Title: Strengthening Partnerships to Prevent Opioid Abuse Act of 2018
Policy area: Health

Summary:
Strengthening Partnerships to Prevent Opioid Abuse Act of 2018
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 suspicious activities related to 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 credible evidence of suspected fraud or other actions taken by MA plans regarding inappropriate prescribing of opioids (as determined by the CMS).

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2905 Introduced in Senate (IS)]

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115th CONGRESS
  2d Session
                                S. 2905

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 SENATE OF THE UNITED STATES

                              May 22, 2018

 Mr. Toomey (for himself and Mrs. McCaskill) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 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 of 2018''.

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 2 years after the 
                date of the enactment of this subsection, the Secretary 
                shall, after consultation with stakeholders, establish 
                a secure Internet website portal 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 any successor entity to a Medicare drug 
                integrity contractor), in accordance with subsection 
                (j)(3) of such section, for the purpose of enabling 
                through such portal--
                            ``(i) the referral by such plans of 
                        suspicious activities 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 
                        (including with respect to information for 
                        activities under section 1893(j)).
                    ``(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 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 with respect to suspicious 
                        activities of a provider of services (including 
                        a prescriber) or supplier, if such provider (or 
                        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 fraud, waste, and abuse, 
                using guidance such as what is provided in the Medicare 
                Program Integrity Manual 4.7.1.
            ``(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 
        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 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)(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 credible evidence of suspected 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 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 may 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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