An act to provide for opioid use disorder prevention, recovery, and treatment, and for other purposes
PL 115-271 (H.R.6), enacted 10/24/2018

132 STAT. 3894 
PUBLIC LAW 115–271—OCT. 24, 2018 
Public Law 115–271 
115th Congress 
An Act 
To provide for opioid use disorder prevention, recovery, and treatment, and for 
other purposes. 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
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 Treat-
ment 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 preg-
nant 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 pro-
vide 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 pro-
grams. 
Sec. 2006. Encouraging appropriate prescribing under Medicare for victims of 
opioid overdose. 
21 USC 301 note. 
Substance Use- 
Disorder 
Prevention that 
Promotes Opioid 
Recovery and 
Treatment for 
Patients and 
Communities 
Act. 
Oct. 24, 2018 
[H.R. 6] 
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132 STAT. 3895 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 phar-
macies. 
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 treat-
ment 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. 
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132 STAT. 3896 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 re-
quirement. 
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 dis-
eases 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 com-
munity 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 men-
tal 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 adop-
tion and use of certified electronic health record technology. 
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132 STAT. 3897 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 Med-
icaid to prevent opioids addictions and enhance access to medication-as-
sisted 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 sen-
iors. 
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, ad-
verse 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 pro-
spective payment system to avoid financial incentives to use opioids in-
stead 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 pre-
vention 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 col-
lection 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. 
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132 STAT. 3898 
PUBLIC LAW 115–271—OCT. 24, 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. 
Sec. 6103. Requiring Medicare Advantage plans and prescription drug plans to pro-
vide 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 sub-
stance 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 work-
force. 
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 over-
dose 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. 
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132 STAT. 3899 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 fac-
tors. 
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 sub-
stance 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 require-
ments 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 dis-
order 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 dis-
order become stably housed. 
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132 STAT. 3900 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 Clear-
inghouse. 
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 Insti-
tute. 
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); 
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132 STAT. 3901 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 redetermina-
tion 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 assist-
ance 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 institu-
tion.’’; 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 
42 USC 1396a 
note. 
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132 STAT. 3902 
PUBLIC LAW 115–271—OCT. 24, 2018 
by section 1006(b)(2)(B) of this Act, including any applicable restric-
tions 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 ADJU-
DICATION OR SENTENCING.—Nothing in this section shall be con-
strued to mandate, encourage, or suggest that a State suspend 
or terminate coverage for individuals before they have been adju-
dicated 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 addi-
tional 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 enact-
ment 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 sub-
section 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 
42 USC 1396a 
note. 
42 USC 1396a 
note. 
42 USC 1396a 
note. 
42 USC 1396a 
note. 
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132 STAT. 3903 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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) pay-
ments 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 behav-
ioral 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 assist-
ance 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 dis-
order; 
‘‘(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 
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132 STAT. 3904 
PUBLIC LAW 115–271—OCT. 24, 2018 
by the Assistant Secretary for Mental Health and Sub-
stance Use for purposes of carrying out the require-
ments 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 individ-
uals 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 
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132 STAT. 3905 
PUBLIC LAW 115–271—OCT. 24, 2018 
providers are needed (including the types of such pro-
viders and geographic area of need) to improve the 
network of providers that treat substance use disorders 
under the State plan (or waiver), including the fol-
lowing: 
‘‘(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 avail-
able 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 para-
graph (2) and receiving payments in accordance with para-
graph (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 
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132 STAT. 3906 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 assess-
ment 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 sustain-
able 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 commu-
nity behavioral health clinics) that offer sub-
stance use disorder treatment, recovery, or 
support services, including short-term detoxi-
fication services, outpatient substance use dis-
order 
services, 
and 
evidence-based 
peer 
recovery services. 
‘‘(bb) Strategies that will incentivize pro-
viders 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 imple-
menting activities set forth in the plan. 
‘‘(dd) Specific measurable targets for 
increasing the substance use disorder treat-
ment 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 treat-
ment or recovery services during the period of 
the demonstration project under this subsection. 
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132 STAT. 3907 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(V) The expected financial impact of the dem-
onstration project under this subsection on the 
State. 
‘‘(VI) A description of all funding sources avail-
able 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 pro-
viders to deliver substance use disorder treatment 
or recovery services resulting from the demonstra-
tion project under this subsection after the termi-
nation 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 advo-
cates, 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 pro-
viders 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 demonstra-
tion project under this subsection, submit to the Secretary 
a quarterly report, with respect to expenditures for sub-
stance use disorder treatment or recovery services for which 
payment is made to the State under this subsection, on 
the following: 
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132 STAT. 3908 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(i) The specific activities with respect to which 
payment under this subsection was provided. 
‘‘(ii) The number of providers that delivered sub-
stance 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 esti-
mated 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 Sec-
retary. 
‘‘(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 dem-
onstration 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 subpara-
graph (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 
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132 STAT. 3909 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 con-
sultation with the Administrator of the Centers for Medi-
care & Medicaid Services, shall submit to Congress a sum-
mary 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 Sec-
retary shall, in collaboration with States selected under para-
graph (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 
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132 STAT. 3910 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 imple-
mented by the State) that indicates when an indi-
vidual enrolled under the plan (or waiver) is pre-
scribed the morphine equivalent for such treat-
ment 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 mon-
itors 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 imple-
menting a claims review automated process under this 
subparagraph that provides for prospective or retro-
spective reviews of claims. Nothing in this subpara-
graph 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
MEDICA-
TIONS 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 medica-
tions 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 phar-
macies dispensing drugs to individuals so enrolled. 
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132 STAT. 3911 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 subpara-
graphs (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 dis-
pensed 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 Sec-
retary shall waive the drug review and utilization require-
ments 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
REQUIRE-
MENTS.—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.— 
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132 STAT. 3912 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 fol-
lowing: ‘‘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 NEO-
NATAL ABSTINENCE SYNDROME AND THEIR MOTHERS; 
GAO STUDY ON GAPS IN MEDICAID COVERAGE FOR PREG-
NANT 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 
42 USC 1396a 
note. 
42 USC 1396r–8 
note. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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.—Sec-
tion 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 amend-
ment, 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 percent-
age has been extended under subparagraph (A), such State 
shall, at the end of the period of such State plan amend-
ment, 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. 
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132 STAT. 3914 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 COV-
ERAGE 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 MED-
ICAL 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. 
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132 STAT. 3915 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(2) EXCEPTION.—The provisions of paragraph (29) of sub-
section (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 facili-
ties 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 semi-
colon; 
(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.—Sec-
tion 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 
42 USC 1396a 
note. 
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132 STAT. 3916 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 care-
takers) 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 promul-
gated 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 serv-
ices under Medicaid, including— 
(i) the mechanisms through which States may pro-
vide such coverage, including through existing statu-
tory 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 serv-
ices. 
(B) Information on selected State experiences in pro-
viding 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 wors-
ening, of behavioral health disorders; 
(iii) reducing chronic and comorbid conditions; and 
(iv) reducing overall health costs. 
(2) RECOMMENDATIONS.—The report required under sub-
section (a) shall include recommendations, including rec-
ommendations for such legislative and administrative actions 
related to improving services, including peer support services, 
and access to peer support services under Medicaid as the 
42 USC 1396a 
note. 
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132 STAT. 3917 
PUBLIC LAW 115–271—OCT. 24, 2018 
Comptroller General of the United States determines appro-
priate. 
SEC. 1009. MEDICAID SUBSTANCE USE DISORDER TREATMENT VIA 
TELEHEALTH. 
(a) DEFINITIONS.—In this section: 
(1) COMPTROLLER GENERAL.—The term ‘‘Comptroller Gen-
eral’’ 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 TELE-
HEALTH, 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 sub-
stance 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 guid-
ance 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 ill-
ness and substance use disorder. 
(2) State options for Federal reimbursement of expenditures 
under Medicaid for education directed to providers serving Med-
icaid beneficiaries with substance use disorders using the hub 
and spoke model, through contracts with managed care entities, 
through administrative claiming for disease management activi-
ties, 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 sub-
stance use disorders for individuals enrolled in Medicaid in 
a school-based health center using services delivered via tele-
health. 
(c) GAO EVALUATION OF CHILDREN’S ACCESS TO SERVICES AND 
TREATMENT FOR SUBSTANCE USE DISORDERS UNDER MEDICAID.— 
(1) STUDY.—The Comptroller General shall evaluate chil-
dren’s access to services and treatment for substance use dis-
orders under Medicaid. The evaluation shall include an analysis 
42 USC 1396a 
note. 
42 USC 1396a 
note. 
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132 STAT. 3918 
PUBLIC LAW 115–271—OCT. 24, 2018 
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, particu-
larly 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 enact-
ment of this Act, the Comptroller General shall submit to 
Congress a report containing the results of the evaluation con-
ducted under paragraph (1), together with recommendations 
for such legislation and administrative action as the Comp-
troller General determines appropriate. 
(d) REPORT ON REDUCING BARRIERS TO USING SERVICES DELIV-
ERED VIA TELEHEALTH AND REMOTE PATIENT MONITORING FOR PEDI-
ATRIC 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 solu-
tions for reducing barriers to using services delivered via tele-
health 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 poten-
tial 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 tele-
health 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 readmis-
sions; 
(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, 
42 USC 1396a 
note. 
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132 STAT. 3919 
PUBLIC LAW 115–271—OCT. 24, 2018 
but not limited to, evidence-based, non-opioid pharmacological 
therapies and non-pharmacological therapies. 
SEC. 1011. ASSESSING BARRIERS TO OPIOID USE DISORDER TREAT-
MENT. 
(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 medi-
cation 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 sub-
stance 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 spe-
cialty pharmacies by providers. 
(2) REQUIREMENTS.—For each model of distribution speci-
fied 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 dis-
order 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 sub-
stance 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 legis-
lation and administrative action as the Comptroller General deter-
mines appropriate. 
SEC. 1012. HELP FOR MOMS AND BABIES. 
(a) MEDICAID STATE PLAN.—Section 1905(a) of the Social Secu-
rity 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 
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132 STAT. 3920 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 DIS-
ORDERS. 
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 regula-
tion).’’. 
SEC. 1014. MACPAC STUDY AND REPORT ON MAT UTILIZATION CON-
TROLS 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 enact-
ment of this Act, the Medicaid and CHIP Payment and Access 
42 USC 1396d 
note. 
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132 STAT. 3921 
PUBLIC LAW 115–271—OCT. 24, 2018 
Commission shall make publicly available a report containing the 
results of the study conducted under subsection (a). 
SEC. 1015. OPIOID ADDICTION TREATMENT PROGRAMS ENHANCE-
MENT. 
(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 ‘‘Sec-
retary’’) 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 Med-
icaid beneficiary population and services provided for the treat-
ment of substance use disorders under Medicaid. 
(2) CONTENT OF REPORT.—The report required under para-
graph (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 sub-
stance 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 commu-
nity-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 subpara-
graph (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; 
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132 STAT. 3922 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 dis-
order 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 serv-
ices 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 para-
graph (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 commu-
nicate 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 sub-
stance 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. 
42 USC 1320d–2 
note. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 data-
bases, 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 Secu-
rity 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 STRATE-
GIES TO PROVIDE HOUSING-RELATED SERVICES AND 
SUPPORTS TO INDIVIDUALS STRUGGLING WITH SUB-
STANCE USE DISORDERS UNDER MEDICAID. 
(a) IN GENERAL.—Not later than 1 year after the date of enact-
ment of this Act, the Secretary of Health and Human Services 
shall issue a report to Congress describing innovative State initia-
tives and strategies for providing housing-related services and sup-
ports 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 Med-
icaid beneficiaries with substance use disorders who are experi-
encing or at risk of experiencing homelessness, including Med-
icaid 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 treat-
ment 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, account-
able care organizations, and other care coordination providers 
42 USC 1396b 
note. 
42 USC 1396b 
note. 
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132 STAT. 3924 
PUBLIC LAW 115–271—OCT. 24, 2018 
to deliver housing-related services and supports and to coordi-
nate 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 amend-
ments; 
(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 dis-
orders who are experiencing or at risk of experiencing homeless-
ness in State Medicaid programs. 
SEC. 1018. TECHNICAL ASSISTANCE AND SUPPORT FOR INNOVATIVE 
STATE STRATEGIES TO PROVIDE HOUSING-RELATED SUP-
PORTS 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 pro-
vide 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 enact-
ment 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 SUB-
STANCE USE DISORDERS. 
(a) IN GENERAL.—Section 1834(m) of the Social Security Act 
(42 U.S.C. 1395m(m)) is amended— 
42 USC 1396a 
note. 
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132 STAT. 3925 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 FUR-
NISHED 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 Sec-
retary, 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 imple-
ment 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 Med-
ical 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 ‘‘para-
graph (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)— 
42 USC 1395m 
note. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
(A) by redesignating subparagraph (N) as subpara-
graph (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 SUB-
STANCES.— 
‘‘(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; 
42 USC 1395x 
note. 
42 USC 1395x 
note. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(ii) a prescription issued that cannot be trans-
mitted electronically under the most recently imple-
mented 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 pre-
scribing 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 practi-
tioner’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 pre-
scribed 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 pre-
scribing 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 strate-
gies 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 subpara-
graph (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 pre-
scribed a covered part D drug to designate a particular 
pharmacy to dispense the covered part D drug to the extent 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 appro-
priate 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 enact-
ment of this Act, the Attorney General shall update the require-
ments 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 PRO-
GRAMS 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 serv-
ices that are furnished by an opioid treatment program for 
the treatment of opioid use disorder, including— 
‘‘(A) opioid agonist and antagonist treatment medica-
tions (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 medica-
tions, if applicable; 
‘‘(C) substance use counseling by a professional to the 
extent authorized under State law to furnish such services; 
42 USC 
1395w–104 note. 
42 USC 
1395w–104 note. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 deter-
mines are appropriate (but in no event to include meals 
or transportation). 
‘‘(2) OPIOID TREATMENT PROGRAM.—The term ‘opioid treat-
ment 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 pro-
gram; 
‘‘(C) is accredited by an accrediting body approved by 
the Substance Abuse and Mental Health Services Adminis-
tration; and 
‘‘(D) meets such additional conditions as the Secretary 
may find necessary to ensure— 
‘‘(i) the health and safety of individuals being fur-
nished 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 deter-
mined appropriate by the Secretary, that no duplicative pay-
ments 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 deter-
mine appropriate. In developing such bundles, the Secretary 
may consider payment rates paid to opioid treatment programs 
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132 STAT. 3930 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 para-
graph (1) of such section).’’. 
SEC. 2006. ENCOURAGING APPROPRIATE PRESCRIBING UNDER MEDI-
CARE 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 pur-
poses 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 indi-
vidual 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 
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132 STAT. 3931 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 INVESTIGA-
TIONS OF CREDIBLE ALLEGATIONS OF FRAUD BY PHAR-
MACIES. 
(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 pursu-
ant 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 para-
graph 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.—Sec-
tion 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 pursu-
ant to section 1857(f)(3)(D)), and section 1903(i)(2)(C), a fraud 
hotline tip (as defined by the Secretary) without further evi-
dence 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. 
42 USC 
1395w–27 note. 
42 USC 
1395w–104 note. 
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132 STAT. 3932 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 docu-
ments 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 sec-
tions 506 and 515B to non-addictive medical products 
intended to treat pain or addiction; 
21 USC 355 note. 
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132 STAT. 3933 
PUBLIC LAW 115–271—OCT. 24, 2018 
(B) considers the risk of addiction of controlled sub-
stances 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 under-
lying 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 sec-
tion 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 con-
trolled 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 surro-
gate 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 sub-
stance (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. 
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132 STAT. 3934 
PUBLIC LAW 115–271—OCT. 24, 2018 
SEC. 3002. EVIDENCE-BASED OPIOID ANALGESIC PRESCRIBING GUIDE-
LINES 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 sub-
section (a), the Commissioner of Food and Drugs shall— 
(1) consult with stakeholders, which may include con-
ducting a public meeting of medical professional societies 
(including any State-based societies), health care providers, 
State medical boards, medical specialties including pain medi-
cine 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 Rep-
resentatives 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 Adminis-
tration an updated report under such subsection. 
(e) STATEMENT TO ACCOMPANY GUIDELINES AND RECOMMENDA-
TIONS.—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 profes-
sional practice. 
21 USC 355–1 
note. 
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132 STAT. 3935 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 CON-
TROLLED 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 CON-
TROLLED 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 CON-
TROLLED 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 manufac-
turers, 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 con-
trolled substance until a date specified in such order; or 
‘‘(C) amend the order to require a recall of the con-
trolled 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 
21 USC 
360bbb–8d. 
21 USC 301 note. 
Stop Counterfeit 
Drugs by 
Regulating and 
Enhancing 
Enforcement 
Now Act. 
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132 STAT. 3936 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 deter-
mines 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 appro-
priate 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 Fed-
eral 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.’’. 
21 USC 331 note. 
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132 STAT. 3937 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 Sec-
retary of Homeland Security to carry out activities related to cus-
toms 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 Secre-
taries 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 capabili-
ties, which may include, as the Secretary determines appro-
priate— 
(i) improvements to facilities, such as upgrades 
or renovations, and support for the maintenance of 
existing import facilities and sites to improve coordina-
tion 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 facili-
tate 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 sub-
stance 
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 deter-
mines appropriate and practicable. 
(c) REPORT.—Not later than 6 months after the date of enact-
ment 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 
21 USC 384f. 
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132 STAT. 3938 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 consulta-
tion 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. Cus-
toms 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 Cos-
metic 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 Com-
mittee on Energy and Commerce of the House of Representa-
tives 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 SUSPEN-
SION.— 
(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)’’; 
21 USC 384g. 
21 USC 301 note. 
Stop Illicit Drug 
Importation Act 
of 2018. 
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132 STAT. 3939 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 regu-
lated by the Secretary; or 
‘‘(II) knowingly or intentionally falsely des-
ignated in an authorized electronic data inter-
change 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 admis-
sion’’ 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 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 regula-
tion 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 pur-
poses described in paragraph (1).’’. 
CHAPTER 4—SECURING OPIOIDS AND UNUSED NAR-
COTICS WITH DELIBERATE DISPOSAL AND PACK-
AGING 
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 Cos-
metic 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 
21 USC 301 note. 
Securing Opioids 
and Unused 
Narcotics with 
Deliberate 
Disposal and 
Packaging Act 
of 2018. 
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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 cer-
tain patients in unit dose packaging, packaging that pro-
vides 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 pur-
poses of rendering drugs nonretrievable (as defined in sec-
tion 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 subpara-
graph (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 subpara-
graph (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 sub-
section (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 dis-
posal 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 
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132 STAT. 3942 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 con-
trolled substances recommended by such agencies for site- 
of-use, in-home disposal; and 
(C) a description of the effectiveness of such rec-
ommendations at preventing the diversion of legally pre-
scribed 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 rec-
ommendations at preventing the diversion of legally pre-
scribed controlled substances; and 
(7) recommendations, as appropriate, on— 
(A) whether site-of-use, in-home controlled substance 
disposal products and packaging technologies require Fed-
eral 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 Fed-
eral 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 
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132 STAT. 3943 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 enact-
ment 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 Adminis-
tration 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 sub-
stances 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 DIS-
ORDERS. 
(a) CONFORMING APPLICABLE NUMBER.—Subclause (II) of sec-
tion 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 Sec-
retary 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 quali-
fied 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 PRACTI-
TIONERS
AND
PHYSICIAN
ASSISTANTS
TO
BECOME
QUALIFYING 
21 USC 355 note. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
PRACTITIONERS.—Clause (iii) of section 303(g)(2)(G) of the Con-
trolled 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 SPECIAL-
ISTS, 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 practi-
tioner, 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 physi-
cian assistant’’ each place it appears and inserting ‘‘nurse practi-
tioner, clinical nurse specialist, certified registered nurse anes-
thetist, 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 practi-
tioners see their patients; 
(2) the average frequency with which patients receive coun-
seling, 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 adminis-
tered; 
(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 quali-
fying practitioner. 
SEC. 3202. MEDICATION-ASSISTED TREATMENT FOR RECOVERY FROM 
SUBSTANCE USE DISORDER. 
(a) WAIVERS FOR MAINTENANCE TREATMENT OR DETOXIFICA-
TION.—Section 303(g)(2)(G)(ii) of the Controlled Substances Act (21 
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132 STAT. 3945 
PUBLIC LAW 115–271—OCT. 24, 2018 
U.S.C. 823(g)(2)(G)(ii)) is amended by adding at the end the fol-
lowing: 
‘‘(VIII) The physician graduated in good standing from 
an accredited school of allopathic medicine or osteopathic medi-
cine 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 osteo-
pathic 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 prac-
tice 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 dis-
orders. 
(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 Serv-
ices’’. 
SEC. 3203. GRANTS TO ENHANCE ACCESS TO SUBSTANCE USE DIS-
ORDER 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 osteo-
pathic 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 
21 USC 829a. 
21 USC 823 note. 
21 USC 823 note. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 sec-
tion 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 deliv-
ered and such other information as may be required by regula-
tions of the Attorney General. 
‘‘(b) MODIFICATION OF NUMBER OF DAYS BEFORE WHICH CON-
TROLLED 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 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 enact-
ment 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 dissemi-
nate, as appropriate, materials for pharmacists, health care pro-
viders, and patients on— 
(1) circumstances under which a pharmacist may, con-
sistent 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 phar-
macist 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 par-
tial fill of prescriptions for certain controlled substances. 
(b) MATERIALS INCLUDED.—In developing materials under sub-
section (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’’. 
21 USC 801 note. 
Safe Disposal of 
Unused 
Medication Act. 
21 USC 829 note. 
21 USC 801 note. 
Empowering 
Pharmacists in 
the Fight Against 
Opioid Abuse 
Act. 
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132 STAT. 3948 
PUBLIC LAW 115–271—OCT. 24, 2018 
SEC. 3222. DISPOSAL OF CONTROLLED SUBSTANCES OF A HOSPICE 
PATIENT BY EMPLOYEES OF A QUALIFIED HOSPICE PRO-
GRAM. 
(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 con-
trolled 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 serv-
ices by the jurisdiction in which the person receiving hos-
pice 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 hos-
pice program regarding the disposal of controlled sub-
stances in a secure and responsible manner so as to discour-
age 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 lan-
guage and manner that they understand to ensure 
that these parties are educated regarding the safe dis-
posal of controlled substances; and 
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132 STAT. 3949 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 adminis-
tration, 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 MANAGE-
MENT. 
(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 indi-
vidual. 
(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 con-
trolled 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 pro-
grams 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 enact-
ment of this Act, the Comptroller General shall submit to Congress 
a report containing the results of the study conducted under sub-
section (a), together with recommendations, if any, for such legisla-
tion and administrative action as the Comptroller General deter-
mines 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’’. 
21 USC 801 note. 
Special 
Registration for 
Telemedicine 
Clarification Act 
of 2018. 
21 USC 822 note. 
21 USC 822 note. 
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PUBLIC LAW 115–271—OCT. 24, 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 reg-
istration 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 GEN-
ERAL.—A controlled’’; and 
(2) by adding at the end the following: 
‘‘(b) DETERMINATION.—In determining whether a controlled sub-
stance analogue was intended for human consumption under sub-
section (a), the following factors may be considered, along with 
any other relevant factors: 
‘‘(1) The marketing, advertising, and labeling of the sub-
stance. 
‘‘(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 sub-
stance is sold and the price at which the substance it is pur-
ported 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, inhala-
tion, ingestion, or any other immediate means. 
‘‘(6) Any controlled substance analogue that is manufac-
tured, 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— 
21 USC 822a 
note. 
Access to 
Increased Drug 
Disposal Act 
of 2018. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
(1) the term ‘‘Attorney General’’ means the Attorney Gen-
eral, acting through the Assistant Attorney General for the 
Office of Justice Programs; 
(2) the term ‘‘authorized collector’’ means a narcotic treat-
ment 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 pharma-
ceutical 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 con-
trolled substances associated with the participation of eligible collec-
tors 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 effective-
ness of the grant, including changes in the participation rate 
of eligible collectors as authorized collectors. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 accord-
ance 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 sub-
sections (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 dis-
tribute controlled substances to a pharmacy or practitioner 
registrant, aggregated by the name and address of each phar-
macy 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 para-
graph (1) shall be made available not later than the 30th day 
of the first month following the quarter to which the information 
relates. 
21 USC 827 note. 
21 USC 801 note. 
Using Data To 
Prevent Opioid 
Diversion Act 
of 2018. 
21 USC 822a 
note. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 Con-
trolled 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 pat-
terns, 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 Con-
trolled 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 
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132 STAT. 3954 
PUBLIC LAW 115–271—OCT. 24, 2018 
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), produc-
tion’’; and 
(C) by adding at the end the following: 
‘‘(2) The Attorney General may, if the Attorney General deter-
mines it will assist in avoiding the overproduction, shortages, or 
diversion of a controlled substance, establish an aggregate or indi-
vidual 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 regula-
tion, for fentanyl, oxycodone, hydrocodone, oxymorphone, or 
hydromorphone (in this subsection referred to as a ‘covered con-
trolled substance’), the Attorney General shall estimate the amount 
21 USC 801 note. 
Opioid Quota 
Reform Act. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 produc-
tion 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 consulta-
tion 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 Com-
mittee on Appropriations of the House of Representatives the fol-
lowing information with regard to each covered controlled sub-
stance: 
‘‘(i) An anonymized count of the total number of manufac-
turers 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 recep-
tacles, 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’’. 
21 USC 826 note. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 fre-
quency.’’. 
(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 Fed-
eral and State privacy laws; and 
‘‘(3) upon discovering a suspicious order or series of orders, 
notify the Administrator of the Drug Enforcement Administra-
tion 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 estab-
lish a centralized database for collecting reports of suspicious 
orders. 
‘‘(2) SATISFACTION OF REPORTING REQUIREMENTS.—If a reg-
istrant reports a suspicious order to the centralized database 
established under paragraph (1), the registrant shall be consid-
ered 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 adminis-
trative, 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 informa-
tion in accordance with paragraph (1) within a reasonable 
period of time after obtaining the information. 
21 USC 832. 
21 USC 801 note. 
Preventing Drug 
Diversion Act 
of 2018. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 estab-
lished 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 enact-
ment 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 Con-
gress 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 legiti-
mate orders of opioids; and 
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132 STAT. 3958 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 subpara-
graph (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 man-
aged 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). 
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132 STAT. 3959 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(iii) The term ‘other specified entity’ means— 
‘‘(I) a prepaid inpatient health plan, as defined in sec-
tion 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 partici-
pants 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 COV-
ERAGE RESPONSIBILITY REQUIREMENT. 
(a) IN GENERAL.—Section 5000A(d)(2)(A) of the Internal Rev-
enue 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 cer-
tifies that— 
‘‘(I) such individual is a member of a recog-
nized 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 
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132 STAT. 3960 
PUBLIC LAW 115–271—OCT. 24, 2018 
year only if the information provided by the indi-
vidual 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 sub-
section (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 BIO-
SIMILAR 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 state-
ment 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.’’; 
21 USC 355 note. 
26 USC 5000A 
note. 
26 USC 5000A 
note. 
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132 STAT. 3961 
PUBLIC LAW 115–271—OCT. 24, 2018 
(B) in subsection (b)— 
(i) in the subsection heading, by inserting ‘‘OR BIO-
SIMILAR
BIOLOGICAL
PRODUCT
APPLICANT’’ 
after 
‘‘APPLICANT’’; 
(ii) in paragraph (1)(B), by striking the first sen-
tence and inserting the following: ‘‘A biosimilar 
biological product applicant that has submitted a bio-
similar 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 Re-
spect to Adult Behavioral Health Meas-
ures 
SEC. 5001. MANDATORY REPORTING WITH RESPECT TO ADULT BEHAV-
IORAL 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 BEHAV-
IORAL HEALTH MEASURES.—Beginning with the State report 
required under subsection (d)(1) for 2024, the Secretary 
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132 STAT. 3962 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 ‘‘sub-
section (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 sub-
section (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 INSTITU-
TIONS 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 sec-
tion 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. 
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. 
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132 STAT. 3963 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 individ-
uals; and 
(C) the discharge process used by such institution, 
including any care continuum of relevant services or facili-
ties 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 supple-
mental 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 pay-
ment 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 stand-
ards, 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, rec-
ommendations 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 stand-
ards 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 bene-
ficiary advocates, health care providers, and Medicaid managed 
care organizations. 
(c) DEFINITIONS.—In this section: 
(1) REPRESENTATIVE SAMPLE OF STATES.—The term ‘‘rep-
resentative sample of States’’ means a non-probability sample 
in which at least two States are selected based on the knowl-
edge 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 ‘‘institu-
tion for mental diseases’’ has the meaning given such term 
in section 435.1010 of title 42, Code of Federal Regulations, 
or any successor regulation. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 fol-
lowing new subparagraph: 
‘‘(E) Mental health and substance use disorder services 
(as defined in paragraph (5)).’’. 
(b) MENTAL HEALTH
AND SUBSTANCE USE DISORDER SERV-
ICES.— 
(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 SERV-
ICES.—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 assist-
ance under such coverage pursuant to section 2112, such preg-
nancy-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 pre-
vent, 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 ‘‘sub-
section (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 
42 USC 1305 
note. 
CHIP Mental 
Health and 
Substance Use 
Disorder Parity 
Act. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘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 require-
ment 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 stake-
holder group of representatives of managed care organizations, 
Medicaid beneficiaries, health care providers, the National 
Association of Medicaid Directors, and other relevant represent-
atives 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— 
42 USC 1396a 
note. 
42 USC 1396a 
note. 
Medicaid Reentry 
Act. 
42 USC 1397bb 
note. 
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132 STAT. 3966 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 cov-
erage 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 DEM-
ONSTRATION 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) eligi-
bility 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 EXPERI-
ENCES 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 
42 USC 1305 
note. 
Medicaid 
Providers Are 
Required To Note 
Experiences in 
Record Systems 
to Help In-need 
Patients Act. 
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132 STAT. 3967 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 CER-
TAIN CONTROLLED SUBSTANCES. 
‘‘(a) IN GENERAL.—Subject to subsection (d), beginning October 
1, 2021, a State— 
‘‘(1) shall require each covered provider to check, in accord-
ance 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 his-
tory of a covered individual with respect to controlled sub-
stances. 
‘‘(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 Medi-
care & 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 pro-
vider, 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 reason-
able and limited access, as determined by the State and ensuring 
documented beneficiary protections regarding the use of such data, 
42 USC 
1396w–3a. 
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132 STAT. 3968 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 Sec-
retary 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 deter-
mined 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 con-
trolled 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 sub-
stances 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 
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132 STAT. 3969 
PUBLIC LAW 115–271—OCT. 24, 2018 
monitoring program described in subsection (b) before dis-
pensing 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 fol-
lowing information: 
‘‘(A) Guidance for States on how States can increase 
the percentage of covered providers who use qualified 
prescription drug monitoring programs described in sub-
section (b). 
‘‘(B) Best practices for how States and covered pro-
viders should use such qualified prescription drug moni-
toring programs to reduce the occurrence of abuse of con-
trolled 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 para-
graph, with respect to a State, is that the State (in this para-
graph referred to as the ‘administering State’) has in place 
agreements with all States that are contiguous to such admin-
istering 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 sub-
stance’ means a drug that is included in schedule II of section 
202(c) of the Controlled Substances Act and, at the option 
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132 STAT. 3970 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 resi-
dents 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 con-
trolled 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 dis-
eases, 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 Adminis-
trator of the Centers for Medicare & Medicaid Services, in consulta-
tion 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 Sec-
retary 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 para-
graph (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— 
42 USC 
1396w–3a note. 
42 USC 
1396w–3a note. 
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132 STAT. 3971 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 des-
ignees of such a director) of managed care organizations 
or pharmaceutical benefit managers to access information 
with respect to all covered individuals served by such man-
aged care organizations or pharmaceutical benefit man-
agers to access as a single data set, in an electronic format; 
and 
(B) shall include any appropriate beneficiary protec-
tions 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 CER-
TAIN 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 CER-
TAIN INSTITUTIONS FOR MENTAL DISEASES.— 
42 USC 1305 
note. 
Individuals in 
Medicaid Deserve 
Care that is 
Appropriate and 
Responsible in its 
Execution Act. 
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132 STAT. 3972 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(1) IN GENERAL.—With respect to calendar quarters begin-
ning 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 serv-
ices 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 pro-
vided 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 individ-
uals 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 amend-
ment to the Secretary to provide such medical assist-
ance 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 set-
tings 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 amend-
ment to the Secretary to provide such medical assist-
ance in accordance with this subsection. 
‘‘(B) SERVICES DESCRIBED.—For purposes of subpara-
graph (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 emo-
tional coping strategies. 
‘‘(iv) Outpatient medication-assisted treatment, 
related therapies, and pharmacology. 
‘‘(v) Counseling and clinical monitoring. 
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132 STAT. 3973 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(vi) Outpatient withdrawal management and 
related treatment designed to alleviate acute emo-
tional, 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 serv-
ices 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 Sec-
retary under clause (ii), the information deemed nec-
essary 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 pro-
vided in accordance with this subsection, the State shall 
carry out each of the requirements described in subpara-
graphs (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 appro-
priate 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, con-
sistent with each of the following outpatient levels 
of care: 
‘‘(I) Early intervention for individuals who, for 
a known reason, are at risk of developing sub-
stance-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 motiva-
tional enhancement therapies and strategies. 
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132 STAT. 3974 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 multi-
dimensional 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, con-
sistent with at least 2 of the following inpatient and 
residential levels of care: 
‘‘(I) Clinically managed, low-intensity residen-
tial 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 signifi-
cant 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 resi-
dence); and 
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132 STAT. 3975 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 individ-
uals 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 indi-
vidual 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 Condi-
tions, 2013’. 
‘‘(B) ELIGIBLE
INDIVIDUAL.—The term ‘eligible indi-
vidual’ 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).’’. 
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132 STAT. 3976 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 con-
ducting 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 CER-
TIFIED 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 cer-
tified 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 psycholo-
gists (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’’. 
Abuse Deterrent 
Access Act 
of 2018. 
42 USC 1396n 
note. 
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132 STAT. 3977 
PUBLIC LAW 115–271—OCT. 24, 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 formu-
lations 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 require-
ments, 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 antago-
nist 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 enroll-
ment 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’’. 
Opioid Addiction 
Action Plan Act. 
42 USC 1395b–2 
note. 
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132 STAT. 3978 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 Prac-
tices 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 sub-
section (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 prospec-
tive payment system for inpatient hospital services under sec-
tion 1886(d) of such Act (42 U.S.C. 1395ww(d)) and the Medi-
care prospective payment system for hospital outpatient depart-
ment 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 dem-
onstration projects, including value-based models, that may 
encourage the use of appropriate medication-assisted treatment 
approved by the Food and Drug Administration for the treat-
ment 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 Med-
icaid 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 
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132 STAT. 3979 
PUBLIC LAW 115–271—OCT. 24, 2018 
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, bio-
pharmaceutical industry members, medical researchers, health 
care providers, the medical device industry, the Medicare pro-
gram, 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 Treat-
ment for Opioid Use Disorders in Medi-
care 
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 PRO-
GRAM. 
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.— 
42 USC 
1395cc–6. 
42 USC 1305 
note. 
Advancing High 
Quality 
Treatment for 
Opioid Use 
Disorders in 
Medicare Act. 
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132 STAT. 3980 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 dis-
order 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 partici-
pants (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 fur-
nished, to applicable beneficiaries participating in the Program. 
‘‘(2) OPIOID USE DISORDER TREATMENT SERVICES.—For pur-
poses 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 serv-
ices (or any combination of such services), as appro-
priate; 
‘‘(iv) social support services, as appropriate; and 
‘‘(v) care management and care coordination serv-
ices, 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 depart-
ment 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, clini-
cians 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— 
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132 STAT. 3981 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 commu-
nity 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 selec-
tion 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 bene-
ficiary; 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, coun-
seling, 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 
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132 STAT. 3982 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 appro-
priate 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 detoxi-
fication 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 promul-
gated 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 deter-
mines 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 termi-
nate 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 dis-
order 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 bene-
ficiary. 
‘‘(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 
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132 STAT. 3983 
PUBLIC LAW 115–271—OCT. 24, 2018 
title, and applicable beneficiaries shall not be required to relin-
quish 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 partici-
pant. A participant may use such per applicable beneficiary 
per month care management fee to deliver additional serv-
ices to applicable beneficiaries, including services not other-
wise eligible for payment under this title. 
‘‘(B) PAYMENT
AMOUNTS.—In carrying out subpara-
graph (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 bene-
ficiary 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 bene-
ficiaries 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 partici-
pant 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 Sec-
retary, in accordance with subparagraph (B). 
‘‘(B) CRITERIA.— 
‘‘(i) IN GENERAL.—Criteria described in subpara-
graph (A) may include consideration of the following: 
‘‘(I) Patient engagement and retention in treat-
ment. 
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132 STAT. 3984 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(II) Evidence-based medication-assisted treat-
ment. 
‘‘(III) Other criteria established by the Sec-
retary. 
‘‘(ii) REQUIRED
CONSULTATION
AND
CONSIDER-
ATION.—In determining criteria described in subpara-
graph (A), the Secretary shall— 
‘‘(I) consult with stakeholders, including clini-
cians 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 inter-
mediate and final evaluation of the program. Each such evalua-
tion 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 evalua-
tion 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 imple-
menting, 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 Insur-
ance 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 sub-
section 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.’’. 
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132 STAT. 3985 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 agree-
ments 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 pre-
scriber 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 
42 USC 
1395w–104 note. 
42 USC 1305 
note. 
Responsible 
Education 
Achieves Care 
and Healthy 
Outcomes for 
Users’ Treatment 
Act of 2018. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 pre-
scribing health care professional for coverage of 
a covered part D drug for a part D eligible indi-
vidual 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 trans-
mission 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 subpara-
graph, the Secretary may require the use of such 
standards adopted under subclause (II) in lieu of 
42 USC 1305 
note. 
Preventing 
Addiction for 
Susceptible 
Seniors Act 
of 2018. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 tech-
nology) that would allow a secure path for communication 
between the Secretary, MA plans under this part, prescrip-
tion 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 initi-
ating or assisting investigations conducted by the 
eligible entity; and 
‘‘(ii) data sharing among such MA plans, prescrip-
tion 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 tech-
nology) 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 pre-
scriber) or supplier, if such provider (including a pre-
scriber) or supplier has been the subject of an adminis-
trative action under this title or title XI with respect 
to similar activities, a notification to such plan of such 
action so taken. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(C) RULEMAKING.—For purposes of this paragraph, 
the Secretary shall, through rulemaking, specify what con-
stitutes 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 pur-
poses of this subsection, communications may only occur 
if the communications are permitted under the Federal 
regulations (concerning the privacy of individually identifi-
able 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 informa-
tion related to opioid overprescribing, and other data deter-
mined 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 pre-
clude 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 CORREC-
TIVE 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 begin-
ning on or after January 1, 2021, a contract under this 
section with an MA organization shall require the organiza-
tion to submit to the Secretary, through the process estab-
lished under subparagraph (B), information on the inves-
tigations, 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). 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 subpara-
graph (B) and the types of information that shall be 
submitted through such process.’’. 
(c) REFERENCE UNDER PART D TO PROGRAM INTEGRITY TRANS-
PARENCY MEASURES.—Section 1860D–4 of the Social Security Act 
(42 U.S.C. 1395w–104) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(m) PROGRAM INTEGRITY TRANSPARENCY MEASURES.—For pro-
gram 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 bene-
ficiaries for prescription drug abuse (as defined 
in paragraph (5)(C)).’’. 
SEC. 6065. COMMIT TO OPIOID MEDICAL PRESCRIBER ACCOUNT-
ABILITY 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 
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PUBLIC LAW 115–271—OCT. 24, 2018 
established under subclause (II), identify pre-
scribers 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 pre-
scriber specialty and geographic area, for identi-
fying 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 pre-
scribers 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 Serv-
ices. 
‘‘(iii) CONTENTS OF NOTIFICATION.—The Secretary 
shall include the following information in the notifica-
tions provided under clause (i): 
‘‘(I) Information on how such prescriber com-
pares to other prescribers within the same spe-
cialty and geographic area. 
‘‘(II) Information on opioid prescribing guide-
lines, 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 appro-
priate 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 notifica-
tions 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 prescrip-
tions 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 
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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 edu-
cation funded through section 6052 of the SUP-
PORT 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 stake-
holders. 
‘‘(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 subpara-
graph 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. 
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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 hos-
pital 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 pre-
scribing 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 MEDI-
CARE 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.— 
42 USC 1305 
note. 
Dr. Todd Graham 
Pain 
Management, 
Treatment, and 
Recovery Act 
of 2018. 
Expanding 
Oversight of 
Opioid 
Prescribing and 
Payment Act 
of 2018. 
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‘‘(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 manage-
ment) would reduce payment incentives to use opioids 
instead of non-opioid alternatives for pain manage-
ment. 
‘‘(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 Sec-
retary 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 para-
graph (9)(B). 
‘‘(D) RULES OF CONSTRUCTION.—Nothing in this para-
graph 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 cov-
ered OPD services (or groups of services) which include 
opioids or non-opioid alternatives for pain manage-
ment.’’. 
(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 
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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 PHYSI-
CIANS 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 practi-
tioner who meets the requirements described in subpara-
graph (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 Sec-
retary, based on an estimate of the average costs of training 
for purposes of receiving a waiver described in subpara-
graph (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 con-
taining 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 sub-
mits an application under subparagraph (B). 
‘‘(ii) The physician or practitioner first receives 
a waiver under section 303(g) of the Controlled Sub-
stances 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: 
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‘‘(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 para-
graph (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 deter-
mined 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 para-
graph (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 para-
graph (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 BENE-
FITS 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. 
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(b) CONSULTATION.—The Secretary shall develop the report 
described in subsection (a) in consultation with relevant stake-
holders, 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, sub-
stance use disorder counseling, peer recovery support serv-
ices, 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 supple-
mental 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 hos-
pitalizations 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 avail-
ability 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 
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a report, on mental and behavioral health services under the Medi-
care 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 pay-
ment 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 enact-
ment 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 Secu-
rity Act and submit to the Committee on Ways and Means and 
the Committee on Energy and Commerce of the House of Represent-
atives and the Committee on Finance of the Senate a report con-
taining 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 sub-
section (a), the Secretary shall consult with— 
(1) relevant agencies within the Department of Health 
and Human Services; 
(2) licensed and practicing osteopathic and allopathic physi-
cians, 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: 
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PUBLIC LAW 115–271—OCT. 24, 2018 
(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 con-
sultation or management of pain with one or more special-
ists in pain management, mental health, or addiction treat-
ment. 
(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 sub-
paragraphs (A) through (E) of paragraph (1). 
(B) Costs and benefits associated with potential expan-
sion 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 Fed-
eral Government that may be relevant to coverage deter-
minations or other coverage requirements under title XVIII 
of the Social Security Act. 
(3) An assessment of all guidance published by the Depart-
ment 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 ele-
ments 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 fol-
lowing: 
(1) Improving coverage of and payment for pain manage-
ment therapies without the use of opioids, including inter-
ventional pain therapies, and options to augment opioid therapy 
with other clinical and complementary, integrative health serv-
ices 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 
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PUBLIC LAW 115–271—OCT. 24, 2018 
therapies approved or cleared by the Food and Drug Adminis-
tration 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 dis-
orders, 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 set-
tings, or between opioid therapy to non-opioid therapy, which 
may include the use of care transition plans. 
(7) Expanding outreach activities designed to educate pro-
viders 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 imple-
menting the options described in subsection (d) would have— 
(1) on expenditures under the Medicare program; and 
(2) on preventing or reducing opioid addiction for individ-
uals 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 stake-
holders, including— 
(1) medical professional organizations; 
42 USC 1395c 
note. 
42 USC 1305 
note. 
Combating 
Opioid Abuse for 
Care in Hospitals 
Act of 2018. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
(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 con-
sumers; 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 individ-
uals 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 other-
wise) for such an individual, or person acting on such 
individual’s behalf, to acknowledge receipt of such notifica-
tion 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 appro-
priate by the Secretary. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
(5) Best practices for such hospital to track opioid pre-
scribing 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 appro-
priate, 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 meas-
ures relating to opioids and opioid use disorders, including 
care, prevention, diagnosis, health outcomes, and treatment 
furnished to individuals with opioid use disorders. The Sec-
retary 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 recommenda-
tions 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 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 Sec-
retary 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 rec-
ommended under paragraph (2)(C), and other such meas-
ures 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 sec-
tion 1886(o). 
‘‘(4) PRIORITIZATION OF MEASURE DEVELOPMENT.—The Sec-
retary shall prioritize for measure development the gaps in 
quality measures identified under paragraph (2)(B). 
‘‘(5) PRIORITIZATION OF MEASURE ENDORSEMENT.—The Sec-
retary— 
‘‘(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 SET-
TING 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. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
(D) Prevention of opioid misuse and abuse after dis-
charge. 
(E) Development of a clinical algorithm to identify 
and treat at-risk, opiate-tolerant patients and reduce reli-
ance 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 Con-
gress a report that contains the following: 
(1) The diagnosis-related group codes identified by the Sec-
retary 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 com-
bination 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 techno-
logical availability. 
SEC. 6095. REQUIRING THE POSTING AND PERIODIC UPDATE OF 
OPIOID PRESCRIBING GUIDANCE FOR MEDICARE BENE-
FICIARIES. 
(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 
42 USC 1395hh 
note. 
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Human Services on or after January 1, 2016, relating to the pre-
scribing of opioids and applicable to opioid prescriptions for individ-
uals 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 guid-
ance on the website described in such subsection. 
(2) CONSULTATION.—The entities specified in this para-
graph 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 Sec-
retary. 
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 subpara-
graph (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 
Providing 
Reliable Options 
for Patients and 
Educational 
Resources Act 
of 2018. 
42 USC 1305 
note. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 PRESCRIP-
TION 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 DIS-
POSAL 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 sub-
stances 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 dis-
posal. 
‘‘(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 sub-
stances.’’. 
(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.’’. 
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SEC. 6104. REVISING MEASURES USED UNDER THE HOSPITAL CON-
SUMER 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 hos-
pital 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 Hos-
pital Consumer Assessment of Healthcare Providers 
and Systems survey in 2018 or 2019 about communica-
tion 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 ADDI-
TIONAL 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, cer-
tified nurse anesthetist, or certified nurse-midwife’’ after 
‘‘physician’’. 
(2) EFFECTIVE DATE.—The amendments made by this sub-
section shall apply with respect to information required to 
42 USC 
1320a–7h note. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 AVAIL-
ABLE.—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: 
42 USC 
1320a–7h note. 
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‘‘(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 facili-
ties, 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 labora-
tories 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 ana-
logues, to enhance— 
(A) clinical diagnostics; 
(B) postmortem data collection; and 
(C) portable testing equipment utilized by law enforce-
ment 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 depart-
ments, as appropriate. 
(c) LABORATORIES.—The Secretary shall require recipients of 
grants or cooperative agreements under subsection (a) to— 
42 USC 247d–10 
note. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
(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 authori-
ties 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 prac-
ticable, for non-fatal exposures of emergency personnel, first 
responders, and other individuals. 
(d) AUTHORIZATION OF APPROPRIATIONS.—To carry out this sec-
tion, 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 INFORMA-
TION 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 INFORMA-
TION 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 reduc-
tion of opioid and other substance use disorders; 
‘‘(2) provides access, to the extent practicable and appro-
priate, 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, treat-
ment, recovery, and other services for opioid and other 
substance use disorders; 
42 USC 300u–16. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 sub-
stances 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 Sub-
stance 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 sup-
port 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 Sec-
retary, 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— 
42 USC 290aa 
note. 
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(i) be a physician, licensed mental health profes-
sional, 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 treat-
ment of, and recovery from, substance use disorders, including 
by expanding access to prevention, treatment, and recovery 
services; 
(3) analyze substance use disorder prevention and treat-
ment strategies in different regions of and populations in the 
United States and evaluate the extent to which Federal sub-
stance use disorder prevention and treatment strategies are 
aligned with State and local substance use disorder prevention 
and treatment strategies; 
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(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 dis-
orders 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 Com-
mittee 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 sub-
section (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 CUR-
TAILING 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; 
42 USC 300u–16 
note. 
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(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 dis-
orders 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 informa-
tion 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— 
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(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 manage-
ment outcomes for patients, whether such limits are associ-
ated with significantly higher rates of negative health out-
comes, 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 Cen-
ters 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 Med-
icaid programs, and State insurance agencies; 
‘‘(D) representatives of health insurance issuers; 
‘‘(E) national accrediting entities and reputable pro-
viders 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 dis-
order; and 
42 USC 290ee–5. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 iden-
tify 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 sub-
section (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 sub-
section (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 imple-
ment such best practices; 
‘‘(2) Indian tribes, tribal organizations, and tribally des-
ignated 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 appro-
priate 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 
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PUBLIC LAW 115–271—OCT. 24, 2018 
on peer support and connection to services that promote sus-
tained 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 sci-
entific 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 
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PUBLIC LAW 115–271—OCT. 24, 2018 
(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 rec-
ommendations 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 iden-
tify 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 pur-
pose 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 develop-
ment of best practices under subsection (a), as applicable, the Sec-
retary, in consultation with appropriate stakeholders, shall consider 
the following: 
(1) The potential for addiction relapse or overdose, 
including overdose death, when opioid medications are pre-
scribed 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 poten-
tially lethal medical concerns, including drug allergies and 
contraindications. 
42 USC 290dd–2 
note. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
(3) The importance of prominently displaying information 
about a patient’s opioid use disorder when a physician or med-
ical 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 regula-
tions. 
(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 Serv-
ices shall annually notify health care providers regarding permitted 
disclosures under Federal health care privacy law during emer-
gencies, including overdoses, of certain health information to fami-
lies, caregivers, and health care providers. 
(b) USE OF MATERIAL.—For the purposes of carrying out sub-
section (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 practi-
tioners, 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) con-
cerning the permitted uses and disclosures, consistent with 
the standards and regulations governing the privacy and secu-
rity 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— 
42 USC 290dd–2 
note. 
42 USC 290dd–2 
note. 
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132 STAT. 4019 
PUBLIC LAW 115–271—OCT. 24, 2018 
(1) facilitate communication between substance use dis-
order treatment providers and other health care providers to 
promote and provide the best possible integrated care; 
(2) avoid inappropriate prescribing that can lead to dan-
gerous drug interactions, overdose, or relapse; and 
(3) notify and involve families and caregivers when individ-
uals 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 Representa-
tives a report that includes— 
(1) information on opioid, non-opioid, and non-pharmaco-
logic 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 treat-
ment resources in urban and rural areas; 
(3) recommendations to prevent, identify, and reduce sub-
stance 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 
42 USC 290bb–1 
note. 
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132 STAT. 4020 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 rec-
ommendations 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 implementa-
tion 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 Con-
trol 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 SUB-
STANCE 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 
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132 STAT. 4021 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 associ-
ated with such activities; and 
‘‘(B) additional information or data, as appropriate, 
on family health history, medication exposures during preg-
nancy, 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 pro-
grams; and’’ and inserting ‘‘, treatment, and cessation pro-
grams;’’; 
(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 neo-
natal 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); 
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132 STAT. 4022 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(2) ensure a pathway for data sharing between States, 
tribal entities, and the Centers for Disease Control and Preven-
tion; 
‘‘(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 author-
ized 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, imple-
menting, 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 avail-
able 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 relation-
ship to any funds made available to carry out 
subparagraph (A) and remaining after application 
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132 STAT. 4023 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 dis-
order 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 devel-
oping, 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 dis-
order 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 Med-
icaid 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 Edu-
cation 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 appro-
priate, to implement the activities under this para-
graph; 
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132 STAT. 4024 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(IV) how the State will monitor local develop-
ment 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 sub-
stance use disorder and medically supervised sub-
stance use, including for the treatment of a sub-
stance use disorder; 
‘‘(V) if applicable, how the State plans to uti-
lize 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 devel-
oped, 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 pro-
grams 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 engage-
ment, as required under section 106(b)(2)(B)(iii)(I), 
regarding available treatment and service options, 
which may include resources available for preg-
nant, perinatal, and postnatal women; and 
‘‘(II) may include activities such as— 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(aa) developing policies, procedures, or 
protocols for the administration or develop-
ment 
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 serv-
ices, 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 profes-
sionals, public and private health facilities, and sub-
stance 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 accord-
ance 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 profes-
sionals are trained on how to follow such protocols 
and are aware of the supports that may be pro-
vided 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 profes-
sionals such as home visiting agency staff and law 
enforcement in relevant topics including— 
‘‘(I) State mandatory reporting laws estab-
lished 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 sub-
stance use disorder, and implications of prenatal 
exposure; 
‘‘(III) the clinical guidance about treating sub-
stance 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 
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132 STAT. 4026 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 edu-
cation programs, maternal and child health and early 
intervention professionals (including home visiting pro-
viders), 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-discipli-
nary 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 treat-
ment 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 tech-
nology for improved data collection and monitoring 
under section 106(b)(2)(B)(iii), including existing elec-
tronic medical records, to measure the outcomes 
achieved through the plans of safe care, including mon-
itoring 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 identifi-
able information on, with respect to infants identified under 
section 106(b)(2)(B)(ii)— 
‘‘(i) the number who experienced removal associ-
ated with parental substance use; 
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132 STAT. 4027 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(ii) the number who experienced removal and sub-
sequently 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 Edu-
cation and the Workforce and the Committee on Appropria-
tions of the House of Representatives that includes the 
information described in subparagraph (E) and rec-
ommendations or observations on the challenges, successes, 
and lessons derived from implementation of the grant pro-
gram. 
‘‘(G) ASSISTING
STATES’ IMPLEMENTATION.—The Sec-
retary shall use the amount reserved under subparagraph 
(B)(i)(I) to provide written guidance and technical assist-
ance 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, terri-
tories, 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 recog-
nizing 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; 
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132 STAT. 4028 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(iii) supporting State efforts to develop informa-
tion 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 DIS-
ORDER 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 DIS-
ORDER TREATMENT WORKFORCE. 
‘‘(a) IN GENERAL.—The Secretary, acting through the Adminis-
trator 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 indi-
vidual 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 indi-
vidual 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). 
42 USC 295h. 
42 USC 5101 
note, 5117aa, 
5117aa–11, 
5117aa–12, 
5117aa–21, 
5117aa–22. 
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132 STAT. 4029 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 pay-
ments 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 des-
ignated 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 agree-
ment, taken alone, shall not constitute a breach of the agree-
ment, 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 sub-
section (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 quali-
fied for loan repayments under this section; and 
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132 STAT. 4030 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(2) the impact of this section on the availability of sub-
stance 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 employ-
ment’ 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, coun-
selors, 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 treat-
ment program, private physician practice, hospital or 
health system-affiliated inpatient treatment center or out-
patient clinic (including an academic medical center-affili-
ated 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, commu-
nity-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 Repay-
ment 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.— 
42 USC 254v. 
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132 STAT. 4031 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(1) IN GENERAL.—Any service described in subsection (a) 
that a participant provides may count towards such partici-
pant’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 sub-
section (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 pro-
grams (as defined in section 4 of the Indian Health Care 
Improvement Act), and other public and nonprofit private enti-
ties’’; 
(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 com-
prehensive 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, evi-
dence-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 fol-
lowing: 
‘‘(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 
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132 STAT. 4032 
PUBLIC LAW 115–271—OCT. 24, 2018 
include best practices related to screening for opioid use dis-
orders, training on screening, brief intervention, and referral 
to treatment), and safe disposal options for prescription medica-
tions (including such options provided by law enforcement or 
other innovative deactivation mechanisms).’’; 
(3) in subsection (d), by inserting ‘‘prevention,’’ after ‘‘diag-
nosis,’’; 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 preven-
tion 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 CONTINU-
ATION 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 over-
dose; 
(2) the use of recovery coaches, as appropriate, to encourage 
individuals who experience a non-fatal overdose to seek treat-
ment 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 medica-
tion, 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. 
42 USC 290dd–4. 
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132 STAT. 4033 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 serv-
ices, 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 pri-
mary 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 appro-
priate; 
(iii) providing follow-up services for patients after 
an overdose to ensure continued recovery and connec-
tion to support services; 
(iv) collecting and evaluating outcome data for 
patients receiving recovery coaching services; and 
(v) providing other services the Secretary deter-
mines necessary to help ensure continued connection 
with recovery support services, including culturally 
appropriate services, as applicable; 
(B) establish policies and procedures, pursuant to Fed-
eral 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 
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132 STAT. 4034 
PUBLIC LAW 115–271—OCT. 24, 2018 
(C) establish integrated models of care for individuals 
who have experienced a non-fatal drug overdose which 
may include patient assessment, follow up, and transpor-
tation 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 treat-
ment 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 back-
ground of patients, to contribute to the appropriate treat-
ment 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 dispropor-
tionate 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 Preven-
tion, 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 Sec-
retary 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). 
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132 STAT. 4035 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 deter-
mined 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 adminis-
tered; 
(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 reoccur-
rences, 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 effective-
ness 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 percent-
age 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 
42 USC 294i 
note. 
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132 STAT. 4036 
PUBLIC LAW 115–271—OCT. 24, 2018 
carry out a demonstration program for purposes of awarding 
grants to hospitals and emergency departments, including free-
standing 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 prescrip-
tion of opioids and alternatives to opioids for pain manage-
ment in the emergency department; and 
(C) develop or continue strategies to provide alter-
natives 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 Complimen-
tary 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 alter-
natives to opioids programs; 
(2) identifying or facilitating the development of best prac-
tices 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 prac-
tices 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 
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132 STAT. 4037 
PUBLIC LAW 115–271—OCT. 24, 2018 
emergency departments, outpatient clinics, critical access hos-
pitals, 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 demo-
graphic characteristics of patients who were treated with an 
alternative pain management protocol, implemented in hos-
pitals, emergency departments, and other acute care settings; 
(2) data on the opioid alternative pain management strate-
gies used, including the number of opioid prescriptions writ-
ten— 
(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 appro-
priate. 
(f) REPORT TO CONGRESS.—Not later than 1 year after comple-
tion of the demonstration program under this section, the Secretary 
shall submit a report to the Congress on the results of the dem-
onstration 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 sec-
tion, 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 appro-
priate agencies, shall award cooperative agreements to eligible enti-
ties for the designation of such entities as Regional Centers of 
Excellence in Substance Use Disorder Education for purposes of 
42 USC 290ee–6. 
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132 STAT. 4038 
PUBLIC LAW 115–271—OCT. 24, 2018 
improving health professional training resources with respect to 
substance use disorder prevention, treatment, and recovery. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a cooperative agree-
ment 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 institu-
tions of higher education, as defined in section 101 of 
the Higher Education Act of 1965, engaged in the preven-
tion, 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 sec-
tion 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 dis-
orders; 
‘‘(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 popu-
lations; 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 evalua-
tion 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’’; 
42 USC 
290bb–7a. 
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132 STAT. 4039 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 chil-
dren, 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 regula-
tions). 
(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-Determina-
tion 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 
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132 STAT. 4040 
PUBLIC LAW 115–271—OCT. 24, 2018 
vocational institution’’ as defined in section 102(c) of such 
Act (20 U.S.C. 1002(c)). 
(G) LOCAL EDUCATIONAL AGENCY.—The term ‘‘local edu-
cational agency’’ has the meaning given such term in sec-
tion 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 com-
munal 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 treat-
ment 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 out-
reach efforts; 
(B) disseminate such best practices to State educational 
agencies, local educational agencies, schools and dor-
mitories funded by the Bureau of Indian Education, institu-
tions 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 indica-
tors described in paragraph (7)(B); and 
(D) provide technical assistance for grantees under 
this subsection. 
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132 STAT. 4041 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 enti-
ties, 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 chil-
dren, 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 sup-
port 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 popu-
lations. 
(6) APPLICATION.—To be eligible for a grant under this 
subsection, an entity shall submit to the Secretary an applica-
tion at such time, in such manner, and containing such informa-
tion 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 sub-
stance 
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 individ-
uals, 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— 
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132 STAT. 4042 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 out-
comes 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 Representa-
tives a report summarizing the effectiveness of the grant pro-
gram under this subsection, based on the information submitted 
in reports required under paragraph (7). 
(9) AUTHORIZATION OF APPROPRIATIONS.—There is author-
ized 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 SUB-
STANCE 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 Sub-
stance 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’’. 
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132 STAT. 4043 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 com-
prehensive 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 allo-
cate 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 activi-
ties 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. 
42 USC 290ee–7. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(f) PREFERENCE.—In awarding grants under subsection (a), 
the Secretary may give preference to eligible entities utilizing tech-
nology-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 manage-
ment, 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 quali-
fied 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 com-
monly 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 reintegra-
tion into the workforce; and 
‘‘(x) other best practices to provide the full con-
tinuum 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 sup-
port sustained and clinically significant recovery, as defined 
by the Assistant Secretary for Mental Health and Sub-
stance Use. 
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132 STAT. 4045 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(E) Provide onsite access to medication, as appro-
priate, 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 sta-
bilize 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 appro-
priate, 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 appro-
priate, and other community partners and the public, 
including patients, to identify and respond to community 
needs; 
‘‘(B) ensuring that the entities described in subpara-
graph (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 dura-
tion 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 
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132 STAT. 4046 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 Sec-
retary of Health and Human Services shall submit to Congress 
a final report that includes— 
(A) an evaluation of the effectiveness of the comprehen-
sive services provided by the Centers established or oper-
ated 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 dis-
orders, 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 representa-
tion of such areas. 
(d) DATA FROM TRIBAL AREAS.—The Director may, in coopera-
tion 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 assist-
ance to such Indian Tribe to collect and report data on adverse 
childhood experiences through the Behavioral Risk Factor Surveil-
lance System, the Youth Risk Behavior Surveillance System, or 
another relevant public health survey or questionnaire. 
(e) AUTHORIZATION OF APPROPRIATIONS.—To carry out this sec-
tion, 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— 
42 USC 242t. 
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132 STAT. 4047 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 sub-
stance 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 Depart-
ment 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 Depart-
ment of the Interior. 
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132 STAT. 4048 
PUBLIC LAW 115–271—OCT. 24, 2018 
(CC) Such other Federal agencies as the Secretaries 
determine to be appropriate. 
(2) DATE OF APPOINTMENTS.—The heads of Federal depart-
ments 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 experi-
enced or are at risk of experiencing trauma; 
(iii) the expeditious referral to and implementation 
of trauma-informed practices and supports that pre-
vent and mitigate the effects of trauma, which may 
include 
whole-family 
and 
multi-generational 
approaches; and 
(iv) community based or multi-generational prac-
tices 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 sub-
stance use; and 
(iv) other ways to improve coordination, planning, 
and communication within and across Federal agen-
cies, 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 
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132 STAT. 4049 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 recom-
mending the set of best practices under subsection (c), the task 
force shall— 
(1) include guidelines for providing professional develop-
ment 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 proc-
esses 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 sup-
port 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 treat-
ment 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 prac-
tices that assist parents, foster parents, and kinship 
and other caregivers in accessing resources related to, 
and developing environments conducive to, the preven-
tion and mitigation of trauma; and 
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132 STAT. 4050 
PUBLIC LAW 115–271—OCT. 24, 2018 
(v) collect and utilize data from screenings, refer-
rals, or the provision of services and supports to 
evaluate outcomes and improve processes for trauma- 
informed services and supports that are culturally sen-
sitive, 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 part-
nerships 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 child-
hood education programs, local social services organiza-
tions, 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 miti-
gate 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 
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132 STAT. 4051 
PUBLIC LAW 115–271—OCT. 24, 2018 
(7) other information that the task force determines appro-
priate 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 Com-
mittee on Energy and Commerce and the Committee on Education 
and the Workforce of the House of Representatives and the Com-
mittee 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 legisla-
tive authority to implement; and 
(2) a report to the Governors describing the opportunities 
for local- and State-level partnerships, professional develop-
ment, 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 Common-
wealth 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 
42 USC 280h–7. 
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132 STAT. 4052 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 agree-
ment for evidence-based activities, which shall include any of the 
following: 
(1) Collaborative efforts between school-based service sys-
tems 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 interven-
tions and supports, or other trauma-informed models of support. 
(3) To provide professional development to teachers, teacher 
assistants, school leaders, specialized instructional support per-
sonnel, 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, 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 fol-
lowing: 
(1) A description of the innovative initiatives, activities, 
or programs to be funded under the grant, contract, or coopera-
tive 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 linguis-
tically 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, con-
tract, 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 serv-
ices. 
(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 appro-
priate. 
(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 sec-
tion, or their designee, shall establish a local interagency agree-
ment among local educational agencies, agencies responsible 
for early childhood education programs, Head Start agencies 
(including Early Head Start agencies), juvenile justice authori-
ties, 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 
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PUBLIC LAW 115–271—OCT. 24, 2018 
(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 activi-
ties 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 geo-
graphical 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 Individ-
uals with Disabilities Education Act (20 U.S.C. 1400 et seq.). 
(j) CONSULTATION WITH INDIAN TRIBES.—In carrying out sub-
section (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 edu-
cational 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 Corpora-
tion’’ 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. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
(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 edu-
cational 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 edu-
cation 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 assist-
ance provided under subsection (a) shall— 
(1) educate early childhood care and education providers 
and professionals working with young children on under-
standing 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, proce-
dures, 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 recom-
mending 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 Serv-
ices 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). 
42 USC 280h–8. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
(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 INFEC-
TIONS 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 imple-
menting 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 deter-
mining 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 para-
graph (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, pediatri-
cians and other primary care providers, obstetrician-gyne-
cologists, and infectious disease clinicians, including HIV clini-
cians. 
‘‘(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- 
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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-Deter-
mination 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 pro-
gram 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 commu-
nity 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 dis-
orders; 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 
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132 STAT. 4058 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 com-
monly 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 Assist-
ant 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 commu-
nity organizations and peer support networks, including such assist-
ance 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 commu-
nity 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.’’. 
42 USC 
290ee–2a. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
Subtitle Q—Creating Opportunities That 
Necessitate New and Enhanced Connec-
tions 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 para-
graph (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 evi-
dence-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 pre-
scribing, drug diversion, or abuse and misuse of con-
trolled substances, and to facilitate better coordination 
among agencies; 
‘‘(vi) enhancing interoperability between the pro-
gram and any health information technology (including 
42 USC 280b–1. 
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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 moni-
toring 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 estab-
lished under section 399O, as described in section 
399O(a). 
‘‘(B) Promoting community or health system interven-
tions. 
‘‘(C) Evaluating interventions to prevent controlled sub-
stance 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 sub-
stance use; and 
‘‘(B) for any other evidence-based activity for pre-
venting 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 Labora-
tory 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 appro-
priate. 
‘‘(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; 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 sec-
tion 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 elec-
tronic-based system. 
‘‘(D) Using data to help identify risk factors associated 
with controlled substance overdoses. 
‘‘(E) Supporting entities involved in providing informa-
tion 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 con-
trolled substance overdoses. 
‘‘(F) Working to enable and encourage the access, 
exchange, and use of information regarding controlled sub-
stance overdoses among data sources and entities. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) CONTROLLED SUBSTANCE.—The term ‘controlled sub-
stance’ 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 car-
rying 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 Com-
prehensive 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 Serv-
ices, acting through the Director of the Centers for Disease Control 
and Prevention and in coordination with the heads of other depart-
ments 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 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 Con-
trolled 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 pre-
scriber 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 pre-
scribing 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; 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(II) more timely inclusion of data within a 
PDMP; 
‘‘(III) active management of the PDMP, in part 
by sending proactive or unsolicited reports to pro-
viders 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 inte-
grating 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 man-
agers, 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 sub-
stance as required by the State to be reported to the PDMP, 
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132 STAT. 4064 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 pat-
terns 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 practi-
tioners, 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 informa-
tion in the PDMP maintained by the State indicates an unlaw-
ful 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 pro-
vided 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 interoper-
ability 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 non-
identifiable 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). 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 dele-
gates, 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 recog-
nized by the Office of the National Coordinator for Health Informa-
tion 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 enforce-
ment, 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 sec-
tion shall be construed to supersede any Federal privacy or 
confidentiality requirement, including the regulations promul-
gated 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 recommenda-
tions for addressing these barriers; 
‘‘(D) determines the progress of grantees in imple-
menting 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 
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PUBLIC LAW 115–271—OCT. 24, 2018 
any recommendations of the Secretary for additional Fed-
eral or State requirements for protection of this informa-
tion; 
‘‘(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 identifi-
able 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 Sub-
stances Act) in schedule II, III, or IV of section 202 of such 
Act. 
‘‘(2) The term ‘dispense’ means to deliver a controlled sub-
stance 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 con-
cerns 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 informa-
tion that does not identify a practitioner, dispenser, or an 
ultimate user and with respect to which there is no reasonable 
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132 STAT. 4067 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 profes-
sional 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 Dis-
order Treatment Providers Receiving 
Federal Funding 
SEC. 7171. REVIEW OF SUBSTANCE USE DISORDER TREATMENT PRO-
VIDERS 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. 
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132 STAT. 4068 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 sub-
sections (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 ‘‘pref-
erence 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 
42 USC 290ee–3 
note. 
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132 STAT. 4069 
PUBLIC LAW 115–271—OCT. 24, 2018 
in accordance with local needs related to substance 
use disorders’’; 
(6) in subsection (c), as so redesignated, by striking ‘‘sub-
section (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 con-
sultation with Indian Tribes, shall identify and establish appro-
priate 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 enact-
ment 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 Sub-
stance Abuse and Mental Health Services Administration, shall 
provide State agencies and Indian Tribes, as applicable, with tech-
nical assistance concerning grant application and submission proce-
dures 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 car-
rying out the grant program under subsection (b), there is author-
ized 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 Cen-
tury 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’’. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
SEC. 7182. REPORT ON INVESTIGATIONS REGARDING PARITY IN 
MENTAL HEALTH AND SUBSTANCE USE DISORDER BENE-
FITS. 
(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 Depart-
ment 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 com-
mitted’’. 
(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 individ-
uals 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 invest-
ment 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 para-
graph (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 
42 USC 290ee–8. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 participa-
tion 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 applica-
tion 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 develop-
ment 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 
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PUBLIC LAW 115–271—OCT. 24, 2018 
(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 respon-
sibility 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 sub-
stance 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 Sec-
retary 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 effective-
ness of the activities conducted by the grantee with respect 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 sub-
stance use disorder treatment or recovery to live independ-
ently 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 Omni-
bus 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 allo-
cated pursuant to clause (iii)(I), shall be the only payments 
required for reimbursement of U.S. Customs and Border Protec-
tion for customs services provided in connection with the proc-
essing 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 
Synthetics 
Trafficking and 
Overdose 
Prevention Act 
of 2018. 
19 USC 1 note. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 sub-
clause (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 con-
sultation 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 para-
graphs (1) and (2) for mail shipments described in clause 
(i) that are comparable to the requirements for the trans-
mission 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 
19 USC 58c note. 
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132 STAT. 4075 
PUBLIC LAW 115–271—OCT. 24, 2018 
as practicable in relation to the transportation of the ship-
ment, consistent with subparagraph (H). 
‘‘(iv) Regulations prescribed under clause (i) shall allow 
for the requirements for the transmission to the Commis-
sioner 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 Post-
master 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 regula-
tions; 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 
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132 STAT. 4076 
PUBLIC LAW 115–271—OCT. 24, 2018 
described in subclause (I). If, at any time, the Commissioner 
determines that a country no longer meets the require-
ments 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 sub-
clause (II) to exclude the countries from the require-
ment described in subclause (I); and 
‘‘(bb) information used to support such determina-
tion 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, sei-
zure, controlled delivery or other law enforcement initia-
tives, 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 car-
riers 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 Com-
mittee on Oversight and Government Reform, and the 
Committee on Homeland Security of the House of Rep-
resentatives.’’. 
(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. Cus-
toms 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.— 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 agen-
cies, 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 ship-
ment 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 tech-
nology.’’. 
(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 Gen-
eral 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 compli-
ance 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. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
(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 inter-
national mail parcels and planned acquisitions and 
advancements in such technology. 
(H) Such other information as the Secretary of Home-
land Security and the Postmaster General consider appro-
priate 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 Gen-
eral 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 pre-
sented by the Postal Service to U.S. Customs and Border Protec-
tion for inspection; 
(4) describing the costs of collecting the information 
required by such subparagraph (K) from foreign postal opera-
tors 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 
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132 STAT. 4079 
PUBLIC LAW 115–271—OCT. 24, 2018 
(7) identifying recommendations, including recommenda-
tions 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 inter-
national mail would be improved by— 
(A) requiring the Postal Service to serve as the con-
signee 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 Home-
land 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 inter-
national 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 
19 USC 1415 
note. 
19 USC 1415 
note. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 NAR-
COTICS. 
(a) IN GENERAL.—The Postmaster General and the Commis-
sioner 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 sub-
stances 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 tech-
nology 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 
19 USC 1583a. 
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132 STAT. 4081 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 Home-
land 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. 
19 USC 58c note. 
19 USC 1436 
note. 
19 USC 1436a. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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, treat-
ment, 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 incor-
porated into and made a part of this section. 
(B) PRIVILEGES AND IMMUNITIES.—Any person who vio-
lates 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. 
15 USC 45d. 
15 USC 45d note. 
15 USC 58 note. 
Opioid Addiction 
Recovery Fraud 
Prevention Act 
of 2018. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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’’, ‘‘indi-
vidual 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 organiza-
tion. 
(vii) Other State or local agencies, including coun-
ties or local governments. 
(viii) Other organizations, as determined to be nec-
essary by the local board. 
(ix) Indian Tribes or tribal organizations. 
(5) PROGRAM
PARTICIPANT.—The term ‘‘program partici-
pant’’ means an individual who— 
(A) is a member of a population of workers described 
in subsection (e)(2) that is served by a participating part-
nership through the pilot program under this section; and 
(B) enrolls with the applicable participating partner-
ship 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 pro-
vider 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)). 
29 USC 3225a. 
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132 STAT. 4084 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 pro-
vider’’— 
(A) means a health care provider that— 
(i) offers services for treating substance use dis-
orders 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 Secu-
rity 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 asso-
ciated 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 sub-
stance 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 
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132 STAT. 4085 
PUBLIC LAW 115–271—OCT. 24, 2018 
may reasonably require, including the information described 
in this subsection. 
(2) SIGNIFICANT IMPACT ON COMMUNITY BY OPIOID AND SUB-
STANCE 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 Dis-
ease 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 spe-
cific 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. 
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132 STAT. 4086 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 employ-
ment 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 announce-
ments, 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 gath-
ered by employer or worker surveys or through other 
methods; 
(v) data or documentation, beyond anecdotal evi-
dence, 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 sub-
grants, based on— 
(i) geography (such as urban and rural distribu-
tion); 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 
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132 STAT. 4087 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 subpara-
graph (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 subpara-
graph (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 estab-
lish 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 Adminis-
tration; 
(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 dem-
onstration 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 manage-
ment 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— 
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132 STAT. 4088 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 partner-
ship. 
(2) SELECTION OF POPULATION TO BE SERVED.—A partici-
pating 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 under-
employed), 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 under-
employed), 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 partner-
ship 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 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 partici-
pants 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 serv-
ices, 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 indi-
vidual to determine the services needed for such indi-
vidual 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 pro-
grams serving the participant such as the core pro-
grams 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 objec-
tives 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 
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132 STAT. 4090 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 partici-
pants 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 condi-
tions; 
(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 refer-
rals to substance use disorder treatment and 
mental health services. 
(E) SUPPORTIVE SERVICES.—Providing supportive serv-
ices, 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 appro-
priate; 
(ii) assistance in establishing eligibility for assist-
ance under Federal, State, Tribal, and local programs 
providing health services, mental health services, voca-
tional services, housing services, transportation serv-
ices, 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 
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132 STAT. 4091 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 indi-
vidual 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 employ-
ment 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.— 
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132 STAT. 4092 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 sub-
section (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 Sec-
retary shall ensure that an independent evaluation is con-
ducted 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 experi-
mental 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 avail-
able to carry out section 170 of such Act for a fiscal year 
shall remain available for use under paragraph (2) for a subse-
quent 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. 
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132 STAT. 4093 
PUBLIC LAW 115–271—OCT. 24, 2018 
Subtitle D—Peer Support Counseling 
Program for Women Veterans 
SEC. 8051. PEER SUPPORT COUNSELING PROGRAM FOR WOMEN VET-
ERANS. 
(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 home-
less, 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 coordi-
nate with such community organizations, State and local govern-
ments, institutions of higher education, chambers of commerce, 
local business organizations, organizations that provide legal assist-
ance, and other organizations as the Secretary considers appro-
priate. 
‘‘(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 coun-
seling 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. 
38 USC 1720F 
note. 
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132 STAT. 4094 
PUBLIC LAW 115–271—OCT. 24, 2018 
Subtitle E—Treating Barriers to 
Prosperity 
SEC. 8061. SHORT TITLE. 
This subtitle may be cited as the ‘‘Treating Barriers to Pros-
perity 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: 
‘‘§ 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 avail-
ability 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.’’. 
40 USC 14510. 
40 USC 101 note. 
Treating Barriers 
to Prosperity Act 
of 2018. 
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132 STAT. 4095 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 Individ-
uals 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 nec-
essary 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, which-
ever 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 Preven-
tion. 
(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 participa-
tion 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. 
42 USC 5301 
note. 
40 USC 
prec. 14501. 
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132 STAT. 4096 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 pursu-
ant 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 REQUIRE-
MENTS.— 
(1) IN
GENERAL.—In administering any amounts appro-
priated 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 alter-
native 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 Represent-
atives 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. 
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132 STAT. 4097 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 rel-
evant 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 Med-
icaid 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. 
42 USC 
290bb–11 note. 
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132 STAT. 4098 
PUBLIC LAW 115–271—OCT. 24, 2018 
(B) How States can employ and coordinate funding 
provided under the Medicaid program, the title IV-E pro-
gram, 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 indi-
vidual 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 sec-
tion 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 REPLICA-
TION 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 REPLICA-
TION PROJECT.— 
‘‘(1) PURPOSE.—The purpose of this subsection is to provide 
resources to the Secretary to support the conduct and evalua-
tion 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 appro-
priate 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; 
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132 STAT. 4099 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 treat-
ment, 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 pro-
vider, 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 guard-
ian’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 reunifi-
cation program, the Secretary shall— 
‘‘(i) determine that the area or areas in which 
the program will be conducted have sufficient sub-
stance use disorder treatment providers and other 
resources (other than those provided with funds made 
available to carry out the project) to successfully con-
duct 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 
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132 STAT. 4100 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 pro-
grams; 
‘‘(iv) assist the entity or entities in securing ade-
quate 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 ran-
domly 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 compo-
nents: a pilot phase, an impact study, and an implementa-
tion 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 
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132 STAT. 4101 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(iii) include measurements of family stability and 
parent, guardian, and child safety for program partici-
pants and the program control group that are con-
sistent with measurements of such factors for partici-
pants 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 compari-
sons 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 sub-
sequent maltreatment); 
‘‘(V) parental or guardian treatment persist-
ence 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 compo-
nent and shall include, in addition to such other informa-
tion as the Secretary may determine, descriptions and anal-
yses of— 
‘‘(i) the adherence of the family recovery and 
reunification program conducted under the project to 
other recovery coaching programs that have been rigor-
ously evaluated and shown to increase family reunifica-
tion 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 inter-
net 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 compo-
nent of the evaluation. 
‘‘(iv) A report that includes— 
‘‘(I) analyses of the extent to which the pro-
gram 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 govern-
ment), or other outcomes, or if the program did 
not produce such outcomes, an analysis of why 
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132 STAT. 4102 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 deter-
mines 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 appro-
priated, 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 provi-
sion 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 consid-
ered 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 interven-
tion 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 
42 USC 
290bb–11. 
42 USC 671 note. 
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132 STAT. 4103 
PUBLIC LAW 115–271—OCT. 24, 2018 
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-sup-
ported 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 prac-
tice 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’’. 
49 USC 101 note. 
Fighting Opioid 
Abuse in 
Transportation 
Act. 
34 USC 10101 
note. 
Reauthorizing 
and Extending 
Grants for 
Recovery from 
Opioid Use 
Programs Act 
of 2018. 
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132 STAT. 4104 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 confiden-
tial business information and sensitive security information, con-
sistent 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 data-
base 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 Transpor-
tation and Infrastructure of the House of Representatives a 
report on the review, including recommendations under sub-
section (c). 
(b) CONTENTS.—The report under subsection (a) shall include— 
49 USC 329 note. 
49 USC 20140 
note. 
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132 STAT. 4105 
PUBLIC LAW 115–271—OCT. 24, 2018 
(1) a description of the process the Department of Transpor-
tation 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 Depart-
ment 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 Transpor-
tation 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 sub-
stance 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 Rep-
resentatives 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. 
5 USC 7301 note. 
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132 STAT. 4106 
PUBLIC LAW 115–271—OCT. 24, 2018 
(3) REPORT.—If an expansion of the substance list is deter-
mined 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 con-
strued 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. 
49 USC 31306 
note. 
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132 STAT. 4107 
PUBLIC LAW 115–271—OCT. 24, 2018 
SEC. 8107. MANDATORY GUIDELINES FOR FEDERAL WORKPLACE DRUG 
TESTING PROGRAMS USING ORAL FLUID. 
(a) DEADLINE.—Not later than December 31, 2018, the Sec-
retary 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 enact-
ment 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 Con-
trol 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 prac-
ticable, the use of electronic signatures or digital signatures 
executed to electronic forms instead of traditional handwritten sig-
natures 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 
49 USC 322 note. 
5 USC 7301 note. 
5 USC 7301 note. 
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132 STAT. 4108 
PUBLIC LAW 115–271—OCT. 24, 2018 
Transportation and Infrastructure of the House of Representatives 
a status report on implementation of the final rule for the Commer-
cial Driver’s License Drug and Alcohol Clearinghouse (81 FR 87686), 
including— 
(1) an updated schedule, including benchmarks, for imple-
menting 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: 
‘‘§ 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 will-
fully— 
‘‘(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 kick-
back, 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 labora-
tory, 
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 
18 USC 220. 
18 USC 1 note. 
Eliminating 
Kickbacks in 
Recovery Act 
of 2018. 
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132 STAT. 4109 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 sec-
tion 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 com-
pensation for the services of the agent under a personal services 
and management contract that meets the requirements of sec-
tion 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 pay-
ment 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 reduc-
tion as determined by the Attorney General, in consultation 
with the Secretary of Health and Human Services, by regula-
tion. 
‘‘(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, 
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132 STAT. 4110 
PUBLIC LAW 115–271—OCT. 24, 2018 
risk reduction, outpatient treatment and care, residential treat-
ment, 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 facili-
ties, 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 REAUTHORIZA-
TION 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 PRO-
GRAM. 
(a) REVIVAL
OF NATIONAL NARCOTICS LEADERSHIP ACT
OF 
1988.— 
21 USC 1701 and 
note, 1702–1708, 
1710–1712, 1714. 
Substance Abuse 
Prevention Act 
of 2018. 
21 USC 1701 
note. 
18 USC 
prec. 201. 
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132 STAT. 4111 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 Reauthor-
ization 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 sub-
stances 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 
21 USC 
1531–1533, 1535. 
21 USC 1524 
note. 
21 USC 1524, 
1532 and note. 
21 USC 1506. 
21 USC 1521 
note. 
21 USC 1521 
note. 
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132 STAT. 4112 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 author-
ized 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 commu-
nity 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 disadvan-
taged areas; 
‘‘(2) develop and disseminate evaluation tools, mechanisms, 
and measures to better assess and document coalition perform-
ance measures and outcomes; and 
‘‘(3) bridge the gap between research and practice by trans-
lating 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.’’. 
21 USC 
1541–1548. 
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132 STAT. 4113 
PUBLIC LAW 115–271—OCT. 24, 2018 
SEC. 8205. REAUTHORIZATION OF THE HIGH-INTENSITY DRUG TRAF-
FICKING 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 treat-
ment 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 fol-
lowing: 
‘‘(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 pro-
ceedings.’’; 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 PRO-
GRAM.— 
‘‘(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 author-
ized to be appropriated to carry out this subsection $2,000,000 
for each of fiscal years 2018 through 2023.’’. 
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132 STAT. 4114 
PUBLIC LAW 115–271—OCT. 24, 2018 
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, inter-
vention, and enforcement resources to address substance use 
addiction and narcotics trafficking.’’. 
SEC. 8209. PROTECTING LAW ENFORCEMENT OFFICERS FROM ACCI-
DENTAL 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 pur-
poses 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 pre-
cursor chemicals, finished methamphetamine, laboratories, and lab-
oratory dump seizures for the purpose of locating or investigating 
illicit activities, such as precursor diversion, laboratories, or meth-
amphetamine 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 
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132 STAT. 4115 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 EDU-
CATION 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 preven-
tion education, compassionate listening services, recovery sup-
port or peer specialists, bereavement and grief support, and 
case management. 
‘‘(2) Continued development of health information tech-
nology 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 informa-
tional tools for families and individuals impacted by a substance 
use disorder and community stakeholders, such as law enforce-
ment 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 addic-
tion, health, and related topics on substance use disorders, 
local issues and community-specific issues related to the drug 
epidemic. 
‘‘(7) Program evaluation.’’. 
42 USC 290ee–9. 
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132 STAT. 4116 
PUBLIC LAW 115–271—OCT. 24, 2018 
SEC. 8213. REIMBURSEMENT OF SUBSTANCE USE DISORDER TREAT-
MENT 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 agen-
cies, 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 govern-
ment, 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). 
42 USC 
290ee–10. 
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132 STAT. 4117 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 para-
graphs (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, Edu-
cation, Labor, and Pensions of the Senate; and 
‘‘(ii) the Committee on Oversight and Government 
Reform, the Committee on the Judiciary, the Com-
mittee 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 Pro-
gram 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 sub-
stance use disorder, including evidence-based education 
campaigns, community-based prevention programs, collec-
tion 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 para-
graph; 
‘‘(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 
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132 STAT. 4118 
PUBLIC LAW 115–271—OCT. 24, 2018 
use disorders who are arrested or under some form of 
criminal justice supervision, including medication assisted 
treatment; 
‘‘(K) other coordinated and joint initiatives among Fed-
eral, State, local, and Tribal agencies to promote com-
prehensive 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 Fed-
eral funds to implement any aspect of the National Drug Con-
trol Strategy, but does not include any agency that receives 
funds for drug control activity solely under the National Intel-
ligence 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 concur-
rently 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, 
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132 STAT. 4119 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 coordi-
nating 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 writ-
ten guidelines setting forth the criteria to be used in deter-
mining whether a gift or donation should be declined under 
this subsection because the acceptance of the gift or donation 
would— 
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132 STAT. 4120 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 reg-
istry 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 sec-
tion 711. 
‘‘(iii) Emerging and Continuing Threats Coordi-
nator, 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 Reduc-
tion 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 equiva-
lent).’’; 
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PUBLIC LAW 115–271—OCT. 24, 2018 
(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 INITIA-
TIVES.—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 poli-
cies, 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 appro-
priate; 
‘‘(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 Con-
trol 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 
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132 STAT. 4122 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 submis-
sion 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 sub-
section; 
‘‘(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 CON-
GRESS.—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 appro-
priate 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’’; 
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132 STAT. 4123 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 enforce-
ment officers; 
‘‘(III) accurate assessment and monitoring of 
international drug production and interdiction pro-
grams and policies; 
‘‘(IV) activities to facilitate and enhance the 
sharing of domestic and foreign intelligence 
information among National Drug Control Pro-
gram Agencies related to the production and traf-
ficking of drugs in the United States and foreign 
countries; and 
‘‘(V) research related to any of these activi-
ties.’’; 
(2) in subsection (e)(2)(A), by striking ‘‘Notwithstanding 
any other provision of law’’ and inserting ‘‘Subject to the avail-
ability 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 author-
ized 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 govern-
ments. The Director shall determine whether the coordinator posi-
tion 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 
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132 STAT. 4124 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 Gen-
eral 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 PRO-
GRAMS.— 
‘‘(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 informa-
tion identifying: 
‘‘(i) all drug control grants and pertinent identi-
fying information for each grant; 
‘‘(ii) any available performance metrics, evalua-
tions, 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 treat-
ment, 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 pro-
grams 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.’’. 
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132 STAT. 4125 
PUBLIC LAW 115–271—OCT. 24, 2018 
(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 CAM-
PAIGN. 
(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 CAM-
PAIGN. 
‘‘(a) EMERGING THREATS COORDINATOR.—The Director shall des-
ignate 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 Fed-
eral, 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 enforce-
ment 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 Pro-
gram Agencies or other agencies; 
‘‘(B) representatives from State, local, and Tribal 
governments; and 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 Chair-
person, 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 agree-
ments, 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 designa-
tion based on information gathered by the Committee, statis-
tical 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 con-
sultation with the Coordinator, shall promulgate and make 
publicly available standards by which a designation under para-
graph (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 pub-
lish 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 termi-
nate 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 
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132 STAT. 4127 
PUBLIC LAW 115–271—OCT. 24, 2018 
of, demand for, and effectiveness of evidence-based preven-
tion, 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 des-
ignated as the emerging drug threat and for expanding 
the availability and effectiveness of evidence-based sub-
stance 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 nec-
essary to implement the plan; 
‘‘(E) an implementation strategy for the media cam-
paign 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 guid-
ance on implementation of the plan described in this sub-
section to the National Drug Control Program Agencies 
and any other relevant agency determined to be necessary 
by the Director. 
‘‘(B) COORDINATOR’S
RESPONSIBILITIES.—The Coordi-
nator 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 agen-
cies identified in the plan, State, local, and Tribal 
governments, and other relevant entities; and 
‘‘(iii) monitor implementation of the plan by coordi-
nating the development and implementation of collec-
tion 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. 
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132 STAT. 4128 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 nega-
tive 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 con-
tinue 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 dis-
orders 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 organiza-
tions related to the national media campaign. 
‘‘(viii) Entertainment industry outreach, inter-
active outreach, media projects and activities, public 
information, news media outreach, and corporate 
sponsorship and participation. 
‘‘(ix) Operational and management expenses. 
‘‘(B) SPECIFIC REQUIREMENTS.— 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(i) CREATIVE SERVICES.—In using amounts for cre-
ative 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 adver-
tising 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 pur-
chased 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 cam-
paign 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 offi-
cials 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 publica-
tions, 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 
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PUBLIC LAW 115–271—OCT. 24, 2018 
that enables consideration of whether the national 
media campaign has contributed to changes in atti-
tude or behaviors among the target audience with 
respect to substance use and such other measures 
of evaluation as the Director determines are appro-
priate. 
‘‘(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
PRO-
GRAM.— 
‘‘(A) IN GENERAL.—The Director shall determine the 
overall purposes and strategy of the national media cam-
paign. 
‘‘(B) DIRECTOR.— 
‘‘(i) IN GENERAL.—The Director shall approve— 
‘‘(I) the strategy of the national media cam-
paign; 
‘‘(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 pub-
licize 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. 
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132 STAT. 4131 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(D) To fund advertising that features any elected offi-
cials, 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 pri-
mary message intended to reduce or prevent substance 
use. 
‘‘(F) To fund advertising containing a primary message 
intended to promote support for the national media cam-
paign 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 RELATION-
SHIP 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, part-
nership, or individual working on behalf of the national 
media campaign; 
‘‘(F) the results of any financial audit of the national 
media campaign; 
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132 STAT. 4132 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 obli-
gated 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 equiva-
lent) 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 ‘‘para-
graph (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); 
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132 STAT. 4133 
PUBLIC LAW 115–271—OCT. 24, 2018 
(iii) by redesignating subparagraph (D) as subpara-
graph (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 ‘‘Coordi-
nator’’; 
(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 part-
ners’’ 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 inter-
agency 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 ‘‘CHAIR-
MAN’’ and inserting ‘‘CHAIRPERSON’’; and 
(ii) by striking ‘‘chairman’’ and inserting ‘‘Chair-
person’’; 
(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 
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132 STAT. 4134 
PUBLIC LAW 115–271—OCT. 24, 2018 
(iv) by striking ‘‘they’’ and inserting ‘‘the mem-
bers’’; 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 para-
graph 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 facili-
tate 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 oper-
ations of— 
(A) the Office; and 
(B) certain programs within the Office, including— 
(i) the High Intensity Drug Trafficking Areas Pro-
gram; 
(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 rec-
ommendations on the— 
(A) policies and activities of the programs and oper-
ations 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 oper-
ations. 
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 fol-
lowing 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. 
21 USC 1715. 
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132 STAT. 4135 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(b) 
DEVELOPMENT
OF
THE
NATIONAL
DRUG
CONTROL 
STRATEGY.— 
‘‘(1) PROMULGATION.—The Director shall promulgate the 
National Drug Control Strategy, which shall set forth a com-
prehensive 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 effec-
tively implementing the National Drug Control Strategy, the 
Director— 
‘‘(A) shall consult with— 
‘‘(i) the heads of the National Drug Control Pro-
gram 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 experi-
ence 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 sub-
mitted 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, quan-
tifiable goals for reducing illicit drug use, and the con-
sequences 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. 
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PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 pro-
grams, 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 perform-
ance 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, quar-
terly 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 perform-
ance, 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 incor-
porated; 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 avail-
ability 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 
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PUBLIC LAW 115–271—OCT. 24, 2018 
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 identi-
fying 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 sub-
stance 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 evi-
dence-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 pri-
vacy 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 
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132 STAT. 4138 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 Govern-
mental 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 para-
graph to amend or modify any law governing inter-
agency 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 informa-
tion classified under criteria established by an Execu-
tive 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 COUNTER-
NARCOTICS STRATEGY.— 
‘‘(i) PURPOSES.—The Southwest Border Counter-
narcotics 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 Pro-
gram Agencies to implement that strategy. 
‘‘(ii) SPECIFIC CONTENT RELATED TO DRUG TUNNELS 
BETWEEN THE UNITED STATES AND MEXICO.—The South-
west 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 traf-
ficking 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 COUNTER-
NARCOTICS STRATEGY.— 
‘‘(i) PURPOSES.—The Northern Border Counter-
narcotics Strategy shall— 
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132 STAT. 4139 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 Pro-
gram 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 commu-
nities 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 Counter-
narcotics 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 assist-
ance, 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 prop-
erly 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 com-
piled 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 Con-
trol Strategy in effect is not sufficiently effective; or 
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132 STAT. 4140 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 commit-
tees— 
‘‘(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 dissemi-
nate, as appropriate, such information as the Director deter-
mines 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 Dash-
board. 
‘‘(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 Dash-
board, the Director shall ensure the user interface of the dash-
board 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 cal-
endar 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 cal-
endar 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 
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132 STAT. 4141 
PUBLIC LAW 115–271—OCT. 24, 2018 
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 prosecu-
tions 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, proba-
tioners, and parolees; 
‘‘(III) crime and criminal activity related to 
such substance; 
‘‘(IV) to the extent practicable, related prosecu-
tions 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 deter-
mines 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, Con-
gress, and the appropriate congressional committees, a report 
assessing the progress of each National Drug Control Program 
Agency toward achieving each goal, objective, and target con-
tained in the National Drug Control Strategy applicable to 
the prior fiscal year. 
‘‘(2) PROCESS FOR DEVELOPMENT OF THE ANNUAL ASSESS-
MENT.—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 perform-
ance measures for the agency developed under this title, 
including progress with respect to— 
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132 STAT. 4142 
PUBLIC LAW 115–271—OCT. 24, 2018 
‘‘(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 para-
graph (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 meas-
ures 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 Reauthoriza-
tion 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)— 
21 USC 1705 
notes. 
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132 STAT. 4143 
PUBLIC LAW 115–271—OCT. 24, 2018 
LEGISLATIVE HISTORY—H.R. 6: 
CONGRESSIONAL RECORD, Vol. 164 (2018): 
June 22, considered and passed House. 
Sept. 17, considered and passed Senate, amended. 
Sept. 28, House concurred in Senate amendment with an amendment pursu-
ant to H. Res. 1099. 
Oct. 3, Senate concurred in House amendment. 
DAILY COMPILATION OF PRESIDENTIAL DOCUMENTS (2018): 
Oct. 24, Presidential remarks and statement. 
(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). 
Approved October 24, 2018. 
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