amendment to the senate amendment to · sec. 5052. state option to provide medicaid coverage for...

AMENDMENT TO THE SENATE AMENDMENT TO

H.R. 6

OFFERED BY Ml. llllll

In lieu of the matter proposed to be inserted by the

Senate amendment, insert the following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 1

(a) SHORT TITLE.This Act may be cited as the 2

Substance UseDisorder Prevention that Promotes 3

Opioid Recovery and Treatment for Patients and Commu-4

nities Act or the SUPPORT for Patients and Commu-5

nities Act. 6

(b) TABLE OF CONTENTS.The table of contents of 7

this Act is as follows: 8

Sec. 1. Short title; table of contents.

TITLE IMEDICAID 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 syn-

drome and their mothers; GAO study on gaps in Medicaid cov-erage for pregnant and postpartum women with substance use disorder.

Sec. 1006. Medicaid health homes for substance-use-disorder Medicaid enroll-ees.

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.

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2 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 hous-

ing-related services and supports to individuals struggling with substance use disorders under Medicaid.

Sec. 1018. Technical assistance and support for innovative State strategies to provide housing-related supports under Medicaid.

TITLE IIMEDICARE 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 estab-

lish drug management programs for at-risk beneficiaries. Sec. 2005. Medicare coverage of certain services furnished by opioid treatment

programs. Sec. 2006. Encouraging appropriate prescribing under Medicare for victims of

opioid overdose. 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

MAPD plans pending investigations of credible allegations of fraud by pharmacies.

TITLE IIIFDA AND CONTROLLED SUBSTANCE PROVISIONS

Subtitle AFDA Provisions

CHAPTER 1IN GENERAL

Sec. 3001. Clarifying FDA regulation of non-addictive pain products. Sec. 3002. Evidence-based opioid analgesic prescribing guidelines and report.

CHAPTER 2STOP 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 3STOP ILLICIT DRUG IMPORTATION

Sec. 3021. Short title. Sec. 3022. Restricting entrance of illicit drugs.

CHAPTER 4SECURING OPIOIDS AND UNUSED NARCOTICS WITH DELIBERATE DISPOSAL AND PACKAGING

Sec. 3031. Short title. Sec. 3032. Safety-enhancing packaging and disposal features.



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3 CHAPTER 5POSTAPPROVAL STUDY REQUIREMENTS

Sec. 3041. Clarifying FDA postmarket authorities.

Subtitle BControlled Substance Provisions

CHAPTER 1MORE 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 disorders.

Sec. 3202. Medication-assisted treatment for recovery from substance use dis-order.

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 2EMPOWERING 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 3SAFE 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 4SPECIAL REGISTRATION FOR TELEMEDICINE CLARIFICATION

Sec. 3231. Short title. Sec. 3232. Regulations relating to a special registration for telemedicine.

CHAPTER 5SYNTHETIC ABUSE AND LABELING OF TOXIC SUBSTANCES

Sec. 3241. Controlled substance analogues.

CHAPTER 6ACCESS 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. Sec. 3257. Duration of grants. Sec. 3258. Accountability and oversight. Sec. 3259. Duration of program. Sec. 3260. Authorization of appropriations.

CHAPTER 7USING DATA TO PREVENT OPIOID DIVERSION

Sec. 3271. Short title. Sec. 3272. Purpose. Sec. 3273. Amendments. Sec. 3274. Report.



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4 CHAPTER 8OPIOID QUOTA REFORM

Sec. 3281. Short title. Sec. 3282. Strengthening considerations for DEA opioid quotas.

CHAPTER 9PREVENTING DRUG DIVERSION

Sec. 3291. Short title. Sec. 3292. Improvements to prevent drug diversion.

TITLE IVOFFSETS

Sec. 4001. Promoting value in Medicaid managed care. Sec. 4002. Requiring reporting by group health plans of prescription drug cov-

erage information for purposes of identifying primary payer sit-uations under the Medicare program.

TITLE VOTHER MEDICAID PROVISIONS

Subtitle AMandatory Reporting With Respect to Adult Behavioral Health Measures

Sec. 5001. Mandatory reporting with respect to adult behavioral health meas-ures.

Subtitle BMedicaid IMD Additional Info

Sec. 5011. Short title. Sec. 5012. MACPAC exploratory study and report on institutions for mental

diseases requirements and practices under Medicaid.

Subtitle CCHIP Mental Health and Substance Use Disorder Parity

Sec. 5021. Short title. Sec. 5022. Ensuring access to mental health and substance use disorder serv-

ices for children and pregnant women under the Childrens Health Insurance Program.

Subtitle DMedicaid Reentry

Sec. 5031. Short title. Sec. 5032. Promoting State innovations to ease transitions integration to the

community for certain individuals.

Subtitle EMedicaid Partnership

Sec. 5041. Short title. Sec. 5042. Medicaid providers are required to note experiences in record sys-

tems to help in-need patients.

Subtitle FIMD 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 insti-tutions for mental diseases.

TITLE VIOTHER MEDICARE PROVISIONS



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5 Subtitle ATesting 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 certified electronic health record tech-nology.

Subtitle BAbuse Deterrent Access

Sec. 6011. Short title. Sec. 6012. Study on abuse-deterrent opioid formulations access barriers under

Medicare.

Subtitle CMedicare Opioid Safety Education

Sec. 6021. Medicare opioid safety education.

Subtitle DOpioid Addiction Action Plan

Sec. 6031. Short title. Sec. 6032. Action plan on recommendations for changes under Medicare and

Medicaid to prevent opioids addictions and enhance access to medication-assisted treatment.

Subtitle EAdvancing High Quality Treatment for Opioid Use Disorders in Medicare

Sec. 6041. Short title. Sec. 6042. Opioid use disorder treatment demonstration program.

Subtitle FResponsible 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 GPreventing 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

seniors. Sec. 6066. No additional funds authorized.

Subtitle HExpanding Oversight of Opioid Prescribing and Payment

Sec. 6071. Short title. Sec. 6072. Medicare Payment Advisory Commission report on opioid payment,

adverse incentives, and data under the Medicare program. Sec. 6073. No additional funds authorized.

Subtitle IDr. Todd Graham Pain Management, Treatment, and Recovery

Sec. 6081. Short title.



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6 Sec. 6082. Review and adjustment of payments under the Medicare outpatient

prospective payment system to avoid financial incentives to use opioids instead of non-opioid alternative treatments.

Sec. 6083. Expanding access under the Medicare program to addiction treat-ment 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 JCombating Opioid Abuse for Care in Hospitals

Sec. 6091. Short title. Sec. 6092. Developing guidance on pain management and opioid use disorder

prevention 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 collection on perioperative opioid use.

Sec. 6095. Requiring the posting and periodic update of opioid prescribing guidance for Medicare beneficiaries.

Subtitle KProviding Reliable Options for Patients and Educational Resources

Sec. 6101. Short title. 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 provide 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 LFighting the Opioid Epidemic With Sunshine

Sec. 6111. Fighting the opioid epidemic with sunshine.

TITLE VIIPUBLIC HEALTH PROVISIONS

Subtitle AAwareness and Training

Sec. 7001. Report on effects on public health of synthetic drug use. Sec. 7002. First responder training.

Subtitle BPilot 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.



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7 Subtitle CIndexing Narcotics, Fentanyl, and Opioids

Sec. 7021. Establishment of substance use disorder information dashboard. Sec. 7022. Interdepartmental Substance Use Disorders Coordinating Com-

mittee. Sec. 7023. National milestones to measure success in curtailing the opioid cri-

sis. Sec. 7024. Study on prescribing limits.

Subtitle DEnsuring Access to Quality Sober Living

Sec. 7031. National recovery housing best practices.

Subtitle EAdvancing Cutting Edge Research

Sec. 7041. Unique research initiatives. Sec. 7042. Pain research.

Subtitle FJessies 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 GProtecting 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 HSubstance Use Disorder Treatment Workforce

Sec. 7071. Loan repayment program for substance use disorder treatment workforce.

Sec. 7072. Clarification regarding service in schools and other community-based settings.

Sec. 7073. Programs for health care workforce.

Subtitle IPreventing Overdoses While in Emergency Rooms

Sec. 7081. Program to support coordination and continuation of care for drug overdose patients.

Subtitle JAlternatives to Opioids in the Emergency Department

Sec. 7091. Emergency department alternatives to opioids demonstration pro-gram.

Subtitle KTreatment, Education, and Community Help To Combat Addiction

Sec. 7101. Establishment of regional centers of excellence in substance use dis-order education.

Sec. 7102. Youth prevention and recovery.



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8 Subtitle LInformation From National Mental Health and Substance Use

Policy Laboratory

Sec. 7111. Information from National Mental Health and Substance Use Policy Laboratory.

Subtitle MComprehensive Opioid Recovery Centers

Sec. 7121. Comprehensive opioid recovery centers.

Subtitle NTrauma-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 identifica-tion, 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 OEliminating Opioid Related Infectious Diseases

Sec. 7141. Reauthorization and expansion of program of surveillance and edu-cation regarding infections associated with illicit drug use and other risk factors.

Subtitle PPeer Support Communities of Recovery

Sec. 7151. Building communities of recovery. Sec. 7152. Peer support technical assistance center.

Subtitle QCreating 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 RReview of Substance Use Disorder Treatment Providers Receiving Federal Funding

Sec. 7171. Review of substance use disorder treatment providers receiving Fed-eral funding.

Subtitle SOther 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 VIIIMISCELLANEOUS

Subtitle ASynthetics 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.



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9 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 re-

quirements and falsity or lack of manifest. Sec. 8009. Effective date; regulations.

Subtitle BOpioid Addiction Recovery Fraud Prevention

Sec. 8021. Short title. Sec. 8022. Definitions. Sec. 8023. Unfair or deceptive acts or practices with respect to substance use

disorder treatment service and products.

Subtitle CAddressing Economic and Workforce Impacts of the Opioid Crisis

Sec. 8041. Addressing economic and workforce impacts of the opioid crisis.

Subtitle DPeer Support Counseling Program for Women Veterans

Sec. 8051. Peer support counseling program for women veterans.

Subtitle ETreating Barriers to Prosperity

Sec. 8061. Short title. Sec. 8062. Drug abuse mitigation initiative.

Subtitle FPilot 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 disorder become stably housed.

Subtitle GHuman 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 HReauthorizing and Extending Grants for Recovery From Opioid Use Programs

Sec. 8091. Short title. Sec. 8092. Reauthorization of the comprehensive opioid abuse grant program.

Subtitle IFighting 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 data-

base. Sec. 8104. GAO report on Department of Transportations collection and use

of drug and alcohol testing data. Sec. 8105. Transportation Workplace Drug and Alcohol Testing Program; addi-

tion of fentanyl and other substances. Sec. 8106. Status reports on hair testing guidelines. Sec. 8107. Mandatory Guidelines for Federal Workplace Drug Testing Pro-

grams using Oral Fluid. Sec. 8108. Electronic recordkeeping.



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10 Sec. 8109. Status reports on Commercial Drivers License Drug and Alcohol

Clearinghouse.

Subtitle JEliminating Kickbacks in Recovery

Sec. 8121. Short title. Sec. 8122. Criminal penalties.

Subtitle KSubstance 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 In-

stitute. Sec. 8205. Reauthorization of the High-Intensity Drug Trafficking Area Pro-

gram. 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 aware-

ness. 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.

TITLE IMEDICAID PROVISIONS 1TO ADDRESS THE OPIOID CRISIS 2SEC. 1001. AT-RISK YOUTH MEDICAID PROTECTION. 3

(a) IN GENERAL.Section 1902 of the Social Secu-4

rity Act (42 U.S.C. 1396a) is amended 5

(1) in subsection (a) 6

(A) by striking and at the end of para-7

graph (82); 8



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11

(B) by striking the period at the end of 1

paragraph (83) and inserting ; and; and 2

(C) by inserting after paragraph (83) the 3

following new paragraph: 4

(84) provide that 5

(A) the State shall not terminate eligi-6

bility for medical assistance under the State 7

plan for an individual who is an eligible juvenile 8

(as defined in subsection (nn)(2)) because the 9

juvenile is an inmate of a public institution (as 10

defined in subsection (nn)(3)), but may suspend 11

coverage during the period the juvenile is such 12

an inmate; 13

(B) in the case of an individual who is an 14

eligible juvenile described in paragraph (2)(A) 15

of subsection (nn), the State shall, prior to the 16

individuals release from such a public institu-17

tion, conduct a redetermination of eligibility for 18

such individual with respect to such medical as-19

sistance (without requiring a new application 20

from the individual) and, if the State deter-21

mines pursuant to such redetermination that 22

the individual continues to meet the eligibility 23

requirements for such medical assistance, the 24

State shall restore coverage for such medical 25



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12

assistance to such an individual upon the indi-1

viduals release from such public institution; 2

and 3

(C) in the case of an individual who is an 4

eligible juvenile described in paragraph (2)(B) 5

of subsection (nn), the State shall process any 6

application for medical assistance submitted by, 7

or on behalf of, such individual such that the 8

State makes a determination of eligibility for 9

such individual with respect to such medical as-10

sistance upon release of such individual from 11

such public institution.; and 12

(2) by adding at the end the following new sub-13

section: 14

(nn) JUVENILE; ELIGIBLE JUVENILE; PUBLIC IN-15

STITUTION.For purposes of subsection (a)(84) and this 16

subsection: 17

(1) JUVENILE.The term juvenile means an 18

individual who is 19

(A) under 21 years of age; or 20

(B) described in subsection 21

(a)(10)(A)(i)(IX). 22

(2) ELIGIBLE JUVENILE.The term eligible 23

juvenile means a juvenile who is an inmate of a 24

public institution and who 25



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13

(A) was determined eligible for medical 1

assistance under the State plan immediately be-2

fore becoming an inmate of such a public insti-3

tution; or 4

(B) is determined eligible for such med-5

ical assistance while an inmate of a public insti-6

tution. 7

(3) INMATE OF A PUBLIC INSTITUTION.The 8

term inmate of a public institution has the meaning 9

given such term for purposes of applying the sub-10

division (A) following paragraph (29) of section 11

1905(a), taking into account the exception in such 12

subdivision for a patient of a medical institution.. 13

(b) NO CHANGE IN EXCLUSION FROM MEDICAL AS-14

SISTANCE FOR INMATES OF PUBLIC INSTITUTIONS. 15

Nothing in this section shall be construed as changing the 16

exclusion from medical assistance under the subdivision 17

(A) following paragraph (29) of section 1905(a) of the So-18

cial Security Act (42 U.S.C. 1396d(a)), including any ap-19

plicable restrictions on a State submitting claims for Fed-20

eral financial participation under title XIX of such Act 21

for such assistance. 22

(c) NO CHANGE IN CONTINUITY OF ELIGIBILITY BE-23

FORE ADJUDICATION OR SENTENCING.Nothing in this 24

section shall be construed to mandate, encourage, or sug-25



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14

gest that a State suspend or terminate coverage for indi-1

viduals before they have been adjudicated or sentenced. 2

(d) EFFECTIVE DATE. 3

(1) IN GENERAL.Except as provided in para-4

graph (2), the amendments made by subsection (a) 5

shall apply to eligibility of juveniles who become in-6

mates of public institutions on or after the date that 7

is 1 year after the date of the enactment of this Act. 8

(2) RULE FOR CHANGES REQUIRING STATE 9

LEGISLATION.In the case of a State plan for med-10

ical assistance under title XIX of the Social Security 11

Act which the Secretary of Health and Human Serv-12

ices determines requires State legislation (other than 13

legislation appropriating funds) in order for the plan 14

to meet the additional requirements imposed by the 15

amendments made by subsection (a), the State plan 16

shall not be regarded as failing to comply with the 17

requirements of such title solely on the basis of its 18

failure to meet these additional requirements before 19

the first day of the first calendar quarter beginning 20

after the close of the first regular session of the 21

State legislature that begins after the date of the en-22

actment of this Act. For purposes of the previous 23

sentence, in the case of a State that has a 2-year 24

legislative session, each year of such session shall be 25



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15

deemed to be a separate regular session of the State 1

legislature. 2

SEC. 1002. HEALTH INSURANCE FOR FORMER FOSTER 3

YOUTH. 4

(a) COVERAGE CONTINUITY FOR FORMER FOSTER 5

CARE CHILDREN UP TO AGE 26. 6

(1) IN GENERAL.Section 7

1902(a)(10)(A)(i)(IX) of the Social Security Act (42 8

U.S.C. 1396a(a)(10)(A)(i)(IX)) is amended 9

(A) in item (bb), by striking are not de-10

scribed in or enrolled under and inserting are 11

not described in and are not enrolled under; 12

(B) in item (cc), by striking responsibility 13

of the State and inserting responsibility of a 14

State; and 15

(C) in item (dd), by striking the State 16

plan under this title or under a waiver of the 17

and inserting a State plan under this title or 18

under a waiver of such a. 19

(2) EFFECTIVE DATE.The amendments made 20

by this subsection shall take effect with respect to 21

foster youth who attain 18 years of age on or after 22

January 1, 2023. 23

(b) GUIDANCE.Not later than 1 year after the date 24

of the enactment of this Act, the Secretary of Health and 25



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16

Human Services shall issue guidance to States, with re-1

spect to the State Medicaid programs of such States 2

(1) on best practices for 3

(A) removing barriers and ensuring 4

streamlined, timely access to Medicaid coverage 5

for former foster youth up to age 26; and 6

(B) conducting outreach and raising 7

awareness among such youth regarding Med-8

icaid coverage options for such youth; and 9

(2) which shall include examples of States that 10

have successfully extended Medicaid coverage to 11

former foster youth up to age 26. 12

SEC. 1003. DEMONSTRATION PROJECT TO INCREASE SUB-13

STANCE USE PROVIDER CAPACITY UNDER 14

THE MEDICAID PROGRAM. 15

Section 1903 of the Social Security Act (42 U.S.C. 16

1396b) is amended by adding at the end the following new 17

subsection: 18

(aa) DEMONSTRATION PROJECT TO INCREASE SUB-19

STANCE USE PROVIDER CAPACITY. 20

(1) IN GENERAL.Not later than the date 21

that is 180 days after the date of the enactment of 22

this subsection, the Secretary shall, in consultation, 23

as appropriate, with the Director of the Agency for 24

Healthcare Research and Quality and the Assistant 25



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17

Secretary for Mental Health and Substance Use, 1

conduct a 54-month demonstration project for the 2

purpose described in paragraph (2) under which the 3

Secretary shall 4

(A) for the first 18-month period of such 5

project, award planning grants described in 6

paragraph (3); and 7

(B) for the remaining 36-month period of 8

such project, provide to each State selected 9

under paragraph (4) payments in accordance 10

with paragraph (5). 11

(2) PURPOSE.The purpose described in this 12

paragraph is for each State selected under para-13

graph (4) to increase the treatment capacity of pro-14

viders participating under the State plan (or a waiv-15

er of such plan) to provide substance use disorder 16

treatment or recovery services under such plan (or 17

waiver) through the following activities: 18

(A) For the purpose described in para-19

graph (3)(C)(i), activities that support an ongo-20

ing assessment of the behavioral health treat-21

ment needs of the State, taking into account 22

the matters described in subclauses (I) through 23

(IV) of such paragraph. 24



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18

(B) Activities that, taking into account 1

the results of the assessment described in sub-2

paragraph (A), support the recruitment, train-3

ing, and provision of technical assistance for 4

providers participating under the State plan (or 5

a waiver of such plan) that offer substance use 6

disorder treatment or recovery services. 7

(C) Improved reimbursement for and ex-8

pansion of, through the provision of education, 9

training, and technical assistance, the number 10

or treatment capacity of providers participating 11

under the State plan (or waiver) that 12

(i) are authorized to dispense drugs 13

approved by the Food and Drug Adminis-14

tration for individuals with a substance use 15

disorder who need withdrawal management 16

or maintenance treatment for such dis-17

order; 18

(ii) have in effect a registration or 19

waiver under section 303(g) of the Con-20

trolled Substances Act for purposes of dis-21

pensing narcotic drugs to individuals for 22

maintenance treatment or detoxification 23

treatment and are in compliance with any 24

regulation promulgated by the Assistant 25



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19

Secretary for Mental Health and Sub-1

stance Use for purposes of carrying out 2

the requirements of such section 303(g); 3

and 4

(iii) are qualified under applicable 5

State law to provide substance use disorder 6

treatment or recovery services. 7

(D) Improved reimbursement for and ex-8

pansion of, through the provision of education, 9

training, and technical assistance, the number 10

or treatment capacity of providers participating 11

under the State plan (or waiver) that have the 12

qualifications to address the treatment or recov-13

ery needs of 14

(i) individuals enrolled under the 15

State plan (or a waiver of such plan) who 16

have neonatal abstinence syndrome, in ac-17

cordance with guidelines issued by the 18

American Academy of Pediatrics and 19

American College of Obstetricians and 20

Gynecologists relating to maternal care 21

and infant care with respect to neonatal 22

abstinence syndrome; 23

(ii) pregnant women, postpartum 24

women, and infants, particularly the con-25



g:\VHLC\092518\092518.308.xml (706790|2)

20

current treatment, as appropriate, and 1

comprehensive case management of preg-2

nant women, postpartum women and in-3

fants, enrolled under the State plan (or a 4

waiver of such plan); 5

(iii) adolescents and young adults be-6

tween the ages of 12 and 21 enrolled 7

under the State plan (or a waiver of such 8

plan); or 9

(iv) American Indian and Alaska Na-10

tive individuals enrolled under the State 11

plan (or a waiver of such plan). 12

(3) PLANNING GRANTS. 13

(A) IN GENERAL.The Secretary shall, 14

with respect to the first 18-month period of the 15

demonstration project conducted under para-16

graph (1), award planning grants to at least 10 17

States selected in accordance with subpara-18

graph (B) for purposes of preparing an applica-19

tion described in paragraph (4)(C) and carrying 20

out the activities described in subparagraph 21

(C). 22

(B) SELECTION.In selecting States for 23

purposes of this paragraph, the Secretary 24

shall 25



g:\VHLC\092518\092518.308.xml (706790|2)

21

(i) select States that have a State 1

plan (or waiver of the State plan) approved 2

under this title; 3

(ii) select States in a manner that 4

ensures geographic diversity; and 5

(iii) give preference to States with a 6

prevalence of substance use disorders (in 7

particular opioid use disorders) that is 8

comparable to or higher than the national 9

average prevalence, as measured by aggre-10

gate per capita drug overdoses, or any 11

other measure that the Secretary deems 12

appropriate. 13

(C) ACTIVITIES DESCRIBED.Activities 14

described in this subparagraph are, with respect 15

to a State, each of the following: 16

(i) Activities that support the devel-17

opment of an initial assessment of the be-18

havioral health treatment needs of the 19

State to determine the extent to which pro-20

viders are needed (including the types of 21

such providers and geographic area of 22

need) to improve the network of providers 23

that treat substance use disorders under 24



g:\VHLC\092518\092518.308.xml (706790|2)

22

the State plan (or waiver), including the 1

following: 2

(I) An estimate of the number 3

of individuals enrolled under the State 4

plan (or a waiver of such plan) who 5

have a substance use disorder. 6

(II) Information on the capacity 7

of providers to provide substance use 8

disorder treatment or recovery serv-9

ices to individuals enrolled under the 10

State plan (or waiver), including in-11

formation on providers who provide 12

such services and their participation 13

under the State plan (or waiver). 14

(III) Information on the gap in 15

substance use disorder treatment or 16

recovery services under the State plan 17

(or waiver) based on the information 18

described in subclauses (I) and (II). 19

(IV) Projections regarding the 20

extent to which the State partici-21

pating under the demonstration 22

project would increase the number of 23

providers offering substance use dis-24

order treatment or recovery services 25



g:\VHLC\092518\092518.308.xml (706790|2)

23

under the State plan (or waiver) dur-1

ing the period of the demonstration 2

project. 3

(ii) Activities that, taking into ac-4

count the results of the assessment de-5

scribed in clause (i), support the develop-6

ment of State infrastructure to, with re-7

spect to the provision of substance use dis-8

order treatment or recovery services under 9

the State plan (or a waiver of such plan), 10

recruit prospective providers and provide 11

training and technical assistance to such 12

providers. 13

(D) FUNDING.For purposes of subpara-14

graph (A), there is appropriated, out of any 15

funds in the Treasury not otherwise appro-16

priated, $50,000,000, to remain available until 17

expended. 18

(4) POST-PLANNING STATES. 19

(A) IN GENERAL.The Secretary shall, 20

with respect to the remaining 36-month period 21

of the demonstration project conducted under 22

paragraph (1), select not more than 5 States in 23

accordance with subparagraph (B) for purposes 24

of carrying out the activities described in para-25



g:\VHLC\092518\092518.308.xml (706790|2)

24

graph (2) and receiving payments in accordance 1

with paragraph (5). 2

(B) SELECTION.In selecting States for 3

purposes of this paragraph, the Secretary 4

shall 5

(i) select States that received a plan-6

ning grant under paragraph (3); 7

(ii) select States that submit to the 8

Secretary an application in accordance 9

with the requirements in subparagraph 10

(C), taking into consideration the quality 11

of each such application; 12

(iii) select States in a manner that 13

ensures geographic diversity; and 14

(iv) give preference to States with a 15

prevalence of substance use disorders (in 16

particular opioid use disorders) that is 17

comparable to or higher than the national 18

average prevalence, as measured by aggre-19

gate per capita drug overdoses, or any 20

other measure that the Secretary deems 21

appropriate. 22

(C) APPLICATIONS. 23

(i) IN GENERAL.A State seeking to 24

be selected for purposes of this paragraph 25



g:\VHLC\092518\092518.308.xml (706790|2)

25

shall submit to the Secretary, at such time 1

and in such form and manner as the Sec-2

retary requires, an application that in-3

cludes such information, provisions, and 4

assurances, as the Secretary may require, 5

in addition to the following: 6

(I) A proposed process for car-7

rying out the ongoing assessment de-8

scribed in paragraph (2)(A), taking 9

into account the results of the initial 10

assessment described in paragraph 11

(3)(C)(i). 12

(II) A review of reimbursement 13

methodologies and other policies re-14

lated to substance use disorder treat-15

ment or recovery services under the 16

State plan (or waiver) that may create 17

barriers to increasing the number of 18

providers delivering such services. 19

(III) The development of a plan, 20

taking into account activities carried 21

out under paragraph (3)(C)(ii), that 22

will result in long-term and sustain-23

able provider networks under the 24

State plan (or waiver) that will offer 25



g:\VHLC\092518\092518.308.xml (706790|2)

26

a continuum of care for substance use 1

disorders. Such plan shall include the 2

following: 3

(aa) Specific activities to 4

increase the number of providers 5

(including providers that spe-6

cialize in providing substance use 7

disorder treatment or recovery 8

services, hospitals, health care 9

systems, Federally qualified 10

health centers, and, as applicable, 11

certified community behavioral 12

health clinics) that offer sub-13

stance use disorder treatment, re-14

covery, or support services, in-15

cluding short-term detoxification 16

services, outpatient substance use 17

disorder services, and evidence- 18

based peer recovery services. 19

(bb) Strategies that will 20

incentivize providers described in 21

subparagraphs (C) and (D) of 22

paragraph (2) to obtain the nec-23

essary training, education, and 24

support to deliver substance use 25



g:\VHLC\092518\092518.308.xml (706790|2)

27

disorder treatment or recovery 1

services in the State. 2

(cc) Milestones and timeli-3

ness for implementing activities 4

set forth in the plan. 5

(dd) Specific measurable 6

targets for increasing the sub-7

stance use disorder treatment 8

and recovery provider network 9

under the State plan (or a waiver 10

of such plan). 11

(IV) A proposed process for re-12

porting the information required 13

under paragraph (6)(A), including in-14

formation to assess the effectiveness 15

of the efforts of the State to expand 16

the capacity of providers to deliver 17

substance use disorder treatment or 18

recovery services during the period of 19

the demonstration project under this 20

subsection. 21

(V) The expected financial im-22

pact of the demonstration project 23

under this subsection on the State. 24



g:\VHLC\092518\092518.308.xml (706790|2)

28

(VI) A description of all funding 1

sources available to the State to pro-2

vide substance use disorder treatment 3

or recovery services in the State. 4

(VII) A preliminary plan for 5

how the State will sustain any in-6

crease in the capacity of providers to 7

deliver substance use disorder treat-8

ment or recovery services resulting 9

from the demonstration project under 10

this subsection after the termination 11

of such demonstration project. 12

(VIII) A description of how the 13

State will coordinate the goals of the 14

demonstration project with any waiver 15

granted (or submitted by the State 16

and pending) pursuant to section 17

1115 for the delivery of substance use 18

services under the State plan, as ap-19

plicable. 20

(ii) CONSULTATION.In completing 21

an application under clause (i), a State 22

shall consult with relevant stakeholders, in-23

cluding Medicaid managed care plans, 24

health care providers, and Medicaid bene-25



g:\VHLC\092518\092518.308.xml (706790|2)

29

ficiary advocates, and include in such ap-1

plication a description of such consultation. 2

(5) PAYMENT. 3

(A) IN GENERAL.For each quarter oc-4

curring during the period for which the dem-5

onstration project is conducted (after the first 6

18 months of such period), the Secretary shall 7

pay under this subsection, subject to subpara-8

graph (C), to each State selected under para-9

graph (4) an amount equal to 80 percent of so 10

much of the qualified sums expended during 11

such quarter. 12

(B) QUALIFIED SUMS DEFINED.For 13

purposes of subparagraph (A), the term quali-14

fied sums means, with respect to a State and 15

a quarter, the amount equal to the amount (if 16

any) by which the sums expended by the State 17

during such quarter attributable to substance 18

use disorder treatment or recovery services fur-19

nished by providers participating under the 20

State plan (or a waiver of such plan) exceeds 1/ 21

4 of such sums expended by the State during 22

fiscal year 2018 attributable to substance use 23

disorder treatment or recovery services. 24



g:\VHLC\092518\092518.308.xml (706790|2)

30

(C) NON-DUPLICATION OF PAYMENT.In 1

the case that payment is made under subpara-2

graph (A) with respect to expenditures for sub-3

stance use disorder treatment or recovery serv-4

ices furnished by providers participating under 5

the State plan (or a waiver of such plan), pay-6

ment may not also be made under subsection 7

(a) with respect to expenditures for the same 8

services so furnished. 9

(6) REPORTS. 10

(A) STATE REPORTS.A State receiving 11

payments under paragraph (5) shall, for the pe-12

riod of the demonstration project under this 13

subsection, submit to the Secretary a quarterly 14

report, with respect to expenditures for sub-15

stance use disorder treatment or recovery serv-16

ices for which payment is made to the State 17

under this subsection, on the following: 18

(i) The specific activities with re-19

spect to which payment under this sub-20

section was provided. 21

(ii) The number of providers that de-22

livered substance use disorder treatment or 23

recovery services in the State under the 24

demonstration project compared to the es-25



g:\VHLC\092518\092518.308.xml (706790|2)

31

timated number of providers that would 1

have otherwise delivered such services in 2

the absence of such demonstration project. 3

(iii) The number of individuals en-4

rolled under the State plan (or a waiver of 5

such plan) who received substance use dis-6

order treatment or recovery services under 7

the demonstration project compared to the 8

estimated number of such individuals who 9

would have otherwise received such services 10

in the absence of such demonstration 11

project. 12

(iv) Other matters as determined by 13

the Secretary. 14

(B) CMS REPORTS. 15

(i) INITIAL REPORT.Not later than 16

October 1, 2020, the Administrator of the 17

Centers for Medicare & Medicaid Services 18

shall, in consultation with the Director of 19

the Agency for Healthcare Research and 20

Quality and the Assistant Secretary for 21

Mental Health and Substance Use, submit 22

to Congress an initial report on 23

(I) the States awarded planning 24

grants under paragraph (3); 25



g:\VHLC\092518\092518.308.xml (706790|2)

32

(II) the criteria used in such se-1

lection; and 2

(III) the activities carried out 3

by such States under such planning 4

grants. 5

(ii) INTERIM REPORT.Not later 6

than October 1, 2022, the Administrator 7

of the Centers for Medicare & Medicaid 8

Services shall, in consultation with the Di-9

rector of the Agency for Healthcare Re-10

search and Quality and the Assistant Sec-11

retary for Mental Health and Substance 12

Use, submit to Congress an interim re-13

port 14

(I) on activities carried out 15

under the demonstration project 16

under this subsection; 17

(II) on the extent to which 18

States selected under paragraph (4) 19

have achieved the stated goals sub-20

mitted in their applications under sub-21

paragraph (C) of such paragraph; 22

(III) with a description of the 23

strengths and limitations of such dem-24

onstration project; and 25



g:\VHLC\092518\092518.308.xml (706790|2)

33

(IV) with a plan for the sustain-1

ability of such project. 2

(iii) FINAL REPORT.Not later than 3

October 1, 2024, the Administrator of the 4

Centers for Medicare & Medicaid Services 5

shall, in consultation with the Director of 6

the Agency for Healthcare Research and 7

Quality and the Assistant Secretary for 8

Mental Health and Substance Use, submit 9

to Congress a final report 10

(I) providing updates on the 11

matters reported in the interim report 12

under clause (ii); 13

(II) including a description of 14

any changes made with respect to the 15

demonstration project under this sub-16

section after the submission of such 17

interim report; and 18

(III) evaluating such dem-19

onstration project. 20

(C) AHRQ REPORT.Not later than 3 21

years after the date of the enactment of this 22

subsection, the Director of the Agency for 23

Healthcare Research and Quality, in consulta-24

tion with the Administrator of the Centers for 25



g:\VHLC\092518\092518.308.xml (706790|2)

34

Medicare & Medicaid Services, shall submit to 1

Congress a summary on the experiences of 2

States awarded planning grants under para-3

graph (3) and States selected under paragraph 4

(4). 5

(7) DATA SHARING AND BEST PRACTICES. 6

During the period of the demonstration project 7

under this subsection, the Secretary shall, in collabo-8

ration with States selected under paragraph (4), fa-9

cilitate data sharing and the development of best 10

practices between such States and States that were 11

not so selected. 12

(8) CMS FUNDING.There is appropriated, 13

out of any funds in the Treasury not otherwise ap-14

propriated, $5,000,000 to the Centers for Medicare 15

& Medicaid Services for purposes of implementing 16

this subsection. Such amount shall remain available 17

until expended.. 18

SEC. 1004. MEDICAID DRUG REVIEW AND UTILIZATION. 19

(a) MEDICAID DRUG UTILIZATION REVIEW. 20

(1) STATE PLAN REQUIREMENT.Section 21

1902(a) of the Social Security Act (42 U.S.C. 22

1396a(a)), as amended by section 1001, is further 23

amended 24



g:\VHLC\092518\092518.308.xml (706790|2)

35

(A) in paragraph (83), at the end, by 1

striking and; 2

(B) in paragraph (84), at the end, by 3

striking the period and inserting ; and; and 4



(85) provide that the State is in compliance 7

with the drug review and utilization requirements 8

under subsection (oo)(1).. 9

(2) DRUG REVIEW AND UTILIZATION REQUIRE-10

MENTS.Section 1902 of the Social Security Act 11

(42 U.S.C. 1396a), as amended by section 1001, is 12

further amended by adding at the end the following 13

new subsection: 14

(oo) DRUG REVIEW AND UTILIZATION REQUIRE-15

MENTS. 16

(1) IN GENERAL.For purposes of subsection 17

(a)(85), the drug review and utilization requirements 18

under this subsection are, subject to paragraph (3) 19

and beginning October 1, 2019, the following: 20

(A) CLAIMS REVIEW LIMITATIONS. 21

(i) IN GENERAL.The State has in 22

place 23

(I) safety edits (as specified by 24

the State) for subsequent fills for 25



g:\VHLC\092518\092518.308.xml (706790|2)

36

opioids and a claims review automated 1

process (as designed and implemented 2

by the State) that indicates when an 3

individual enrolled under the State 4

plan (or under a waiver of the State 5

plan) is prescribed a subsequent fill of 6

opioids in excess of any limitation 7

that may be identified by the State; 8

(II) safety edits (as specified by 9

the State) on the maximum daily mor-10

phine equivalent that can be pre-11

scribed to an individual enrolled under 12

the State plan (or under a waiver of 13

the State plan) for treatment of 14

chronic pain and a claims review auto-15

mated process (as designed and imple-16

mented by the State) that indicates 17

when an individual enrolled under the 18

plan (or waiver) is prescribed the mor-19

phine equivalent for such treatment in 20

excess of any limitation that may be 21

identified by the State; and 22

(III) a claims review automated 23

process (as designed and implemented 24

by the State) that monitors when an 25



g:\VHLC\092518\092518.308.xml (706790|2)

37

individual enrolled under the State 1

plan (or under a waiver of the State 2

plan) is concurrently prescribed 3

opioids and 4

(aa) benzodiazepines; or 5

(bb) antipsychotics. 6

(ii) MANAGED CARE ENTITIES.The 7

State requires each managed care entity 8

(as defined in section 1932(a)(1)(B)) with 9

respect to which the State has a contract 10

under section 1903(m) or under section 11

1905(t)(3) to have in place, subject to 12

paragraph (3), with respect to individuals 13

who are eligible for medical assistance 14

under the State plan (or under a waiver of 15

the State plan) and who are enrolled with 16

the entity, the limitations described in sub-17

clauses (I) and (II) of clause (i) and a 18

claims review automated process described 19

in subclause (III) of such clause. 20

(iii) RULES OF CONSTRUCTION. 21

Nothing in this subparagraph may be con-22

strued as prohibiting a State or managed 23

care entity from designing and imple-24

menting a claims review automated process 25



g:\VHLC\092518\092518.308.xml (706790|2)

38

under this subparagraph that provides for 1

prospective or retrospective reviews of 2

claims. Nothing in this subparagraph shall 3

be understood as prohibiting the exercise 4

of clinical judgment from a provider en-5

rolled as a participating provider in a 6

State plan (or waiver of the State plan) or 7

contracting with a managed care entity re-8

garding the best items and services for an 9

individual enrolled under such State plan 10

(or waiver). 11

(B) PROGRAM TO MONITOR 12

ANTIPSYCHOTIC MEDICATIONS BY CHILDREN. 13

The State has in place a program (as designed 14

and implemented by the State) to monitor and 15

manage the appropriate use of antipsychotic 16

medications by children enrolled under the 17

State plan (or under a waiver of the State plan) 18

and submits annually to the Secretary such in-19

formation as the Secretary may require on ac-20

tivities carried out under such program for indi-21

viduals not more than the age of 18 years gen-22

erally and children in foster care specifically. 23

(C) FRAUD AND ABUSE IDENTIFICA-24

TION.The State has in place a process (as de-25



g:\VHLC\092518\092518.308.xml (706790|2)

39

signed and implemented by the State) that 1

identifies potential fraud or abuse of controlled 2

substances by individuals enrolled under the 3

State plan (or under a waiver of the State 4

plan), health care providers prescribing drugs 5

to individuals so enrolled, and pharmacies dis-6

pensing drugs to individuals so enrolled. 7

(D) REPORTS.The State shall include 8

in the annual report submitted to the Secretary 9

under section 1927(g)(3)(D) information on the 10

limitations, requirement, program, and proc-11

esses applied by the State under subparagraphs 12

(A) through (C) in accordance with such man-13

ner and time as specified by the Secretary. 14

(E) CLARIFICATION.Nothing shall pre-15

vent a State from satisfying the requirement 16

(i) described in subparagraph (A) by 17

having safety edits or a claims review auto-18

mated process described in such subpara-19

graph that was in place before October 1, 20

2019; 21

(ii) described in subparagraph (B) 22

by having a program described in such 23

subparagraph that was in place before 24

such date; or 25



g:\VHLC\092518\092518.308.xml (706790|2)

40

(iii) described in subparagraph (C) 1

by having a process described in such sub-2

paragraph that was in place before such 3

date. 4

(2) ANNUAL REPORT BY SECRETARY.For 5

each fiscal year beginning with fiscal year 2020, the 6

Secretary shall submit to Congress a report on the 7

most recent information submitted by States under 8

paragraph (1)(D). 9

(3) EXCEPTIONS. 10

(A) CERTAIN INDIVIDUALS EXEMPTED. 11

The drug review and utilization requirements 12

under this subsection shall not apply with re-13

spect to an individual who 14

(i) is receiving 15

(I) hospice or palliative care; or 16

(II) treatment for cancer; 17

(ii) is a resident of a long-term care 18

facility, of a facility described in section 19

1905(d), or of another facility for which 20

frequently abused drugs are dispensed for 21

residents through a contract with a single 22

pharmacy; or 23

(iii) the State elects to treat as ex-24

empted from such requirements. 25



g:\VHLC\092518\092518.308.xml (706790|2)

41

(B) EXCEPTION RELATING TO ENSURING 1

ACCESS.In order to ensure reasonable access 2

to health care, the Secretary shall waive the 3

drug review and utilization requirements under 4

this subsection, with respect to a State, in the 5

case of natural disasters and similar situations, 6

and in the case of the provision of emergency 7

services (as defined for purposes of section 8

1860D4(c)(5)(D)(ii)(II)).. 9

(3) MANAGED CARE ENTITIES.Section 1932 10

of the Social Security Act (42 U.S.C. 1396u2) is 11

amended by adding at the end the following new 12

subsection: 13

(i) DRUG UTILIZATION REVIEW ACTIVITIES AND 14

REQUIREMENTS.Beginning not later than October 1, 15

2019, each contract under a State plan with a managed 16

care entity (other than a primary care case manager) 17

under section 1903(m) shall provide that the entity is in 18

compliance with the applicable provisions of section 19

438.3(s)(2) of title 42, Code of Federal Regulations, sec-20

tion 483.3(s)(4)) of such title, and section 483.3(s)(5) of 21

such title, as such provisions were in effect on March 31, 22

2018.. 23



g:\VHLC\092518\092518.308.xml (706790|2)

42

(b) IDENTIFYING AND ADDRESSING INAPPROPRIATE 1

PRESCRIBING AND BILLING PRACTICES UNDER MED-2

ICAID. 3

(1) IN GENERAL.Section 1927(g) of the So-4

cial Security Act (42 U.S.C. 1396r8(g)) is amend-5

ed 6

(A) in paragraph (1)(A) 7

(i) by striking of section 8

1903(i)(10)(B) and inserting of section 9

1902(a)(54); 10

(ii) by striking , by not later than 11

January 1, 1993,; 12

(iii) by inserting after gross over-13

use, the following: excessive utilization,; 14

and 15

(iv) by striking or inappropriate or 16

medically unnecessary care and inserting 17

inappropriate or medically unnecessary 18

care, or prescribing or billing practices 19

that indicate abuse or excessive utiliza-20

tion; and 21

(B) in paragraph (2)(B) 22

(i) by inserting after gross overuse, 23

the following: excessive utilization,; and 24



g:\VHLC\092518\092518.308.xml (706790|2)

43

(ii) by striking or inappropriate or 1

medically unnecessary care and inserting 2

inappropriate or medically unnecessary 3

care, or prescribing or billing practices 4

that indicate abuse or excessive utiliza-5

tion. 6

(2) EFFECTIVE DATE.The amendments made 7

by paragraph (1) shall take effect with respect to 8

retrospective drug use reviews conducted on or after 9

October 1, 2020. 10

SEC. 1005. GUIDANCE TO IMPROVE CARE FOR INFANTS 11

WITH NEONATAL ABSTINENCE SYNDROME 12

AND THEIR MOTHERS; GAO STUDY ON GAPS 13

IN MEDICAID COVERAGE FOR PREGNANT 14

AND POSTPARTUM WOMEN WITH SUBSTANCE 15

USE DISORDER. 16

(a) GUIDANCE.Not later than 1 year after the date 17

of the enactment of this Act, the Secretary of Health and 18

Human Services shall issue guidance to improve care for 19

infants with neonatal abstinence syndrome and their fami-20

lies. Such guidance shall include 21

(1) best practices from States with respect to 22

innovative or evidenced-based payment models that 23

focus on prevention, screening, treatment, plans of 24

safe care, and postdischarge services for mothers 25



g:\VHLC\092518\092518.308.xml (706790|2)

44

and fathers with substance use disorders and babies 1

with neonatal abstinence syndrome that improve 2

care and clinical outcomes; 3

(2) recommendations for States on available fi-4

nancing options under the Medicaid program under 5

title XIX of such Act and under the Childrens 6

Health Insurance Program under title XXI of such 7

Act for Childrens Health Insurance Program 8

Health Services Initiative funds for parents with 9

substance use disorders, infants with neonatal absti-10

nence syndrome, and home-visiting services; 11

(3) guidance and technical assistance to State 12

Medicaid agencies regarding additional flexibilities 13

and incentives related to screening, prevention, and 14

postdischarge services, including parenting supports, 15

and infant-caregiver bonding, including 16

breastfeeding when it is appropriate; and 17

(4) guidance regarding suggested terminology 18

and ICD codes to identify infants with neonatal ab-19

stinence syndrome and neonatal opioid withdrawal 20

syndrome, which could include opioid-exposure, 21

opioid withdrawal not requiring pharmacotherapy, 22

and opioid withdrawal requiring pharmacotherapy. 23

(b) GAO STUDY.Not later than 1 year after the 24

date of the enactment of this Act, the Comptroller General 25



g:\VHLC\092518\092518.308.xml (706790|2)

45

of the United States shall conduct a study, and submit 1

to Congress a report, addressing gaps in coverage for 2

pregnant women with substance use disorder under the 3

Medicaid program under title XIX of the Social Security 4

Act, and gaps in coverage for postpartum women with sub-5

stance use disorder who had coverage during their preg-6

nancy under the Medicaid program under such title. 7

SEC. 1006. MEDICAID HEALTH HOMES FOR SUBSTANCE- 8

USE-DISORDER MEDICAID ENROLLEES. 9

(a) EXTENSION OF ENHANCED FMAP FOR CERTAIN 10

HEALTH HOMES FOR INDIVIDUALS WITH SUBSTANCE 11

USE DISORDERS.Section 1945(c) of the Social Security 12

Act (42 U.S.C. 1396w4(c)) is amended 13

(1) in paragraph (1), by inserting subject to 14

paragraph (4), after except that,; and 15

(2) by adding at the end the following new 16

paragraph: 17

(4) SPECIAL RULE RELATING TO SUBSTANCE 18

USE DISORDER HEALTH HOMES. 19

(A) IN GENERAL.In the case of a State 20

with an SUD-focused State plan amendment 21

approved by the Secretary on or after October 22

1, 2018, the Secretary may, at the request of 23

the State, extend the application of the Federal 24

medical assistance percentage described in 25



g:\VHLC\092518\092518.308.xml (706790|2)

46

paragraph (1) to payments for the provision of 1

health home services to SUD-eligible individuals 2

under such State plan amendment, in addition 3

to the first 8 fiscal year quarters the State plan 4

amendment is in effect, for the subsequent 2 5

fiscal year quarters that the State plan amend-6

ment is in effect. Nothing in this section shall 7

be construed as prohibiting a State with a State 8

plan amendment that is approved under this 9

section and that is not an SUD-focused State 10

plan amendment from additionally having ap-11

proved on or after such date an SUD-focused 12

State plan amendment under this section, in-13

cluding for purposes of application of this para-14

graph. 15

(B) REPORT REQUIREMENTS.In the 16

case of a State with an SUD-focused State plan 17

amendment for which the application of the 18

Federal medical assistance percentage has been 19

extended under subparagraph (A), such State 20

shall, at the end of the period of such State 21

plan amendment, submit to the Secretary a re-22

port on the following, with respect to SUD-eli-23

gible individuals provided health home services 24

under such State plan amendment: 25



g:\VHLC\092518\092518.308.xml (706790|2)

47

(i) The quality of health care pro-1

vided to such individuals, with a focus on 2

outcomes relevant to the recovery of each 3

such individual. 4

(ii) The access of such individuals to 5

health care. 6

(iii) The total expenditures of such 7

individuals for health care. 8

For purposes of this subparagraph, the Sec-9

retary shall specify all applicable measures for 10

determining quality, access, and expenditures. 11

(C) BEST PRACTICES.Not later than 12

October 1, 2020, the Secretary shall make pub-13

licly available on the internet website of the 14

Centers for Medicare & Medicaid Services best 15

practices for designing and implementing an 16

SUD-focused State plan amendment, based on 17

the experiences of States that have State plan 18

amendments approved under this section that 19

include SUD-eligible individuals. 20

(D) DEFINITIONS.For purposes of this 21

paragraph: 22

(i) SUD-ELIGIBLE INDIVIDUALS. 23

The term SUD-eligible individual means, 24



g:\VHLC\092518\092518.308.xml (706790|2)

48

with respect to a State, an individual who 1

satisfies all of the following: 2

(I) The individual is an eligible 3

individual with chronic conditions. 4

(II) The individual is an indi-5

vidual with a substance use disorder. 6

(III) The individual has not pre-7

viously received health home services 8

under any other State plan amend-9

ment approved for the State under 10

this section by the Secretary. 11

(ii) SUD-FOCUSED STATE PLAN 12

AMENDMENT.The term SUD-focused 13

State plan amendment means a State plan 14

amendment under this section that is de-15

signed to provide health home services pri-16

marily to SUD-eligible individuals.. 17

(b) REQUIREMENT FOR STATE MEDICAID PLANS TO 18

PROVIDE COVERAGE FOR MEDICATION-ASSISTED TREAT-19

MENT. 20

(1) REQUIREMENT FOR STATE MEDICAID PLANS 21

TO PROVIDE COVERAGE FOR MEDICATION-ASSISTED 22

TREATMENT.Section 1902(a)(10)(A) of the Social 23

Security Act (42 U.S.C. 1396a(a)(10)(A)) is amend-24



g:\VHLC\092518\092518.308.xml (706790|2)

49

ed, in the matter preceding clause (i), by striking 1

and (28) and inserting (28), and (29). 2

(2) INCLUSION OF MEDICATION-ASSISTED 3

TREATMENT AS MEDICAL ASSISTANCE.Section 4

1905(a) of the Social Security Act (42 U.S.C. 5

1396d(a)) is amended 6

(A) in paragraph (28), by striking and 7

at the end; 8

(B) by redesignating paragraph (29) as 9

paragraph (30); and 10



(29) subject to paragraph (2) of subsection 13

(ee), for the period beginning October 1, 2020, and 14

ending September 30, 2025, medication-assisted 15

treatment (as defined in paragraph (1) of such sub-16

section); and. 17

(3) MEDICATION-ASSISTED TREATMENT DE-18

FINED; WAIVERS.Section 1905 of the Social Secu-19

rity Act (42 U.S.C. 1396d) is amended by adding at 20

the end the following new subsection: 21

(ee) MEDICATION-ASSISTED TREATMENT. 22

(1) DEFINITION.For purposes of subsection 23

(a)(29), the term medication-assisted treatment 24



g:\VHLC\092518\092518.308.xml (706790|2)

50

(A) means all drugs approved under sec-1

tion 505 of the Federal Food, Drug, and Cos-2

metic Act (21 U.S.C. 355), including metha-3

done, and all biological products licensed under 4

section 351 of the Public Health Service Act 5

(42 U.S.C. 262) to treat opioid use disorders; 6

and 7

(B) includes, with respect to the provision 8

of such drugs and biological products, coun-9

seling services and behavioral therapy. 10

(2) EXCEPTION.The provisions of paragraph 11

(29) of subsection (a) shall not apply with respect to 12

a State for the period specified in such paragraph, 13

if before the beginning of such period the State cer-14

tifies to the satisfaction of the Secretary that imple-15

menting such provisions statewide for all individuals 16

eligible to enroll in the State plan (or waiver of the 17

State plan) would not be feasible by reason of a 18

shortage of qualified providers of medication-assisted 19

treatment, or facilities providing such treatment, 20

that will contract with the State or a managed care 21

entity with which the State has a contract under 22

section 1903(m) or under section 1905(t)(3).. 23

(4) EFFECTIVE DATE. 24



g:\VHLC\092518\092518.308.xml (706790|2)

51

(A) IN GENERAL.Subject to subpara-1

graph (B), the amendments made by this sub-2

section shall apply with respect to medical as-3

sistance provided on or after October 1, 2020, 4

and before October 1, 2025. 5

(B) EXCEPTION FOR STATE LEGISLA-6

TION.In the case of a State plan under title 7

XIX of the Social Security Act (42 U.S.C. 1396 8

et seq.) that the Secretary of Health and 9

Human Services determines requires State leg-10

islation in order for the respective plan to meet 11

any requirement imposed by the amendments 12

made by this subsection, the respective plan 13

shall not be regarded as failing to comply with 14

the requirements of such title solely on the 15

basis of its failure to meet such an additional 16

requirement before the first day of the first cal-17

endar quarter beginning after the close of the 18

first regular session of the State legislature that 19

begins after the date of the enactment of this 20

Act. For purposes of the previous sentence, in 21

the case of a State that has a 2-year legislative 22

session, each year of the session shall be consid-23

ered to be a separate regular session of the 24

State legislature. 25



g:\VHLC\092518\092518.308.xml (706790|2)

52 SEC. 1007. CARING RECOVERY FOR INFANTS AND BABIES. 1

(a) STATE PLAN AMENDMENT.Section 1902(a) of 2

the Social Security Act (42 U.S.C. 1396a(a)), as amended 3

by sections 1001 and 1004, is further amended 4

(1) in paragraph (84)(C), by striking and 5

after the semicolon; 6

(2) in paragraph (85), by striking the period at 7

the end and inserting ; and; and 8

(3) by inserting after paragraph (85), the fol-9

lowing new paragraph: 10

(86) provide, at the option of the State, for 11

making medical assistance available on an inpatient 12

or outpatient basis at a residential pediatric recovery 13

center (as defined in subsection (pp)) to infants with 14

neonatal abstinence syndrome.. 15

(b) RESIDENTIAL PEDIATRIC RECOVERY CENTER 16

DEFINED.Section 1902 of such Act (42 U.S.C. 1396a), 17

as amended by sections 1001 and 1004, is further amend-18

ed by adding at the end the following new subsection: 19

(pp) RESIDENTIAL PEDIATRIC RECOVERY CENTER 20

DEFINED. 21

(1) IN GENERAL.For purposes of section 22

1902(a)(86), the term residential pediatric recovery 23

center means a center or facility that furnishes 24

items and services for which medical assistance is 25

available under the State plan to infants with the di-26



g:\VHLC\092518\092518.308.xml (706790|2)

53

agnosis of neonatal abstinence syndrome without any 1

other significant medical risk factors. 2

(2) COUNSELING AND SERVICES.A residen-3

tial pediatric recovery center may offer counseling 4

and other services to mothers (and other appropriate 5

family members and caretakers) of infants receiving 6

treatment at such centers if such services are other-7

wise covered under the State plan under this title or 8

under a waiver of such plan. Such other services 9

may include the following: 10

(A) Counseling or referrals for services. 11

(B) Activities to encourage caregiver-in-12

fant bonding. 13

(C) Training on caring for such infants.. 14

(c) EFFECTIVE DATE.The amendments made by 15

this section take effect on the date of enactment of this 16

Act and shall apply to medical assistance furnished on or 17

after that date, without regard to final regulations to carry 18

out such amendments being promulgated as of such date. 19

SEC. 1008. PEER SUPPORT ENHANCEMENT AND EVALUA-20

TION REVIEW. 21

(a) IN GENERAL.Not later than 2 years after the 22

date of the enactment of this Act, the Comptroller General 23

of the United States shall submit to the Committee on 24

Energy and Commerce of the House of Representatives, 25



g:\VHLC\092518\092518.308.xml (706790|2)

54

the Committee on Finance of the Senate, and the Com-1

mittee on Health, Education, Labor and Pensions of the 2

Senate a report on the provision of peer support services 3

under the Medicaid program. 4

(b) CONTENT OF REPORT. 5

(1) IN GENERAL.The report required under 6

subsection (a) shall include the following informa-7

tion: 8

(A) Information on State coverage of peer 9

support services under Medicaid, including 10

(i) the mechanisms through which 11

States may provide such coverage, includ-12

ing through existing statutory authority or 13

through waivers; 14

(ii) the populations to which States 15

have provided such coverage; 16

(iii) the payment models, including 17

any alternative payment models, used by 18

States to pay providers of such services; 19

and 20

(iv) where available, information on 21

Federal and State spending under Med-22

icaid for peer support services. 23

(B) Information on selected State experi-24

ences in providing medical assistance for peer 25

amendment to the senate amendment to · sec. 5052. state option to provide medicaid coverage for...

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