance misuse, abuse, and 
                overdoses, including changes in patterns of controlled substance 
                use; and
                    ``(B) for any other evidence-based activity for preventing 
                controlled substance misuse, abuse, and overdoses as the 
                Director determines appropriate.
            ``(4) Research.--The Director, in coordination with the Assistant 
        Secretary for Mental Health and Substance Use and the National Mental 
        Health and Substance Use Policy Laboratory established under section 
        501A, as appropriate and applicable, may conduct studies and evaluations 
        to address substance use disorders, including preventing substance use 
        disorders or other related topics the Director determines appropriate.
    ``(b) Enhanced Controlled Substance Overdose Data Collection, Analysis, and 
Dissemination Grants.--
            ``(1) In general.--The Director of the Centers for Disease Control 
        and Prevention may--
                    ``(A) to the extent practicable, carry out any controlled 
                substance overdose data collection activities described in 
                paragraph (2);
                    ``(B) provide training and technical assistance to States, 
                localities, and Indian tribes for purposes of carrying out such 
                activity;
                    ``(C) award grants to States, localities, and Indian tribes 
                for purposes of carrying out such activity; and
                    ``(D) coordinate with the Assistant Secretary for Mental 
                Health and Substance Use to collect data pursuant to section 
                505(d)(1)(A) (relating to the number of individuals admitted to 
                emergency departments as a result of the abuse of alcohol or 
                other drugs).
            ``(2) Controlled substance overdose data collection and analysis 
        activities.--A controlled substance overdose data collection, analysis, 
        and dissemination activity described in this paragraph is any of the 
        following activities:
                    ``(A) Improving the timeliness of reporting data to the 
                public, including data on fatal and nonfatal overdoses of 
                controlled substances.
                    ``(B) Enhancing the comprehensiveness of controlled 
                substance overdose data by collecting information on such 
                overdoses from appropriate sources such as toxicology reports, 
                autopsy reports, death scene investigations, and emergency 
                departments.
                    ``(C) Modernizing the system for coding causes of death 
                related to controlled substance overdoses to use an electronic-
                based system.
                    ``(D) Using data to help identify risk factors associated 
                with controlled substance overdoses.
                    ``(E) Supporting entities involved in providing information 
                on controlled substance overdoses, such as coroners, medical 
                examiners, and public health laboratories to improve accurate 
                testing and standardized reporting of causes and contributing 
                factors to controlled substances overdoses and analysis of 
                various opioid analogues to controlled substance overdoses.
                    ``(F) Working to enable and encourage the access, exchange, 
                and use of information regarding controlled substance overdoses 
                among data sources and entities.
    ``(c) Definitions.--In this section:
            ``(1) Controlled substance.--The term `controlled substance' has the 
        meaning given that term in section 102 of the Controlled Substances Act.
            ``(2) Indian tribe.--The term `Indian tribe' has the meaning given 
        that term in section 4 of the Indian Self-Determination and Education 
        Assistance Act.
    ``(d) Authorization of Appropriations.--For purposes of carrying out this 
section, section 399O of this Act, and section 102 of the Comprehensive 
Addiction and Recovery Act of 2016 (Public Law 114-198), there is authorized to 
be appropriated $496,000,000 for each of fiscal years 2019 through 2023.''.
    (b) Education and Awareness.--Section 102 of the Comprehensive Addiction and 
Recovery Act of 2016 (Public Law 114-198) is amended--
            (1) by amending subsection (a) to read as follows:
    ``(a) In General.--The Secretary of Health and Human Services, acting 
through the Director of the Centers for Disease Control and Prevention and in 
coordination with the heads of other departments and agencies, shall advance 
education and awareness regarding the risks related to misuse and abuse of 
opioids, as appropriate, which may include developing or improving existing 
programs, conducting activities, and awarding grants that advance the education 
and awareness of--
            ``(1) the public, including patients and consumers--
                    ``(A) generally; and
                    ``(B) regarding such risks related to unused opioids and the 
                dispensing options under section 309(f) of the Controlled 
                Substances Act, as applicable; and
            ``(2) providers, which may include--
                    ``(A) providing for continuing education on appropriate 
                prescribing practices;
                    ``(B) education related to applicable State or local 
                prescriber limit laws, information on the use of non-addictive 
                alternatives for pain management, and the use of overdose 
                reversal drugs, as appropriate;
                    ``(C) disseminating and improving the use of evidence-based 
                opioid prescribing guidelines across relevant health care 
                settings, as appropriate, and updating guidelines as necessary;
                    ``(D) implementing strategies, such as best practices, to 
                encourage and facilitate the use of prescriber guidelines, in 
                accordance with State and local law;
                    ``(E) disseminating information to providers about 
                prescribing options for controlled substances, including such 
                options under section 309(f) of the Controlled Substances Act, 
                as applicable; and
                    ``(F) disseminating information, as appropriate, on the 
                National Pain Strategy developed by or in consultation with the 
                Assistant Secretary for Health; and
            ``(3) other appropriate entities.''; and
            (2) in subsection (b)--
                    (A) by striking ``opioid abuse'' each place such term 
                appears and inserting ``opioid misuse and abuse''; and
                    (B) in paragraph (2), by striking ``safe disposal of 
                prescription medications and other'' and inserting ``non-
                addictive treatment options, safe disposal options for 
                prescription medications, and other applicable''.

SEC. 7162. PRESCRIPTION DRUG MONITORING PROGRAM.

    Section 399O of the Public Health Service Act (42 U.S.C. 280g-3) is amended 
to read as follows:

``SEC. 399O. PRESCRIPTION DRUG MONITORING PROGRAM.

    ``(a) Program.--
            ``(1) In general.--Each fiscal year, the Secretary, acting through 
        the Director of the Centers for Disease Control and Prevention, in 
        coordination with the heads of other departments and agencies as 
        appropriate, shall support States or localities for the purpose of 
        improving the efficiency and use of PDMPs, including--
                    ``(A) establishment and implementation of a PDMP;
                    ``(B) maintenance of a PDMP;
                    ``(C) improvements to a PDMP by--
                            ``(i) enhancing functional components to work 
                        toward--
                                    ``(I) universal use of PDMPs among providers 
                                and their delegates, to the extent that State 
                                laws allow;
                                    ``(II) more timely inclusion of data within 
                                a PDMP;
                                    ``(III) active management of the PDMP, in 
                                part by sending proactive or unsolicited reports 
                                to providers to inform prescribing; and
                                    ``(IV) ensuring the highest level of ease in 
                                use of and access to PDMPs by providers and 
                                their delegates, to the extent that State laws 
                                allow;
                            ``(ii) in consultation with the Office of the 
                        National Coordinator for Health Information Technology, 
                        improving the intrastate interoperability of PDMPs by--
                                    ``(I) making PDMPs more actionable by 
                                integrating PDMPs within electronic health 
                                records and health information technology 
                                infrastructure; and
                                    ``(II) linking PDMP data to other data 
                                systems within the State, including--
                                            ``(aa) the data of pharmacy benefit 
                                        managers, medical examiners and 
                                        coroners, and the State's Medicaid 
                                        program;
                                            ``(bb) worker's compensation data; 
                                        and
                                            ``(cc) prescribing data of providers 
                                        of the Department of Veterans Affairs 
                                        and the Indian Health Service within the 
                                        State;
                            ``(iii) in consultation with the Office of the 
                        National Coordinator for Health Information Technology, 
                        improving the interstate interoperability of PDMPs 
                        through--
                                    ``(I) sharing of dispensing data in near-
                                real time across State lines; and
                                    ``(II) integration of automated queries for 
                                multistate PDMP data and analytics into clinical 
                                workflow to improve the use of such data and 
                                analytics by practitioners and dispensers; or
                            ``(iv) improving the ability to include treatment 
                        availability resources and referral capabilities within 
                        the PDMP.
            ``(2) Legislation.--As a condition on the receipt of support under 
        this section, the Secretary shall require a State or locality to 
        demonstrate that it has enacted legislation or regulations--
                    ``(A) to provide for the implementation of the PDMP; and
                    ``(B) to permit the imposition of appropriate penalties for 
                the unauthorized use and disclosure of information maintained by 
                the PDMP.
    ``(b) PDMP Strategies.--The Secretary shall encourage a State or locality, 
in establishing, improving, or maintaining a PDMP, to implement strategies that 
improve--
            ``(1) the reporting of dispensing in the State or locality of a 
        controlled substance to an ultimate user so the reporting occurs not 
        later than 24 hours after the dispensing event;
            ``(2) the consultation of the PDMP by each prescribing practitioner, 
        or their designee, in the State or locality before initiating treatment 
        with a controlled substance, or any substance as required by the State 
        to be reported to the PDMP, and over the course of ongoing treatment for 
        each prescribing event;
            ``(3) the consultation of the PDMP before dispensing a controlled 
        substance, or any substance as required by the State to be reported to 
        the PDMP;
            ``(4) the proactive notification to a practitioner when patterns 
        indicative of controlled substance misuse by a patient, including opioid 
        misuse, are detected;
            ``(5) the availability of data in the PDMP to other States, as 
        allowable under State law; and
            ``(6) the availability of nonidentifiable information to the Centers 
        for Disease Control and Prevention for surveillance, epidemiology, 
        statistical research, or educational purposes.
    ``(c) Drug Misuse and Abuse.--In consultation with practitioners, 
dispensers, and other relevant and interested stakeholders, a State receiving 
support under this section--
            ``(1) shall establish a program to notify practitioners and 
        dispensers of information that will help to identify and prevent the 
        unlawful diversion or misuse of controlled substances;
            ``(2) may, to the extent permitted under State law, notify the 
        appropriate authorities responsible for carrying out drug diversion 
        investigations if the State determines that information in the PDMP 
        maintained by the State indicates an unlawful diversion or abuse of a 
        controlled substance;
            ``(3) may conduct analyses of controlled substance program data for 
        purposes of providing appropriate State agencies with aggregate reports 
        based on such analyses in as close to real-time as practicable, 
        regarding prescription patterns flagged as potentially presenting a risk 
        of misuse, abuse, addiction, overdose, and other aggregate information, 
        as appropriate and in compliance with applicable Federal and State laws 
        and provided that such reports shall not include protected health 
        information; and
            ``(4) may access information about prescriptions, such as claims 
        data, to ensure that such prescribing and dispensing history is updated 
        in as close to real-time as practicable, in compliance with applicable 
        Federal and State laws and provided that such information shall not 
        include protected health information.
    ``(d) Evaluation and Reporting.--As a condition on receipt of support under 
this section, the State shall report on interoperability with PDMPs of other 
States and Federal agencies, where appropriate, intrastate interoperability with 
health information technology systems such as electronic health records, health 
information exchanges, and e-prescribing, where appropriate, and whether or not 
the State provides automatic, up-to-date, or daily information about a patient 
when a practitioner (or the designee of a practitioner, where permitted) 
requests information about such patient.
    ``(e) Evaluation and Reporting.--A State receiving support under this 
section shall provide the Secretary with aggregate nonidentifiable information, 
as permitted by State law, to enable the Secretary--
            ``(1) to evaluate the success of the State's program in achieving 
        the purpose described in subsection (a); or
            ``(2) to prepare and submit to the Congress the report required by 
        subsection (i)(2).
    ``(f) Education and Access to the Monitoring System.--A State receiving 
support under this section shall take steps to--
            ``(1) facilitate prescribers and dispensers, and their delegates, as 
        permitted by State law, to use the PDMP, to the extent practicable; and
            ``(2) educate prescribers and dispensers, and their delegates on the 
        benefits of the use of PDMPs.
    ``(g) Electronic Format.--The Secretary may issue guidelines specifying a 
uniform electronic format for the reporting, sharing, and disclosure of 
information pursuant to PDMPs. To the extent possible, such guidelines shall be 
consistent with standards recognized by the Office of the National Coordinator 
for Health Information Technology.
    ``(h) Rules of Construction.--
            ``(1) Functions otherwise authorized by law.--Nothing in this 
        section shall be construed to restrict the ability of any authority, 
        including any local, State, or Federal law enforcement, narcotics 
        control, licensure, disciplinary, or program authority, to perform 
        functions otherwise authorized by law.
            ``(2) Additional privacy protections.--Nothing in this section shall 
        be construed as preempting any State from imposing any additional 
        privacy protections.
            ``(3) Federal privacy requirements.--Nothing in this section shall 
        be construed to supersede any Federal privacy or confidentiality 
        requirement, including the regulations promulgated under section 264(c) 
        of the Health Insurance Portability and Accountability Act of 1996 
        (Public Law 104-191; 110 Stat. 2033) and section 543 of this Act.
            ``(4) No federal private cause of action.--Nothing in this section 
        shall be construed to create a Federal private cause of action.
    ``(i) Progress Report.--Not later than 3 years after the date of enactment 
of this section, the Secretary shall--
            ``(1) complete a study that--
                    ``(A) determines the progress of grantees in establishing 
                and implementing PDMPs consistent with this section;
                    ``(B) provides an analysis of the extent to which the 
                operation of PDMPs has--
                            ``(i) reduced inappropriate use, abuse, diversion 
                        of, and overdose with, controlled substances;
                            ``(ii) established or strengthened initiatives to 
                        ensure linkages to substance use disorder treatment 
                        services; or
                            ``(iii) affected patient access to appropriate care 
                        in States operating PDMPs;
                    ``(C) determine the progress of grantees in achieving 
                interstate interoperability and intrastate interoperability of 
                PDMPs, including an assessment of technical, legal, and 
                financial barriers to such progress and recommendations for 
                addressing these barriers;
                    ``(D) determines the progress of grantees in implementing 
                near real-time electronic PDMPs;
                    ``(E) provides an analysis of the privacy protections in 
                place for the information reported to the PDMP in each State or 
                locality receiving support under this section and any 
                recommendations of the Secretary for additional Federal or State 
                requirements for protection of this information;
                    ``(F) determines the progress of States or localities in 
                implementing technological alternatives to centralized data 
                storage, such as peer-to-peer file sharing or data pointer 
                systems, in PDMPs and the potential for such alternatives to 
                enhance the privacy and security of individually identifiable 
                data; and
                    ``(G) evaluates the penalties that States or localities have 
                enacted for the unauthorized use and disclosure of information 
                maintained in PDMPs, and the criteria used by the Secretary to 
                determine whether such penalties qualify as appropriate for 
                purposes of subsection (a)(2); and
            ``(2) submit a report to the Congress on the results of the study.
    ``(j) Advisory Council.--
            ``(1) Establishment.--A State or locality may establish an advisory 
        council to assist in the establishment, improvement, or maintenance of a 
        PDMP consistent with this section.
            ``(2) Limitation.--A State or locality may not use Federal funds for 
        the operations of an advisory council to assist in the establishment, 
        improvement, or maintenance of a PDMP.
            ``(3) Sense of congress.--It is the sense of the Congress that, in 
        establishing an advisory council to assist in the establishment, 
        improvement, or maintenance of a PDMP, a State or locality should 
        consult with appropriate professional boards and other interested 
        parties.
    ``(k) Definitions.--For purposes of this section:
            ``(1) The term `controlled substance' means a controlled substance 
        (as defined in section 102 of the Controlled Substances Act) in schedule 
        II, III, or IV of section 202 of such Act.
            ``(2) The term `dispense' means to deliver a controlled substance to 
        an ultimate user by, or pursuant to the lawful order of, a practitioner, 
        irrespective of whether the dispenser uses the Internet or other means 
        to effect such delivery.
            ``(3) The term `dispenser' means a physician, pharmacist, or other 
        person that dispenses a controlled substance to an ultimate user.
            ``(4) The term `interstate interoperability' with respect to a PDMP 
        means the ability of the PDMP to electronically share reported 
        information with another State if the information concerns either the 
        dispensing of a controlled substance to an ultimate user who resides in 
        such other State, or the dispensing of a controlled substance prescribed 
        by a practitioner whose principal place of business is located in such 
        other State.
            ``(5) The term `intrastate interoperability' with respect to a PDMP 
        means the integration of PDMP data within electronic health records and 
        health information technology infrastructure or linking of a PDMP to 
        other data systems within the State, including the State's Medicaid 
        program, workers' compensation programs, and medical examiners or 
        coroners.
            ``(6) The term `nonidentifiable information' means information that 
        does not identify a practitioner, dispenser, or an ultimate user and 
        with respect to which there is no reasonable basis to believe that the 
        information can be used to identify a practitioner, dispenser, or an 
        ultimate user.
            ``(7) The term `PDMP' means a prescription drug monitoring program 
        that is State-controlled.
            ``(8) The term `practitioner' means a physician, dentist, 
        veterinarian, scientific investigator, pharmacy, hospital, or other 
        person licensed, registered, or otherwise permitted, by the United 
        States or the jurisdiction in which the individual practices or does 
        research, to distribute, dispense, conduct research with respect to, 
        administer, or use in teaching or chemical analysis, a controlled 
        substance in the course of professional practice or research.
            ``(9) The term `State' means each of the 50 States, the District of 
        Columbia, and any commonwealth or territory of the United States.
            ``(10) The term `ultimate user' means a person who has obtained from 
        a dispenser, and who possesses, a controlled substance for the person's 
        own use, for the use of a member of the person's household, or for the 
        use of an animal owned by the person or by a member of the person's 
        household.
            ``(11) The term `clinical workflow' means the integration of 
        automated queries for prescription drug monitoring programs data and 
        analytics into health information technologies such as electronic health 
        record systems, health information exchanges, and/or pharmacy dispensing 
        software systems, thus streamlining provider access through automated 
        queries.''.

   Subtitle R--Review of Substance Use Disorder Treatment Providers Receiving 
                                 Federal Funding

SEC. 7171. REVIEW OF SUBSTANCE USE DISORDER TREATMENT PROVIDERS RECEIVING 
              FEDERAL FUNDING.

    (a) In General.--The Secretary of Health and Human Services (in this section 
referred to as the ``Secretary'') shall conduct a review of entities that 
receive Federal funding for the provision of substance use disorder treatment 
services. The review shall include:
            (1) The length of time the entity has provided substance use 
        disorder treatment services and the geographic area served by the 
        entity.
            (2) A detailed analysis of the patient population served by the 
        entity, including but not limited to the number of patients, types of 
        diagnosed substance use disorders and the demographic information of 
        such patients, including sex, race, ethnicity, and socioeconomic status.
            (3) Detailed information on the types of substance use disorders for 
        which the entity has the experience, capability, and capacity to provide 
        such services.
            (4) An analysis of how the entity handles patients requiring 
        treatment for a substance use disorder that the organization is not able 
        to treat.
            (5) An analysis of what is needed in order to improve the entity's 
        ability to meet the addiction treatment needs of the communities served 
        by that entity.
            (6) Based on the identified needs of the communities served, a 
        description of unmet needs and inadequate services and how such needs 
        and services could be better addressed to treat individuals with 
        methamphetamine, cocaine, including crack cocaine, heroin, opioid, and 
        other substance use disorders.
    (b) Report.--Not later than 2 years after the date of the enactment of this 
Act, the Secretary shall develop and submit to Congress a plan to direct 
appropriate resources to entities that provide substance use disorder treatment 
services in order to address inadequacies in services or funding identified 
through the survey described in subsection (a).

                       Subtitle S--Other Health Provisions

SEC. 7181. STATE RESPONSE TO THE OPIOID ABUSE CRISIS.

    (a) In General.--Section 1003 of the 21st Century Cures Act (Public Law 114-
255) is amended--
            (1) in subsection (a)--
                    (A) by striking ``the authorization of appropriations under 
                subsection (b) to carry out the grant program described in 
                subsection (c)'' and inserting ``subsection (h) to carry out the 
                grant program described in subsection (b)''; and
                    (B) by inserting ``and Indian Tribes'' after ``States'';
            (2) by striking subsection (b);
            (3) by redesignating subsections (c) through (e) as subsections (b) 
        through (d), respectively;
            (4) by redesignating subsection (f) as subsection (j);
            (5) in subsection (b), as so redesignated--
                    (A) in paragraph (1)--
                            (i) in the paragraph heading, by inserting ``and 
                        tribal'' after ``State'';
                            (ii) by striking ``States for the purpose of 
                        addressing the opioid abuse crisis within such States'' 
                        and inserting ``States and Indian Tribes for the purpose 
                        of addressing the opioid abuse crisis within such States 
                        and Indian Tribes'';
                            (iii) by inserting ``or Indian Tribes'' after 
                        ``preference to States''; and
                            (iv) by inserting before the period of the second 
                        sentence ``or other Indian Tribes, as applicable''; and
                    (B) in paragraph (2)--
                            (i) in the matter preceding subparagraph (A), by 
                        striking ``to a State'';
                            (ii) in subparagraph (A), by striking ``Improving 
                        State'' and inserting ``Establishing or improving'';
                            (iii) in subparagraph (C), by inserting ``preventing 
                        diversion of controlled substances,'' after ``treatment 
                        programs,''; and
                            (iv) in subparagraph (E), by striking ``as the State 
                        determines appropriate, related to addressing the opioid 
                        abuse crisis within the State'' and inserting ``as the 
                        State or Indian Tribe determines appropriate, related to 
                        addressing the opioid abuse crisis within the State or 
                        Indian Tribe, including directing resources in 
                        accordance with local needs related to substance use 
                        disorders'';
            (6) in subsection (c), as so redesignated, by striking ``subsection 
        (c)'' and inserting ``subsection (b)'';
            (7) in subsection (d), as so redesignated--
                    (A) in the matter preceding paragraph (1), by striking ``the 
                authorization of appropriations under subsection (b)'' and 
                inserting ``subsection (h)''; and
                    (B) in paragraph (1), by striking ``subsection (c)'' and 
                inserting ``subsection (b)''; and
            (8) by inserting after subsection (d), as so redesignated, the 
        following:
    ``(e) Indian Tribes.--
            ``(1) Definition.--For purposes of this section, the term `Indian 
        Tribe' has the meaning given the term `Indian tribe' in section 4 of the 
        Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).
            ``(2) Appropriate mechanisms.--The Secretary, in consultation with 
        Indian Tribes, shall identify and establish appropriate mechanisms for 
        Tribes to demonstrate or report the information as required under 
        subsections (b), (c), and (d).
    ``(f) Report to Congress.--Not later than 1 year after the date on which 
amounts are first awarded after the date of enactment of this subsection, 
pursuant to subsection (b), and annually thereafter, the Secretary shall submit 
to the Committee on Health, Education, Labor, and Pensions of the Senate and the 
Committee on Energy and Commerce of the House of Representatives a report 
summarizing the information provided to the Secretary in reports made pursuant 
to subsection (c), including the purposes for which grant funds are awarded 
under this section and the activities of such grant recipients.
    ``(g) Technical Assistance.--The Secretary, including through the Tribal 
Training and Technical Assistance Center of the Substance Abuse and Mental 
Health Services Administration, shall provide State agencies and Indian Tribes, 
as applicable, with technical assistance concerning grant application and 
submission procedures under this section, award management activities, and 
enhancing outreach and direct support to rural and underserved communities and 
providers in addressing the opioid crisis.
    ``(h) Authorization of Appropriations.--For purposes of carrying out the 
grant program under subsection (b), there is authorized to be appropriated 
$500,000,000 for each of fiscal years 2019 through 2021, to remain available 
until expended.
    ``(i) Set Aside.--Of the amounts made available for each fiscal year to 
award grants under subsection (b) for a fiscal year, 5 percent of such amount 
for such fiscal year shall be made available to Indian Tribes, and up to 15 
percent of such amount for such fiscal year may be set aside for States with the 
highest age-adjusted rate of drug overdose death based on the ordinal ranking of 
States according to the Director of the Centers for Disease Control and 
Prevention.''.
    (b) Conforming Amendment.--Section 1004(c) of the 21st Century Cures Act 
(Public Law 114-255) is amended by striking ``, the FDA Innovation Account, or 
the Account For the State Response to the Opioid Abuse Crisis'' and inserting 
``or the FDA Innovation Account''.

SEC. 7182. REPORT ON INVESTIGATIONS REGARDING PARITY IN MENTAL HEALTH AND 
              SUBSTANCE USE DISORDER BENEFITS.

    (a) In General.--Section 13003 of the 21st Century Cures Act (Public Law 
114-255) is amended--
            (1) in subsection (a)--
                    (A) by striking ``with findings of any serious violation 
                regarding'' and inserting ``concerning''; and
                    (B) by inserting ``and the Committee on Education and the 
                Workforce'' after ``Energy and Commerce''; and
            (2) in subsection (b)(1)--
                    (A) by inserting ``complaints received and number of'' 
                before ``closed''; and
                    (B) by inserting before the period ``, and, for each such 
                investigation closed, which agency conducted the investigation, 
                whether the health plan that is the subject of the investigation 
                is fully insured or not fully insured and a summary of any 
                coordination between the applicable State regulators and the 
                Department of Labor, the Department of Health and Human 
                Services, or the Department of the Treasury, and references to 
                any guidance provided by the agencies addressing the category of 
                violation committed''.
    (b) Applicability.--The amendments made by subsection (a) shall apply with 
respect to the second annual report required under such section 13003 and each 
such annual report thereafter.

SEC. 7183. CAREER ACT.

    (a) In General.--The Secretary of Health and Human Services (referred to in 
this section as the ``Secretary''), in consultation with the Secretary of Labor, 
shall continue or establish a program to support individuals in substance use 
disorder treatment and recovery to live independently and participate in the 
workforce.
    (b) Grants Authorized.--In carrying out the activities under this section, 
the Secretary shall, on a competitive basis, award grants for a period of not 
more than 5 years to entities to enable such entities to carry out evidence-
based programs to help individuals in substance use disorder treatment and 
recovery to live independently and participate in the workforce. Such entities 
shall coordinate, as applicable, with Indian tribes or tribal organizations (as 
applicable), State boards and local boards (as defined in section 3 of the 
Workforce Innovation and Opportunity Act (29 U.S.C. 3102), lead State agencies 
with responsibility for a workforce investment activity (as defined in such 
section 3), and State agencies responsible for carrying out substance use 
disorder prevention and treatment programs.
    (c) Priority.--
            (1) In general.--In awarding grants under this section, the 
        Secretary shall give priority based on the State in which the entity is 
        located. Priority shall be given among States according to a formula 
        based on the rates described in paragraph (2) and weighted as described 
        in paragraph (3).
            (2) Rates.--The rates described in this paragraph are the following:
                    (A) The amount by which the rate of drug overdose deaths in 
                the State, adjusted for age, is above the national overdose 
                mortality rate, as determined by the Director of the Centers for 
                Disease Control and Prevention.
                    (B) The amount by which the rate of unemployment for the 
                State, based on data provided by the Bureau of Labor Statistics 
                for the preceding 5 calendar years for which there is available 
                data, is above the national average.
                    (C) The amount by which rate of labor force participation in 
                the State, based on data provided by the Bureau of Labor 
                Statistics for the preceding 5 calendar years for which there is 
                available data, is below the national average.
            (3) Weighting.--The rates described in paragraph (2) shall be 
        weighted as follows:
                    (A) The rate described in paragraph (2)(A) shall be weighted 
                70 percent.
                    (B) The rate described in paragraph (2)(B) shall be weighted 
                15 percent.
                    (C) The rate described in paragraph (2)(C) shall be weighted 
                15 percent.
    (d) Preference.--In awarding grants under this section, the Secretary shall 
give preference to entities located in areas within States with the greatest 
need, with such need based on the highest mortality rate related to substance 
use disorder.
    (e) Definitions.--In this section:
            (1) Eligible entity.--The term ``eligible entity'' means an entity 
        that offers treatment or recovery services for individuals with 
        substance use disorders, and partners with one or more local or State 
        stakeholders, which may include local employers, community 
        organizations, the local workforce development board, local and State 
        governments, and Indian Tribes or tribal organizations, to support 
        recovery, independent living, and participation in the workforce.
            (2) Indian tribes; tribal organization.--The terms ``Indian Tribe'' 
        and ``tribal organization'' have the meanings given the terms ``Indian 
        tribe'' and ``tribal organization'' in section 4 of the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 5304).
            (3) State.--The term ``State'' includes only the several States and 
        the District of Columbia.
    (f) Applications.--An eligible entity shall submit an application at such 
time and in such manner as the Secretary may require. In submitting an 
application, the entity shall demonstrate the ability to partner with local 
stakeholders, which may include local employers, community stakeholders, the 
local workforce development board, local and State governments, and Indian 
Tribes or tribal organizations, as applicable, to--
            (1) identify gaps in the workforce due to the prevalence of 
        substance use disorders;
            (2) in coordination with statewide employment and training 
        activities, including coordination and alignment of activities carried 
        out by entities provided grant funds under section 8041, help 
        individuals in recovery from a substance use disorder transition into 
        the workforce, including by providing career services, training services 
        as described in paragraph (2) of section 134(c) of the Workforce 
        Innovation and Opportunity Act (29 U.S.C. 3174(c)), and related services 
        described in section 134(a)(3) of such Act (42 U.S.C. 3174(a)); and
            (3) assist employers with informing their employees of the 
        resources, such as resources related to substance use disorders that are 
        available to their employees.
    (g) Use of Funds.--An entity receiving a grant under this section shall use 
the funds to conduct one or more of the following activities:
            (1) Hire case managers, care coordinators, providers of peer 
        recovery support services, as described in section 547(a) of the Public 
        Health Service Act (42 U.S.C. 290ee-2(a)), or other professionals, as 
        appropriate, to provide services that support treatment, recovery, and 
        rehabilitation, and prevent relapse, recidivism, and overdose, including 
        by encouraging--
                    (A) the development and strengthening of daily living 
                skills; and
                    (B) the use of counseling, care coordination, and other 
                services, as appropriate, to support recovery from substance use 
                disorders.
            (2) Implement or utilize innovative technologies, which may include 
        the use of telemedicine.
            (3) In coordination with the lead State agency with responsibility 
        for a workforce investment activity or local board described in 
        subsection (b), provide--
                    (A) short-term prevocational training services; and
                    (B) training services that are directly linked to the 
                employment opportunities in the local area or the planning 
                region.
    (h) Support for State Strategy.--An eligible entity shall include in its 
application under subsection (f) information describing how the services and 
activities proposed in such application are aligned with the State, outlying 
area, or Tribal strategy, as applicable, for addressing issues described in such 
application and how such entity will coordinate with existing systems to deliver 
services as described in such application.
    (i) Data Reporting and Program Oversight.--Each eligible entity awarded a 
grant under this section shall submit to the Secretary a report at such time and 
in such manner as the Secretary may require. Such report shall include a 
description of--
            (1) the programs and activities funded by the grant;
            (2) outcomes of the population of individuals with a substance use 
        disorder the grantee served through activities described in subsection 
        (g); and
            (3) any other information that the Secretary may require for the 
        purpose of ensuring that the grantee is complying with all of the 
        requirements of the grant.
    (j) Reports to Congress.--
            (1) Preliminary report.--Not later than 2 years after the end of the 
        first year of the grant period under this section, the Secretary shall 
        submit to Congress a preliminary report that analyzes reports submitted 
        under subsection (i).
            (2) Final report.--Not later than 2 years after submitting the 
        preliminary report required under paragraph (1), the Secretary shall 
        submit to Congress a final report that includes--
                    (A) a description of how the grant funding was used, 
                including the number of individuals who received services under 
                subsection (g)(3) and an evaluation of the effectiveness of the 
                activities conducted by the grantee with respect to outcomes of 
                the population of individuals with substance use disorder who 
                receive services from the grantee; and
                    (B) recommendations related to best practices for health 
                care professionals to support individuals in substance use 
                disorder treatment or recovery to live independently and 
                participate in the workforce.
    (k) Authorization of Appropriations.--There is authorized to be appropriated 
$5,000,000 for each of fiscal years 2019 through 2023 for purposes of carrying 
out this section.

                            TITLE VIII--MISCELLANEOUS

           Subtitle A--Synthetics Trafficking and Overdose Prevention

SEC. 8001. SHORT TITLE.

    This subtitle may be cited as the ``Synthetics Trafficking and Overdose 
Prevention Act of 2018'' or ``STOP Act of 2018''.

SEC. 8002. CUSTOMS FEES.

    (a) In General.--Section 13031(b)(9) of the Consolidated Omnibus Budget 
Reconciliation Act of 1985 (19 U.S.C. 58c(b)(9)) is amended by adding at the end 
the following:
            ``(D)(i) With respect to the processing of items that are sent to 
        the United States through the international postal network by `Inbound 
        Express Mail service' or `Inbound EMS' (as that service is described in 
        the mail classification schedule referred to in section 3631 of title 
        39, United States Code), the following payments are required:
                    ``(I) $1 per Inbound EMS item.
                    ``(II) If an Inbound EMS item is formally entered, the fee 
                provided for under subsection (a)(9), if applicable.
            ``(ii) Notwithstanding section 451 of the Tariff Act of 1930 (19 
        U.S.C. 1451), the payments required by clause (i), as allocated pursuant 
        to clause (iii)(I), shall be the only payments required for 
        reimbursement of U.S. Customs and Border Protection for customs services 
        provided in connection with the processing of an Inbound EMS item.
            ``(iii)(I) The payments required by clause (i)(I) shall be allocated 
        as follows:
                    ``(aa) 50 percent of the amount of the payments shall be 
                paid on a quarterly basis by the United States Postal Service to 
                the Commissioner of U.S. Customs and Border Protection in 
                accordance with regulations prescribed by the Secretary of the 
                Treasury to reimburse U.S. Customs and Border Protection for 
                customs services provided in connection with the processing of 
                Inbound EMS items.
                    ``(bb) 50 percent of the amount of the payments shall be 
                retained by the Postal Service to reimburse the Postal Service 
                for services provided in connection with the customs processing 
                of Inbound EMS items.
            ``(II) Payments received by U.S. Customs and Border Protection under 
        subclause (I)(aa) shall, in accordance with section 524 of the Tariff 
        Act of 1930 (19 U.S.C. 1524), be deposited in the Customs User Fee 
        Account and used to directly reimburse each appropriation for the amount 
        paid out of that appropriation for the costs incurred in providing 
        services to international mail facilities. Amounts deposited in 
        accordance with the preceding sentence shall be available until expended 
        for the provision of such services.
            ``(III) Payments retained by the Postal Service under subclause 
        (I)(bb) shall be used to directly reimburse the Postal Service for the 
        costs incurred in providing services in connection with the customs 
        processing of Inbound EMS items.
            ``(iv) Beginning in fiscal year 2021, the Secretary, in consultation 
        with the Postmaster General, may adjust, not more frequently than once 
        each fiscal year, the amount described in clause (i)(I) to an amount 
        commensurate with the costs of services provided in connection with the 
        customs processing of Inbound EMS items, consistent with the obligations 
        of the United States under international agreements.''.
    (b) Conforming Amendments.--Section 13031(a) of the Consolidated Omnibus 
Budget Reconciliation Act of 1985 (19 U.S.C. 58c(a)) is amended--
            (1) in paragraph (6), by inserting ``(other than an item subject to 
        a fee under subsection (b)(9)(D))'' after ``customs officer''; and
            (2) in paragraph (10)--
                    (A) in subparagraph (C), in the matter preceding clause (i), 
                by inserting ``(other than Inbound EMS items described in 
                subsection (b)(9)(D))'' after ``release''; and
                    (B) in the flush at the end, by inserting ``or of Inbound 
                EMS items described in subsection (b)(9)(D),'' after ``(C),''.
    (c) Effective Date.--The amendments made by this section shall take effect 
on January 1, 2020.

SEC. 8003. MANDATORY ADVANCE ELECTRONIC INFORMATION FOR POSTAL SHIPMENTS.

    (a) Mandatory Advance Electronic Information.--
            (1) In general.--Section 343(a)(3)(K) of the Trade Act of 2002 
        (Public Law 107-210; 19 U.S.C. 2071 note) is amended to read as follows:
                    ``(K)(i) The Secretary shall prescribe regulations requiring 
                the United States Postal Service to transmit the information 
                described in paragraphs (1) and (2) to the Commissioner of U.S. 
                Customs and Border Protection for international mail shipments 
                by the Postal Service (including shipments to the Postal Service 
                from foreign postal operators that are transported by private 
                carrier) consistent with the requirements of this subparagraph.
                    ``(ii) In prescribing regulations under clause (i), the 
                Secretary shall impose requirements for the transmission to the 
                Commissioner of information described in paragraphs (1) and (2) 
                for mail shipments described in clause (i) that are comparable 
                to the requirements for the transmission of such information 
                imposed on similar non-mail shipments of cargo, taking into 
                account the parameters set forth in subparagraphs (A) through 
                (J).
                    ``(iii) The regulations prescribed under clause (i) shall 
                require the transmission of the information described in 
                paragraphs (1) and (2) with respect to a shipment as soon as 
                practicable in relation to the transportation of the shipment, 
                consistent with subparagraph (H).
                    ``(iv) Regulations prescribed under clause (i) shall allow 
                for the requirements for the transmission to the Commissioner of 
                information described in paragraphs (1) and (2) for mail 
                shipments described in clause (i) to be implemented in phases, 
                as appropriate, by--
                            ``(I) setting incremental targets for increasing the 
                        percentage of such shipments for which information is 
                        required to be transmitted to the Commissioner; and
                            ``(II) taking into consideration--
                                    ``(aa) the risk posed by such shipments;
                                    ``(bb) the volume of mail shipped to the 
                                United States by or through a particular 
                                country; and
                                    ``(cc) the capacities of foreign postal 
                                operators to provide that information to the 
                                Postal Service.
                    ``(v)(I) Notwithstanding clause (iv), the Postal Service 
                shall, not later than December 31, 2018, arrange for the 
                transmission to the Commissioner of the information described in 
                paragraphs (1) and (2) for not less than 70 percent of the 
                aggregate number of mail shipments, including 100 percent of 
                mail shipments from the People's Republic of China, described in 
                clause (i).
                    ``(II) If the requirements of subclause (I) are not met, the 
                Comptroller General of the United States shall submit to the 
                appropriate congressional committees, not later than June 30, 
                2019, a report--
                            ``(aa) assessing the reasons for the failure to meet 
                        those requirements; and
                            ``(bb) identifying recommendations to improve the 
                        collection by the Postal Service of the information 
                        described in paragraphs (1) and (2).
                    ``(vi)(I) Notwithstanding clause (iv), the Postal Service 
                shall, not later than December 31, 2020, arrange for the 
                transmission to the Commissioner of the information described in 
                paragraphs (1) and (2) for 100 percent of the aggregate number 
                of mail shipments described in clause (i).
                    ``(II) The Commissioner, in consultation with the Postmaster 
                General, may determine to exclude a country from the requirement 
                described in subclause (I) to transmit information for mail 
                shipments described in clause (i) from the country if the 
                Commissioner determines that the country--
                            ``(aa) does not have the capacity to collect and 
                        transmit such information;
                            ``(bb) represents a low risk for mail shipments that 
                        violate relevant United States laws and regulations; and
                            ``(cc) accounts for low volumes of mail shipments 
                        that can be effectively screened for compliance with 
                        relevant United States laws and regulations through an 
                        alternate means.
                    ``(III) The Commissioner shall, at a minimum on an annual 
                basis, re-evaluate any determination made under subclause (II) 
                to exclude a country from the requirement described in subclause 
                (I). If, at any time, the Commissioner determines that a country 
                no longer meets the requirements under subclause (II), the 
                Commissioner may not further exclude the country from the 
                requirement described in subclause (I).
                    ``(IV) The Commissioner shall, on an annual basis, submit to 
                the appropriate congressional committees--
                            ``(aa) a list of countries with respect to which the 
                        Commissioner has made a determination under subclause 
                        (II) to exclude the countries from the requirement 
                        described in subclause (I); and
                            ``(bb) information used to support such 
                        determination with respect to such countries.
                    ``(vii)(I) The Postmaster General shall, in consultation 
                with the Commissioner, refuse any shipments received after 
                December 31, 2020, for which the information described in 
                paragraphs (1) and (2) is not transmitted as required under this 
                subparagraph, except as provided in subclause (II).
                    ``(II) If remedial action is warranted in lieu of refusal of 
                shipments pursuant to subclause (I), the Postmaster General and 
                the Commissioner shall take remedial action with respect to the 
                shipments, including destruction, seizure, controlled delivery 
                or other law enforcement initiatives, or correction of the 
                failure to provide the information described in paragraphs (1) 
                and (2) with respect to the shipments.
                    ``(viii) Nothing in this subparagraph shall be construed to 
                limit the authority of the Secretary to obtain information 
                relating to international mail shipments from private carriers 
                or other appropriate parties.
                    ``(ix) In this subparagraph, the term `appropriate 
                congressional committees' means--
                            ``(I) the Committee on Finance and the Committee on 
                        Homeland Security and Governmental Affairs of the 
                        Senate; and
                            ``(II) the Committee on Ways and Means, the 
                        Committee on Oversight and Government Reform, and the 
                        Committee on Homeland Security of the House of 
                        Representatives.''.
            (2) Joint strategic plan on mandatory advance information.--Not 
        later than 60 days after the date of the enactment of this Act, the 
        Secretary of Homeland Security and the Postmaster General shall develop 
        and submit to the appropriate congressional committees a joint strategic 
        plan detailing specific performance measures for achieving--
                    (A) the transmission of information as required by section 
                343(a)(3)(K) of the Trade Act of 2002, as amended by paragraph 
                (1); and
                    (B) the presentation by the Postal Service to U.S. Customs 
                and Border Protection of all mail targeted by U.S. Customs and 
                Border Protection for inspection.
    (b) Capacity Building.--
            (1) In general.--Section 343(a) of the Trade Act of 2002 (Public Law 
        107-210; 19 U.S.C. 2071 note) is amended by adding at the end the 
        following:
            ``(5) Capacity building.--
                    ``(A) In general.--The Secretary, with the concurrence of 
                the Secretary of State, and in coordination with the Postmaster 
                General and the heads of other Federal agencies, as appropriate, 
                may provide technical assistance, equipment, technology, and 
                training to enhance the capacity of foreign postal operators--
                            ``(i) to gather and provide the information required 
                        by paragraph (3)(K); and
                            ``(ii) to otherwise gather and provide postal 
                        shipment information related to--
                                    ``(I) terrorism;
                                    ``(II) items the importation or introduction 
                                of which into the United States is prohibited or 
                                restricted, including controlled substances; and
                                    ``(III) such other concerns as the Secretary 
                                determines appropriate.
                    ``(B) Provision of equipment and technology.--With respect 
                to the provision of equipment and technology under subparagraph 
                (A), the Secretary may lease, loan, provide, or otherwise assist 
                in the deployment of such equipment and technology under such 
                terms and conditions as the Secretary may prescribe, including 
                nonreimbursable loans or the transfer of ownership of equipment 
                and technology.''.
            (2) Joint strategic plan on capacity building.--Not later than 1 
        year after the date of the enactment of this Act, the Secretary of 
        Homeland Security and the Postmaster General shall, in consultation with 
        the Secretary of State, jointly develop and submit to the appropriate 
        congressional committees a joint strategic plan--
                    (A) detailing the extent to which U.S. Customs and Border 
                Protection and the United States Postal Service are engaged in 
                capacity building efforts under section 343(a)(5) of the Trade 
                Act of 2002, as added by paragraph (1);
                    (B) describing plans for future capacity building efforts; 
                and
                    (C) assessing how capacity building has increased the 
                ability of U.S. Customs and Border Protection and the Postal 
                Service to advance the goals of this subtitle and the amendments 
                made by this subtitle.
    (c) Report and Consultations by Secretary of Homeland Security and 
Postmaster General.--
            (1) Report.--Not later than 180 days after the date of the enactment 
        of this Act, and annually thereafter until 3 years after the Postmaster 
        General has met the requirement under clause (vi) of subparagraph (K) of 
        section 343(a)(3) of the Trade Act of 2002, as amended by subsection 
        (a)(1), the Secretary of Homeland Security and the Postmaster General 
        shall, in consultation with the Secretary of State, jointly submit to 
        the appropriate congressional committees a report on compliance with 
        that subparagraph that includes the following:
                    (A) An assessment of the status of the regulations required 
                to be promulgated under that subparagraph.
                    (B) An update regarding new and existing agreements reached 
                with foreign postal operators for the transmission of the 
                information required by that subparagraph.
                    (C) A summary of deliberations between the United States 
                Postal Service and foreign postal operators with respect to 
                issues relating to the transmission of that information.
                    (D) A summary of the progress made in achieving the 
                transmission of that information for the percentage of shipments 
                required by that subparagraph.
                    (E) An assessment of the quality of that information being 
                received by foreign postal operators, as determined by the 
                Secretary of Homeland Security, and actions taken to improve the 
                quality of that information.
                    (F) A summary of policies established by the Universal 
                Postal Union that may affect the ability of the Postmaster 
                General to obtain the transmission of that information.
                    (G) A summary of the use of technology to detect illicit 
                synthetic opioids and other illegal substances in international 
                mail parcels and planned acquisitions and advancements in such 
                technology.
                    (H) Such other information as the Secretary of Homeland 
                Security and the Postmaster General consider appropriate with 
                respect to obtaining the transmission of information required by 
                that subparagraph.
            (2) Consultations.--Not later than 180 days after the date of the 
        enactment of this Act, and every 180 days thereafter until the 
        Postmaster General has met the requirement under clause (vi) of section 
        343(a)(3)(K) of the Trade Act of 2002, as amended by subsection (a)(1), 
        to arrange for the transmission of information with respect to 100 
        percent of the aggregate number of mail shipments described in clause 
        (i) of that section, the Secretary of Homeland Security and the 
        Postmaster General shall provide briefings to the appropriate 
        congressional committees on the progress made in achieving the 
        transmission of that information for that percentage of shipments.
    (d) Government Accountability Office Report.--Not later than June 30, 2019, 
the Comptroller General of the United States shall submit to the appropriate 
congressional committees a report--
            (1) assessing the progress of the United States Postal Service in 
        achieving the transmission of the information required by subparagraph 
        (K) of section 343(a)(3) of the Trade Act of 2002, as amended by 
        subsection (a)(1), for the percentage of shipments required by that 
        subparagraph;
            (2) assessing the quality of the information received from foreign 
        postal operators for targeting purposes;
            (3) assessing the specific percentage of targeted mail presented by 
        the Postal Service to U.S. Customs and Border Protection for inspection;
            (4) describing the costs of collecting the information required by 
        such subparagraph (K) from foreign postal operators and the costs of 
        implementing the use of that information;
            (5) assessing the benefits of receiving that information with 
        respect to international mail shipments;
            (6) assessing the feasibility of assessing a customs fee under 
        section 13031(b)(9) of the Consolidated Omnibus Budget Reconciliation 
        Act of 1985, as amended by section 8002, on international mail shipments 
        other than Inbound Express Mail service in a manner consistent with the 
        obligations of the United States under international agreements; and
            (7) identifying recommendations, including recommendations for 
        legislation, to improve the compliance of the Postal Service with such 
        subparagraph (K), including an assessment of whether the detection of 
        illicit synthetic opioids in the international mail would be improved 
        by--
                    (A) requiring the Postal Service to serve as the consignee 
                for international mail shipments containing goods; or
                    (B) designating a customs broker to act as an importer of 
                record for international mail shipments containing goods.
    (e) Technical Correction.--Section 343 of the Trade Act of 2002 (Public Law 
107-210; 19 U.S.C. 2071 note) is amended in the section heading by striking 
``advanced'' and inserting ``advance''.
    (f) Appropriate Congressional Committees Defined.--In this section, the term 
``appropriate congressional committees'' means--
            (1) the Committee on Finance and the Committee on Homeland Security 
        and Governmental Affairs of the Senate; and
            (2) the Committee on Ways and Means, the Committee on Oversight and 
        Government Reform, and the Committee on Homeland Security of the House 
        of Representatives.

SEC. 8004. INTERNATIONAL POSTAL AGREEMENTS.

    (a) Existing Agreements.--
            (1) In general.--In the event that any provision of this subtitle, 
        or any amendment made by this subtitle, is determined to be in violation 
        of obligations of the United States under any postal treaty, convention, 
        or other international agreement related to international postal 
        services, or any amendment to such an agreement, the Secretary of State 
        should negotiate to amend the relevant provisions of the agreement so 
        that the United States is no longer in violation of the agreement.
            (2) Rule of construction.--Nothing in this subsection shall be 
        construed to permit delay in the implementation of this subtitle or any 
        amendment made by this subtitle.
    (b) Future Agreements.--
            (1) Consultations.--Before entering into, on or after the date of 
        the enactment of this Act, any postal treaty, convention, or other 
        international agreement related to international postal services, or any 
        amendment to such an agreement, that is related to the ability of the 
        United States to secure the provision of advance electronic information 
        by foreign postal operators, the Secretary of State should consult with 
        the appropriate congressional committees (as defined in section 
        8003(f)).
            (2) Expedited negotiation of new agreement.--To the extent that any 
        new postal treaty, convention, or other international agreement related 
        to international postal services would improve the ability of the United 
        States to secure the provision of advance electronic information by 
        foreign postal operators as required by regulations prescribed under 
        section 343(a)(3)(K) of the Trade Act of 2002, as amended by section 
        8003(a)(1), the Secretary of State should expeditiously conclude such an 
        agreement.

SEC. 8005. COST RECOUPMENT.

    (a) In General.--The United States Postal Service shall, to the extent 
practicable and otherwise recoverable by law, ensure that all costs associated 
with complying with this subtitle and amendments made by this subtitle are 
charged directly to foreign shippers or foreign postal operators.
    (b) Costs Not Considered Revenue.--The recovery of costs under subsection 
(a) shall not be deemed revenue for purposes of subchapter I and II of chapter 
36 of title 39, United States Code, or regulations prescribed under that 
chapter.

SEC. 8006. DEVELOPMENT OF TECHNOLOGY TO DETECT ILLICIT NARCOTICS.

    (a) In General.--The Postmaster General and the Commissioner of U.S. Customs 
and Border Protection, in coordination with the heads of other agencies as 
appropriate, shall collaborate to identify and develop technology for the 
detection of illicit fentanyl, other synthetic opioids, and other narcotics and 
psychoactive substances entering the United States by mail.
    (b) Outreach to Private Sector.--The Postmaster General and the Commissioner 
shall conduct outreach to private sector entities to gather information 
regarding the current state of technology to identify areas for innovation 
relating to the detection of illicit fentanyl, other synthetic opioids, and 
other narcotics and psychoactive substances entering the United States.

SEC. 8007. CIVIL PENALTIES FOR POSTAL SHIPMENTS.

    Section 436 of the Tariff Act of 1930 (19 U.S.C. 1436) is amended by adding 
at the end the following new subsection:
    ``(e) Civil Penalties for Postal Shipments.--
            ``(1) Civil penalty.--A civil penalty shall be imposed against the 
        United States Postal Service if the Postal Service accepts a shipment in 
        violation of section 343(a)(3)(K)(vii)(I) of the Trade Act of 2002.
            ``(2) Modification of civil penalty.--
                    ``(A) In general.--U.S. Customs and Border Protection shall 
                reduce or dismiss a civil penalty imposed pursuant to paragraph 
                (1) if U.S. Customs and Border Protection determines that the 
                United States Postal Service--
                            ``(i) has a low error rate in compliance with 
                        section 343(a)(3)(K) of the Trade Act of 2002;
                            ``(ii) is cooperating with U.S. Customs and Border 
                        Protection with respect to the violation of section 
                        343(a)(3)(K)(vii)(I) of the Trade Act of 2002; or
                            ``(iii) has taken remedial action to prevent future 
                        violations of section 343(a)(3)(K)(vii)(I) of the Trade 
                        Act of 2002.
                    ``(B) Written notification.--U.S. Customs and Border 
                Protection shall issue a written notification to the Postal 
                Service with respect to each exercise of the authority of 
                subparagraph (A) to reduce or dismiss a civil penalty imposed 
                pursuant to paragraph (1).
            ``(3) Ongoing lack of compliance.--If U.S. Customs and Border 
        Protection determines that the United States Postal Service--
                    ``(A) has repeatedly committed violations of section 
                343(a)(3)(K)(vii)(I) of the Trade Act of 2002,
                    ``(B) has failed to cooperate with U.S. Customs and Border 
                Protection with respect to violations of section 
                343(a)(3)(K)(vii)(I) of the Trade Act of 2002, and
                    ``(C) has an increasing error rate in compliance with 
                section 343(a)(3)(K) of the Trade Act of 2002,
        civil penalties may be imposed against the United States Postal Service 
        until corrective action, satisfactory to U.S. Customs and Border 
        Protection, is taken.''.

SEC. 8008. REPORT ON VIOLATIONS OF ARRIVAL, REPORTING, ENTRY, AND CLEARANCE 
              REQUIREMENTS AND FALSITY OR LACK OF MANIFEST.

    (a) In General.--The Commissioner of U.S. Customs and Border Protection 
shall submit to the appropriate congressional committees an annual report that 
contains the information described in subsection (b) with respect to each 
violation of section 436 of the Tariff Act of 1930 (19 U.S.C. 1436), as amended 
by section 8007, and section 584 of such Act (19 U.S.C. 1584) that occurred 
during the previous year.
    (b) Information Described.--The information described in this subsection is 
the following:
            (1) The name and address of the violator.
            (2) The specific violation that was committed.
            (3) The location or port of entry through which the items were 
        transported.
            (4) An inventory of the items seized, including a description of the 
        items and the quantity seized.
            (5) The location from which the items originated.
            (6) The entity responsible for the apprehension or seizure, 
        organized by location or port of entry.
            (7) The amount of penalties assessed by U.S. Customs and Border 
        Protection, organized by name of the violator and location or port of 
        entry.
            (8) The amount of penalties that U.S. Customs and Border Protection 
        could have levied, organized by name of the violator and location or 
        port of entry.
            (9) The rationale for negotiating lower penalties, organized by name 
        of the violator and location or port of entry.
    (c) Appropriate Congressional Committees Defined.--In this section, the term 
``appropriate congressional committees'' means--
            (1) the Committee on Finance and the Committee on Homeland Security 
        and Governmental Affairs of the Senate; and
            (2) the Committee on Ways and Means, the Committee on Oversight and 
        Government Reform, and the Committee on Homeland Security of the House 
        of Representatives.

SEC. 8009. EFFECTIVE DATE; REGULATIONS.

    (a) Effective Date.--This subtitle and the amendments made by this subtitle 
(other than the amendments made by section 8002) shall take effect on the date 
of the enactment of this Act.
    (b) Regulations.--Not later than 1 year after the date of the enactment of 
this Act, such regulations as are necessary to carry out this subtitle and the 
amendments made by this subtitle shall be prescribed.

             Subtitle B--Opioid Addiction Recovery Fraud Prevention

SEC. 8021. SHORT TITLE.

    This subtitle may be cited as the ``Opioid Addiction Recovery Fraud 
Prevention Act of 2018''.

SEC. 8022. DEFINITIONS.

    For purposes of this subtitle only, and not be construed or applied as to 
challenge or affect the characterization, definition, or treatment under any 
other statute, regulation, or rule:
            (1) Substance use disorder treatment product.--The term ``substance 
        use disorder treatment product'' means a product for use or marketed for 
        use in the treatment, cure, or prevention of a substance use disorder, 
        including an opioid use disorder.
            (2) Substance use disorder treatment service.--The term ``substance 
        use disorder treatment service'' means a service that purports to 
        provide referrals to treatment, treatment, or recovery housing for 
        people diagnosed with, having, or purporting to have a substance use 
        disorder, including an opioid use disorder.

SEC. 8023. UNFAIR OR DECEPTIVE ACTS OR PRACTICES WITH RESPECT TO SUBSTANCE USE 
              DISORDER TREATMENT SERVICE AND PRODUCTS.

    (a) Unlawful Activity.--It is unlawful to engage in an unfair or deceptive 
act or practice with respect to any substance use disorder treatment service or 
substance use disorder treatment product.
    (b) Enforcement by the Federal Trade Commission.--
            (1) Unfair or deceptive acts or practices.--A violation of 
        subsection (a) shall be treated as a violation of a rule under section 
        18 of the Federal Trade Commission Act (15 U.S.C. 57a) regarding unfair 
        or deceptive acts or practices.
            (2) Powers of the federal trade commission.--
                    (A) In general.--The Federal Trade Commission shall enforce 
                this section in the same manner, by the same means, and with the 
                same jurisdiction, powers, and duties as though all applicable 
                terms and provisions of the Federal Trade Commission Act (15 
                U.S.C. 41 et seq.) were incorporated into and made a part of 
                this section.
                    (B) Privileges and immunities.--Any person who violates 
                subsection (a) shall be subject to the penalties and entitled to 
                the privileges and immunities provided in the Federal Trade 
                Commission Act as though all applicable terms and provisions of 
                the Federal Trade Commission Act (15 U.S.C. 41 et seq.) were 
                incorporated and made part of this section.
    (c) Authority Preserved.--Nothing in this subtitle shall be construed to 
limit the authority of the Federal Trade Commission or the Food and Drug 
Administration under any other provision of law.

   Subtitle C--Addressing Economic and Workforce Impacts of the Opioid Crisis

SEC. 8041. ADDRESSING ECONOMIC AND WORKFORCE IMPACTS OF THE OPIOID CRISIS.

    (a) Definitions.--Except as otherwise expressly provided, in this section:
            (1) WIOA definitions.--The terms ``core program'', ``individual with 
        a barrier to employment'', ``local area'', ``local board'', ``one-stop 
        operator'', ``outlying area'', ``State'', ``State board'', and 
        ``supportive services'' have the meanings given the terms in section 3 
        of the Workforce Innovation and Opportunity Act (29 U.S.C. 3102).
            (2) Education provider.--The term ``education provider'' means--
                    (A) an institution of higher education, as defined in 
                section 101 of the Higher Education Act of 1965 (20 U.S.C. 
                1001); or
                    (B) a postsecondary vocational institution, as defined in 
                section 102(c) of such Act (20 U.S.C. 1002(c)).
            (3) Eligible entity.--The term ``eligible entity'' means--
                    (A) a State workforce agency;
                    (B) an outlying area; or
                    (C) a Tribal entity.
            (4) Participating partnership.--The term ``participating 
        partnership'' means a partnership--
                    (A) evidenced by a written contract or agreement; and
                    (B) including, as members of the partnership, a local board 
                receiving a subgrant under subsection (d) and 1 or more of the 
                following:
                            (i) The eligible entity.
                            (ii) A treatment provider.
                            (iii) An employer or industry organization.
                            (iv) An education provider.
                            (v) A legal service or law enforcement organization.
                            (vi) A faith-based or community-based organization.
                            (vii) Other State or local agencies, including 
                        counties or local governments.
                            (viii) Other organizations, as determined to be 
                        necessary by the local board.
                            (ix) Indian Tribes or tribal organizations.
            (5) Program participant.--The term ``program participant'' means an 
        individual who--
                    (A) is a member of a population of workers described in 
                subsection (e)(2) that is served by a participating partnership 
                through the pilot program under this section; and
                    (B) enrolls with the applicable participating partnership to 
                receive any of the services described in subsection (e)(3).
            (6) Provider of peer recovery support services.--The term ``provider 
        of peer recovery support services'' means a provider that delivers peer 
        recovery support services through an organization described in section 
        547(a) of the Public Health Service Act (42 U.S.C. 290ee-2(a)).
            (7) Secretary.--The term ``Secretary'' means the Secretary of Labor.
            (8) State workforce agency.--The term ``State workforce agency'' 
        means the lead State agency with responsibility for the administration 
        of a program under chapter 2 or 3 of subtitle B of title I of the 
        Workforce Innovation and Opportunity Act (29 U.S.C. 3161 et seq., 3171 
        et seq.).
            (9) Substance use disorder.--The term ``substance use disorder'' has 
        the meaning given such term by the Assistant Secretary for Mental Health 
        and Substance Use.
            (10) Treatment provider.--The term ``treatment provider''--
                    (A) means a health care provider that--
                            (i) offers services for treating substance use 
                        disorders and is licensed in accordance with applicable 
                        State law to provide such services; and
                            (ii) accepts health insurance for such services, 
                        including coverage under title XIX of the Social 
                        Security Act (42 U.S.C. 1396 et seq.); and
                    (B) may include--
                            (i) a nonprofit provider of peer recovery support 
                        services;
                            (ii) a community health care provider;
                            (iii) a Federally qualified health center (as 
                        defined in section 1861(aa) of the Social Security Act 
                        (42 U.S.C. 1395x));
                            (iv) an Indian health program (as defined in section 
                        3 of the Indian Health Care Improvement Act (25 U.S.C. 
                        1603)), including an Indian health program that serves 
                        an urban center (as defined in such section); and
                            (v) a Native Hawaiian health center (as defined in 
                        section 12 of the Native Hawaiian Health Care 
                        Improvement Act (42 U.S.C. 11711)).
            (11) Tribal entity.--The term ``Tribal entity'' includes any Indian 
        Tribe, tribal organization, Indian-controlled organization serving 
        Indians, Native Hawaiian organization, or Alaska Native entity, as such 
        terms are defined or used in section 166 of the Workforce Innovation and 
        Opportunity Act (29 U.S.C. 3221).
    (b) Pilot Program and Grants Authorized.--
            (1) In general.--The Secretary, in consultation with the Secretary 
        of Health and Human Services, shall carry out a pilot program to address 
        economic and workforce impacts associated with a high rate of a 
        substance use disorder. In carrying out the pilot program, the Secretary 
        shall make grants, on a competitive basis, to eligible entities to 
        enable such entities to make subgrants to local boards to address the 
        economic and workforce impacts associated with a high rate of a 
        substance use disorder.
            (2) Grant amounts.--The Secretary shall make each such grant in an 
        amount that is not less than $500,000, and not more than $5,000,000, for 
        a fiscal year.
    (c) Grant Applications.--
            (1) In general.--An eligible entity applying for a grant under this 
        section shall submit an application to the Secretary at such time and in 
        such form and manner as the Secretary may reasonably require, including 
        the information described in this subsection.
            (2) Significant impact on community by opioid and substance use 
        disorder-related problems.--
                    (A) Demonstration.--An eligible entity shall include in the 
                application--
                            (i) information that demonstrates significant impact 
                        on the community by problems related to opioid abuse or 
                        another substance use disorder, by--
                                    (I) identifying the counties, communities, 
                                regions, or local areas that have been 
                                significantly impacted and will be served 
                                through the grant (each referred to in this 
                                section as a ``service area''); and
                                    (II) demonstrating for each such service 
                                area, an increase equal to or greater than the 
                                national increase in such problems, between--
                                            (aa) 1999; and
                                            (bb) 2016 or the latest year for 
                                        which data are available; and
                            (ii) a description of how the eligible entity will 
                        prioritize support for significantly impacted service 
                        areas described in clause (i)(I).
                    (B) Information.--To meet the requirements described in 
                subparagraph (A)(i)(II), the eligible entity may use information 
                including data on--
                            (i) the incidence or prevalence of opioid abuse and 
                        other substance use disorders;
                            (ii) the age-adjusted rate of drug overdose deaths, 
                        as determined by the Director of the Centers for Disease 
                        Control and Prevention;
                            (iii) the rate of non-fatal hospitalizations related 
                        to opioid abuse or other substance use disorders;
                            (iv) the number of arrests or convictions, or a 
                        relevant law enforcement statistic, that reasonably 
                        shows an increase in opioid abuse or another substance 
                        use disorder; or
                            (v) in the case of an eligible entity described in 
                        subsection (a)(3)(C), other alternative relevant data as 
                        determined appropriate by the Secretary.
                    (C) Support for state strategy.--The eligible entity may 
                include in the application information describing how the 
                proposed services and activities are aligned with the State, 
                outlying area, or Tribal strategy, as applicable, for addressing 
                problems described in subparagraph (A) in specific service areas 
                or across the State, outlying area, or Tribal land.
            (3) Economic and employment conditions demonstrate additional 
        federal support needed.--
                    (A) Demonstration.--An eligible entity shall include in the 
                application information that demonstrates that a high rate of a 
                substance use disorder has caused, or is coincident to--
                            (i) an economic or employment downturn in the 
                        service area; or
                            (ii) persistent economically depressed conditions in 
                        such service area.
                    (B) Information.--To meet the requirements of subparagraph 
                (A), an eligible entity may use information including--
                            (i) documentation of any layoff, announced future 
                        layoff, legacy industry decline, decrease in an 
                        employment or labor market participation rate, or 
                        economic impact, whether or not the result described in 
                        this clause is overtly related to a high rate of a 
                        substance use disorder;
                            (ii) documentation showing decreased economic 
                        activity related to, caused by, or contributing to a 
                        high rate of a substance use disorder, including a 
                        description of how the service area has been impacted, 
                        or will be impacted, by such a decrease;
                            (iii) information on economic indicators, labor 
                        market analyses, information from public announcements, 
                        and demographic and industry data;
                            (iv) information on rapid response activities (as 
                        defined in section 3 of the Workforce Innovation and 
                        Opportunity Act (29 U.S.C. 3102)) that have been or will 
                        be conducted, including demographic data gathered by 
                        employer or worker surveys or through other methods;
                            (v) data or documentation, beyond anecdotal 
                        evidence, showing that employers face challenges filling 
                        job vacancies due to a lack of skilled workers able to 
                        pass a drug test; or
                            (vi) any additional relevant data or information on 
                        the economy, workforce, or another aspect of the service 
                        area to support the application.
    (d) Subgrant Authorization and Application Process.--
            (1) Subgrants authorized.--
                    (A) In general.--An eligible entity receiving a grant under 
                subsection (b)--
                            (i) may use not more than 5 percent of the grant 
                        funds for the administrative costs of carrying out the 
                        grant;
                            (ii) in the case of an eligible entity described in 
                        subparagraph (A) or (B) of subsection (a)(3), shall use 
                        the remaining grant funds to make subgrants to local 
                        entities in the service area to carry out the services 
                        and activities described in subsection (e); and
                            (iii) in the case of an eligible entity described in 
                        subsection (a)(3)(C), shall use the remaining grant 
                        funds to carry out the services and activities described 
                        in subsection (e).
                    (B) Equitable distribution.--In making subgrants under this 
                subsection, an eligible entity shall ensure, to the extent 
                practicable, the equitable distribution of subgrants, based on--
                            (i) geography (such as urban and rural 
                        distribution); and
                            (ii) significantly impacted service areas as 
                        described in subsection (c)(2).
                    (C) Timing of subgrant funds distribution.--An eligible 
                entity making subgrants under this subsection shall disburse 
                subgrant funds to a local board receiving a subgrant from the 
                eligible entity by the later of--
                            (i) the date that is 90 days after the date on which 
                        the Secretary makes the funds available to the eligible 
                        entity; or
                            (ii) the date that is 15 days after the date that 
                        the eligible entity makes the subgrant under 
                        subparagraph (A)(ii).
            (2) Subgrant application.--
                    (A) In general.--A local board desiring to receive a 
                subgrant under this subsection from an eligible entity shall 
                submit an application at such time and in such manner as the 
                eligible entity may reasonably require, including the 
                information described in this paragraph.
                    (B) Contents.--Each application described in subparagraph 
                (A) shall include--
                            (i) an analysis of the estimated performance of the 
                        local board in carrying out the proposed services and 
                        activities under the subgrant--
                                    (I) based on--
                                            (aa) primary indicators of 
                                        performance described in section 
                                        116(c)(1)(A)(i) of the Workforce 
                                        Innovation and Opportunity Act (29 
                                        U.S.C. 3141(c)(1)(A)(i), to assess 
                                        estimated effectiveness of the proposed 
                                        services and activities, including the 
                                        estimated number of individuals with a 
                                        substance use disorder who may be served 
                                        by the proposed services and activities;
                                            (bb) the record of the local board 
                                        in serving individuals with a barrier to 
                                        employment; and
                                            (cc) the ability of the local board 
                                        to establish a participating 
                                        partnership; and
                                    (II) which may include or utilize--
                                            (aa) data from the National Center 
                                        for Health Statistics of the Centers for 
                                        Disease Control and Prevention;
                                            (bb) data from the Center for 
                                        Behavioral Health Statistics and Quality 
                                        of the Substance Abuse and Mental Health 
                                        Services Administration;
                                            (cc) State vital statistics;
                                            (dd) municipal police department 
                                        records;
                                            (ee) reports from local coroners; or
                                            (ff) other relevant data; and
                            (ii) in the case of a local board proposing to serve 
                        a population described in subsection (e)(2)(B), a 
                        demonstration of the workforce shortage in the 
                        professional area to be addressed under the subgrant 
                        (which may include substance use disorder treatment and 
                        related services, non-addictive pain therapy and pain 
                        management services, mental health care treatment 
                        services, emergency response services, or mental health 
                        care), which shall include information that can 
                        demonstrate such a shortage, such as--
                                    (I) the distance between--
                                            (aa) communities affected by opioid 
                                        abuse or another substance use disorder; 
                                        and
                                            (bb) facilities or professionals 
                                        offering services in the professional 
                                        area; or
                                    (II) the maximum capacity of facilities or 
                                professionals to serve individuals in an 
                                affected community, or increases in arrests 
                                related to opioid or another substance use 
                                disorder, overdose deaths, or nonfatal overdose 
                                emergencies in the community.
    (e) Subgrant Services and Activities.--
            (1) In general.--Each local board that receives a subgrant under 
        subsection (d) shall carry out the services and activities described in 
        this subsection through a participating partnership.
            (2) Selection of population to be served.--A participating 
        partnership shall elect to provide services and activities under the 
        subgrant to one or both of the following populations of workers:
                    (A) Workers, including dislocated workers, individuals with 
                barriers to employment, new entrants in the workforce, or 
                incumbent workers (employed or underemployed), each of whom--
                            (i) is directly or indirectly affected by a high 
                        rate of a substance use disorder; and
                            (ii) voluntarily confirms that the worker, or a 
                        friend or family member of the worker, has a history of 
                        opioid abuse or another substance use disorder.
                    (B) Workers, including dislocated workers, individuals with 
                barriers to employment, new entrants in the workforce, or 
                incumbent workers (employed or underemployed), who--
                            (i) seek to transition to professions that support 
                        individuals with a substance use disorder or at risk for 
                        developing such disorder, such as professions that 
                        provide--
                                    (I) substance use disorder treatment and 
                                related services;
                                    (II) services offered through providers of 
                                peer recovery support services;
                                    (III) non-addictive pain therapy and pain 
                                management services;
                                    (IV) emergency response services; or
                                    (V) mental health care; and
                            (ii) need new or upgraded skills to better serve 
                        such a population of struggling or at-risk individuals.
            (3) Services and activities.--Each participating partnership shall 
        use funds available through a subgrant under this subsection to carry 
        out 1 or more of the following:
                    (A) Engaging employers.--Engaging with employers to--
                            (i) learn about the skill and hiring requirements of 
                        employers;
                            (ii) learn about the support needed by employers to 
                        hire and retain program participants, and other 
                        individuals with a substance use disorder, and the 
                        support needed by such employers to obtain their 
                        commitment to testing creative solutions to employing 
                        program participants and such individuals;
                            (iii) connect employers and workers to on-the-job or 
                        customized training programs before or after layoff to 
                        help facilitate reemployment;
                            (iv) connect employers with an education provider to 
                        develop classroom instruction to complement on-the-job 
                        learning for program participants and such individuals;
                            (v) help employers develop the curriculum design of 
                        a work-based learning program for program participants 
                        and such individuals;
                            (vi) help employers employ program participants or 
                        such individuals engaging in a work-based learning 
                        program for a transitional period before hiring such a 
                        program participant or individual for full-time 
                        employment of not less than 30 hours a week; or
                            (vii) connect employers to program participants 
                        receiving concurrent outpatient treatment and job 
                        training services.
                    (B) Screening services.--Providing screening services, which 
                may include--
                            (i) using an evidence-based screening method to 
                        screen each individual seeking participation in the 
                        pilot program to determine whether the individual has a 
                        substance use disorder;
                            (ii) conducting an assessment of each such 
                        individual to determine the services needed for such 
                        individual to obtain or retain employment, including an 
                        assessment of strengths and general work readiness; or
                            (iii) accepting walk-ins or referrals from 
                        employers, labor organizations, or other entities 
                        recommending individuals to participate in such program.
                    (C) Individual treatment and employment plan.--Developing an 
                individual treatment and employment plan for each program 
                participant--
                            (i) in coordination, as appropriate, with other 
                        programs serving the participant such as the core 
                        programs within the workforce development system under 
                        the Workforce Innovation and Opportunity Act (29 U.S.C. 
                        3101 et seq.); and
                            (ii) which shall include providing a case manager to 
                        work with each participant to develop the plan, which 
                        may include--
                                    (I) identifying employment and career goals;
                                    (II) exploring career pathways that lead to 
                                in-demand industries and sectors, as determined 
                                by the State board and the head of the State 
                                workforce agency or, as applicable, the Tribal 
                                entity;
                                    (III) setting appropriate achievement 
                                objectives to attain the employment and career 
                                goals identified under subclause (I); or
                                    (IV) developing the appropriate combination 
                                of services to enable the participant to achieve 
                                the employment and career goals identified under 
                                subclause (I).
                    (D) Outpatient treatment and recovery care.--In the case of 
                a participating partnership serving program participants 
                described in paragraph (2)(A) with a substance use disorder, 
                providing individualized and group outpatient treatment and 
                recovery services for such program participants that are offered 
                during the day and evening, and on weekends. Such treatment and 
                recovery services--
                            (i) shall be based on a model that utilizes combined 
                        behavioral interventions and other evidence-based or 
                        evidence-informed interventions; and
                            (ii) may include additional services such as--
                                    (I) health, mental health, addiction, or 
                                other forms of outpatient treatment that may 
                                impact a substance use disorder and co-occurring 
                                conditions;
                                    (II) drug testing for a current substance 
                                use disorder prior to enrollment in career or 
                                training services or prior to employment;
                                    (III) linkages to community services, 
                                including services offered by partner 
                                organizations designed to support program 
                                participants; or
                                    (IV) referrals to health care, including 
                                referrals to substance use disorder treatment 
                                and mental health services.
                    (E) Supportive services.--Providing supportive services, 
                which shall include services such as--
                            (i) coordinated wraparound services to provide 
                        maximum support for program participants to assist the 
                        program participants in maintaining employment and 
                        recovery for not less than 12 months, as appropriate;
                            (ii) assistance in establishing eligibility for 
                        assistance under Federal, State, Tribal, and local 
                        programs providing health services, mental health 
                        services, vocational services, housing services, 
                        transportation services, social services, or services 
                        through early childhood education programs (as defined 
                        in section 103 of the Higher Education Act of 1965 (20 
                        U.S.C. 1003));
                            (iii) services offered through providers of peer 
                        recovery support services;
                            (iv) networking and mentorship opportunities; or
                            (v) any supportive services determined necessary by 
                        the local board.
                    (F) Career and job training services.--Offering career 
                services and training services, and related services, 
                concurrently or sequentially with the services provided under 
                subparagraphs (B) through (E). Such services shall include the 
                following:
                            (i) Services provided to program participants who 
                        are in a pre-employment stage of the program, which may 
                        include--
                                    (I) initial education and skills 
                                assessments;
                                    (II) traditional classroom training funded 
                                through individual training accounts under 
                                chapter 3 of subtitle B of title I of the 
                                Workforce Innovation and Opportunity Act (29 
                                U.S.C. 3171 et seq.);
                                    (III) services to promote employability 
                                skills such as punctuality, personal maintenance 
                                skills, and professional conduct;
                                    (IV) in-depth interviewing and evaluation to 
                                identify employment barriers and to develop 
                                individual employment plans;
                                    (V) career planning that includes--
                                            (aa) career pathways leading to in-
                                        demand, high-wage jobs; and
                                            (bb) job coaching, job matching, and 
                                        job placement services;
                                    (VI) provision of payments and fees for 
                                employment and training-related applications, 
                                tests, and certifications; or
                                    (VII) any other appropriate career service 
                                or training service described in section 134(c) 
                                of the Workforce Innovation and Opportunity Act 
                                (29 U.S.C. 3174(c)).
                            (ii) Services provided to program participants 
                        during their first 6 months of employment to ensure job 
                        retention, which may include--
                                    (I) case management and support services, 
                                including a continuation of the services 
                                described in clause (i);
                                    (II) a continuation of skills training, and 
                                career and technical education, described in 
                                clause (i) that is conducted in collaboration 
                                with the employers of such participants;
                                    (III) mentorship services and job retention 
                                support for such participants; or
                                    (IV) targeted training for managers and 
                                workers working with such participants (such as 
                                mentors), and human resource representatives in 
                                the business in which such participants are 
                                employed.
                            (iii) Services to assist program participants in 
                        maintaining employment for not less than 12 months, as 
                        appropriate.
                    (G) Proven and promising practices.--Leading efforts in the 
                service area to identify and promote proven and promising 
                strategies and initiatives for meeting the needs of employers 
                and program participants.
            (4) Limitations.--A participating partnership may not use--
                    (A) more than 10 percent of the funds received under a 
                subgrant under subsection (d) for the administrative costs of 
                the partnership;
                    (B) more than 10 percent of the funds received under such 
                subgrant for the provision of treatment and recovery services, 
                as described in paragraph (3)(D); and
                    (C) more than 10 percent of the funds received under such 
                subgrant for the provision of supportive services described in 
                paragraph (3)(E) to program participants.
    (f) Performance Accountability.--
            (1) Reports.--The Secretary shall establish quarterly reporting 
        requirements for recipients of grants and subgrants under this section 
        that, to the extent practicable, are based on the performance 
        accountability system under section 116 of the Workforce Innovation and 
        Opportunity Act (29 U.S.C. 3141) and, in the case of a grant awarded to 
        an eligible entity described in subsection (a)(3)(C), section 166(h) of 
        such Act (29 U.S.C. 3221(h)), including the indicators described in 
        subsection (c)(1)(A)(i) of such section 116 and the requirements for 
        local area performance reports under subsection (d) of such section 116.
            (2) Evaluations.--
                    (A) Authority to enter into agreements.--The Secretary shall 
                ensure that an independent evaluation is conducted on the pilot 
                program carried out under this section to determine the impact 
                of the program on employment of individuals with substance use 
                disorders. The Secretary shall enter into an agreement with 
                eligible entities receiving grants under this section to pay for 
                all or part of such evaluation.
                    (B) Methodologies to be used.--The independent evaluation 
                required under this paragraph shall use experimental designs 
                using random assignment or, when random assignment is not 
                feasible, other reliable, evidence-based research methodologies 
                that allow for the strongest possible causal inferences.
    (g) Funding.--
            (1) Covered fiscal year.--In this subsection, the term ``covered 
        fiscal year'' means any of fiscal years 2019 through 2023.
            (2) Using funding for national dislocated worker grants.--Subject to 
        paragraph (4) and notwithstanding section 132(a)(2)(A) and subtitle D of 
        the Workforce Innovation and Opportunity Act (29 U.S.C. 3172(a)(2)(A), 
        3221 et seq.), the Secretary may use, to carry out the pilot program 
        under this section for a covered fiscal year--
                    (A) funds made available to carry out section 170 of such 
                Act (29 U.S.C. 3225) for that fiscal year;
                    (B) funds made available to carry out section 170 of such 
                Act that remain available for that fiscal year; and
                    (C) funds that remain available under section 172(f) of such 
                Act (29 U.S.C. 3227(f)).
            (3) Availability of funds.--Funds appropriated under section 136(c) 
        of such Act (29 U.S.C. 3181(c)) and made available to carry out section 
        170 of such Act for a fiscal year shall remain available for use under 
        paragraph (2) for a subsequent fiscal year until expended.
            (4) Limitation.--The Secretary may not use more than $100,000,000 of 
        the funds described in paragraph (2) for any covered fiscal year under 
        this section.

         Subtitle D--Peer Support Counseling Program for Women Veterans

SEC. 8051. PEER SUPPORT COUNSELING PROGRAM FOR WOMEN VETERANS.

    (a) In General.--Section 1720F(j) of title 38, United States Code, is 
amended by adding at the end the following new paragraph:
    ``(4)(A) As part of the counseling program under this subsection, the 
Secretary shall emphasize appointing peer support counselors for women veterans. 
To the degree practicable, the Secretary shall seek to recruit women peer 
support counselors with expertise in--
            ``(i) female gender-specific issues and services;
            ``(ii) the provision of information about services and benefits 
        provided under laws administered by the Secretary; or
            ``(iii) employment mentoring.
    ``(B) To the degree practicable, the Secretary shall emphasize facilitating 
peer support counseling for women veterans who are eligible for counseling and 
services under section 1720D of this title, have post-traumatic stress disorder 
or suffer from another mental health condition, are homeless or at risk of 
becoming homeless, or are otherwise at increased risk of suicide, as determined 
by the Secretary.
    ``(C) The Secretary shall conduct outreach to inform women veterans about 
the program and the assistance available under this paragraph.
    ``(D) In carrying out this paragraph, the Secretary shall coordinate with 
such community organizations, State and local governments, institutions of 
higher education, chambers of commerce, local business organizations, 
organizations that provide legal assistance, and other organizations as the 
Secretary considers appropriate.
    ``(E) In carrying out this paragraph, the Secretary shall provide adequate 
training for peer support counselors, including training carried out under the 
national program of training required by section 304(c) of the Caregivers and 
Veterans Omnibus Health Services Act of 2010 (38 U.S.C. 1712A note).''.
    (b) Funding.--The Secretary of Veterans Affairs shall carry out paragraph 
(4) of section 1720F(j) of title 38, United States Code, as added by subsection 
(a), using funds otherwise made available to the Secretary. No additional funds 
are authorized to be appropriated by reason of such paragraph.
    (c) Report to Congress.--Not later than 2 years after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall submit to the 
Committees on Veterans' Affairs of the Senate and House of Representatives a 
report on the peer support counseling program under section 1720F(j) of title 
38, United States Code, as amended by this section. Such report shall include--
            (1) the number of peer support counselors in the program;
            (2) an assessment of the effectiveness of the program; and
            (3) a description of the oversight of the program.

                   Subtitle E--Treating Barriers to Prosperity

SEC. 8061. SHORT TITLE.

    This subtitle may be cited as the ``Treating Barriers to Prosperity Act of 
2018''.

SEC. 8062. DRUG ABUSE MITIGATION INITIATIVE.

    (a) In General.--Chapter 145 of title 40, United States Code, is amended by 
inserting after section 14509 the following:
``Sec. 14510. Drug abuse mitigation initiative
    ``(a) In General.--The Appalachian Regional Commission may provide technical 
assistance to, make grants to, enter into contracts with, or otherwise provide 
amounts to individuals or entities in the Appalachian region for projects and 
activities to address drug abuse, including opioid abuse, in the region, 
including projects and activities--
            ``(1) to facilitate the sharing of best practices among States, 
        counties, and other experts in the region with respect to reducing such 
        abuse;
            ``(2) to initiate or expand programs designed to eliminate or reduce 
        the harm to the workforce and economic growth of the region that results 
        from such abuse;
            ``(3) to attract and retain relevant health care services, 
        businesses, and workers; and
            ``(4) to develop relevant infrastructure, including broadband 
        infrastructure that supports the use of telemedicine.
    ``(b) Limitation on Available Amounts.--Of the cost of any activity eligible 
for a grant under this section--
            ``(1) not more than 50 percent may be provided from amounts 
        appropriated to carry out this section; and
            ``(2) notwithstanding paragraph (1)--
                    ``(A) in the case of a project to be carried out in a county 
                for which a distressed county designation is in effect under 
                section 14526, not more than 80 percent may be provided from 
                amounts appropriated to carry out this section; and
                    ``(B) in the case of a project to be carried out in a county 
                for which an at-risk designation is in effect under section 
                14526, not more than 70 percent may be provided from amounts 
                appropriated to carry out this section.
    ``(c) Sources of Assistance.--Subject to subsection (b), a grant provided 
under this section may be provided from amounts made available to carry out this 
section in combination with amounts made available--
            ``(1) under any other Federal program (subject to the availability 
        of subsequent appropriations); or
            ``(2) from any other source.
    ``(d) Federal Share.--Notwithstanding any provision of law limiting the 
Federal share under any other Federal program, amounts made available to carry 
out this section may be used to increase that Federal share, as the Appalachian 
Regional Commission determines to be appropriate.''.
    (b) Clerical Amendment.--The analysis for chapter 145 of title 40, United 
States Code, is amended by inserting after the item relating to section 14509 
the following:

``14510. Drug abuse mitigation initiative.''.

 Subtitle F--Pilot Program to Help Individuals in Recovery From a Substance Use 
                          Disorder Become Stably Housed

SEC. 8071. PILOT PROGRAM TO HELP INDIVIDUALS IN RECOVERY FROM A SUBSTANCE USE 
              DISORDER BECOME STABLY HOUSED.

    (a) Authorization of Appropriations.--There is authorized to be appropriated 
under this section such sums as may be necessary for each of fiscal years 2019 
through 2023 for assistance to States to provide individuals in recovery from a 
substance use disorder stable, temporary housing for a period of not more than 2 
years or until the individual secures permanent housing, whichever is earlier.
    (b) Allocation of Appropriated Amounts.--
            (1) In general.--The amounts appropriated or otherwise made 
        available to States under this section shall be allocated based on a 
        funding formula established by the Secretary of Housing and Urban 
        Development (referred to in this section as the ``Secretary'') not later 
        than 60 days after the date of enactment of this Act.
            (2) Criteria.--
                    (A) In general.--The funding formula required under 
                paragraph (1) shall ensure that any amounts appropriated or 
                otherwise made available under this section are allocated to 
                States with an age-adjusted rate of drug overdose deaths that is 
                above the national overdose mortality rate, according to the 
                Centers for Disease Control and Prevention.
                    (B) Priority.--
                            (i) In general.--Among such States, priority shall 
                        be given to States with the greatest need, as such need 
                        is determined by the Secretary based on the following 
                        factors, and weighting such factors as described in 
                        clause (ii):
                                    (I) The highest average rates of 
                                unemployment based on data provided by the 
                                Bureau of Labor Statistics for calendar years 
                                2013 through 2017.
                                    (II) The lowest average labor force 
                                participation rates based on data provided by 
                                the Bureau of Labor Statistics for calendar 
                                years 2013 through 2017.
                                    (III) The highest age-adjusted rates of drug 
                                overdose deaths based on data from the Centers 
                                for Disease Control and Prevention.
                            (ii) Weighting.--The factors described in clause (i) 
                        shall be weighted as follows:
                                    (I) The rate described in clause (i)(I) 
                                shall be weighted at 15 percent.
                                    (II) The rate described in clause (i)(II) 
                                shall be weighted at 15 percent.
                                    (III) The rate described in clause (i)(III) 
                                shall be weighted at 70 percent.
            (3) Distribution.--Amounts appropriated or otherwise made available 
        under this section shall be distributed according to the funding formula 
        established by the Secretary under paragraph (1) not later than 30 days 
        after the establishment of such formula.
    (c) Use of Funds.--
            (1) In general.--Any State that receives amounts pursuant to this 
        section shall expend at least 30 percent of such funds within one year 
        of the date funds become available to the grantee for obligation.
            (2) Priority.--Any State that receives amounts pursuant to this 
        section shall distribute such amounts giving priority to entities with 
        the greatest need and ability to deliver effective assistance in a 
        timely manner.
            (3) Administrative costs.--Any State that receives amounts pursuant 
        to this section may use up to 5 percent of any grant for administrative 
        costs.
    (d) Rules of Construction.--
            (1) In general.--Except as otherwise provided by this section, 
        amounts appropriated, or amounts otherwise made available to States 
        under this section shall be treated as though such funds were community 
        development block grant funds under title I of the Housing and Community 
        Development Act of 1974 (42 U.S.C. 5301 et seq.).
            (2) No match.--No matching funds shall be required in order for a 
        State to receive any amounts under this section.
    (e) Authority to Waive or Specify Alternative Requirements.--
            (1) In general.--In administering any amounts appropriated or 
        otherwise made available under this section, the Secretary may waive or 
        specify alternative requirements to any provision under title I of the 
        Housing and Community Development Act of 1974 (42 U.S.C. 5301 et seq.) 
        except for requirements related to fair housing, nondiscrimination, 
        labor standards, the environment, and requirements that activities 
        benefit persons of low- and moderate-income, upon a finding that such a 
        waiver is necessary to expedite or facilitate the use of such funds.
            (2) Notice of intent.--The Secretary shall provide written notice of 
        its intent to exercise the authority to specify alternative requirements 
        under paragraph (1) to the Committee on Banking, Housing, and Urban 
        Affairs of the Senate and the Committee on Financial Services of the 
        House of Representatives not later than 15 business days before such 
        exercise of authority occurs.
            (3) Notice to the public.--The Secretary shall provide written 
        notice of its intent to exercise the authority to specify alternative 
        requirements under paragraph (1) to the public via notice, on the 
        internet website of the Department of Housing and Urban Development, and 
        by other appropriate means, not later than 15 business days before such 
        exercise of authority occurs.
    (f) Technical Assistance.--For the 2-year period following the date of 
enactment of this Act, the Secretary may use not more than 2 percent of the 
funds made available under this section for technical assistance to grantees.
    (g) State.--For purposes of this section the term ``State'' includes any 
State as defined in section 102 of the Housing and Community Development Act of 
1974 (42 U.S.C. 5302) and the District of Columbia.

                           Subtitle G--Human Services

SEC. 8081. SUPPORTING FAMILY-FOCUSED RESIDENTIAL TREATMENT.

    (a) Definitions.--In this section:
            (1) Family-focused residential treatment program.--The term 
        ``family-focused residential treatment program'' means a trauma-informed 
        residential program primarily for substance use disorder treatment for 
        pregnant and postpartum women and parents and guardians that allows 
        children to reside with such women or their parents or guardians during 
        treatment to the extent appropriate and applicable.
            (2) Medicaid program.--The term ``Medicaid program'' means the 
        program established under title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.).
            (3) Secretary.--The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (4) Title iv-e program.--The term ``title IV-E program'' means the 
        program for foster care, prevention, and permanency established under 
        part E of title IV of the Social Security Act (42 U.S.C. 670 et seq.).
    (b) Guidance on Family-focused Residential Treatment Programs.--
            (1) In general.--Not later than 180 days after the date of enactment 
        of this Act, the Secretary, in consultation with divisions of the 
        Department of Health and Human Services administering substance use 
        disorder or child welfare programs, shall develop and issue guidance to 
        States identifying opportunities to support family-focused residential 
        treatment programs for the provision of substance use disorder 
        treatment. Before issuing such guidance, the Secretary shall solicit 
        input from representatives of States, health care providers with 
        expertise in addiction medicine, obstetrics and gynecology, neonatology, 
        child trauma, and child development, health plans, recipients of family-
        focused treatment services, and other relevant stakeholders.
            (2) Additional requirements.--The guidance required under paragraph 
        (1) shall include descriptions of the following:
                    (A) Existing opportunities and flexibilities under the 
                Medicaid program, including under waivers authorized under 
                section 1115 or 1915 of the Social Security Act (42 U.S.C. 1315, 
                1396n), for States to receive Federal Medicaid funding for the 
                provision of substance use disorder treatment for pregnant and 
                postpartum women and parents and guardians and, to the extent 
                applicable, their children, in family-focused residential 
                treatment programs.
                    (B) How States can employ and coordinate funding provided 
                under the Medicaid program, the title IV-E program, and other 
                programs administered by the Secretary to support the provision 
                of treatment and services provided by a family-focused 
                residential treatment facility such as substance use disorder 
                treatment and services, including medication-assisted treatment, 
                family, group, and individual counseling, case management, 
                parenting education and skills development, the provision, 
                assessment, or coordination of care and services for children, 
                including necessary assessments and appropriate interventions, 
                non-emergency transportation for necessary care provided at or 
                away from a program site, transitional services and supports for 
                families leaving treatment, and other services.
                    (C) How States can employ and coordinate funding provided 
                under the Medicaid program and the title IV-E program (including 
                as amended by the Family First Prevention Services Act enacted 
                under title VII of division E of Public Law 115-123, and 
                particularly with respect to the authority under subsections 
                (a)(2)(C) and (j) of section 472 and section 474(a)(1) of the 
                Social Security Act (42 U.S.C. 672, 674(a)(1)) (as amended by 
                section 50712 of Public Law 115-123) to provide foster care 
                maintenance payments for a child placed with a parent who is 
                receiving treatment in a licensed residential family-based 
                treatment facility for a substance use disorder) to support 
                placing children with their parents in family-focused 
                residential treatment programs.

SEC. 8082. IMPROVING RECOVERY AND REUNIFYING FAMILIES.

    (a) Family Recovery and Reunification Program Replication Project.--Section 
435 of the Social Security Act (42 U.S.C. 629e) is amended by adding at the end 
the following:
    ``(e) Family Recovery and Reunification Program Replication Project.--
            ``(1) Purpose.--The purpose of this subsection is to provide 
        resources to the Secretary to support the conduct and evaluation of a 
        family recovery and reunification program replication project (referred 
        to in this subsection as the `project') and to determine the extent to 
        which such programs may be appropriate for use at different intervention 
        points (such as when a child is at risk of entering foster care or when 
        a child is living with a guardian while a parent is in treatment). The 
        family recovery and reunification program conducted under the project 
        shall use a recovery coach model that is designed to help reunify 
        families and protect children by working with parents or guardians with 
        a substance use disorder who have temporarily lost custody of their 
        children.
            ``(2) Program components.--The family recovery and reunification 
        program conducted under the project shall adhere closely to the elements 
        and protocol determined to be most effective in other recovery coaching 
        programs that have been rigorously evaluated and shown to increase 
        family reunification and protect children and, consistent with such 
        elements and protocol, shall provide such items and services as--
                    ``(A) assessments to evaluate the needs of the parent or 
                guardian;
                    ``(B) assistance in receiving the appropriate benefits to 
                aid the parent or guardian in recovery;
                    ``(C) services to assist the parent or guardian in 
                prioritizing issues identified in assessments, establishing 
                goals for resolving such issues that are consistent with the 
                goals of the treatment provider, child welfare agency, courts, 
                and other agencies involved with the parent or guardian or their 
                children, and making a coordinated plan for achieving such 
                goals;
                    ``(D) home visiting services coordinated with the child 
                welfare agency and treatment provider involved with the parent 
                or guardian or their children;
                    ``(E) case management services to remove barriers for the 
                parent or guardian to participate and continue in treatment, as 
                well as to re-engage a parent or guardian who is not 
                participating or progressing in treatment;
                    ``(F) access to services needed to monitor the parent's or 
                guardian's compliance with program requirements;
                    ``(G) frequent reporting between the treatment provider, 
                child welfare agency, courts, and other agencies involved with 
                the parent or guardian or their children to ensure appropriate 
                information on the parent's or guardian's status is available to 
                inform decision-making; and
                    ``(H) assessments and recommendations provided by a recovery 
                coach to the child welfare caseworker responsible for 
                documenting the parent's or guardian's progress in treatment and 
                recovery as well as the status of other areas identified in the 
                treatment plan for the parent or guardian, including a 
                recommendation regarding the expected safety of the child if the 
                child is returned to the custody of the parent or guardian that 
                can be used by the caseworker and a court to make permanency 
                decisions regarding the child.
            ``(3) Responsibilities of the secretary.--
                    ``(A) In general.--The Secretary shall, through a grant or 
                contract with 1 or more entities, conduct and evaluate the 
                family recovery and reunification program under the project.
                    ``(B) Requirements.--In identifying 1 or more entities to 
                conduct the evaluation of the family recovery and reunification 
                program, the Secretary shall--
                            ``(i) determine that the area or areas in which the 
                        program will be conducted have sufficient substance use 
                        disorder treatment providers and other resources (other 
                        than those provided with funds made available to carry 
                        out the project) to successfully conduct the program;
                            ``(ii) determine that the area or areas in which the 
                        program will be conducted have enough potential program 
                        participants, and will serve a sufficient number of 
                        parents or guardians and their children, so as to allow 
                        for the formation of a control group, evaluation results 
                        to be adequately powered, and preliminary results of the 
                        evaluation to be available within 4 years of the 
                        program's implementation;
                            ``(iii) provide the entity or entities with 
                        technical assistance for the program design, including 
                        by working with 1 or more entities that are or have been 
                        involved in recovery coaching programs that have been 
                        rigorously evaluated and shown to increase family 
                        reunification and protect children so as to make sure 
                        the program conducted under the project adheres closely 
                        to the elements and protocol determined to be most 
                        effective in such other recovery coaching programs;
                            ``(iv) assist the entity or entities in securing 
                        adequate coaching, treatment, child welfare, court, and 
                        other resources needed to successfully conduct the 
                        family recovery and reunification program under the 
                        project; and
                            ``(v) ensure the entity or entities will be able to 
                        monitor the impacts of the program in the area or areas 
                        in which it is conducted for at least 5 years after 
                        parents or guardians and their children are randomly 
                        assigned to participate in the program or to be part of 
                        the program's control group.
            ``(4) Evaluation requirements.--
                    ``(A) In general.--The Secretary, in consultation with the 
                entity or entities conducting the family recovery and 
                reunification program under the project, shall conduct an 
                evaluation to determine whether the program has been implemented 
                effectively and resulted in improvements for children and 
                families. The evaluation shall have 3 components: a pilot phase, 
                an impact study, and an implementation study.
                    ``(B) Pilot phase.--The pilot phase component of the 
                evaluation shall consist of the Secretary providing technical 
                assistance to the entity or entities conducting the family 
                recovery and reunification program under the project to ensure--
                            ``(i) the program's implementation adheres closely 
                        to the elements and protocol determined to be most 
                        effective in other recovery coaching programs that have 
                        been rigorously evaluated and shown to increase family 
                        reunification and protect children; and
                            ``(ii) random assignment of parents or guardians and 
                        their children to be participants in the program or to 
                        be part of the program's control group is being carried 
                        out.
                    ``(C) Impact study.--The impact study component of the 
                evaluation shall determine the impacts of the family recovery 
                and reunification program conducted under the project on the 
                parents and guardians and their children participating in the 
                program. The impact study component shall--
                            ``(i) be conducted using an experimental design that 
                        uses a random assignment research methodology;
                            ``(ii) consistent with previous studies of other 
                        recovery coaching programs that have been rigorously 
                        evaluated and shown to increase family reunification and 
                        protect children, measure outcomes for parents and 
                        guardians and their children over multiple time periods, 
                        including for a period of 5 years; and
                            ``(iii) include measurements of family stability and 
                        parent, guardian, and child safety for program 
                        participants and the program control group that are 
                        consistent with measurements of such factors for 
                        participants and control groups from previous studies of 
                        other recovery coaching programs so as to allow results 
                        of the impact study to be compared with the results of 
                        such prior studies, including with respect to 
                        comparisons between program participants and the program 
                        control group regarding--
                                    ``(I) safe family reunification;
                                    ``(II) time to reunification;
                                    ``(III) permanency (such as through measures 
                                of reunification, adoption, or placement with 
                                guardians);
                                    ``(IV) safety (such as through measures of 
                                subsequent maltreatment);
                                    ``(V) parental or guardian treatment 
                                persistence and engagement;
                                    ``(VI) parental or guardian substance use;
                                    ``(VII) juvenile delinquency;
                                    ``(VIII) cost; and
                                    ``(IX) other measurements agreed upon by the 
                                Secretary and the entity or entities operating 
                                the family recovery and reunification program 
                                under the project.
                    ``(D) Implementation study.--The implementation study 
                component of the evaluation shall be conducted concurrently with 
                the conduct of the impact study component and shall include, in 
                addition to such other information as the Secretary may 
                determine, descriptions and analyses of--
                            ``(i) the adherence of the family recovery and 
                        reunification program conducted under the project to 
                        other recovery coaching programs that have been 
                        rigorously evaluated and shown to increase family 
                        reunification and protect children; and
                            ``(ii) the difference in services received or 
                        proposed to be received by the program participants and 
                        the program control group.
                    ``(E) Report.--The Secretary shall publish on an internet 
                website maintained by the Secretary the following information:
                            ``(i) A report on the pilot phase component of the 
                        evaluation.
                            ``(ii) A report on the impact study component of the 
                        evaluation.
                            ``(iii) A report on the implementation study 
                        component of the evaluation.
                            ``(iv) A report that includes--
                                    ``(I) analyses of the extent to which the 
                                program has resulted in increased 
                                reunifications, increased permanency, case 
                                closures, net savings to the State or States 
                                involved (taking into account both costs borne 
                                by States and the Federal government), or other 
                                outcomes, or if the program did not produce such 
                                outcomes, an analysis of why the replication of 
                                the program did not yield such results;
                                    ``(II) if, based on such analyses, the 
                                Secretary determines the program should be 
                                replicated, a replication plan; and
                                    ``(III) such recommendations for legislation 
                                and administrative action as the Secretary 
                                determines appropriate.
            ``(5) Appropriation.--In addition to any amounts otherwise made 
        available to carry out this subpart, out of any money in the Treasury of 
        the United States not otherwise appropriated, there are appropriated 
        $15,000,000 for fiscal year 2019 to carry out the project, which shall 
        remain available through fiscal year 2026.''.
    (b) Clarification of Payer of Last Resort Application to Child Welfare 
Prevention and Family Services.--Section 471(e)(10) of the Social Security Act 
(42 U.S.C. 671(e)(10)), as added by section 50711(a)(2) of division E of Public 
Law 115-123, is amended--
            (1) in subparagraph (A), by inserting ``, nor shall the provision of 
        such services or programs be construed to permit the State to reduce 
        medical or other assistance available to a recipient of such services or 
        programs'' after ``under this Act''; and
            (2) by adding at the end the following:
                    ``(C) Payer of last resort.--In carrying out its 
                responsibilities to ensure access to services or programs under 
                this subsection, the State agency shall not be considered to be 
                a legally liable third party for purposes of satisfying a 
                financial commitment for the cost of providing such services or 
                programs with respect to any individual for whom such cost would 
                have been paid for from another public or private source but for 
                the enactment of this subsection (except that whenever 
                considered necessary to prevent a delay in the receipt of 
                appropriate early intervention services by a child or family in 
                a timely fashion, funds provided under section 474(a)(6) may be 
                used to pay the provider of services or programs pending 
                reimbursement from the public or private source that has 
                ultimate responsibility for the payment).''.
    (c) Effective Date.--The amendments made by subsection (b) shall take effect 
as if included in section 50711 of division E of Public Law 115-123.

SEC. 8083. BUILDING CAPACITY FOR FAMILY-FOCUSED RESIDENTIAL TREATMENT.

    (a) Definitions.--In this section:
            (1) Eligible entity.--The term ``eligible entity'' means a State, 
        county, local, or tribal health or child welfare agency, a private 
        nonprofit organization, a research organization, a treatment service 
        provider, an institution of higher education (as defined under section 
        101 of the Higher Education Act of 1965 (20 U.S.C. 1001)), or another 
        entity specified by the Secretary.
            (2) Family-focused residential treatment program.--The term 
        ``family-focused residential treatment program'' means a trauma-informed 
        residential program primarily for substance use disorder treatment for 
        pregnant and postpartum women and parents and guardians that allows 
        children to reside with such women or their parents or guardians during 
        treatment to the extent appropriate and applicable.
            (3) Secretary.--The term ``Secretary'' means the Secretary of Health 
        and Human Services.
    (b) Support for the Development of Evidence-based Family-focused Residential 
Treatment Programs.--
            (1) Authority to award grants.--The Secretary shall award grants to 
        eligible entities for purposes of developing, enhancing, or evaluating 
        family-focused residential treatment programs to increase the 
        availability of such programs that meet the requirements for promising, 
        supported, or well-supported practices specified in section 471(e)(4)(C) 
        of the Social Security Act (42 U.S.C. 671(e)(4)(C))) (as added by the 
        Family First Prevention Services Act enacted under title VII of division 
        E of Public Law 115-123).
            (2) Evaluation requirement.--The Secretary shall require any 
        evaluation of a family-focused residential treatment program by an 
        eligible entity that uses funds awarded under this section for all or 
        part of the costs of the evaluation be designed to assist in the 
        determination of whether the program may qualify as a promising, 
        supported, or well-supported practice in accordance with the 
        requirements of such section 471(e)(4)(C).
    (c) Authorization of Appropriations.--There is authorized to be appropriated 
to the Secretary to carry out this section, $20,000,000 for fiscal year 2019, 
which shall remain available through fiscal year 2023.

  Subtitle H--Reauthorizing and Extending Grants for Recovery From Opioid Use 
                                    Programs

SEC. 8091. SHORT TITLE.

    This subtitle may be cited as the ``Reauthorizing and Extending Grants for 
Recovery from Opioid Use Programs Act of 2018'' or the ``REGROUP Act of 2018''.

SEC. 8092. REAUTHORIZATION OF THE COMPREHENSIVE OPIOID ABUSE GRANT PROGRAM.

    Section 1001(a)(27) of the Omnibus Crime Control and Safe Streets Act of 
1968 (34 U.S.C. 10261(a)(27)) is amended by striking ``through 2021'' and 
inserting ``and 2018, and $330,000,000 for each of fiscal years 2019 through 
2023''.

               Subtitle I--Fighting Opioid Abuse in Transportation

SEC. 8101. SHORT TITLE.

    This subtitle may be cited as the ``Fighting Opioid Abuse in Transportation 
Act''.

SEC. 8102. ALCOHOL AND CONTROLLED SUBSTANCE TESTING OF MECHANICAL EMPLOYEES.

    (a) In General.--Not later than 2 years after the date of enactment of this 
Act, the Secretary of Transportation shall publish a rule in the Federal 
Register revising the regulations promulgated under section 20140 of title 49, 
United States Code, to cover all employees of railroad carriers who perform 
mechanical activities.
    (b) Definition of Mechanical Activities.--For the purposes of the rule under 
subsection (a), the Secretary shall define the term ``mechanical activities'' by 
regulation.

SEC. 8103. DEPARTMENT OF TRANSPORTATION PUBLIC DRUG AND ALCOHOL TESTING 
              DATABASE.

    (a) In General.--Subject to subsection (c), the Secretary of Transportation 
shall--
            (1) not later than March 31, 2019, establish and make publicly 
        available on its website a database of the drug and alcohol testing data 
        reported by employers for each mode of transportation; and
            (2) update the database annually.
    (b) Contents.--The database under subsection (a) shall include, for each 
mode of transportation--
            (1) the total number of drug and alcohol tests by type of substance 
        tested;
            (2) the drug and alcohol test results by type of substance tested;
            (3) the reason for the drug or alcohol test, such as pre-employment, 
        random, post-accident, reasonable suspicion or cause, return-to-duty, or 
        follow-up, by type of substance tested; and
            (4) the number of individuals who refused testing.
    (c) Commercially Sensitive Data.--The Department of Transportation shall not 
release any commercially sensitive data or personally identifiable data 
furnished by an employer under this section unless the data is aggregated or 
otherwise in a form that does not identify the employer providing the data.
    (d) Savings Clause.--Nothing in this section may be construed as limiting or 
otherwise affecting the requirements of the Secretary of Transportation to 
adhere to requirements applicable to confidential business information and 
sensitive security information, consistent with applicable law.

SEC. 8104. GAO REPORT ON DEPARTMENT OF TRANSPORTATION'S COLLECTION AND USE OF 
              DRUG AND ALCOHOL TESTING DATA.

    (a) In General.--Not later than 2 years after the date the Department of 
Transportation public drug and alcohol testing database is established under 
section 8103, the Comptroller General of the United States shall--
            (1) review the Department of Transportation Drug and Alcohol Testing 
        Management Information System; and
            (2) submit to the Committee on Commerce, Science, and Transportation 
        of the Senate and the Committee on Transportation and Infrastructure of 
        the House of Representatives a report on the review, including 
        recommendations under subsection (c).
    (b) Contents.--The report under subsection (a) shall include--
            (1) a description of the process the Department of Transportation 
        uses to collect and record drug and alcohol testing data submitted by 
        employers for each mode of transportation;
            (2) an assessment of whether and, if so, how the Department of 
        Transportation uses the data described in paragraph (1) in carrying out 
        its responsibilities; and
            (3) an assessment of the Department of Transportation public drug 
        and alcohol testing database under section 8103.
    (c) Recommendations.--The report under subsection (a) may include 
recommendations regarding--
            (1) how the Department of Transportation can best use the data 
        described in subsection (b)(1);
            (2) any improvements that could be made to the process described in 
        subsection (b)(1);
            (3) whether and, if so, how the Department of Transportation public 
        drug and alcohol testing database under section 8103 could be made more 
        effective; and
            (4) such other recommendations as the Comptroller General considers 
        appropriate.

SEC. 8105. TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAM; ADDITION 
              OF FENTANYL AND OTHER SUBSTANCES.

    (a) Mandatory Guidelines for Federal Workplace Drug Testing Programs.--
            (1) In general.--Not later than 180 days after the date of enactment 
        of this Act, the Secretary of Health and Human Services shall--
                    (A) determine whether a revision of the Mandatory Guidelines 
                for Federal Workplace Drug Testing Programs to expand the opiate 
                category on the list of authorized substance testing to include 
                fentanyl is justified, based on the reliability and cost-
                effectiveness of available testing; and
                    (B) consider whether to include with the determination under 
                subparagraph (A) a separate determination on whether a revision 
                of the Mandatory Guidelines for Federal Workplace Drug Testing 
                Programs to expand the list of substances authorized for testing 
                to include any other drugs or other substances listed in 
                schedule I and II of section 202 of the Controlled Substances 
                Act (21 U.S.C. 812) is justified based on the criteria described 
                in subparagraph (A).
            (2) Revision of guidelines.--If an expansion of the substance list 
        is determined to be justified under paragraph (1), the Secretary of 
        Health and Human Services shall--
                    (A) notify the Committee on Commerce, Science, and 
                Transportation of the Senate and the Committee on Transportation 
                and Infrastructure of the House of Representatives of the 
                determination; and
                    (B) publish in the Federal Register, not later than 18 
                months after the date of the determination under that paragraph, 
                a final notice of the revision of the Mandatory Guidelines for 
                Federal Workplace Drug Testing Programs to expand the list of 
                substances authorized to be tested to include the substance or 
                substances determined to be justified for inclusion.
            (3) Report.--If an expansion of the substance list is determined not 
        to be justified under paragraph (1), the Secretary of Health and Human 
        Services shall submit to the Committee on Commerce, Science, and 
        Transportation of the Senate and the Committee on Transportation and 
        Infrastructure of the House of Representatives a report explaining, in 
        detail, the reasons the expansion of the list of authorized substances 
        is not justified.
    (b) Department of Transportation Drug-testing Panel.--If an expansion is 
determined to be justified under subsection (a)(1), the Secretary of 
Transportation shall publish in the Federal Register, not later than 18 months 
after the date the final notice is published under subsection (a)(2), a final 
rule revising part 40 of title 49, Code of Federal Regulations, to include such 
substances in the Department of Transportation's drug-testing panel, consistent 
with the Mandatory Guidelines for Federal Workplace Drug Testing Programs as 
revised by the Secretary of Health and Human Services under subsection (a).
    (c) Savings Provision.--Nothing in this section may be construed as--
            (1) delaying the publication of the notices described in sections 
        8106 and 8107 of this Act until the Secretary of Health and Human 
        Services makes a determination or publishes a notice under this section; 
        or
            (2) limiting or otherwise affecting any authority of the Secretary 
        of Health and Human Services or the Secretary of Transportation to 
        expand the list of authorized substance testing to include an additional 
        substance.

SEC. 8106. STATUS REPORTS ON HAIR TESTING GUIDELINES.

    (a) In General.--Not later than 60 days after the date of enactment of this 
Act, and annually thereafter until the date that the Secretary of Health and 
Human Services publishes in the Federal Register a final notice of scientific 
and technical guidelines for hair testing in accordance with section 5402(b) of 
the Fixing America's Surface Transportation Act (Public Law 114-94; 129 Stat. 
1312), the Secretary of Health and Human Services shall submit to the Committee 
on Commerce, Science, and Transportation of the Senate and the Committee on 
Transportation and Infrastructure of the House of Representatives a report on--
            (1) the status of the hair testing guidelines;
            (2) an explanation for why the hair testing guidelines have not been 
        issued; and
            (3) an estimated date of completion of the hair testing guidelines.
    (b) Requirement.--To the extent practicable and consistent with the 
objective of the hair testing described in subsection (a) to detect illegal or 
unauthorized use of substances by the individual being tested, the final notice 
of scientific and technical guidelines under that subsection, as determined by 
the Secretary of Health and Human Services, shall eliminate the risk of positive 
test results, of the individual being tested, caused solely by the drug use of 
others and not caused by the drug use of the individual being tested.

SEC. 8107. MANDATORY GUIDELINES FOR FEDERAL WORKPLACE DRUG TESTING PROGRAMS 
              USING ORAL FLUID.

    (a) Deadline.--Not later than December 31, 2018, the Secretary of Health and 
Human Services shall publish in the Federal Register a final notice of the 
Mandatory Guidelines for Federal Workplace Drug Testing Programs using Oral 
Fluid, based on the notice of proposed mandatory guidelines published in the 
Federal Register on May 15, 2015 (94 FR 28054).
    (b) Requirement.--To the extent practicable and consistent with the 
objective of the testing described in subsection (a) to detect illegal or 
unauthorized use of substances by the individual being tested, the final notice 
of scientific and technical guidelines under that subsection, as determined by 
the Secretary of Health and Human Services, shall eliminate the risk of positive 
test results, of the individual being tested, caused solely by the drug use of 
others and not caused by the drug use of the individual being tested.
    (c) Rule of Construction.--Nothing in this section may be construed as 
requiring the Secretary of Health and Human Services to reissue a notice of 
proposed mandatory guidelines to carry out subsection (a).

SEC. 8108. ELECTRONIC RECORDKEEPING.

    (a) Deadline.--Not later than 1 year after the date of enactment of this 
Act, the Secretary of Health and Human Services shall--
            (1) ensure that each certified laboratory that requests approval for 
        the use of completely paperless electronic Federal Drug Testing Custody 
        and Control Forms from the National Laboratory Certification Program's 
        Electronic Custody and Control Form systems receives approval for those 
        completely paperless electronic forms instead of forms that include any 
        combination of electronic traditional handwritten signatures executed on 
        paper forms; and
            (2) establish a deadline for a certified laboratory to request 
        approval under paragraph (1).
    (b) Savings Clause.--Nothing in this section may be construed as limiting or 
otherwise affecting any authority of the Secretary of Health and Human Services 
to grant approval to a certified laboratory for use of completely paperless 
electronic Federal Drug Testing Custody and Control Forms, including to grant 
approval outside of the process under subsection (a).
    (c) Electronic Signatures.--Not later than 18 months after the date of the 
deadline under subsection (a)(2), the Secretary of Transportation shall issue a 
final rule revising part 40 of title 49, Code of Federal Regulations, to 
authorize, to the extent practicable, the use of electronic signatures or 
digital signatures executed to electronic forms instead of traditional 
handwritten signatures executed on paper forms.

SEC. 8109. STATUS REPORTS ON COMMERCIAL DRIVER'S LICENSE DRUG AND ALCOHOL 
              CLEARINGHOUSE.

    (a) In General.--Not later than 60 days after the date of enactment of this 
Act, and annually thereafter until the compliance date, the Administrator of the 
Federal Motor Carrier Safety Administration shall submit to the Committee on 
Commerce, Science, and Transportation of the Senate and the Committee on 
Transportation and Infrastructure of the House of Representatives a status 
report on implementation of the final rule for the Commercial Driver's License 
Drug and Alcohol Clearinghouse (81 FR 87686), including--
            (1) an updated schedule, including benchmarks, for implementing the 
        final rule as soon as practicable, but not later than the compliance 
        date; and
            (2) a description of each action the Federal Motor Carrier Safety 
        Administration is taking to implement the final rule before the 
        compliance date.
    (b) Definition of Compliance Date.--In this section, the term ``compliance 
date'' means the earlier of--
            (1) January 6, 2020; or
            (2) the date that the national clearinghouse required under section 
        31306a of title 49, United States Code, is operational.

                  Subtitle J--Eliminating Kickbacks in Recovery

SEC. 8121. SHORT TITLE.

    This subtitle may be cited as the ``Eliminating Kickbacks in Recovery Act of 
2018''.

SEC. 8122. CRIMINAL PENALTIES.

    (a) In General.--Chapter 11 of title 18, United States Code, is amended by 
inserting after section 219 the following:
``Sec. 220. Illegal remunerations for referrals to recovery homes, clinical 
              treatment facilities, and laboratories
    ``(a) Offense.--Except as provided in subsection (b), whoever, with respect 
to services covered by a health care benefit program, in or affecting interstate 
or foreign commerce, knowingly and willfully--
            ``(1) solicits or receives any remuneration (including any kickback, 
        bribe, or rebate) directly or indirectly, overtly or covertly, in cash 
        or in kind, in return for referring a patient or patronage to a recovery 
        home, clinical treatment facility, or laboratory; or
            ``(2) pays or offers any remuneration (including any kickback, 
        bribe, or rebate) directly or indirectly, overtly or covertly, in cash 
        or in kind--
                    ``(A) to induce a referral of an individual to a recovery 
                home, clinical treatment facility, or laboratory; or
                    ``(B) in exchange for an individual using the services of 
                that recovery home, clinical treatment facility, or laboratory,
shall be fined not more than $200,000, imprisoned not more than 10 years, or 
both, for each occurrence.
    ``(b) Applicability.--Subsection (a) shall not apply to--
            ``(1) a discount or other reduction in price obtained by a provider 
        of services or other entity under a health care benefit program if the 
        reduction in price is properly disclosed and appropriately reflected in 
        the costs claimed or charges made by the provider or entity;
            ``(2) a payment made by an employer to an employee or independent 
        contractor (who has a bona fide employment or contractual relationship 
        with such employer) for employment, if the employee's payment is not 
        determined by or does not vary by--
                    ``(A) the number of individuals referred to a particular 
                recovery home, clinical treatment facility, or laboratory;
                    ``(B) the number of tests or procedures performed; or
                    ``(C) the amount billed to or received from, in part or in 
                whole, the health care benefit program from the individuals 
                referred to a particular recovery home, clinical treatment 
                facility, or laboratory;
            ``(3) a discount in the price of an applicable drug of a 
        manufacturer that is furnished to an applicable beneficiary under the 
        Medicare coverage gap discount program under section 1860D-14A(g) of the 
        Social Security Act (42 U.S.C. 1395w-114a(g));
            ``(4) a payment made by a principal to an agent as compensation for 
        the services of the agent under a personal services and management 
        contract that meets the requirements of section 1001.952(d) of title 42, 
        Code of Federal Regulations, as in effect on the date of enactment of 
        this section;
            ``(5) a waiver or discount (as defined in section 1001.952(h)(5) of 
        title 42, Code of Federal Regulations, or any successor regulation) of 
        any coinsurance or copayment by a health care benefit program if--
                    ``(A) the waiver or discount is not routinely provided; and
                    ``(B) the waiver or discount is provided in good faith;
            ``(6) a remuneration described in section 1128B(b)(3)(I) of the 
        Social Security Act (42 U.S.C. 1320a-7b(b)(3)(I));
            ``(7) a remuneration made pursuant to an alternative payment model 
        (as defined in section 1833(z)(3)(C) of the Social Security Act) or 
        pursuant to a payment arrangement used by a State, health insurance 
        issuer, or group health plan if the Secretary of Health and Human 
        Services has determined that such arrangement is necessary for care 
        coordination or value-based care; or
            ``(8) any other payment, remuneration, discount, or reduction as 
        determined by the Attorney General, in consultation with the Secretary 
        of Health and Human Services, by regulation.
    ``(c) Regulations.--The Attorney General, in consultation with the Secretary 
of Health and Human Services, may promulgate regulations to clarify the 
exceptions described in subsection (b).
    ``(d) Preemption.--
            ``(1) Federal law.--This section shall not apply to conduct that is 
        prohibited under section 1128B of the Social Security Act (42 U.S.C. 
        1320a-7b).
            ``(2) State law.--Nothing in this section shall be construed to 
        occupy the field in which any provisions of this section operate to the 
        exclusion of State laws on the same subject matter.
    ``(e) Definitions.--In this section--
            ``(1) the terms `applicable beneficiary' and `applicable drug' have 
        the meanings given those terms in section 1860D-14A(g) of the Social 
        Security Act (42 U.S.C. 1395w-114a(g));
            ``(2) the term `clinical treatment facility' means a medical setting 
        , other than a hospital, that provides detoxification, risk reduction, 
        outpatient treatment and care, residential treatment, or rehabilitation 
        for substance use, pursuant to licensure or certification under State 
        law;
            ``(3) the term `health care benefit program' has the meaning given 
        the term in section 24(b);
            ``(4) the term `laboratory' has the meaning given the term in 
        section 353 of the Public Health Service Act (42 U.S.C. 263a); and
            ``(5) the term `recovery home' means a shared living environment 
        that is, or purports to be, free from alcohol and illicit drug use and 
        centered on peer support and connection to services that promote 
        sustained recovery from substance use disorders.''.
    (b) Clerical Amendment.--The table of sections for chapter 11 of title 18, 
United States Code, is amended by inserting after the item related to section 
219 the following:

``220. Illegal remunerations for referrals to recovery homes, clinical 
                            treatment facilities, and laboratories.''.

                     Subtitle K--Substance Abuse Prevention

SEC. 8201. SHORT TITLE.

    This subtitle may be cited as the ``Substance Abuse Prevention Act of 
2018''.

SEC. 8202. REAUTHORIZATION OF THE OFFICE OF NATIONAL DRUG CONTROL POLICY.

    (a) Office of National Drug Control Policy Reauthorization Act of 1998.--
            (1) In general.--The Office of National Drug Control Policy 
        Reauthorization Act of 1998 (21 U.S.C. 1701 et seq.), as in effect on 
        September 29, 2003, and as amended by the laws described in paragraph 
        (2), is revived and restored.
            (2) Laws described.--The laws described in this paragraph are:
                    (A) The Office of National Drug Control Policy 
                Reauthorization Act of 2006 (Public Law 109-469; 120 Stat. 
                3502).
                    (B) The Presidential Appointment Efficiency and Streamlining 
                Act of 2011 (Public Law 112-166; 126 Stat. 1283).
    (b) Reauthorization.--
            (1) In general.--Section 714 of the Office of National Drug Control 
        Policy Reauthorization Act of 1998 (21 U.S.C. 1711) is amended by 
        striking ``such sums as may be necessary for each of fiscal years 2006 
        through 2010'' and inserting ``$18,400,000 for each of fiscal years 2018 
        through 2023''.
            (2) Repeal of termination.--The Office of National Drug Control 
        Policy Reauthorization Act of 1998 (21 U.S.C. 1701 et seq.) is amended 
        by striking section 715 (21 U.S.C. 1712).

SEC. 8203. REAUTHORIZATION OF THE DRUG-FREE COMMUNITIES PROGRAM.

    (a) Revival of National Narcotics Leadership Act of 1988.--
            (1) In general.--Chapter 2 of the National Narcotics Leadership Act 
        of 1988 (21 U.S.C. 1521 et seq.), except for subchapter II (21 U.S.C. 
        1541 et seq.), as in effect on September 29, 1997, and as amended by the 
        laws described in paragraph (2), is revived and restored.
            (2) Laws described.--The laws described in this paragraph are:
                    (A) Public Law 107-82 (115 Stat. 814).
                    (B) The Office of National Drug Control Policy 
                Reauthorization Act of 2006 (Public Law 109-469: 120 Stat. 
                3502), as amended by paragraph (4).
            (3) Amendment to termination provision.--Section 1009 of the 
        National Narcotics Leadership Act of 1988 (21 U.S.C. 1056) is amended by 
        inserting ``and sections 1021 through 1035'' after ``section 1007''.
            (4) Technical correction.--
                    (A) In general.--Title VIII of the Office of National Drug 
                Control Policy Reauthorization Act of 2006 (Public Law 109-469; 
                120 Stat. 3535) is amended by striking ``Drug-Free Communities 
                Act of 1997'' each place it appears and inserting ``National 
                Narcotics Leadership Act of 1988''.
                    (B) Effective date.--The amendments made by subparagraph (A) 
                shall take effect as though enacted as part of the Office of 
                National Drug Control Policy Reauthorization Act of 2006 (Public 
                Law 109-469; 120 Stat. 3502).
    (b) Amendment to National Narcotics Leadership Act of 1988.--Chapter 2 of 
subtitle A of title I of the National Narcotics Leadership Act of 1988 (21 
U.S.C. 1521 et seq.) is amended--
            (1) in section 1022 (21 U.S.C. 1522), by striking ``substance 
        abuse'' each place it appears and inserting ``substance use and 
        misuse'';
            (2) in section 1023 (21 U.S.C. 1523), by striking paragraph (9) and 
        inserting the following:
            ``(9) Substance use and misuse.--The term `substance use and misuse' 
        means--
                    ``(A) the illegal use or misuse of drugs, including 
                substances for which a listing is effect under any of schedules 
                I through V under section 202 of the Controlled Substances Act 
                (21 U.S.C. 812);
                    ``(B) the misuse of inhalants or over-the-counter drugs; or
                    ``(C) the use of alcohol, tobacco, or other related product 
                as such use is prohibited by State or local law.'';
            (3) in section 1024 (21 U.S.C. 1524), by striking subsections (a) 
        and (b) and inserting the following:
    ``(a) In General.--There is authorized to be appropriated to the Office of 
National Drug Control Policy to carry out this chapter $99,000,000 for each of 
fiscal years 2018 through 2023.
    ``(b) Administrative Costs.--Not more than 8 percent of the funds 
appropriated to carry out this chapter may be used by the Office of National 
Drug Control Policy to pay administrative costs associated with the 
responsibilities of the Office under this chapter.'';
            (4) in subchapter I (21 U.S.C. 1531 et seq.)--
                    (A) by striking ``substance abuse'' each place it appears 
                and inserting ``substance use and misuse''; and
                    (B) in section 1032(b)(1)(A) (21 U.S.C. 1532(b)(1)(A)), by 
                striking clause (iii) and inserting the following:
                            ``(iii) Renewal grants.--Subject to clause (iv), the 
                        Administrator may award a renewal grant to a grant 
                        recipient under this subparagraph for each fiscal year 
                        of the 4-fiscal-year period following the first fiscal 
                        year for which the initial additional grant is awarded 
                        in an amount not to exceed the following:
                                    ``(I) For the first and second fiscal years 
                                of the 4-fiscal-year period, the amount of the 
                                non-Federal funds, including in-kind 
                                contributions, raised by the coalition for the 
                                applicable fiscal year is not less than 125 
                                percent of the amount awarded.
                                    ``(II) For the third and fourth fiscal tears 
                                of the 4-fiscal-year period, the amount of the 
                                non-Federal funds, including in-kind 
                                contributions, raised by the coalition for the 
                                applicable fiscal year is not less than 150 
                                percent of the amount awarded.''; and
            (5) by striking subchapter II (21 U.S.C. 1541 et seq.).

SEC. 8204. REAUTHORIZATION OF THE NATIONAL COMMUNITY ANTI-DRUG COALITION 
              INSTITUTE.

    Section 4 of Public Law 107-82 (21 U.S.C. 1521 note) is amended to read as 
follows:

``SEC. 4. AUTHORIZATION FOR NATIONAL COMMUNITY ANTIDRUG COALITION INSTITUTE.

    ``(a) In General.--The Director shall, using amounts authorized to be 
appropriated by subsection (d), make a competitive grant to provide for the 
continuation of the National Community Anti-drug Coalition Institute.
    ``(b) Eligible Organizations.--An organization eligible for the grant under 
subsection (a) is any national nonprofit organization that represents, provides 
technical assistance and training to, and has special expertise and broad, 
national-level experience in community antidrug coalitions under this 
subchapter.
    ``(c) Use of Grant Amount.--The organization that receives the grant under 
subsection (a) shall continue a National Community Anti-Drug Coalition Institute 
to--
            ``(1) provide education, training, and technical assistance for 
        coalition leaders and community teams, with emphasis on the development 
        of coalitions serving economically disadvantaged areas;
            ``(2) develop and disseminate evaluation tools, mechanisms, and 
        measures to better assess and document coalition performance measures 
        and outcomes; and
            ``(3) bridge the gap between research and practice by translating 
        knowledge from research into practical information.
    ``(d) Authorization of Appropriations.--The Director shall, using amounts 
authorized to be appropriated by section 1032 of the National Narcotics 
Leadership Act of 1988 (15 U.S.C. 1532), make a grant of $2 million under 
subsection (a), for each of the fiscal years 2018 through 2023.''.

SEC. 8205. REAUTHORIZATION OF THE HIGH-INTENSITY DRUG TRAFFICKING AREA PROGRAM.

    Section 707 of the Office of National Drug Control Policy Reauthorization 
Act of 1998 (21 U.S.C. 1706) is amended--
            (1) in subsection (f), by striking ``no Federal'' and all that 
        follows through ``programs.'' and inserting the following: ``not more 
        than a total of 5 percent of Federal funds appropriated for the Program 
        are expended for substance use disorder treatment programs and drug 
        prevention programs.'';
            (2) in subsection (p)--
                    (A) in paragraph (4), by striking ``and'' at the end;
                    (B) in paragraph (5), by striking the period at the end and 
                inserting ``; and''; and
                    (C) by adding at the end the following:
            ``(6) $280,000,000 for each of fiscal years 2018 through 2023.''; 
        and
            (3) in subsection (q)--
                    (A) by striking paragraph (2) and inserting the following:
            ``(2) Required uses.--The funds used under paragraph (1) shall be 
        used to ensure the safety of neighborhoods and the protection of 
        communities, including the prevention of the intimidation of witnesses 
        of illegal drug distribution and related activities and the 
        establishment of, or support for, programs that provide protection or 
        assistance to witnesses in court proceedings.''; and
                    (B) by adding at the end the following:
            ``(3) Best practice models.--The Director shall work with HIDTAs to 
        develop and maintain best practice models to assist State, local, and 
        Tribal governments in addressing witness safety, relocation, financial 
        and housing assistance, or any other services related to witness 
        protection or assistance in cases of illegal drug distribution and 
        related activities. The Director shall ensure dissemination of the best 
        practice models to each HIDTA.''.

SEC. 8206. REAUTHORIZATION OF DRUG COURT PROGRAM.

    Section 1001(a)(25)(A) of title I of the Omnibus Crime Control and Safe 
Streets Act of 1968 (34 U.S.C. 10261(a)(25)(A)) is amended by striking ``Except 
as provided'' and all that follows and inserting the following: ``Except as 
provided in subparagraph (C), there is authorized to be appropriated to carry 
out part EE $75,000,000 for each of fiscal years 2018 through 2023.''.

SEC. 8207. DRUG COURT TRAINING AND TECHNICAL ASSISTANCE.

    Section 705 of the Office of National Drug Control Policy Reauthorization 
Act of 1998 (21 U.S.C. 1704) is amended by adding at the end the following:
    ``(e) Drug Court Training and Technical Assistance Program.--
            ``(1) Grants authorized.--The Director may make a grant to a 
        nonprofit organization for the purpose of providing training and 
        technical assistance to drug courts.
            ``(2) Authorization of appropriations.--There is authorized to be 
        appropriated to carry out this subsection $2,000,000 for each of fiscal 
        years 2018 through 2023.''.

SEC. 8208. DRUG OVERDOSE RESPONSE STRATEGY.

    Section 707 of the Office of National Drug Control Policy Reauthorization 
Act of 1998 (21 U.S.C. 1706) is amended by adding at the end the following:
    ``(r) Drug Overdose Response Strategy Implementation.--The Director may use 
funds appropriated to carry out this section to implement a drug overdose 
response strategy in high intensity drug trafficking areas on a nationwide basis 
by--
            ``(1) coordinating multi-disciplinary efforts to prevent, reduce, 
        and respond to drug overdoses, including the uniform reporting of fatal 
        and non-fatal overdoses to public health and safety officials;
            ``(2) increasing data sharing among public safety and public health 
        officials concerning drug-related abuse trends, including new 
        psychoactive substances, and related crime; and
            ``(3) enabling collaborative deployment of prevention, intervention, 
        and enforcement resources to address substance use addiction and 
        narcotics trafficking.''.

SEC. 8209. PROTECTING LAW ENFORCEMENT OFFICERS FROM ACCIDENTAL EXPOSURE.

    Section 707 of the Office of National Drug Control Policy Reauthorization 
Act of 1998 (21 U.S.C. 1706), as amended by section 8208, is amended by adding 
at the end the following:
    ``(s) Supplemental Grants.--The Director is authorized to use not more than 
$10,000,000 of the amounts otherwise appropriated to carry out this section to 
provide supplemental competitive grants to high intensity drug trafficking areas 
that have experienced high seizures of fentanyl and new psychoactive substances 
for the purposes of--
            ``(1) purchasing portable equipment to test for fentanyl and other 
        substances;
            ``(2) training law enforcement officers and other first responders 
        on best practices for handling fentanyl and other substances; and
            ``(3) purchasing protective equipment, including overdose reversal 
        drugs.''.

SEC. 8210. COPS ANTI-METH PROGRAM.

    Section 1701 of title I of the Omnibus Crime Control and Safe Streets Act of 
1968 (34 U.S.C. 10381) is amended--
            (1) by redesignating subsection (k) as subsection (l); and
            (2) by inserting after subsection (j) the following:
    ``(k) COPS Anti-Meth Program.--The Attorney General shall use amounts 
otherwise appropriated to carry out this section for a fiscal year (beginning 
with fiscal year 2019) to make competitive grants, in amounts of not less than 
$1,000,000 for such fiscal year, to State law enforcement agencies with high 
seizures of precursor chemicals, finished methamphetamine, laboratories, and 
laboratory dump seizures for the purpose of locating or investigating illicit 
activities, such as precursor diversion, laboratories, or methamphetamine 
traffickers.''.

SEC. 8211. COPS ANTI-HEROIN TASK FORCE PROGRAM.

    Section 1701 of title I of the Omnibus Crime Control and Safe Streets Act of 
1968 (34 U.S.C. 10381) is amended--
            (1) by redesignating subsection (l), as so redesignated by section 
        8210, as subsection (m); and
            (2) by inserting after subsection (k), as added by section 8210, the 
        following:
    ``(l) Cops Anti-heroin Task Force Program.--The Attorney General shall use 
amounts otherwise appropriated to carry out this section, or other amounts as 
appropriated, for a fiscal year (beginning with fiscal year 2019) to make 
competitive grants to State law enforcement agencies in States with high per 
capita rates of primary treatment admissions, for the purpose of locating or 
investigating illicit activities, through Statewide collaboration, relating to 
the distribution of heroin, fentanyl, or carfentanil or relating to the unlawful 
distribution of prescription opioids.''.

SEC. 8212. COMPREHENSIVE ADDICTION AND RECOVERY ACT EDUCATION AND AWARENESS.

    Title VII of the Comprehensive Addiction and Recovery Act of 2016 (Public 
Law 114-198; 130 Stat. 735) is amended by adding at the end the following:

``SEC. 709. SERVICES FOR FAMILIES AND PATIENTS IN CRISIS.

    ``(a) In General.--The Secretary of Health and Human Services may make 
grants to entities that focus on addiction and substance use disorders and 
specialize in family and patient services, advocacy for patients and families, 
and educational information.
    ``(b) Allowable Uses.--A grant awarded under this section may be used for 
nonprofit national, State, or local organizations that engage in the following 
activities:
            ``(1) Expansion of resource center services with professional, 
        clinical staff that provide, for families and individuals impacted by a 
        substance use disorder, support, access to treatment resources, brief 
        assessments, medication and overdose prevention education, compassionate 
        listening services, recovery support or peer specialists, bereavement 
        and grief support, and case management.
            ``(2) Continued development of health information technology systems 
        that leverage new and upcoming technology and techniques for prevention, 
        intervention, and filling resource gaps in communities that are 
        underserved.
            ``(3) Enhancement and operation of treatment and recovery resources, 
        easy-to-read scientific and evidence-based education on addiction and 
        substance use disorders, and other informational tools for families and 
        individuals impacted by a substance use disorder and community 
        stakeholders, such as law enforcement agencies.
            ``(4) Provision of training and technical assistance to State and 
        local governments, law enforcement agencies, health care systems, 
        research institutions, and other stakeholders.
            ``(5) Expanding upon and implementing educational information using 
        evidence-based information on substance use disorders.
            ``(6) Expansion of training of community stakeholders, law 
        enforcement officers, and families across a broad-range of addiction, 
        health, and related topics on substance use disorders, local issues and 
        community-specific issues related to the drug epidemic.
            ``(7) Program evaluation.''.

SEC. 8213. REIMBURSEMENT OF SUBSTANCE USE DISORDER TREATMENT PROFESSIONALS.

    Not later than January 1, 2020, the Comptroller General of the United States 
shall submit to Congress a report examining how substance use disorder services 
are reimbursed.

SEC. 8214. SOBRIETY TREATMENT AND RECOVERY TEAMS (START).

    Title V of the Public Health Service Act (42 U.S.C. 290dd et seq.) is 
amended by adding at the end the following:

``SEC. 550. SOBRIETY TREATMENT AND RECOVERY TEAMS.

    ``(a) In General.--The Secretary may make grants to States, units of local 
government, or tribal governments to establish or expand Sobriety Treatment And 
Recovery Team (referred to in this section as `START') or other similar programs 
to determine the effectiveness of pairing social workers or mentors with 
families that are struggling with a substance use disorder and child abuse or 
neglect in order to help provide peer support, intensive treatment, and child 
welfare services to such families.
    ``(b) Allowable Uses.--A grant awarded under this section may be used for 
one or more of the following activities:
            ``(1) Training eligible staff, including social workers, social 
        services coordinators, child welfare specialists, substance use disorder 
        treatment professionals, and mentors.
            ``(2) Expanding access to substance use disorder treatment services 
        and drug testing.
            ``(3) Enhancing data sharing with law enforcement agencies, child 
        welfare agencies, substance use disorder treatment providers, judges, 
        and court personnel.
            ``(4) Program evaluation and technical assistance.
    ``(c) Program Requirements.--A State, unit of local government, or tribal 
government receiving a grant under this section shall--
            ``(1) serve only families for which--
                    ``(A) there is an open record with the child welfare agency; 
                and
                    ``(B) substance use disorder was a reason for the record or 
                finding described in paragraph (1); and
            ``(2) coordinate any grants awarded under this section with any 
        grant awarded under section 437(f) of the Social Security Act focused on 
        improving outcomes for children affected by substance abuse.
    ``(d) Technical Assistance.--The Secretary may reserve not more than 5 
percent of funds provided under this section to provide technical assistance on 
the establishment or expansion of programs funded under this section from the 
National Center on Substance Abuse and Child Welfare.''.

SEC. 8215. PROVIDER EDUCATION.

    Not later than 60 days after the date of enactment of this Act, the Attorney 
General, in consultation with the Secretary of Health and Human Services, shall 
complete the plan related to medical registration coordination required by 
Senate Report 114-239, which accompanied the Veterans Care Financial Protection 
Act of 2017 (Public Law 115-131; 132 Stat. 334).

SEC. 8216. DEFINITIONS.

    Section 702 of the Office of National Drug Control Policy Reauthorization 
Act of 1998 (21 U.S.C. 1701) is amended--
            (1) by striking paragraphs (5), (12), and (13);
            (2) by redesignating paragraph (11) as paragraph (17);
            (3) by redesignating paragraphs (9) and (10) as paragraphs (14) and 
        (15), respectively;
            (4) by redesignating paragraphs (6), (7), and (8) as paragraphs 
        (10), (11), and (12), respectively;
            (5) by redesignating paragraphs (1), (2), (3), and (4) as paragraphs 
        (3), (4), (5), and (6), respectively;
            (6) by inserting before paragraph (3), as so redesignated, the 
        following:
            ``(1) Agency.--The term `agency' has the meaning given the term 
        `executive agency' in section 102 of title 31, United States Code.
            ``(2) Appropriate congressional committees.--
                    ``(A) In general.--The term `appropriate congressional 
                committees' means--
                            ``(i) the Committee on the Judiciary, the Committee 
                        on Appropriations, and the Committee on Health, 
                        Education, Labor, and Pensions of the Senate; and
                            ``(ii) the Committee on Oversight and Government 
                        Reform, the Committee on the Judiciary, the Committee on 
                        Energy and Commerce, and the Committee on Appropriations 
                        of the House of Representatives.
                    ``(B) Submission to congress.--Any submission to Congress 
                shall mean submission to the appropriate congressional 
                committees.'';
            (7) by amending paragraph (3), as so redesignated, to read as 
        follows:
            ``(3) Demand reduction.--The term `demand reduction' means any 
        activity conducted by a National Drug Control Program Agency, other than 
        an enforcement activity, that is intended to reduce or prevent the use 
        of drugs or support, expand, or provide treatment and recovery efforts, 
        including--
                    ``(A) education about the dangers of illicit drug use;
                    ``(B) services, programs, or strategies to prevent substance 
                use disorder, including evidence-based education campaigns, 
                community-based prevention programs, collection and disposal of 
                unused prescription drugs, and services to at-risk populations 
                to prevent or delay initial use of an illicit drug;
                    ``(C) substance use disorder treatment;
                    ``(D) support for long-term recovery from substance use 
                disorders;
                    ``(E) drug-free workplace programs;
                    ``(F) drug testing, including the testing of employees;
                    ``(G) interventions for illicit drug use and dependence;
                    ``(H) expanding availability of access to health care 
                services for the treatment of substance use disorders;
                    ``(I) international drug control coordination and 
                cooperation with respect to activities described in this 
                paragraph;
                    ``(J) pre- and post-arrest criminal justice interventions 
                such as diversion programs, drug courts, and the provision of 
                evidence-based treatment to individuals with substance use 
                disorders who are arrested or under some form of criminal 
                justice supervision, including medication assisted treatment;
                    ``(K) other coordinated and joint initiatives among Federal, 
                State, local, and Tribal agencies to promote comprehensive drug 
                control strategies designed to reduce the demand for, and the 
                availability of, illegal drugs;
                    ``(L) international illicit drug use education, prevention, 
                treatment, recovery, research, rehabilitation activities, and 
                interventions for illicit drug use and dependence; and
                    ``(M) research related to illicit drug use and any of the 
                activities described in this paragraph.'';
            (8) by inserting after paragraph (6), as so redesignated, the 
        following:
            ``(7) Emerging drug threat.--The term `emerging drug threat' means 
        the occurrence of a new and growing trend in the use of an illicit drug 
        or class of drugs, including rapid expansion in the supply of or demand 
        for such drug.
            ``(8) Illicit drug use; illicit drugs; illegal drugs.--The terms 
        `illicit drug use', `illicit drugs', and `illegal drugs' include the 
        illegal or illicit use of prescription drugs.
            ``(9) Law enforcement.--The term `law enforcement' or `drug law 
        enforcement' means all efforts by a Federal, State, local, or Tribal 
        government agency to enforce the drug laws of the United States or any 
        State, including investigation, arrest, prosecution, and incarceration 
        or other punishments or penalties.'';
            (9) by amending paragraph (11), as so redesignated, to read as 
        follows:
            ``(11) National drug control program agency.--The term `National 
        Drug Control Program Agency' means any agency (or bureau, office, 
        independent agency, board, division, commission, subdivision, unit, or 
        other component thereof) that is responsible for implementing any aspect 
        of the National Drug Control Strategy, including any agency that 
        receives Federal funds to implement any aspect of the National Drug 
        Control Strategy, but does not include any agency that receives funds 
        for drug control activity solely under the National Intelligence Program 
        or the Joint Military Intelligence Program.'';
            (10) in paragraph (12), as so redesignated--
                    (A) by inserting ``or `Strategy''' before ``means''; and
                    (B) by inserting ``, including any report, plan, or strategy 
                required to be incorporated into or issued concurrently with 
                such strategy'' before the period at the end;
            (11) by inserting after paragraph (12), as so redesignated, the 
        following:
            ``(13) Nonprofit organization.--The term `nonprofit organization' 
        means an organization that is described in section 501(c)(3) of the 
        Internal Revenue Code of 1986 and exempt from tax under section 501(a) 
        of such Code.'';
            (12) in paragraph (14), as so redesignated, by striking ``Unless the 
        context clearly indicates otherwise, the'' and inserting ``The'';
            (13) by inserting after paragraph (15), as so redesignated, the 
        following:
            ``(16) Substance use disorder treatment.--The term `substance use 
        disorder treatment' means an evidence-based, professionally directed, 
        deliberate, and planned regimen including evaluation, observation, 
        medical monitoring, and rehabilitative services and interventions such 
        as pharmacotherapy, behavioral therapy, and individual and group 
        counseling, on an inpatient or outpatient basis, to help patients with 
        substance use disorder reach recovery.''; and
            (14) in paragraph (17), as so redesignated--
                    (A) by redesignating subparagraphs (B), (C), (D), and (E), 
                as subparagraphs (C), (D), (E), and (F), respectively;
                    (B) by inserting after subparagraph (A) the following:
                    ``(B) domestic law enforcement;'';
                    (C) in subparagraph (E), as so redesignated, by striking 
                ``and'' at the end;
                    (D) in subparagraph (F), as so redesignated, by striking the 
                period at the end and inserting a semicolon; and
                    (E) by adding at the end the following:
                    ``(G) activities to prevent the diversion of drugs for their 
                illicit use; and
                    ``(H) research related to any of the activities described in 
                this paragraph.''.

SEC. 8217. AMENDMENTS TO ADMINISTRATION OF THE OFFICE.

    (a) Responsibilities of Office.--Section 703(a) of the Office of National 
Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1702(a)) is amended--
            (1) by striking paragraph (1) and inserting the following:
            ``(1) lead the national drug control effort, including coordinating 
        with the National Drug Control Program Agencies;'';
            (2) in paragraph (2), by inserting before the semicolon the 
        following: ``, including the National Drug Control Strategy'';
            (3) in paragraph (3), by striking ``and'' at the end; and
            (4) by striking paragraph (4) and all that follows through ``the 
        National Academy of Sciences.'' and inserting the following:
            ``(4) evaluate the effectiveness of national drug control policy 
        efforts, including the National Drug Control Program Agencies' program, 
        by developing and applying specific goals and performance measurements 
        and monitoring the agencies' program-level spending;
            ``(5) identify and respond to emerging drug threats related to 
        illicit drug use;
            ``(6) administer the Drug-Free Communities Program, the High-
        Intensity Drug Trafficking Areas Program, and other grant programs 
        directly authorized to be administered by the Office in furtherance of 
        the National Drug Control Strategy; and
            ``(7) facilitate broad-scale information sharing and data 
        standardization among Federal, State, and local entities to support the 
        national drug control efforts.''.
    (b) Ethics Guidelines.--Section 703(d) of the Office of National Drug 
Control Policy Reauthorization Act of 1998 (21 U.S.C. 1702(d)) is amended by 
adding at the end the following:
            ``(4) Ethics guidelines.--The Director shall establish written 
        guidelines setting forth the criteria to be used in determining whether 
        a gift or donation should be declined under this subsection because the 
        acceptance of the gift or donation would--
                    ``(A) reflect unfavorably upon the ability of the Director 
                or the Office, or any employee of the Office, to carry out 
                responsibilities or official duties under this chapter in a fair 
                and objective manner; or
                    ``(B) compromise the integrity or the appearance of 
                integrity of programs or services provided under this chapter or 
                of any official involved in those programs or services.
            ``(5) Registry of gifts.--The Director shall maintain a list of--
                    ``(A) the source and amount of each gift or donation 
                accepted by the Office; and
                    ``(B) the source and amount of each gift or donation 
                accepted by a contractor to be used in its performance of a 
                contract for the Office.
            ``(6) Report to congress.--The Director shall include in the annual 
        assessment under section 706(g) a copy of the registry maintained under 
        paragraph (5).''.
    (c) Appointment of Director and Deputy Director.--Section 704(a) of the 
Office of National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 
1703(a)) is amended--
            (1) in paragraph (1), by striking subparagraphs (A), (B), and (C), 
        and inserting the following:
                    ``(A) Director.--
                            ``(i) In general.--There shall be at the head of the 
                        Office a Director who shall hold the same rank and 
                        status as the head of an executive department listed in 
                        section 101 of title 5, United States Code.
                            ``(ii) Appointment.--The Director shall be appointed 
                        by the President, by and with the advice and consent of 
                        the Senate, and shall serve at the pleasure of the 
                        President.
                    ``(B) Deputy director.--There shall be a Deputy Director who 
                shall report directly to the Director, and who shall be 
                appointed by the President, and shall serve at the pleasure of 
                the President.
                    ``(C) Coordinators.--The following coordinators shall be 
                appointed by the Director:
                            ``(i) Performance Budget Coordinator, as described 
                        in section 704(c)(4).
                            ``(ii) Interdiction Coordinator, as described in 
                        section 711.
                            ``(iii) Emerging and Continuing Threats Coordinator, 
                        as described in section 709.
                            ``(iv) State, Local, and Tribal Affairs Coordinator, 
                        to carry out the activities described in section 704(j).
                            ``(v) Demand Reduction Coordinator, as described in 
                        subparagraph (D).
                    ``(D) Demand reduction coordinator.--The Director shall 
                designate or appoint a United States Demand Reduction 
                Coordinator to be responsible for the activities described in 
                section 702(3). The Director shall determine whether the 
                coordinator position is a noncareer appointee in the Senior 
                Executive Service or a career appointee in a position at level 
                15 of the General Schedule (or equivalent).'';
            (2) in paragraph (5), by striking ``such official'' and inserting 
        ``such officer or employee''; and
            (3) by adding at the end the following:
            ``(6) Prohibition on the use of funds for ballot initiatives.--No 
        funds authorized under this title may be obligated for the purpose of 
        expressly advocating the passage or defeat of a State or local ballot 
        initiative.''.
    (d) Consultation.--Section 704(b) of the Office of National Drug Control 
Policy Reauthorization Act of 1998 (21 U.S.C. 1703(b)) is amended--
            (1) in paragraph (19), by striking ``; and'' and inserting a 
        semicolon;
            (2) in paragraph (20), by striking the period at the end and 
        inserting ``; and''; and
            (3) by adding at the end the following:
            ``(21) in order to formulate the national drug control policies, 
        goals, objectives, and priorities--
                    ``(A) shall consult with and assist--
                            ``(i) State and local governments;
                            ``(ii) National Drug Control Program Agencies;
                            ``(iii) each committee, working group, council, or 
                        other entity established under this chapter, as 
                        appropriate;
                            ``(iv) the public;
                            ``(v) appropriate congressional committees; and
                            ``(vi) any other person in the discretion of the 
                        Director; and
                    ``(B) may--
                            ``(i) establish advisory councils;
                            ``(ii) acquire data from agencies; and
                            ``(iii) request data from any other entity.''.
    (e) National Drug Control Program Budget.--Section 704(c) of the Office of 
National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1703(c)) is 
amended--
            (1) in paragraph (2)--
                    (A) in subparagraph (A), by striking ``paragraph (1)(C);'' 
                and inserting the following: ``paragraph (1)(C) and include--
                            ``(i) the funding level for each National Drug 
                        Control Program agency; and
                            ``(ii) alternative funding structures that could 
                        improve progress on achieving the goals fo the National 
                        Drug Control Strategy; and'';
                    (B) in subparagraph (B), strike ``the President; and'' and 
                inserting ``the President and Congress.''; and
                    (C) by striking subparagraph (C);
            (2) in paragraph (3)(E), by striking clause (ii) and inserting the 
        following:
                            ``(ii) Certification.--The Director shall--
                                    ``(I) review each budget submission 
                                submitted under subparagraph (A);
                                    ``(II) based on the review under clause (i), 
                                make a determination as to whether the budget 
                                submission of a National Drug Control Program 
                                agency includes the funding levels and 
                                initiatives described in subparagraph (B); and
                                    ``(III) submit to the appropriate 
                                congressional committees--
                                            ``(aa) a written statement that 
                                        either--

                                                    ``(AA) certifies that the 
                                                budget submission includes 
                                                sufficient funding; or

                                                    ``(BB) decertifies the 
                                                budget submission as not 
                                                including sufficient funding;

                                            ``(bb) a copy of the description 
                                        made under subparagraph (B); and
                                            ``(cc) the budget recommendations 
                                        made under subsection (b)(8).''; and
            (3) by adding at the end the following:
            ``(5) Performance-budget coordinator.--
                    ``(A) Designation.--The Director shall designate or appoint 
                a United States Performance-Budget Coordinator to--
                            ``(i) ensure the Director has sufficient information 
                        necessary to analyze the performance of each National 
                        Drug Control Program Agency, the impact Federal funding 
                        has had on the goals in the Strategy, and the likely 
                        contributions to the goals of the Strategy based on 
                        funding levels of each National Drug Control Program 
                        Agency, to make an independent assessment of the budget 
                        request of each agency under this subsection;
                            ``(ii) advise the Director on agency budgets, 
                        performance measures and targets, and additional data 
                        and research needed to make informed policy decisions 
                        under this section and section 706; and
                            ``(iii) other duties as may be determined by the 
                        Director with respect to measuring or assessing 
                        performance or agency budgets.
                    ``(B) Determination of position.--The Director shall 
                determine whether the coordinator position is a noncareer 
                appointee in the Senior Executive Service or a career appointee 
                in a position at level 15 of the General Schedule (or 
                equivalent).
            ``(6) Budget estimate or request submission to congress.--Whenever 
        the Director submits any budget estimate or request to the President or 
        the Office of Management and Budget, the Director shall concurrently 
        transmit to the appropriate congressional committees a detailed 
        statement of the budgetary needs of the Office to execute its mission 
        based on the good-faith assessment of the Director.''.
    (f) Powers and Responsibilities of the Director.--Section 704 of the Office 
of National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1703) is 
amended--
            (1) in subsection (d)(8)--
                    (A) in subparagraph (D), by striking ``and'' at the end;
                    (B) in subparagraph (E)--
                            (i) in clause (i)--
                                    (I) by striking ``Congress, including to the 
                                Committees on Appropriations of the Senate and 
                                the House of Representatives, the authorizing 
                                committees for the Office,'' and inserting ``the 
                                appropriate congressional committees''; and
                                    (II) by striking ``or agencies'';
                            (ii) in clause (ii)--
                                    (I) by striking ``Congress'' and inserting 
                                ``the appropriate congressional committees''; 
                                and
                                    (II) by adding ``and'' at the end; and
                            (iii) by adding at the end the following:
                            ``(iii) funds may only be used for--
                                    ``(I) expansion of demand reduction 
                                activities;
                                    ``(II) interdiction of illicit drugs on the 
                                high seas, in United States territorial waters, 
                                and at United States ports of entry by officers 
                                and employees of National Drug Control Program 
                                Agencies and domestic and foreign law 
                                enforcement officers;
                                    ``(III) accurate assessment and monitoring 
                                of international drug production and 
                                interdiction programs and policies;
                                    ``(IV) activities to facilitate and enhance 
                                the sharing of domestic and foreign intelligence 
                                information among National Drug Control Program 
                                Agencies related to the production and 
                                trafficking of drugs in the United States and 
                                foreign countries; and
                                    ``(V) research related to any of these 
                                activities.'';
            (2) in subsection (e)(2)(A), by striking ``Notwithstanding any other 
        provision of law'' and inserting ``Subject to the availability of 
        appropriations''; and
            (3) by adding at the end the following:
    ``(i) Model Acts Program.--
            ``(1) In general.--The Director shall provide for or shall enter 
        into an agreement with a nonprofit organization to--
                    ``(A) advise States on establishing laws and policies to 
                address illicit drug use issues; and
                    ``(B) revise such model State drug laws and draft 
                supplementary model State laws to take into consideration 
                changes in illicit drug use issues in the State involved.
            ``(2) Authorization of appropriations.--There is authorized to be 
        appropriated to carry out this subsection $1,250,000 for each of fiscal 
        years 2018 through 2023.
    ``(j) State, Local, and Tribal Affairs Coordinator.--The Director shall 
designate or appoint a United States State, Local, and Tribal Affairs 
Coordinator to perform the duties of the Office outlined in this section and 706 
and such other duties as may be determined by the Director with respect to 
coordination of drug control efforts between agencies and State, local, and 
Tribal governments. The Director shall determine whether the coordinator 
position is a noncareer appointee in the Senior Executive Service or a career 
appointee in a position at level 15 of the General Schedule (or equivalent).
    ``(k) Harm Reduction Programs .--When developing the national drug control 
policy, any policy of the Director, including policies relating to syringe 
exchange programs for intravenous drug users, shall be based on the best 
available medical and scientific evidence regarding the effectiveness of such 
policy in promoting individual health and preventing the spread of infectious 
disease and the impact of such policy on drug addiction and use. In making any 
policy relating to harm reduction programs, the Director shall consult with the 
National Institutes of Health and the National Academy of Sciences.''.
    (g) Accounting of Funds Expended.--Section 705 of the Office of National 
Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1704(d)), as amended 
by section 8207 is further amended--
            (1) by amending subsection (d) to read as follows:
    ``(d) Accounting of Funds Expended.--
            ``(1) In general.--Not later than February 1 of each year, in 
        accordance with guidance issued by the Director, the head of each 
        National Drug Control Program Agency shall submit to the Director a 
        detailed accounting of all funds expended by the agency for National 
        Drug Control Program activities during the previous fiscal year and 
        shall ensure such detailed accounting is authenticated for the previous 
        fiscal year by the Inspector General for such agency prior to the 
        submission to the Director as frequently as determined by the Inspector 
        General but not less frequently that every 3 years.
            ``(2) Submission to congress.--The Director shall submit to Congress 
        not later than April 1 of each year the information submitted to the 
        Director under paragraph (1).''; and
            (2) by adding at the end the following:
    ``(f) Tracking System for Federally Funded Grant Programs.--
            ``(1) Establishment.--The Director, or the head of an agency 
        designated by the Director, in coordination with the Secretary of Health 
        and Human Services, shall track federally-funded grant programs to--
                    ``(A) ensure the public has electronic access to information 
                identifying:
                            ``(i) all drug control grants and pertinent 
                        identifying information for each grant;
                            ``(ii) any available performance metrics, 
                        evaluations, or other information indicating the 
                        effectiveness of such programs;
                    ``(B) facilitate efforts to identify duplication, overlap, 
                or gaps in funding to provide increased accountability of 
                Federally-funded grants for substance use disorder treatment, 
                prevention, and enforcement; and
                    ``(C) identify barriers in the grant application process 
                impediments that applicants currently have in the grant 
                application process with applicable agencies.
            ``(2) National drug control agencies.--The head of each National 
        Drug Control Program Agency shall provide to the Director a complete 
        list of all drug control program grant programs and any other relevant 
        information for inclusion in the system developed under paragraph (1) 
        and annually update such list.
            ``(3) Updating existing systems.--The Director may meet the 
        requirements of this subsection by utilizing, updating, or improving 
        existing Federal information systems to ensure they meet the 
        requirements of this subsection.
            ``(4) Report.--Not later than 3 years after the date of enactment of 
        this subsection, the Comptroller General of the United States shall 
        submit to Congress a report examining implementation of this 
        subsection.''.
    (h) Technical and Conforming Amendment.--Section 1105 of the Office of 
National Drug Control Policy Reauthorization Act of 2006 (21 U.S.C. 1701 note) 
is repealed.

SEC. 8218. EMERGING THREATS COMMITTEE, PLAN, AND MEDIA CAMPAIGN.

    (a) In General.--Section 709 of the Office of National Drug Control Policy 
Reauthorization Act of 1998 (21 U.S.C. 1708) is amended to read as follows:

``SEC. 709. EMERGING THREATS COMMITTEE, PLAN, AND MEDIA CAMPAIGN.

    ``(a) Emerging Threats Coordinator.--The Director shall designate or appoint 
a United States Emerging and Continuing Threats Coordinator to perform the 
duties of that position described in this section and such other duties as may 
be determined by the Director. The Director shall determine whether the 
coordinator position is a noncareer appointee in the Senior Executive Service or 
a career appointee in a position at level 15 of the General Schedule (or 
equivalent).
    ``(b) Emerging Threats Committee.--
            ``(1) In general.--The Emerging Threats Committee shall--
                    ``(A) monitor evolving and emerging drug threats in the 
                United States;
                    ``(B) identify and discuss evolving and emerging drug trends 
                in the United States using the criteria required to be 
                established under paragraph (6);
                    ``(C) assist in the formulation of and oversee 
                implementation of any plan described in subsection (d);
                    ``(D) provide such other advice to the Coordinator and 
                Director concerning strategy and policies for emerging drug 
                threats and trends as the Committee determines to be 
                appropriate; and
                    ``(E) disseminate and facilitate the sharing with Federal, 
                State, local, and Tribal officials and other entities as 
                determined by the Director of pertinent information and data 
                relating to--
                            ``(i) recent trends in drug supply and demand;
                            ``(ii) fatal and nonfatal overdoses;
                            ``(iii) demand for and availability of evidence-
                        based substance use disorder treatment, including the 
                        extent of the unmet treatment need, and treatment 
                        admission trends;
                            ``(iv) recent trends in drug interdiction, supply, 
                        and demand from State, local, and Tribal law enforcement 
                        agencies; and
                            ``(v) other subject matter as determined necessary 
                        by the Director.
            ``(2) Chairperson.--The Director shall designate one of the members 
        of the Emerging Threats Committee to serve as Chairperson.
            ``(3) Members.--The Director shall appoint other members of the 
        Committee, which shall include--
                    ``(A) representatives from National Drug Control Program 
                Agencies or other agencies;
                    ``(B) representatives from State, local, and Tribal 
                governments; and
                    ``(C) representatives from other entities as designated by 
                the Director.
            ``(4) Meetings.--The members of the Emerging Threats Committee shall 
        meet, in person and not through any delegate or representative, not less 
        frequently than once per calendar year, before June 1. At the call of 
        the Director or the Chairperson, the Emerging Threats Committee may hold 
        additional meetings as the members may choose.
            ``(5) Contract, agreement, and other authority.--The Director may 
        award contracts, enter into interagency agreements, manage individual 
        projects, and conduct other activities in support of the identification 
        of emerging drug threats and in support of the development, 
        implementation, and assessment of any Emerging Threat Response Plan.
            ``(6) Criteria to identify emerging drug threats.--Not later than 
        180 days after the date on which the Committee first meets, the 
        Committee shall develop and recommend to the Director criteria to be 
        used to identify an emerging drug threat or the termination of an 
        emerging drug threat designation based on information gathered by the 
        Committee, statistical data, and other evidence.
    ``(c) Designation.--
            ``(1) In general.--The Director, in consultation with the 
        Coordinator, the Committee, and the head of each National Drug Control 
        Program Agency, may designate an emerging drug threat in the United 
        States.
            ``(2) Standards for designation.--The Director, in consultation with 
        the Coordinator, shall promulgate and make publicly available standards 
        by which a designation under paragraph (1) and the termination of such 
        designation may be made. In developing such standards, the Director 
        shall consider the recommendations of the committee and other criteria 
        the Director considers to be appropriate.
            ``(3) Public statement required.--The Director shall publish a 
        public written statement on the portal of the Office explaining the 
        designation of an emerging drug threat or the termination of such 
        designation and shall notify the appropriate congressional committees of 
        the availability of such statement when a designation or termination of 
        such designation has been made.
    ``(d) Plan.--
            ``(1) Public availability of plan.--Not later than 90 days after 
        making a designation under subsection (c), the Director shall publish 
        and make publicly available an Emerging Threat Response Plan and notify 
        the President and the appropriate congressional committees of such 
        plan's availability.
            ``(2) Timing.--Concurrently with the annual submissions under 
        section 706(g), the Director shall update the plan and report on 
        implementation of the plan, until the Director issues the public 
        statement required under subsection (c)(3) to terminate the emerging 
        drug threat designation.
            ``(3) Contents of an emerging threat response plan.--The Director 
        shall include in the plan required under this subsection--
                    ``(A) a comprehensive strategic assessment of the emerging 
                drug threat, including the current availability of, demand for, 
                and effectiveness of evidence-based prevention, treatment, and 
                enforcement programs and efforts to respond to the emerging drug 
                threat;
                    ``(B) comprehensive, research-based, short- and long-term, 
                quantifiable goals for addressing the emerging drug threat, 
                including for reducing the supply of the drug designated as the 
                emerging drug threat and for expanding the availability and 
                effectiveness of evidence-based substance use disorder treatment 
                and prevention programs to reduce the demand for the emerging 
                drug threat;
                    ``(C) performance measures pertaining to the plan's goals, 
                including quantifiable and measurable objectives and specific 
                targets;
                    ``(D) the level of funding needed to implement the plan, 
                including whether funding is available to be reprogrammed or 
                transferred to support implementation of the plan or whether 
                additional appropriations are necessary to implement the plan;
                    ``(E) an implementation strategy for the media campaign 
                under subsection (f), including goals as described under 
                subparagraph (B) of this paragraph and performance measures, 
                objectives, and targets, as described under subparagraph (C) of 
                this paragraph; and
                    ``(F) any other information necessary to inform the public 
                of the status, progress, or response of an emerging drug threat.
            ``(4) Implementation.--
                    ``(A) In general.--Not later than 120 days after the date on 
                which a designation is made under subsection (c), the Director, 
                in consultation with the President, the appropriate 
                congressional committees, and the head of each National Drug 
                Control Program Agency, shall issue guidance on implementation 
                of the plan described in this subsection to the National Drug 
                Control Program Agencies and any other relevant agency 
                determined to be necessary by the Director.
                    ``(B) Coordinator's responsibilities.--The Coordinator 
                shall--
                            ``(i) direct the implementation of the plan among 
                        the agencies identified in the plan, State, local, and 
                        Tribal governments, and other relevant entities;
                            ``(ii) facilitate information-sharing between 
                        agencies identified in the plan, State, local, and 
                        Tribal governments, and other relevant entities; and
                            ``(iii) monitor implementation of the plan by 
                        coordinating the development and implementation of 
                        collection and reporting systems to support performance 
                        measurement and adherence to the plan by agencies 
                        identified in plan, where appropriate.
                    ``(C) Reporting.--Not later than 180 days after the date on 
                which a designation is made under subsection (c) and in 
                accordance with subparagraph (A), the head of each agency 
                identified in the plan shall submit to the Coordinator a report 
                on implementation of the plan.
    ``(e) Evaluation of Media Campaign.--Upon designation of an emerging drug 
threat, the Director shall evaluate whether a media campaign would be 
appropriate to address that threat.
    ``(f) National Anti-drug Media Campaign.--
            ``(1) In general.--The Director shall, to the extent feasible and 
        appropriate, conduct a national anti-drug media campaign (referred to in 
        this subtitle as the `national media campaign') in accordance with this 
        subsection for the purposes of--
                    ``(A) preventing substance abuse among people in the United 
                States;
                    ``(B) educating the public about the dangers and negative 
                consequences of substance use and abuse, including patient and 
                family education about the characteristics and hazards of 
                substance abuse and methods to safeguard against substance use, 
                to include the safe disposal of prescription medications;
                    ``(C) supporting evidence-based prevention programs 
                targeting the attitudes, perception, and beliefs of persons 
                concerning substance use and intentions to initiate or continue 
                such use;
                    ``(D) encouraging individuals affected by substance use 
                disorders to seek treatment and providing such individuals with 
                information on--
                            ``(i) how to recognize addiction issues;
                            ``(ii) what forms of evidence-based treatment 
                        options are available; and
                            ``(iii) how to access such treatment;
                    ``(E) combating the stigma of addiction and substance use 
                disorders, including the stigma of treating such disorders with 
                medication-assisted treatment therapies; and
                    ``(F) informing the public about the dangers of any drug 
                identified by the Director as an emerging drug threat as 
                appropriate.
            ``(2) Use of funds.--
                    ``(A) In general.--Amounts made available to carry out this 
                subsection for the national media campaign may only be used for 
                the following:
                            ``(i) The purchase of media time and space, 
                        including the strategic planning for, tracking, and 
                        accounting of, such purchases.
                            ``(ii) Creative and talent costs, consistent with 
                        subparagraph (B)(i).
                            ``(iii) Advertising production costs, which may 
                        include television, radio, internet, social media, and 
                        other commercial marketing venues.
                            ``(iv) Testing and evaluation of advertising.
                            ``(v) Evaluation of the effectiveness of the 
                        national media campaign.
                            ``(vi) Costs of contracts to carry out activities 
                        authorized by this subsection.
                            ``(vii) Partnerships with professional and civic 
                        groups, community-based organizations, including faith-
                        based organizations, and government organizations 
                        related to the national media campaign.
                            ``(viii) Entertainment industry outreach, 
                        interactive outreach, media projects and activities, 
                        public information, news media outreach, and corporate 
                        sponsorship and participation.
                            ``(ix) Operational and management expenses.
                    ``(B) Specific requirements.--
                            ``(i) Creative services.--In using amounts for 
                        creative and talent costs under subparagraph (A)(ii), 
                        the Director shall use creative services donated at no 
                        cost to the Government wherever feasible and may only 
                        procure creative services for advertising--
                                    ``(I) responding to high-priority or 
                                emergent campaign needs that cannot timely be 
                                obtained at no cost; or
                                    ``(II) intended to reach a minority, ethnic, 
                                or other special audience that cannot reasonably 
                                be obtained at no cost.
                            ``(ii) Testing and evaluation of advertising.--In 
                        using amounts for testing and evaluation of advertising 
                        under subparagraph (A)(iv), the Director shall test all 
                        advertisements prior to use in the national media 
                        campaign to ensure that the advertisements are effective 
                        with the target audience and meet industry-accepted 
                        standards. The Director may waive this requirement for 
                        advertisements using no more than 10 percent of the 
                        purchase of advertising time purchased under this 
                        subsection in a fiscal year and no more than 10 percent 
                        of the advertising space purchased under this subsection 
                        in a fiscal year, if the advertisements respond to 
                        emergent and time-sensitive campaign needs or the 
                        advertisements will not be widely utilized in the 
                        national media campaign.
                            ``(iii) Consultation.--For the planning of the 
                        campaign under paragraph (1), the Director may consult 
                        with--
                                    ``(I) the head of any appropriate National 
                                Drug Control Program Agency;
                                    ``(II) experts on the designated drug;
                                    ``(III) State, local, and Tribal government 
                                officials and relevant agencies;
                                    ``(IV) communications professionals;
                                    ``(V) the public; and
                                    ``(VI) appropriate congressional committees.
                            ``(iv) Evaluation of effectiveness of national media 
                        campaign.--In using amounts for the evaluation of the 
                        effectiveness of the national media campaign under 
                        subparagraph (A)(v), the Director shall--
                                    ``(I) designate an independent entity to 
                                evaluate by April 20 of each year the 
                                effectiveness of the national media campaign 
                                based on data from--
                                            ``(aa) the Monitoring the Future 
                                        Study published by the Department of 
                                        Health and Human Services;
                                            ``(bb) the National Survey on Drug 
                                        Use and Health; and
                                            ``(cc) other relevant studies or 
                                        publications, as determined by the 
                                        Director, including tracking and 
                                        evaluation data collected according to 
                                        marketing and advertising industry 
                                        standards; and
                                    ``(II) ensure that the effectiveness of the 
                                national media campaign is evaluated in a manner 
                                that enables consideration of whether the 
                                national media campaign has contributed to 
                                changes in attitude or behaviors among the 
                                target audience with respect to substance use 
                                and such other measures of evaluation as the 
                                Director determines are appropriate.
            ``(3) Advertising.--In carrying out this subsection, the Director 
        shall ensure that sufficient funds are allocated to meet the stated 
        goals of the national media campaign.
            ``(4) Responsibilities and functions under the program.--
                    ``(A) In general.--The Director shall determine the overall 
                purposes and strategy of the national media campaign.
                    ``(B) Director.--
                            ``(i) In general.--The Director shall approve--
                                    ``(I) the strategy of the national media 
                                campaign;
                                    ``(II) all advertising and promotional 
                                material used in the national media campaign; 
                                and
                                    ``(III) the plan for the purchase of 
                                advertising time and space for the national 
                                media campaign.
                            ``(ii) Implementation.--The Director shall be 
                        responsible for implementing a focused national media 
                        campaign to meet the purposes set forth in paragraph (1) 
                        and shall ensure--
                                    ``(I) information disseminated through the 
                                campaign is accurate and scientifically valid; 
                                and
                                    ``(II) the campaign is designed using 
                                strategies demonstrated to be the most effective 
                                at achieving the goals and requirements of 
                                paragraph (1), which may include--
                                            ``(aa) a media campaign, as 
                                        described in paragraph (2);
                                            ``(bb) local, regional, or 
                                        population specific messaging;
                                            ``(cc) the development of websites 
                                        to publicize and disseminate 
                                        information;
                                            ``(dd) conducting outreach and 
                                        providing educational resources for 
                                        parents;
                                            ``(ee) collaborating with law 
                                        enforcement agencies; and
                                            ``(ff) providing support for school-
                                        based public health education classes to 
                                        improve teen knowledge about the effects 
                                        of substance use.
            ``(5) Prohibitions.--None of the amounts made available under 
        paragraph (2) may be obligated or expended for any of the following:
                    ``(A) To supplant current anti-drug community-based 
                coalitions.
                    ``(B) To supplant pro bono public service time donated by 
                national and local broadcasting networks for other public 
                service campaigns.
                    ``(C) For partisan political purposes, or to express 
                advocacy in support of or to defeat any clearly identified 
                candidate, clearly identified ballot initiative, or clearly 
                identified legislative or regulatory proposal.
                    ``(D) To fund advertising that features any elected 
                officials, persons seeking elected office, cabinet level 
                officials, or other Federal officials employed pursuant to 
                section 213 of Schedule C of title 5, Code of Federal 
                Regulations.
                    ``(E) To fund advertising that does not contain a primary 
                message intended to reduce or prevent substance use.
                    ``(F) To fund advertising containing a primary message 
                intended to promote support for the national media campaign or 
                private sector contributions to the national media campaign.
            ``(6) Matching requirement.--
                    ``(A) In general.--Amounts made available under paragraph 
                (2) for media time and space shall be matched by an equal amount 
                of non-Federal funds for the national media campaign, or be 
                matched with in-kind contributions of the same value.
                    ``(B) No-cost match advertising direct relationship 
                requirement.--The Director shall ensure that not less than 85 
                percent of no-cost match advertising directly relates to 
                substance abuse prevention consistent with the specific purposes 
                of the national media campaign.
                    ``(C) No-cost match advertising not directly related.--The 
                Director shall ensure that no-cost match advertising that does 
                not directly relate to substance abuse prevention consistent 
                with the purposes of the national media campaign includes a 
                clear anti-drug message. Such message is not required to be the 
                primary message of the match advertising.
            ``(7) Financial and performance accountability.--The Director shall 
        cause to be performed--
                    ``(A) audits and reviews of costs of the national media 
                campaign pursuant to section 4706 of title 41, United States 
                Code; and
                    ``(B) an audit to determine whether the costs of the 
                national media campaign are allowable under chapter 43 of title 
                41, United States Code.
            ``(8) Report to congress.--The Director shall submit on an annual 
        basis a report to Congress that describes--
                    ``(A) the strategy of the national media campaign and 
                whether specific objectives of the national media campaign were 
                accomplished;
                    ``(B) steps taken to ensure that the national media campaign 
                operates in an effective and efficient manner consistent with 
                the overall strategy and focus of the national media campaign;
                    ``(C) plans to purchase advertising time and space;
                    ``(D) policies and practices implemented to ensure that 
                Federal funds are used responsibly to purchase advertising time 
                and space and eliminate the potential for waste, fraud, and 
                abuse;
                    ``(E) all contracts entered into with a corporation, 
                partnership, or individual working on behalf of the national 
                media campaign;
                    ``(F) the results of any financial audit of the national 
                media campaign;
                    ``(G) a description of any evidence used to develop the 
                national media campaign;
                    ``(H) specific policies and steps implemented to ensure 
                compliance with this section;
                    ``(I) a detailed accounting of the amount of funds obligated 
                during the previous fiscal year for carrying out the national 
                media campaign, including each recipient of funds, the purpose 
                of each expenditure, the amount of each expenditure, any 
                available outcome information, and any other information 
                necessary to provide a complete accounting of the funds 
                expended; and
                    ``(J) a review and evaluation of the effectiveness of the 
                national media campaign strategy for the past year.
            ``(9) Required notice for communication from the office.--Any 
        communication, including an advertisement, paid for or otherwise 
        disseminated by the Office directly or through a contract awarded by the 
        Office shall include a prominent notice informing the audience that the 
        communication was paid for by the Office.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to the Office to carry out this section, $25,000,000 for each of 
fiscal years 2018 through 2023.''.
    (b) Technical and Conforming Amendment.--Subsection (a) of section 203 of 
the Office of National Drug Control Policy Reauthorization Act of 2006 (21 
U.S.C. 1708a) is repealed.

SEC. 8219. DRUG INTERDICTION.

    (a) Repeal.--This first section 711 of the Office of National Drug Control 
Policy Reauthorization Act of 1998 (21 U.S.C. 1710) is repealed.
    (b) Amendments.--Section 711 of the Office of National Drug Control Policy 
Reauthorization Act of 1998 (21 U.S.C. 1710), as added by Public Law 109-469 
(120 Stat. 3507), is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1)--
                            (i) by striking ``The United'' and inserting ``The 
                        Director shall designate or appoint an appointee in the 
                        Senior Executive Service or an appointee in a position 
                        at level 15 of the General Schedule (or equivalent) as 
                        the United''; and
                            (ii) by striking ``shall'' and inserting ``to'';
                    (B) in paragraph (2)(B)--
                            (i) by striking ``March 1'' and inserting 
                        ``September 1''; and
                            (ii) by striking ``paragraph (3)'' and inserting 
                        ``paragraph (4)'';
                    (C) in paragraph (3)--
                            (i) by striking ``also, at his discretion,''; and
                            (ii) by striking ``the Office of Supply Reduction 
                        for that purpose'' and inserting ``assist in carrying 
                        out such responsibilities''; and
                    (D) in paragraph (4)--
                            (i) in subparagraph (B), by striking ``The United'' 
                        and inserting ``Before submission of the National Drug 
                        Control Strategy or annual assessment required under 
                        section 706, as applicable, the United'';
                            (ii) by striking subparagraphs (C) and (E);
                            (iii) by redesignating subparagraph (D) as 
                        subparagraph (C);
                            (iv) in subparagraph (C), as so redesignated--
                                    (I) in the matter preceding clause (i)--
                                            (aa) by striking ``March 1'' and 
                                        inserting ``September 1'';
                                            (bb) by inserting ``the Director, 
                                        acting through'' before ``the United 
                                        States'';
                                            (cc) by inserting a comma after 
                                        ``Coordinator'';
                                            (dd) by striking ``a report on 
                                        behalf of the Director''; and
                                            (ee) by striking ``, which shall 
                                        include'' and inserting ``a report 
                                        that'';
                                    (II) by redesignating clauses (i), (ii), and 
                                (iii) as subclauses (I), (II), and (III), and 
                                adjusting the margins accordingly;
                                    (III) by inserting before subclause (I), as 
                                so redesignated, the following:
                            ``(i) includes--'';
                                    (IV) in clause (i), as so redesignated--
                                            (aa) in subclause (I), as so 
                                        redesignated, by inserting ``, including 
                                        information about how each National Drug 
                                        Control Program agency conducting drug 
                                        interdiction activities is engaging with 
                                        relevant international partners'' after 
                                        ``Plan'';
                                            (bb) in subclause (II), as so 
                                        redesignated, by striking ``, as well 
                                        as'' and inserting ``and'';
                                            (cc) in subclause III, as so 
                                        redesignated--

                                                    (AA) by striking ``, as well 
                                                as'' and inserting ``and''; and

                                                    (BB) by striking the period 
                                                at the end and inserting ``; 
                                                and''; and

                                    (V) by adding at the end the following:
                            ``(ii) may include recommendations for changes to 
                        existing agency authorities or laws governing 
                        interagency relationships.''; and
                            (v) by adding at the end the following:
                    ``(D) Classified annex.--Each report required to be 
                submitted under subparagraph (C) shall be in unclassified form, 
                but may include a classified annex.'';
            (2) in subsection (b)--
                    (A) in paragraph (1)(B), by inserting ``and how to 
                strengthen international partnerships to better achieve the 
                goals of that plan'' after ``that plan'';
                    (B) in paragraph (2)--
                            (i) in the paragraph heading, by striking 
                        ``Chairman'' and inserting ``Chairperson''; and
                            (ii) by striking ``chairman'' and inserting 
                        ``Chairperson'';
                    (C) in paragraph (3)--
                            (i) by striking ``prior to March 1'' and inserting 
                        ``before June 1'';
                            (ii) by striking ``either'' each place it appears;
                            (iii) by striking ``current chairman'' and inserting 
                        ``Chairperson''; and
                            (iv) by striking ``they'' and inserting ``the 
                        members''; and
                    (D) in paragraph (4)--
                            (i) by striking ``chairman'' each place it appears 
                        and inserting ``Chairperson'';
                            (ii) in the first sentence, by striking ``a 
                        report'';
                            (iii) by inserting ``a report'' after 
                        ``committees''; and
                            (iv) by striking the second sentence and inserting 
                        the following: ``The report required under this 
                        paragraph shall be in unclassified form, but may include 
                        a classified annex.''; and
            (3) by adding at the end the following:
    ``(c) International Coordination.--The Director may facilitate international 
drug control coordination efforts.''.

SEC. 8220. GAO AUDIT.

    Not later than 4 years after the date of enactment of this Act, and every 4 
years thereafter, the Comptroller General of the United States shall--
            (1) conduct an audit relating to the programs and operations of--
                    (A) the Office; and
                    (B) certain programs within the Office, including--
                            (i) the High Intensity Drug Trafficking Areas 
                        Program;
                            (ii) the Drug-Free Communities Program; and
                            (iii) the campaign under section 709(f) of the 
                        Office of National Drug Control Policy Reauthorization 
                        Act of 1998 (21 U.S.C. 1708(f)); and
            (2) submit to the Director and the appropriate congressional 
        committees a report containing an evaluation of and recommendations on 
        the--
                    (A) policies and activities of the programs and operations 
                subject to the audit;
                    (B) economy, efficiency, and effectiveness in the 
                administration of the reviewed programs and operations; and
                    (C) policy or management changes needed to prevent and 
                detect fraud and abuse in such programs and operations.

SEC. 8221. NATIONAL DRUG CONTROL STRATEGY.

    (a) In General.--Section 706 of the Office of National Drug Control Policy 
Reauthorization Act of 1998 (21 U.S.C. 1705) is amended to read as follows:

``SEC. 706. NATIONAL DRUG CONTROL STRATEGY.

    ``(a) In General.--
            ``(1) Statement of drug policy priorities.--The Director shall 
        release a statement of drug control policy priorities in the calendar 
        year of a Presidential inauguration following the inauguration, but not 
        later than April 1.
            ``(2) National drug control strategy submitted by the president.--
        Not later than the first Monday in February following the year in which 
        the term of the President commences, and every 2 years thereafter, the 
        President shall submit to Congress a National Drug Control Strategy.
    ``(b) Development of the National Drug Control Strategy.--
            ``(1) Promulgation.--The Director shall promulgate the National Drug 
        Control Strategy, which shall set forth a comprehensive plan to reduce 
        illicit drug use and the consequences of such illicit drug use in the 
        United States by limiting the availability of and reducing the demand 
        for illegal drugs and promoting prevention, early intervention, 
        treatment, and recovery support for individuals with substance use 
        disorders.
            ``(2) State and local commitment.--The Director shall seek the 
        support and commitment of State, local, and Tribal officials in the 
        formulation and implementation of the National Drug Control Strategy.
            ``(3) Strategy based on evidence.--The Director shall ensure the 
        National Drug Control Strategy is based on the best available evidence 
        regarding the policies that are most effective in reducing the demand 
        for and supply of illegal drugs.
            ``(4) Process for development and submission of national drug 
        control strategy.--In developing and effectively implementing the 
        National Drug Control Strategy, the Director--
                    ``(A) shall consult with--
                            ``(i) the heads of the National Drug Control Program 
                        Agencies;
                            ``(ii) each Coordinator listed in section 704;
                            ``(iii) the Interdiction Committee and the Emerging 
                        Threats Committee;
                            ``(iv) the appropriate congressional committees and 
                        any other committee of jurisdiction;
                            ``(v) State, local, and Tribal officials;
                            ``(vi) private citizens and organizations, including 
                        community and faith-based organizations, with experience 
                        and expertise in demand reduction;
                            ``(vii) private citizens and organizations with 
                        experience and expertise in supply reduction; and
                            ``(viii) appropriate representatives of foreign 
                        governments; and
                    ``(B) in satisfying the requirements of subparagraph (A), 
                shall ensure, to the maximum extent possible, that State, local, 
                and Tribal officials and relevant private organizations commit 
                to support and take steps to achieve the goals and objectives of 
                the National Drug Control Strategy.
    ``(c) Contents of the National Drug Control Strategy.--
            ``(1) In general.--The National Drug Control Strategy submitted 
        under subsection (a)(2) shall include the following:
                    ``(A) A mission statement detailing the major functions of 
                the National Drug Control Program.
                    ``(B) Comprehensive, research-based, long-range, 
                quantifiable goals for reducing illicit drug use, and the 
                consequences of illicit drug use in the United States.
                    ``(C) Annual quantifiable and measurable objectives and 
                specific targets to accomplish long-term quantifiable goals that 
                the Director determines may be achieved during each year 
                beginning on the date on which the National Drug Control 
                Strategy is submitted.
                    ``(D) A 5-year projection for the National Drug Control 
                Program and budget priorities.
                    ``(E) A review of international, State, local, and private 
                sector drug control activities to ensure that the United States 
                pursues coordinated and effective drug control at all levels of 
                government.
                    ``(F) A description of how each goal established under 
                subparagraph (B) will be achieved, including for each goal--
                            ``(i) a list of each relevant National Drug Control 
                        Program Agency and each such agency's related programs, 
                        activities, and available assets and the role of each 
                        such program, activity, and asset in achieving such 
                        goal;
                            ``(ii) a list of relevant stakeholders and each such 
                        stakeholder's role in achieving such goal;
                            ``(iii) an estimate of Federal funding and other 
                        resources needed to achieve such goal;
                            ``(iv) a list of each existing or new coordinating 
                        mechanism needed to achieve such goal; and
                            ``(v) a description of the Office's role in 
                        facilitating the achievement of such goal.
                    ``(G) For each year covered by the Strategy, a performance 
                evaluation plan for each goal established under subparagraph (B) 
                for each National Drug Control Program Agency, including--
                            ``(i) specific performance measures for each 
                        National Drug Control Program Agency;
                            ``(ii) annual and, to the extent practicable, 
                        quarterly objectives and targets for each performance 
                        measure; and
                            ``(iii) an estimate of Federal funding and other 
                        resources needed to achieve each performance objective 
                        and target.
                    ``(H) A list identifying existing data sources or a 
                description of data collection needed to evaluate performance, 
                including a description of how the Director will obtain such 
                data.
                    ``(I) A list of any anticipated challenges to achieving the 
                National Drug Control Strategy goals and planned actions to 
                address such challenges.
                    ``(J) A description of how each goal established under 
                subparagraph (B) was determined, including--
                            ``(i) a description of each required consultation 
                        and a description of how such consultation was 
                        incorporated; and
                            ``(ii) data, research, or other information used to 
                        inform the determination to establish the goal.
                    ``(K) A description of the current prevalence of illicit 
                drug use in the United States, including both the availability 
                of illicit drugs and the prevalence of substance use disorders.
                    ``(L) Such other statistical data and information as the 
                Director considers appropriate to demonstrate and assess trends 
                relating to illicit drug use, the effects and consequences of 
                illicit drug use (including the effects on children), supply 
                reduction, demand reduction, drug-related law enforcement, and 
                the implementation of the National Drug Control Strategy.
                    ``(M) A systematic plan for increasing data collection to 
                enable real time surveillance of drug control threats, 
                developing analysis and monitoring capabilities, and identifying 
                and addressing policy questions related to the National Drug 
                Control Strategy and Program, which shall include--
                            ``(i) a list of policy-relevant questions for which 
                        the Director and each National Drug Control Program 
                        Agency intends to develop evidence to support the 
                        National Drug Control Program and Strategy;
                            ``(ii) a list of data the Director and each National 
                        Drug Control Program Agency intends to collect, use, or 
                        acquire to facilitate the use of evidence in drug 
                        control policymaking and monitoring;
                            ``(iii) a list of methods and analytical approaches 
                        that may be used to develop evidence to support the 
                        National Drug Control Program and Strategy and related 
                        policy;
                            ``(iv) a list of any challenges to developing 
                        evidence to support policymaking, including any barriers 
                        to accessing, collecting, or using relevant data;
                            ``(v) a description of the steps the Director and 
                        the head of each National Drug Control Program Agency 
                        will take to effectuate the plan; and
                            ``(vi) any other relevant information as determined 
                        by the Director.
                    ``(N) A plan to expand treatment of substance use disorders, 
                which shall--
                            ``(i) identify unmet needs for treatment for 
                        substance use disorders and a strategy for closing the 
                        gap between available and needed treatment;
                            ``(ii) describe the specific roles and 
                        responsibilities of the relevant National Drug Control 
                        Programs for implementing the plan;
                            ``(iii) identify the specific resources required to 
                        enable the relevant National Drug Control Agencies to 
                        implement that strategy; and
                            ``(iv) identify the resources, including private 
                        sources, required to eliminate the unmet need for 
                        evidence-based substance use disorder treatment.
            ``(2) Consultation.--In developing the plan required under paragraph 
        (1), the Director shall consult with the following:
                    ``(A) The public.
                    ``(B) Any evaluation or analysis units and personnel of the 
                Office.
                    ``(C) Office officials responsible for implementing privacy 
                policy.
                    ``(D) Office officials responsible for data governance.
                    ``(E) The appropriate congressional committees.
                    ``(F) Any other individual or entity as determined by the 
                Director.
            ``(3) Additional strategies.--
                    ``(A) In general.--The Director shall include in the 
                National Drug Control Strategy the additional strategies 
                described under this paragraph and shall comply with the 
                following:
                            ``(i) Provide a copy of the additional strategies to 
                        the appropriate congressional committees and to the 
                        Committee on Armed Services and the Committee on 
                        Homeland Security of the House of Representatives, and 
                        the Committee on Homeland Security and Governmental 
                        Affairs and the Committee on Armed Services of the 
                        Senate.
                            ``(ii) Issue the additional strategies in 
                        consultation with the head of each relevant National 
                        Drug Control Program Agency, any relevant official of a 
                        State, local, or Tribal government, and the government 
                        of other relevant countries.
                            ``(iii) Not change any existing agency authority or 
                        construe any strategy described under this paragraph to 
                        amend or modify any law governing interagency 
                        relationship but may include recommendations about 
                        changes to such authority or law.
                            ``(iv) Present separately from the rest of any 
                        strategy described under this paragraph any information 
                        classified under criteria established by an Executive 
                        order, or whose public disclosure, as determined by the 
                        Director or the head of any relevant National Drug 
                        Control Program Agency, would be detrimental to the law 
                        enforcement or national security activities of any 
                        Federal, State, local, or Tribal agency.
                    ``(B) Requirement for southwest border counternarcotics 
                strategy.--
                            ``(i) Purposes.--The Southwest Border 
                        Counternarcotics Strategy shall--
                                    ``(I) set forth the Government's strategy 
                                for preventing the illegal trafficking of drugs 
                                across the international border between the 
                                United States and Mexico, including through 
                                ports of entry and between ports of entry on 
                                that border;
                                    ``(II) state the specific roles and 
                                responsibilities of the relevant National Drug 
                                Control Program Agencies for implementing that 
                                strategy; and
                                    ``(III) identify the specific resources 
                                required to enable the relevant National Drug 
                                Control Program Agencies to implement that 
                                strategy.
                            ``(ii) Specific content related to drug tunnels 
                        between the united states and mexico.--The Southwest 
                        Border Counternarcotics Strategy shall include--
                                    ``(I) a strategy to end the construction and 
                                use of tunnels and subterranean passages that 
                                cross the international border between the 
                                United States and Mexico for the purpose of 
                                illegal trafficking of drugs across such border; 
                                and
                                    ``(II) recommendations for criminal 
                                penalties for persons who construct or use such 
                                a tunnel or subterranean passage for such a 
                                purpose.
                    ``(C) Requirement for northern border counternarcotics 
                strategy.--
                            ``(i) Purposes.--The Northern Border 
                        Counternarcotics Strategy shall--
                                    ``(I) set forth the strategy of the Federal 
                                Government for preventing the illegal 
                                trafficking of drugs across the international 
                                border between the United States and Canada, 
                                including through ports of entry and between 
                                ports of entry on the border;
                                    ``(II) state the specific roles and 
                                responsibilities of each relevant National Drug 
                                Control Program Agency for implementing the 
                                strategy;
                                    ``(III) identify the specific resources 
                                required to enable the relevant National Drug 
                                Control Program Agencies to implement the 
                                strategy;
                                    ``(IV) be designed to promote, and not 
                                hinder, legitimate trade and travel; and
                                    ``(V) reflect the unique nature of small 
                                communities along the international border 
                                between the United States and Canada, ongoing 
                                cooperation and coordination with Canadian law, 
                                enforcement authorities, and variations in the 
                                volumes of vehicles and pedestrians crossing 
                                through ports of entry along the international 
                                border between the United States and Canada.
                            ``(ii) Specific content related to cross-border 
                        indian reservations.--The Northern Border 
                        Counternarcotics Strategy shall include--
                                    ``(I) a strategy to end the illegal 
                                trafficking of drugs to or through Indian 
                                reservations on or near the international border 
                                between the United States and Canada; and
                                    ``(II) recommendations for additional 
                                assistance, if any, needed by Tribal law 
                                enforcement agencies relating to the strategy, 
                                including an evaluation of Federal technical and 
                                financial assistance, infrastructure capacity 
                                building, and interoperability deficiencies.
            ``(4) Classified information.--Any contents of the National Drug 
        Control Strategy that involve information properly classified under 
        criteria established by an Executive order shall be presented to 
        Congress separately from the rest of the National Drug Control Strategy.
            ``(5) Selection of data and information.--In selecting data and 
        information for inclusion in the Strategy, the Director shall ensure--
                    ``(A) the inclusion of data and information that will permit 
                analysis of current trends against previously compiled data and 
                information where the Director believes such analysis enhances 
                long-term assessment of the National Drug Control Strategy; and
                    ``(B) the inclusion of data and information to permit a 
                standardized and uniform assessment of the effectiveness of drug 
                treatment programs in the United States.
    ``(d) Submission of Revised Strategy.--The President may submit to Congress 
a revised National Drug Control Strategy that meets the requirements of this 
section--
            ``(1) at any time, upon a determination of the President, in 
        consultation with the Director, that the National Drug Control Strategy 
        in effect is not sufficiently effective; or
            ``(2) if a new President or Director takes office.
    ``(e) Failure of Director to Submit National Drug Control Strategy.--If the 
Director does not submit a National Drug Control Strategy to Congress in 
accordance with subsection (a)(2), not later than five days after the first 
Monday in February following the year in which the term of the President 
commences, the Director shall send a notification to the appropriate 
congressional committees--
            ``(1) explaining why the Strategy was not submitted; and
            ``(2) specifying the date by which the Strategy will be submitted.
    ``(f) Drug Control Data Dashboard.--
            ``(1) In general.--The Director shall collect and disseminate, as 
        appropriate, such information as the Director determines is appropriate, 
        but not less than the information described in this subsection. The data 
        shall be publicly available in a machine-readable format on the online 
        portal of the Office, and to the extent practicable on the Drug Control 
        Data Dashboard.
            ``(2) Establishment.--The Director shall publish to the online 
        portal of the office in a machine-readable, sortable, and searchable 
        format, or to the extent practicable, establish and maintain a data 
        dashboard on the online portal of the Office to be known as the `Drug 
        Control Data Dashboard'. To the extent practicable, when establishing 
        the Drug Control Dashboard, the Director shall ensure the user interface 
        of the dashboard is constructed with modern design standards. To the 
        extent practicable, the data made available on the dashboard shall be 
        publicly available in a machine-readable format and searchable by year, 
        agency, drug, and location.
            ``(3) Data.--The data included in the Drug Control Data Dashboard 
        shall be updated quarterly to the extent practicable, but not less 
        frequently than annually and shall include, at a minimum, the following:
                    ``(A) For each substance identified by the Director as 
                having a significant impact on the prevalence of illicit drug 
                use--
                            ``(i) data sufficient to show the quantities of such 
                        substance available in the United States, including--
                                    ``(I) the total amount seized and disrupted 
                                in the calendar year and each of the previous 3 
                                calendar years, including to the extent 
                                practicable the amount seized by State, local, 
                                and Tribal governments;
                                    ``(II) the known and estimated flows into 
                                the United States from all sources in the 
                                calendar year and each of the previous 3 
                                calendar years;
                                    ``(III) the total amount of known flows that 
                                could not be interdicted or disrupted in the 
                                calendar year and each of the previous 3 
                                calendar years;
                                    ``(IV) the known and estimated levels of 
                                domestic production in the calendar year and 
                                each of the previous three calendar years, 
                                including the levels of domestic production if 
                                the drug is a prescription drug, as determined 
                                under the Federal Food, Drug, and Cosmetic Act, 
                                for which a listing is in effect under section 
                                202 of the Controlled Substances Act (21 U.S.C. 
                                812);
                                    ``(V) the average street price for the 
                                calendar year and the highest known street price 
                                during the preceding 10-year period; and
                                    ``(VI) to the extent practicable, related 
                                prosecutions by State, local, and Tribal 
                                governments;
                            ``(ii) data sufficient to show the frequency of use 
                        of such substance, including--
                                    ``(I) use of such substance in the workplace 
                                and productivity lost by such use;
                                    ``(II) use of such substance by arrestees, 
                                probationers, and parolees;
                                    ``(III) crime and criminal activity related 
                                to such substance;
                                    ``(IV) to the extent practicable, related 
                                prosecutions by State, local, and Tribal 
                                governments;
                    ``(B) For the calendar year and each of the previous three 
                years data sufficient to show, disaggregated by State and, to 
                the extent feasible, by region within a State, county, or city, 
                the following:
                            ``(i) The number of fatal and non-fatal overdoses 
                        caused by each drug identified under subparagraph 
                        (A)(i).
                            ``(ii) The prevalence of substance use disorders.
                            ``(iii) The number of individuals who have received 
                        substance use disorder treatment, including medication 
                        assisted treatment, for a substance use disorder, 
                        including treatment provided through publicly-financed 
                        health care programs.
                            ``(iv) The extent of the unmet need for substance 
                        use disorder treatment, including the unmet need for 
                        medication-assisted treatment.
                    ``(C) Data sufficient to show the extent of prescription 
                drug diversion, trafficking, and misuse in the calendar year and 
                each of the previous 3 calendar years.
                    ``(D) Any quantifiable measures the Director determines to 
                be appropriate to detail progress toward the achievement of the 
                goals of the National Drug Control Strategy.
    ``(g) Development of an Annual National Drug Control Assessment.--
            ``(1) Timing.--Not later than the first Monday in February of each 
        year, the Director shall submit to the President, Congress, and the 
        appropriate congressional committees, a report assessing the progress of 
        each National Drug Control Program Agency toward achieving each goal, 
        objective, and target contained in the National Drug Control Strategy 
        applicable to the prior fiscal year.
            ``(2) Process for development of the annual assessment.--Not later 
        than November 1 of each year, the head of each National Drug Control 
        Program Agency shall submit, in accordance with guidance issued by the 
        Director, to the Director an evaluation of progress by the agency with 
        respect to the National Drug Control Strategy goals using the 
        performance measures for the agency developed under this title, 
        including progress with respect to--
                    ``(A) success in achieving the goals of the National Drug 
                Control Strategy;
                    ``(B) success in reducing domestic and foreign sources of 
                illegal drugs;
                    ``(C) success in expanding access to and increasing the 
                effectiveness of substance use disorder treatment;
                    ``(D) success in protecting the borders of the United States 
                (and in particular the Southwestern border of the United States) 
                from penetration by illegal narcotics;
                    ``(E) success in reducing crime associated with drug use in 
                the United States;
                    ``(F) success in reducing the negative health and social 
                consequences of drug use in the United States;
                    ``(G) implementation of evidence-based substance use 
                disorder treatment and prevention programs in the United States 
                and improvements in the adequacy and effectiveness of such 
                programs; and
                    ``(H) success in increasing the prevention of illicit drug 
                use.
            ``(3) Contents of the annual assessment.--The Director shall include 
        in the annual assessment required under paragraph (1)--
                    ``(A) a summary of each evaluation received by the Director 
                under paragraph (2);
                    ``(B) a summary of the progress of each National Drug 
                Control Program Agency toward the National Drug Control Strategy 
                goals of the agency using the performance measures for the 
                agency developed under this chapter;
                    ``(C) an assessment of the effectiveness of each National 
                Drug Control Program Agency and program in achieving the 
                National Drug Control Strategy for the previous year, including 
                a specific evaluation of whether the applicable goals, measures, 
                objectives, and targets for the previous year were met; and
                    ``(D) the assessments required under this subsection shall 
                be based on the Performance Measurement System.''.
    (b) Technical and Conforming Amendments.--
            (1) Section 704(b) of the Office of National Drug Control Policy 
        Reauthorization Act of 1998 (21 U.S.C. 1703(b)) is amended--
                    (A) by striking paragraphs (13) and (17); and
                    (B) in paragraph (14)(A), by striking ``paragraph (13)'' and 
                inserting ``section 706(g)(2)''.
            (2) The Office of National Drug Control Policy Reauthorization Act 
        of 2006 (Public Law 109-469; 120 Stat. 3502) is amended by striking 
        sections 1110 and 1110A.

SEC. 8222. TECHNICAL AND CONFORMING AMENDMENTS TO THE OFFICE OF NATIONAL DRUG 
              CONTROL POLICY REAUTHORIZATION ACT OF 1998.

    The Office of National Drug Control Policy Reauthorization Act of 1998 (21 
U.S.C. 1701 et seq.) is amended--
            (1) by striking section 703(b) (21 U.S.C. 1702(b));
            (2) in section 704 (21 U.S.C. 1703)--
                    (A) in subsection (c)--
                            (i) in paragraph (3)(C)--
                                    (I) in the matter before clause (i), by 
                                inserting ``requests a level of funding that 
                                will not enable achievement of the goals of the 
                                National Drug Control Strategy, including'' 
                                after ``request that'';
                                    (II) in clause (iii)--
                                            (aa) by striking ``drug treatment'' 
                                        and inserting ``substance use disorder 
                                        prevention and treatment''; and
                                            (bb) by striking the semicolon at 
                                        the end and inserting ``; and'';
                                    (III) by striking clauses (iv), (vi), and 
                                (vii);
                                    (IV) by redesignating clause (v) as clause 
                                (iv); and
                                    (V) in clause (iv), as so redesignated, by 
                                striking the semicolon and inserting a period;
                            (ii) in paragraph (4)(A), by striking ``$1,000,000'' 
                        and inserting ``$5,000,000 or 10 percent of a specific 
                        program or account''; and
                    (B) in subsection (f)--
                            (i) by striking the first paragraph (5); and
                            (ii) by striking the second paragraph (4); and
            (3) by striking section 708 (21 U.S.C. 1707).

                          Subtitle L--Budgetary Effects

SEC. 8231. BUDGETARY EFFECT.

    (a) In General.--The budgetary effects of this Act shall not be entered on 
either PAYGO scorecard maintained pursuant to section 4(d) of the Statutory Pay-
As-You-Go Act of 2010 (2 U.S.C. 933(d)).
    (b) Senate PAYGO Scorecards.--The budgetary effects of this Act shall not be 
entered on any PAYGO scorecard maintained for purposes of section 4106 of H. 
Con. Res. 71 (115th Congress).
            Attest:

                                                                          Clerk.