Title: Rural DOCS Act
Policy area: Health

Summary:
Rural Development of Opioid Capacity Services Act or the Rural DOCS Act
This bill requires the Centers for Medicare & Medicaid Services (CMS) to carry out a demonstration project to provide an enhanced federal matching rate for state Medicaid expenditures related to the expansion of substance-use treatment and recovery services.
The CMS must select 10 states for inclusion under the demonstration project, giving preference to states that have a prevalence of substance-use disorders (in particular, opioid-use disorders) comparable to or higher than the national average.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5477 Introduced in House (IH)]

<DOC>






115th CONGRESS
  2d Session
                                H. R. 5477

    To amend title XIX of the Social Security Act to provide for a 
demonstration project to increase substance use provider capacity under 
                         the Medicaid program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 11, 2018

Mr. O'Halleran introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
    To amend title XIX of the Social Security Act to provide for a 
demonstration project to increase substance use provider capacity under 
                         the Medicaid program.

    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 ``Rural Development of Opioid Capacity 
Services Act'' or the ``Rural DOCS Act''.

SEC. 2. 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.--Beginning January 1, 2019, the Secretary 
        shall conduct a 5-year demonstration project under which the 
        Secretary shall provide to an eligible State (as defined in 
        paragraph (2)(A)) payments, in accordance with paragraph (3), 
        with respect to expenditures by such eligible State for 
        incentives, training, and technical assistance for providers 
        under the State plan (or a waiver of such plan) to expand 
        substance use treatment and recovery services for individuals 
        enrolled under such State plan (or waiver), including each of 
        the following activities:
                    ``(A) Activities that support the development of an 
                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:
                            ``(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 
                        services to individuals enrolled under the 
                        State plan (or waiver), including information 
                        on providers who provide such services.
                            ``(iii) Information on the gap in substance 
                        use disorder treatment under the State plan (or 
                        waiver) based on the information described in 
                        clauses (i) and (ii).
                            ``(iv) Projections regarding the extent to 
                        which participating under the demonstration 
                        project would increase the number of providers 
                        offering substance use disorder services under 
                        the State plan (or waiver) during the period of 
                        the demonstration project.
                    ``(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 current, new, and 
                prospective participating providers under the State 
                plan (or a waiver of such plan) that specialize in 
                substance use disorder treatment and recovery.
                    ``(C) Activities that specifically expand, 
                including through the provision of incentives, the 
                number 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 licensed or certified under 
                        applicable State law to provide substance use 
                        disorder treatment and recovery services.
                    ``(D) Activities that specifically expand, 
                including through the provision of incentives, the 
                number of providers participating under the State plan 
                (or waiver) that have the qualifications to address the 
                treatment and 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) postpartum women and infants, 
                        particularly the concurrent treatment and 
                        comprehensive case management of 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).
            ``(2) Eligible states.--
                    ``(A) Definition.--For purposes of this subsection, 
                the term `eligible State' means a State selected by the 
                Secretary under subparagraph (B).
                    ``(B) Selection.--For purposes of this subsection, 
                the Secretary shall select 10 States that meet the 
                criteria for eligibility under subparagraph (C). In 
                selecting such States, the Secretary shall--
                            ``(i) select States in a manner that 
                        ensures geographic diversity;
                            ``(ii) 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 
                        drug overdoses, or any other measure that the 
                        Secretary deems appropriate; and
                            ``(iii) take into consideration the quality 
                        of applications submitted under subparagraph 
                        (D).
                    ``(C) Criteria for eligibility.--To be eligible for 
                selection under subparagraph (B), a State shall--
                            ``(i) have a State plan (or waiver of the 
                        State plan) approved under this title; and
                            ``(ii) submit to the Secretary an 
                        application in accordance with the requirements 
                        in subparagraph (D).
                    ``(D) Applications.--For purposes of this 
                paragraph, a State 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 undertaking 
                        the assessment described in paragraph (1)(A).
                            ``(ii) A proposed process for reviewing 
                        reimbursement methodologies and other policies 
                        related to substance use disorder services 
                        under the State plan (or waiver) that may 
                        create barriers to increasing the number of 
                        providers delivering substance use disorder 
                        services.
                            ``(iii) A proposed process for developing a 
                        plan 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:
                                    ``(I) Specific activities to 
                                increase access to providers (including 
                                providers that specialize in providing 
                                substance use disorder services, 
                                hospitals, health care systems, and 
                                Federally qualified health centers) 
                                that offer substance use disorder 
                                treatment, recovery, and support 
                                services, including short-term 
                                detoxification services, outpatient 
                                substance use disorder services, and 
                                evidence-based peer recovery services.
                                    ``(II) Strategies that will 
                                incentivize providers described in 
                                paragraph (1)(C) to obtain the 
                                necessary training, education, and 
                                support to deliver substance use 
                                disorder services in the State.
                                    ``(III) Milestones and timeliness 
                                for implementing activities set forth 
                                in the plan.
                                    ``(IV) Specific measurable targets 
                                for increasing the substance use 
                                disorder provider network under the 
                                State plan (or a waiver of such plan).
                            ``(iv) A proposed process for reporting the 
                        information required under paragraph (4)(A), 
                        including information demonstrating the 
                        progress of the efforts of the State to expand 
                        the capacity of providers to deliver substance 
                        use disorder services during the period of the 
                        demonstration project under this subsection.
                            ``(v) A projected five-year budget for the 
                        State to carry out under the demonstration 
                        project under this subsection the activities 
                        set forth in the plan.
            ``(3) Payment.--
                    ``(A) In general.--For each quarter occurring 
                during the period for which the demonstration project 
                is conducted, the Secretary shall pay under this 
                subsection, subject to subparagraph (B), to each 
                eligible State an amount equal to 90 percent of so much 
                of the sums expended during such quarter as are 
                attributable to activities described in paragraph (1).
                    ``(B) Non-duplication of payment.--In the case that 
                payment is made under subparagraph (A) with respect to 
                expenditures for activities carried out by an eligible 
                State under the demonstration project under this 
                subsection, payment may not also be made under 
                subsection (a) with respect to expenditures for the 
                same activities carried out by the eligible State.
            ``(4) Reports.--
                    ``(A) State reports.--A State receiving payments 
                under this subsection shall, for the period of the 
                demonstration project under this subsection, submit to 
                the Secretary a quarterly report, with respect to 
                expenditures for activities 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 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 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) Interim report.--Not later than 
                        October 1, 2022, the Administrator of the 
                        Centers for Medicare & Medicaid Services shall 
                        submit to Congress an interim report on 
                        activities carried out under the demonstration 
                        project under this subsection.
                            ``(ii) Final report.--Not later than 
                        October 1, 2024, the Administrator of the 
                        Centers for Medicare & Medicaid Services shall 
                        submit to Congress a final report on activities 
                        carried out under the demonstration project 
                        under this subsection.''.
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