Title: Strengthening Partnerships to Prevent Opioid Abuse Act
Policy area: Health

Summary:
Strengthening Partnerships to Prevent Opioid Abuse Act
This bill requires the Centers for Medicare & Medicaid Services (CMS) to establish a secure online portal to allow: (1) data sharing among the CMS, Medicare prescription drug benefit plans, and Medicare Advantage (MA) plans; and (2) referrals by such plans of substantiated fraud, waste, or abuse in order to initiate or assist investigations by contracted entities under the Medicare Integrity Program. The CMS must disseminate and report certain collected information to such plans, including information regarding providers that were referred through the portal and trends in identifying suspicious activity.
Additionally, for plan years beginning on or after January 1, 2021, MA organizations must submit information to the CMS regarding investigations or other actions taken by MA plans against providers that prescribe high volumes of opioids (as determined by the CMS).

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5715 Introduced in House (IH)]

<DOC>






115th CONGRESS
  2d Session
                                H. R. 5715

To amend title XVIII of the Social Security Act to provide for certain 
 program integrity transparency measures under Medicare parts C and D.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 9, 2018

 Mr. Renacci (for himself, Ms. Sewell of Alabama, Mr. Guthrie, and Mr. 
   Peters) introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on Energy 
    and Commerce, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide for certain 
 program integrity transparency measures under Medicare parts C and D.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Strengthening Partnerships to 
Prevent Opioid Abuse Act''.

SEC. 2. 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 two 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 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 fraud, waste, or abuse of a 
                        provider of services or supplier, if such 
                        provider 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 fraud, waste, and abuse, 
                using guidance such as what is provided in the Medicare 
                Program Integrity Manual 4.7.1.
                    ``(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 two years after the 
        date of 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 be 
        construed as precluding or otherwise affecting referrals 
        described in subparagraph (A) that may otherwise be made to law 
        enforcement entities or to the Secretary.''.
    (b) Contract Requirement To Communicate Plan Corrective Actions 
Against Opioids Over-prescribers.--Section 1857(e)(4)(C) of the Social 
Security Act (42 U.S.C. 1395w-27(e)(4)(C)) 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 and other actions taken by such 
                plans related to providers of services who prescribe a 
                high volume 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 
                        `high volume of opioids' and a method for 
                        determining if a provider of services 
                        prescribes such a high volume; 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).''.
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