I 115th CONGRESS 2d Session H. R. 5477 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.

1. Short title This Act may be cited as the Rural Development of Opioid Capacity Services Act or the Rural DOCS Act . 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. .