115 HR 6 EH: SUPPORT for Patients and Communities Act
U.S. House of Representatives
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EN
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1.Short title; table of contents
(a)This Act may be cited as the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act
or the SUPPORT for Patients and Communities Act
. (b)The table of contents for 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. Drug management program for at-risk beneficiaries.
Sec. 1005. Medicaid drug review and utilization.
Sec. 1006. Guidance to improve care for infants with neonatal abstinence syndrome and their mothers; GAO study on gaps in Medicaid coverage for pregnant and postpartum women with substance use disorder.
Sec. 1007. Medicaid health homes for opioid-use-disorder Medicaid enrollees.
Title II—Medicare Provisions to Address the Opioid Crisis
Sec. 2001. Authority not to apply certain Medicare telehealth requirements in the case of certain treatment of a substance use disorder or co-occurring mental health disorder.
Sec. 2002. Encouraging the use of non-opioid analgesics for the management of post-surgical pain.
Sec. 2003. Requiring a review of current opioid prescriptions for chronic pain and screening for opioid use disorder to be included in the Welcome to Medicare initial preventive physical examination.
Sec. 2004. Modification of payment for certain outpatient surgical services.
Sec. 2005. Requiring e-prescribing for coverage of covered part D controlled substances.
Sec. 2006. Requiring prescription drug plan sponsors under Medicare to establish drug management programs for at-risk beneficiaries.
Sec. 2007. Medicare coverage of certain services furnished by opioid treatment programs.
Title III—Other Health Provisions to Address the Opioid Crisis
Sec. 3001. Clarifying FDA regulation of non-addictive pain and addiction therapies.
Sec. 3002. Surveillance and Testing of Opioids to Prevent Fentanyl Deaths.
Sec. 3003. Allowing for more flexibility with respect to medication-assisted treatment for opioid use disorders.
Sec. 3004. High-quality, evidence-based opioid analgesic prescribing guidelines and report.
Sec. 3005. Report on opioids prescribing practices for pregnant women.
Sec. 3006. Guidelines for prescribing naloxone.
Sec. 3007. Requiring a survey of substance use disorder treatment providers receiving Federal funding.
Title IV—Offsets
Sec. 4001. Promoting value in Medicaid managed care.
Sec. 4002. Extending period of application of Medicare secondary payer rules for individuals with end stage renal disease.
Sec. 4003. Requiring reporting by group health plans of prescription drug coverage information for purposes of identifying primary payer situations under the Medicare program.
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 diseases requirements and practices under Medicaid.
Subtitle C—CHIP Mental Health 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 community 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.
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 certified electronic health record technology.
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. Short title.
Sec. 6022. Provision of information regarding opioid use and pain management as part of Medicare & You handbook.
Subtitle D—Opioid 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 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. Medicare notifications to outlier prescribers of opioids.
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, adverse 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 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 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. 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 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 K—Stop Excessive Narcotics in our Retirement Communities Protection
Sec. 6101. Short title.
Sec. 6102. Suspension of payments by Medicare prescription drug plans and MA–PD plans pending investigations of credible allegations of fraud by pharmacies.
Subtitle L—Providing Reliable Options for Patients and Educational Resources
Sec. 6111. Short title.
Sec. 6112. 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. 6113. Requiring Medicare Advantage plans and prescription drug plans to provide information on the safe disposal of prescription drugs.
Sec. 6114. Revising measures used under the Hospital Consumer Assessment of Healthcare Providers and Systems survey relating to pain management.
Title VII—Other Health Provisions
Subtitle A—Synthetic Drug Awareness
Sec. 7001. Short title.
Sec. 7002. Report on effects on public health of synthetic drug use.
Subtitle B—Empowering Pharmacists in the Fight Against Opioid Abuse
Sec. 7011. Short title.
Sec. 7012. Programs and materials for training on certain circumstances under which a pharmacist may decline to fill a prescription.
Subtitle C—Indexing Narcotics, Fentanyl, and Opioids
Sec. 7021. Short title.
Sec. 7022. Establishment of substance use disorder information dashboard.
Sec. 7023. Interagency Substance Use Disorder Coordinating Committee.
Subtitle D—Ensuring Access to Quality Sober Living
Sec. 7031. Short title.
Sec. 7032. National recovery housing best practices.
Subtitle E—Advancing Cutting Edge Research
Sec. 7041. Short title.
Sec. 7042. Unique research initiatives.
Subtitle F—Jessie’s Law
Sec. 7051. Short title.
Sec. 7052. Inclusion of opioid addiction history in patient records.
Sec. 7053. Communication with families during emergencies.
Subtitle G—Safe Disposal of Unused Medication
Sec. 7061. Short title.
Sec. 7062. Disposal of controlled substances of a deceased hospice patient by employees of a qualified hospice program.
Subtitle H—Substance Use Disorder Workforce Loan Repayment
Sec. 7071. Short title.
Sec. 7072. Loan repayment program for substance use disorder treatment employees.
Subtitle I—Preventing Overdoses While in Emergency Rooms
Sec. 7081. Short title.
Sec. 7082. Program to support emergency room discharge and care coordination for drug overdose patients.
Subtitle J—Alternatives to Opioids in the Emergency Department
Sec. 7091. Short title.
Sec. 7092. Emergency department alternatives to opioids demonstration program.
Subtitle K—Stop Counterfeit Drugs by Regulating and Enhancing Enforcement Now
Sec. 7101. Short title.
Sec. 7102. Detention, refusal, and destruction of drugs offered for importation.
Sec. 7103. Notification, nondistribution, and recall of adulterated or misbranded drug products.
Sec. 7104. Single source pattern of shipments of adulterated or misbranded drugs.
Sec. 7105. Fund to strengthen efforts of FDA to combat the opioid and substance use epidemic.
Sec. 7106. Consideration of potential for misuse and abuse required for drug approval.
Subtitle L—Treatment, Education, and Community Help to Combat Addiction
Sec. 7111. Short title.
Sec. 7112. Establishment of Regional Centers of Excellence in Substance Use Disorder Education.
Subtitle M—Guidance from National Mental Health and Substance Use Policy Laboratory
Sec. 7121. Guidance from National Mental Health and Substance Use Policy Laboratory.
Subtitle N—Comprehensive Opioid Recovery Centers
Sec. 7131. Short title.
Sec. 7132. Comprehensive opioid recovery centers.
Subtitle O—Poison Center Network Enhancement
Sec. 7141. Short title.
Sec. 7142. Reauthorization of poison control centers national toll-free number.
Sec. 7143. Reauthorization of nationwide public awareness campaign to promote poison control center utilization.
Sec. 7144. Reauthorization of the poison control center grant program.
Subtitle P—Eliminating Opioid Related Infectious Diseases
Sec. 7151. Short title.
Sec. 7152. Reauthorization and expansion of program of surveillance and education regarding infections associated with illicit drug use and other risk factors.
Subtitle Q—Better Pain Management Through Better Data
Sec. 7161. Short title.
Sec. 7162. Guidance addressing alternative approaches to data collection and labeling claims for opioid sparing.
Subtitle R—Special Registration for Telemedicine Clarification
Sec. 7171. Short title.
Sec. 7172. Deadline for interim final regulations for a special registration To engage in the practice of telemedicine.
Subtitle S—Peer Support Communities of Recovery
Sec. 7181. Short title.
Sec. 7182. Building communities of recovery.
Subtitle T—Stop Illicit Drug Importation
Sec. 7191. Short title.
Sec. 7192. Detention, refusal, and destruction of drugs offered for importation.
Sec. 7193. Seizure.
Sec. 7194. Debarring violative individuals or companies.
Subtitle U—Creating Opportunities that Necessitate New and Enhanced Connections That Improve Opioid Navigation Strategies
Sec. 7201. Short title.
Sec. 7202. Preventing overdoses of controlled substances.
Sec. 7203. Prescription drug monitoring program.
Subtitle V—Securing Opioids and Unused Narcotics with Deliberate Disposal and Packaging
Sec. 7211. Short title.
Sec. 7212. Improved technologies, controls, or measures with respect to the packaging or disposal of certain drugs.
Subtitle W—Postapproval study requirements
Sec. 7221. Postapproval study requirements.
Title VIII—Miscellaneous
Subtitle A—Synthetics Trafficking and Overdose Prevention
Sec. 8001. Short title; table of contents.
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 requirements and falsity or lack of manifest.
Sec. 8009. Effective date; regulations.
Subtitle B—Recognizing Early Childhood Trauma Related to Substance Abuse
Sec. 8011. Short title.
Sec. 8012. Recognizing Early Childhood Trauma Related to Substance Abuse.
Subtitle C—Assisting States’ Implementation of Plans of Safe Care
Sec. 8021. Short title.
Sec. 8022. Assisting States with implementation of plans of safe care.
Subtitle D—Improving the Federal Response to Families Impacted by Substance Use Disorder
Sec. 8031. Short title.
Sec. 8032. Interagency Task Force to Improve the Federal Response to Families Impacted by Substance Use Disorders.
Subtitle E—Establishment of an Advisory Committee on Opioids and the Workplace
Sec. 8041. Establishment of an Advisory Committee on Opioids and the Workplace.
Subtitle F—Veterans Treatment Court Improvement
Sec. 8051. Short title.
Sec. 8052. Hiring by Department of Veterans Affairs of additional Veterans Justice Outreach Specialists.
Subtitle G—Peer support counseling program for women veterans
Sec. 8061. Peer support counseling program for women veterans.
Subtitle H—Treating Barriers to Prosperity
Sec. 8071. Short title.
Sec. 8072. Drug abuse mitigation initiative.
Subtitle I—Supporting Grandparents Raising Grandchildren
Sec. 8081. Short title.
Sec. 8082. Findings.
Sec. 8083. Advisory Council To Support Grandparents Raising Grandchildren.
Sec. 8084. Definitions.
Subtitle J—Reauthorizing and Extending Grants for Recovery from Opioid Use Programs
Sec. 8091. Short title.
Sec. 8092. Reauthorization of the comprehensive opioid abuse grant program.
Title IX—SITSA Act
Sec. 9001. Short title.
Sec. 9002. Establishment of schedule A.
Sec. 9003. Temporary and permanent scheduling of schedule A substances.
Sec. 9004. Penalties.
Sec. 9005. False labeling of schedule A controlled substances.
Sec. 9006. Registration requirements for handlers of schedule A substances.
Sec. 9007. Additional conforming amendments.
Sec. 9008. Controlled substance analogues.
Sec. 9009. Rules of construction.
Sec. 9010. Study by Comptroller General.
Sec. 9011. Report on controlled substance analogues sold by means of the Internet.
Sec. 9012. Controlled substance analogues.
Title X—THRIVE Act
Sec. 10001. Short title.
Sec. 10002. Demonstration program to study the impact of using rental vouchers for supportive housing for individuals recovering from opioid use disorders or other substance use disorders.
Sec. 10003. Repeal of Rental Voucher Demonstration Program.
Sec. 10004. Demonstration Close-Out.
Sec. 10005. No additional funds authorized.
Title XI—IMD CARE Act
Sec. 11001. Short title.
Sec. 11002. Medicaid State plan option to provide services for certain individuals with targeted SUDs in institutions for mental diseases.
Sec. 11003. Promoting value in Medicaid managed care.
<enum>I</enum><header>Medicaid Provisions to Address the Opioid Crisis</header>
<section id="H39595BF93B7F4488B8A72A3788584EEE"><enum>1001.</enum><header>At-risk youth Medicaid protection</header>
<subsection id="H501D2ED14AD04B4BB7463614BCBAF2A5"><enum>(a)</enum><header>In general</header><text>Section 1902 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a</external-xref>) is amended—</text> <paragraph id="H1D1661C15D634D82B68490EA94352504"><enum>(1)</enum><text>in subsection (a)—</text>
<subparagraph id="HE6B04330AA0B4508A3A25DA3B9BC32E6"><enum>(A)</enum><text>by striking <quote>and</quote> at the end of paragraph (82);</text></subparagraph> <subparagraph id="HD7F27663443B4A7C8F1E3E1CFA3F2D33"><enum>(B)</enum><text>by striking the period at the end of paragraph (83) and inserting <quote>; and</quote>; and</text></subparagraph>
<subparagraph id="HE783F46B033F4569BD1C66C8A61C7C0B"><enum>(C)</enum><text>by inserting after paragraph (83) the following new paragraph:</text> <quoted-block id="HAED5C953056F46EAA92EE9BAFE242389" style="OLC"> <paragraph display-inline="no-display-inline" id="H89C6FC869D8848B8BE9A4E7FF9F99D6D"><enum>(84)</enum><text>provide that—</text>
<subparagraph id="H1D837A3DA0194E87AF5A0BB520709EF3"><enum>(A)</enum><text display-inline="yes-display-inline">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;</text></subparagraph> <subparagraph id="H092FCB0974DB4C99A2915512020BE3B2"><enum>(B)</enum><text display-inline="yes-display-inline">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 redetermination 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</text></subparagraph>
<subparagraph id="H845F6330B9324BF69BFE792891FDC910" commented="no"><enum>(C)</enum><text display-inline="yes-display-inline">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 assistance 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 institution.</text></subparagraph></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph> <paragraph id="H549FDA6F3F074EF3BA80A9CB09032ABF"><enum>(2)</enum><text>by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HFD4E6A8EAA1F4C2EA3BBB875B8320611" style="OLC">
<subsection id="H800AD0839CF14C6E87F2B267A110AFBB"><enum>(nn)</enum><header>Juvenile; eligible juvenile; public institution</header><text display-inline="yes-display-inline">For purposes of subsection (a)(84) and this subsection:</text> <paragraph id="HC21C6CEF78CE4AEBA6C910A3C5B1F2D0"><enum>(1)</enum><header>Juvenile</header><text>The term <term>juvenile</term> means an individual who is—</text>
<subparagraph id="HCF7806B8EBB346F5BBA20A58C00028B6"><enum>(A)</enum><text>under 21 years of age; or</text></subparagraph> <subparagraph id="H3C40289F5CC048EFB4A21E99B4B3F030"><enum>(B)</enum><text display-inline="yes-display-inline">described in subsection (a)(10)(A)(i)(IX).</text></subparagraph></paragraph>
<paragraph id="HDD5F49B9349F4E139766F5F09ADADA23"><enum>(2)</enum><header>Eligible juvenile</header><text display-inline="yes-display-inline">The term <term>eligible juvenile</term> means a juvenile who is an inmate of a public institution and who—</text> <subparagraph id="HDCC572ED9C5C45E1B1B79969603D251C"><enum>(A)</enum><text>was determined eligible for medical assistance under the State plan immediately before becoming an inmate of such a public institution; or</text></subparagraph>
<subparagraph id="H9DB1C3B460BC42B2B40ED5DCD3E89F43"><enum>(B)</enum><text>is determined eligible for such medical assistance while an inmate of a public institution.</text></subparagraph></paragraph> <paragraph id="HC842517D3C614BDE97AEE276E715B85B"><enum>(3)</enum><header>Inmate of a public institution</header><text display-inline="yes-display-inline">The term <term>inmate of a public institution</term> has the meaning given such term for purposes of applying the subdivision (A) following paragraph (29) of section 1905(a), taking into account the exception in such subdivision for a patient of a medical institution.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection>
<subsection commented="no" id="H5CCC2F015B41448D82EAABA6F68C3006"><enum>(b)</enum><header>No change in exclusion from medical assistance for inmates of public institutions</header><text>Nothing in this section shall be construed as changing the exclusion from medical assistance under the subdivision (A) following paragraph (29) of section 1905(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(a)</external-xref>), including any applicable restrictions on a State submitting claims for Federal financial participation under title XIX of such Act for such assistance.</text></subsection> <subsection id="H4F16046045BF4F35AB09E5A444EDDE71"><enum>(c)</enum><header>No change in continuity of eligibility before adjudication or sentencing</header><text display-inline="yes-display-inline">Nothing in this section shall be construed to mandate, encourage, or suggest that a State suspend or terminate coverage for individuals before they have been adjudicated or sentenced.</text></subsection>
<subsection id="H75DF63DA28364C1F9E1CDBE53AB98DA7"><enum>(d)</enum><header>Effective date</header>
<paragraph id="HC3EAD413D7494607BC321B13B29A7321"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph> <paragraph id="HF92BCEA25ADD4602A4871AB9A50592E8"><enum>(2)</enum><header>Rule for changes requiring state legislation</header><text>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 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.</text></paragraph></subsection></section>
<section id="H78D56ACC710840DBB89AB914F2612A70"><enum>1002.</enum><header>Health Insurance for Former Foster Youth</header>
<subsection id="H41CCB818C83D47D28083E8B10D4278CA"><enum>(a)</enum><header>Coverage continuity for former foster care children up to age 26</header>
<paragraph id="H292DE68274164C639D675370A4FEFF1E"><enum>(1)</enum><header>In general</header><text>Section 1902(a)(10)(A)(i)(IX) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(10)(A)(i)(IX)</external-xref>) is amended—</text> <subparagraph id="H86E19E62EBB24476B0D90030F5D3DC7E"><enum>(A)</enum><text>in item (bb), by striking <quote>are not described in or enrolled under</quote> and inserting <quote>are not described in and are not enrolled under</quote>;</text></subparagraph>
<subparagraph id="H4CE9267A188544938BC494472AFDF956"><enum>(B)</enum><text>in item (cc), by striking <quote>responsibility of the State</quote> and inserting <quote>responsibility of a State</quote>; and</text></subparagraph> <subparagraph id="H69527D8D44144C0FAE745B195916E4F7"><enum>(C)</enum><text>in item (dd), by striking <quote>the State plan under this title or under a waiver of the</quote> and inserting <quote>a State plan under this title or under a waiver of such a</quote>.</text></subparagraph></paragraph>
<paragraph id="HC19F4E71E1F0469D925A18071DC2366D" commented="no" display-inline="no-display-inline"><enum>(2)</enum><header>Effective date</header><text>The amendments made by this subsection shall take effect with respect to foster youth who attain 18 years of age on or after January 1, 2023.</text></paragraph></subsection> <subsection id="HDA31A180DC0E4F4590183778746C92D5"><enum>(b)</enum><header>Guidance</header><text>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—</text>
<paragraph id="HC85709BA1CA24C79B70B999C7A609D0B"><enum>(1)</enum><text>on best practices for—</text> <subparagraph id="H9B66C8EC19E446649E7116C414389173"><enum>(A)</enum><text>removing barriers and ensuring streamlined, timely access to Medicaid coverage for former foster youth up to age 26; and</text></subparagraph>
<subparagraph id="HFE2528EACFBB4375A6C62E62438ADCD0"><enum>(B)</enum><text>conducting outreach and raising awareness among such youth regarding Medicaid coverage options for such youth; and</text></subparagraph></paragraph> <paragraph id="HAFA0A0CA0C0D4BA7B66269D04AE4EBDB"><enum>(2)</enum><text>which shall include examples of States that have successfully extended Medicaid coverage to former foster youth up to age 26.</text></paragraph></subsection></section>
<section id="HA80D36910F304D2CA1A56E821A021926" section-type="subsequent-section"><enum>1003.</enum><header>Demonstration project to increase substance use provider capacity under the Medicaid program</header><text display-inline="no-display-inline">Section 1903 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396b">42 U.S.C. 1396b</external-xref>) is amended by adding at the end the following new subsection:</text> <quoted-block display-inline="no-display-inline" id="H93EDDF3BBC8E40F59133772B58DCFDA0" style="OLC"> <subsection id="H2B83F6E113D44A6A96F958648DBA7B3F"><enum>(aa)</enum><header>Demonstration project to increase substance use provider capacity</header> <paragraph id="H62F6A550A43948A5A11D0360D10680F4"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than the date that is 180 days after the date of the enactment of this section, 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—</text>
<subparagraph id="HA3811C18BF124DA5915B59326834BA14"><enum>(A)</enum><text>for the first 18-month period of such project, award planning grants described in paragraph (3); and</text></subparagraph> <subparagraph id="H4785E98DE7F94BB3A99B1EFB9DD4F959"><enum>(B)</enum><text display-inline="yes-display-inline">for the remaining 36-month period of such project, provide to each State selected under paragraph (4) payments in accordance with paragraph (5).</text></subparagraph></paragraph>
<paragraph id="H3124F0858D35472A88293DC57D25DAF0"><enum>(2)</enum><header>Purpose</header><text>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:</text> <subparagraph commented="no" id="HF3A834DFB54946D3942EE86446612895"><enum>(A)</enum><text display-inline="yes-display-inline">For the purpose described in paragraph (3)(C)(i), activities that support an ongoing assessment of the behavioral health treatment needs of the State, taking into account the matters described in subclauses (I) through (IV) of such paragraph.</text></subparagraph>
<subparagraph commented="no" id="H974E0B3F023741A5AF781964A54B4F7C"><enum>(B)</enum><text display-inline="yes-display-inline">Activities that, taking into account the results of the assessment described in subparagraph (A), support the recruitment, training, and provision of technical assistance for providers participating under the State plan (or a waiver of such plan) that offer substance use disorder treatment or recovery services.</text></subparagraph> <subparagraph commented="no" id="H82E35E0E5F95412BB184C44DB50EEBFB"><enum>(C)</enum><text display-inline="yes-display-inline">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—</text>
<clause commented="no" id="H325631749636448AA33EEF6172CAB123"><enum>(i)</enum><text>are authorized to dispense drugs approved by the Food and Drug Administration for individuals with a substance use disorder who need withdrawal management or maintenance treatment for such disorder;</text></clause> <clause commented="no" id="HE917C17A62954D82A0E941A68BE3DAB1"><enum>(ii)</enum><text>have in effect a registration or waiver under section 303(g) of the Controlled Substances Act for purposes of dispensing narcotic drugs to individuals for maintenance treatment or detoxification treatment and are in compliance with any regulation promulgated by the Assistant Secretary for Mental Health and Substance Use for purposes of carrying out the requirements of such section 303(g); and</text></clause>
<clause commented="no" id="H0B3F2D102A31496681E38D32EB31E3FC"><enum>(iii)</enum><text>are qualified under applicable State law to provide substance use disorder treatment or recovery services.</text></clause></subparagraph> <subparagraph commented="no" id="HF0FD3C6F009C4631B62675AC9AD0B5B0"><enum>(D)</enum><text display-inline="yes-display-inline">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—</text>
<clause commented="no" id="HD2024B450DA841C584BC7237C53F59FB"><enum>(i)</enum><text>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;</text></clause> <clause commented="no" id="H821F2D69FBA041D3ABDB039188CD4A73"><enum>(ii)</enum><text>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);</text></clause>
<clause commented="no" id="H65F1E744BCF84E00828346916EE639BF"><enum>(iii)</enum><text>adolescents and young adults between the ages of 12 and 21 enrolled under the State plan (or a waiver of such plan); or</text></clause> <clause commented="no" id="H8160EAF7AB1044549EA94CE15827D352"><enum>(iv)</enum><text>American Indian and Alaska Native individuals enrolled under the State plan (or a waiver of such plan).</text></clause></subparagraph></paragraph>
<paragraph id="H6BA4D0F413384766A29017021F06AF74"><enum>(3)</enum><header>Planning grants</header>
<subparagraph id="HF309ADD6F49F41D19FEC8F95841D4A29" commented="no"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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).</text></subparagraph> <subparagraph id="HA99D74E1820040CEABACCDF8308BDA30"><enum>(B)</enum><header>Selection</header><text>In selecting States for purposes of this paragraph, the Secretary shall—</text>
<clause id="HABCB3085AED54C46B8FBA23415E6C64D"><enum>(i)</enum><text display-inline="yes-display-inline">select States that have a State plan (or waiver of the State plan) approved under this title;</text></clause> <clause id="H350B6AB54B4C426DB2E152AEBF07643A"><enum>(ii)</enum><text>select States in a manner that ensures geographic diversity; and</text></clause>
<clause id="HC94F975A00EF4490A9E99081F6F9D1C4"><enum>(iii)</enum><text display-inline="yes-display-inline">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.</text></clause></subparagraph> <subparagraph id="HAD915B94C8B64EBE8278ED3797186461"><enum>(C)</enum><header>Activities described</header><text>Activities described in this subparagraph are, with respect to a State, each of the following:</text>
<clause id="HA62E9E8246704B9187576B45CB0130C5" commented="no" display-inline="no-display-inline"><enum>(i)</enum><text display-inline="yes-display-inline">Activities that support the development of an initial assessment of the behavioral health treatment needs of the State to determine the extent to which providers are needed (including the types of such providers and geographic area of need) to improve the network of providers that treat substance use disorders under the State plan (or waiver), including the following:</text> <subclause id="H033AAAE2AC734F958B3A75FB499C58CA" commented="no"><enum>(I)</enum><text>An estimate of the number of individuals enrolled under the State plan (or a waiver of such plan) who have a substance use disorder.</text></subclause>
<subclause id="H57D05FF285E74079B91A3C194AA6DC05" commented="no"><enum>(II)</enum><text>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).</text></subclause> <subclause id="HA36BA50E40014A4FBE21B6C6F6FA520D" commented="no"><enum>(III)</enum><text>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).</text></subclause>
<subclause id="HC2CA1AC81E39423D8E6F7938CFDD196B" commented="no"><enum>(IV)</enum><text>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.</text></subclause></clause> <clause id="H049A3E579F304D4A886450399A2DB700"><enum>(ii)</enum><text>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.</text></clause></subparagraph>
<subparagraph id="HC2487A9B635842FDB04BECF761C700E3" commented="no"><enum>(D)</enum><header>Funding</header><text>For purposes of subparagraph (A), there is appropriated, out of any funds in the Treasury not otherwise appropriated, $50,000,000, to remain available until expended.</text></subparagraph></paragraph> <paragraph id="HBCECAD67AFF64D47A50A4560EDB2E736"><enum>(4)</enum><header>Post-planning States</header> <subparagraph id="H21EDE969186A4A5A980936D253406BF8"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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 paragraph (2) and receiving payments in accordance with paragraph (5).</text></subparagraph>
<subparagraph id="HAA929F1C81D443E1B0727D3E655C9213"><enum>(B)</enum><header>Selection</header><text display-inline="yes-display-inline">In selecting States for purposes of this paragraph, the Secretary shall—</text> <clause id="H219C44BF3DCA4ECBBD9CB8430EF6F354"><enum>(i)</enum><text>select States that received a planning grant under paragraph (3);</text></clause>
<clause id="H47BC23D6611D4AABBE14FF5C08D19C21"><enum>(ii)</enum><text>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;</text></clause> <clause id="H7096AF85EE2F48CA8349267AACBB47D5"><enum>(iii)</enum><text>select States in a manner that ensures geographic diversity; and</text></clause>
<clause commented="no" id="HE9C20EFEC3694D5FB42BBDCCE5D5C357"><enum>(iv)</enum><text>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.</text></clause></subparagraph> <subparagraph commented="no" id="HFBB7FD4A73DA45C7A5BC127113EFAB3D"><enum>(C)</enum><header>Applications</header> <clause id="H0AD5BC0AE7184B189A9016F824102507"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">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:</text>
<subclause id="HF36910C71F7747469735101104DD0DE1" commented="no"><enum>(I)</enum><text display-inline="yes-display-inline">A proposed process for carrying out the ongoing assessment described in paragraph (2)(A), taking into account the results of the initial assessment described in paragraph (3)(C)(i).</text></subclause> <subclause id="H2C5C335849F64D78B928817D5126A6F0" commented="no"><enum>(II)</enum><text>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.</text></subclause>
<subclause id="H07E279E678C54BC39BF69555C633640E" commented="no"><enum>(III)</enum><text>The development of a plan, taking into account activities carried out under paragraph (3)(C)(ii), that will result in long-term and sustainable provider networks under the State plan (or waiver) that will offer a continuum of care for substance use disorders. Such plan shall include the following:</text> <item id="H6AB43081B7E14955BD5B32AE4493BF13" commented="no"><enum>(aa)</enum><text display-inline="yes-display-inline">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 community behavioral health clinics) that offer substance use disorder treatment, recovery, or support services, including short-term detoxification services, outpatient substance use disorder services, and evidence-based peer recovery services.</text></item>
<item id="H0A5B938C27EA4BFCB5F8042922E9A63B" commented="no"><enum>(bb)</enum><text display-inline="yes-display-inline">Strategies that will incentivize providers 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.</text></item> <item id="H339DCCDF13F94216963AB4B7B85E3BE6" commented="no"><enum>(cc)</enum><text>Milestones and timeliness for implementing activities set forth in the plan.</text></item>
<item id="HF17D23AC4EAC4B63BC05165E19988601" commented="no"><enum>(dd)</enum><text>Specific measurable targets for increasing the substance use disorder treatment and recovery provider network under the State plan (or a waiver of such plan).</text></item></subclause> <subclause id="H8509DCE9C44D4F86BF3AD700301B3B61" commented="no"><enum>(IV)</enum><text>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 treatment or recovery services during the period of the demonstration project under this subsection.</text></subclause>
<subclause id="H68A4BD1EF39043E0BC1F01E0FA77883B" commented="no"><enum>(V)</enum><text>The expected financial impact of the demonstration project under this subsection on the State.</text></subclause> <subclause id="H17B2BD6BE27C436D939DEF857BDAA75E"><enum>(VI)</enum><text>A description of all funding sources available to the State to provide substance use disorder treatment or recovery services in the State.</text></subclause>
<subclause id="HE175578888D142278D053FEEA9833F34"><enum>(VII)</enum><text>A preliminary plan for how the State will sustain any increase in the capacity of providers to deliver substance use disorder treatment or recovery services resulting from the demonstration project under this subsection after the termination of such demonstration project.</text></subclause> <subclause id="HAE19967E62244A7D817AFE5A253BFC7C"><enum>(VIII)</enum><text display-inline="yes-display-inline">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.</text></subclause></clause>
<clause id="H76D26B18303142FF9D351D77CE03C594"><enum>(ii)</enum><header>Consultation</header><text>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 advocates, and include in such application a description of such consultation.</text></clause></subparagraph></paragraph> <paragraph id="H87A327E1AFD84FDCB41457296B93F622"><enum>(5)</enum><header>Payment</header> <subparagraph id="H95E065919B4C47C282EBC8185AA77407" commented="no"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph id="HBBB6B7B95B5D41FD974AB47865720C19"><enum>(B)</enum><header>Qualified sums defined</header><text>For purposes of subparagraph (A), the term <term>qualified sums</term> 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 treatment or recovery services furnished by providers 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 treatment or recovery services.</text></subparagraph> <subparagraph id="H79FA703860B245F5B1EE8AD754D1ADAD" commented="no"><enum>(C)</enum><header>Non-duplication of payment</header><text display-inline="yes-display-inline">In the case that payment is made under subparagraph (A) with respect to expenditures for substance use 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.</text></subparagraph></paragraph>
<paragraph id="HE6306C1AF3C843508CEF104D7B1F01A0"><enum>(6)</enum><header>Reports</header>
<subparagraph id="H7F6BAB010FEF43C1B084D53D0D3168CE"><enum>(A)</enum><header>State reports</header><text display-inline="yes-display-inline">A State receiving payments under paragraph (5) shall, for the period of the demonstration project under this subsection, submit to the Secretary a quarterly report, with respect to expenditures for substance use treatment or recovery services for which payment is made to the State under this subsection, on the following:</text> <clause commented="no" id="H63C51A51EC3A4318B7BD7348901C48E6"><enum>(i)</enum><text display-inline="yes-display-inline">The specific activities with respect to which payment under this subsection was provided.</text></clause>
<clause commented="no" id="H3FA314940283405CBF5DF4DB26A118C6"><enum>(ii)</enum><text>The number of providers that delivered substance 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.</text></clause> <clause commented="no" id="HD753B1FCDD71449F84611BA5C3437628"><enum>(iii)</enum><text>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 estimated number of such individuals who would have otherwise received such services in the absence of such demonstration project.</text></clause>
<clause id="H9CAEBED53A9249A380C8A1045B1F93D8"><enum>(iv)</enum><text display-inline="yes-display-inline">Other matters as determined by the Secretary.</text></clause></subparagraph> <subparagraph commented="no" id="H748CE7255336470C82D5263FFA91FCD4"><enum>(B)</enum><header>CMS reports</header> <clause id="HB0CB769978A84F97999E7B270E74DA0A"><enum>(i)</enum><header>Initial report</header><text display-inline="yes-display-inline">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—</text>
<subclause id="H2A7460C0CEA346B198A36034DAEF4439"><enum>(I)</enum><text>the States awarded planning grants under paragraph (3);</text></subclause> <subclause id="H5AB4808ACFED4C028491F464ED7EC3C4"><enum>(II)</enum><text>the criteria used in such selection; and</text></subclause>
<subclause id="HF4D8ECDCBC144DBE8158F91B65916323"><enum>(III)</enum><text>the activities carried out by such States under such planning grants.</text></subclause></clause> <clause commented="no" id="HCC9A7D96088D4E6FA596E3028EBE339C"><enum>(ii)</enum><header>Interim report</header><text display-inline="yes-display-inline">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—</text>
<subclause id="HB211B56C043142A3AC6F1A16516206D5"><enum>(I)</enum><text>on activities carried out under the demonstration project under this subsection;</text></subclause> <subclause id="HE63B8EF652D84AED8EDE54BA90EFBC29" commented="no"><enum>(II)</enum><text>on the extent to which States selected under paragraph (4) have achieved the stated goals submitted in their applications under subparagraph (C) of such paragraph;</text></subclause>
<subclause id="HF8629E2F7DD54828B05E159E19810DCA"><enum>(III)</enum><text>with a description of the strengths and limitations of such demonstration project; and</text></subclause> <subclause id="H61B3873AAA3A4183AE094D6174FF03AA"><enum>(IV)</enum><text>with a plan for the sustainability of such project.</text></subclause></clause>
<clause commented="no" id="H1C8B6366EA16453F83F14114A2FAC63D"><enum>(iii)</enum><header>Final report</header><text display-inline="yes-display-inline">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—</text> <subclause id="H139912A7CA5744488D21C2EFD397A965"><enum>(I)</enum><text>providing updates on the matters reported in the interim report under clause (ii);</text></subclause>
<subclause id="HE049AF8AAA244F1995FCE41F21A27B27"><enum>(II)</enum><text>including a description of any changes made with respect to the demonstration project under this subsection after the submission of such interim report; and</text></subclause> <subclause id="H80E050E2DBA344CE9A0E7E2F3669C110"><enum>(III)</enum><text>evaluating such demonstration project.</text></subclause></clause></subparagraph>
<subparagraph id="HECD960B019D743F9A2EEA151635A29A8"><enum>(C)</enum><header>AHRQ report</header><text>Not later than 3 years after the date of the enactment of this subsection, the Director of the Agency for Healthcare Research and Quality, on consultation with the Administrator of the Centers for Medicare & Medicaid Services, shall submit to Congress a summary on the experiences of States awarded planning grants under paragraph (3) and States selected under paragraph (4).</text></subparagraph></paragraph> <paragraph id="H22F35E48B019437C9947F8CC8ADD38DE" commented="no"><enum>(7)</enum><header>Data sharing and best practices</header><text>During the period of the demonstration project under this subsection, the Secretary shall, in collaboration with States selected under paragraph (4), facilitate data sharing and the development of best practices between such States and States that were not so selected.</text></paragraph>
<paragraph id="HE1345A375C2D433BAB8D9BCE52B9828E"><enum>(8)</enum><header>CMS funding</header><text display-inline="yes-display-inline">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.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></section> <section id="HFAECB059BF704405804196AC78078286" section-type="subsequent-section"><enum>1004.</enum><header>Drug management program for at-risk beneficiaries</header> <subsection id="H838C25FA6230451F851C539DEE7EF8B1"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Title XIX of the Social Security Act is amended by inserting after section 1927 (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-8">42 U.S.C. 1396r–8</external-xref>) the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H66431B6EAE244C32BAB8697FEC44587A" style="OLC">
<section id="HF208499EEE8543BF9E778DD88921F36D"><enum>1927A.</enum><header>Drug management program for at-risk beneficiaries</header>
<subsection id="HDA3460BD5C1B4DD7B38F9DF51CB6E235"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Beginning January 1, 2020, a State shall operate a qualified drug management program under which a State may enroll certain at-risk beneficiaries identified by the State under the program.</text></subsection> <subsection id="HA7FE70F0D02743F791954E7E822CAC95"><enum>(b)</enum><header>Qualified drug management program</header><text>For purposes of this section, the term <term>qualified drug management program</term> means, with respect to a State, a program carried out by the State (including through a contract with a pharmacy benefit manager) that provides at least for the following:</text>
<paragraph id="HF887A267FC5C458281F58765C25884BF"><enum>(1)</enum><header>Identification of at-risk individuals</header><text>Under the program, the State identifies, in accordance with subsection (c), individuals enrolled under the State plan (or waiver of the State plan) who are at-risk beneficiaries.</text></paragraph> <paragraph id="H01992A2C72714F72A7A795FA633DE190"><enum>(2)</enum><header>Elements of program</header> <subparagraph id="HAE312062BA204DBA95D0F0A7394DBCAB"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Under the program, the State, with respect to each individual identified under paragraph (1) and enrolled under the program under paragraph (5)—</text>
<clause id="HCDDFEA2F82EA4870ACD0D2B6B7432BFC"><enum>(i)</enum><text display-inline="yes-display-inline">subject to subparagraphs (B) and (C), selects at least one, but not more than three, health care providers and at least one, but not more than three, pharmacies for each such individual for purposes of clause (ii), in accordance with a selection process that takes into account reasonable factors such as the individual’s previous utilization of items and services from health care providers and pharmacies, geographic proximity of the individual to such health care providers and pharmacies, access of the individual to health care, reasonable travel time, information regarding housing status, and any known preference of the individual for a certain health care provider or pharmacy; and</text></clause> <clause id="H4DE7DBD3A4194F3F972015FB42E821C7"><enum>(ii)</enum><text>requires that any controlled substance furnished to such individual during the period for which such individual is enrolled under the program be prescribed by a health care provider selected under clause (i) for such individual and dispensed by a pharmacy selected under clause (i) for such individual in order for such controlled substance to be covered under the State plan (or waiver).</text></clause></subparagraph>
<subparagraph id="H4AF5F29A2F9C4F10A46CAB1F7A163BBD"><enum>(B)</enum><header>Beneficiary preference</header><text display-inline="yes-display-inline">In the case of an individual receiving a notice under paragraph (3)(A) of being identified as potentially being an at-risk beneficiary described in such paragraph, such individual may submit, during the 30-day period following receipt of such notice, preferences for which health care providers and pharmacies the individual would prefer the State to select under subparagraph (A). The State shall select or change the selection of health care providers and pharmacies under subparagraph (A) for the individuals based on such preferences, except that in the case that State determines that such selection (or change of selection) of a health care provider or pharmacy under subparagraph (A) is contributing or would contribute to prescription drug abuse or drug diversion by the individual, the State may select or change the selection of health care provider or pharmacy for the individual without regard to the preferences of the individual described in this subparagraph. If the State selects or changes the selection pursuant to the preceding sentence without regard to the preferences of the individual, the State shall provide the individual with at least 30 days written notice of the selection or change of selection and a rationale for the selection or change.</text></subparagraph> <subparagraph id="H286DE20E51AA4E14B85E82C3A5EF3965"><enum>(C)</enum><header>Treatment of pharmacy with multiple locations</header><text display-inline="yes-display-inline">For purposes of subparagraph (A)(i), in the case of a pharmacy that has multiple locations that share real-time electronic prescription data, all such locations of the pharmacy shall collectively be treated as one pharmacy.</text></subparagraph>
<subparagraph commented="no" id="H766A45955BDE4965AE09F59B40935297"><enum>(D)</enum><header>Treatment of existing FFS drug management programs</header><text display-inline="yes-display-inline">In the case of a patient review and restriction program (as identified in the annual report submitted to the Secretary under section 1927(g)(3)(D)) operated by a State pursuant to section 1915(a)(2) before the date of the enactment of this section, such program shall be treated as a qualified drug management program.</text></subparagraph> <subparagraph commented="no" id="H6BD09280FB4C4A26ADD2048C69ED2077"><enum>(E)</enum><header>Reasonable access</header><text>The program shall ensure, including through waiver of elements of the program (including under subparagraph (A)(ii)), reasonable access to health care (including access to health care providers and pharmacies with respect to prescription drugs described in subparagraph (A)) in the case of individuals with multiple residences, 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)).</text></subparagraph></paragraph>
<paragraph id="H675961144E5749E6A01854F047A26FB5"><enum>(3)</enum><header>Notification to identified individuals</header><text>Under the program, the State provides each individual who is identified under paragraph (1), prior to enrolling such individual under the program, at least one notification of each of the following:</text> <subparagraph commented="no" display-inline="no-display-inline" id="H2C17AB1FE9D649368763E3A8EF35EE7A"><enum>(A)</enum><text>Notice that the State has identified the individual as potentially being an at-risk beneficiary for abuse or misuse of a controlled substance.</text></subparagraph>
<subparagraph id="HD0074C983BDC4DF289A8CBC775F91E6F"><enum>(B)</enum><text>The name, address, and contact information of each health care provider and pharmacy that may be selected for the individual under paragraph (2)(A).</text></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="H292BB7FC30A9444EB37351603BBDA047"><enum>(C)</enum><text>Information describing all State and Federal public health resources that are designed to address such abuse or misuse to which the individual has access, including mental health services, substance use disorder and recovery services, and other counseling services.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HB5D52ED59D8A4A148D7F11A310B1B88C"><enum>(D)</enum><text display-inline="yes-display-inline">Notice of, and information about, the right of the individual to—</text> <clause id="HB262FF9EBC834E4EAEFAAA00F43B5439"><enum>(i)</enum><text>submit preferences of the individual for health care providers and pharmacies to be selected under paragraph (2)(A), including as described in paragraph (2)(B);</text></clause>
<clause id="H4E43506935794C38B98A6777DC81C5DE"><enum>(ii)</enum><text>appeal under paragraph (4)—</text> <subclause id="HCD9822F2B7FD41809D63415AC9F830F1"><enum>(I)</enum><text>such identification described in subparagraph (A); and</text></subclause>
<subclause id="HB3CD5366FC6041EC94388195D74E2198"><enum>(II)</enum><text>the selection of health care providers and pharmacies under paragraph (2)(A).</text></subclause></clause></subparagraph> <subparagraph id="HAC57A89477F641FC8E022E68C5312BED"><enum>(E)</enum><text>An explanation of the meaning and consequences of the identification of the individual as potentially being an at-risk beneficiary for abuse or misuse of a controlled substance, including an explanation of the program.</text></subparagraph>
<subparagraph id="H50605E3BE81E4E1EBAF72D2E1C6E14F8"><enum>(F)</enum><text display-inline="yes-display-inline">Information, including a contact list and clear instructions, that explain how the individual can contact the appropriate entities administering the program in order to submit preferences described in paragraph (2)(B) and any other communications relating to the program.</text></subparagraph></paragraph> <paragraph id="H8B37E7F87F264F96B349FB796D1CE694"><enum>(4)</enum><header>Appeals process</header><text display-inline="yes-display-inline">Under the program, the State provides for an appeals process under which, with respect to an individual identified under paragraph (1)—</text>
<subparagraph id="HE546B8E585684DBDB7F98D145F080ACD"><enum>(A)</enum><text>such individual may appeal—</text> <clause id="H838586AF79F643FD9071705A3AC80618"><enum>(i)</enum><text>such identification; and</text></clause>
<clause id="H41ACBC70570442BEB753CACBC11332CE"><enum>(ii)</enum><text display-inline="yes-display-inline">the selection of a health care provider or pharmacy under paragraph (2)(A);</text></clause></subparagraph> <subparagraph commented="no" id="HB8BCD7F9196E4A9D8F2CC9853EA51AA6"><enum>(B)</enum><text display-inline="yes-display-inline">in the case of an appeal described in subparagraph (A)(ii), the State shall accommodate the health care provider or pharmacy preferred by the individual for selection for purposes of paragraph (2)(A), unless the State determines that a change to the selection of health care provider or pharmacy under such paragraph is contributing or would contribute to prescription drug abuse or drug diversion by the individual;</text></subparagraph>
<subparagraph id="H24789927E1454FDC8E085C954BEDBAE3"><enum>(C)</enum><text>such individual is provided a period of not less than 30 days following the date of receipt of the notice described in paragraph (3) to submit such appeal; and</text></subparagraph> <subparagraph commented="no" id="H58A23DEA01AF45969C0C63CD4C17F792"><enum>(D)</enum><text>the State must make a determination with respect to an appeal described in subparagraph (A), and notify the individual of such determination, prior to enrollment of such individual in the program.</text></subparagraph></paragraph>
<paragraph id="H6D3FC1D22EFE44A3A270A5E74842CD3E"><enum>(5)</enum><header>Enrollment</header><text>Under the program, the State initially enrolls individuals who are identified under paragraph (1) in the program for a 12-month period—</text> <subparagraph id="H957B95C734FA4C099A393045FD5B21A2"><enum>(A)</enum><text>in the case of such an individual who does not submit an appeal under paragraph (4) within the period applied by the State pursuant to subparagraph (C) of such paragraph, beginning on the day after the last day of such period; and</text></subparagraph>
<subparagraph id="H622D3357C6C4481CA71E5118D14EE262"><enum>(B)</enum><text display-inline="yes-display-inline">in the case of such an individual who does submit an appeal under paragraph (4) within the period applied by the State pursuant to subparagraph (C) of such paragraph but such appeal is denied, beginning not later than 30 days after the date of such denial.</text></subparagraph></paragraph> <paragraph id="H74C0B4A466B848868E0D587F9F989C95"><enum>(6)</enum><header>Notification of health care providers and pharmacies</header><text display-inline="yes-display-inline">Under the program, the State provides to each health care provider and pharmacy selected for an individual under paragraph (2)—</text>
<subparagraph id="HC1D95C867B8F4DA89E2AF8E891D3D8F6"><enum>(A)</enum><text>notification that the individual is an at-risk beneficiary enrolled under the program and that the provider or pharmacy has been selected for the individual under paragraph (2);</text></subparagraph> <subparagraph id="H6E8EE50902AD4A84B747B4BC2C221B6F"><enum>(B)</enum><text>information on such program and the role of being so selected; and</text></subparagraph>
<subparagraph commented="no" id="H8B971103591C459FB41DA5A118CD506C"><enum>(C)</enum><text display-inline="yes-display-inline">a process through which the provider or pharmacy can submit a concern or complaint with respect to being so selected.</text></subparagraph></paragraph> <paragraph id="H3AE47BDC73CA470CA74B5A14D8F9C134"><enum>(7)</enum><header>Continuation of enrollment</header><text>Under the program, the State, with respect to an individual enrolled under the program, provides for a process to—</text>
<subparagraph id="H9C57BD7459BA40BDB3FF071FD755E16D"><enum>(A)</enum><text display-inline="yes-display-inline">not later than 30 days before the end of the 12-month period for which the individual is so enrolled pursuant to paragraph (5)—</text> <clause id="H969EA22BF4C144B795ED97AA80903C43"><enum>(i)</enum><text display-inline="yes-display-inline">assess, in accordance with publicly available evidence-based guidelines, whether or not such individual should continue to be enrolled under the program; and</text></clause>
<clause id="HF1333A11716B442C9598DDB42F2A99EF"><enum>(ii)</enum><text>notify such individual of the results of the assessment under clause (i);</text></clause></subparagraph> <subparagraph id="H7347F3CC6DA04986B393D80E725EFC49"><enum>(B)</enum><text>continue, subject to subparagraph (C), enrollment of such individual if such assessment recommends such continuation; and</text></subparagraph>
<subparagraph id="HF4677F5317D144918AA7DA3016D768F9"><enum>(C)</enum><text>appeal the continuation of enrollment in accordance with the appeals process described in paragraph (4).</text></subparagraph></paragraph></subsection> <subsection id="H93402F03981A4531920016BEE27F758E"><enum>(c)</enum><header>At-Risk beneficiary</header> <paragraph id="H38B21788242D4652A1BC5CC565B12E0B"><enum>(1)</enum><header>Identification</header><text display-inline="yes-display-inline">For purposes of this section, a State shall identify an individual enrolled under the State plan (or waiver of the State plan) as an at-risk beneficiary if the individual is not an exempted individual described in paragraph (2) and—</text>
<subparagraph commented="no" id="HCB7FF52499344FBB8110CACAE47A7DF2"><enum>(A)</enum><text>is identified as such an at-risk beneficiary through the use of publicly available evidence-based guidelines that indicate misuse or abuse of a controlled substance; or</text></subparagraph> <subparagraph commented="no" id="HD800E276BE544E898C4379567C1EF9CD"><enum>(B)</enum><text display-inline="yes-display-inline">the State received notification from a PDP sponsor or Medicare Advantage organization that such individual was identified as being an at-risk beneficiary for prescription drug abuse for enrollment in a drug management program established by the sponsor or organization pursuant to section 1860D–4(c)(5) and such identification has not been terminated under subparagraph (F) of such section.</text></subparagraph></paragraph>
<paragraph id="H1D39449BCB9E4D14B43675B2E3B5824E"><enum>(2)</enum><header>Exempted individual described</header><text>For purposes of paragraph (1), an exempted individual described in this paragraph is an individual who—</text> <subparagraph id="H0821F1273EAC442688D4F4D979FF9D12"><enum>(A)</enum><text>is receiving—</text>
<clause id="HCDD9F288BE134AB2A3E5C187C6D5EBA0"><enum>(i)</enum><text>hospice or palliative care; or</text></clause> <clause id="HA6CC775EEB3B4C2C9151E97C5327C9DA"><enum>(ii)</enum><text>treatment for cancer;</text></clause></subparagraph>
<subparagraph id="H909A6109E2EF4C1FB69CD13C38A5B4DD"><enum>(B)</enum><text>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 residents through a contract with a single pharmacy; or</text></subparagraph> <subparagraph id="H48BB52E86B8E425793A9AD7E08EFB9EB"><enum>(C)</enum><text>the State elects to treat as an exempted individual for purposes of paragraph (1).</text></subparagraph></paragraph></subsection>
<subsection id="H9238E01515AF49BEAF4A3499310118D2"><enum>(d)</enum><header>Application of privacy rules clarification</header><text display-inline="yes-display-inline">The Secretary 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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1320d-2">42 U.S.C. 1320d–2</external-xref> note), related to the sharing of data under subsection (b)(6) 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.</text></subsection> <subsection id="H380DBBBF9E944319826BB1026A3CFDA5"><enum>(e)</enum><header>Reports</header> <paragraph commented="no" id="H70954AD7CD21475687F6E6786F111DAF"><enum>(1)</enum><header>Annual reports</header><text display-inline="yes-display-inline">A State operating a qualified drug management program shall include in the annual report submitted to the Secretary under section 1927(g)(3)(D), beginning with such reports submitted for 2021, the following information:</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H957A5046EEF14D09AE04E2F25B581A9E"><enum>(A)</enum><text>The number of individuals enrolled under the State plan (or waiver of the State plan) who are enrolled under the program and the percentage of individuals enrolled under the State plan (or waiver) who are enrolled under such program.</text></subparagraph> <subparagraph commented="no" id="H82B7F5513CF040BE9AFE5C5A801D1830"><enum>(B)</enum><text display-inline="yes-display-inline">The number of prescriptions for controlled substances that were dispensed per month during each such year per individual enrolled under the program, including the daily morphine milligram equivalents and the quantity prescribed for each such prescription.</text></subparagraph>
<subparagraph commented="no" id="HF3B8EFFFAC434BD0BDABAB28511C6156"><enum>(C)</enum><text>The number of pharmacies filling prescriptions for controlled substances for individuals enrolled under such program.</text></subparagraph> <subparagraph commented="no" id="H6A56C80A38D4409988A21E5363376549"><enum>(D)</enum><text>The number of health care providers writing prescriptions for controlled substances (other than prescriptions for a refill) for individuals enrolled under such program.</text></subparagraph>
<subparagraph commented="no" id="HC1122B1BBEEA494D92D940529A8F4331"><enum>(E)</enum><text>Any other data that the Secretary may require.</text></subparagraph> <subparagraph commented="no" id="HC6D2A1126818476699F0D6D709BDF864"><enum>(F)</enum><text>Any report submitted by a managed care entity under subsection (f)(1)(B) with respect to the year involved.</text></subparagraph><continuation-text commented="no" continuation-text-level="paragraph">For each such report for a year after 2021, the information described in this paragraph shall be provided in a manner that compares such information with respect to the prior calendar year to such information with respect to the second prior calendar year.</continuation-text></paragraph>
<paragraph commented="no" id="HED609CC8D63648B7AA8DF723B6151C21"><enum>(2)</enum><header>MACPAC reports and review</header><text display-inline="yes-display-inline">Not later than 2 years after the date of the enactment of this section, the Medicaid and CHIP Payment and Access Commission (in this section referred to as <quote>MACPAC</quote>), in consultation with the National Association of Medicaid Directors, pharmacy benefit managers, managed care organizations, health care providers (including pharmacists), beneficiary advocates, and other stakeholders, shall publish a report that includes—</text> <subparagraph commented="no" id="H8DE3835D2F6A4C838768A0EAB1FB9762"><enum>(A)</enum><text>best practices for operating drug management programs, based on a review of a representative sample of States administering such a program;</text></subparagraph>
<subparagraph commented="no" id="H51A6D1399C07436295196E410D874480"><enum>(B)</enum><text display-inline="yes-display-inline">a summary of the experience of the appeals process under drug management programs operated by several States, such as the frequency at which individuals appealed the identification of being an at-risk individual, the frequency at which individuals appealed the selection of a health care provider or pharmacy under such a program, the timeframes for such appeals, a summary of the reasons for such appeals, and the design of such appeals processes;</text></subparagraph> <subparagraph commented="no" id="H9A00BC93845E4813B1F3F9068E57589B"><enum>(C)</enum><text display-inline="yes-display-inline">a summary of trends and the effectiveness of qualified drug management programs operated under this section; and</text></subparagraph>
<subparagraph commented="no" id="H16B7686BCA3B4B3BB8EE1A69AD6DB187"><enum>(D)</enum><text display-inline="yes-display-inline">recommendations to States on how improvements can be made with respect to the operation of such programs.</text></subparagraph><continuation-text commented="no" continuation-text-level="paragraph">In reporting on State practices, the MACPAC shall consider how such programs have been implemented in rural areas, under fee-for-service as well as managed care arrangements, and the extent to which such programs have resulted in increased efficiencies to such States or to the Federal Government under this title.</continuation-text></paragraph> <paragraph id="HEA1CFB33DAAB4844942FDDB78403F1AE"><enum>(3)</enum><header>Report on plan for coordinated care</header><text display-inline="yes-display-inline">Not later than January 1, 2021, each State operating a qualified drug management program shall submit to the Administrator of the Centers for Medicare & Medicaid Services a report on how such State plans to provide coordinated care for individuals enrolled under the State plan (or waiver of the State plan) and—</text>
<subparagraph id="H9280D86F9B864F66A687B21804F95BC0"><enum>(A)</enum><text>who are enrolled under the program; or</text></subparagraph> <subparagraph id="H64BBD8F0A7B04237B429015274BFFEC8"><enum>(B)</enum><text>who are enrolled with a managed care entity and enrolled under such a qualified drug management program operated by such entity.</text></subparagraph></paragraph></subsection>
<subsection id="H4BF70BAE8C9C40C3A408C6FADB0250A9"><enum>(f)</enum><header>Applicability to managed care entities</header>
<paragraph id="HC79E3901F9CA4251A792061D960C9A6C"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">With respect to any contract that a State enters into on or after January 1, 2020, with a managed care entity (as defined in section 1932(a)(1)(B)) pursuant to section 1903(m), the State shall, as a condition of the contract, require the managed care entity—</text> <subparagraph id="H33571EE2E9B54AFCAD8A4526AB0CAF26"><enum>(A)</enum><text>to operate a qualified drug management program (as defined in subsection (b)) for at-risk beneficiaries who are enrolled with such entity and identified by the managed care entity by means of application of paragraph (2);</text></subparagraph>
<subparagraph id="H660B322AB5304252A2E19BA4B001DFBC"><enum>(B)</enum><text display-inline="yes-display-inline">to submit to the State an annual report on the matters described in subparagraphs (A) through (E) of subsection (e)(1); and</text></subparagraph> <subparagraph id="HABF55F1A91FC4A0F8D14BEC255F8AB1C"><enum>(C)</enum><text display-inline="yes-display-inline">to submit to the State a list (and as necessary update such list) of individuals enrolled with such entity under the qualified drug management program operated by such entity under subparagraph (A) for purposes of allowing State plans for which medical assistance is paid on a fee-for-service basis to have access to such information.</text></subparagraph></paragraph>
<paragraph id="H7694DD71C07E4915A9967E8EAED67F54"><enum>(2)</enum><header>Application</header><text display-inline="yes-display-inline">For purposes of applying, with respect to a managed care entity—</text> <subparagraph id="H1806369E089E4CC4BDB50A40A268B1A9"><enum>(A)</enum><text>under paragraph (1)(A)—</text>
<clause id="H40ECD27643C242559EF474944A08E341"><enum>(i)</enum><text>the definition of the term <term>qualified drug management program</term> under subsection (b), other than paragraph (2)(D) of such subsection; and</text></clause> <clause id="H1503FF8E32034483947E5DCF13C68C74"><enum>(ii)</enum><text>the provisions of paragraphs (1) and (2) of subsection (c); and</text></clause></subparagraph>
<subparagraph id="H6DA1A8A6CE4A4335BAF4D9DDFDB42365"><enum>(B)</enum><text>under paragraph (1)(B), the report requirements described in subparagraphs (A) through (E) of subsection (e)(1);</text></subparagraph><continuation-text continuation-text-level="paragraph">each reference in such subsection (b) and paragraphs of subsection (c) to <quote>a State</quote> or <quote>the State</quote> (other than to <quote>a State plan</quote> or <quote>the State plan</quote>) shall be deemed a reference to the managed care entity, each reference under such subsection, paragraphs, or subparagraphs to individuals enrolled under the State plan (or waiver of the State plan) shall be deemed a reference to individuals enrolled with such entity, and each reference under such subsection, paragraphs, or subparagraphs to individuals enrolled under the qualified drug management program operated by the State shall be deemed a reference to individuals enrolled under the qualified drug management program operated by the managed care entity.</continuation-text></paragraph></subsection> <subsection id="HAE5301958B1C415C86D6B46A6603613D"><enum>(g)</enum><header>Controlled substance defined</header><text display-inline="yes-display-inline">For purposes of this section, the term <term>controlled substance</term> means a drug that is included in schedule II, III, or IV of section 202(c) of the Controlled Substances Act, or any combination thereof, as specified by the State.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection commented="no" id="H6B16B62EE17044D58C8CC02C6479C729"><enum>(b)</enum><header>Guidance on at-Risk population transitioning between Medicaid FFS and managed care</header><text display-inline="yes-display-inline">Not later than October 1, 2019, the Secretary of Health and Human Services shall issue guidance for State Medicaid programs, with respect to individuals who are enrolled under a State plan (or waiver of such plan) under title XIX of the Social Security Act and under a drug management program, for purposes of providing best practices—</text> <paragraph commented="no" id="HD52E1D20F920407C8D708D9F275816B3"><enum>(1)</enum><text>for transitioning, as applicable, such individuals from fee-for-service Medicaid (and such a program operated by the State) to receiving medical assistance under such title through a managed care entity (as defined in section 1932(a)(1)(B) of the Social Security Act) with a contract that with the State pursuant to section 1903(m) of such Act (and such a program operated by such entity); and</text></paragraph>
<paragraph commented="no" id="H2C2EE7420C334F14AFA67140849FFB38"><enum>(2)</enum><text display-inline="yes-display-inline">for transitioning, as applicable, such individuals from receiving medical assistance under such title through a managed care entity (as defined in section 1932(a)(1)(B) of the Social Security Act) with a contract that with the State pursuant to section 1903(m) of such Act (and such a program operated by such entity) to fee-for-service Medicaid (and such a program operated by the State).</text></paragraph></subsection> <subsection id="H79587A3404954FF8A4D53E3260CCE681"><enum>(c)</enum><header>Guidance on at-Risk population transitioning to Medicare</header> <paragraph id="H32D156B156864AF2B09648ADE2EEB308"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than January 1, 2020, the Secretary of Health and Human Services, after consultation with the Federal Coordinated Health Care Office established under section 2602 of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1315b">42 U.S.C. 1315b</external-xref>), shall issue guidance for State Medicaid programs, with respect to transitioning individuals, providing for—</text>
<subparagraph id="HBA35CDB26AD84F5B834F4601B56C2AD3"><enum>(A)</enum><text>notification to be submitted by the State to the Centers for Medicare & Medicaid Services and such individuals of the status of such individuals as transitioning individuals;</text></subparagraph> <subparagraph id="H709FA858886342EDA9979D42CCF99BD3"><enum>(B)</enum><text>notification to such individuals about enrollment under a prescription drug plan under part D of such title or under a MA–PD plan under part C of such title;</text></subparagraph>
<subparagraph id="H865F4831F918492696A0AEDF8113D49B"><enum>(C)</enum><text>best practices for transitioning such individuals to such a plan; and</text></subparagraph> <subparagraph id="HC381772F691C48A18B94B310F7207C10"><enum>(D)</enum><text display-inline="yes-display-inline">best practices for coordination between the qualified drug management program (as described in section 1927A(b) of the Social Security Act, as added by subsection (a)) carried out by the State and a drug management program carried out under such a plan pursuant to section 1860D–4(c)(5) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-10">42 U.S.C. 1395w–10(c)(5)</external-xref>).</text></subparagraph></paragraph>
<paragraph id="HC42734C91C0F410B98214ADC9ECB6866"><enum>(2)</enum><header>Transitioning individuals</header><text>For purposes of paragraph (1), a transitioning individual is an individual who, with respect to a month—</text> <subparagraph id="H40C02445BA214F3EBB7D019FC990913D"><enum>(A)</enum><text display-inline="yes-display-inline">is enrolled under the State plan (or waiver of the State plan) and under the qualified drug management program (as described in section 1927A(b) of the Social Security Act, as added by subsection (a)) carried out by the State; and</text></subparagraph>
<subparagraph id="H2D0D1910D0534342A646AF672585510E"><enum>(B)</enum><text>is expected to become eligible for the Medicare program under title XVIII of such Act during the subsequent 12-month period.</text></subparagraph></paragraph></subsection></section> <section id="HA6CD08947ABF45FEA885BCF010288CFA" commented="no"><enum>1005.</enum><header>Medicaid drug review and utilization</header> <subsection id="H7CA17A13D95540D5B3425422ADA3AE98" commented="no"><enum>(a)</enum><header>Medicaid drug utilization review</header> <paragraph id="HF5F9A822464643D9AA41E819E5526991" commented="no"><enum>(1)</enum><header>State plan requirement</header><text display-inline="yes-display-inline">Section 1902(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)</external-xref>), as amended by section 101, is further amended—</text>
<subparagraph id="HA34C9DFF61494C4D9C4179985E9BA791" commented="no"><enum>(A)</enum><text>in paragraph (83), at the end, by striking <quote>and</quote>;</text></subparagraph> <subparagraph id="H1FF3A4B1250343779E34601635A55258" commented="no"><enum>(B)</enum><text>in paragraph (84), at the end, by striking the period and inserting <quote>; and</quote>; and</text></subparagraph>
<subparagraph id="HD2B1E9D621F74711ADEAC7F0FDD9719D" commented="no"><enum>(C)</enum><text>by inserting after paragraph (84) the following new paragraph:</text> <quoted-block style="OLC" id="HEB216532C2734CF2AEF0EE425CBA7FF4" display-inline="no-display-inline"> <paragraph id="H6D5AFEA64F1948C0872EC8C0C470FBEA" commented="no"><enum>(85)</enum><text display-inline="yes-display-inline">provide that the State is in compliance with the drug review and utilization requirements under subsection (oo)(1).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph>
<paragraph id="H0480AE473D3B460992F1B23A0C1A7001" commented="no"><enum>(2)</enum><header>Drug review and utilization requirements</header><text>Section 1902 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a</external-xref>), as amended by section 101, is further amended by adding at the end the following new subsection:</text> <quoted-block style="OLC" id="HC28DEBEB087B47259DFD9F336CD261FF" display-inline="no-display-inline"> <subsection id="HB2881B7A43FB4B77AC8033BA15888A5F" commented="no"><enum>(oo)</enum><header>Drug review and utilization requirements</header> <paragraph id="HA8F3091F9C4A44B09825583F7CC74276" commented="no"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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:</text>
<subparagraph id="H60DB21442A9F4845AE281EE2C203C272" commented="no"><enum>(A)</enum><header>Claims review limitations</header>
<clause id="H908ED1B45F8E44E9A553D39E09430808" commented="no"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">The State has in place—</text> <subclause id="H2A0ACDDC74474F3E9095FF62FC92E203" commented="no"><enum>(I)</enum><text>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;</text></subclause>
<subclause id="HF737598F98F247E19A6A3302280DD3D4" commented="no"><enum>(II)</enum><text display-inline="yes-display-inline">safety edits (as specified by the State) on the maximum daily morphine equivalent that 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 implemented by the State) that indicates when an individual enrolled under the plan (or waiver) is prescribed the morphine equivalent for such treatment in excess of any limitation that may be identified by the State; and</text></subclause> <subclause id="H8C343C560CAA47DB973392015BE1A9BD" commented="no"><enum>(III)</enum><text display-inline="yes-display-inline">a claims review automated process (as designed and implemented by the State) that monitors when an individual enrolled under the State plan (or under a waiver of the State plan) is concurrently prescribed opioids and—</text>
<item id="H01AEED006FAC49E080B3EABB4300C3BD" commented="no"><enum>(aa)</enum><text>benzodiazepines; or</text></item> <item id="HF2F60B3556B64810A269CD6985B2C789" commented="no"><enum>(bb)</enum><text>antipsychotics.</text></item></subclause></clause>
<clause id="HD0568C872C5B4CED9C9EE793D63354B0" commented="no"><enum>(ii)</enum><header>Managed care entities</header><text display-inline="yes-display-inline">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.</text></clause> <clause id="HD1E6A23AD2554B6AA730F2EAC5BA2903" commented="no"><enum>(iii)</enum><header>Rules of construction</header><text display-inline="yes-display-inline">Nothing in this subparagraph may be construed as prohibiting a State or managed care entity from designing and implementing a claims review automated process under this subparagraph that provides for prospective or retrospective reviews of claims. Nothing in this subparagraph 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).</text></clause></subparagraph>
<subparagraph id="HBA8E63B659874A33B34E6279F2F3D028" commented="no"><enum>(B)</enum><header>Program to monitor antipsychotic medications by children</header><text display-inline="yes-display-inline">The State has in place a program (as designed and implemented by the State) to monitor and manage the appropriate use of antipsychotic medications 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.</text></subparagraph> <subparagraph id="H768FAF82959E40D3A72CD50428E33B86" commented="no"><enum>(C)</enum><header>Fraud and abuse identification</header><text display-inline="yes-display-inline">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 pharmacies dispensing drugs to individuals so enrolled.</text></subparagraph>
<subparagraph id="HA2510978BECB456693049E467EBDD3F2" commented="no"><enum>(D)</enum><header>Reports</header><text>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 subparagraphs (A) through (C) in accordance with such manner and time as specified by the Secretary.</text></subparagraph> <subparagraph id="H410C67A2CF5844D7A1EE26EFAC9F1776" commented="no"><enum>(E)</enum><header>Clarification</header><text display-inline="yes-display-inline">Nothing shall prevent a State from satisfying the requirement—</text>
<clause id="HF570B1FF306C48D3BFF2AA4CC1B04B33" commented="no"><enum>(i)</enum><text display-inline="yes-display-inline">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;</text></clause> <clause id="HD74BE9F4AB7440EEB93FC9D18B8F4A7B" commented="no"><enum>(ii)</enum><text>described in subparagraph (B) by having a program described in such subparagraph that was in place before such date; or</text></clause>
<clause id="H0DF5B4F6919240648A459785399D29FE" commented="no"><enum>(iii)</enum><text>described in subparagraph (C) by having a process described in such subparagraph that was in place before such date.</text></clause></subparagraph></paragraph> <paragraph id="H06A026009DC246C38668C213E1FB1DF1" commented="no"><enum>(2)</enum><header>Annual report by Secretary</header><text>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).</text></paragraph>
<paragraph id="H4F6663EF2C4349468E026F7ECD928F15" commented="no"><enum>(3)</enum><header>Exceptions</header>
<subparagraph id="HAF8870E0B6EC488995E398C2DB51C136" commented="no"><enum>(A)</enum><header>Certain individuals exempted</header><text display-inline="yes-display-inline">The drug review and utilization requirements under this subsection shall not apply with respect to an individual who—</text> <clause id="H47559ECB3F3A4451AF2421EA1E01B157" commented="no"><enum>(i)</enum><text>is receiving—</text>
<subclause id="H4F1CD08B1EBE4CF08E43FFB14EBF98FE" commented="no"><enum>(I)</enum><text>hospice or palliative care; or</text></subclause> <subclause id="H473F6000DC3844B3AC3886EE25447B3A" commented="no"><enum>(II)</enum><text>treatment for cancer;</text></subclause></clause>
<clause id="H00E980202E7E48628AA9166F2A902FE4" commented="no"><enum>(ii)</enum><text>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 residents through a contract with a single pharmacy; or</text></clause> <clause id="HE70F550913254DCCAED6AC934F716385" commented="no"><enum>(iii)</enum><text>the State elects to treat as exempted from such requirements.</text></clause></subparagraph>
<subparagraph id="H8B9DDA52556F4A7EBB9F243A8B580504" commented="no"><enum>(B)</enum><header> Exception relating to ensuring access</header><text display-inline="yes-display-inline">In order to ensure reasonable access to health care, the Secretary shall waive the drug review and utilization requirements 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)).</text></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph> <paragraph id="H07583951DAB048AC96D4B666C8DEB249" commented="no"><enum>(3)</enum><header>Managed care entities</header><text>Section 1932 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396u-2">42 U.S.C. 1396u–2</external-xref>) is amended by adding at the end the following new subsection: </text>
<quoted-block style="OLC" id="H27500EE5CE9F4DFC834E9D3A5B015A77" display-inline="no-display-inline">
<subsection id="H726058C4DBE94F27AA4E6C8F9D00BBF9" commented="no"><enum>(i)</enum><header>Drug utilization review activities and requirements</header><text display-inline="yes-display-inline">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 of the 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.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> <subsection id="HE93EDBA7D2AB4DF8A8293967724AA7E4" commented="no"><enum>(b)</enum><header>Identifying and addressing inappropriate prescribing and billing practices under Medicaid</header> <paragraph id="H0F8C6CE3CA4A4552A3862617F4FD4BC2" commented="no"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1927(g) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-8">42 U.S.C. 1396r–8(g)</external-xref>) is amended—</text>
<subparagraph id="HA130CAC87FEE4446A116DE8E54553023" commented="no"><enum>(A)</enum><text display-inline="yes-display-inline">in paragraph (1)(A)—</text> <clause id="HCC61D7172D8B4464B179DFD73B2BB9A5" commented="no"><enum>(i)</enum><text>by striking <quote>of section 1903(i)(10)(B)</quote> and inserting <quote>of section 1902(a)(54)</quote>;</text></clause>
<clause id="HC57D11EAF1C443629F1D7446B7DDFB49" commented="no"><enum>(ii)</enum><text>by striking <quote>, by not later than January 1, 1993,</quote>;</text></clause> <clause id="HBBA460ECCA574380A9F8EB1C281C0BEA" commented="no"><enum>(iii)</enum><text>by inserting after <quote>gross overuse,</quote> the following: <quote>excessive utilization,</quote>; and</text></clause>
<clause id="HC140143F27894C68A6D226CE17EAA36C" commented="no"><enum>(iv)</enum><text>by striking <quote>or inappropriate or medically unnecessary care</quote> and inserting <quote>inappropriate or medically unnecessary care, or prescribing or billing practices that indicate abuse or excessive utilization</quote>; and</text></clause></subparagraph> <subparagraph id="HBBD36F041C6442C09204789223AB659C" commented="no"><enum>(B)</enum><text>in paragraph (2)(B)—</text>
<clause id="H3406CC9A5A054072B88574397FA8CD8F" commented="no"><enum>(i)</enum><text>by inserting after <quote>gross overuse,</quote> the following: <quote>excessive utilization,</quote>; and</text></clause> <clause id="H97497A3DCAAC40C0936AC06820AA5D52" commented="no"><enum>(ii)</enum><text>by striking <quote>or inappropriate or medically unnecessary care</quote> and inserting <quote>inappropriate or medically unnecessary care, or prescribing or billing practices that indicate abuse or excessive utilization</quote>.</text></clause></subparagraph></paragraph>
<paragraph id="HA2C72492E2A74464A11ADB46053A6B01" commented="no"><enum>(2)</enum><header>Effective date</header><text display-inline="yes-display-inline">The amendments made by paragraph (1) shall take effect with respect to retrospective drug use reviews conducted on or after October 1, 2020.</text></paragraph></subsection></section> <section id="HA79F1DA88F6D4DB98186E5AC149620CF" section-type="subsequent-section" commented="no"><enum>1006.</enum><header>Guidance to improve care for infants with neonatal abstinence syndrome and their mothers; GAO study on gaps in Medicaid coverage for pregnant and postpartum women with substance use disorder</header> <subsection id="HD8A520842B9A4DDEA81E6DA92B1B4A27" commented="no"><enum>(a)</enum><header>Guidance</header><text display-inline="yes-display-inline">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—</text>
<paragraph id="HDF05E2DD3CE849119BCAA14EDCB48A94" commented="no"><enum>(1)</enum><text>the types of services, including post-discharge services and parenting supports, for families of babies with neonatal abstinence syndrome that States may cover under the Medicaid program under title XIX of the Social Security Act;</text></paragraph> <paragraph id="HE6A041E51F8F4B3BB8795DE9EED3F051" commented="no"><enum>(2)</enum><text display-inline="yes-display-inline">best practices from States with respect to innovative or evidenced-based payment models that focus on prevention, screening, treatment, plans of safe care, and post-discharge services for mothers and fathers with substance use disorders and babies with neonatal abstinence syndrome that improve care and clinical outcomes;</text></paragraph>
<paragraph id="H4EE59E05A6C94569B3EBEB11B1025457" commented="no"><enum>(3)</enum><text display-inline="yes-display-inline">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; and</text></paragraph> <paragraph id="H100A6E7FCB9849ABA0A09CCC64202162" commented="no"><enum>(4)</enum><text>guidance and technical assistance to State Medicaid agencies regarding additional flexibilities and incentives related to screening, prevention, and post-discharge services, including parenting supports.</text></paragraph></subsection>
<subsection id="H2B74B345FD6C4566B157E43F84B87C75" commented="no"><enum>(b)</enum><header>GAO study</header><text>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.</text></subsection></section> <section id="HC572E53E09BC4B2AB61347DD94AABC27"><enum>1007.</enum><header>Medicaid health homes for opioid-use-disorder Medicaid enrollees</header> <subsection id="H07B33C04BC054758B6C07D9492FBE1A0"><enum>(a)</enum><header>Extension of enhanced FMAP for certain health homes for individuals with substance use disorders</header><text>Section 1945 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396w-4">42 U.S.C. 1396w–4</external-xref>) is amended—</text>
<paragraph id="H62D63C9BC2E04F929AFA42C306AED02F"><enum>(1)</enum><text>in subsection (c)—</text> <subparagraph id="HDD8A3C61C0C04925A03212317171669E"><enum>(A)</enum><text>in paragraph (1), by inserting <quote>subject to paragraph (4),</quote> after <quote>except that,</quote>; and</text></subparagraph>
<subparagraph id="HD8A5378CBF794C6894789DEA2C84F8E4"><enum>(B)</enum><text>by adding at the end the following new paragraph:</text> <quoted-block style="OLC" id="H419BB6BF9B6F431FBE08C8AF570978F0" display-inline="no-display-inline"> <paragraph id="HCAD2130BBAA24AA397B15AD64AB02F0E"><enum>(4)</enum><header>Special rule relating to substance use disorder health homes</header> <subparagraph id="H20B33354337749869C5D8F5E7FE83892"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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 amendment, 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.</text></subparagraph>
<subparagraph id="H6A9B6F15F92B4EE2960E4FDD34381467"><enum>(B)</enum><header>Report requirements</header><text display-inline="yes-display-inline">In the case of a State with an SUD-focused State plan amendment for which the application of the Federal medical assistance percentage has been extended under subparagraph (A), such State shall, at the end of the period of such State plan amendment, submit to the Secretary a report on the following, with respect to SUD-eligible individuals provided health home services under such State plan amendment:</text> <clause id="H01FFFAB19AA84D6CB5F9061EF6854437"><enum>(i)</enum><text>The quality of health care provided to such individuals, with a focus on outcomes relevant to the recovery of each such individual.</text></clause>
<clause id="H16FC1368F8774C948B1CC3019FC3C10E"><enum>(ii)</enum><text>The access of such individuals to health care.</text></clause> <clause id="H6B07E1C612604A248537926978C79E3C"><enum>(iii)</enum><text display-inline="yes-display-inline">The total expenditures of such individuals for health care.</text></clause><continuation-text continuation-text-level="subparagraph">For purposes of this subparagraph, the Secretary shall specify all applicable measures for determining quality, access, and expenditures.</continuation-text></subparagraph>
<subparagraph id="HC0789B1160694183AD78A70C9E939DF7"><enum>(C)</enum><header>Best practices</header><text display-inline="yes-display-inline">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.</text></subparagraph> <subparagraph id="H8154FAE8741F4054941570C1359D5252"><enum>(D)</enum><header>Definitions</header><text display-inline="yes-display-inline">For purposes of this paragraph:</text>
<clause id="HC295679CED2549C493AB7A1938F66A63"><enum>(i)</enum><header>SUD-eligible individuals</header><text>The term <quote>SUD-eligible individual</quote> means, with respect to a State, an individual who satisfies all of the following:</text> <subclause id="H7C7F77346C284D6797B846BA64AEB410"><enum>(I)</enum><text display-inline="yes-display-inline">The individual is an eligible individual with chronic conditions.</text></subclause>
<subclause id="H7190D69979074CA1B280892564C493A8"><enum>(II)</enum><text display-inline="yes-display-inline">The individual is an individual with a substance use disorder.</text></subclause> <subclause id="H79B7C662B85A4624A284992CB6047D6E"><enum>(III)</enum><text display-inline="yes-display-inline">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.</text></subclause></clause>
<clause id="HCA21F969AB72488B9449225B6E8E66C5"><enum>(ii)</enum><header>SUD-focused State plan amendment</header><text display-inline="yes-display-inline">The term <quote>SUD-focused State plan amendment</quote> means a State plan amendment under this section that is designed to provide health home services primarily to SUD-eligible individuals.</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph></subsection> <subsection id="H997B6E8BCA5149A1B6D8F00309FA2A56"><enum>(b)</enum><header>Requirement for State Medicaid plans to provide coverage for medication-assisted treatment</header> <paragraph id="H4F8C43648BB743B48A6A7C4482A92623"><enum>(1)</enum><header>Requirement for State Medicaid plans to provide coverage for medication-assisted treatment</header><text display-inline="yes-display-inline">Section 1902(a)(10)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(10)(A)</external-xref>) is amended, in the matter preceding clause (i), by striking <quote>and (28)</quote> and inserting <quote>(28), and (29)</quote>.</text></paragraph>
<paragraph id="HA371C117829B4F469BB28C74AB48CA06"><enum>(2)</enum><header>Inclusion of medication-assisted treatment as medical assistance</header><text>Section 1905(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(a)</external-xref>) is amended—</text> <subparagraph id="HD274EB9DBA164BADA6998B877A01C08C"><enum>(A)</enum><text>in paragraph (28), by striking <quote>and</quote> at the end;</text></subparagraph>
<subparagraph id="H71973260EC05435AB796A00025BB36DE"><enum>(B)</enum><text>by redesignating paragraph (29) as paragraph (30); and</text></subparagraph> <subparagraph id="H40051EE4BABD4244BC3F67ABB7771200"><enum>(C)</enum><text>by inserting after paragraph (28) the following new paragraph:</text>
<quoted-block style="traditional" display-inline="no-display-inline" id="H59DDDE01DC7147BFB51EB3A440FBCE53">
<paragraph id="H48D4F72DE9CF4740B9164674BBABCE98"><enum>(29)</enum><text>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</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph> <paragraph id="H8EB5A5BF21994D1A83BB5A5CCDD19AC7"><enum>(3)</enum><header>Medication-assisted treatment defined; Waivers</header><text>Section 1905 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d</external-xref>) is amended by adding at the end the following new subsection:</text>
<quoted-block style="OLC" display-inline="no-display-inline" id="HFE396B2C4BB8438DB9B42119F9CFEF93">
<subsection id="H775DEB50403F4F52B5AFB53B44A941D4"><enum>(ee)</enum><header>Medication-assisted treatment</header>
<paragraph id="H786B2F26E45841B5B0DC1992E45B5AE5"><enum>(1)</enum><header>Definition</header><text display-inline="yes-display-inline">For purposes of subsection (a)(29), the term <quote>medication-assisted treatment</quote>—</text> <subparagraph id="H24A00E782D414EE5A920F59E8C53513D"><enum>(A)</enum><text>means all drugs approved under section 505 of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355</external-xref>), including methadone, and all biological products licensed under section 351 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/262">42 U.S.C. 262</external-xref>) to treat opioid use disorders; and</text></subparagraph>
<subparagraph id="H542BC31B0A9944F2894154ACF6D776A7"><enum>(B)</enum><text>includes, with respect to the provision of such drugs and biological products, counseling services and behavioral therapy.</text></subparagraph></paragraph> <paragraph id="H1634DE3F32B84A648702FC75E63AFDD5"><enum>(2)</enum><header>Exception</header><text display-inline="yes-display-inline">The provisions of paragraph (29) of subsection (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 facilities 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).</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph>
<paragraph id="H8EC2FD04BFD14241AF748B5FE88AE5C7"><enum>(4)</enum><header>Effective date</header>
<subparagraph id="H4DB0FDA407D04409A8E1FECDCB99F99E"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></subparagraph> <subparagraph id="H07D98E3F141D4CC48D4CD3238C1F5D66"><enum>(B)</enum><header>Exception for State legislation</header><text display-inline="yes-display-inline">In the case of a State plan under title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> 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.</text></subparagraph></paragraph></subsection></section>
<enum>II</enum><header>Medicare Provisions to Address the Opioid Crisis</header>
<section id="H63AC8BD5202A46748AE7314CF02C1E5D"><enum>2001.</enum><header>Authority not to apply certain Medicare telehealth requirements in the case of certain treatment of a substance use disorder or co-occurring mental health disorder</header><text display-inline="no-display-inline">Section 1834(m) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(m)</external-xref>) is amended—</text> <paragraph id="H0450555F08524D1D997799B03A618C66"><enum>(1)</enum><text>in paragraph (2)(B)(i), by inserting <quote>and paragraph (7)(E)</quote> after <quote>Subject to clause (ii)</quote>; and</text></paragraph>
<paragraph id="H303B24113E78446989EECE32E6F1D742"><enum>(2)</enum><text>by adding at the end the following new paragraphs:</text> <quoted-block display-inline="no-display-inline" id="HDD626069AF1B48478EDEE111907223F6" style="OLC"> <paragraph id="HE067D5DEBA4A44CBAD130B927F06DD98"><enum>(7)</enum><header>Authority not to apply certain requirements in the case of certain treatment of substance use disorder or co-occurring mental health disorder</header> <subparagraph id="H3FC3F799EAB3452EAD874CB8224A5F68"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">For purposes of payment under this subsection, in the case of telehealth services described in subparagraph (C) furnished on or after January 1, 2020, to an eligible beneficiary (as defined in subparagraph (F)) for the treatment of a substance use disorder or a mental health disorder that is co-occurring with a substance use disorder, the Secretary is authorized to, through rulemaking, not apply any of the requirements described in subparagraph (B). </text></subparagraph>
<subparagraph id="HA0649A8B03B649C28D9476144F030BFE"><enum>(B)</enum><header>Requirements described</header><text display-inline="yes-display-inline">For purposes of this paragraph, the requirements described in this subparagraph are any of the following:</text> <clause id="H7140D266DC4F4C01862D41479ABC501B"><enum>(i)</enum><text>Qualifications for an originating site under paragraph (4)(C)(ii).</text></clause>
<clause id="H03CBD0F75E5944D9A45CC09C4A405F82"><enum>(ii)</enum><text>Geographic limitations under paragraph (4)(C)(i).</text></clause></subparagraph> <subparagraph id="HCA55EB89E19F4C96855DED5BE8F47DB1"><enum>(C)</enum><header>Telehealth services described</header><text display-inline="yes-display-inline">For purposes of this paragraph, the telehealth services described in this subparagraph are services that are both telehealth services (as described in paragraph (4)(F)) and identified by the Secretary, through rulemaking, as services that are the most commonly furnished (as defined by the Secretary) under this part to individuals diagnosed with a substance use disorder or a mental health disorder that is co-occurring with a substance use disorder.</text></subparagraph>
<subparagraph id="HDC026B8F9E744572805BC7F3DDAFB4B8"><enum>(D)</enum><header>Clarification</header><text display-inline="yes-display-inline">Nothing in this paragraph shall be construed as limiting or otherwise affecting the authority of the Secretary to limit or eliminate the non-application pursuant to this paragraph of any of the requirements under subparagraph (B). </text></subparagraph> <subparagraph id="H80CD53D38ABC41B599D30A3E8F2670B4"><enum>(E)</enum><header>Treatment of originating site facility fee</header><text display-inline="yes-display-inline">No facility fee shall be paid under paragraph (2)(B) to an originating site with respect to a telehealth service described in subparagraph (B) for which payment is made under this subsection by reason of the non-application of a requirement described in subparagraph (B) pursuant to this paragraph if payment for such service would not otherwise be permitted under this subsection if such requirement were applied. </text></subparagraph>
<subparagraph id="HC0A9F69908AA4962BA1B67AB13A2B753"><enum>(F)</enum><header>Eligible beneficiary defined</header><text display-inline="yes-display-inline">For purposes of this paragraph, the term <term>eligible beneficiary</term> means an individual who—</text> <clause id="H3361771FA3B2438EB70ABC29C19CFB48"><enum>(i)</enum><text>is entitled to, or enrolled for, benefits under part A and enrolled for benefits under this part;</text></clause>
<clause id="HAE7334879996492F9F3F3B40DD56FAC0"><enum>(ii)</enum><text>has a diagnosis for a substance use disorder; and</text></clause> <clause id="H0D7F7B64C6D04E6CBED82C82409D14A0"><enum>(iii)</enum><text>meets such other criteria as the Secretary determines appropriate.</text></clause></subparagraph>
<subparagraph id="H8C9B7C67FA5449239DE978ACE53C4AF9"><enum>(G)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than 5 years after the date of the enactment of this paragraph, the Secretary shall submit to Congress a report on the impact of any non-application under this paragraph of any of the requirements described in subparagraph (B) on</text> <clause id="HADFC82D52A5E45EDB576F258F7F28DE4"><enum>(i)</enum><text display-inline="yes-display-inline">the utilization of health care services related to substance use disorder, such as behavioral health services and emergency department visits; and</text></clause>
<clause id="H2472D282DA1B4BAFB43E5F16287C3832"><enum>(ii)</enum><text display-inline="yes-display-inline">health outcomes related to substance use disorder, such as substance use overdose deaths.</text></clause></subparagraph> <subparagraph id="HF107FE1392C04140A4538C7A814D2D34"><enum>(H)</enum><header>Funding</header><text display-inline="yes-display-inline">For purposes of carrying out this paragraph, in addition to funds otherwise available, the Secretary shall provide for the transfer, from the Federal Supplementary Medical 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.</text></subparagraph></paragraph>
<paragraph id="H94B882B032694675A269A280EB482BB6"><enum>(8)</enum><header>Rule of construction</header><text display-inline="yes-display-inline">Nothing in this subsection may be construed as waiving requirements under this title to comply with applicable State law, including State licensure requirements.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section> <section id="HE491C6B7BB1F4D078E5320C7607403DB"><enum>2002.</enum><header>Encouraging the use of non-opioid analgesics for the management of post-surgical pain</header><text display-inline="no-display-inline">Section 1833(t)(6) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(t)(6)</external-xref>) is amended—</text>
<paragraph id="HBBFB072584074216B80003042E0F8CF8"><enum>(1)</enum><text>in subparagraph (C)(i), by inserting <quote>or, in the case of an eligible non-opioid analgesic (as defined in subparagraph (J)), during a period of 5 years,</quote> after <quote>3 years,</quote>; and</text></paragraph> <paragraph id="H8DC681B056BE4B74B56AB5441415F811"><enum>(2)</enum><text>by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H21D8AB0580A04116968E1E42D783BAB8" style="OLC">
<subparagraph id="HB3BCE7DB75C34EECB691D315B9A0188E"><enum>(J)</enum><header>Eligible non-opioid analgesic defined</header><text display-inline="yes-display-inline">In this paragraph, the term <term>eligible non-opioid analgesic</term> means a drug or biological—</text> <clause id="H3F8ED40E598E4C96856C2007163DBC50"><enum>(i)</enum><text>that is an analgesic that is not an opioid;</text></clause>
<clause commented="no" id="HB29EDA7AD8D3424A86A257F2DFF7EC5D"><enum>(ii)</enum><text>that demonstrated substantial clinical improvement, as determined by the Secretary; and</text></clause> <clause id="HF4F305F5139444149CDB697C3976EB28"><enum>(iii)</enum><text>for which payment—</text>
<subclause id="H4D4F0CC235964E0C92306AC476E82710"><enum>(I)</enum><text>as an outpatient hospital service under this part was not being made as of the date of the enactment of this subparagraph; or</text></subclause> <subclause id="H4BFBAE0C11AE43C5828806C085DD1F31"><enum>(II)</enum><text>was being made under this paragraph as of such date.</text></subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section>
<section id="H7D3DC328994E43D8988A4672F70F72E1"><enum>2003.</enum><header>Requiring a review of current opioid prescriptions for chronic pain and screening for opioid use disorder to be included in the Welcome to Medicare initial preventive physical examination</header>
<subsection id="HF6A440C7F0F14203984A7834568D0B72"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1861(ww) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(ww)</external-xref>) is amended—</text> <paragraph id="HD12F7BDDAC1849CAB663323CB14AF6F8"><enum>(1)</enum><text>in paragraph (1), by inserting <quote>and a review of current opioid prescriptions and screening for opioid use disorder (as defined in paragraph (4)),</quote> before <quote>but does not include</quote>; and</text></paragraph>
<paragraph id="H49F36D259E7B4BE88744D4F4F829C0E2"><enum>(2)</enum><text>by adding at the end the following new paragraph:</text> <quoted-block display-inline="no-display-inline" id="HC71133093B1B47248FDCB61336F895AE" style="OLC"> <paragraph id="H74368EF176A648CBB6CF8D1F3905162F" indent="up1"><enum>(4)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="H2C482252C8B94087BB5504B84B04380D"><enum>(A)</enum><text>For purposes of paragraph (1), the term <term>a review of current opioid prescriptions and screening for opioid use disorder</term> means, with respect to an individual—</text>
<clause id="H8CF21D01B33B498C83F6EB9565BA240D" indent="up1"><enum>(i)</enum><text display-inline="yes-display-inline">a review by a physician or qualified non-physician practitioner of all current prescriptions of the individual; and</text></clause> <clause id="H73A46726B2484EA3B5054BB4D29CA443" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">in the case of an individual determined by the review of a physician or qualified non-physician practitioner under subparagraph (A) to have a current prescription for opioids for chronic pain that has been prescribed for a minimum period of time (as specified by the Secretary)—</text>
<subclause id="H4EE0B1809A7345A8BDD646B4E3AEAF10"><enum>(I)</enum><text display-inline="yes-display-inline">a review by the physician or practitioner of the potential risk factors to the individual for opioid use disorder;</text></subclause> <subclause id="HE74EFF9812C64EDDB0E503A55BC333BB"><enum>(II)</enum><text display-inline="yes-display-inline">an evaluation by the physician or practitioner of pain of the individual;</text></subclause>
<subclause id="H2AE94CA1368344079605D455DA9D2088"><enum>(III)</enum><text display-inline="yes-display-inline">the provision of information regarding non-opioid treatment options for the treatment and management of any chronic pain of the individual; and</text></subclause> <subclause id="H62CA97A7C8894E02A3618213518B3935"><enum>(IV)</enum><text display-inline="yes-display-inline">if determined necessary by the physician or practitioner based on the results of the review and evaluation conducted as described in this paragraph, an appropriate referral by the physician or practitioner for additional treatment.</text></subclause></clause></subparagraph>
<subparagraph id="H95513D4F92E54182B4EC440CE4FBFD19" indent="up1"><enum>(B)</enum><text>For purposes of this paragraph, the term <term>qualified non-physician practitioner</term> means a physician assistant, nurse practitioner, or clinical nurse specialist.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> <subsection id="HDFA945FC22F949FAB24F142FBE26D63B"><enum>(b)</enum><header>Clarification</header><text display-inline="yes-display-inline">Nothing in the amendments made by subsection (a) 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.</text></subsection>
<subsection id="H170DB30962734ADBAAFA374F40D54CC8"><enum>(c)</enum><header>Effective date</header><text>The amendments made by subsection (a) shall apply with respect to initial preventive physical examinations furnished on or after January 1, 2020.</text></subsection></section> <section id="H1512811DE6B14787AE3DB94D2C5CD52E"><enum>2004.</enum><header>Modification of payment for certain outpatient surgical services</header> <subsection id="H07FFDFA6A33A474BA9743ACB007D0999"><enum>(a)</enum><header>Freeze of payment for certain services furnished in ambulatory surgical centers</header><text display-inline="yes-display-inline">Section 1833(i)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(i)(2)</external-xref>) is amended by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H2EC652F8CF0A47E4B26DB3BDFFD9BDE5" style="OLC">
<subparagraph id="H2641291407C54C16B571F811D88DDC24" indent="up1"><enum>(F)</enum>
<clause commented="no" display-inline="yes-display-inline" id="H49403E8C080F4D269188392B30DEEBA7"><enum>(i)</enum><text display-inline="yes-display-inline">With respect to a targeted procedure (as defined in clause (ii)) furnished during 2020 or a subsequent year (before 2024) to an individual in an ambulatory surgical center, the payment amount for such procedure that would otherwise be determined under the revised payment system under subparagraph (D), without application of this subparagraph, shall be equal to the payment amount for such procedure furnished in 2016.</text></clause> <clause id="H5AA78316EFDB4EA68B72FEBBF3CEA0B5" indent="up1"><enum>(ii)</enum><text>For purposes of clause (i), the term <quote>targeted procedure</quote> means a procedure to which Healthcare Common Procedure Coding System code 62310 (or, for years beginning after 2016, 62321), 62311 (or, for years beginning after 2016, 62323), 62264, 64490, 64493, or G0260, or any successor code, apply.</text></clause>
<clause commented="no" id="H7E49F73D81A64CD9A51701EC452E238D" indent="up1"><enum>(iii)</enum><text>This subparagraph shall not be applied in a budget-neutral manner.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="H6FDFA28963F84B71976C082505566DED"><enum>(b)</enum><header>Data collection</header> <paragraph id="H2C121746E037493894F9BF575FBBD6B2"><enum>(1)</enum><header>In general</header><text>The Comptroller General shall collect data relating to the cost differential between targeted procedures (as defined in section 1833(i)(2)(F)(ii) of the Social Security Act, as added by subsection (a)) that are performed in a hospital operating room and such procedures that are performed in an office setting within a hospital in order to determine whether such procedures are being properly coded for claims, based on setting, for payment under section 1833(i)(2)(D) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(i)(2)(D)</external-xref>) and to determine if further changes are needed in the classification system for covered outpatient department services (as described in section 1833(t)(2)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(t)(2)(A)</external-xref>).</text></paragraph>
<paragraph id="H01D2D9B7FEEC47C884D8E4AB0FFE83CE"><enum>(2)</enum><header>Report</header><text>Not later than 4 years after the date of the enactment of this Act, the Comptroller General shall submit a report to the Committee on Energy and Commerce and the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate containing—</text> <subparagraph commented="no" id="H0A24E3ADD2154E439200AD0B5093E324"><enum>(A)</enum><text display-inline="yes-display-inline">a determination of whether procedures described in paragraph (1) are being properly coded for claims, based on setting, for payment under section 1833(i)(2)(D) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(i)(2)(D)</external-xref>); and</text></subparagraph>
<subparagraph commented="no" id="H4DF3922D1532474AA7452C46F159F2E6"><enum>(B)</enum><text display-inline="yes-display-inline">recommendations on any changes the Comptroller General determines are needed in the classification system for covered outpatient department services (as described in section 1833(t)(2)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(t)(2)(A)</external-xref>).</text></subparagraph></paragraph></subsection> <subsection id="HF58AE8A8BAA24F829D048B67120FCDCC"><enum>(c)</enum><header>Study</header><text display-inline="yes-display-inline">Not later than 3 years 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 the extent to which procedures described in section 1833(i)(2)(F)(ii) of the Social Security Act, as added by subsection (a), are effective at preventing the need for opioids for individuals furnished such procedures.</text></subsection></section>
<section id="HED858FDAA60442E787D18B6A2BFF83A8"><enum>2005.</enum><header>Requiring e-prescribing for coverage of covered part D controlled substances</header>
<subsection id="H023AF49286D6492890402CA5C99422EC"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1860D–4(e) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-104">42 U.S.C. 1395w–104(e)</external-xref>) is amended by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="HC8D09B7CBD5B4855A5D35B1F267C2D96" style="OLC"> <paragraph id="HAC86E97615CC4EDFA88ABF4405AAEB3D"><enum>(7)</enum><header>Requirement of e-prescribing for controlled substances</header> <subparagraph id="H85232883881E4B9988D5574612E1664F"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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).</text></subparagraph>
<subparagraph id="H35A5DE996C7A40CC927B856DA4816CAC"><enum>(B)</enum><header>Exception for certain circumstances</header><text display-inline="yes-display-inline">The Secretary shall, pursuant to rulemaking, specify circumstances with respect to which the Secretary may waive the requirement under subparagraph (A), with respect to a covered part D drug, including in the case of—</text> <clause id="H3458016CF5F14978B50AF927FBA795D7"><enum>(i)</enum><text display-inline="yes-display-inline">a prescription issued when the practitioner and dispenser are the same entity;</text></clause>
<clause id="H0494D74962A04428978887BD4A86458F"><enum>(ii)</enum><text>a prescription issued that cannot be transmitted electronically under the most recently implemented version of the National Council for Prescription Drug Programs SCRIPT Standard;</text></clause> <clause id="H476EC7A3612542458CD3DA94E6F51649"><enum>(iii)</enum><text>a prescription issued by a practitioner who has received a waiver or a renewal thereof for a specified period determined by the Secretary, not to exceed 1 year, from the requirement to use electronic prescribing, pursuant to a process established by regulation by the Secretary, 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;</text></clause>
<clause id="HBB74A22ABE1041EFA00CD766F80AF46B"><enum>(iv)</enum><text>a prescription issued by a practitioner under circumstances in which, notwithstanding the practitioner’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 prescribed by electronic prescription in a timely manner, and such delay would adversely impact the individual’s medical condition involved;</text></clause> <clause id="H742D6BB817F1404583B00929779C8338"><enum>(v)</enum><text display-inline="yes-display-inline">a prescription issued by a practitioner allowing for the dispensing of a non-patient specific prescription pursuant to a standing order, approved protocol for drug therapy, collaborative drug management, or comprehensive medication management, in response to a public health emergency, or other circumstances where the practitioner may issue a non-patient specific prescription;</text></clause>
<clause id="H327BF30838524C5689D4E818ED187973"><enum>(vi)</enum><text>a prescription issued by a practitioner prescribing a drug under a research protocol;</text></clause> <clause id="H94639A34AAFF45F38235C850E4E45C37"><enum>(vii)</enum><text display-inline="yes-display-inline">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 strategies that include elements to assure safe use; and </text></clause>
<clause id="HD99022A6F9914EB0B68E43769702D534"><enum>(viii)</enum><text display-inline="yes-display-inline">a prescription issued by a practitioner for an individual who—</text> <subclause id="H597AE3BF4D9840BDAEC17427FF0496AA"><enum>(I)</enum><text>receives hospice care under this title; or</text></subclause>
<subclause id="H610BA5559B9149BCBD1259BE81BBAA3C"><enum>(II)</enum><text>is a resident of a skilled nursing facility (as defined in section 1819(a)), or a medical institution or nursing facility for which payment is made for an institutionalized individual under section 1902(q)(1)(B), for which frequently abused drugs are dispensed for residents through a contract with a single pharmacy, as determined by the Secretary in accordance with this paragraph.</text></subclause></clause></subparagraph> <subparagraph id="HB0FB452435F04DA7BA10AF573829D794"><enum>(C)</enum><header>Dispensing</header><text display-inline="yes-display-inline">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 subparagraph (A). 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. Nothing in this paragraph shall be construed as affecting the ability of the beneficiary involved to designate a particular pharmacy to dispense a prescribed drug to the extent consistent with the requirements under subsection (b)(1) and under this paragraph.</text></subparagraph>
<subparagraph id="HED72BD7E699946C196ADAAD9AAB2CE3B"><enum>(D)</enum><header>Enforcement</header><text display-inline="yes-display-inline">The Secretary shall, pursuant to rulemaking, have authority to enforce and specify appropriate penalties for non-compliance with the requirement under subparagraph (A).</text></subparagraph></paragraph><after-quoted-block>. </after-quoted-block></quoted-block></subsection> <subsection id="HCA3A97548C19481D9AAEA10A9F23BF00"><enum>(b)</enum><header>Effective date</header><text>The amendment made by subsection (a) shall apply to coverage of drugs prescribed on or after January 1, 2021.</text></subsection></section>
<section id="H10033F6947E4488CB08E0D909AFB09B4" section-type="subsequent-section"><enum>2006.</enum><header>Requiring prescription drug plan sponsors under Medicare to establish drug management programs for at-risk beneficiaries</header><text display-inline="no-display-inline">Section 1860D–4(c) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-104">42 U.S.C. 1395w–104(c)</external-xref>) is amended—</text> <paragraph id="HB1B084EBA11441E79A265CB9F34AC7B3"><enum>(1)</enum><text>in paragraph (1), by inserting after subparagraph (E) the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H26BA5D09965847BE843D372FF15778EC" style="OLC">
<subparagraph id="HF3BA2D1DA6114E1B8BC4920944C3AEE8"><enum>(F)</enum><text display-inline="yes-display-inline">With respect to plan years beginning on or after January 1, 2021, a drug management program for at-risk beneficiaries described in paragraph (5).</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph> <paragraph id="H195CEF9A19684C70BF32B20FBEBE1563"><enum>(2)</enum><text>in paragraph (5)(A), by inserting <quote>(and for plan years beginning on or after January 1, 2021, a PDP sponsor shall)</quote> after <quote>A PDP sponsor may</quote>.</text></paragraph></section>
<section id="HFE4879200FEC403A9845C17DD311C08A" section-type="subsequent-section" commented="no"><enum>2007.</enum><header>Medicare coverage of certain services furnished by opioid treatment programs</header>
<subsection id="H2EC86E455FC84BCD8908065C5AEA6949" commented="no"><enum>(a)</enum><header>Coverage</header><text display-inline="yes-display-inline">Section 1861(s)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(s)(2)</external-xref>) is amended—</text> <paragraph id="HC4E8C3EE5DA54671B07566F9D5616012" commented="no"><enum>(1)</enum><text>in subparagraph (FF), by striking at the end <quote>and</quote>;</text></paragraph>
<paragraph id="HF995A27560ED497584C22BE22080BBD6" commented="no"><enum>(2)</enum><text>in subparagraph (GG), by inserting at the end <quote>; and</quote>; and</text></paragraph> <paragraph id="HC2457322E39648D4ADFEBB3DCF22C0F0" commented="no"><enum>(3)</enum><text>by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HF8B421F5D8A14491AA58A3173419864D" style="OLC">
<subparagraph id="HB7A3B53316604D3F8D683BB3241CD7C9" commented="no"><enum>(HH)</enum><text display-inline="yes-display-inline">opioid use disorder treatment services (as defined in subsection (jjj)).</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> <subsection id="H7D8FB5D7DAE041E298EFB252D5CBAD85" commented="no"><enum>(b)</enum><header>Opioid use disorder treatment services and opioid treatment program defined</header><text>Section 1861 of the Social Security Act is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H09D847D391F34AF399EE8B572EE5E853" style="OLC">
<subsection id="H6BE15F76E4A74B9B8F2217519B4932AF" commented="no"><enum>(jjj)</enum><header>Opioid use disorder treatment services; opioid treatment program</header>
<paragraph id="H99122186FB994E8C90CA2A5772045AC2" commented="no"><enum>(1)</enum><header>Opioid use disorder treatment services</header><text display-inline="yes-display-inline">The term <term>opioid use disorder treatment services</term> means items and services that are furnished by an opioid treatment program for the treatment of opioid use disorder, including—</text> <subparagraph id="H5455F06638284AD0ABFCE74580E10C71" commented="no"><enum>(A)</enum><text display-inline="yes-display-inline">opioid agonist and antagonist treatment medications (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;</text></subparagraph>
<subparagraph id="H66EA98EF91524C5EA0CF83C3AA77F34D" commented="no"><enum>(B)</enum><text display-inline="yes-display-inline">dispensing and administration of such medications, if applicable;</text></subparagraph> <subparagraph id="HC7CB8B9821E241A49741E960915C21CC" commented="no"><enum>(C)</enum><text display-inline="yes-display-inline">substance use counseling by a professional to the extent authorized under State law to furnish such services;</text></subparagraph>
<subparagraph id="H4A693E19567E48C1BB688A6DC5592DAD" commented="no"><enum>(D)</enum><text display-inline="yes-display-inline">individual and group therapy with a physician or psychologist (or other mental health professional to the extent authorized under State law);</text></subparagraph> <subparagraph id="H36D792B1A47B4798B3A3A6185F9AD72D" commented="no"><enum>(E)</enum><text display-inline="yes-display-inline">toxicology testing, and</text></subparagraph>
<subparagraph id="HAA147BFB4CDC45478F0C37B948EE4011" commented="no"><enum>(F)</enum><text display-inline="yes-display-inline">other items and services that the Secretary determines are appropriate (but in no event to include meals or transportation).</text></subparagraph></paragraph> <paragraph id="HB24358804A2B4F7798DA345C8D06277F" commented="no"><enum>(2)</enum><header>Opioid treatment program</header><text display-inline="yes-display-inline">The term <term>opioid treatment program</term> means an entity that is opioid treatment program (as defined in section 8.2 of title 42 of the Code of Federal Regulations, or any successor regulation) that—</text>
<subparagraph id="HD3A1EB80AFCA435C91536D4B87A7D6FA" commented="no"><enum>(A)</enum><text display-inline="yes-display-inline">is enrolled under section 1866(j);</text></subparagraph> <subparagraph id="H4C38E6B01C6F4166BA294177A45010A5" commented="no"><enum>(B)</enum><text>has in effect a certification by the Substance Abuse and Mental Health Services Administration for such a program;</text></subparagraph>
<subparagraph id="H6C8694438EBC466D85818A34879260B8" commented="no"><enum>(C)</enum><text>is accredited by an accrediting body approved by the Substance Abuse and Mental Health Services Administration; and</text></subparagraph> <subparagraph id="HB1B90FA8D10D4A02B9A932CC459D756A" commented="no"><enum>(D)</enum><text>meets such additional conditions as the Secretary may find necessary to ensure—</text>
<clause id="HE8C65C2381334EA4A77690D9977FE49A" commented="no"><enum>(i)</enum><text display-inline="yes-display-inline">the health and safety of individuals being furnished services under such program; and</text></clause> <clause id="HE1C8A7D1CFC24884B1FA3B25B1AA0528" commented="no"><enum>(ii)</enum><text display-inline="yes-display-inline">the effective and efficient furnishing of such services.</text></clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H8E084674FE314CE6A90E0D934A15FB83" commented="no"><enum>(c)</enum><header>Payment</header>
<paragraph id="HECF34B9A51B94917A60FB7C0C6FB6E91" commented="no"><enum>(1)</enum><header>In general</header><text>Section 1833(a)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(a)(1)</external-xref>) is amended—</text> <subparagraph id="H88DDD9452F4849F68708BFACFC466DC6" commented="no"><enum>(A)</enum><text>by striking <quote>and (BB)</quote> and inserting <quote>(BB)</quote>; and</text></subparagraph>
<subparagraph id="H5665A68E1DA247BDBE509D3B31088C11" commented="no"><enum>(B)</enum><text>by inserting before the semicolon at the end the following <quote>, 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</quote>.</text></subparagraph></paragraph> <paragraph id="HCC5177038A674543B6C2849D8D7A6EB6" commented="no"><enum>(2)</enum><header>Payment determination</header><text>Section 1834 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m</external-xref>) is amended by adding at the end the following new subsection:</text>
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<subsection id="H9552AEDF76934A0E9FDD26F5CA16D4A1" commented="no"><enum>(w)</enum><header>Opioid use disorder treatment services</header>
<paragraph id="HEAF24B86DA7C4233A6C0261A41FB49B1" commented="no"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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 determined appropriate by the Secretary, that no duplicative payments are made under this part or part D for items and services furnished by an opioid treatment program.</text></paragraph> <paragraph id="H8A187F167A424A0283E3B17490FA8F64" commented="no"><enum>(2)</enum><header>Considerations</header><text display-inline="yes-display-inline">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 determine appropriate. In developing such bundles, the Secretary may consider payment rates paid to opioid treatment programs for comparable services under State plans under title XIX or under the TRICARE program under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/10/55">chapter 55</external-xref> of title 10 of the United States Code.</text></paragraph>
<paragraph id="H5488EC7A9CAF4A72A5ACAFEF66B2D0FA" commented="no"><enum>(3)</enum><header>Annual updates</header><text display-inline="yes-display-inline">The Secretary shall provide an update each year to the bundled payment amounts under this subsection.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> <subsection id="HC9892D7B7ED54681B61E52D7665C30FF" commented="no"><enum>(d)</enum><header>Including opioid treatment programs as Medicare providers</header><text display-inline="yes-display-inline">Section 1866(e) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(e)</external-xref>) is amended—</text>
<paragraph id="HDF95D666B0EB4BFEB87105F9D6E8E51B" commented="no"><enum>(1)</enum><text>in paragraph (1), by striking at the end <quote>and</quote>;</text></paragraph> <paragraph id="H15F68B8CA5F44A97B13AC64DBB47C182" commented="no"><enum>(2)</enum><text>in paragraph (2), by striking the period at the end and inserting <quote>; and</quote>; and</text></paragraph>
<paragraph id="HD55FC5A79B7D49328B13450DCB9E9AE4" commented="no"><enum>(3)</enum><text>by adding at the end the following new paragraph:</text> <quoted-block display-inline="no-display-inline" id="H93CAF7D5BFD84CD3AB7856075F0193E8" style="OLC"> <paragraph id="HE89EADFAA8564D119B40CA27D8F86A24" commented="no"><enum>(3)</enum><text display-inline="yes-display-inline">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 paragraph (1) of such section).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection></section>
<enum>III</enum><header>Other Health Provisions to Address the Opioid Crisis</header>
<section id="H535476B46F004257A43872D54FA4FD18"><enum>3001.</enum><header>Clarifying FDA regulation of non-addictive pain and addiction therapies</header>
<subsection id="H45B3E0B0B62C4FFBB5248A36B567CBD5"><enum>(a)</enum><header>Public meetings</header><text display-inline="yes-display-inline">Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services, 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 pain or addiction, which may include—</text> <paragraph id="H806ACD25C5E241F185E6566C533C54AA"><enum>(1)</enum><text display-inline="yes-display-inline">the application of novel clinical trial designs (consistent with section 3021 of the 21st Century Cures Act (<external-xref legal-doc="public-law" parsable-cite="pl/114/255">Public Law 114–255</external-xref>)), use of real world evidence (consistent with section 505F of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355g">21 U.S.C. 355g</external-xref>)), and use of patient experience data (consistent with section 569C of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/360bbb-8c">21 U.S.C. 360bbb–8c</external-xref>)) for the development of non-addictive medical products intended to treat pain or addiction; and</text></paragraph>
<paragraph id="H65B09956677240039F28CCA3A52EC9A5"><enum>(2)</enum><text display-inline="yes-display-inline">the application of eligibility criteria under sections 506 and 515B of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/356">21 U.S.C. 356</external-xref>, 360e–3) for non-addictive medical products intended to treat pain or addiction.</text></paragraph></subsection> <subsection id="HD001EAC3408E4F4882A1907D785C1DEF"><enum>(b)</enum><header>Guidance</header><text display-inline="yes-display-inline">Not later than 1 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 documents shall include information regarding—</text>
<paragraph id="H454C03EB42BB483E8E315D5391EE1B86"><enum>(1)</enum><text display-inline="yes-display-inline">how the Food and Drug Administration may apply sections 506 and 515B of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/356">21 U.S.C. 356</external-xref>, 360e–3) to non-addictive medical products intended to treat pain or addiction, including the circumstances under which the Secretary—</text> <subparagraph id="H6BB2C2DE8089475792D0A9DA16C276A8"><enum>(A)</enum><text display-inline="yes-display-inline">may apply the eligibility criteria under such sections 506 and 515B to non-opioid or non-addictive medical products intended to treat pain or addiction;</text></subparagraph>
<subparagraph id="HF00B53EFFD2B4CACB32C4C469AD0C302"><enum>(B)</enum><text display-inline="yes-display-inline">considers the risk of addiction of controlled substances approved to treat pain when establishing unmet medical need; and</text></subparagraph> <subparagraph id="HE602A95D28BF4D5E8119ADA37CF8B942"><enum>(C)</enum><text display-inline="yes-display-inline">considers pain, pain control, or pain management in assessing whether a disease or condition is a serious or life-threatening disease or condition; and</text></subparagraph></paragraph>
<paragraph id="H3D9F8FA71C044FBCA569EB06C603DB81"><enum>(2)</enum><text display-inline="yes-display-inline">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 underlying disease, and the manner in which sponsors may use surrogate endpoints, intermediate endpoints, and real world evidence.</text></paragraph></subsection> <subsection id="H6ECF3FD87FBF4C439F00BFF0FBC7E3C9"><enum>(c)</enum><header>Medical product defined</header><text display-inline="yes-display-inline">In this section, the term <term>medical product</term> means a drug (as defined in section 201(g)(1) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/321">21 U.S.C. 321(g)(1)</external-xref>)), biological product (as defined in section 351(i) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/262">42 U.S.C. 262(i)</external-xref>)), or device (as defined in section 201(h) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/321">21 U.S.C. 321(h)</external-xref>)).</text></subsection></section>
<section id="H6C7DA96B1342415FB7CEAE39F93AD258"><enum>3002.</enum><header>Surveillance and Testing of Opioids to Prevent Fentanyl Deaths</header>
<subsection id="H5FA556907C6345CFA210DA0E3224CE57"><enum>(a)</enum><header>Public health laboratories to detect fentanyl</header><text>Part F of title III of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/262">42 U.S.C. 262</external-xref> et seq.) is amended—</text> <paragraph id="HF52E4CB60F954225B9BDDC375024DBF0"><enum>(1)</enum><text>in the heading of part F, by striking <quote><header-in-text level="part" style="traditional">and clinical laboratories</header-in-text></quote> and inserting <quote><header-in-text level="part" style="traditional">, clinical laboratories, and public health laboratories</header-in-text></quote>; and</text></paragraph>
<paragraph id="H108C1CEC41E54C28B519FCE582A8168E"><enum>(2)</enum><text>by adding at the end the following new subpart:</text> <quoted-block style="OLC" id="HA4C69B1691494BB9A58F0B261F0D19BE" display-inline="no-display-inline"> <subpart id="H8741F42E63484FB191549D37A321889A"><enum>4</enum><header>Public Health Laboratories</header> <section id="HDC247B27EF72404CBC932ED19C89A5EF"><enum>355.</enum><header>Public health laboratories to detect fentanyl</header> <subsection id="H3EAACF4869964E49AF0A70A0F0C464DD"><enum>(a)</enum><header>In general</header><text>The Secretary shall establish a program to award grants to Federal, State, and local agencies to support the establishment or operation of public health laboratories to detect fentanyl, its analogues, and other synthetic opioids, as described in subsection (b).</text></subsection>
<subsection id="H8EB3CB015CD7447A8A7C7BDA37E3737D"><enum>(b)</enum><header>Standards</header><text display-inline="yes-display-inline">The Secretary, in consultation with the Director of the National Institute of Standards and Technology, shall—</text> <paragraph id="HB381A471B68C4F9B95522E9843A76B3F"><enum>(1)</enum><text>develop standards for safely and effectively handling and testing fentanyl, its analogues, and other synthetic opioids;</text></paragraph>
<paragraph id="HB81305370994405EBDBEBEA5FC157484"><enum>(2)</enum><text display-inline="yes-display-inline">develop fentanyl and fentanyl analog reference materials and quality control standards and protocols to calibrate instrumentation for clinical diagnostics and postmortem surveillance; and</text></paragraph> <paragraph id="HABBA7C021F884726BA9722A964998A40"><enum>(3)</enum><text>include in the standards developed pursuant to paragraph (1) procedures for encountering new and emerging synthetic opioid formulations and reporting those findings to other Federal, State, and local public health laboratories.</text></paragraph></subsection>
<subsection id="H8FB1326B79DE4F69860A27E5C960F7F7"><enum>(c)</enum><header>Laboratories</header><text display-inline="yes-display-inline">The Secretary shall require grantees under subsection (a) to—</text> <paragraph commented="no" id="H5A72C7FE4D0441CB8BE5AE1FC9AF6DBE"><enum>(1)</enum><text display-inline="yes-display-inline">follow the standards established under subsection (b) and be capable of providing systematic and routine laboratory testing of drugs for the purposes of obtaining and disseminating public health information to Federal, State, and local public health officials, laboratories, and other entities the Secretary deems appropriate;</text></paragraph>
<paragraph id="H882913ED32824B73991A00822D290F0D"><enum>(2)</enum><text display-inline="yes-display-inline">work with law enforcement agencies and public health authorities, as feasible, to develop real-time information on the purity and movement of fentanyl, its analogues, and other synthetic opioids;</text></paragraph> <paragraph id="HB4B97AF6743548AA8511B79B93E33424"><enum>(3)</enum><text display-inline="yes-display-inline">assist State and local law enforcement agencies in testing seized drugs when State and local forensic laboratories request additional assistance; </text></paragraph>
<paragraph id="HEDC5EA9051284493864287FE2BE9B949"><enum>(4)</enum><text display-inline="yes-display-inline">provide early warning information and advice to Federal, State, and local law enforcement agencies and public health authorities regarding potential significant changes in the supply of fentanyl, its analogues, and other synthetic opioids;</text></paragraph> <paragraph id="H329432C195E84DBC834F3540B4C9AB39"><enum>(5)</enum><text display-inline="yes-display-inline">provide biosurveillance for non-fatal exposures; and</text></paragraph>
<paragraph id="H0C5FC364A8094A2F83F931D5C2C87980"><enum>(6)</enum><text>provide diagnostic testing for non-fatal exposures of emergency personnel.</text></paragraph></subsection> <subsection id="HB8E395E494F9449E87332532818731B1"><enum>(d)</enum><header>Authorization of appropriations</header><text>To carry out this section, there is authorized to be appropriated $15,000,000 for each of fiscal years 2019 through 2023.</text></subsection></section></subpart><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection>
<subsection id="H23372D8A4F354F75AB90ECF12DF7E9CB"><enum>(b)</enum><header>Enhanced fentanyl surveillance</header><text>Title III of the Public Health Service Act is amended by inserting after section 317T of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/247b-22">42 U.S.C. 247b–22</external-xref>) the following new section:</text> <quoted-block style="OLC" id="H3CE5F8EA2BB647CCBF577BB8BD449F79" display-inline="no-display-inline"> <section id="HF757529B792D443A930CE065295EB3C2"><enum>317U.</enum><header>Enhanced fentanyl surveillance</header> <subsection id="H1FC934A4BA704A28AB27BC81182C41A3"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Director of the Centers for Disease Control and Prevention shall enhance its drug surveillance program by—</text>
<paragraph id="HCD9ECE0240E740998871A893C802FB46"><enum>(1)</enum><text>expanding its surveillance program to include all 50 States and the territories of the United States;</text></paragraph> <paragraph id="H6DBD51B887AD43F5A23AA95CB956142E"><enum>(2)</enum><text display-inline="yes-display-inline">increasing and accelerating the collection of data on fentanyl, its analogues, and other synthetic opioids and new emerging drugs of abuse, including related overdose data from medical examiners and drug treatment admissions; and</text></paragraph>
<paragraph id="H79EE42A7FAA341CF9F5F9BBDD4AB3B36"><enum>(3)</enum><text display-inline="yes-display-inline">utilizing available and emerging information on fentanyl, its analogues, and other synthetic opioids and new emerging drugs of abuse, including information from—</text> <subparagraph id="HFE4966EFA225429BBAEEAC0F80D16B3D"><enum>(A)</enum><text>the National Drug Early Warning System;</text></subparagraph>
<subparagraph id="H02BF76697C21468AA70BDF65772F33A8"><enum>(B)</enum><text>State and local public health authorities; and</text></subparagraph> <subparagraph id="H6642000D34844EE9BA7ACD3652FA6085"><enum>(C)</enum><text>Federal, State, and local public health laboratories.</text></subparagraph></paragraph></subsection>
<subsection id="H70F2D62DA99845E585E3F5200B45DB56"><enum>(b)</enum><header>Authorization of appropriations</header><text>To carry out this section, there is authorized to be appropriated $10,000,000 for each of fiscal years 2019 through 2023.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="HB770F77C6B2A44BF8B9FC4DB9F594EB7"><enum>(c)</enum><header>Pilot program for point-of-Use testing of illicit drugs for dangerous contaminants</header><text>Part P of title III of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/280g">42 U.S.C. 280g</external-xref> et seq.) is amended by adding at the end the following new section:</text>
<quoted-block style="OLC" id="HD69840CA785D49D0951BF57C72F0859C" display-inline="no-display-inline">
<section id="H814F37D93A6A45AA9143E873924C5868"><enum>399V–7.</enum><header>Pilot program for point-of-Use testing of illicit drugs for dangerous contaminants</header>
<subsection id="H5847B283D9EE4560BF011374EB29FDC2"><enum>(a)</enum><header>In general</header><text>The Secretary shall—</text> <paragraph id="H90F905FC5B5749518D03323ED1AB84B3"><enum>(1)</enum><text>establish a pilot program through which 5 State or local agencies conduct, in 5 States, point-of-use testing of illicit drugs for dangerous contaminants;</text></paragraph>
<paragraph id="H359A4595E1234E1A9139E35FF551E8DC"><enum>(2)</enum><text display-inline="yes-display-inline">establish metrics to evaluate the success of the pilot program in reducing drug overdose rates; and</text></paragraph> <paragraph id="H1B0B4EE3952548CEB5F1E19CA701E04A"><enum>(3)</enum><text>based on such metrics, conduct an annual evaluation of the pilot program and submit an annual report to the Congress containing the results of such evaluation.</text></paragraph></subsection>
<subsection id="HC8DE13E70F8242718EA5EC9A4FEFF214"><enum>(b)</enum><header>Authorization of appropriations</header><text>To carry out this section, there is authorized to be appropriated $5,000,000 for each of fiscal years 2019 through 2023.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section> <section id="HA076BF5084634716BD9DFB8F209B71DA"><enum>3003.</enum><header>Allowing for more flexibility with respect to medication-assisted treatment for opioid use disorders</header> <subsection id="H0A165651DA7241A9A1C6D31AD89F3A97"><enum>(a)</enum><header>Conforming applicable number</header><text display-inline="yes-display-inline">Subclause (II) of section 303(g)(2)(B)(iii) of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/823">21 U.S.C. 823(g)(2)(B)(iii)</external-xref>) is amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="H5A6B5B578196443EBB6660359D06C3BD" style="OLC">
<subclause id="H2AF322E384664D13933295D6F078C3E4" indent="up3"><enum>(II)</enum><text display-inline="yes-display-inline">The applicable number is—</text> <item id="H33F3C23CB9A54C6ABF88E1EBA765AC56"><enum>(aa)</enum><text>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 Secretary of the need and intent of the practitioner to treat up to 100 patients; </text></item>
<item id="HA8C9F90A2BE1427C8ED27B95F6ABEF10"><enum>(bb)</enum><text>100 if the practitioner holds additional credentialing, as defined in section 8.2 of title 42, Code of Federal Regulations (or successor regulations); or</text></item> <item id="H945642164F6644ACA1D6402404F2B6D9"><enum>(cc)</enum><text>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 qualified practice setting (as described in section 8.615 of title 42, Code of Federal Regulations (or successor regulations)).</text></item></subclause><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H4ED388C311BF4A6FAC2F61F24DA491A5"><enum>(b)</enum><header>Eliminating any time limitation for nurse practitioners and physician assistants To become qualifying practitioners</header><text display-inline="yes-display-inline">Clause (iii) of section 303(g)(2)(G) of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/823">21 U.S.C. 823(g)(2)(G)</external-xref>) is amended—</text> <paragraph id="H2F8ED861F10842D6BE40483BB90636DB"><enum>(1)</enum><text>in subclause (I), by striking <quote>or</quote> at the end; and</text></paragraph>
<paragraph id="H87FC28912C3B46EF88F9F6162AD982C3"><enum>(2)</enum><text>by amending subclause (II) to read as follows:</text> <quoted-block style="OLC" id="H96DE4842DBF348D8BE1B4B66010BEC7D" display-inline="no-display-inline"> <subclause id="HD9EC914D51DF40C9BAC84FEEA45B02D0" indent="up2"><enum>(II)</enum><text display-inline="yes-display-inline">a qualifying other practitioner, as defined in clause (iv), who is a nurse practitioner or physician assistant; or</text></subclause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection>
<subsection id="HF2C3D9EF4FBF4E82892DD7544E0B5DD2"><enum>(c)</enum><header>Imposing a time limitation for clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwifes To become qualifying practitioners</header><text display-inline="yes-display-inline">Clause (iii) of section 303(g)(2)(G) of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/823">21 U.S.C. 823(g)(2)(G)</external-xref>), as amended by subsection (b), is further amended by adding at the end the following:</text> <quoted-block style="OLC" id="HCEEE9E20CEC444B5A47521EADC1CCB19" display-inline="no-display-inline"> <subclause id="H167DE302DA324A628448E843F0DF44B7" indent="up2"><enum>(III)</enum><text display-inline="yes-display-inline">for the period beginning on October 1, 2018, and ending on October 1, 2023, a qualifying other practitioner, as defined in clause (iv), who is a clinical nurse specialist, certified registered nurse anesthetist, or certified nurse midwife.</text></subclause><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H610874CDBD8A492FA167E7B281D38B0A" commented="no"><enum>(d)</enum><header>Definition of qualifying other practitioner</header><text display-inline="yes-display-inline">Section 303(g)(2)(G)(iv) of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/823">21 U.S.C. 823(g)(2)(G)(iv)</external-xref>) is amended by striking <quote>nurse practitioner or physician assistant</quote> each place it appears and inserting <quote>nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse midwife, or physician assistant</quote>.</text></subsection> <subsection id="H2E289335D3024E698274A8B0959F949C" commented="no"><enum>(e)</enum><header>Report by Secretary</header><text display-inline="yes-display-inline">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 (<external-xref legal-doc="usc" parsable-cite="usc/21/823">21 U.S.C. 823(g)(2)(G)(iii)</external-xref>)) 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—</text>
<paragraph id="HD62C65F1797A470681E1EF2B7F391335" commented="no"><enum>(1)</enum><text display-inline="yes-display-inline">the average frequency with which qualifying practitioners see their patients;</text></paragraph> <paragraph id="HDC0AD815BAA148DFABDC1488EC9511F0" commented="no"><enum>(2)</enum><text display-inline="yes-display-inline">the average frequency with which patients receive counseling, including the rates by which such counseling is provided by such a qualifying practitioner directly, or by referral;</text></paragraph>
<paragraph id="H47DF294511374CE093E123F149184766" commented="no"><enum>(3)</enum><text>the frequency of toxicology testing, including the average frequency with which random toxicology testing is administered;</text></paragraph> <paragraph id="H2BF9D3BE14D440C18E562A3441757E91" commented="no"><enum>(4)</enum><text>the average monthly patient caseload for each type of qualifying practitioner;</text></paragraph>
<paragraph id="H9597D3EF69DE452391E62EBE68C57552" commented="no"><enum>(5)</enum><text>the treatment retention rates for patients; </text></paragraph> <paragraph id="H6E35DD0782B34710BFEDFC0E26D050FA" commented="no"><enum>(6)</enum><text>overdose and mortality rates; and</text></paragraph>
<paragraph id="H67E8AF79748648EAA74A37C5F2ED1351"><enum>(7)</enum><text display-inline="yes-display-inline">any available information regarding the diversion of drugs by patients receiving such treatment from such a qualifying practitioner.</text></paragraph></subsection></section> <section id="HE522290FBC1B4014AF8DECF5C3BDEDF5"><enum>3004.</enum><header>High-quality, evidence-based opioid analgesic prescribing guidelines and report</header> <subsection id="H49A3B81E7EDB4C4F9A394EF09AF1EDEB"><enum>(a)</enum><header>Guidelines</header><text>The Commissioner of Food and Drugs shall develop high-quality, evidence-based opioid analgesic prescribing guidelines for the indication-specific treatment of acute pain in the relevant therapeutic areas where such guidelines do not exist. </text></subsection>
<subsection id="H85C9F0FF5AA24EEDAF75D3257C66F68B"><enum>(b)</enum><header>Public input</header><text>In developing the guidelines under subsection (a), the Commissioner of Food and Drugs shall— </text> <paragraph id="H6954EEBAF40B4B9ABB34729E5BA656DD"><enum>(1)</enum><text>conduct a public workshop, open to representatives of State medical societies and medical boards, various medical specialties including pain medicine specialty societies, patient groups, pharmacists, universities, and others; and </text></paragraph>
<paragraph id="H41FBABBB7EC7498F8B214AD95B6EAE3D"><enum>(2)</enum><text>provide a period for the submission of comments by the public. </text></paragraph></subsection> <subsection id="H17247320A7EC4843B2450B58A838D26F"><enum>(c)</enum><header>Report</header><text>Not later than the date that is 2 years after the date of enactment of this Act, the Commissioner of Food and Drugs 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, and post on the public website of the Food and Drug Administration, a report on how the guidelines under subsection (a) will be utilized to protect the public health.</text></subsection>
<subsection id="H748DA60BAD99410BA7B051AFA1E1AF26"><enum>(d)</enum><header>Updates</header><text>The Commissioner of Food and Drugs shall periodically—</text> <paragraph id="HDEC514E92EAB44CA809521287665EF6F"><enum>(1)</enum><text>update the guidelines under subsection (a), informed by public input described in subsection (b); and</text></paragraph>
<paragraph id="H30A4FD567AA1480D92F36EBFA0BDA4E9"><enum>(2)</enum><text>submit to the committees specified in subsection (c) and post on the public website of the Food and Drug Administration an updated report under subsection (c).</text></paragraph></subsection> <subsection id="H7E10460F61284790AA2744E0E36570B8" display-inline="no-display-inline"><enum>(e)</enum><header>Statement To accompany guidelines and recommendations</header><text display-inline="yes-display-inline">The Commissioner of Food and Drugs shall ensure that any opioid analgesic prescribing guidelines and other recommendations developed under this section are accompanied by a clear statement that such guidelines or recommendations, as applicable—</text>
<paragraph id="H9EB7218BDBFB4910A6E668E939DA9DFB"><enum>(1)</enum><text>are intended to help inform clinical decisionmaking by prescribers and patients; and</text></paragraph> <paragraph id="H28611B97F22042B4A40230D88E5FF63B"><enum>(2)</enum><text>should not be used by other parties, including pharmacy benefit management companies, retail or community pharmacies, or public and private payors, 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 professional practice.</text></paragraph></subsection>
<subsection id="HA008351ED4F34757AF7033D35EF831A7"><enum>(f)</enum><header>Definition</header><text>In this section, the term <quote>evidence-based</quote> means informed by a robust and systemic review of treatment efficacy and clinical evidence. </text></subsection></section> <section id="H8B2DB1C2C8D443298DC40F3BE93A335B" section-type="subsequent-section"><enum>3005.</enum><header>Report on opioids prescribing practices for pregnant women</header> <subsection id="HF3DACE21F62041B981E42C2B839537A8"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 180 days 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, and the Substance Abuse and Mental Health Services Administration shall develop and submit to the Congress a report—</text>
<paragraph id="H968C4E3AD9A6400295FD163A03124EB2"><enum>(1)</enum><text>on opioids prescribing practices for pregnant women and recommendations for such practices;</text></paragraph> <paragraph id="H4EF463BB7687410E8EE7E6B7DE0B992B"><enum>(2)</enum><text>that provides recommendations for identifying and reducing opioids misuse during pregnancy; </text></paragraph>
<paragraph id="H405586CBD56045218F07C8EBFFBB303D"><enum>(3)</enum><text display-inline="yes-display-inline">on prescription opioid misuse during pregnancy in urban and rural areas;</text></paragraph> <paragraph id="H4E08F25DD3B947BA9A2561E93BD61DD0"><enum>(4)</enum><text>on prescription opioid use during pregnancy for the purpose of medication-assisted treatment in urban and rural areas;</text></paragraph>
<paragraph id="HAB6F7E2DA7044BA6B3DE293DC09C4DF9"><enum>(5)</enum><text display-inline="yes-display-inline">evaluating current utilization of non-opiate pain management practices in place of prescription opioids during pregnancy;</text></paragraph> <paragraph id="HFB21353F91114A6DB4337A515ED7E9CA"><enum>(6)</enum><text>providing guidelines encouraging the use of non-opioid pain management practices during pregnancy when safe and effective; and</text></paragraph>
<paragraph id="HF3086B5BE6EA4D37AEBAA729C488418C"><enum>(7)</enum><text>that provides recommendations for increasing public awareness and education of opioid use disorder in pregnancy, including available treatment resources in urban and rural areas.</text></paragraph></subsection> <subsection id="HC60F41A9F56F4AE9AADB7B958735DE1B"><enum>(b)</enum><header>No additional funds</header><text display-inline="yes-display-inline">No additional funds are authorized to be appropriated for purposes of carrying out subsection (a).</text></subsection></section>
<section id="H0B238AC73D544416A8E6E0159D48F7F1" section-type="subsequent-section"><enum>3006.</enum><header>Guidelines for prescribing naloxone</header>
<subsection id="H3BFB65BFF83243FEA792F8734E356EE8"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 180 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall issue guidelines for prescribing an opioid overdose reversal drug.</text></subsection> <subsection id="H615D03E3E2674C168819D93628F5D9C5"><enum>(b)</enum><header>Contents</header><text display-inline="yes-display-inline">In issuing guidelines under subsection (a), the Secretary shall address the following:</text>
<paragraph commented="no" id="H128075E90C434465889DA24CC32F4751"><enum>(1)</enum><text>Co-prescribing an opioid overdose reversal drug in conjunction with any prescribed opioid.</text></paragraph> <paragraph id="HEC29DAA7EAB6486084EF3D1B9328279A"><enum>(2)</enum><text>Dosage safety.</text></paragraph>
<paragraph id="HBA194096BF254088B25C8E1A4274872E"><enum>(3)</enum><text>Prescribing an opioid overdose reversal drug to an individual other than a patient.</text></paragraph> <paragraph id="HD6F785D6BAD94D248431606F45E067F0"><enum>(4)</enum><text>Standing orders.</text></paragraph>
<paragraph id="H1DED1688574048B9B05CEE74812D0F96"><enum>(5)</enum><text>Other distribution, education, and safety measures as determined necessary.</text></paragraph></subsection></section> <section id="H8D4305A844F245F9AC62FBFE4D2D8986"><enum>3007.</enum><header>Requiring a survey of substance use disorder treatment providers receiving Federal funding</header> <subsection id="HA423C75CC07C495A9E8897EAA1749478"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services (in this section referred to as the <quote>Secretary</quote>) shall conduct a survey of all entities that receive Federal funding for the purpose of providing substance use disorder treatment services. The survey shall direct such entities to provide the following information:</text>
<paragraph id="H9388B28E363B406B96B7419362EEE763"><enum>(1)</enum><text>The length of time the entity has provided substance use disorder treatment services.</text></paragraph> <paragraph id="HB871B374EB004F2195147DA9F697C288"><enum>(2)</enum><text>A detailed description of the patient population served by the entity, including but not limited to the number of patients, type of addictions, geographic area served, as well as gender, racial, ethnic and socioeconomic demographics of such patients.</text></paragraph>
<paragraph id="H8DD454D35FEC491FB11F065A39E538CB"><enum>(3)</enum><text>A detailed description of the types of addiction for which the entity has the experience, capability, and capacity to provide such services.</text></paragraph> <paragraph id="H814C61CE96B14AD8B4439E12CB25566B"><enum>(4)</enum><text>An explanation of how the entity handles patients requiring treatment for a substance use disorder that the organization is not able to treat.</text></paragraph>
<paragraph id="H8A901BC371CF44EB90F7AA8142E5515F"><enum>(5)</enum><text>A description of what is needed, in the opinion of the entity, in order to improve the entity’s ability to meet the addiction treatment needs of the communities served by that entity.</text></paragraph> <paragraph id="H4B3B7F154C3A487CBECF07BACC5C8FEA"><enum>(6)</enum><text>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 through additional Federal, State, or local government resources or funding to treat addiction to methamphetamine, crack cocaine, other types of cocaine, heroin, opioids, and other commonly abused drugs.</text></paragraph></subsection>
<subsection id="H7643C3DD4E8A4477B23E0757E42226AB"><enum>(b)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than 1 year 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).</text></subsection></section> <enum>IV</enum><header>Offsets</header> <section id="HD2EA40A6E1CD4E789E755523345DFB44"><enum>4001.</enum><header>Promoting value in Medicaid managed care</header><text display-inline="no-display-inline">Section 1903(m) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396b">42 U.S.C. 1396b(m)</external-xref>) is amended by adding at the end the following new paragraph:</text>
<quoted-block id="H9D4C68D2B3A74D63B00C8DEDC7C434DB" style="OLC">
<paragraph id="H3063A2CF54BD4D38AE06CF4342F7CC0E" indent="up1"><enum>(7)</enum>
<subparagraph id="H33231B89F807494888C0D58A1A902ECD" display-inline="yes-display-inline"><enum>(A)</enum><text display-inline="yes-display-inline">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).</text></subparagraph> <subparagraph id="H0F3F7340FF4D4DDCA66B1CC528FDE42F" indent="up1"><enum>(B)</enum><text>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—</text>
<clause id="H6B8AE36E010E4FED8668E1C525B00324"><enum>(i)</enum><text>has satisfied the requirement of section 438.8 of title 42, Code of Federal Regulations (or any successor regulation), by electing—</text> <subclause id="HD8382E52CB7B4A959707D34421F856FB"><enum>(I)</enum><text>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</text></subclause>
<subclause id="HE824712C7940419D900A956893BA33B2"><enum>(II)</enum><text display-inline="yes-display-inline">in the case of a State not described in subparagraph (C), to apply a minimum medical loss ratio that is equal to 85 percent; and</text></subclause></clause> <clause id="HE34147125F7342F49D47764A2409D86D"><enum>(ii)</enum><text>recovered all or a portion of the expenditures as a result of the entity’s failure to meet such ratio.</text></clause></subparagraph>
<subparagraph id="H9077BE8213DF48E189FA7E05F26CCC76" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">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.</text></subparagraph> <subparagraph id="H915177728C004032B212EC51D3DD38DA" indent="up1"><enum>(D)</enum><text>For purposes of this paragraph:</text>
<clause id="HAE743287AD064D30B2EB3566B529EDE1"><enum>(i)</enum><text display-inline="yes-display-inline">The term <term>managed care entity</term> means a medicaid managed care organization described in section 1932(a)(1)(B)(i).</text></clause> <clause id="HFE1CBAC93C534B5E8FE2A073B8EF4E34"><enum>(ii)</enum><text display-inline="yes-display-inline">The term <term>minimum medical loss ratio</term> 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).</text></clause>
<clause id="H01FFABF1187742FF857F1A3B9C8F38FF"><enum>(iii)</enum><text>The term <term>other specified entity</term> means—</text> <subclause id="HA6DE7043E85D4C12B3C953DBA319BBC7"><enum>(I)</enum><text display-inline="yes-display-inline">a prepaid inpatient health plan, as defined in section 438.2 of title 42, Code of Federal Regulations (or any successor regulation); and</text></subclause>
<subclause id="H55E181DA6FC448E3BBAE1739512E2D16"><enum>(II)</enum><text display-inline="yes-display-inline">a prepaid ambulatory health plan, as defined in such section (or any successor regulation).</text></subclause></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></section> <section id="HD82EC7CC1CFF407BA666DB583E3316F1" section-type="subsequent-section"><enum>4002.</enum><header>Extending period of application of Medicare secondary payer rules for individuals with end stage renal disease</header><text display-inline="no-display-inline">Section 1862(b)(1)(C) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395y">42 U.S.C. 1395y(b)(1)(C)</external-xref>) is amended—</text>
<paragraph id="H2D2DD9A3FABD4479B5D32225AB822E7E"><enum>(1)</enum><text>in the last sentence, by inserting <quote>and before January 1, 2020</quote> after <quote>date of enactment of the Balanced Budget Act of 1997</quote>; and </text></paragraph> <paragraph id="HC0BB54B7A3B54C4C86BFA993FF801CF0"><enum>(2)</enum><text>by adding at the end the following new sentence: <quote>Effective for items and services furnished on or after January 1, 2020 (with respect to periods beginning on or after July 1, 2018), clauses (i) and (ii) shall be applied by substituting <quote>33-month</quote> for <quote>12-month</quote> each place it appears.</quote>. </text></paragraph></section>
<section id="HE322FCA96EB741FDA842CA613D2C73CA" section-type="subsequent-section"><enum>4003.</enum><header>Requiring reporting by group health plans of prescription drug coverage information for purposes of identifying primary payer situations under the Medicare program</header><text display-inline="no-display-inline">Clause (i) of section 1862(b)(7)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395y">42 U.S.C. 1395y(b)(7)(A)</external-xref>) is amended to read as follows:</text> <quoted-block style="OLC" id="H268FBF6B03954D399390D998B3D639CD" display-inline="no-display-inline"> <clause id="H0C49BDE8741D48EE87E22A5BE115BE41"><enum>(i)</enum><text display-inline="yes-display-inline">secure from the plan sponsor and plan participants such information as the Secretary shall specify for the purpose of identifying situations where the group health plan is or has been—</text>
<subclause id="H6EE4D30486864D3D85E4DCDDF7803DD5"><enum>(I)</enum><text>a primary plan to the program under this title; or</text></subclause> <subclause id="HF447E4FB7A1D42E78AC0543B8A730C9D"><enum>(II)</enum><text>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</text></subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block></section>
<enum>V</enum><header>Other Medicaid Provisions</header>
<subtitle id="H0C15B747D8804E1D9DF808566375DBC9"><enum>A</enum><header>Mandatory reporting with respect to adult behavioral health measures</header>
<section id="H6E19494FF41E4B81A6695308FEC3F22B" section-type="subsequent-section"><enum>5001.</enum><header>Mandatory reporting with respect to adult behavioral health measures</header><text display-inline="no-display-inline">Section 1139B of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1320b-9b">42 U.S.C. 1320b–9b</external-xref>) is amended—</text> <paragraph id="H3ABB0BD6EFFA4959ACF44567D7626380"><enum>(1)</enum><text>in subsection (b)—</text>
<subparagraph id="H5F06FC4E33D84A759F07F36B81D6EE54"><enum>(A)</enum><text>in paragraph (3)—</text> <clause id="H8C039BC7CA294224848548D836019777"><enum>(i)</enum><text>by striking <quote>Not later than January 1, 2013</quote> and inserting the following:</text>
<quoted-block style="OLC" id="HA0F9D80BE6414E1288594DA41E52D2CC" display-inline="no-display-inline">
<subparagraph id="HB3BC889A59164757B746C9DDD398EEC5"><enum>(A)</enum><header>Voluntary reporting</header><text display-inline="yes-display-inline">Not later than January 1, 2013</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></clause> <clause id="HA575963577284CA982B890DD855402EC"><enum>(ii)</enum><text>by adding at the end the following:</text>
<quoted-block style="OLC" id="HDE4C871943B2411386BE7069C79B6D1F" display-inline="no-display-inline">
<subparagraph id="HFED6A788517642B3BB8E8CE1710389FE"><enum>(B)</enum><header>Mandatory reporting with respect to behavioral health measures</header><text display-inline="yes-display-inline">Beginning with the State report required under subsection (d)(1) for 2024, the Secretary 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.</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></clause></subparagraph> <subparagraph id="HE3040792E8FF4975AC4FE69932E93E58"><enum>(B)</enum><text>in paragraph (5), by adding at the end the following new subparagraph: </text>
<quoted-block style="OLC" id="H3122FA13417C414D85BB1CEC9E64B94C" display-inline="no-display-inline">
<subparagraph id="H55EB0457005349E0A4F8DC1B592C0E87"><enum>(C)</enum><header>Behavioral health measures</header><text display-inline="yes-display-inline">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.</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph> <paragraph id="HC79320F9525F4A8B8D23B5B062458F51"><enum>(2)</enum><text>in subsection (d)(1)(A)—</text>
<subparagraph id="H3778F123AF4E427F91244A8F6E8E2DA0"><enum>(A)</enum><text>by striking <quote>the such plan</quote> and inserting <quote>such plan</quote>; and</text></subparagraph> <subparagraph id="HE731D85AF08D4C2D906EA8F05EEC43A4"><enum>(B)</enum><text>by striking <quote>subsection (a)(5)</quote> and inserting <quote>subsection (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 subsection (b)(5) and any updates or changes to such measures (as required under subsection (b)(3))</quote>.</text></subparagraph></paragraph></section></subtitle>
<subtitle id="HE4B545D2242740F8A09CCE8F0103D33F"><enum>B</enum><header>Medicaid IMD Additional Info</header>
<section id="H7B94EAA69661451C9AEBA7DF83F79434" section-type="subsequent-section"><enum>5011.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>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</short-title></quote> or the <quote><short-title>Medicaid IMD ADDITIONAL INFO Act</short-title></quote>.</text></section> <section id="HC80D71D28E664345A54F5BB6FBBA8D2A" section-type="subsequent-section"><enum>5012.</enum><header>MACPAC exploratory study and report on institutions for mental diseases requirements and practices under Medicaid</header> <subsection id="H6A9EE4AF41724523A4083B10C0A2A659"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than January 1, 2020, the Medicaid and CHIP Payment and Access Commission established under section 1900 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref>) 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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> 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):</text>
<paragraph id="H36D2554799CE44DBAA09185E0437BC5A"><enum>(1)</enum><text display-inline="yes-display-inline">A description of such institutions for mental diseases in each such State, including at a minimum—</text> <subparagraph id="HB89FEFACAE5F42AB90C2E862BB0BB2D7"><enum>(A)</enum><text>the number of such institutions in the State;</text></subparagraph>
<subparagraph id="HB560155DF46A4D7BB0DE587F1372A99A"><enum>(B)</enum><text>the facility type of such institutions in the State; and</text></subparagraph> <subparagraph id="H9530114147544B0B9D095676AE4A10C1"><enum>(C)</enum><text>any coverage limitations under each such State plan (or waiver) on scope, duration, or frequency of such services.</text></subparagraph></paragraph>
<paragraph id="HED613516D8E14C618FC62C0268E1F34F"><enum>(2)</enum><text>With respect to each such institution for mental diseases in each such State, a description of—</text> <subparagraph id="HEAEDD03CF74148829F11584E1EC1AB96"><enum>(A)</enum><text>such services provided at such institution;</text></subparagraph>
<subparagraph id="HA94564A12281454080ED8C0DED26C980"><enum>(B)</enum><text>the process, including any timeframe, used by such institution to clinically assess and reassess such individuals; and</text></subparagraph> <subparagraph id="H0B16BDDE2DE44A12A35F5959E28F3341"><enum>(C)</enum><text>the discharge process used by such institution, including any care continuum of relevant services or facilities provided or used in such process.</text></subparagraph></paragraph>
<paragraph id="H1C2C7FC27EEC4AEFA4AD95FDE4A58386"><enum>(3)</enum><text>A description of—</text> <subparagraph id="H73881FC96E8C47CD95F931225C334185"><enum>(A)</enum><text>any Federal waiver that each such State has for such institutions and the Federal statutory authority for such waiver; and</text></subparagraph>
<subparagraph id="HBB135FCB5D9E4E5FB6BF2DDBEF4806A7"><enum>(B)</enum><text>any other Medicaid funding sources used by each such State for funding such institutions, such as supplemental payments.</text></subparagraph></paragraph> <paragraph id="H2FAB31D5693E4A9383F94AC76B585136"><enum>(4)</enum><text>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 payment under the State plan (or waiver) and how each such State determines if such requirements have been met.</text></paragraph>
<paragraph id="H0B35C6CD11684711874AA9F156DE4217"><enum>(5)</enum><text>A summary of State standards (such as quality standards, 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.</text></paragraph> <paragraph id="H5D4BF2E5EC61449A96348764F126A9E5"><enum>(6)</enum><text>Recommendations for actions by Congress and the Centers for Medicare & Medicaid Services. such as how State Medicaid programs may improve care and improve standards 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.</text></paragraph></subsection>
<subsection id="H052DB2EE6C004A37915B2C8A7CD0A394"><enum>(b)</enum><header>Stakeholder input</header><text display-inline="yes-display-inline">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 beneficiary advocates, health care providers, and Medicaid managed care organizations.</text></subsection> <subsection id="H781B6A2EE5C6407380806AED225F5BE2"><enum>(c)</enum><header>Definitions</header><text>In this section:</text>
<paragraph id="H9DA60F350C2A422B9B56C771DC3827A7"><enum>(1)</enum><header>Representative sample of States</header><text display-inline="yes-display-inline">The term <quote>representative sample of States</quote> means a non-probability sample in which at least two States are selected based on the knowledge and professional judgment of the selector.</text></paragraph> <paragraph id="H29051114FF8040AB83EC44176A656A3A"><enum>(2)</enum><header>State</header><text display-inline="yes-display-inline">The term <quote>State</quote> means each of the 50 States, the District of Columbia, and any commonwealth or territory of the United States.</text></paragraph>
<paragraph id="HDA8BB2E78E3D49709999A9E6B022F4C8"><enum>(3)</enum><header>Institution for mental diseases</header><text display-inline="yes-display-inline">The term <quote>institution for mental diseases</quote> has the meaning given such term in section 435.1009 of title 42, Code of Federal Regulations, or any successor regulation.</text></paragraph></subsection></section></subtitle> <subtitle id="H702FC8A68DCA41399F511BEFDC263027"><enum>C</enum><header>CHIP Mental Health Parity</header> <section display-inline="no-display-inline" id="H5AA4FBBAAC034A62B456EB64B5FFABF9" section-type="subsequent-section"><enum>5021.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>CHIP Mental Health Parity Act</short-title></quote>.</text></section>
<section id="HE7795C49597B49E4A5DBB76CE2C5625A" section-type="subsequent-section" commented="no"><enum>5022.</enum><header>Ensuring access to mental health and substance use disorder services for children and pregnant women under the Children’s Health Insurance Program</header>
<subsection id="H91D3DA11BC8E452999A5A3BC31ED9D4B" commented="no"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 2103(c)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397cc">42 U.S.C. 1397cc(c)(1)</external-xref>) is amended by adding at the end the following new subparagraph:</text> <quoted-block display-inline="no-display-inline" id="H56967F697D5848E1AB3C912408D4EB7C" style="OLC"> <subparagraph id="H67BB044D68FC4FABA0C894D466287694" commented="no"><enum>(E)</enum><text display-inline="yes-display-inline">Mental health and substance use disorder services (as defined in paragraph (5)).</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H1C231362258F42AA8ECB1668393A5271" commented="no"><enum>(b)</enum><header>Mental health and substance use disorder services</header>
<paragraph id="HD6D2F73AE9FB4DB2A5FC416358AD33FE" commented="no"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Section 2103(c) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397cc">42 U.S.C. 1397cc(c)</external-xref>) is amended—</text> <subparagraph id="HB06C9942768D4FBBBA9CACA852539BBD" commented="no"><enum>(A)</enum><text>by redesignating paragraphs (5), (6), (7), and (8) as paragraphs (6), (7), (8), and (9), respectively; and</text></subparagraph>
<subparagraph id="H95B6D0E4DA7040E08091ACF3F12AF526" commented="no"><enum>(B)</enum><text>by inserting after paragraph (4) the following new paragraph:</text> <quoted-block display-inline="no-display-inline" id="HC1D107CBD5C144AD86ED428168D1F432" style="OLC"> <paragraph id="HD909666FF06040718DF40FAE23F28EA1" commented="no"><enum>(5)</enum><header>Mental health and substance use disorder services</header><text display-inline="yes-display-inline">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 assistance under such coverage pursuant to section 2112, such pregnancy-related assistance for targeted low-income women (as defined in section 2112(d)) shall—</text>
<subparagraph id="HF02D13B5C3BF4EB9A3E8EFD50EF18A6E" commented="no"><enum>(A)</enum><text display-inline="yes-display-inline">include coverage of mental health services (including behavioral health treatment) necessary to prevent, diagnose, and treat a broad range of mental health symptoms and disorders, including substance use disorders; and</text></subparagraph> <subparagraph id="HD90B37FD90D24B4DA2B796336B926849" commented="no"><enum>(B)</enum><text display-inline="yes-display-inline">be delivered in a culturally and linguistically appropriate manner.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph>
<paragraph id="HC033194DBA49478AAF7D968CB1205B16" commented="no"><enum>(2)</enum><header>Conforming amendments</header>
<subparagraph id="H0E3BE70EA5224316BB0995F5A172089C" commented="no"><enum>(A)</enum><text>Section 2103(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397cc">42 U.S.C. 1397cc(a)</external-xref>) is amended, in the matter before paragraph (1), by striking <quote>paragraphs (5), (6), and (7)</quote> and inserting <quote>paragraphs (5), (6), (7), and (8)</quote>.</text></subparagraph> <subparagraph id="HC70A7B503C584D2B80582AFA1C2926BE" commented="no"><enum>(B)</enum><text>Section 2110(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397jj">42 U.S.C. 1397jj(a)</external-xref>) is amended—</text>
<clause id="HA6DA39E9BA2E41059FD9575070A0A3F3" commented="no"><enum>(i)</enum><text>in paragraph (18), by striking <quote>substance abuse</quote> each place it appears and inserting <quote>substance use</quote>; and</text></clause> <clause id="HA7EEFD3688C34A93BC2DB1555F8A96A2" commented="no"><enum>(ii)</enum><text>in paragraph (19), by striking <quote>substance abuse</quote> and inserting <quote>substance use</quote>. </text></clause></subparagraph>
<subparagraph id="HB550563A9C8C4976957D2A25336D73E5" commented="no"><enum>(C)</enum><text display-inline="yes-display-inline">Section 2110(b)(5)(A)(i) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397jj">42 U.S.C. 1397jj(b)(5)(A)(i)</external-xref>) is amended by striking <quote>subsection (c)(5)</quote> and inserting <quote>subsection (c)(6)</quote>.</text></subparagraph></paragraph></subsection> <subsection id="H198C7C0C0DF94A0AAF244FE9AC97DFC3" commented="no"><enum>(c)</enum><header>Assuring access to care</header><text display-inline="yes-display-inline">Section 2102(a)(7)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397bb">42 U.S.C. 1397bb(c)(2)</external-xref>) is amended by striking <quote>section 2103(c)(5)</quote> and inserting <quote>paragraphs (5) and (6) of section 2103(c)</quote>.</text></subsection>
<subsection id="H9EAA594859CC4CF4A37E5D0552A97855" commented="no"><enum>(d)</enum><header>Mental health services parity</header><text display-inline="yes-display-inline">Subparagraph (A) of paragraph (7) of section 2103(c) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397cc">42 U.S.C. 1397cc(c)</external-xref>) (as redesignated by subsection (b)(1)) is amended to read as follows:</text> <quoted-block display-inline="no-display-inline" id="H5C567B7BCCA7463EA10D2F6C6E648512" style="OLC"> <subparagraph id="H6580C64ED5B74163939E919A2538850D" commented="no"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H216D7F1EE3604E03AC5DAA23AB081FE2" commented="no"><enum>(e)</enum><header>Effective date</header>
<paragraph id="HF4120D0563554FF98A2251C76C9B02DA" commented="no"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></paragraph> <paragraph id="H26E72E589E454E2480C1BC54D0C7FA18" commented="no"><enum>(2)</enum><header>Exception for State legislation</header><text>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 requirement 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.</text></paragraph></subsection></section></subtitle>
<subtitle id="H83CA5466336140F7AAE7CF4BA29CE69F"><enum>D</enum><header>Medicaid Reentry</header>
<section id="H1A97F185E368480FA745A5F780750507" section-type="subsequent-section"><enum>5031.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Medicaid Reentry Act</short-title></quote>.</text></section> <section id="HA337A3BF96044395B1C7ADA48A4D29DB"><enum>5032.</enum><header>Promoting State innovations to ease transitions integration to the community for certain individuals</header> <subsection id="HDF5F9453F19144D78F5600641BF84B37"><enum>(a)</enum><header>Stakeholder group development of best practices; State Medicaid program innovation</header> <paragraph id="H4E97D370638C4AA787124F3E6F6E048E"><enum>(1)</enum><header>Stakeholder group best practices</header><text display-inline="yes-display-inline">Not later than 6 months after the date of the enactment of this Act, the Secretary of Health and Human Services shall convene a stakeholder group of representatives of managed care organizations, Medicaid beneficiaries, health care providers, the National Association of Medicaid Directors, and other relevant representatives 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—</text>
<subparagraph id="HAB7D9F8670994B10A7328105FCE35434"><enum>(A)</enum><text>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 coverage or coverage under the State Medicaid plan under title XIX of the Social Security Act, as applicable, and relevant social services; and</text></subparagraph> <subparagraph id="H67230B4FFE774A51AB18BD6E213558A8"><enum>(B)</enum><text>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.</text></subparagraph></paragraph>
<paragraph id="H3986A017F0C44AB88E8AEC1020E7CFE4"><enum>(2)</enum><header>State Medicaid program innovation</header><text display-inline="yes-display-inline">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.</text></paragraph></subsection> <subsection id="H66F67778674243CEA2B04BF6F117261E"><enum>(b)</enum><header>Guidance on innovative service delivery systems demonstration project opportunities</header><text display-inline="yes-display-inline">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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1315">42 U.S.C. 1315</external-xref>) 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—</text>
<paragraph id="H9E9A43BE574341E6965C7E8D257C8F87"><enum>(1)</enum><text>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</text></paragraph> <paragraph id="H87F6EF47487E458D96DB868F0E9C874C"><enum>(2)</enum><text>providing health care services for such individuals during such period.</text></paragraph></subsection>
<subsection id="H8203AC045F1F4E8D86A5AF8A3CB314FF"><enum>(c)</enum><header>Rule of construction</header><text display-inline="yes-display-inline">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) eligibility of an individual for medical assistance under title XIX of the Social Security Act while such individual is an inmate of a public institution.</text></subsection></section></subtitle> <subtitle id="H5018CBE215B14BFAAC31077B8952F561"><enum>E</enum><header>Medicaid Partnership</header> <section id="H155618CDDD204E5DAB21E85572B788DA" section-type="subsequent-section"><enum>5041.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Medicaid Providers Are Required To Note Experiences in Record Systems to Help In-need Patients Act</short-title></quote> or the <quote><short-title>Medicaid PARTNERSHIP Act</short-title></quote>.</text></section>
<section id="HE2C302611BE447B3A0D96A0BFD28BD72" commented="no"><enum>5042.</enum><header>Medicaid providers are required to note experiences in record systems to help in-need patients</header>
<subsection id="H85FE7A6CEB804DD99E9B87A0022FE525" commented="no"><enum>(a)</enum><header>Requirements under the Medicaid program relating to qualified prescription drug monitoring programs and prescribing certain controlled substances</header><text>Title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.) is amended by inserting after section 1943 the following new section:</text> <quoted-block style="OLC" id="H8E95BC171D0C47068138CBAC37917E7A" display-inline="no-display-inline"> <section id="H51E4F585ACF649E3BE03891D705598D2" commented="no"><enum>1944.</enum><header>Requirements relating to qualified prescription drug monitoring programs and prescribing certain controlled substances</header> <subsection id="H86BD35892562489FA8642A9DE9A419DC" commented="no"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Beginning October 1, 2021, a State shall, subject to subsection (d), require each covered provider to check, in accordance 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.</text></subsection>
<subsection id="H9E92A136C2C0486DACEF827A21ADEB11" commented="no"><enum>(b)</enum><header>Qualified prescription drug monitoring program described</header><text>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:</text> <paragraph id="H16F798D7F14B4CE59BAE401D5C27A857" commented="no"><enum>(1)</enum><text display-inline="yes-display-inline">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:</text>
<subparagraph id="HA37739FB4E33452E89C817D14F19AB71" commented="no"><enum>(A)</enum><text>Information regarding the prescription drug history of a covered individual with respect to controlled substances.</text></subparagraph> <subparagraph id="H68584748154247A2BD3664D79FD6929B" commented="no"><enum>(B)</enum><text display-inline="yes-display-inline">The number and type of controlled substances prescribed to and filled for the covered individual during at least the most recent 12-month period.</text></subparagraph>
<subparagraph id="H6E28B89D1AEA4FCD81075283803A0BAF" commented="no"><enum>(C)</enum><text display-inline="yes-display-inline">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 Medicare & Medicaid Services) of each covered provider who prescribed a controlled substance to the covered individual during at least the most recent 12-month period.</text></subparagraph></paragraph> <paragraph id="H4EA4A7D6F045415EBE23CC6ACBA25F29" commented="no"><enum>(2)</enum><text>The program facilitates the integration of information described in paragraph (1) into the workflow of a covered provider, which may include the electronic system the covered provider uses to prescribe controlled substances.</text></paragraph><continuation-text continuation-text-level="subsection" commented="no">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 reasonable and limited access, as determined by the State and ensuring documented beneficiary protections regarding the use of such data, 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 has a contract to manage the pharmaceutical benefit with respect to individuals enrolled in the State plan (or 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.</continuation-text></subsection>
<subsection id="H22936A224F634886ABD515B17C8C43D7" commented="no"><enum>(c)</enum><header>Application of privacy rules clarification</header><text>The Secretary 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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1320d-2">42 U.S.C. 1320d–2</external-xref> 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.</text></subsection> <subsection id="HC8DAB2D6EE30475EB9CDED40022737FA" commented="no"><enum>(d)</enum><header>Ensuring access</header><text>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)).</text></subsection>
<subsection id="H5493785B9D4A4A9A824A946D4579077F" commented="no"><enum>(e)</enum><header>Reports</header><text display-inline="yes-display-inline"></text> <paragraph id="H254D3019331D4E6DA5F1334D70525D29" commented="no"><enum>(1)</enum><header>State reports</header><text display-inline="yes-display-inline">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: </text>
<subparagraph id="H73750C1CE8174A6DB70BB425F8A61FA6" commented="no"><enum>(A)</enum><text display-inline="yes-display-inline">The percentage of covered providers (as determined 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.</text></subparagraph> <subparagraph id="HEBBA7E72B3954B75B17C11C35878F13D" commented="no"><enum>(B)</enum><text>Aggregate trends with respect to prescribing controlled substances such as—</text>
<clause id="H7EC0667AD62F4BE590A1FF45F8D2E1E7" commented="no"><enum>(i)</enum><text>the quantity of daily morphine milligram equivalents prescribed for controlled substances;</text></clause> <clause id="HB1B25C5D266342FEACD5458871575CB9" commented="no"><enum>(ii)</enum><text>the number and quantity of daily morphine milligram equivalents prescribed for controlled substances per covered individual; and</text></clause>
<clause id="HC7906B5B07CA43AE9427756FEB93490C" commented="no"><enum>(iii)</enum><text display-inline="yes-display-inline">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).</text></clause></subparagraph> <subparagraph id="H17BAA6FD8F0E4309BCAE034D995ED4B6" commented="no"><enum>(C)</enum><text>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 drug management program before dispensing a controlled substance to such individual.</text></subparagraph></paragraph>
<paragraph id="HCAE52B91DCBC496A8FCD93B9BEE03D3D" commented="no"><enum>(2)</enum><header>Report by CMS</header><text>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 following information:</text> <subparagraph id="H12E5750FAFD54C8B8EFFADD5D8F1150F" commented="no"><enum>(A)</enum><text>Guidance for States on how States can increase the percentage of covered providers who use qualified prescription drug monitoring programs described in subsection (b).</text></subparagraph>
<subparagraph id="H5378CAFC551145C387A7E460A38DC7A6" commented="no"><enum>(B)</enum><text>Best practices for how States and covered providers should use such qualified prescription drug monitoring programs to reduce the occurrence of abuse of controlled substances.</text></subparagraph></paragraph></subsection> <subsection id="HEBC315B7DEC747F3BA3997043693D312" commented="no"><enum>(f)</enum><header>Increase to Federal matching rate for certain expenditures relating to qualified prescription drug management programs</header><text display-inline="yes-display-inline">The Secretary shall increase the Federal medical assistance percentage or Federal matching rate that would otherwise apply to a State under section 1903(a) for a calendar quarter occurring during the period beginning October 1, 2018, and ending September 30, 2021, for expenditures by the State for activities under the State plan (or waiver of the State plan) to implement a prescription drug management program that satisfies the criteria described in paragraphs (1) and (2) of subsection (b) if the State (in this subsection referred to as the <quote>administering State</quote>) has in place agreements with all States that are contiguous to such administering State that, when combined, enable covered providers in all such contiguous States to access, through the prescription drug management 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. In no case shall an increase under this subsection result in a Federal medical assistance percentage or Federal matching rate that exceeds 100 percent.</text></subsection>
<subsection id="H33D190B4ACC14C5F9B6300ECC020800F" commented="no"><enum>(g)</enum><header>Rule of construction</header><text display-inline="yes-display-inline">Nothing in this section prevents a State from requiring pharmacists to check the prescription drug history of covered individuals through a qualified drug management program before dispensing controlled substances to such individuals. </text></subsection> <subsection id="HCAB5A7D42BCF4C2CA9571D9DD60531D2" commented="no"><enum>(h)</enum><header>Definitions</header><text>In this section:</text>
<paragraph id="H3B7B0DFCE6114D74B3163BEFE3AFADA5" commented="no"><enum>(1)</enum><header>Controlled substance</header><text display-inline="yes-display-inline">The term <term>controlled substance</term> means a drug that is included in schedule II of section 202(c) of the Controlled Substances Act and, at the option of the State involved, a drug included in schedule III or IV of such section.</text></paragraph> <paragraph id="H3DDC1C93AD1C4AE4B9455F4EB4EF3D3B" commented="no"><enum>(2)</enum><header>Covered individual</header><text display-inline="yes-display-inline">The term <term>covered individual</term> 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—</text>
<subparagraph id="H3D97768981B445298CB17ECCA0B6A849" commented="no"><enum>(A)</enum><text>is receiving—</text> <clause id="H817126C0C6CA47E3B63A9E1098D3710D" commented="no"><enum>(i)</enum><text>hospice or palliative care; or</text></clause>
<clause id="H803C18A975D64FC0BF4DA63AC5D4532F" commented="no"><enum>(ii)</enum><text>treatment for cancer;</text></clause></subparagraph> <subparagraph id="H167311D17D0D44BBB16C344333EAD866" commented="no"><enum>(B)</enum><text>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 residents through a contract with a single pharmacy; or</text></subparagraph>
<subparagraph id="H42F7DAE9A07D4EAE940CEDE5B92358C1" commented="no"><enum>(C)</enum><text>the State elects to treat as exempted from such term.</text></subparagraph></paragraph> <paragraph id="HD5CF55E9B2A24EDEA2807751A0CA4FC4" commented="no"><enum>(3)</enum><header>Covered provider</header> <subparagraph id="HF8F9C9F9E98A4F45A41742FE2AC809A4" commented="no"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">The term <term>covered provider</term> 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 controlled substance (or the designee of such provider).</text></subparagraph>
<subparagraph id="H994CE6EFDEFF4BDD9B555EDB1CDA90B9" commented="no"><enum>(B)</enum><header>Exceptions</header>
<clause id="H352C703853B0494D919413B5B86026A5" commented="no"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">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).</text></clause> <clause id="H8DB8B2F4892B4E59A2E568275F94A73B" commented="no"><enum>(ii)</enum><header>Exceptions process</header><text display-inline="yes-display-inline">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 diseases, shall determine, based on such consultations, the types of health care providers (if any) that should be exempted from the definition of the term <term>covered provider</term> for purposes of this section.</text></clause></subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H40CA5AA13C1F47E19767BC8C86E05722" commented="no"><enum>(b)</enum><header>Guidance</header><text>Not later than October 1, 2019, the Administrator of the Centers for Medicare & Medicaid Services, in consultation 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.</text></subsection> <subsection id="H16A6B35D3070451D8BF406BD82C152DF" commented="no"><enum>(c)</enum><header>Development of model State practices</header> <paragraph id="H6756041CC36F4646BE03535308DD8EB3" commented="no"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than October 1, 2020, the Secretary 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 paragraph (2) of section 1944(b) of the Social Security Act, as added by subsection (a), for the following purposes:</text>
<subparagraph id="H585A9A0A105D495B8A865194B65FBB1E" commented="no"><enum>(A)</enum><text>Monitoring and preventing fraud, waste, and abuse.</text></subparagraph> <subparagraph id="H7F8AB6C26DB248F5B2E04CEC1447D0FA" commented="no"><enum>(B)</enum><text>Improving health care for individuals enrolled in a State plan under title XIX of such Act (or waiver of such plan) who—</text>
<clause id="H5431137F29164D09B8EC34C4BF8ACC6C" commented="no"><enum>(i)</enum><text>transition in and out of coverage under such title; </text></clause> <clause id="H7F1C8D10BB7C42F3BC10AD2858C604C7" commented="no"><enum>(ii)</enum><text>may have sources of health care coverage in addition to coverage under such title; or</text></clause>
<clause id="HBBB3925F90D84B10BA0467FFA4D28DF9" commented="no"><enum>(iii)</enum><text>pay for prescription drugs with cash.</text></clause></subparagraph> <subparagraph id="HF0AA7B83C0264747947BDDCD174811E6" commented="no"><enum>(C)</enum><text>Any other purposes specified by the Secretary.</text></subparagraph></paragraph>
<paragraph id="H3D75712A1C5F44F9B27170A080C4C9E3" commented="no"><enum>(2)</enum><header>Elements of model practices</header><text>The model practices described in paragraph (1)—</text> <subparagraph id="HF48827E17E874093BE9CB12FDB07EE16" commented="no"><enum>(A)</enum><text>shall include strategies for assisting States in allowing the medical director or pharmacy director (or designees of such a director) of managed care organizations or pharmaceutical benefit managers to access information with respect to all covered individuals served by such managed care organizations or pharmaceutical benefit managers to access as a single data set, in an electronic format; and</text></subparagraph>
<subparagraph id="H353E66CB315A4F64822580F4C8F4EB83" commented="no"><enum>(B)</enum><text>shall include any appropriate beneficiary protections and privacy guidelines.</text></subparagraph></paragraph> <paragraph id="HBC37C702CCDA4218AF14F6078DFCC121" commented="no"><enum>(3)</enum><header>Consultation</header><text>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.</text></paragraph></subsection>
<subsection id="H8F84D18D9ECF4ABCBB91F665E4554EA4" commented="no"><enum>(d)</enum><header>Report by Comptroller General</header><text>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.</text></subsection></section></subtitle> <enum>VI</enum><header>Other Medicare Provisions</header> <subtitle id="HC3526758C8664D5295AEEFF45A07331E"><enum>A</enum><header>Testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology</header> <section id="H8E32F063BA724B7E8E6AD54770616EB8" section-type="subsequent-section"><enum>6001.</enum><header>Testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology</header><text display-inline="no-display-inline">Section 1115A(b)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1315a">42 U.S.C. 1315a(b)(2)(B)</external-xref>) is amended by adding at the end the following new clause:</text>
<quoted-block id="H6DA593A19BEB433FA1C727B7B6916157" style="OLC">
<clause id="H99F7BFC0B7E1490EAB94AA5DB1283E45"><enum>(xxv)</enum><text display-inline="yes-display-inline">Providing, for the adoption and use of certified 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 psychologists (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))).</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></section></subtitle> <subtitle id="H0DD8BA17FBFB4D18B2B87BC563809954"><enum>B</enum><header>Abuse Deterrent Access</header> <section id="H9C533CEC4514485A8D144FA43BDC7903" section-type="subsequent-section"><enum>6011.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited at the <quote><short-title>Abuse Deterrent Access Act of 2018</short-title></quote>.</text></section>
<section id="HF084F9DAFE5848A492002420F2219BD1" section-type="subsequent-section"><enum>6012.</enum><header>Study on abuse-deterrent opioid formulations access barriers under Medicare</header>
<subsection id="H3973705627514186BF670962C566A17E"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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 the adequacy of access to abuse-deterrent opioid formulations 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 requirements, the price of such formulations, and prior authorization requirements.</text></subsection> <subsection id="HFA538554A86744808420F823A91B595B"><enum>(b)</enum><header>Definition of abuse-deterrent opioid formulation</header><text display-inline="yes-display-inline">In this section, the term <quote>abuse-deterrent opioid formulation</quote> means an opioid that is a prodrug or that has certain abuse-deterrent properties, such as physical or chemical barriers, agonist or antagonist combinations, aversion properties, delivery system mechanisms, or other features designed to prevent abuse of such opioid.</text></subsection></section></subtitle>
<subtitle id="H940092B7FE4F41E79D6117D2B28C7A25"><enum>C</enum><header>Medicare Opioid Safety Education</header>
<section id="H46653D6F12BA4CE5811D429309980243" section-type="subsequent-section"><enum>6021.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Medicare Opioid Safety Education Act of 2018</short-title></quote>.</text></section> <section id="HEF4D865D473D4B75924315DD643839BD" section-type="subsequent-section"><enum>6022.</enum><header>Provision of information regarding opioid use and pain management as part of Medicare & You handbook</header> <subsection id="H642E2117A51846F5A2DF98E9D10C22E0"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1804 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395b-2">42 U.S.C. 1395b–2</external-xref>) is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H0B45C17528654068B9B14D70491BBA71" style="OLC">
<subsection id="HA315B88B04A84940975CFE51732D5761"><enum>(d)</enum><text display-inline="yes-display-inline">The notice provided under subsection (a) shall include—</text> <paragraph id="HC628B2239F4A44CEAA1DBDC93E01D57E"><enum>(1)</enum><text>educational resources, compiled by the Secretary, regarding opioid use and pain management; and</text></paragraph>
<paragraph id="H585BE440366643A39FE75A416E33927C"><enum>(2)</enum><text>a description of alternative, non-opioid pain management treatments covered under this title.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="HE9C172C74983490B97803CCA22492781"><enum>(b)</enum><header>Effective date</header><text>The amendment made by subsection (a) shall apply to notices distributed prior to each Medicare open enrollment period beginning after January 1, 2019.</text></subsection></section></subtitle>
<subtitle id="HB1D1B4C0E27442DA9FF1003F95CC69B8"><enum>D</enum><header>Opioid Addiction Action Plan</header>
<section id="H0019857DA3E24D79BE1787E965E9E67E" section-type="subsequent-section"><enum>6031.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Opioid Addiction Action Plan Act</short-title></quote>.</text></section> <section id="H6AF5290276BF4FB38596EDBFDD234601" section-type="subsequent-section"><enum>6032.</enum><header>Action plan on recommendations for changes under Medicare and Medicaid to prevent opioids addictions and enhance access to medication-assisted treatment</header> <subsection id="HFDBC3CB08F6646AA9681910152759E87"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than January 1, 2019, the Secretary of Health and Human Services (in this section referred to as the <quote>Secretary</quote>), in collaboration with the Pain Management Best Practices Inter-Agency Task Force convened under section 101(b) of the Comprehensive Addiction and Recovery Act of 2016 (<external-xref legal-doc="public-law" parsable-cite="pl/114/198">Public Law 114–198</external-xref>), shall develop an action plan that provides recommendations described in subsection (b).</text></subsection>
<subsection id="H3D5609FCB33544AF8D014E52F1BD47DF"><enum>(b)</enum><header>Action plan components</header><text display-inline="yes-display-inline">Recommendations described in this subsection are, based on an examination by the Secretary of potential obstacles to an effective response to the opioid crisis, recommendations, as determined appropriate by the Secretary, on the following:</text> <paragraph id="H8588057D4D224959827E55D9EF373849"><enum>(1)</enum><text display-inline="yes-display-inline">Recommendations on changes to the Medicare program under title XVIII of the Social Security Act and the Medicaid program under title XIX of such Act that would enhance coverage and payment under such programs of all medication-assisted treatment approved by the Food and Drug Administration for the treatment of opioid addiction and other therapies that manage chronic and acute pain and treat and minimize risk of opioid addiction, including recommendations on changes to the Medicare prospective payment system for hospital inpatient department services under section 1886(d) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(d)</external-xref>) and the Medicare prospective payment system for hospital outpatient department services under section 1833(t) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(t)</external-xref>) that would allow for separate payment for such therapies, if medically appropriate and if necessary to encourage development and adoption of such therapies.</text></paragraph>
<paragraph id="H3E97B7CB17974E87817A5FE4AD3B1882"><enum>(2)</enum><text display-inline="yes-display-inline">Recommendations for payment and service delivery models to be tested by the Center for Medicare and Medicaid Innovation and other federally authorized demonstration projects, including value-based models, that may encourage the use of appropriate medication-assisted treatment approved by the Food and Drug Administration for the treatment of opioid addiction and other therapies that manage chronic and acute pain and treat and minimize risk of opioid addiction.</text></paragraph> <paragraph id="H0B55BFEB57F947578F50AF2B34EADF52"><enum>(3)</enum><text display-inline="yes-display-inline">Recommendations for data collection that could facilitate research and policy making regarding prevention of opioid addiction and coverage and payment under the Medicare and Medicaid programs of appropriate opioid addiction treatments.</text></paragraph>
<paragraph id="H104499D864B04844890D6D537923CBAC"><enum>(4)</enum><text display-inline="yes-display-inline">Recommendations for policies under the Medicare program and under the Medicaid program that can expand access for rural, or medically underserved communities to the full range of medication-assisted treatment approved by the Food and Drug Administration for the treatment of opioid addiction and other therapies that manage chronic and acute pain and treatment and minimize risk of opioid addiction.</text></paragraph> <paragraph id="H31A6EC001FE54A1898DF5E8371BD2190"><enum>(5)</enum><text display-inline="yes-display-inline">Recommendations on changes to the Medicare program and the Medicaid program to address coverage or payment barriers to patient access to medical devices that are non-opioid based treatments approved by the 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.</text></paragraph></subsection>
<subsection id="H064BE042B82A40A0B5B8918EB313FDB0"><enum>(c)</enum><header>Stakeholder meetings</header>
<paragraph id="H3FFB038AC153415BB47907A1C4D5C377"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Beginning not later than 3 months after the date of the enactment of this Act, the Secretary shall convene a public stakeholder meeting to solicit public comment on the components of the action plan recommendations described in subsection (b).</text></paragraph> <paragraph id="H2ADA60A1222343B1998AA776B509F14D"><enum>(2)</enum><header>Participants</header><text>Participants of meetings described in paragraph (1) shall include representatives from the Food and Drug Administration and National Institutes of Health, biopharmaceutical industry members, medical researchers, health care providers, the medical device industry, the Medicare program, the Medicaid program, and patient advocates.</text></paragraph></subsection>
<subsection id="HF660EA26866D419EA3F7EB4AFA25A701"><enum>(d)</enum><header>Request for information</header><text display-inline="yes-display-inline">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.</text></subsection> <subsection display-inline="no-display-inline" id="H3BA5D25BA3534BC588F6A5C217A8843C"><enum>(e)</enum><header>Report to Congress</header><text display-inline="yes-display-inline">Not later than June 1, 2019, the Secretary shall submit to Congress, and make public, a report that includes—</text>
<paragraph id="H2F7DAA6602484F60861DA62CE6BA00A3"><enum>(1)</enum><text display-inline="yes-display-inline">a summary of recommendations that have emerged under the action plan;</text></paragraph> <paragraph id="H1A23E901375D408784ED8A896F78C293"><enum>(2)</enum><text display-inline="yes-display-inline">the Secretary’s planned next steps with respect to the action plan; and</text></paragraph>
<paragraph id="H54BBF4C7AC284F1192C4D945D3FBA8CB"><enum>(3)</enum><text display-inline="yes-display-inline">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.</text></paragraph></subsection> <subsection id="HBA59B9E039B34D6BADD8BB25643708D5"><enum>(f)</enum><header>Definition of Medication-Assisted treatment</header><text>In this section, the term <term>medication-assisted treatment</term> includes opioid treatment programs, behavioral therapy, and medications to treat substance abuse disorder.</text></subsection></section></subtitle>
<subtitle id="H765437573D194972B1FCBA749F208EB0"><enum>E</enum><header>Advancing High Quality Treatment for Opioid Use Disorders in Medicare</header>
<section id="H7DA35707F5A940919F8E304AD3B90CBB" section-type="subsequent-section"><enum>6041.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act</short-title></quote>.</text></section> <section id="H7140D101E8A44338A3F022E0C19AE865"><enum>6042.</enum><header>Opioid use disorder treatment demonstration program</header><text display-inline="no-display-inline">Title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et seq.) is amended by inserting after section 1866E (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc-5">42 U.S.C. 1395cc–5</external-xref>) the following new section:</text>
<quoted-block style="OLC" id="H4F00949CBE9F4C68913BCD94AB327D1D" display-inline="no-display-inline">
<section id="H7EB8CAD1551049AA94BC6746D4E424AD"><enum>1866F.</enum><header>Opioid use disorder treatment demonstration program</header>
<subsection id="H10C83A8D051542DC880CC1DE9942B5AE"><enum>(a)</enum><header>Implementation of 4-year demonstration program</header>
<paragraph id="H149AF60613E542788D600ED59BF7D351"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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 <quote>Program</quote>) to increase access of applicable beneficiaries to opioid use disorder 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 participants (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 furnished, to applicable beneficiaries participating in the Program.</text></paragraph> <paragraph id="HF2EE9B671D82477FB3552771EC7E71B7"><enum>(2)</enum><header>Opioid use disorder treatment services</header><text display-inline="yes-display-inline">For purposes of this section, the term <term>opioid use disorder treatment services</term>—</text>
<subparagraph id="HFC863CB0C7774E02AFB8E7F3726E7561"><enum>(A)</enum><text display-inline="yes-display-inline">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</text></subparagraph> <subparagraph id="H8BB742E8E5264952A48F216BBDAC8D27"><enum>(B)</enum><text>includes—</text>
<clause id="HE3070822FFC7440FAD6AA15C4B9D1EE4"><enum>(i)</enum><text>medication assisted treatment;</text></clause> <clause id="H8CEB65EA31974C078BDA8AC369B9A133"><enum>(ii)</enum><text>treatment planning;</text></clause>
<clause id="H672B56DCA99D445E9CC174EFECDD95D9"><enum>(iii)</enum><text>psychiatric, psychological, or counseling services (or any combination of such services), as appropriate;</text></clause> <clause id="HEA9055FDE37D42ACA561366235E180FF"><enum>(iv)</enum><text>social support services, as appropriate; and</text></clause>
<clause id="H4DE85810C0F64A6D85E1FF804A39134A"><enum>(v)</enum><text>care management and care coordination services, including coordination with other providers of services and suppliers not on an opioid use disorder care team.</text></clause></subparagraph></paragraph></subsection> <subsection id="H765398B5C6894A1E9A1854FBC39E61C9"><enum>(b)</enum><header>Program design</header> <paragraph id="H732ED6A44CAB4D5B9BD2835593FA36EE"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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:</text>
<subparagraph id="HC63106C5F2714EA786CA32902F011A9E"><enum>(A)</enum><text display-inline="yes-display-inline">Reduces hospitalizations and emergency department visits.</text></subparagraph> <subparagraph id="HA5C6D4D61FD24AD5993B5E053BC38F86"><enum>(B)</enum><text>Increases use of medication-assisted treatment for opioid use disorders.</text></subparagraph>
<subparagraph id="HB70D1C06822447D1BFAC744F22C28B44"><enum>(C)</enum><text display-inline="yes-display-inline">Improves health outcomes of individuals with opioid use disorders, including by reducing the incidence of infectious diseases (such as hepatitis C and HIV).</text></subparagraph> <subparagraph id="H81638AA76B9A4112B5FC01411635032F" commented="no"><enum>(D)</enum><text>Does not increase the total spending on items and services under this title.</text></subparagraph>
<subparagraph id="HD0089D4EC7B14D60AB8C78CD1D2A483B"><enum>(E)</enum><text display-inline="yes-display-inline">Reduces deaths from opioid overdose.</text></subparagraph> <subparagraph id="HF54F5A8D653D4C8AAAF30B2C05D7C9C2"><enum>(F)</enum><text>Reduces the utilization of inpatient residential treatment.</text></subparagraph></paragraph>
<paragraph id="HBCDF231F32944962B465EFD7549243EB"><enum>(2)</enum><header>Consultation</header><text>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, clinicians in the primary care community, and beneficiary groups.</text></paragraph></subsection> <subsection id="HEB5883AEEBF94AD3B18E395D450D5F83"><enum>(c)</enum><header>Participants; opioid use disorder care teams</header> <paragraph id="H4D59E8250178465DB5028E434908975A"><enum>(1)</enum><header>Participants</header> <subparagraph id="HCE3590881D654D3F9AC056E31BDDC3C6"><enum>(A)</enum><header>Definition</header><text display-inline="yes-display-inline">In this section, the term <term>participant</term> means an entity or individual—</text>
<clause id="H5C6872E4F00B494D89CF6950C2C604D4"><enum>(i)</enum><text>that is otherwise enrolled under this title and that is—</text> <subclause id="HC435ACD0979743BB82330A6D2A9DEFBE"><enum>(I)</enum><text>a physician (as defined in section 1861(r)(1));</text></subclause>
<subclause id="H8C504A527D694AFAB8E2AE89F222DD89"><enum>(II)</enum><text>a group practice comprised of at least one physician described in subclause (I);</text></subclause> <subclause id="H395FC5CC999344289EC74ECA4B4F24CB"><enum>(III)</enum><text>a hospital outpatient department;</text></subclause>
<subclause id="H3EB24E918148455FA9DF38457E43D0D6"><enum>(IV)</enum><text>a federally qualified health center (as defined in section 1861(aa)(4));</text></subclause> <subclause id="H436894A09AFD4C2F8325F51A0B4E5AB1"><enum>(V)</enum><text display-inline="yes-display-inline">a rural health clinic (as defined in section 1861(aa)(2));</text></subclause>
<subclause id="HEA5A138401494200902503D6D5DFB9B0"><enum>(VI)</enum><text display-inline="yes-display-inline">a community mental health center (as defined in section 1861(ff)(3)(B));</text></subclause> <subclause id="HDB0BEEEF8E0C497C915BFC30A7DB1F0A"><enum>(VII)</enum><text display-inline="yes-display-inline">a clinic certified as a certified community behavioral health clinic pursuant to section 223 of the Protecting Access to Medicare Act of 2014; or</text></subclause>
<subclause id="H1445785882EB43C591DAC18F1F9F693E"><enum>(VIII)</enum><text display-inline="yes-display-inline">any other individual or entity specified by the Secretary;</text></subclause></clause> <clause id="H9B63379CBEC14E75A97BCF6F20544FD4"><enum>(ii)</enum><text display-inline="yes-display-inline">that applied for and was selected to participate in the Program pursuant to an application and selection process established by the Secretary; and</text></clause>
<clause id="H4D24419BE76A472BB6BCD0CA4E368045"><enum>(iii)</enum><text display-inline="yes-display-inline">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.</text></clause></subparagraph> <subparagraph id="H27E8EA379DAF4D989FEA3137E53E845B"><enum>(B)</enum><header>Preference</header><text display-inline="yes-display-inline">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.</text></subparagraph></paragraph>
<paragraph id="H60FDC5CD956844B698E941889E4C6024" commented="no"><enum>(2)</enum><header>Opioid use disorder care teams</header>
<subparagraph id="H2E528FB5E247422EBDB612723E811EB6" commented="no"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">For purposes of this section, the term <term>opioid use disorder care team</term> means a team of health care practitioners established by a participant described in paragraph (1)(A) that—</text> <clause id="H7C4F01F32D2F45A8A51D98B33E3D8912" commented="no"><enum>(i)</enum><text display-inline="yes-display-inline">shall include—</text>
<subclause id="H23399D2247754DBABA711DBA4052FBF3"><enum>(I)</enum><text>at least one physician (as defined in section 1861(r)(1)) furnishing primary care services or addiction treatment services to an applicable beneficiary; and</text></subclause> <subclause id="H35E7396D28B04670A22E6DF7A73D554D"><enum>(II)</enum><text>at least one eligible practitioner (as defined in paragraph (3)(A)), who may be a physician who meets the criterion in subclause (I); and</text></subclause></clause>
<clause id="H3629F85E89D844119DFDB8403A9862AD"><enum>(ii)</enum><text>may include other practitioners licensed under State law to furnish psychiatric, psychological, counseling, and social services to applicable beneficiaries.</text></clause></subparagraph> <subparagraph id="HA69935D64C744A97BC80B36F40C6BFBD" commented="no"><enum>(B)</enum><header>Requirements for receipt of payment under Program</header><text display-inline="yes-display-inline">In order to receive payments under subsection (e), each participant in the Program shall—</text>
<clause id="HB00CFCF01DE0449DB2D36939560AE1DF" commented="no"><enum>(i)</enum><text display-inline="yes-display-inline">furnish opioid use disorder treatment services through opioid use disorder care teams to applicable beneficiaries who agree to receive the services;</text></clause> <clause id="H2026D267C76642E0927997B8645541B0" commented="no"><enum>(ii)</enum><text display-inline="yes-display-inline">meet minimum criteria, as established by the Secretary; and</text></clause>
<clause id="HC8041EBFCBFD4B4688D2364A09FF37D7" commented="no"><enum>(iii)</enum><text display-inline="yes-display-inline">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 appropriate to—</text> <subclause id="HE63CF56B3277445FB0DCFCF5BED5D967"><enum>(I)</enum><text display-inline="yes-display-inline">monitor and evaluate the Program;</text></subclause>
<subclause id="H84288387ABF74B35A72C60788AF87563"><enum>(II)</enum><text>determine if minimum criteria are met under clause (ii); and</text></subclause> <subclause id="HBE0C9CE3B73A4CDCA56F73011858D874"><enum>(III)</enum><text>determine the incentive payment under subsection (e).</text></subclause></clause></subparagraph></paragraph>
<paragraph id="H7229160C8C2C49608C0BDAD420A4B9AA"><enum>(3)</enum><header>Eligible practitioners; Other provider-related definitions and application provisions</header>
<subparagraph id="H7E86C13642194E96A546CDD096B977E3"><enum>(A)</enum><header>Eligible practitioners</header><text display-inline="yes-display-inline">For purposes of this section, the term <term>eligible practitioner</term> means a physician or other health care practitioner, such as a nurse practitioner, that—</text> <clause id="H527769C21DB64384B0A6111B2BFB768A"><enum>(i)</enum><text display-inline="yes-display-inline">is enrolled under section 1866(j)(1); </text></clause>
<clause id="H6CA8510F92D34622A2FBD94381D04681"><enum>(ii)</enum><text display-inline="yes-display-inline">is authorized to prescribe or dispense narcotic drugs to individuals for maintenance treatment or detoxification treatment; and</text></clause> <clause id="H56D8C3B402C84283891C254E127E5DFA"><enum>(iii)</enum><text>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 promulgated by the Substance Abuse and Mental Health Services Administration to carry out such section.</text></clause></subparagraph>
<subparagraph id="HC92CD40ECA2C40B28B6CA7A12C7DE6D2" commented="no"><enum>(B)</enum><header>Addiction specialists</header><text display-inline="yes-display-inline">For purposes of subsection (e)(1)(B)(iv), the term <term>addiction specialist</term> means a physician that possesses expert knowledge and skills in addiction medicine, as evidenced by appropriate certification from a specialty body, a certificate of advanced qualification in addiction medicine, or completion of an accredited residency or fellowship in addiction medicine or addiction psychiatry, as determined by the Secretary.</text></subparagraph></paragraph></subsection> <subsection id="H80C5F6725991400C817D05517C7753FB"><enum>(d)</enum><header>Participation of applicable beneficiaries</header><text display-inline="yes-display-inline"></text>
<paragraph id="H832F50F26EE94325868A24E393CB9841"><enum>(1)</enum><header>Applicable beneficiary defined</header><text display-inline="yes-display-inline">In this section, the term <term>applicable beneficiary</term> means an individual who—</text> <subparagraph id="HB0DE273902A5418B81A00FAEFEF7467D"><enum>(A)</enum><text>is entitled to, or enrolled for, benefits under part A and enrolled for benefits under part B;</text></subparagraph>
<subparagraph id="HEE08DACE86E94F09B8AB12E1BFBCB860"><enum>(B)</enum><text>is not enrolled in a Medicare Advantage plan under part C;</text></subparagraph> <subparagraph id="HFBEEEE60935A44499F8F5BEA19D59FB0"><enum>(C)</enum><text>has a current diagnosis for an opioid use disorder; and</text></subparagraph>
<subparagraph id="HF6884DC10E3C49AAA76CCED7021A9121"><enum>(D)</enum><text>meets such other criteria as the Secretary determines appropriate.</text></subparagraph><continuation-text continuation-text-level="paragraph">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).</continuation-text></paragraph> <paragraph id="HA76CFB8769DC46D682FA81D379F7B45F"><enum>(2)</enum><header>Voluntary beneficiary participation; limitation on number of beneficiaries</header><text display-inline="yes-display-inline">An applicable beneficiary may participate in the Program on a voluntary basis and may terminate participation in the Program at any time. Not more than 20,000 applicable beneficiaries may participate in the Program at any time.</text></paragraph>
<paragraph id="HEC01BDF9F14849138D3C8C7CB4BDDF41"><enum>(3)</enum><header>Services</header><text display-inline="yes-display-inline">In order to participate in the Program, an applicable beneficiary shall agree to receive opioid use disorder 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 beneficiary.</text></paragraph> <paragraph id="HBE19E2CA69D54B819CB065D2DC6D9A5C"><enum>(4)</enum><header>Beneficiary access to services</header><text display-inline="yes-display-inline">Nothing in this section shall be construed as encouraging providers to limit applicable beneficiary access to services covered under this title and applicable beneficiaries shall not be required to relinquish access to any benefit under this title as a condition of receiving services from a participant in the Program.</text></paragraph></subsection>
<subsection id="H1C34C40AC4C3411BBA15D31584B2FF5D"><enum>(e)</enum><header>Payments</header><text></text> <paragraph id="H9CA5D8235F644AE1946035CA7CE53BF8"><enum>(1)</enum><header>Per applicable beneficiary per month care management fee</header> <subparagraph id="H9D6D528BDB394627A01EFF424B4ACCD9"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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 participant. A participant may use such per applicable beneficiary per month care management fee to deliver additional services to applicable beneficiaries, including services not otherwise eligible for payment under this title.</text></subparagraph>
<subparagraph id="H0134623EC54E4027B35BFFA3257C85B8"><enum>(B)</enum><header>Payment amounts</header><text display-inline="yes-display-inline">In carrying out subparagraph (A), the Secretary shall—</text> <clause id="H95057F9758DD4C608E9A19273036E9E3"><enum>(i)</enum><text display-inline="yes-display-inline">consider payments otherwise payable under this title for opioid use disorder treatment services and the needs of applicable beneficiaries; </text></clause>
<clause id="H62CE93DE0D3C402593EABEDBA16C71D7"><enum>(ii)</enum><text display-inline="yes-display-inline">pay a higher per applicable beneficiary per month care management fee for an applicable beneficiary 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;</text></clause> <clause id="H002B89B848D24748B0754B4D0C2FF0A9"><enum>(iii)</enum><text display-inline="yes-display-inline">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; </text></clause>
<clause id="HD39B5CE58DF24F91957E30B0CC6CBB79"><enum>(iv)</enum><text display-inline="yes-display-inline">pay higher per applicable beneficiary per month care management fees for participants that have established opioid use disorder care teams that include an addiction specialist (as defined in subsection (c)(3)(B)); and</text></clause> <clause id="HF4AA82ED5A29499192ABBEB62BF70549"><enum>(v)</enum><text display-inline="yes-display-inline">take into account whether a participant’s opioid use disorder care team refers applicable beneficiaries to other suppliers or providers for any opioid use disorder treatment services.</text></clause></subparagraph>
<subparagraph id="HDED071E319E54FADAA060C68F87EB0C1"><enum>(C)</enum><header>No duplicate payment</header><text display-inline="yes-display-inline">The Secretary shall make payments under this paragraph to only one participant for services furnished to an applicable beneficiary during a calendar month.</text></subparagraph></paragraph> <paragraph id="HF147C6A17E224798817C7F47523CB1E1"><enum>(2)</enum><header>Incentive payments</header> <subparagraph id="H03E9ADB87FC949FEB4A9D7FB11D0166C"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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 Secretary, in accordance with subparagraph (B).</text></subparagraph>
<subparagraph id="HDD943987CB094AE194C0554AC83516FA"><enum>(B)</enum><header>Criteria</header>
<clause id="H1E8B79544AD84DE0B98E8ADF8FD15C4C"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">Criteria described in subparagraph (A) may include consideration of the following:</text> <subclause id="H5BF060CF2DA3486E9C08F3D59C307BAC"><enum>(I)</enum><text display-inline="yes-display-inline">Patient engagement and retention in treatment.</text></subclause>
<subclause id="H525AE484DEAF4287A4F23C8798B3599C"><enum>(II)</enum><text>Evidence-based medication-assisted treatment.</text></subclause> <subclause id="H0CE9393F521940369756916AA3CA3E8A"><enum>(III)</enum><text>Other criteria established by the Secretary.</text></subclause></clause>
<clause id="H5897D79017E14C3A9D0DB0CB8BB49DF1"><enum>(ii)</enum><header>Required consultation and consideration</header><text display-inline="yes-display-inline">In determining criteria described in subparagraph (A), the Secretary shall—</text> <subclause id="HC2B498453EA44849B8A920FD15951AEA"><enum>(I)</enum><text>consult with stakeholders, including clinicians in the primary care community and in the field of addiction medicine; and</text></subclause>
<subclause id="HCE6987BAB36A4973A7A509328636BD5D"><enum>(II)</enum><text>consider existing clinical guidelines for the treatment of opioid use disorders.</text></subclause></clause></subparagraph> <subparagraph id="HBF8C76D15C264DF8B3931F89A9A71A22"><enum>(C)</enum><header>No duplicate payment</header><text display-inline="yes-display-inline">The Secretary shall ensure that no duplicate payments under this paragraph are made with respect to an applicable beneficiary.</text></subparagraph></paragraph></subsection>
<subsection id="H32876D41E2854B1DA233F4E23667F544"><enum>(f)</enum><header>Multipayer strategy</header><text display-inline="yes-display-inline">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.</text></subsection> <subsection id="HFAA32D69C1E24E7E91FB44BB1C835C33"><enum>(g)</enum><header>Evaluation</header> <paragraph id="H08D22024796B4BF3A5CAF2EF5561BEA5"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall conduct an intermediate and final evaluation of the program. Each such evaluation shall determine the extent to which each of the purposes described in subsection (b) have been accomplished under the Program. </text></paragraph>
<paragraph id="H245DE240CB7E41E1ADFDE8A4CD2509AB"><enum>(2)</enum><header>Reports</header><text display-inline="yes-display-inline">The Secretary shall submit to the Secretary and Congress—</text> <subparagraph id="H5EF3520C0ACA40E9869542F589A9F8B6"><enum>(A)</enum><text>a report with respect to the intermediate evaluation under paragraph (1) not later than 3 years after the date of the implementation of the Program; and</text></subparagraph>
<subparagraph id="H403170DBD15C4A2A9BED81A8D98C6C37"><enum>(B)</enum><text display-inline="yes-display-inline">a report with respect to the final evaluation under paragraph (1) not later than 6 years after such date. </text></subparagraph></paragraph></subsection> <subsection id="HA532B903788941DD8FC9AF5311C4FCB3"><enum>(h)</enum><header>Funding</header> <paragraph id="H599164E61E034DEA87DB1A6B4ADFF3B2"><enum>(1)</enum><header>Administrative funding</header><text display-inline="yes-display-inline">For the purposes of implementing, 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 Insurance Trust Fund under section 1841.</text></paragraph>
<paragraph id="H135C5C2CFC8B41618516B02B40CE5BAB"><enum>(2)</enum><header>Care management fees and incentives</header><text display-inline="yes-display-inline">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.</text></paragraph> <paragraph id="HC6AA7A7698624336AE7F0376EBD3DED2"><enum>(3)</enum><header>Availability</header><text>Amounts transferred under this subsection for a fiscal year shall be available until expended.</text></paragraph></subsection>
<subsection id="H3CB3C3ADBAC844BB87BC0A0B2E05064A"><enum>(i)</enum><header>Waivers</header><text>The Secretary may waive any provision of this title as may be necessary to carry out the Program under this section.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section></subtitle> <subtitle id="HA5221382BA594EF1B10AED3F3481565A"><enum>F</enum><header>Responsible Education Achieves Care and Healthy Outcomes for Users’ Treatment</header> <section id="HBB21F4CA7B31489C8BFCD3DD3F1CEEA2" section-type="subsequent-section"><enum>6051.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Responsible Education Achieves Care and Healthy Outcomes for Users’ Treatment Act of 2018</short-title></quote> or the <quote><short-title>REACH OUT Act of 2018</short-title></quote>.</text></section>
<section id="H3C32207B75C6428B9FFA6AE1F8183985" section-type="subsequent-section"><enum>6052.</enum><header>Grants to provide technical assistance to outlier prescribers of opioids</header>
<subsection id="HEB8568A3358340628B52C390D9657155"><enum>(a)</enum><header>Grants authorized</header><text>The Secretary of Health and Human Services (in this section referred to as the <quote>Secretary</quote>) shall, through the Centers for Medicare & Medicaid Services, award grants, contracts, or cooperative agreements to eligible entities for the purposes described in subsection (b).</text></subsection> <subsection id="H62E903698E374C918655DFD574A4BDDE"><enum>(b)</enum><header>Use of funds</header><text>Grants, contracts, and cooperative agreements awarded under subsection (a) shall be used to support eligible entities through technical assistance—</text>
<paragraph id="HE533DE0EAAB246D086AE78E06193DFF9"><enum>(1)</enum><text display-inline="yes-display-inline">to educate and provide outreach to outlier prescribers of opioids about best practices for prescribing opioids;</text></paragraph> <paragraph id="HF0AF6162924F443BAF72B8F3707731B3"><enum>(2)</enum><text display-inline="yes-display-inline">to educate and provide outreach to outlier prescribers of opioids about non-opioid pain management therapies; and</text></paragraph>
<paragraph id="H0A8F05F309A64F549602F7530A118E80"><enum>(3)</enum><text>to reduce the amount of opioid prescriptions prescribed by outlier prescribers of opioids.</text></paragraph></subsection> <subsection id="H1A9FE35BA75F4FCB9565B4A011A2E39B"><enum>(c)</enum><header>Application</header><text>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.</text></subsection>
<subsection id="HACF4A3AEB2CF469E8E28E61DECFEAF50"><enum>(d)</enum><header>Geographic distribution</header><text>In awarding grants, contracts, and cooperative agreements under this section, the Secretary shall prioritize establishing technical assistance resources in each State.</text></subsection> <subsection id="HBCBB6A4B88DC410E8DBD6DB27A8EEA69"><enum>(e)</enum><header>Definitions</header><text>In this section:</text>
<paragraph id="H58A5050541E74CDAB7F4442542C56EDC"><enum>(1)</enum><header>Eligible entity</header><text>The term <quote>eligible entity</quote> means—</text> <subparagraph id="H62FA710084804B94AED9725DFCEBF22A"><enum>(A)</enum><text>an organization—</text>
<clause id="HFBFBEC7C784847E398E333A9F46707DB"><enum>(i)</enum><text>that has demonstrated experience providing technical assistance to health care professionals on a State or regional basis; and</text></clause> <clause id="H5149C567E1ED477B89CAC085B1897AAF"><enum>(ii)</enum><text>that has at least—</text>
<subclause id="H87DD5DD100D749CDB31045018DFE36D1"><enum>(I)</enum><text>one individual who is a representative of consumers on its governing body; and</text></subclause> <subclause id="H9B944711114349EABAD6D9809A3F3B37"><enum>(II)</enum><text>one individual who is a representative of health care providers on its governing body; or</text></subclause></clause></subparagraph>
<subparagraph id="H38CA159DF1BA48F4A228B369FFF18941"><enum>(B)</enum><text display-inline="yes-display-inline">an entity that is a quality improvement entity with a contract under part B of title XI of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1320c">42 U.S.C. 1320c</external-xref> et seq.).</text></subparagraph></paragraph> <paragraph id="H84B4EFCAC751481496FFE72C95B39A57"><enum>(2)</enum><header>Outlier prescriber of opioids</header><text display-inline="yes-display-inline">The term <quote>outlier prescriber of opioids</quote> means a prescriber, identified by the Secretary of Health and Human Services (through use of prescriber information provided by prescriber National Provider Identifiers included pursuant to section 1860D–4(c)(4)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-104">42 U.S.C. 1395w–104(c)(4)(A)</external-xref>) on claims for covered part D drugs for part D eligible individuals enrolled in prescription drug plans under part D of title XVIII of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-101">42 U.S.C. 1395w–101</external-xref> et seq.) and MA–PD plans under part C of such title (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-21">42 U.S.C. 1395w–21</external-xref> et seq.)) as prescribing, as compared to other prescribers in the specialty of the prescriber and geographic area, amounts of opioids in excess of a threshold (and other criteria) specified by the Secretary, after consultation with stakeholders.</text></paragraph>
<paragraph id="HD6F32DE8C87C4A7C868516CDE9366CF1"><enum>(3)</enum><header>Prescribers</header><text>The term <quote>prescriber</quote> means any health care professional, including a nurse practitioner or physician assistant, who is licensed to prescribe opioids by the State or territory in which such professional practices.</text></paragraph></subsection> <subsection id="H8E905575BAAA4F9B9B264E19BEB22886"><enum>(f)</enum><header>Funding</header><text display-inline="yes-display-inline">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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395t">42 U.S.C. 1395t</external-xref>), to remain available until expended.</text></subsection></section></subtitle>
<subtitle id="H7A54E79F996345F2BDED7658A323EED4"><enum>G</enum><header>Preventing Addiction for Susceptible Seniors</header>
<section id="HBB3867640C184CC6938D69941E5E804C" section-type="subsequent-section"><enum>6061.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote>Preventing Addiction for Susceptible Seniors Act of 2018</quote> or the <quote>PASS Act of 2018</quote> .</text></section> <section id="HD0F77A92ADAF41E8B9AA6D5316821244"><enum>6062.</enum><header>Electronic prior authorization for covered part D drugs</header> <subsection id="HCEF500C511714FF89EDA7249F5B7A94C"><enum>(a)</enum><header>Inclusion in electronic prescription program</header><text display-inline="yes-display-inline">Section 1860D–4(e)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-104">42 U.S.C. 1395w–104(e)(2)</external-xref>) is amended by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H6BCD5B1838C749EE85CF9A90317D5F87" style="OLC">
<subparagraph id="H264C4EC8085042C3A9B86E09201F07AF"><enum>(E)</enum><header>Electronic prior authorization</header>
<clause id="HB75DEFFF0B3C42CA8143010900A3D266"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than January 1, 2021, the program shall provide for the secure electronic transmission of—</text> <subclause id="HFAC32E955B2E47BE8B4705CF43952706"><enum>(I)</enum><text>a prior authorization request from the prescribing health care professional for coverage of a covered part D drug for a part D eligible individual 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</text></subclause>
<subclause id="H760F07AB945744A7BFC0E8534F2B069A"><enum>(II)</enum><text>a response, in accordance with this subparagraph, from such PDP sponsor or Medicare Advantage organization, respectively, to such professional.</text></subclause></clause> <clause id="H8F13F7DF962F41A588E4C291F3157E88"><enum>(ii)</enum><header>Electronic transmission</header> <subclause id="HBA5454217E9C4CF38CA6E73713CAB4BF"><enum>(I)</enum><header>Exclusions</header><text display-inline="yes-display-inline">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).</text></subclause>
<subclause id="HC84959AAA8CD46048B0FB49EBC366262"><enum>(II)</enum><header>Standards</header><text display-inline="yes-display-inline">In order to be treated, for purposes of this subparagraph, as an electronic transmission described in clause (i), such transmission 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.</text></subclause> <subclause id="HADF63B54D5E34506A280D12A70D8A454"><enum>(III)</enum><header>Application</header><text display-inline="yes-display-inline">Notwithstanding any other provision of law, for purposes of this subparagraph, the Secretary may require the use of such standards adopted under subclause (II) in lieu of any other applicable standards for an electronic transmission described in clause (i) for a covered part D drug for a part D eligible individual.</text></subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H958EA165CBF740BAADE87509AEB36EE9"><enum>(b)</enum><header>Sense of Congress regarding electronic prior authorization</header><text>It is the sense of the Congress that—</text> <paragraph id="HB646958E91A3438AAAF7326579A13377"><enum>(1)</enum><text display-inline="yes-display-inline">there should be increased use of electronic prior authorizations for coverage of covered part D drugs for part D eligible individuals enrolled in prescription drug plans under part D of title XVIII of the Social Security Act and MA–PD plans under part C of such title to reduce access delays by resolving coverage issues before prescriptions for such drugs are transmitted; and</text></paragraph>
<paragraph id="HE88799DE864B4D339D9C310CB6D409AF"><enum>(2)</enum><text>greater priority should be placed on increasing the adoption of use of such electronic prior authorizations among prescribers of such drugs, pharmacies, PDP sponsors, and Medicare Advantage organizations.</text></paragraph></subsection></section> <section id="HAC7EDF2CF3C64594971A9C0C6B02A22E"><enum>6063.</enum><header>Program integrity transparency measures under Medicare parts C and D</header> <subsection id="HF880A7DB0FB14070BB828C2F609D8D87"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1859 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-28">42 U.S.C. 1395w–28</external-xref>) is amended by adding at the end the following new subsection:</text>
<quoted-block style="OLC" id="H0F2DE320C9DC4ACB895053F36073970E" display-inline="no-display-inline">
<subsection id="HD489236E260D40AEA4F4AC4F35D05815"><enum>(i)</enum><header>Program integrity transparency measures</header>
<paragraph id="H03104B47F265498E9AECFACD10A4F7D2"><enum>(1)</enum><header>Program integrity portal</header>
<subparagraph id="HACAB56E35E314F49A7C2A47F33410C32"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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 technology) that would allow a secure path for communication between the Secretary, MA plans under this part, prescription drug plans under part D, and an eligible entity with a contract under section 1893 (such as a Medicare drug integrity contractor or 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)—</text> <clause id="H60C767A39B3541ACA5131F2C72240EAC"><enum>(i)</enum><text>the referral by such plans of substantiated fraud, waste, and abuse for initiating or assisting investigations conducted by the eligible entity; and</text></clause>
<clause id="HF1D8FC17FE934E01999320991BE92BF3"><enum>(ii)</enum><text>data sharing among such MA plans, prescription drug plans, and the Secretary.</text></clause></subparagraph> <subparagraph id="H018441DC9D2A40EF867577ABC99CC825"><enum>(B)</enum><header>Required uses of portal</header><text display-inline="yes-display-inline">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 technology) established under subparagraph (A):</text>
<clause id="HDC27887263FF4652BE4B4A1566107000" commented="no"><enum>(i)</enum><text display-inline="yes-display-inline">Providers of services and suppliers that have been referred pursuant to subparagraph (A)(i) during the previous 12-month period.</text></clause> <clause id="HFD86A456207548D0966B045E9F4E13FC"><enum>(ii)</enum><text>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.</text></clause>
<clause id="H86ADDBBDEC4A46C2BAFA43674083BBEC" commented="no"><enum>(iii)</enum><text>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.</text></clause> <clause id="H0AE11704005746E7AAA254AA6923E266"><enum>(iv)</enum><text display-inline="yes-display-inline">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 fraud, waste, or abuse of a provider of services or supplier, if such provider or supplier has been the subject of an administrative action under this title or title XI with respect to similar activities, a notification to such plan of such action so taken.</text></clause></subparagraph>
<subparagraph id="HE012915D9F88494BB412BDAF1CCC6AF3"><enum>(C)</enum><header>Rulemaking</header><text display-inline="yes-display-inline">For purposes of this paragraph, the Secretary shall, through rulemaking, specify what constitutes substantiated fraud, waste, and abuse, using guidance such as what is provided in the Medicare Program Integrity Manual 4.7.1. 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.</text></subparagraph> <subparagraph id="H5C420DA3EB8744B288CB1FD7B08CADDC"><enum>(D)</enum><header>HIPAA compliant information only</header><text display-inline="yes-display-inline">For purposes of this subsection, communications may only occur if the communications are permitted under the Federal regulations (concerning the privacy of individually identifiable health information) promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996.</text></subparagraph></paragraph>
<paragraph id="HBC55D7D94C6D4CF08D6E17BC75F886A9"><enum>(2)</enum><header>Quarterly reports</header><text display-inline="yes-display-inline">Beginning 2 years after the date of 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—</text> <subparagraph id="HCCD679C825BA45B6BC5B46D35A749141"><enum>(A)</enum><text>include administrative actions, pertinent information related to opioid overprescribing, and other data determined appropriate by the Secretary in consultation with stakeholders; and</text></subparagraph>
<subparagraph id="H29E960A9C75643F5BCC6630A1DC84F86"><enum>(B)</enum><text>be anonymized information submitted by plans without identifying the source of such information.</text></subparagraph></paragraph> <paragraph id="H9857B03671B247EE8CC301B45FEAD501" commented="no"><enum>(3)</enum><header>Clarification</header><text>Nothing in this subsection shall be construed as precluding or otherwise affecting referrals described in subparagraph (A) that may otherwise be made to law enforcement entities or to the Secretary.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="HC5293FF1788E41959FF47C8C4106C136"><enum>(b)</enum><header>Contract requirement to communicate plan corrective actions against opioid over-prescribers</header><text display-inline="yes-display-inline">Section 1857(e) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-27">42 U.S.C. 1395w–27(e)</external-xref>) is amended by adding at the end the following new paragraph: </text> <quoted-block style="OLC" id="H5152A8BFE6064445B4FE345F9FCD8BA6" display-inline="no-display-inline"> <paragraph id="H9D55CD5D952D4E9C9F5ECD744B4AA351"><enum>(5)</enum><header>Communicating plan corrective actions against opioids over-prescribers</header> <subparagraph id="HD5FDD97A05AE4D1ABF070B0ECF1337EC"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Beginning with plan years beginning on or after January 1, 2021, a contract under this section with an MA organization shall require the organization to submit to the Secretary, through the process established under subparagraph (B), information on the investigations and other actions taken by such plans related to providers of services who prescribe a high volume of opioids.</text></subparagraph>
<subparagraph id="H5E3CFBE16B7844F2B2469CD33BED567B"><enum>(B)</enum><header>Process</header><text display-inline="yes-display-inline">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).</text></subparagraph> <subparagraph id="H8CBBB1A8F2874E188BD547AB0421F1B2"><enum>(C)</enum><header>Regulations</header><text display-inline="yes-display-inline">For purposes of this paragraph, including as applied under section 1860D–12(b)(3)(D), the Secretary shall, pursuant to rulemaking—</text>
<clause id="H21CBDC3FB76C42FB97FF2F9EA04831D9"><enum>(i)</enum><text>specify a definition for the term <term>high volume of opioids</term> and a method for determining if a provider of services prescribes such a high volume; and</text></clause> <clause id="HA568A10C701945348B68FA2B61BB25E1"><enum>(ii)</enum><text>establish the process described in subparagraph (B) and the types of information that shall be submitted through such process. </text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H8D481CD07D0445A8906D18F4EF577211"><enum>(c)</enum><header>Reference under part D to program integrity transparency measures</header><text display-inline="yes-display-inline">Section 1860D–4 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-104">42 U.S.C. 1395w–104</external-xref>) is amended by adding at the end the following new subsection:</text> <quoted-block style="OLC" id="H7BA054EB76F1480CA952EDDC4CF3A270" display-inline="no-display-inline"> <subsection id="HC9529E8387914C68AEA6E94981B14653"><enum>(m)</enum><header>Program integrity transparency measures</header><text display-inline="yes-display-inline">For program integrity transparency measures applied with respect to prescription drug plan and MA plans, see section 1859(i).</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section>
<section id="H81F584A299BD4A5AB589EBC2C5DCBA39"><enum>6064.</enum><header>Expanding eligibility for medication therapy management programs under part D</header><text display-inline="no-display-inline">Section 1860D–4(c)(2)(A)(ii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-104">42 U.S.C. 1395w–104(c)(2)(A)(ii)</external-xref>) is amended—</text> <paragraph id="HC2950B8C6FDE46ED876856CFA887F19F"><enum>(1)</enum><text>by redesignating subclauses (I) through (III) as items (aa) through (cc), respectively, and adjusting the margins accordingly;</text></paragraph>
<paragraph id="H5E617314EC314305B79B94EB4F59FB7D"><enum>(2)</enum><text>by striking <quote>are part D eligible individuals who—</quote> and inserting </text> <quoted-block style="OLC" id="HAC2972D83E8C43ABB556CE3EE9F49571" display-inline="yes-display-inline"><text display-inline="yes-display-inline">are the following:</text>
<subclause id="H5D96D1F6BE4A4D14905EB388A28679B2"><enum>(I)</enum><text display-inline="yes-display-inline">Part D eligible individuals who—</text></subclause><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph> <paragraph id="HA755BD1C08BE47F8A60A823A39AAA410"><enum>(3)</enum><text>by adding at the end the following new subclause:</text>
<quoted-block style="OLC" id="H8C231781AC564047A984084EBB9BC78B" display-inline="no-display-inline">
<subclause id="HFF9E474488384EBF937404CC83756B28"><enum>(II)</enum><text display-inline="yes-display-inline">Beginning January 1, 2021, at-risk beneficiaries for prescription drug abuse (as defined in paragraph (5)(C)).</text></subclause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section> <section id="HD183AEFDC19E4888A33BDA8E41FA0281"><enum>6065.</enum><header>Medicare notifications to outlier prescribers of opioids</header><text display-inline="no-display-inline">Section 1860D–4(c)(4) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-104">42 U.S.C. 1395w–104(c)(4)</external-xref>) is amended by adding at the end the following new subparagraph: </text>
<quoted-block style="OLC" id="H66AE2F06F26B432AB7AFB30F50C97DD8" display-inline="no-display-inline">
<subparagraph id="H93EF65F7BACA45888FC95C2D01A809F7"><enum>(D)</enum><header>Outlier prescriber notification</header>
<clause id="H2CEC38E4DB694D5986DBA59A608E6953"><enum>(i)</enum><header>Notification</header><text display-inline="yes-display-inline">Beginning not later than 2 years after the date of the enactment of this subparagraph, 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 specified in accordance with clause (iii).</text></clause> <clause id="H557712E25E5743C4A6F1D2212760305F"><enum>(ii)</enum><header>Identification of outlier prescribers of opioids</header> <subclause id="HA4E6D958D6D74A83B0F26254C02DC527"><enum>(I)</enum><header>In general</header><text display-inline="yes-display-inline">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 threshold established under subclause (II), conduct an analysis to identify prescribers that are outlier opioid prescribers for a period specified by the Secretary. </text></subclause>
<subclause id="H71DD185BA7344324BF359A758511CEEB"><enum>(II)</enum><header>Establishment of threshold</header><text display-inline="yes-display-inline">For purposes of subclause (I) and subject to subclause (III), the Secretary shall, after consultation with stakeholders, establish a threshold, based on prescriber specialty and geographic area, for identifying 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.</text></subclause> <subclause id="H764F930DC31E416DB8FC5BFCE12CF11B"><enum>(III)</enum><header>Exclusions</header><text display-inline="yes-display-inline">The Secretary may exclude the following individuals and prescribers from the analysis under this clause:</text>
<item id="HC8E5DFEEC4E0431284CF750532D6D95A"><enum>(aa)</enum><text>Individuals receiving hospice services.</text></item> <item id="H295BCF3ED9AC4F65B8AC6BF855DFEDE4"><enum>(bb)</enum><text>Individuals with a cancer diagnosis.</text></item>
<item id="H2C12214CCA9E407CBAB49502ECF46C26"><enum>(cc)</enum><text>Prescribers who are the subject of an investigation by the Centers for Medicare & Medicaid Services or the Office of Inspector General of the Department of Health and Human Services. </text></item></subclause></clause> <clause id="HC0659098F12D47629CF41C819B3C593F"><enum>(iii)</enum><header>Contents of notification</header><text>The Secretary shall, based on input from stakeholders, specify the resources and other information to be included in notifications provided under clause (i).</text></clause>
<clause id="HA3120708B1B54381A0C4CFF910EFC18F"><enum>(iv)</enum><header>Modifications and expansions</header>
<subclause id="H0DED8CC901DB4A1B8F3B2B5EFE8C9B4C"><enum>(I)</enum><header>Frequency</header><text display-inline="yes-display-inline">Beginning 5 years after the date of the enactment of this subparagraph, the Secretary may change the frequency of the notifications described in clause (i) based on stakeholder input.</text></subclause> <subclause id="H9A7C46C20365427F86FE601FBFE0EC1D"><enum>(II)</enum><header>Expansion to other prescriptions</header><text display-inline="yes-display-inline">The Secretary may expand notifications under this subparagraph to include identifications and notifications with respect to concurrent prescriptions 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.</text></subclause></clause>
<clause id="HEB0E7A2EFAD840C0B5C5921D72EECFED"><enum>(v)</enum><header>Opioids defined</header><text>For purposes of this subparagraph, the term <term>opioids</term> has such meaning as specified by the Secretary through program instruction or otherwise. </text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></section> <section id="H6AEAB2DC96244E8686FACBABCD1022DD"><enum>6066.</enum><header>No additional funds authorized</header><text display-inline="no-display-inline">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.</text></section></subtitle>
<subtitle id="H0733CB148D4B471BA4D57622A18508F2"><enum>H</enum><header>Expanding Oversight of Opioid Prescribing and Payment</header>
<section id="H16CDC6073F3A4093BE2825981CD181D3" section-type="subsequent-section"><enum>6071.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote>Expanding Oversight of Opioid Prescribing and Payment Act of 2018</quote>. </text></section> <section id="H34AA836414C14600B710D3090A20C0F0" section-type="subsequent-section"><enum>6072.</enum><header>Medicare Payment Advisory Commission report on opioid payment, adverse incentives, and data under the Medicare program</header><text display-inline="no-display-inline">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:</text>
<paragraph id="H24625E3E982C47898C45AA6609E8C497"><enum>(1)</enum><text display-inline="yes-display-inline">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 hospital settings.</text></paragraph> <paragraph id="H68AF31C30C2D4FA49BEA09A0A45A10FB"><enum>(2)</enum><text>The identification of incentives under the hospital inpatient prospective payment system under section 1886 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww</external-xref>) and incentives under the hospital outpatient prospective payment system under section 1833(t) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(t)</external-xref>) for prescribing 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.</text></paragraph>
<paragraph id="H0E3A760EDE014267948E97B85E1BA7E9"><enum>(3)</enum><text>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.</text></paragraph></section> <section id="H9F2D869940F5424486DE212DBA6A5132"><enum>6073.</enum><header>No additional funds authorized</header><text display-inline="no-display-inline">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.</text></section></subtitle>
<subtitle id="HFE3A4F54365547A38AD4171E18E0F2C5"><enum>I</enum><header>Dr. Todd Graham Pain Management, Treatment, and Recovery</header>
<section id="H5051A4E3D2F94610A200584894DF1F26" section-type="subsequent-section"><enum>6081.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote>Dr. Todd Graham Pain Management, Treatment, and Recovery Act of 2018</quote>.</text></section> <section id="H8B10B3541D6C4E2CA4C71DDB89E00F7B"><enum>6082.</enum><header>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</header> <subsection id="H7F9449EE7BA743CA94BD35E322C32669"><enum>(a)</enum><header>Outpatient prospective payment system</header><text display-inline="yes-display-inline">Section 1833(t) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(t)</external-xref>) is amended by adding at the end the following new paragraph:</text>
<quoted-block style="OLC" id="H8AB30C4F86674B069FEF6FB64B17522A" display-inline="no-display-inline">
<paragraph id="HB69CFC154ECB47ECBEB973C54F79CBC5"><enum>(22)</enum><header>Review and revisions of payments for non-opioid alternative treatments</header>
<subparagraph id="H737A640F2EAD49C1BEB8671B4BF52758"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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—</text> <clause id="H30B7E49B42F14C38A4E4BEE80C8160DC"><enum>(i)</enum><text display-inline="yes-display-inline">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;</text></clause>
<clause id="HB102E92317534B1DBF7BC2F8C30EFAF6"><enum>(ii)</enum><text display-inline="yes-display-inline">may, as the Secretary determines appropriate, conduct subsequent reviews of such payments; and</text></clause> <clause id="H657249FA0FB94642A854DB323EBDEFD8"><enum>(iii)</enum><text display-inline="yes-display-inline">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 management) would reduce payment incentives to use opioids instead of non-opioid alternatives for pain management.</text></clause></subparagraph>
<subparagraph id="H46810A8F8A6E4D98A1C0170FE503AAE7"><enum>(B)</enum><header>Priority</header><text display-inline="yes-display-inline">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.</text></subparagraph> <subparagraph id="HF7D6AB8A143846B995CC623628ABF689"><enum>(C)</enum><header>Revisions</header><text display-inline="yes-display-inline">If the Secretary identifies revisions to payments pursuant to subparagraph (A)(iii), the Secretary 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 paragraph (9)(B).</text></subparagraph>
<subparagraph id="H4E5E4EAD8D8E481BAB5F0C98B9F59E5B"><enum>(D)</enum><header>Rules of construction</header><text display-inline="yes-display-inline">Nothing in this paragraph shall be construed to preclude the Secretary—</text> <clause id="HAF541E6732F243A4BE0227B2982D3DA5"><enum>(i)</enum><text>from conducting a demonstration before making the revisions described in subparagraph (C); or</text></clause>
<clause id="H552BC2777A65482A90C117E4BBA8D6FB"><enum>(ii)</enum><text>prior to implementation of this paragraph, from changing payments under this subsection for covered OPD services (or groups of services) which include opioids or non-opioid alternatives for pain management.</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="HAF222DA80AAC4A5E9E9BB3AC0DA7704A"><enum>(b)</enum><header>Ambulatory surgical centers</header><text display-inline="yes-display-inline">Section 1833(i) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(i)</external-xref>) is amended by adding at the end the following new paragraph:</text>
<quoted-block style="OLC" id="H78E70E368DE34868ADBEA60483F75272" display-inline="no-display-inline">
<paragraph id="H8014F447167D4DE68D4821C54EE25F42" indent="up1"><enum>(8)</enum><text display-inline="yes-display-inline">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 this paragraph, in an appropriate manner (as determined by the Secretary).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section> <section id="H5A5A6E5F580643A891DF64AC2B8DFC37" section-type="subsequent-section" commented="no"><enum>6083.</enum><header>Expanding access under the Medicare program to addiction treatment in Federally qualified health centers and rural health clinics</header> <subsection id="H26B7086EAC184CC58E41700C788042FB" commented="no"><enum>(a)</enum><header>Federally qualified health centers</header><text display-inline="yes-display-inline">Section 1834(o) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(o)</external-xref>) is amended by adding at the end the following new paragraph: </text>
<quoted-block style="OLC" id="HF9F325CEEB32484AB5DA4F8FA28BA165" display-inline="no-display-inline">
<paragraph id="H2623F9F09DC948318E9A7B2E1C780851" commented="no"><enum>(3)</enum><header>Additional payments for certain FQHCs with physicians or other practitioners receiving DATA 2000 waivers</header>
<subparagraph id="H9E7BFDAF692A4AF6BE2283DEC2D32BAB" commented="no"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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 practitioner who meets the requirements described in subparagraph (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 Secretary, based on an estimate of the average costs of training for purposes of receiving a waiver described in subparagraph (C)(ii). Such a payment may be made only one time with respect to each such physician or practitioner.</text></subparagraph> <subparagraph id="H60E6BEC6228D4B55A3BB89B4D4657126" commented="no"><enum>(B)</enum><header>Application</header><text display-inline="yes-display-inline">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 containing 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.</text></subparagraph>
<subparagraph id="H1C7858617458498F8778B4997EEEAD37" commented="no"><enum>(C)</enum><header>Requirements</header><text>For purposes of subparagraph (A), the requirements described in this subparagraph, with respect to a physician or practitioner, are the following:</text> <clause id="H1913FC6D79DC4D4F9E2DDC0B84AD174B" commented="no"><enum>(i)</enum><text display-inline="yes-display-inline">The physician or practitioner is employed by or working under contract with a Federally qualified health center described in subparagraph (A) that submits an application under subparagraph (B).</text></clause>
<clause id="H5563E8C9BA6D483A8CEDE99196635A23" commented="no"><enum>(ii)</enum><text display-inline="yes-display-inline">The physician or practitioner first receives a waiver under section 303(g) of the Controlled Substances Acton or after January 1, 2019.</text></clause></subparagraph> <subparagraph id="HA1F0624D956E47FDBCE171F46272FD25" commented="no"><enum>(D)</enum><header>Funding</header><text display-inline="yes-display-inline">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.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H00C05C91A221476086D17381F9965D17" commented="no"><enum>(b)</enum><header>Rural health clinic</header><text display-inline="yes-display-inline">Section 1833 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l</external-xref>) is amended—</text> <paragraph id="H22BD625AD6744CBBAC6886BE89415516" commented="no"><enum>(1)</enum><text display-inline="yes-display-inline">by redesignating the subsection (z) relating to medical review of spinal subluxation services as subsection (aa); and</text></paragraph>
<paragraph id="H13893AB615C144B3831069218F798DBF" commented="no"><enum>(2)</enum><text>by adding at the end the following new subsection:</text> <quoted-block style="OLC" id="H9DA53A8C76A24FD98CC9871DB74BA5F6" display-inline="no-display-inline"> <subsection id="HEB13296042104338A6991A7507CF2C6A" commented="no"><enum>(bb)</enum><header>Additional payments for certain rural health clinics with physicians or practitioners receiving DATA 2000 waivers</header> <paragraph id="H884E235D09364EF780A0CE1C12A2F7C6" commented="no"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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 paragraph (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 determined 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.</text></paragraph>
<paragraph id="HC4F73F7B326942478A94CD9A6839505A" commented="no"><enum>(2)</enum><header>Application</header><text display-inline="yes-display-inline">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 paragraph (1) furnishing services described in such paragraph at such clinic.</text></paragraph> <paragraph id="H31D63F25F8534EC58F5A97A41998177F" commented="no"><enum>(3)</enum><header>Requirements</header><text>For purposes of paragraph (1), the requirements described in this paragraph, with respect to a physician or practitioner, are the following:</text>
<subparagraph id="H9A6CF44287F24B16B6DC26214D29782B" display-inline="no-display-inline" commented="no"><enum>(A)</enum><text display-inline="yes-display-inline">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 paragraph (2).</text></subparagraph> <subparagraph id="H498DFD1CA37D46C795DB365B7AC4E1FA" display-inline="no-display-inline" commented="no"><enum>(B)</enum><text display-inline="yes-display-inline">The physician or practitioner first receives a waiver under section 303(g) of the Controlled Substances Acton or after January 1, 2019.</text></subparagraph></paragraph>
<paragraph id="HD960EA1EC2504D389A1CD605ED190124" commented="no"><enum>(4)</enum><header>Funding</header><text display-inline="yes-display-inline">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.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection></section> <section id="H149D977BA0D84D6F8A44D9A5531BE734" display-inline="no-display-inline" section-type="subsequent-section"><enum>6084.</enum><header>Studying the availability of supplemental benefits designed to treat or prevent substance use disorders under Medicare Advantage plans</header> <subsection id="H40500732040B4BA0A1D73197EB4CAD74"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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 <quote>Secretary</quote>) 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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-22">42 U.S.C. 1395w–22(a)(3)(A)</external-xref>)) 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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-28">42 U.S.C. 1395w–28(b)(6)</external-xref>)) offered to individuals entitled to medical assistance under title XIX of such Act and other such Medicare Advantage plans.</text></subsection>
<subsection id="H98D4732C10DB44FC9F3F2F736E7E82E6"><enum>(b)</enum><header>Consultation</header><text>The Secretary shall develop the report described in subsection (a) in consultation with relevant stakeholders, including—</text> <paragraph id="HE2B3A115A5354284A9FEB9E6A164987E"><enum>(1)</enum><text>individuals entitled to benefits under part A or enrolled under part B of title XVIII of the Social Security Act;</text></paragraph>
<paragraph id="H8EB50E920A284CC6B7F828BEAF2F4F2D"><enum>(2)</enum><text>entities who advocate on behalf of such individuals;</text></paragraph> <paragraph id="H54109434407C4302A766630EA3CAE52D"><enum>(3)</enum><text>Medicare Advantage organizations;</text></paragraph>
<paragraph id="HE6C7DE8E8E9A41CE93631EF2EB0BA906"><enum>(4)</enum><text>pharmacy benefit managers; and</text></paragraph> <paragraph id="H09F871B739AF4E76976AD361A12D4301"><enum>(5)</enum><text>providers of services and suppliers (as such terms are defined in section 1861 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x</external-xref>)).</text></paragraph></subsection>
<subsection id="HECB7E0E25F3648D9AF9C16C928FEB1B2"><enum>(c)</enum><header>Contents</header><text>The report described in subsection (a) shall include an analysis on the following:</text> <paragraph id="H8D9B91F26699494AAFDAEBA843C2448F"><enum>(1)</enum><text>The extent to which plans described in such subsection offer supplemental health care benefits relating to coverage of—</text>
<subparagraph id="HD8E82AEC6AD04059927526A1F25D56F3"><enum>(A)</enum><text>medication-assisted treatments for opioid use, substance use disorder counseling, peer recovery support services, or other forms of substance use disorder treatments (whether furnished in an inpatient or outpatient setting); and</text></subparagraph> <subparagraph id="H03FD178821594C22B93AC8FB0FC760CA"><enum>(B)</enum><text>non-opioid alternatives for the treatment of pain.</text></subparagraph></paragraph>
<paragraph id="H56668F992D6F46989B65D5B48EC58391"><enum>(2)</enum><text>Challenges associated with such plans offering supplemental health care benefits relating to coverage of items and services described in subparagraph (A) or (B) of paragraph (1).</text></paragraph> <paragraph id="H9BE944D1313B4F448CE5B48275BC85CA"><enum>(3)</enum><text display-inline="yes-display-inline">The impact, if any, of increasing the applicable rebate percentage determined under section 1854(b)(1)(C) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-24">42 U.S.C. 1395w–24(b)(1)(C)</external-xref>) 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.</text></paragraph>
<paragraph id="H6703F91420F74BE0A2A2BD163ABC5B5C"><enum>(4)</enum><text display-inline="yes-display-inline">Potential ways to improve upon such coverage or to incentivize such plans to offer additional supplemental health care benefits relating to such coverage.</text></paragraph></subsection></section> <section id="HA2C15A02796A4A23B39247D38C8C1C41" section-type="subsequent-section" display-inline="no-display-inline"><enum>6085.</enum><header>Clinical psychologist services models under the Center for Medicare and Medicaid Innovation; GAO study and report</header> <subsection id="H52F0E0E8716E4F6086C1B514B64E3B57"><enum>(a)</enum><header>CMI models</header><text display-inline="yes-display-inline">Section 1115A(b)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1315a">42 U.S.C. 1315a(b)(2)(B)</external-xref> is amended by adding at the end the following new clauses:</text>
<quoted-block style="OLC" id="HC110EEAAC80D4BECA8C82EF3D1891D74" display-inline="no-display-inline">
<clause id="H133871BFC756498DBF862933F2A3C3D3"><enum>(xxv)</enum><text display-inline="yes-display-inline">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)).</text></clause> <clause id="H9C686E514E3D4438AA2E3FAC01B7586C"><enum>(xxvi)</enum><text display-inline="yes-display-inline">Exploring ways to avoid unnecessary hospitalizations 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 availability of treatment options, including the availability of qualified psychologist services (as defined in section 1861(ii)).</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="HAA59571DE49C4C678D5DA140353A92E2"><enum>(b)</enum><header>GAO study and report</header><text>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 a report, on mental and behavioral health services under the Medicare program under title XVIII of the Social Security Act, including an examination of the following:</text> <paragraph id="H368F21658A0847F98CE517A173340ACE"><enum>(1)</enum><text>Information about services furnished by psychiatrists, clinical psychologists, and other professionals. </text></paragraph>
<paragraph id="HAB6E7A2DFA714671BFBAC513196B9728"><enum>(2)</enum><text display-inline="yes-display-inline">Information about ways that Medicare beneficiaries familiarize themselves about the availability of Medicare payment for qualified psychologist services (as defined in section 1861(ii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(ii)</external-xref>) and ways that the provision of such information could be improved.</text></paragraph></subsection></section> <section id="HA0FB9A36A1434FA89271DBFC24721891" display-inline="no-display-inline" section-type="subsequent-section"><enum>6086.</enum><header>Pain management study</header> <subsection id="H9FE99A888EAA4EF6B6B73FCE7270C443"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 1 year after the date of enactment 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 Security Act and submit to the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a report containing 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.</text></subsection>
<subsection id="HFB911E5EBA014A7FBE8280BABAC86124"><enum>(b)</enum><header>Consultation</header><text display-inline="yes-display-inline">In developing the report described in subsection (a), the Secretary shall consult with—</text> <paragraph id="HBE86FE3B80B24D6B9026ED5C9855B510"><enum>(1)</enum><text>relevant agencies within the Department of Health and Human Services;</text></paragraph>
<paragraph id="HAEC012A9BE4143A0925E852A32A66EE6"><enum>(2)</enum><text display-inline="yes-display-inline">licensed and practicing osteopathic and allopathic physicians, behavioral health practitioners, physician assistants, nurse practitioners, dentists, pharmacists, and other providers of health services;</text></paragraph> <paragraph id="H094F6E1B0C2C494BBFE549BF04648AD8"><enum>(3)</enum><text display-inline="yes-display-inline">providers and suppliers of services (as such terms are defined in section 1861 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x</external-xref>));</text></paragraph>
<paragraph id="HE743BD5E96AB446A9573DC2A56B8A626"><enum>(4)</enum><text>substance abuse and mental health professional organizations;</text></paragraph> <paragraph id="HA71DB16F13004F24ACCED549B5C706D3"><enum>(5)</enum><text>pain management professional organizations and advocacy entities, including individuals who personally suffer chronic pain;</text></paragraph>
<paragraph id="H71041B5B1E93469485DBCBE29E429309"><enum>(6)</enum><text>medical professional organizations and medical specialty organizations;</text></paragraph> <paragraph id="H961A9E49848F4405B5750B454BF00822"><enum>(7)</enum><text>licensed health care providers who furnish alternative pain management services; </text></paragraph>
<paragraph id="HDA9BBA0FF2494164AADC8FF590D44D04"><enum>(8)</enum><text display-inline="yes-display-inline">organizations with expertise in the development of innovative medical technologies for pain management;</text></paragraph> <paragraph id="HBFB111556D0948638EE093BDBC9C1DAA"><enum>(9)</enum><text>beneficiary advocacy organizations; and</text></paragraph>
<paragraph id="HD2D909CA217944C5B2E50379F5B9232D"><enum>(10)</enum><text display-inline="yes-display-inline">other organizations with expertise in the assessment, diagnosis, treatment, and management of pain, as determined appropriate by the Secretary.</text></paragraph></subsection> <subsection id="HC1CEA8AE9DB74A26BB117A3D956A33A4"><enum>(c)</enum><header>Contents</header><text display-inline="yes-display-inline">The report described in subsection (a) shall include the following:</text>
<paragraph id="HD97DD964E8DD484FB25F497FE3DF973C"><enum>(1)</enum><text>An analysis of payment and coverage under title XVIII of the Social Security Act with respect to the following:</text> <subparagraph id="H6173BAC2A9804F418F6262A1482B06A6"><enum>(A)</enum><text>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.</text></subparagraph>
<subparagraph id="H61C1928608B74465826477E8A6DC6093"><enum>(B)</enum><text>Evidence-based treatments and technologies that monitor substance use withdrawal and prevent overdoses of opioids.</text></subparagraph> <subparagraph id="H6F7916FD91CA42D58F4158CC90F85A04"><enum>(C)</enum><text>Evidence-based treatments and technologies that treat substance use disorders. </text></subparagraph>
<subparagraph id="HC636A91CA11D45889807C8E73B2BE1F0" commented="no"><enum>(D)</enum><text display-inline="yes-display-inline">Items and services furnished by practitioners through a multi-disciplinary treatment model for pain management, including the patient-centered medical home.</text></subparagraph> <subparagraph id="HEE5DF51F3E89450D946747648504258A"><enum>(E)</enum><text display-inline="yes-display-inline">Medical devices, non-opioid based drugs, and other therapies (including interventional and integrative pain therapies) approved or cleared by the Food and Drug Administration for the treatment of pain.</text></subparagraph>
<subparagraph id="HC721B52711B64614B5781A9889F0DD6E"><enum>(F)</enum><text display-inline="yes-display-inline">Items and services furnished to beneficiaries with psychiatric disorders, substance use disorders, or who are at risk of suicide, or have comorbidities and require consultation or management of pain with one or more specialists in pain management, mental health, or addiction treatment.</text></subparagraph></paragraph> <paragraph id="HD2FCE306581B4703AED96F776EFF8892"><enum>(2)</enum><text>An evaluation of the following:</text>
<subparagraph id="H79FC9F0E1F4049BA8149633C9DAB7CA4"><enum>(A)</enum><text>Barriers inhibiting individuals entitled to benefits under part A or enrolled under part B of such title from accessing treatments and technologies described in subparagraphs (A) through (F) of paragraph (1).</text></subparagraph> <subparagraph id="HF73B09E9D05344F192E53AF2A269C8D4"><enum>(B)</enum><text display-inline="yes-display-inline">Costs and benefits associated with potential expansion 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.</text></subparagraph>
<subparagraph id="HEDB956AE7C9646EFA5C86070ED62E273"><enum>(C)</enum><text display-inline="yes-display-inline">Pain management guidance published by the Federal Government that may be relevant to coverage determinations or other coverage requirements under title XVIII of the Social Security Act. </text></subparagraph></paragraph> <paragraph id="H251742082132420894DA18DA54B8D361" commented="no"><enum>(3)</enum><text display-inline="yes-display-inline">An assessment of all guidance published by the Department 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 elements of the <quote>Va/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain</quote> 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.</text></paragraph>
<paragraph id="H9B5BADB31C464F8E9F5E50A4FB7D8DFF"><enum>(4)</enum><text>The options described in subsection (d).</text></paragraph> <paragraph id="H5F61BD38F3B44D5E808AFCDBF1CD78E0"><enum>(5)</enum><text>The impact analysis described in subsection (e).</text></paragraph></subsection>
<subsection id="H3A9C5A8B60D2499981A90F5CB06C6E9F"><enum>(d)</enum><header>Options</header><text>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 following:</text> <paragraph id="H4546A10DC17D47BAA0F850F369DEDD1D"><enum>(1)</enum><text display-inline="yes-display-inline">Improving coverage of and payment for pain management therapies without the use of opioids, including interventional pain therapies, and options to augment opioid therapy with other clinical and complementary, integrative health services to minimize the risk of substance use disorder, including in a hospital setting.</text></paragraph>
<paragraph id="H68221672AA784841812C974134EFCC0D"><enum>(2)</enum><text display-inline="yes-display-inline">Improving coverage of and payment for medical devices and non-opioid based pharmacological and non-pharmacological therapies approved or cleared by the Food and Drug Administration for the treatment of pain as an alternative or augment to opioid therapy.</text></paragraph> <paragraph id="HF8F24C768EEF4BD0A8C2B4C992A673A9"><enum>(3)</enum><text display-inline="yes-display-inline">Improving and disseminating treatment strategies for beneficiaries with psychiatric disorders, substance use disorders, or who are at risk of suicide, and treatment strategies to address health disparities related to opioid use and opioid abuse treatment.</text></paragraph>
<paragraph id="H4EFE02340BD2411D8361BE9B2677D987"><enum>(4)</enum><text display-inline="yes-display-inline">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.</text></paragraph> <paragraph id="HC5F50DC170BD41519B7ADBB630348CC0"><enum>(5)</enum><text display-inline="yes-display-inline">Educating providers on risks of coadministration of opioids and other drugs, particularly benzodiazepines.</text></paragraph>
<paragraph id="H10C416677988478B8759039F0D55F0B0"><enum>(6)</enum><text display-inline="yes-display-inline">Ensuring appropriate case management for beneficiaries who transition between inpatient and outpatient hospital settings, or between opioid therapy to non-opioid therapy, which may include the use of care transition plans.</text></paragraph> <paragraph id="HD2CD243E28CE4AE497B863B4BB388AFB"><enum>(7)</enum><text display-inline="yes-display-inline">Expanding outreach activities designed to educate providers 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.</text></paragraph>
<paragraph id="HF0B5399B0DED4F4A99E6C98AF3C7FB02"><enum>(8)</enum><text>Creating a beneficiary education tool on alternatives to opioids for chronic pain management.</text></paragraph></subsection> <subsection id="H367F6C3BCC904FEF88D5E15422271101"><enum>(e)</enum><header>Impact analysis</header><text display-inline="yes-display-inline">The impact analysis described in this subsection consists of an analysis of any potential effects implementing the options described in subsection (d) would have—</text>
<paragraph id="HA67B16703CDB4B3E83441E53949863ED"><enum>(1)</enum><text>on expenditures under the Medicare program; and</text></paragraph> <paragraph id="HF91B3AB903BD4C6D9207F40A6EB128EA"><enum>(2)</enum><text>on preventing or reducing opioid addiction for individuals receiving benefits under the Medicare program.</text></paragraph></subsection></section></subtitle>
<subtitle id="H006A36E2DBC644609293EDC1EBF11330"><enum>J</enum><header>Combating Opioid Abuse for Care in Hospitals</header>
<section id="HCB3BE8B87DD34CF3B518D2E8D0BF0A1B" section-type="subsequent-section"><enum>6091.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote>Combating Opioid Abuse for Care in Hospitals Act of 2018</quote> or the <quote>COACH Act of 2018</quote>.</text></section> <section id="H3FB0C111082E4D4999291595C41F5780" section-type="subsequent-section"><enum>6092.</enum><header>Developing guidance on pain management and opioid use disorder prevention for hospitals receiving payment under part A of the Medicare program</header> <subsection id="H4D308874C7814EB6B7D7424F7CB5454A"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than January 1, 2019, the Secretary of Health and Human Services (in this section referred to as the <quote>Secretary</quote>) 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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395c">42 U.S.C. 1395c</external-xref> et seq.) on pain management strategies and opioid use disorder prevention strategies with respect to individuals entitled to benefits under such part.</text></subsection>
<subsection id="HBA0CECE4BDFD4AD486258FF99640A5BF"><enum>(b)</enum><header>Consultation</header><text>In developing the guidance described in subsection (a), the Secretary shall consult with relevant stakeholders, including—</text> <paragraph id="HE5908B5AA79D4AAE812323C5DA59479E"><enum>(1)</enum><text>medical professional organizations;</text></paragraph>
<paragraph id="H49ABA594EB52484DB9EC72EB80DCD256"><enum>(2)</enum><text>providers and suppliers of services (as such terms are defined in section 1861 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x</external-xref>));</text></paragraph> <paragraph id="H2532415FCAFE44F3BDFC090C7D26B692"><enum>(3)</enum><text display-inline="yes-display-inline">health care consumers or groups representing such consumers; and</text></paragraph>
<paragraph id="H27A867A8CF13462A8CA651E6250DA9FC"><enum>(4)</enum><text>other entities determined appropriate by the Secretary.</text></paragraph></subsection> <subsection id="H23E0F092859848D2885BD513D6690662"><enum>(c)</enum><header>Contents</header><text>The guidance described in subsection (a) shall include, with respect to hospitals and individuals described in such subsection, the following:</text>
<paragraph id="HBC5AA372B8254E289A74605510E6FD98"><enum>(1)</enum><text>Best practices regarding evidence-based screening and practitioner education initiatives relating to screening and treatment protocols for opioid use disorder, including—</text> <subparagraph id="HCFD8D82139314519ACCD60E36C549AB6"><enum>(A)</enum><text>methods to identify such individuals at-risk of opioid use disorder, including risk stratification;</text></subparagraph>
<subparagraph id="HCCA3AF73DA644373842B26098A3428E7"><enum>(B)</enum><text>ways to prevent, recognize, and treat opioid overdoses; and</text></subparagraph> <subparagraph id="H9131863475034D468281D862A1C141D4"><enum>(C)</enum><text>resources available to such individuals, such as opioid treatment programs, peer support groups, and other recovery programs.</text></subparagraph></paragraph>
<paragraph id="H432BDAFB95124B0CA5F6227AF316A29A"><enum>(2)</enum><text>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—</text> <subparagraph id="H6DB25D7BFEEC466AB39CB486354FB126"><enum>(A)</enum><text>the adverse effects of prolonged opioid use;</text></subparagraph>
<subparagraph id="HAE0ED17417994480AAEDAE3873412652"><enum>(B)</enum><text>non-opioid, evidence-based, non-pharmacological pain management treatments;</text></subparagraph> <subparagraph id="H17703F02BA4942F9A9FA31EE9BD64148"><enum>(C)</enum><text>monitoring programs for individuals who have been prescribed opioids; and</text></subparagraph>
<subparagraph id="H5B2C7F73F1974C97A2CB38C10BEB96BC"><enum>(D)</enum><text>the prescribing of naloxone along with an initial opioid prescription.</text></subparagraph></paragraph> <paragraph id="HD40220B88DF9414D927A87F2026CBFFC"><enum>(3)</enum><text>Best practices for such hospitals to make such individuals aware of the risks associated with opioid use (which may include use of the notification template described in paragraph (4)).</text></paragraph>
<paragraph id="H761A8AA6DA04474EAAA56A2AB6C2F506"><enum>(4)</enum><text>A notification template developed by the Secretary, for use as appropriate, for such individuals who are prescribed an opioid that—</text> <subparagraph id="H4C4D299E4AD747589610EF9BFAFA58A0"><enum>(A)</enum><text>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;</text></subparagraph>
<subparagraph id="H1B422E558D384511B8C686B27EC95233"><enum>(B)</enum><text>highlights multimodal and evidence-based non-opioid alternatives for pain management;</text></subparagraph> <subparagraph id="HF93D843C3FA84D27A99D3840DB1D9ECE"><enum>(C)</enum><text>encourages such individuals to talk to their health care providers about such alternatives;</text></subparagraph>
<subparagraph id="H6A8429CCADD54F6A8B9566EDC40115DE"><enum>(D)</enum><text>provides for a method (through signature or otherwise) for such an individual, or person acting on such individual’s behalf, to acknowledge receipt of such notification template;</text></subparagraph> <subparagraph id="H860926369DCB4E9BAF27F41E83A56321"><enum>(E)</enum><text>is worded in an easily understandable manner and made available in multiple languages determined appropriate by the Secretary; and</text></subparagraph>
<subparagraph id="HD26867F7B84C48BF8D2A29CF55D73F86"><enum>(F)</enum><text>includes any other information determined appropriate by the Secretary.</text></subparagraph></paragraph> <paragraph id="HEEA8423B9E49452C848BF8FFF5E6E859"><enum>(5)</enum><text>Best practices for such hospital to track opioid prescribing trends by practitioners furnishing items and services at such hospital, including—</text>
<subparagraph id="H9A135F20472A4A2F9010155505DDEBA8"><enum>(A)</enum><text>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;</text></subparagraph> <subparagraph id="HA934BAEFB1B9481FA7E68A94FFD3D390"><enum>(B)</enum><text>guidance on checking the medical records of such individuals against information included in prescription drug monitoring programs;</text></subparagraph>
<subparagraph id="H9F38760803C24BB698121C202FE72911"><enum>(C)</enum><text>strategies to reduce long-term opioid prescriptions; and</text></subparagraph> <subparagraph id="H3E2321B4519248B4900705BBB0FD39BF"><enum>(D)</enum><text>methods to identify such practitioners who may be over-prescribing opioids.</text></subparagraph></paragraph>
<paragraph id="H1CBE6A4955C3469CB88C8FDE78F6B73B"><enum>(6)</enum><text>Other information the Secretary determines appropriate, 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.</text></paragraph></subsection></section> <section id="H87DEF57DBF1B40C9BE8E9F0C550ECFB0" display-inline="no-display-inline"><enum>6093.</enum><header>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</header> <subsection id="H11B667E8C7BE4969B997C0498B43C375"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1890A of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395aaa-1">42 U.S.C. 1395aaa–1</external-xref>) is amended by adding at the end the following new subsection:</text>
<quoted-block id="H6CCA2BF6079D40F49968B53FFD6FEC03" style="OLC">
<subsection id="H6C8C988AEF5C4644AEE9BE7FA31538BD"><enum>(g)</enum><header>Technical expert panel review of opioid and opioid use disorder quality measures</header>
<paragraph id="H4938E1050B124F8294943174F139C639"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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 measures relating to opioids and opioid use disorders, including care, prevention, diagnosis, health outcomes, and treatment furnished to individuals with opioid use disorders. The Secretary 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.</text></paragraph> <paragraph id="HE0430ED146894B5C94F932EFEB7B4DED"><enum>(2)</enum><header>Review and assessment</header><text>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—</text>
<subparagraph id="H494C6EA9BF3A4CB79FAB7F7874AB83A2"><enum>(A)</enum><text>review quality measures that relate to opioids and opioid use disorders, including existing measures and those under development;</text></subparagraph> <subparagraph id="H762D4E12D7B242358ACE98978060DFFA"><enum>(B)</enum><text>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</text></subparagraph>
<subparagraph id="H03E43F9EFF624B8C93D90106F3B82ECA"><enum>(C)</enum><text display-inline="yes-display-inline">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 recommendations 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 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).</text></subparagraph></paragraph> <paragraph id="HE6841AF3866A41088ECC573C36BEA031"><enum>(3)</enum><header>Consideration of measures by secretary</header><text>The Secretary shall consider—</text>
<subparagraph id="H549884264DD14D9C8209910F10DE12E6"><enum>(A)</enum><text>using opioid and opioid use disorder measures (including measures used under the Merit-Based Incentive Payment System under section 1848(q), measures recommended under paragraph (2)(C), and other such measures identified by the Secretary) in alternative payment models under section 1833(z)(3)(C) and in the shared savings program under section 1899; and</text></subparagraph> <subparagraph id="H7EA7990C4211418FA8C506474B51EA0E"><enum>(B)</enum><text>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 section 1886(o).</text></subparagraph></paragraph>
<paragraph id="H4BEB5A2367204EBF92AAC7933760A177"><enum>(4)</enum><header>Prioritization of measure development</header><text>The Secretary shall prioritize for measure development the gaps in quality measures identified under paragraph (2)(B).</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="H4DDCB264B32849768C2C65AB9F6BABED"><enum>(b)</enum><header>Expedited endorsement process for opioid measures</header><text display-inline="yes-display-inline">Section 1890(b)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395aaa">42 U.S.C. 1395aaa(b)(2)</external-xref>) is amended by adding at the end the following new flush sentence:</text>
<quoted-block style="OLC" id="HDD1B74718C2447A19831E39193721A31" display-inline="no-display-inline">
<quoted-block-continuation-text quoted-block-continuation-text-level="paragraph">Such endorsement process shall, as determined practicable by the entity, provide for an expedited process with respect to the endorsement of such measures relating to opioids and opioid use disorders.</quoted-block-continuation-text><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section>
<section id="H5FB03833355E4671BD1CD5071C426590" section-type="subsequent-section"><enum>6094.</enum><header>Technical expert panel on reducing surgical setting opioid use; Data collection on perioperative opioid use</header>
<subsection id="H54ED44F3E7E9418290BB87DD06E36DE3"><enum>(a)</enum><header>Technical expert panel on reducing surgical setting opioid use</header>
<paragraph id="H2780800DAFD84FD8A2957C9B3579CD46"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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:</text> <subparagraph id="H70CD0ADB6748430EAFEEB16227C734AA"><enum>(A)</enum><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph id="HD4086A9EF05446EF964A2B5C20489E13"><enum>(B)</enum><text>Shared decision making with patients and families on pain management, including recommendations for the development of an evaluation and management code for purposes of payment under the Medicare program under title XVIII of the Social Security Act that would account for time spent on shared decision making.</text></subparagraph> <subparagraph id="H87D2ECBF26B54DE9B1A02B0DAC0DB281"><enum>(C)</enum><text>Education on the safe use, storage, and disposal of opioids.</text></subparagraph>
<subparagraph id="HD4B6F9E6C05F4F818354C4F14E593899"><enum>(D)</enum><text>Prevention of opioid misuse and abuse after discharge.</text></subparagraph> <subparagraph id="H2D35A2DCA7D5407D8E68E513877A6C61"><enum>(E)</enum><text>Development of a clinical algorithm to identify and treat at-risk, opiate-tolerant patients and reduce reliance on opioids for acute pain during the perioperative period.</text></subparagraph></paragraph>
<paragraph id="HF831CEF7C66B4CEDB8140C29EE66FEF9"><enum>(2)</enum><header>Report</header><text>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.</text></paragraph></subsection> <subsection id="H8E60FAAB3E914831AF04FDFAEEA5597B"><enum>(b)</enum><header>Data collection on perioperative opioid use</header><text>Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report that contains the following:</text>
<paragraph id="HB6A81EDBFF324B06AC9A3BCD739755F9"><enum>(1)</enum><text>The diagnosis-related group codes identified by the Secretary as having the highest volume of surgeries.</text></paragraph> <paragraph id="HDC8E5060BAD947019219ECB2A13284A4"><enum>(2)</enum><text>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—</text>
<subparagraph id="HA441D2D9E8464A25B14ACB7B369C6335"><enum>(A)</enum><text display-inline="yes-display-inline">surgical volumes, practices, and opioid prescribing patterns; </text></subparagraph> <subparagraph id="HCF2E90D627BE46E5B70D73AEBA5FBED5"><enum>(B)</enum><text>opioid consumption, including—</text>
<clause id="H37A336F2A8254CBA802EDB88973C926C"><enum>(i)</enum><text>perioperative days of therapy;</text></clause> <clause id="HAE40DFE22BCE4A23ABECFA406AFE76FA"><enum>(ii)</enum><text>average daily dose at the hospital, including dosage greater than 90 milligram morphine equivalent;</text></clause>
<clause id="H74D06225DAEF4189B3CCDFFDE65D2890"><enum>(iii)</enum><text>post-discharge prescriptions and other combination drugs that are used before intervention and after intervention;</text></clause> <clause id="H9E444FC6C5204013973F08C2CFC30377"><enum>(iv)</enum><text>quantity and duration of opioid prescription at discharge; and</text></clause>
<clause id="HC5E8572D18F8473AB21A23F092B25E0E"><enum>(v)</enum><text>quantity consumed and number of refills;</text></clause></subparagraph> <subparagraph id="H8014BB5BEDD54530A454471E5A62330D"><enum>(C)</enum><text>regional anesthesia and analgesia practices, including pre-surgical and post-surgical injections;</text></subparagraph>
<subparagraph id="HD4F242E01DC140A9A14EE19E21C3A1D4"><enum>(D)</enum><text>naloxone reversal;</text></subparagraph> <subparagraph id="HD4E607DDFD9747B6B5277957071DFDAA"><enum>(E)</enum><text>post-operative respiratory failure;</text></subparagraph>
<subparagraph id="H69E3E2E09ADB40B2849A12CBFC9EA34D"><enum>(F)</enum><text>information about storage and disposal; and</text></subparagraph> <subparagraph id="H68A669E1C6A84D7780FB19E488900D99"><enum>(G)</enum><text>such other information as the Secretary may specify.</text></subparagraph></paragraph>
<paragraph id="HE3E83EF22C4F4B4F8484EA9CEFFD4530"><enum>(3)</enum><text display-inline="yes-display-inline">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 technological availability.</text></paragraph></subsection></section> <section id="HEF0F2E5736DA4824ACF143010F7628CD"><enum>6095.</enum><header>Requiring the posting and periodic update of opioid prescribing guidance for Medicare beneficiaries</header> <subsection id="H55C5C7EEDFE64ED4ACDD17C3F6FEAB8E"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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 <quote>Secretary</quote>) shall post on the public website of the Centers for Medicare & Medicaid Services all guidance published by the Department of Health and Human Services on or after January 1, 2016, relating to the prescribing of opioids and applicable to opioid prescriptions for individuals entitled to benefits under part A of title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395c">42 U.S.C. 1395c</external-xref> et seq.) or enrolled under part B of such title of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395j">42 U.S.C. 1395j</external-xref> et seq.).</text></subsection>
<subsection id="H1F55AB571C1E4BFC9161D1C79A99271F"><enum>(b)</enum><header>Update of guidance</header>
<paragraph id="H9EB0623F92ED4202834DB444B9187AC2"><enum>(1)</enum><header>Periodic update</header><text display-inline="yes-display-inline">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 guidance on the website described in such subsection.</text></paragraph> <paragraph id="HC6870AF72404491DA75A3FCC769075C6"><enum>(2)</enum><header>Consultation</header><text>The entities specified in this paragraph are the following:</text>
<subparagraph id="H4F3D80EE7ECC4DD1BDD842A7294C49DD"><enum>(A)</enum><text display-inline="yes-display-inline">Medical professional organizations.</text></subparagraph> <subparagraph id="HF65141A216DE42BCB3C5F2BF91809B34"><enum>(B)</enum><text>Providers and suppliers of services (as such terms are defined in section 1861 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x</external-xref>)).</text></subparagraph>
<subparagraph id="HC14B7B3511104F23A390EFD82733299E"><enum>(C)</enum><text>Health care consumers or groups representing such consumers.</text></subparagraph> <subparagraph id="HD94F5779BD0844CE969105AD4CD6BE9C"><enum>(D)</enum><text>Other entities determined appropriate by the Secretary.</text></subparagraph></paragraph></subsection></section></subtitle>
<subtitle id="H399817E0FAF54433A951889E38129BBD"><enum>K</enum><header>Stop Excessive Narcotics in our Retirement Communities Protection</header>
<section id="H35B3E4A787504974812D2F88941F07BB" section-type="subsequent-section"><enum>6101.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Stop Excessive Narcotics in our Retirement Communities Protection Act</short-title> of 2018</quote> or the <quote><short-title>SENIOR Communities Protection Act</short-title> of 2018</quote>.</text></section> <section id="H5C2C280490DD4C948D8FEAC56CA9AF35"><enum>6102.</enum><header>Suspension of payments by Medicare prescription drug plans and MA–PD plans pending investigations of credible allegations of fraud by pharmacies</header> <subsection id="H5F4BDFA4AADE4F8A9B8149DC9868B5A9"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1860D–12(b) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-112">42 U.S.C. 1395w–112(b)</external-xref>) is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H515E88D718DD406D8F6E05EF00B60CBC" style="OLC">
<paragraph id="H4E1824C3D5ED491C888941C53B91A633"><enum>(7)</enum><header>Suspension of payments pending investigation of credible allegations of fraud by pharmacies</header>
<subparagraph id="H839506D6D21047038484C4E04FD6A068"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">The provisions of section 1862(o) 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 provisions apply with respect to the Secretary, a provider of services or supplier, and payments to such provider of services or supplier under this title.</text></subparagraph> <subparagraph id="HC6377015E18F483DAD6D6481E894E696"><enum>(B)</enum><header>Rule of construction</header><text display-inline="yes-display-inline">Nothing in this paragraph shall be construed as limiting the authority of a PDP sponsor to conduct postpayment review.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H6BEC445370A34F418C60F411693105A5"><enum>(b)</enum><header>Application to MA–PD plans</header><text display-inline="yes-display-inline">Section 1857(f)(3) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-27">42 U.S.C. 1395w–27(f)(3)</external-xref>) is amended by adding at the end the following new subparagraph:</text> <quoted-block display-inline="no-display-inline" id="HC2E0CE2D507345A5BB92D18CBB3C1606" style="OLC"> <subparagraph id="H0FB79885367C40D1A61EC8CB37D90B04"><enum>(D)</enum><header>Suspension of payments pending investigation of credible allegations of fraud by pharmacies</header><text display-inline="yes-display-inline">Section 1860D–12(b)(7).</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H7108995F715B445E835FF5C9B14D3404"><enum>(c)</enum><header>Conforming amendment</header><text display-inline="yes-display-inline">Section 1862(o)(3) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395y">42 U.S.C. 1395y(o)(3)</external-xref>) is amended by inserting <quote>, section 1860D–12(b)(7) (including as applied pursuant to section 1857(f)(3)(D)),</quote> after <quote>this subsection</quote>.</text></subsection> <subsection commented="no" id="H033F1594708A422F8B0DE63F53362752"><enum>(d)</enum><header>Clarification relating to credible allegation of fraud</header><text display-inline="yes-display-inline">Section 1862(o) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395y">42 U.S.C. 1395y(o)</external-xref>) is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H095D0D9E42F14C76AC0D6FF522CA9B32" style="OLC">
<paragraph commented="no" id="HEC19E48C5A174DA6B8F1A545C80A0A86"><enum>(4)</enum><header>Credible allegation of fraud</header><text display-inline="yes-display-inline">In carrying out this subsection, section 1860D–12(b)(7) (including as applied pursuant to section 1857(f)(3)(D)), and section 1903(i)(2)(C), a fraud hotline tip (as defined by the Secretary) without further evidence shall not be treated as sufficient evidence for a credible allegation of fraud.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="HF2AA57B0E95F446FA8D917CC23626CA1"><enum>(e)</enum><header>Effective date</header><text display-inline="yes-display-inline">The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2020.</text></subsection></section></subtitle>
<subtitle id="H6F016DA3C1D946FCB53599B3F07DE1C0"><enum>L</enum><header>Providing Reliable Options for Patients and Educational Resources</header>
<section id="HCCC229BB9A2749CABAD62782ABF9382D" section-type="subsequent-section"><enum>6111.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote>Providing Reliable Options for Patients and Educational Resources Act of 2018</quote> or the <quote>PROPER Act of 2018</quote>.</text></section> <section id="H8ED9BABB1EE54F818E93C02B684EB9F8" section-type="subsequent-section"><enum>6112.</enum><header>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</header><text display-inline="no-display-inline">Section 1860D–4(a)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-104">42 U.S.C. 1395w–104(a)(1)</external-xref>) is amended—</text>
<paragraph id="H5CD0427983A044EE85B08DE512D4EC88"><enum>(1)</enum><text>in subparagraph (A), by inserting <quote>, subject to subparagraph (C),</quote> before <quote>including</quote>; </text></paragraph> <paragraph id="H8BAD723F737D4EA3B017DAA78FFCD653"><enum>(2)</enum><text>in subparagraph (B), by adding at the end the following new clause:</text>
<quoted-block style="OLC" id="HB8264544D5814B3680B31E4A0432C540" display-inline="no-display-inline">
<clause id="HEF2BCB65A1884A9A9B5CA84E69381FFB"><enum>(vi)</enum><text display-inline="yes-display-inline">For plan year 2021 and each subsequent plan year, subject to subparagraph (C), with respect to the treatment of pain—</text> <subclause id="HF1C93B0F3909438F950E1797572ABA91"><enum>(I)</enum><text>the risks associated with prolonged opioid use; and</text></subclause>
<subclause id="HC1594B6FD65044CEB047F0E64362041F"><enum>(II)</enum><text>coverage of nonpharmacological therapies, devices, and nonopioid medications—</text> <item id="HC19AD0936D914578B6E0F7C0CAAA00E4"><enum>(aa)</enum><text>in the case of an MA-PD plan under part C, under such plan; and</text></item>
<item id="H7B28784443C34FCE8AC003DA7CBC0AC5"><enum>(bb)</enum><text>in the case of a prescription drug plan, under such plan and under parts A and B.</text></item></subclause></clause><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph> <paragraph id="HB94571A13D8948648486C7AF09D55E4C"><enum>(3)</enum><text>by adding at the end the following new subparagraph:</text>
<quoted-block style="OLC" id="HBEC0C68336C44DD093EA63F19FCC88F8" display-inline="no-display-inline">
<subparagraph id="H7BACF3D7AE9D451FA7E23A2F3CD3D1F6"><enum>(C)</enum><header>Targeted provision of information</header><text display-inline="yes-display-inline">A PDP sponsor of a prescription drug plan may, in lieu of disclosing 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.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section> <section id="H18AE2894B14F46919A50A945A48E8991"><enum>6113.</enum><header>Requiring Medicare Advantage plans and prescription drug plans to provide information on the safe disposal of prescription drugs</header> <subsection id="HA7D9961AF4A34459A4A230FE546A63CB"><enum>(a)</enum><header>Medicare Advantage</header><text display-inline="yes-display-inline">Section 1852 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-22">42 U.S.C. 1395w–22</external-xref>) is amended by adding at the end the following new subsection:</text>
<quoted-block style="OLC" id="H54CB14B4418C47BD99154874CABD5FCB" display-inline="no-display-inline">
<subsection id="H5F6A588C3EE34DCDA53CED8E72F0D305"><enum>(n)</enum><header>Provision of information relating to the safe disposal of certain prescription drugs</header>
<paragraph id="H6F775349ECC1470882941E1313695D7B"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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 substances 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 disposal.</text></paragraph> <paragraph id="HC0CDFFB2A2AC4DBDA88AC19FC2351ABC"><enum>(2)</enum><header>Criteria</header><text>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 substances. </text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="HD5A3A26D4E4945B0AE06F3ABAD2EF262"><enum>(b)</enum><header>Prescription drug plans</header><text>Section 1860D–4(c)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-104">42 U.S.C. 1395w–104(c)(2)(B)</external-xref>) is amended—</text> <paragraph id="H54484589A00E4E5AA6C5B3CB7E6BF685"><enum>(1)</enum><text>by striking <quote>may include elements that promote</quote>;</text></paragraph>
<paragraph id="HB2CC82839F71467A9723EDD26BFF5075"><enum>(2)</enum><text>by redesignating clauses (i) through (iii) as subclauses (I) through (III) and adjusting the margins accordingly;</text></paragraph> <paragraph id="H1659501EB66F468BB4D49B021EDD76B2"><enum>(3)</enum><text>by inserting before subclause (I), as so redesignated, the following new clause:</text>
<quoted-block style="OLC" id="H9312737971F8436094E3674161082E3D" display-inline="no-display-inline">
<clause id="H04282A31A2F94489B22E07D2F7CB3FE9"><enum>(i)</enum><text display-inline="yes-display-inline">may include elements that promote—</text></clause><after-quoted-block>;</after-quoted-block></quoted-block></paragraph> <paragraph id="HE912A23A25474E6382C2DF9C1A6B185B"><enum>(4)</enum><text>in subclause (III), as so redesignated, by striking the period at the end and inserting <quote>; and</quote>; and</text></paragraph>
<paragraph id="HD93EDBA2BD4548ADA906DC0812B9EF5A"><enum>(5)</enum><text>by adding at the end the following new clause:</text> <quoted-block style="OLC" id="H10B5A04949DB46D490BF6803E2857C96" display-inline="no-display-inline"> <clause id="HC47E27CEB1ED4DFE973D62D89B0E3963"><enum>(ii)</enum><text display-inline="yes-display-inline">with respect to plan years beginning on or after January 1, 2021, shall provide for—</text>
<subclause id="H9027455F23D549F98967C2910BAD3775"><enum>(I)</enum><text>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</text></subclause> <subclause id="H2BBFC386319E4A9C9304A157F9E23F2A"><enum>(II)</enum><text>cost-effective means by which an enrollee may so safely dispose of such drugs.</text></subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection></section>
<section id="H7C743B486C9C415B93AA194624B9B3B7" section-type="subsequent-section"><enum>6114.</enum><header>Revising measures used under the Hospital Consumer Assessment of Healthcare Providers and Systems survey relating to pain management</header>
<subsection id="HC61939F1AA7A425C9071534E32FCE48F"><enum>(a)</enum><header>Restriction on the use of pain questions in HCAHPS</header><text display-inline="yes-display-inline">Section 1886(b)(3)(B)(viii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(b)(3)(B)(viii)</external-xref>) is amended by adding at the end the following new subclause:</text> <quoted-block style="OLC" id="H012BF48C6F7F4DCB97175837AF0B209B" display-inline="no-display-inline"> <subclause id="HCD556D8560A34F1399282BDF202D3644" indent="up4"><enum>(XII)</enum> <item id="HEB22716AF8F8468EB1C0AAD8A3525EC3" display-inline="yes-display-inline"><enum>(aa)</enum><text>With respect to a Hospital Consumer Assessment of Healthcare Providers and Systems survey (or a successor survey) conducted on or after January 1, 2019, 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.</text></item>
<item id="HA434C54C9DD94F1AA7BCD285F8E24982" indent="up1"><enum>(bb)</enum><text display-inline="yes-display-inline">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 about communication by hospital staff with an individual about such individual’s pain.</text></item></subclause><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="HBAB42AF4FFD5428AADB42F277F1AC656"><enum>(b)</enum><header>Restriction on use of 2018 pain questions in the hospital value-based purchasing program</header><text display-inline="yes-display-inline">Section 1886(o)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(o)(2)(B)</external-xref>) is amended by adding at the end the following new clause:</text>
<quoted-block style="OLC" id="HAFEDB32583944C078DFE589BF394FD0E" display-inline="no-display-inline">
<clause id="H54855258C43C48839DC64101817BECF1"><enum>(iii)</enum><header>HCAHPS pain questions</header><text display-inline="yes-display-inline">The Secretary may not include under subparagraph (A) a measure that is based on the questions appearing on the Hospital Consumer Assessment of Healthcare Providers and Systems survey in 2018 about communication by hospital staff with an individual about the individual’s pain.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section></subtitle> <enum>VII</enum><header>Other Health Provisions</header> <subtitle id="H5A9886682041415AB73370AA4F25661F"><enum>A</enum><header>Synthetic Drug Awareness</header> <section id="H6E9E47819A1B4B888CEC57D184443959" section-type="subsequent-section"><enum>7001.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Synthetic Drug Awareness Act of 2018</short-title></quote>.</text></section>
<section id="HCEDA780B43FD40189547E644F3317F5A"><enum>7002.</enum><header>Report on effects on public health of synthetic drug use</header>
<subsection id="H9A40F9F7365748A3A4AF4EDC7B6AE08B"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 3 years after the date of the enactment of this Act, the Surgeon General of the Public Health Service shall submit to Congress a report on the health effects of new psychoactive substances (including synthetic drugs) used since January 2010 by persons who are at least 12 years of age but no more than 18 years of age.</text></subsection> <subsection id="H165CDCC0D5CF4E9AA8FE721A9972B39B"><enum>(b)</enum><header>New psychoactive substance defined</header><text display-inline="yes-display-inline">For purposes of subsection (a), the term <quote>new psychoactive substance</quote> means a controlled substance analogue (as defined in section 102(32) of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/802">21 U.S.C. 802(32)</external-xref>).</text></subsection></section></subtitle>
<subtitle id="HF474BD3CE25441AFA3EFB93383881F71"><enum>B</enum><header>Empowering Pharmacists in the Fight Against Opioid Abuse</header>
<section id="H19A3A3BFA66B4F7FB18398F65D49CCE8" section-type="subsequent-section"><enum>7011.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Empowering Pharmacists in the Fight Against Opioid Abuse Act</short-title></quote>.</text></section> <section id="HF489A1F5BECA4E6BA0FF465DEA2B56CE"><enum>7012.</enum><header>Programs and materials for training on certain circumstances under which a pharmacist may decline to fill a prescription</header> <subsection id="H72895A0500E244BAA3270ABAB8477B47"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services, in consultation with the Administrator of the Drug Enforcement Administration, the Commissioner of Food and Drugs, the Director of the Centers for Disease Control and Prevention, and the Assistant Secretary for Mental Health and Substance Use, shall develop and disseminate programs and materials for training pharmacists, health care providers, and patients on—</text>
<paragraph id="H39B580526A5445F99B6AC36D5146EEA0"><enum>(1)</enum><text display-inline="yes-display-inline">circumstances under which a pharmacist may, consistent with section 201 of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/811">21 U.S.C. 811</external-xref>) 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 pharmacist suspects the prescription is fraudulent, forged, or otherwise indicative of abuse or diversion; and</text></paragraph> <paragraph id="H74C3A032365F46CF8A821134DAC9CDB4"><enum>(2)</enum><text>any Federal requirements pertaining to declining to fill a prescription under such circumstances.</text></paragraph></subsection>
<subsection id="H9DB29F385BBC420B822B275C1219A5C7"><enum>(b)</enum><header>Materials included</header><text display-inline="yes-display-inline">In developing materials under subsection (a), the Secretary of Health and Human Services shall include information educating—</text> <paragraph id="HA4E85C29F6234D358AD176C39ED78D39"><enum>(1)</enum><text>pharmacists on how to decline to fill a prescription and actions to take after declining to fill a prescription; and</text></paragraph>
<paragraph id="HF0B5FD7B242B4593B92C1B567BE6754D"><enum>(2)</enum><text>other health care practitioners and the public on a pharmacist’s responsibility to decline to fill prescriptions in certain circumstances.</text></paragraph></subsection> <subsection id="H185AEB0E3C5748088DD97A64E1775312"><enum>(c)</enum><header>Stakeholder input</header><text display-inline="yes-display-inline">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.</text></subsection></section></subtitle>
<subtitle id="HAE8A87FEAE444834A2F7CE71167ECFAB"><enum>C</enum><header>Indexing Narcotics, Fentanyl, and Opioids</header>
<section id="H8777E073E46D472FA05EFA7F2DC3D071" section-type="subsequent-section"><enum>7021.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote>Indexing Narcotics, Fentanyl, and Opioids Act of 2018</quote> or the <quote>INFO Act</quote>.</text></section> <section id="H42338F5AA1C641ADB28FC988392F48E6"><enum>7022.</enum><header>Establishment of substance use disorder information dashboard</header><text display-inline="no-display-inline">Title XVII of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300u">42 U.S.C. 300u</external-xref> et seq.) is amended by adding at the end the following new section:</text>
<quoted-block style="OLC" id="H80F2BEF984304966BB876E70123403F8" display-inline="no-display-inline">
<section id="H65BE5FF76C6041A2BFCD4E9B200014B7"><enum>1711.</enum><header>Establishment of substance use disorder information dashboard</header>
<subsection id="H7F3014B6627E4124A94C942B87736BB3"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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 a public information dashboard that—</text> <paragraph id="H7EE53C6791784ABDA82F6E44F81B8917"><enum>(1)</enum><text>coordinates information on programs within the Department of Health and Human Services related to the reduction of opioid abuse and other substance use disorders;</text></paragraph>
<paragraph id="HA089368B2FE84ABAA98626D85A8FE8EE"><enum>(2)</enum><text>provides access to publicly available data from other Federal agencies; State, local, and Tribal governments; nonprofit organizations; law enforcement; medical experts; public health educators; and research institutions regarding prevention, treatment, recovery, and other services for opioid use disorder and other substance use disorders;</text></paragraph> <paragraph id="H3F32348C066046ADA2B4EE8468CBAA1B" commented="no"><enum>(3)</enum><text display-inline="yes-display-inline">provides comparable data on substance use disorder prevention and treatment strategies in different regions and population of the United States;</text></paragraph>
<paragraph id="HC0A9A6DC34C2480195BC360E47FAB56A"><enum>(4)</enum><text display-inline="yes-display-inline">provides recommendations for health care providers on alternatives to controlled substances for pain management, including approaches studied by the National Institutes of Health Pain Consortium and the National Center for Complimentary and Integrative Health; and</text></paragraph> <paragraph id="HE9F5DCF5D0CB492EB4AB48AD0A1F29A0"><enum>(5)</enum><text display-inline="yes-display-inline">provides guidelines and best practices for health care providers regarding treatment of substance use disorders.</text></paragraph></subsection>
<subsection id="H1513CF82959E4AF98812948213D2B0B1"><enum>(b)</enum><header>Controlled substance defined</header><text>In this section, the term <quote>controlled substance</quote> has the meaning given that term in section 102 of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/802">21 U.S.C. 802</external-xref>).</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section> <section id="H7D2E26B9A4B94480B390E187273C72A9"><enum>7023.</enum><header>Interagency Substance Use Disorder Coordinating Committee</header> <subsection id="H9C5EE19CFC434B74B2F60EE58F5C6FF2"><enum>(a)</enum><header>Establishment</header><text display-inline="yes-display-inline">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 <quote>Secretary</quote>) shall, in consultation with the Director of National Drug Control Policy, establish a committee, to be known as the Interagency Substance Use Disorder Coordinating Committee (in this section referred to as the <quote>Committee</quote> ), to coordinate all efforts within the Department of Health and Human Services concerning substance use disorder.</text></subsection>
<subsection id="H460DC983D46743DFAFD72D4DF972936A"><enum>(b)</enum><header>Membership</header>
<paragraph id="HC38935CC43114D3C8FF889BEE6438A83"><enum>(1)</enum><header>Federal members</header><text display-inline="yes-display-inline">The following individuals shall be the Federal members of the Committee:</text> <subparagraph id="H0FF3647475FC47029E96DA8BF057D441"><enum>(A)</enum><text>The Secretary, who shall service as the Chair of the Committee.</text></subparagraph>
<subparagraph id="HAF0BEE60C1EA448CAE0501D29F8CDA6A"><enum>(B)</enum><text>The Attorney General of the United States.</text></subparagraph> <subparagraph id="H02A0EA72FC214424A68E636F48D40A45"><enum>(C)</enum><text>The Secretary of Labor.</text></subparagraph>
<subparagraph id="H85CD55F1E77442D9B97B8A1DA270FEEC"><enum>(D)</enum><text>The Secretary of Housing and Urban Development.</text></subparagraph> <subparagraph id="HD5268EC250FE41D9BF668CB74A042DA8"><enum>(E)</enum><text>The Secretary of Education.</text></subparagraph>
<subparagraph id="H04BF10A5159945B5ADA188E402197BF7"><enum>(F)</enum><text>The Secretary of Veterans Affairs.</text></subparagraph> <subparagraph id="H66B6420DA21D44F9BEE7283604789D7E"><enum>(G)</enum><text>The Commissioner of Social Security.</text></subparagraph>
<subparagraph id="H93501DA3497348C48060B5EDFBB1FB23"><enum>(H)</enum><text>The Assistant Secretary for Mental Health and Substance Use.</text></subparagraph> <subparagraph id="H92CE8078C80F4B5B960F3F9D8DFEA1B5"><enum>(I)</enum><text>The Director of the Centers for Disease Control and Prevention.</text></subparagraph>
<subparagraph id="H9955CAD461FE473C8C00F5349B0D6569"><enum>(J)</enum><text>The Director of the National Institutes of Health and the Directors of such national research institutes of the National Institutes of Health as the Secretary determines appropriate.</text></subparagraph> <subparagraph id="HFC1E528771F142D2B3C912C295D67688"><enum>(K)</enum><text>The Administrator of the Centers for Medicare & Medicaid Services.</text></subparagraph>
<subparagraph id="HC0F1B640776445D3B2DDB1CC554C536F"><enum>(L)</enum><text>The Director of National Drug Control Policy.</text></subparagraph> <subparagraph id="H6F1F9B1E28944BC99D8A00C991F7AA14"><enum>(M)</enum><text>Representatives of other Federal agencies that serve individuals with substance use disorder.</text></subparagraph></paragraph>
<paragraph id="H36B467292FEA4A2097AFBE0747823A25"><enum>(2)</enum><header>Non-Federal members</header><text display-inline="yes-display-inline">The Committee shall include a minimum of 17 non-Federal members appointed by the Secretary, of which—</text> <subparagraph id="H2737C9C571EB4E42956949DF5FCE7B9B"><enum>(A)</enum><text>at least two such members shall be an individual who has received treatment for a diagnosis of an opioid use disorder;</text></subparagraph>
<subparagraph id="HD69DD4B26AB94F01A44C69BBB1576539"><enum>(B)</enum><text>at least two such members shall be an individual who has received treatment for a diagnosis of a substance use disorder other than an opioid use disorder;</text></subparagraph> <subparagraph id="H6EC2E6660AD34FE3866656D4B28255DE"><enum>(C)</enum><text>at least two such members shall be a State Alcohol and Substance Abuse Director;</text></subparagraph>
<subparagraph id="HEAC1E5D435CB448FA1F1451229592CD4"><enum>(D)</enum><text>at least two such members shall be a representative of a leading research, advocacy, or service organization for adults with substance use disorder;</text></subparagraph> <subparagraph id="HAFE60C71B39E4791A9C1A95971A7340C"><enum>(E)</enum><text>at least two such members shall—</text>
<clause id="H685F833167C44D0C93B5C8B0252D5430"><enum>(i)</enum><text>be a physician, licensed mental health professional, advance practice registered nurse, or physician assistant; and</text></clause> <clause id="HCB1C7507385A48879EF2C74619599403"><enum>(ii)</enum><text>have experience in treating individuals with opioid use disorder or other substance use disorders;</text></clause></subparagraph>
<subparagraph id="HE302CCD8B9D345CF86466105DE0FBBD2"><enum>(F)</enum><text>at least one such member shall be a substance use disorder treatment professional who is employed with an opioid treatment program;</text></subparagraph> <subparagraph id="H337B715EAAC64D2F97C155D394019C22"><enum>(G)</enum><text>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;</text></subparagraph>
<subparagraph id="H7385BE8106234AC7B97B77BE42A012A5"><enum>(H)</enum><text>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;</text></subparagraph> <subparagraph id="H50DFE5E08948454AA492955689BAA24C"><enum>(I)</enum><text>at least one such member shall be a State-certified substance use disorder peer support specialist;</text></subparagraph>
<subparagraph id="H76107EE6E9B8403983AC82B701A6D65B"><enum>(J)</enum><text>at least one such member shall be a drug court judge or a judge with experience in adjudicating cases related to substance use disorder;</text></subparagraph> <subparagraph id="H58E5432B77E147A19E99A91BF4F921E9"><enum>(K)</enum><text>at least one such member shall be a law enforcement officer or correctional officer with extensive experience in interacting with adults with a substance use disorder; and</text></subparagraph>
<subparagraph id="HF18F04F0C2EB429C8ABF705D613D4EA2"><enum>(L)</enum><text>at least one such member shall be an individual with experience providing services for homeless individuals and working with adults with a substance use disorder.</text></subparagraph></paragraph></subsection> <subsection id="H7AF85BAA2C2D40D39FA0C839643C85E3"><enum>(c)</enum><header>Terms</header> <paragraph id="HE107CE8BA193477BB7CD7CDCB8AAD576"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></paragraph>
<paragraph id="HEC26CF539EE44BB2B21FA977C1281B8C"><enum>(2)</enum><header>Vacancies</header><text display-inline="yes-display-inline">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.</text></paragraph></subsection> <subsection id="HA6EA59DE52DB41339953DCECC5C6D9AA"><enum>(d)</enum><header>Meetings</header><text>The Committee shall meet not fewer than two times each year.</text></subsection>
<subsection id="HBC63084C671B4BBA83E20442441F5DB1"><enum>(e)</enum><header>Duties</header><text display-inline="yes-display-inline">The Committee shall—</text> <paragraph id="H74CE9FB6233A41F99338588891488B0D"><enum>(1)</enum><text display-inline="yes-display-inline">monitor opioid use disorder and other substance use disorder research, services, and support and prevention activities across all relevant Federal agencies, including coordination of Federal activities with respect to opioid use disorder and other substance use disorders;</text></paragraph>
<paragraph id="H7B8A3B80901B43C0988158E817F7200C"><enum>(2)</enum><text display-inline="yes-display-inline">identify and provide to the Secretary recommendations for improving Federal grants and programs for the prevention and treatment of, and recovery from, opioid use disorder and other substance use disorders;</text></paragraph> <paragraph id="H48B80BB2F22B45118230BFFCC0CD6AB2"><enum>(3)</enum><text display-inline="yes-display-inline">review substance use disorder prevention and treatment strategies in different regions and populations in the United States and evaluate the extent to which Federal substance use disorder prevention and treatment strategies are aligned with State and local substance use disorder prevention and treatment strategies;</text></paragraph>
<paragraph id="HF0FB37619D7E4434A8F60BD845B72657"><enum>(4)</enum><text display-inline="yes-display-inline">make recommendations to the Secretary regarding any appropriate changes with respect to the activities and strategies described in paragraphs (1) through (3);</text></paragraph> <paragraph id="HD62083D68B814988B040B426074B4DBD"><enum>(5)</enum><text display-inline="yes-display-inline">make recommendations to the Secretary regarding public participation in decisions relating to opioid use disorder and other substance use disorders and the process by which public feedback can be better integrated into such decisions; and</text></paragraph>
<paragraph id="H6C487069DB7D4EBBAA3FB3BF1E065382"><enum>(6)</enum><text display-inline="yes-display-inline">make recommendations to ensure that opioid use disorder and other substance use disorder research, services, and support and prevention activities of the Department of Health and Human Services and other Federal agencies are not unnecessarily duplicative.</text></paragraph></subsection> <subsection id="HD6E30EAB91D348399D5880C81C4848F4"><enum>(f)</enum><header>Annual report</header> <paragraph id="H2D57354E10B14DE78DA08017B4596A6B"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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 public information dashboard established under section 7022(a) a report summarizing the activities carried out by the Committee pursuant to subsection (e), including any findings resulting from such activities.</text></paragraph>
<paragraph id="HA98FA883EC3D426F9C085AFCD7BA7C6D"><enum>(2)</enum><header>Recommendation for Committee extension</header><text>After the publication of the second report of the Committee under paragraph (1), the Secretary shall submit to Congress a recommendation on whether or not the operations of the Committee should continue after the termination date described in subsection (i).</text></paragraph></subsection> <subsection id="HE124DBE199E54088B69C0CAC2F18851F"><enum>(g)</enum><header>Working groups</header><text>The Committee may establish working groups for purposes of carrying out the duties described in subsection (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.</text></subsection>
<subsection id="HD81D1CF19AAB4BCABECF0AD978AAC55A"><enum>(h)</enum><header>Federal Advisory Committee Act</header><text>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.</text></subsection> <subsection id="HA264E5677EAC45C09131EE8F0E991E6D"><enum>(i)</enum><header>Sunset</header><text>The Committee shall terminate on the date that is 6 years after the date on which the Committee is established under subsection (a).</text></subsection></section></subtitle>
<subtitle id="HEBE3609F867D4B81B36F6DDC0DBC9DD8"><enum>D</enum><header>Ensuring Access to Quality Sober Living</header>
<section id="H25528D6EAF724CD1827E5F69C0A68740" section-type="subsequent-section"><enum>7031.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Ensuring Access to Quality Sober Living Act of 2018</short-title></quote>.</text></section> <section id="HF87F05D9F1E64CFA842FC0966419232F"><enum>7032.</enum><header>National recovery housing best practices</header><text display-inline="no-display-inline">Part P of title III of the Public Health Service Act is amended by adding at the end the following new section:</text>
<quoted-block style="OLC" id="H6E6879C0971F4D17B759B752CBA902FA" display-inline="no-display-inline">
<section id="HF3BA1640B18848A6A572ACB64E47A457"><enum>399V–7.</enum><header>National recovery housing best practices</header>
<subsection id="H21145FD3D3614648BB69C77E49D8510E"><enum>(a)</enum><header>Best practices</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services, in consultation with the Secretary for Housing and Urban Development, patients with a history of opioid use disorder, and other stakeholders, which may include State accrediting entities and reputable providers, analysts, and stakeholders of recovery housing services, such as the National Alliance for Recovery Residences, shall identify or facilitate the development of best practices, which may include model laws for implementing suggested minimum standards, for operating recovery housing.</text></subsection> <subsection id="H6AE993E3D36F483EB0626F3E38EC669D"><enum>(b)</enum><header>Dissemination</header><text>The Secretary shall disseminate the best practices identified or developed under subsection (a) to—</text>
<paragraph id="H6227C5EEAC8E460EB02EB46B81133638"><enum>(1)</enum><text>State agencies, which may include the provision of technical assistance to State agencies seeking to adopt or implement such best practices;</text></paragraph> <paragraph id="H03EACA3F25BA42FF879FB8F225ABEAD0"><enum>(2)</enum><text>recovery housing entities; and</text></paragraph>
<paragraph id="H02964ECD85284EF58C7C1A06773CDCD0"><enum>(3)</enum><text>the public, as appropriate.</text></paragraph></subsection> <subsection id="H35F765D299AC4A188939D80EEC9CF8B7"><enum>(c)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section:</text>
<paragraph id="HCE9180E37B10450390E5EFD6B67B31F1"><enum>(1)</enum><text>The term <term>recovery housing</term> means a shared living environment free from alcohol and illicit drug use and centered on peer support and connection to services, including medication-assisted treatment services, that promote sustained recovery from substance use disorders.</text></paragraph> <paragraph id="H1E77A4BC267F42339DE6A4A30CEDD68E"><enum>(2)</enum><text display-inline="yes-display-inline">The term <quote>State</quote> includes any of the several States, the District of Columbia, each Indian tribe or tribal organization (as those terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act), and any territory or possession of the United States.</text></paragraph></subsection>
<subsection id="HD760357B1074451D9D303982274B2BFA"><enum>(d)</enum><header>Authorization of appropriations</header><text>To carry out this section, there is authorized to be appropriated $3,000,000 for the period of fiscal years 2019 through 2021.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section></subtitle> <subtitle id="HCEE06C5DAFA04B2B8763CBE5EDDFD79A"><enum>E</enum><header>Advancing Cutting Edge Research</header> <section id="H7F7E356A4DFB4DB8AC9454E601697615" section-type="subsequent-section"><enum>7041.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Advancing Cutting Edge Research Act</short-title></quote> or the <quote><short-title>ACE Research Act</short-title></quote>.</text></section>
<section id="HD9F12D143876433593E1CAC588741B74"><enum>7042.</enum><header>Unique research initiatives</header><text display-inline="no-display-inline">Section 402(n)(1) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/282">42 U.S.C. 282(n)(1)</external-xref>) is amended—</text> <paragraph id="H4D77BFAC41E34122AA321FA372113205"><enum>(1)</enum><text>in subparagraph (A), by striking <quote>or</quote>;</text></paragraph>
<paragraph id="HC1F824DE07AB4C69A82185B5C09B253F"><enum>(2)</enum><text>in subparagraph (B), by striking the period and inserting <quote>; or</quote>; and</text></paragraph> <paragraph id="HD5D007B6F0BB41C59DAD0F51F14380EA"><enum>(3)</enum><text>by adding at the end the following:</text>
<quoted-block id="H63DE3ECC8CCF44AE857029A8E31013F3" style="OLC">
<subparagraph id="HE501F58B15E54D3AA7C0DCC2B0E91CD0"><enum>(C)</enum><text>high impact cutting-edge research that fosters scientific 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.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section></subtitle> <subtitle id="H24E86FBE8D174D0391D2DFAB5A80ACB1"><enum>F</enum><header>Jessie’s Law</header> <section id="H5009569A6F304698AD4B1155FF68F31A" section-type="subsequent-section"><enum>7051.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as <quote>Jessie’s Law</quote>.</text></section>
<section id="HB7BA527AA9A0426FAABF7F076FB79E8C"><enum>7052.</enum><header>Inclusion of opioid addiction history in patient records</header>
<subsection id="H91E9AD081A304B1AB1B64D10E9DAE270"><enum>(a)</enum><header>Best practices</header>
<paragraph id="H90E7D7EA846E46CD89415AD990B0D727"><enum>(1)</enum><header>In general</header><text>Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services, 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 identify or facilitate the development of best practices regarding—</text> <subparagraph id="H08B2124DE1964BF3815093644E6946BF"><enum>(A)</enum><text>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;</text></subparagraph>
<subparagraph id="H9431B5F1BD084B2598B8F137E1754782"><enum>(B)</enum><text>what constitutes the patient’s request for the purpose described in subparagraph (A); and</text></subparagraph> <subparagraph id="HE24987587E3A471391C8D6AC59853903"><enum>(C)</enum><text>the process and methods by which the information should be so displayed.</text></subparagraph></paragraph>
<paragraph id="H5E2DA074AC7D467AB908AA988639EB75"><enum>(2)</enum><header>Dissemination</header><text>The Secretary shall disseminate the best practices developed under paragraph (1) to health care providers and State agencies.</text></paragraph></subsection> <subsection id="H15B0BFC79A0C47719F26D43294B0BB12"><enum>(b)</enum><header>Requirements</header><text>In identifying or facilitating the development of best practices under subsection (a), as applicable, the Secretary, in consultation with appropriate stakeholders, shall consider the following:</text>
<paragraph id="H3A89AE83FB2F44768E68098573F56BA6"><enum>(1)</enum><text>The potential for addiction relapse or overdose, including overdose death, when opioid medications are prescribed to a patient recovering from opioid use disorder.</text></paragraph> <paragraph id="H731BF82E11B842AA808F9EF8F01F9652"><enum>(2)</enum><text>The benefits of displaying information about a patient’s opioid use disorder history in a manner similar to other potentially lethal medical concerns, including drug allergies and contraindications.</text></paragraph>
<paragraph id="H9B07A6D41037440E8068BC1C5D6DF6C7"><enum>(3)</enum><text>The importance of prominently displaying information about a patient’s opioid use disorder when a physician or medical professional is prescribing medication, including methods for avoiding alert fatigue in providers.</text></paragraph> <paragraph id="H5A55E9C81026419DB7F5B2BC763D3D2E"><enum>(4)</enum><text>The importance of a variety of appropriate medical professionals, including physicians, nurses, and pharmacists, to have access to information described in this section when prescribing or dispensing opioid medication, consistent with Federal and State laws and regulations.</text></paragraph>
<paragraph id="H74D1D08F08B94B04AE6E0FAA3A8E77FE"><enum>(5)</enum><text>The importance of protecting patient privacy, including the requirements related to consent for disclosure of substance use disorder information under all applicable laws and regulations.</text></paragraph> <paragraph id="H15F0A3D0543E4FD18FF3F926D768FA45"><enum>(6)</enum><text>All applicable Federal and State laws and regulations.</text></paragraph></subsection></section>
<section id="H556D91673F2B4DB9B7FF5EB5E3BC0765"><enum>7053.</enum><header>Communication with families during emergencies</header>
<subsection id="HADCE838AA4FC4427918AFEC6B90A9A48"><enum>(a)</enum><header> Promoting awareness of authorized disclosures during emergencies</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services, acting through the Administrator of the Centers for Medicare & Medicaid Services and the Administrator of the Health Resources and Services Administration, shall annually develop and disseminate written materials (electronically or by other means) to health care providers regarding permitted disclosures under Federal health care privacy law during emergencies, including overdoses, of certain health information to families, caregivers, and health care providers.</text></subsection> <subsection id="H7C4A32DE8C474D1686F2D2756B51FFA7"><enum>(b)</enum><header>Use of material</header><text>For the purposes of carrying out subsection (a), the Secretary of Health and Human Services may use material produced under section 11004 of the 21st Century Cures Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1320d-2">42 U.S.C. 1320d–2</external-xref> note).</text></subsection></section></subtitle>
<subtitle id="HD71AB3D26E1C42FD944D969B970B58CD"><enum>G</enum><header>Safe Disposal of Unused Medication</header>
<section id="HD647FE21410343D99F178CB00E1DD876" section-type="subsequent-section"><enum>7061.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Safe Disposal of Unused Medication Act</short-title></quote>.</text></section> <section id="H2290DFFCDBD441E2985BD3F00792C8FB"><enum>7062.</enum><header>Disposal of controlled substances of a deceased hospice patient by employees of a qualified hospice program</header><text display-inline="no-display-inline">Subsection (g) of section 302 of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/822">21 U.S.C. 822</external-xref>) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H817497E79352497E8517B05FE58C7DF4" style="OLC">
<paragraph id="HF748DA10F6FE49A8984C111F7777D964" indent="up1"><enum>(5)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H431FB3D038B54AF5BA3BD56E930E4473"><enum>(A)</enum><text display-inline="yes-display-inline">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 after the death of such person, so long as such disposal occurs onsite in accordance with all applicable Federal, State, Tribal, and local law.</text></subparagraph> <subparagraph id="H0F376C6450AD4F5FBC4F471C1C804489" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">For the purposes of this paragraph:</text>
<clause id="HD7B4EFE7B54B484DBB9592FF8824FE79"><enum>(i)</enum><text>The terms <term>hospice care</term> and <term>hospice program</term> have the meanings given to those terms in section 1861(dd) of the Social Security Act.</text></clause> <clause id="HE02BBF31024F4D3D94665C70BD1D0CF9"><enum>(ii)</enum><text display-inline="yes-display-inline">The term <quote>employee of a qualified hospice program</quote> means a physician, nurse, or other person who—</text>
<subclause id="HA9D084442C0D4B1BAFE23F68F2477EA0"><enum>(I)</enum><text display-inline="yes-display-inline">is employed by, or pursuant to arrangements made by, a qualified hospice program;</text></subclause> <subclause id="H7EEA7401F90341DABFDA0D21C9BE1D9D"><enum>(II)</enum> <item id="HF1C99159C3A648CDAFEBB229CF4C1239" display-inline="yes-display-inline"><enum>(aa)</enum><text display-inline="yes-display-inline">is licensed to perform medical or nursing services by the jurisdiction in which the person receiving hospice care was located; and</text></item>
<item id="H0EA243A794C44647B32E67B59D25EE46" indent="up1"><enum>(bb)</enum><text>is acting within the scope of such employment in accordance with applicable State law; and</text></item></subclause> <subclause id="H51C9332F66B946E2946B645E73512492" commented="no"><enum>(III)</enum><text display-inline="yes-display-inline">has completed training through the qualified hospice program regarding the disposal of controlled substances in a secure and responsible manner so as to discourage abuse, misuse, or diversion.</text></subclause></clause>
<clause id="H6FB22C3448A3438EB345721BDF227EAA"><enum>(iii)</enum><text display-inline="yes-display-inline">The term <term>qualified hospice program</term> means a hospice program that—</text> <subclause id="HBD170EFFFF27427C8C7D752460533565"><enum>(I)</enum><text>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; </text></subclause>
<subclause id="H559449E5B3CA469099B38BBEFB3EDBF0"><enum>(II)</enum><text>at the time when the controlled substances are first ordered—</text> <item id="H197D71D34E814836BD13DD4351962AFF"><enum>(aa)</enum><text>provides a copy of the written policies and procedures to the patient or patient representative and family;</text></item>
<item id="H7C904DBD08A745878A6AA8196FD61990"><enum>(bb)</enum><text>discusses the policies and procedures with the patient or representative and the family in a language and manner that they understand to ensure that these parties are educated regarding the safe disposal of controlled substances; and</text></item> <item id="H1512B352B49743B1BC1A034129DA3CF7"><enum>(cc)</enum><text>documents in the patient’s clinical record that the written policies and procedures were provided and discussed; and</text></item></subclause>
<subclause id="HD145248133BC42F4A1A9052EE505222A" commented="no"><enum>(III)</enum><text display-inline="yes-display-inline">at the time following the disposal of the controlled substances— </text> <item id="H1AC60711886442F5B5B87541AD793F5F" commented="no"><enum>(aa)</enum><text display-inline="yes-display-inline">documents in the patient’s clinical record the type of controlled substance, dosage, route of administration, and quantity so disposed; and</text></item>
<item id="H8233FEBFD8414B39902BB9172F1A1191" commented="no"><enum>(bb)</enum><text display-inline="yes-display-inline">the time, date, and manner in which that disposal occurred.</text></item></subclause></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></section></subtitle> <subtitle id="HDF9287AB16B740CFBF174B474BD78E44"><enum>H</enum><header>Substance Use Disorder Workforce Loan Repayment</header> <section id="HE2352FA339B64736957C2FE822709725" section-type="subsequent-section"><enum>7071.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Substance Use Disorder Workforce Loan Repayment Act of 2018</short-title></quote>.</text></section>
<section id="HCC554B82371B4EFD9D4A93E40B902559"><enum>7072.</enum><header>Loan repayment program for substance use disorder treatment employees</header><text display-inline="no-display-inline">Title VII of the Public Health Service Act is amended—</text> <paragraph id="H7786FEC99CFB4909A6BDDE0D63167B9B"><enum>(1)</enum><text>by redesignating part F as part G; and</text></paragraph>
<paragraph id="HB4C46E970AAD449595C263A8367ECBF5"><enum>(2)</enum><text>by inserting after part E (<external-xref legal-doc="usc" parsable-cite="usc/42/294n">42 U.S.C. 294n</external-xref> et seq.) the following:</text> <quoted-block display-inline="no-display-inline" id="H6B1797D6A21A4B1EB99E202DB90367E4" style="OLC"> <part id="H5BC53D0309C947FE94B0C9D3693EFF19"><enum>F</enum><header>Substance use disorder treatment employees</header> <section id="HCB605875156A4D3CBB15B1C11CDC2048"><enum>781.</enum><header>Loan repayment program for substance use disorder treatment employees</header> <subsection id="HAA34B699E2F44E339AB41E89BD1AC4C6"><enum>(a)</enum><header>In general</header><text>The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall carry out a program under which—</text>
<paragraph id="HFD35506713BC42D49567F59058A9382B"><enum>(1)</enum><text display-inline="yes-display-inline">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</text></paragraph> <paragraph id="H0B5F0678A02A4E738E2FDDA0FF038295"><enum>(2)</enum><text>the individuals each agree to complete a period of service in a substance use disorder treatment job, as described in subsection (d).</text></paragraph></subsection>
<subsection id="H2E685E19C7B740458BAEE331392CAE18"><enum>(b)</enum><header>Payments</header><text display-inline="yes-display-inline">For each year of obligated service by an individual pursuant to an agreement under subsection (a), the Secretary shall make a payment to such individual as follows:</text> <paragraph id="HD9CC880B7CE94AD3949B12C0CAC20883"><enum>(1)</enum><header>Service in a shortage area</header><text display-inline="yes-display-inline">The Secretary shall pay—</text>
<subparagraph id="H329AF9ACBC184CFBA6F495EA9CEBBE55"><enum>(A)</enum><text display-inline="yes-display-inline">for each year of obligated service by an individual pursuant to an agreement under subsection (a), <fraction>1/6</fraction> of the principal of and interest on each eligible loan of the individual which is outstanding on the date the individual began service pursuant to the agreement; and</text></subparagraph> <subparagraph id="H874C3CCAB913423FABB115FBD6D836D9"><enum>(B)</enum><text>for completion of the sixth and final year of such service, the remainder of such principal and interest.</text></subparagraph></paragraph>
<paragraph id="H0ECF870B81E946D68E2D894CC804046F"><enum>(2)</enum><header>Maximum amount</header><text>The total amount of payments under this section to any individual shall not exceed $250,000.</text></paragraph></subsection> <subsection id="HA208B6807C4D4302AE77D6EE03115392"><enum>(c)</enum><header>Eligible loans</header><text>The loans eligible for repayment under this section are each of the following:</text>
<paragraph id="H40BB709FD18F453BA5B1DD8D0D2D7A1F"><enum>(1)</enum><text display-inline="yes-display-inline">Any loan for education or training for a substance use disorder treatment job.</text></paragraph> <paragraph id="H603527C5985C495A9E89D18B72979713"><enum>(2)</enum><text>Any loan under part E of title VIII (relating to nursing student loans).</text></paragraph>
<paragraph id="HB01B22EC773343CE8502425B5CD06255"><enum>(3)</enum><text display-inline="yes-display-inline">Any Federal Direct Stafford Loan, Federal Direct PLUS Loan, or 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).</text></paragraph> <paragraph id="H6E757B6FCF8745B2B8E893454D03F0E7"><enum>(4)</enum><text>Any Federal Perkins Loan under part E of title I of the Higher Education Act of 1965.</text></paragraph>
<paragraph id="H476A1E3BF8594AAE8448829CC4590BA1"><enum>(5)</enum><text>Any other Federal loan as determined appropriate by the Secretary.</text></paragraph></subsection> <subsection id="HA56F062041914C55AB8507EC14221435"><enum>(d)</enum><header>Period of service</header><text display-inline="yes-display-inline">The period of service required by an agreement under subsection (a) shall consist of up to 6 years of full-time employment, with no more than 1 year passing between any 2 years of covered employment, in a substance use disorder treatment job in the United States in—</text>
<paragraph id="H85761A4455F145198CAE444C56E4822F"><enum>(1)</enum><text display-inline="yes-display-inline">a Mental Health Professional Shortage Area, as designated under section 332; or</text></paragraph> <paragraph id="H203DB4DC5310464C8E8FD9C513F74A8A"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text></paragraph></subsection>
<subsection id="H2A0C4956219D40E6AA2D61215F971A07"><enum>(e)</enum><header>Ineligibility for double benefits</header><text>No borrower may, for the same service, receive a reduction of loan obligations or a loan repayment under both—</text> <paragraph id="HA73F1D871C004E3BACC844C9D637237B"><enum>(1)</enum><text>this subsection; and</text></paragraph>
<paragraph id="H7E930B50F61E4893B318FFA015343A02"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text></paragraph></subsection> <subsection id="H179212EA3F934D8896BABD4D9CD5DF43"><enum>(f)</enum><header>Breach</header> <paragraph id="H96CEB8CF070A439BBC65E08EC6B9ACF1"><enum>(1)</enum><header>Liquidated damages formula</header><text>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).</text></paragraph>
<paragraph id="H26438F07371A423CA5BEA7BA385E62DF"><enum>(2)</enum><header>Limitation</header><text display-inline="yes-display-inline">The failure by an individual to complete the full period of service obligated pursuant to such an agreement, taken alone, shall not constitute a breach of the agreement, so long as the individual completed in good faith the years of service for which payments were made to the individual under this section.</text></paragraph></subsection> <subsection id="H025828578BF045849D9F2E08D7F0EE65"><enum>(g)</enum><header>Additional criteria</header><text display-inline="yes-display-inline">The Secretary—</text>
<paragraph id="H2C9E9A68FEC64D65889BA595A49FE01B"><enum>(1)</enum><text>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</text></paragraph> <paragraph id="HD96520D8E7E34B1392AB65727EAC007C"><enum>(2)</enum><text>shall give notice to the committees specified in subsection (h) of any criteria and rules so established.</text></paragraph></subsection>
<subsection id="H0856E61E43884F6283F80B9449B7D7AE"><enum>(h)</enum><header>Report to Congress</header><text display-inline="yes-display-inline">Not later than 5 years after the date of enactment of the <short-title>Substance Use Disorder Workforce Loan Repayment Act of 2018</short-title>, 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—</text> <paragraph id="H745B7BD197B74119B3C08FD5193CC517"><enum>(1)</enum><text>the number and location of borrowers who have qualified for loan repayments under this section; and</text></paragraph>
<paragraph id="H51D2E4135A46458FAD52A8D3665DAC19"><enum>(2)</enum><text>the impact of this section on the availability of substance use disorder treatment employees nationally and in shortage areas and counties described in subsection (d).</text></paragraph></subsection> <subsection id="H705939797921459B824164A411AED965"><enum>(i)</enum><header>Definition</header><text display-inline="yes-display-inline">In this section:</text>
<paragraph id="HE79CD726560344DDB2790C9794E27DD0"><enum>(1)</enum><text display-inline="yes-display-inline">The term <term>municipality</term> means a city, town, or other public body created by or pursuant to State law, or an Indian Tribe.</text></paragraph> <paragraph id="H6D6E3DEFB95D4D50806A60C9C047B342"><enum>(2)</enum><text>The term <term>substance use disorder treatment job</term> means a full-time job (including a fellowship)—</text>
<subparagraph id="H947A7864141649E5BF7E603A7B8A95E7"><enum>(A)</enum><text display-inline="yes-display-inline">where the primary intent and function of the job is the direct treatment or recovery support of patients with or in recovery from a substance use disorder, such as a physician, physician assistant, registered nurse, nurse practitioner, advanced practice registered nurse, social worker, recovery coach, mental health counselor, addictions counselor, psychologist or other behavioral health professional, or any other relevant professional as determine by the Secretary; and</text></subparagraph> <subparagraph id="H914179C1B15448608D96F02560F48723"><enum>(B)</enum><text display-inline="yes-display-inline">which is located at a substance use disorder treatment program, private physician practice, hospital or health system-affiliated inpatient treatment center or outpatient clinic (including an academic medical center-affiliated 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, community-based organization, telehealth platform, migrant health center, health program or facility operated by a tribe or tribal organization, Federal medical facility, or any other facility as determined appropriate for purposes of this section by the Secretary.</text></subparagraph></paragraph></subsection>
<subsection id="H858D2E4D953A40D296A2C5A945B28CDF"><enum>(j)</enum><header>Authorization of appropriations</header><text display-inline="yes-display-inline">There are authorized to be appropriated to carry out this section $25,000,000 for each of fiscal years 2019 through 2028.</text></subsection></section></part><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section></subtitle> <subtitle id="H50790003D9DC4199B011178F619F8401"><enum>I</enum><header>Preventing Overdoses While in Emergency Rooms</header> <section id="H631C7B44024E43D2A69C76D7E37436B9" section-type="subsequent-section"><enum>7081.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Preventing Overdoses While in Emergency Rooms Act of 2018</short-title></quote>.</text></section>
<section id="H6182E0B4A94F4B09858A5280A75C36F8"><enum>7082.</enum><header>Program to support emergency room discharge and care coordination for drug overdose patients</header>
<subsection id="H0BDE355DAC804D0EA85692BCCF4C9CED"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services shall establish a program (in this subtitle referred to as the <quote>Program</quote>) to develop protocols for discharging patients who have presented with a drug overdose and enhance the integration and coordination of care and treatment options for individuals with substance use disorder after discharge.</text></subsection> <subsection id="H5271B1B9AA924318B97395108A7A213A"><enum>(b)</enum><header>Grant establishment and participation</header> <paragraph id="H0F6B8D1FB3C243D3A17570EADC2D0858"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">In carrying out the Program, the Secretary shall award grants on a competitive basis to not more than 20 eligible entities described in paragraph (2).</text></paragraph>
<paragraph id="H01FBB0BC1B8546FF8BF2634F8E6D08A8"><enum>(2)</enum><header>Eligibility</header>
<subparagraph id="H97B2AA4DE3C346A6A01C6F0BFD9B2372"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">To be eligible for a grant under this subsection, an entity shall be—</text> <clause id="H1212CC3C9A5A4461A4AF84FB17BF751F"><enum>(i)</enum><text>a health care site described in subparagraph (B); or</text></clause>
<clause id="HA6FA7156A58A41888FA3C8DDCDFA2225"><enum>(ii)</enum><text>a health care site coordinator described in subparagraph (C).</text></clause></subparagraph> <subparagraph id="HC3129E76048341329445CBA33A3E22CC"><enum>(B)</enum><header>Health care sites</header><text display-inline="yes-display-inline">To be eligible for a grant under this section, a health care site shall—</text>
<clause id="H198CDB0207AB4748BC004A81D1EB8852" commented="no"><enum>(i)</enum><text>submit an application to the Secretary at such time, in such manner, and containing such information as specified by the Secretary;</text></clause> <clause id="H542957D7CB184C889FB8C317205EEDDA"><enum>(ii)</enum><text>have an emergency department;</text></clause>
<clause id="HDCF0017922034B5FB23C2606A729078E"><enum>(iii)</enum>
<subclause id="H6A1CBFC6F59E4D3FA1FBA33CD82E7E9C" commented="no" display-inline="yes-display-inline"><enum>(I)</enum><text display-inline="yes-display-inline">have a licensed health care professional onsite who has a waiver under section 303(g) of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/823">21 U.S.C. 823(g)</external-xref>) to dispense or prescribe covered drugs; or</text></subclause> <subclause id="HC9010F3C0987417DB70BDF45A74F4561" indent="up1"><enum>(II)</enum><text>have a demonstrable plan to hire a sufficient number of full-time licensed health care professionals who have waivers described in subclause (I) to administer such treatment onsite;</text></subclause></clause>
<clause id="HECC4F1EE971342C28F32723CD21EA0A6"><enum>(iv)</enum><text display-inline="yes-display-inline">have in place an agreement with a sufficient number and range of entities certified under applicable State and Federal law, such as pursuant to registration or a waiver under section 303(g) of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/823">21 U.S.C. 823(g)</external-xref>) or certification as described in section 8.2 of title 42 of the Code of Federal Regulations, to provide treatment for substance use disorder such that the entity or the resulting network of entities with an agreement with the hospital cumulatively are capable of providing all evidence-based services for the treatment of substance use disorder, as medically appropriate for the individual involved, including—</text> <subclause id="H54EBFBA02DBC49029FC19BA3C8C9C666"><enum>(I)</enum><text display-inline="yes-display-inline">medication-assisted treatment;</text></subclause>
<subclause id="H90042AC2810048D19DAF71A1937DEF4F"><enum>(II)</enum><text display-inline="yes-display-inline">withdrawal and detoxification services that include patient evaluation, stabilization, and readiness for and entry into treatment; and</text></subclause> <subclause id="HC2BBC8157DCF461AA5335FE8B5BED75F"><enum>(III)</enum><text>counseling;</text></subclause></clause>
<clause id="HDA12D7E11A484B94B4A69531390F91D8"><enum>(v)</enum><text display-inline="yes-display-inline">deploy onsite peer recovery specialists to help connect patients with treatment and recovery support services; and</text></clause> <clause id="HB75087BE98774A10B1B5E6DAD6652744"><enum>(vi)</enum><text>include the provision of overdose reversal medication in discharge protocols for opioid overdose patients.</text></clause></subparagraph>
<subparagraph id="HBCC262808071464B82763296BFED44D6"><enum>(C)</enum><header>Health care site coordinators</header><text>To be eligible for a grant under this section, a health care site coordinator shall—</text> <clause id="HCBFEE850FF9948AD8BF8712A009D83EE"><enum>(i)</enum><text display-inline="yes-display-inline">be an organization described in <external-xref legal-doc="usc" parsable-cite="usc/26/501">section 501(c)(3)</external-xref> of the Internal Revenue Code of 1986 (and exempt from tax under section 501(a) of such Code) or a State, local, or Tribal government;</text></clause>
<clause id="HFDF066220ED3466D9577FE4DC5CB736A"><enum>(ii)</enum><text>submit an application to the Secretary at such time, in such manner, and containing such information as specified by the Secretary; and</text></clause> <clause id="HB23E6D33F63C4A89AB3E93B5FB2007BA"><enum>(iii)</enum><text>have an agreement with multiple eligible health care sites described in subparagraph (B).</text></clause></subparagraph></paragraph>
<paragraph id="HC9070F040CCC4629A953E89E095BA149"><enum>(3)</enum><header>Preference</header><text display-inline="yes-display-inline">In awarding grants under this section, the Secretary may give preference to eligible entities described in paragraph (2) that meet either or both of the following criteria:</text> <subparagraph id="H9A186254A6454699BB557A9F917254AD"><enum>(A)</enum><text>The eligible health care site is, or the eligible health care site coordinator has an agreement described in paragraph (2)(C)(iii) with a site that is, a critical access hospital (as defined in section 1861(mm)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(mm)(1)</external-xref>)), a low-volume hospital (as defined in section 1886(d)(12)(C)(i) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(d)(12)(C)(i)</external-xref>)), or a sole community hospital (as defined in section 1886(d)(5)(D)(iii) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(d)(5)(D)(iii)</external-xref>)).</text></subparagraph>
<subparagraph id="HC13E9716461C4148AC344D9C52D4A315"><enum>(B)</enum><text display-inline="yes-display-inline">The eligible health care site or the eligible health care site coordinator is located in a geographic area with a drug overdose rate that is higher than the national rate, or in a geographic area with a rate of emergency department visits for overdoses that is higher than the national rate, as determined by the Secretary based on the most recent data from the Centers for Disease Control and Prevention.</text></subparagraph></paragraph> <paragraph id="HA12431F6058C4C458066CC66AF4E04E3"><enum>(4)</enum><header>Medication-assisted treatment defined</header><text display-inline="yes-display-inline">For purposes of this section, the term <term>medication-assisted treatment</term> means the use of a drug approved under section 505 of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355</external-xref>) or a biological product licensed under section 351 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/262">42 U.S.C. 262</external-xref>), in combination with behavioral health services, to provide an individualized approach to the treatment of substance use disorders, including opioid use disorders.</text></paragraph></subsection>
<subsection id="H0DA235909F3841E295E28E6F4B20B2CE"><enum>(c)</enum><header>Period of grant</header><text display-inline="yes-display-inline">A grant awarded to an eligible entity under this section shall be for a period of at least 2 years.</text></subsection> <subsection commented="no" id="H122ECDFF738C46DCA1448621040BFBAE"><enum>(d)</enum><header>Grant uses</header> <paragraph commented="no" id="HB829C6A159E94D049AF8CCDCD5D698CF"><enum>(1)</enum><header>Required uses</header><text display-inline="yes-display-inline">A grant awarded under this section to an eligible entity shall be used for both of the following purposes:</text>
<subparagraph commented="no" id="HF920862E7F1A467F9CBFCE038D66FD13"><enum>(A)</enum><text display-inline="yes-display-inline">To establish policies and procedures that address the provision of overdose reversal medication, prescription and dispensing of medication-assisted treatment to an emergency department patient who has had a non-fatal overdose or who is at risk of a drug overdose, and the subsequent referral to evidence-based treatment upon discharge for patients who have experienced a non-fatal drug overdose or who are at risk of a drug overdose.</text></subparagraph> <subparagraph commented="no" id="H2E1D070386E64B78A0C58142C50B882B"><enum>(B)</enum><text display-inline="yes-display-inline">To develop best practices for treating non-fatal drug overdoses, including with respect to care coordination and integrated care models for long term treatment and recovery options for individuals who have experienced a non-fatal drug overdose.</text></subparagraph></paragraph>
<paragraph commented="no" id="H3527F57544794C9E956BF8477B36D7F6"><enum>(2)</enum><header>Additional permissible uses</header><text display-inline="yes-display-inline">A grant awarded under this section to an eligible entity may be used for any of the following purposes:</text> <subparagraph commented="no" id="HAB7C92F4CEAE416B835B60884A9EBB04"><enum>(A)</enum><text display-inline="yes-display-inline">To hire emergency department peer recovery specialists; counselors; therapists; social workers; or other licensed medical professionals specializing in the treatment of substance use disorder.</text></subparagraph>
<subparagraph commented="no" id="H482A890F954A445CB30D11133F0D4319"><enum>(B)</enum><text display-inline="yes-display-inline">To establish integrated models of care for individuals who have experienced a non-fatal drug overdose which may include patient assessment, follow up, and transportation to treatment facilities.</text></subparagraph> <subparagraph commented="no" id="H009BDD84B2684412BA5E6D8D32ED6310"><enum>(C)</enum><text>To provide for options for increasing the availability and access of medication-assisted treatment and other evidence-based treatment for individuals with substance use disorders.</text></subparagraph>
<subparagraph id="H0F61B798971749D78E7651BBF2A7F8F2"><enum>(D)</enum><text>To offer consultation with and referral to other supportive services that help in treatment and recovery.</text></subparagraph></paragraph></subsection> <subsection id="HE0D346DA889F4ED49CE95B604A715CF8"><enum>(e)</enum><header>Reporting requirements</header> <paragraph id="H4A73660864394AD38FDFA6069DE70375"><enum>(1)</enum><header>Reports by grantees</header><text display-inline="yes-display-inline">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—</text>
<subparagraph id="HF71D58283705408DADED949082F7FBFA"><enum>(A)</enum><text display-inline="yes-display-inline">the number of individuals treated at the site (or, in the case of an eligible health care site coordinator, at sites covered by the agreement referred to in subsection (b)(2)(C)(iii)) for non-fatal overdoses in the emergency department;</text></subparagraph> <subparagraph id="H8FBFD64C955B4069823DF026812029F2"><enum>(B)</enum><text>the number of individuals administered each medication-assisted treatment at such site or sites in the emergency department;</text></subparagraph>
<subparagraph id="HFDE28045FE52444E937F3A7EE15E5914"><enum>(C)</enum><text>the number of individuals referred by such site or sites 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;</text></subparagraph> <subparagraph id="H834ACE79B1AC44C1935F91C37BF38098"><enum>(D)</enum><text display-inline="yes-display-inline">the frequency and number of patient readmissions for non-fatal overdoses and substance use disorder;</text></subparagraph>
<subparagraph id="HD8129C70FEF749A1BDB57DC005D70320"><enum>(E)</enum><text>for what the grant funding was used; and</text></subparagraph> <subparagraph id="H1A204E1762D6423BAD7A88E43D778AD9"><enum>(F)</enum><text>the effectiveness of, and any other relevant additional data regarding, having an onsite health care professional to administer and begin medication-assisted treatment for substance use disorders.</text></subparagraph></paragraph>
<paragraph commented="no" id="HC88F504FEA87484FAC5FD907EB458291"><enum>(2)</enum><header>Report by Secretary</header><text display-inline="yes-display-inline">Not less than 1 year after the conclusion of the Program, the Secretary shall submit to Congress a report that includes—</text> <subparagraph commented="no" id="H0EA895871B294D2D898AB04AFC801404"><enum>(A)</enum><text>findings of the Program;</text></subparagraph>
<subparagraph commented="no" id="H1DC82E85A6444BA28930354D843C8840"><enum>(B)</enum><text>overall patient outcomes under the Program, such as with respect to hospital readmission;</text></subparagraph> <subparagraph commented="no" id="HC9CA85A70496419BB30FE9E8A7069AE8"><enum>(C)</enum><text>what percentage of patients treated by a site funded through a grant under this section were readmitted to a hospital for non-fatal or fatal overdose; </text></subparagraph>
<subparagraph id="H6D873C0C10C24B6A8AB7D21B1E0B8679"><enum>(D)</enum><text>an evaluation determining the effectiveness of having a practitioner onsite to administer and begin medication-assisted treatment for substance use disorder; and</text></subparagraph> <subparagraph commented="no" id="HABB4BA1745B14CDDA24EC9BA6F1BB4B9"><enum>(E)</enum><text>a compilation of voluntary guidelines and best practices from the reports submitted under paragraph (1).</text></subparagraph></paragraph></subsection>
<subsection id="HE16ED163A9454A8DA5219CE73DC944AE"><enum>(f)</enum><header>Authorization of appropriations</header><text display-inline="yes-display-inline">There is authorized to be appropriated to carry out this subtitle $50,000,000 for the period of fiscal years 2019 through 2023.</text></subsection></section></subtitle> <subtitle id="HB3F451887CCF44BD81D3B8A3D277B83D"><enum>J</enum><header>Alternatives to Opioids in the Emergency Department</header> <section id="H00EFCCE784544AD38365015A5866F978" section-type="subsequent-section"><enum>7091.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Alternatives to Opioids in the Emergency Department Act</short-title></quote> or the <quote>ALTO Act</quote>.</text></section>
<section id="HBB6B716BA45F4AFD9EBC1565304361C3"><enum>7092.</enum><header>Emergency department alternatives to opioids demonstration program</header>
<subsection id="HE24313281A5945FE98C61B357DD8E080"><enum>(a)</enum><header>Demonstration program grants</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services (in this section referred to as the <quote>Secretary</quote>) shall carry out a demonstration program under which the Secretary shall award grants to hospitals and emergency departments, including freestanding emergency departments, to develop, implement, enhance, or study alternative pain management protocols and treatments that limit the use and prescription of opioids in emergency departments.</text></subsection> <subsection id="HDC460C33E38849CCB4DDFF8856A77D57"><enum>(b)</enum><header>Eligibility</header><text display-inline="yes-display-inline">To be eligible to receive a grant under subsection (a), 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. </text></subsection>
<subsection id="H9798F3C4FB484AA29A66F230B71C4DD8"><enum>(c)</enum><header>Geographic diversity</header><text>In awarding grants under this section, the Secretary shall seek to ensure geographical diversity among grant recipients. </text></subsection> <subsection id="HC782E0F02409417882C28899AABECF4D" display-inline="no-display-inline"><enum>(d)</enum><header>Use of funds</header><text display-inline="yes-display-inline">Grants under subsection (a) shall be used to—</text>
<paragraph id="H21C0A9504B5D4D21A8C08EF73506BA0D"><enum>(1)</enum><text display-inline="yes-display-inline">target common painful conditions, such as renal colic, sciatica, headaches, musculoskeletal pain, and extremity fractures;</text></paragraph> <paragraph id="H395B863860A04F028411F19D6FEC1F26"><enum>(2)</enum><text display-inline="yes-display-inline">train providers and other hospital personnel on protocols and the use of treatments that limit the use and prescription of opioids in the emergency department; and</text></paragraph>
<paragraph id="H46A1ADD6A726445B89C677223A848238"><enum>(3)</enum><text display-inline="yes-display-inline">provide alternatives to opioids to patients with painful conditions, not including patients who present with pain related to cancer, end-of-life symptom palliation, or complex multisystem trauma.</text></paragraph></subsection> <subsection id="H61279A6986BA4AE08C911F5FCD3F75ED" display-inline="no-display-inline"><enum>(e)</enum><header>Consultation</header><text display-inline="yes-display-inline">The Secretary shall implement a process for recipients of grants under subsection (a) to consult (in a manner that allows for sharing of evidence-based best practices) with each other and with persons having robust knowledge, including emergency departments and physicians that have successfully deployed alternative pain management protocols, such as non-drug approaches studied through the National Center for Complimentary and Integrative Health including acupuncture that limit the use of opioids. The Secretary shall offer to each recipient of a grant under subsection (a) technical support as necessary.</text></subsection>
<subsection id="HFFAF5452EFD44762BEC53CF634078944"><enum>(f)</enum><header>Report to the Secretary</header><text display-inline="yes-display-inline">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 State and Federal statutes and regulations regarding disclosure of patient information—</text> <paragraph id="HC8C7F97A9A1746668FB64CAD4F84ADF4"><enum>(1)</enum><text display-inline="yes-display-inline">a description of and specific information about the alternative pain management protocols employed;</text></paragraph>
<paragraph id="H20CDBAFDA43446C88CBD2847A632535B"><enum>(2)</enum><text>data on the alternative pain management protocols and treatments employed, including—</text> <subparagraph id="HBF880AE3146D40FDA11FC30B859DA0C2"><enum>(A)</enum><text>during a baseline period before the program began, as defined by the Secretary;</text></subparagraph>
<subparagraph id="H40B39FF48A7B42788FD3306E892F07D8"><enum>(B)</enum><text>at various stages of the program, as determined by the Secretary; and</text></subparagraph> <subparagraph id="HEA89503F48F54F61BF33CC993FC192F8"><enum>(C)</enum><text>the conditions for which the alternative pain management protocols and treatments were employed;</text></subparagraph></paragraph>
<paragraph id="HF4560188F155476F83D22B96C4D80A53"><enum>(3)</enum><text>the success of each specific alternative pain management protocol;</text></paragraph> <paragraph id="HDFE98F44A58343848CEA7C8155351BF4"><enum>(4)</enum><text>data on the opioid prescriptions written, including—</text>
<subparagraph id="HFBADB2F2CEA94589AF2C1FAEB3866A4F"><enum>(A)</enum><text display-inline="yes-display-inline">during a baseline period before the program began, as defined by the Secretary;</text></subparagraph> <subparagraph id="H85089C0ECF8C4489849F0B4568EAC25B"><enum>(B)</enum><text display-inline="yes-display-inline">at various stages of the program, as determined by the Secretary; and</text></subparagraph>
<subparagraph id="H28A29C6854914F519E21A844FFB5B981"><enum>(C)</enum><text display-inline="yes-display-inline">the conditions for which the opioids were prescribed;</text></subparagraph></paragraph> <paragraph id="HD35D748F8C1848A7BC9270851D37B67F"><enum>(5)</enum><text display-inline="yes-display-inline">the demographic characteristics of patients who were treated with an alternative pain management protocol, including age, sex, race, ethnicity, and insurance status and type;</text></paragraph>
<paragraph id="H397D8730D8104BCA9612B3D8C593B1DF"><enum>(6)</enum><text>data on patients who were eventually prescribed opioids after alternative pain management protocols and treatments were employed; and</text></paragraph> <paragraph id="HF7D8DDE56BDA47D89B27F68813EFD332"><enum>(7)</enum><text>any other information the Secretary deems necessary.</text></paragraph></subsection>
<subsection id="H259A8DF33E004C1991CED3A830037982"><enum>(g)</enum><header>Report to Congress</header><text display-inline="yes-display-inline">Not later than 1 year after completion of the demonstration program under this section, the Secretary shall submit a report to the Congress on the results of the demonstration program and include in the report—</text> <paragraph id="H2BBE778D9E7E47E69C0D27E2390135E2"><enum>(1)</enum><text display-inline="yes-display-inline">the number of applications received and the number funded;</text></paragraph>
<paragraph id="H4D49DE39B73841DA8B74B3004F0DF653"><enum>(2)</enum><text display-inline="yes-display-inline">a summary of the reports described in subsection (f), including standardized data; and</text></paragraph> <paragraph id="H13CAEE6F6AAF42C6AF898470EBBF79F8"><enum>(3)</enum><text display-inline="yes-display-inline">recommendations for broader implementation of pain management protocols that limit the use and prescription of opioids in emergency departments or other areas of the health care delivery system.</text></paragraph></subsection>
<subsection id="H433C6EB704F340B7ACBADD107E7E98D5"><enum>(h)</enum><header>Authorization of appropriations</header><text>To carry out this section, there is authorized to be appropriated $10,000,000 for each of fiscal years 2019 through 2021.</text></subsection></section></subtitle> <subtitle id="HDAD69215A49445CAB33EE5D912F3F36B"><enum>K</enum><header>Stop Counterfeit Drugs by Regulating and Enhancing Enforcement Now</header> <section id="H1A4776C3A7174F449C077B31B7BEC76E" section-type="subsequent-section"><enum>7101.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Stop Counterfeit Drugs by Regulating and Enhancing Enforcement Now Act</short-title></quote> or the <quote><short-title>SCREEN Act</short-title></quote>.</text></section>
<section id="HF299944F73D34B52AEBED14968E7AF45"><enum>7102.</enum><header>Detention, refusal, and destruction of drugs offered for importation</header>
<subsection id="HC2F23204375D4C43B868D5EB51BBE213"><enum>(a)</enum><header>Increasing the maximum dollar amount of drugs subject to destruction</header><text>The sixth sentence in section 801(a) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/381">21 U.S.C. 381(a)</external-xref>) is amended by striking <quote>except that the Secretary</quote> and all that follows through the two periods at the end and inserting <quote>except that the Secretary of Health and Human Services may destroy, without the opportunity for export, any drug refused admission under this section, if such drug is declared to be valued at an amount that is $2,500 or less (or such higher amount as the Secretary of the Treasury may set by regulation pursuant to section 498(a)(1) of the Tariff Act of 1930 or such higher amount as the Commissioner of Food and Drugs may set based on a finding by the Commissioner that the higher amount is in the interest of public health), or if such drug is entering the United States by mail, and was not brought into compliance as described under subsection (b).</quote>.</text></subsection> <subsection id="HB34800FA3CD04A04AFB336B02E238420"><enum>(b)</enum><header>Destruction of articles of concern</header><text>The sixth sentence of section 801(a) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/381">21 U.S.C. 381(a)</external-xref>), as amended by subsection (a), is further amended by inserting before the period at the end the following: <quote>; and the Secretary of Health and Human Services may destroy, without the opportunity for export, any article refused admission under clause (6) of the third sentence of this subsection</quote>.</text></subsection>
<subsection commented="no" id="H524531C89FCC4983996101099884145E"><enum>(c)</enum><header>Technical amendments</header><text display-inline="yes-display-inline">The seventh, eighth, and ninth sentences of section 801(a) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/381">21 U.S.C. 381(a)</external-xref>) are amended—</text> <paragraph commented="no" id="H7E245D20928549C291D1D64DE73ED989"><enum>(1)</enum><text>by striking <quote>a drug</quote> each place it appears and inserting <quote>an article</quote>; and</text></paragraph>
<paragraph commented="no" id="H480278832471490FA8A814BA72EB2251"><enum>(2)</enum><text>by striking <quote>the drug</quote> each place it appears and inserting <quote>the article</quote>.</text></paragraph></subsection> <subsection id="HF42C665813114ED4A90FA858BEE30A88"><enum>(d)</enum><header>Rule of construction</header><text display-inline="yes-display-inline">The last sentence in section 801(a) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/381">21 U.S.C. 381(a)</external-xref>) is amended to read as follows: <quote>Clauses (2), (5), and (6) of the third sentence of this subsection shall not be construed to prohibit the admission of narcotic or nonnarcotic drugs or other substances, the importation of which is permitted under the Controlled Substances Import and Export Act.</quote>.</text></subsection></section>
<section id="HBDFC699EDF324433B263701770DF29E3"><enum>7103.</enum><header>Notification, nondistribution, and recall of adulterated or misbranded drug products</header>
<subsection id="HD279427456B14A5694FB0C8296EF0A59"><enum>(a)</enum><header>Prohibited Acts</header><text display-inline="yes-display-inline">Section 301 of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/331">21 U.S.C. 331</external-xref>) is amended by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="H7AD07BBA3A0A4727AF2A2F983329B05F" style="OLC"> <subsection id="H14AD935B65524A138EEE14D2F79241E3"><enum>(eee)</enum><text display-inline="yes-display-inline">The failure to comply with any order issued under section 569D.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H42EC0BF3F234430AB169AEFB8797E965"><enum>(b)</enum><header>Notification, nondistribution, and recall of adulterated or misbranded drugs</header><text>Subchapter E of chapter V of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/360bbb">21 U.S.C. 360bbb</external-xref> et seq.) is amended by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="H3BAE9C8962D3416DB2B14D86177D2A30" style="OLC"> <section id="HDD89CD57A3174E8493C75495D48B9C1E" commented="no"><enum>569D.</enum><header>Notification, Nondistribution, And Recall Of Adulterated Or Misbranded Drugs</header> <subsection id="HA1366335058B4A3AAB38015CDA8FA49C" commented="no"><enum>(a)</enum><header>Order To cease distribution and recall</header> <paragraph id="H56243D8D9C6547D8BB6E8EA5CFC91DA1" commented="no"><enum>(1)</enum><header>In general</header><text>Upon a determination that the use or consumption of, or exposure to, a drug may present an imminent or substantial hazard to the public health, the Secretary shall issue an order requiring any person who distributes the drug to immediately cease distribution of the drug.</text></paragraph>
<paragraph id="H26140C91F6A94A729FD655D7D3E6A185" commented="no"><enum>(2)</enum><header>Hearing</header><text>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—</text> <subparagraph id="HC5CB62AD54764E2EBC8F17421DB0C6E1" commented="no"><enum>(A)</enum><text>the actions required by the order; and</text></subparagraph>
<subparagraph id="HAC40660FF9C745F4B535BA5B6CD5E925" commented="no"><enum>(B)</enum><text>whether the order should be amended to require a recall of the drug.</text></subparagraph></paragraph> <paragraph id="H6B3FAC63CD704CF2B3C6D2961843E916" commented="no"><enum>(3)</enum><header>Inadequate grounds</header><text>If, after providing an opportunity for a hearing under paragraph (2), the Secretary determines that inadequate grounds exist to support the actions required by the order, the Secretary shall vacate the order.</text></paragraph>
<paragraph id="H9B9976BACAB84FF28413C9F254FB9CFD" commented="no"><enum>(4)</enum><header>Amendment to order to require recall</header><text display-inline="yes-display-inline">If, after providing an opportunity for an informal hearing under paragraph (2), the Secretary determines that the order should be amended to include a recall of the drug with respect to which the order was issued, the Secretary shall—</text> <subparagraph id="H9BCC6B3F7B8248E4B18628213BB46099" commented="no"><enum>(A)</enum><text>amend the order to require a recall; and</text></subparagraph>
<subparagraph id="HAA0FD8C582F540C183E5E4AFD11539F2" commented="no"><enum>(B)</enum><text>after consultation with the drug sponsor, specify a timetable in which the recall will occur.</text></subparagraph></paragraph> <paragraph id="HBD98A429697B4BCA8E45598FC5886C5F" display-inline="no-display-inline" commented="no"><enum>(5)</enum><header>Notice to persons affected</header><text display-inline="yes-display-inline">An order under this subsection shall require any person who distributes the drug to provide for notice, including to individuals as appropriate, to persons who may be affected by the order to cease distribution of or recall the drug, as applicable.</text></paragraph>
<paragraph id="HEB1EA5F9D1BE4A1C9595075EBC1CC6D5" commented="no"><enum>(6)</enum><header>Action following order</header><text display-inline="yes-display-inline">Any person who is subject to an order under paragraph (1) or (4) shall immediately cease distribution of or recall, as applicable, the drug and provide notification as required by such order. </text></paragraph></subsection> <subsection id="H517DB7259B9A47BDA538D029291FD73C" commented="no"><enum>(b)</enum><header>Notice to consumers and health officials</header><text>The Secretary shall, as the Secretary determines to be necessary, provide notice of a recall order under this section to—</text>
<paragraph id="HB781B105123C4631912DCAEA65282C5D" commented="no"><enum>(1)</enum><text>consumers to whom the drug was, or may have been, distributed; and</text></paragraph> <paragraph id="H98C1F07540D04688B7203432ACCF80C4" commented="no"><enum>(2)</enum><text>appropriate State and local health officials.</text></paragraph></subsection>
<subsection id="HDA85679C001D44D4839F95FCDF91BF4E" commented="no"><enum>(c)</enum><header>Order To recall</header>
<paragraph id="HA2DA77A11FA646B1A05CB3B9DB392E70" commented="no"><enum>(1)</enum><header>Contents</header><text>An order to recall a drug under subsection (a) shall—</text> <subparagraph id="H0B4A586560D2451C88437C949169B897" commented="no"><enum>(A)</enum><text>require periodic reports to the Secretary describing the progress of the recall; and</text></subparagraph>
<subparagraph id="H06BCB6D5FF0141799F49A22F30B89759" commented="no"><enum>(B)</enum><text>provide for notice, including to individuals as appropriate, to persons who may be affected by the recall.</text></subparagraph></paragraph> <paragraph id="H8D17372A365345A08ABB0E9359FFB7F8" commented="no"><enum>(2)</enum><header>Assistance allowed</header><text>In providing for notice under paragraph (1)(B), the Secretary may allow for the assistance of health professionals, State or local officials, or other individuals designated by the Secretary.</text></paragraph>
<paragraph id="HCD1ABEF8A9324834AC8FB6457BE55958" commented="no"><enum>(3)</enum><header>Nondelegation</header><text display-inline="yes-display-inline">An order under this section 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, is an official senior to such Director, or is so designated by such Director.</text></paragraph></subsection> <subsection id="HC0884B79050947C0BE43C3D81AC77C6C" commented="no"><enum>(d)</enum><header>Savings clause</header><text>Nothing contained in this section shall be construed as limiting—</text>
<paragraph id="HFB16338E4ABF4307964391852AA0A337" commented="no"><enum>(1)</enum><text>the authority of the Secretary to issue an order to cease distribution of, or to recall, an drug under any other provision of this Act or the Public Health Service Act; or</text></paragraph> <paragraph id="H1561F61E13174DDE80EC9EFE4971C5CC" commented="no"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="HD35A010B97294B9D8637B097A58C7306"><enum>(c)</enum><header>Drugs subject to refusal</header><text display-inline="yes-display-inline">The third sentence of subsection (a) of section 801 of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/381">21 U.S.C. 381</external-xref>) is amended by inserting <quote>or (5) in the case of a drug, such drug is subject to an order under section 568 to cease distribution of or recall the drug,</quote> before <quote>then such article shall be refused admission</quote>.</text></subsection> <subsection id="HCB8B4AD91C6743D9805F974CB319F87F"><enum>(d)</enum><header>Application</header><text>Sections 301(eee) and 569D of the Federal Food, Drug, and Cosmetic Act, as added by subsections (a) and (b), shall apply with respect to a drug as of such date, not later than 1 year after the date of the enactment of this Act, as the Secretary of Health and Human Services shall specify.</text></subsection></section>
<section commented="no" id="H84797627F5F743C29E426DD621272031"><enum>7104.</enum><header>Single source pattern of shipments of adulterated or misbranded drugs</header><text display-inline="no-display-inline">Section 801 of the Federal Food, Drug, and Cosmetic Act is amended by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="H0953B32571F0410FA3578DF7C9DF3E19" style="OLC"> <subsection commented="no" id="HDA6F3BF3F2DE4CD38BC96BA0868B0A50"><enum>(t)</enum><header>Single source pattern of shipments of adulterated or misbranded drugs</header><text>If the Secretary identifies a pattern of adulterated or misbranded drugs being offered for import from the same manufacturer, distributor, or importer, the Secretary may by order choose to treat all drugs being offered for import from such manufacturer, distributor, or importer as adulterated or misbranded unless otherwise demonstrated.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section id="H28657A4D3E71481E9B44221472283E00"><enum>7105.</enum><header>Fund to strengthen efforts of FDA to combat the opioid and substance use epidemic</header><text display-inline="no-display-inline">Chapter X of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/391">21 U.S.C. 391</external-xref> et seq.) is amended by adding at the end the following: </text> <quoted-block style="OLC" id="HB174FCB2AA8E4E54BAFA9D274C98C3CE" display-inline="no-display-inline"> <section id="H2356E62C1B62473C8B1BAFD8D8A44B84"><enum>1015.</enum><header>Fund to strengthen efforts of FDA to combat the opioid and substance use epidemic</header> <subsection id="HC61FD8B6B2884F04816C4E13C0A863B8"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Commissioner of Food and Drugs shall use any funds appropriated pursuant to the authorization of appropriations under subsection (c) to carry out the programs and activities described in subsection (d) to strengthen and facilitate the Food and Drug Administration’s efforts to address the opioid and substance use epidemic. Such funds shall be in addition to any funds which are otherwise available to carry out such programs and activities.</text></subsection>
<subsection id="HEE990B004F6D46CDA511571845DC85E1"><enum>(b)</enum><header>FDA Opioid and Substance Use Epidemic Response Fund</header>
<paragraph id="H9CE59EDF354B4464AFA11E02ABC97655"><enum>(1)</enum><header>Establishment of fund</header><text display-inline="yes-display-inline">There is established in the Treasury a fund, to be known as the FDA Opioid and Substance Use Epidemic Response Fund (referred to in this subsection as the <quote>Fund</quote>), for purposes of funding the programs and activities described in subsection (d).</text></paragraph> <paragraph id="HD976CC5522C741C19C075D46F3B4C00D"><enum>(2)</enum><header>Transfer</header><text>For the period of fiscal years 2019 through 2023, $110,000,000 shall be transferred to the Fund from the general fund of the Treasury.</text></paragraph>
<paragraph id="H7A837B6AD419469B8F9CAEBCCE0543F7"><enum>(3)</enum><header>Amounts deposited</header><text display-inline="yes-display-inline">Any amounts transferred under paragraph (2) shall remain unavailable in the Fund until such amounts are appropriated pursuant to subsection (c).</text></paragraph></subsection> <subsection id="H7E90FECA838243E881BBC8FD2063C387"><enum>(c)</enum><header>Appropriations</header> <paragraph id="HAD69B3AB2D434FCDAA40E342F88BC9BC"><enum>(1)</enum><header>Authorization of appropriations</header><text display-inline="yes-display-inline">For the period of fiscal years 2019 through 2023, there is authorized to be appropriated from the Fund to the Food and Drug Administration, for the purpose of carrying out the programs and activities described in subsection (d), an amount not to exceed the total amount transferred to the Fund under subsection (b)(2). Notwithstanding subsection (g), such funds shall remain available until expended.</text></paragraph>
<paragraph id="HF156101819964AB0B002F3CCDC9B1E64"><enum>(2)</enum><header>Offsetting future appropriations</header><text display-inline="yes-display-inline">For any of fiscal years 2019 through 2023, for any discretionary appropriation out of the Fund to the Food and Drug Administration pursuant to the authorization of appropriations under paragraph (1) for the purpose of carrying out the programs and activities described in subsection (d), the total amount of such appropriations for the applicable fiscal year (not to exceed the total amount remaining in the Fund) shall be subtracted from the estimate of discretionary budget authority and the resulting outlays for any estimate under the Congressional Budget and Impoundment Control Act of 1974 or the Balanced Budget and Emergency Deficit Control Act of 1985, and the amount transferred to the Fund shall be reduced by the same amount.</text></paragraph></subsection> <subsection commented="no" id="HA0A90204E097431F923E89578164B67E"><enum>(d)</enum><header>Food and Drug Administration</header><text>The entirety of the funds made available pursuant to subsection (c)(1) shall be for the Commissioner of Food and Drugs, pursuant to applicable authorities in the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/201">42 U.S.C. 201</external-xref> et seq.) or this Act and other applicable Federal law, to support widespread innovation in non-opioid and non-addictive medical products for pain treatment, access to opioid addiction treatments, appropriate use of approved opioids, and efforts to reduce illicit importation of opioids. Such support may include the following programs and activities:</text>
<paragraph id="H4F1CDAA492BA4BE8A5281C463AF3A8D9"><enum>(1)</enum><text display-inline="yes-display-inline">Obligating contract funds beginning in fiscal year 2019 for an educational campaign that will—</text> <subparagraph id="H236A663DEFCB48BDA1CE1EF01063F667"><enum>(A)</enum><text>educate patients and their families to differentiate opioid medications;</text></subparagraph>
<subparagraph id="H3D3DD407AF424072A1A2258E2DBCCDC4"><enum>(B)</enum><text>raise awareness about preferred storage and disposal methods; and</text></subparagraph> <subparagraph id="H8B0B715901E2486DAD4AACA56B9C01BA"><enum>(C)</enum><text>inform patients, families, and communities about medication-assisted treatment options.</text></subparagraph></paragraph>
<paragraph id="H0C99D97D7C6040C498F9C7F1EAFBC8E3"><enum>(2)</enum><text>Building the Food and Drug Administration’s presence in international mail facilities, including through—</text> <subparagraph id="H65FC82FC70134F7F8075004E98FE2BE5"><enum>(A)</enum><text>improvements in equipment and information technology enhancements to identify unapproved, counterfeit, or other unlawful pharmaceuticals for destruction;</text></subparagraph>
<subparagraph id="H8F5A56C6238140D49AD734AACBBCB29A"><enum>(B)</enum><text>increased and improved surveillance;</text></subparagraph> <subparagraph id="H345719803F8D42D39E90569F20CC8C50"><enum>(C)</enum><text>renovations at international mail facility locations; and</text></subparagraph>
<subparagraph id="H9B121D527F084028BD1800B9CD56ABF9"><enum>(D)</enum><text>the purchase of laboratory equipment.</text></subparagraph></paragraph> <paragraph id="HCBCF12069E0C4216B3E3BC987C545A6E"><enum>(3)</enum><text>Enhancing the identification and targeting of entities offering products and products being offered by such entities for import into the United States through review and analysis of Internet websites, import data, and other sources of intelligence for purposes of making the best use of the Food and Drug Administration’s inspection and analytical resources.</text></paragraph>
<paragraph id="H2C4210F1579543EE80F30307D5CF4074"><enum>(4)</enum><text>Increasing the number of staff of the Food and Drug Administration to increase the number of packages being examined, ensuring the safety of the staff undertaking such examinations, and ensuring that packages identified as illegal, counterfeit, misbranded, or adulterated are removed from commerce through available authorities, including administrative destruction.</text></paragraph> <paragraph id="H43205569F95C47CDA017404C1FB23F3E"><enum>(5)</enum><text>Enhancing the Food and Drug Administration’s criminal investigations resources (including full-time equivalent employees and equipment), imports surveillance, and international work.</text></paragraph>
<paragraph id="H54C2EF0FCD934E11BB3F006B501C3203"><enum>(6)</enum><text>Obtaining for the Food and Drug Administration equipment and full-time equivalent employees needed to efficiently screen and analyze products offered for import, including by building data libraries of new substances and analogues to facilitate identification and evaluation of pharmaceutical-based agents and by purchasing screening technologies for use at international mail facilities.</text></paragraph> <paragraph id="HB8E722445102438289FB562158DE03AD"><enum>(7)</enum><text>Operating the Food and Drug Administration’s forensic laboratory facility to ensure adequate laboratory space and functionality for additional work and full-time equivalent employees.</text></paragraph></subsection>
<subsection commented="no" id="H6E67883ADDDD423792C9CBC42C95A0E5"><enum>(e)</enum><header>Accountability and oversight</header>
<paragraph commented="no" id="H0B11611EBFCC43C4BFA900BAC9920329"><enum>(1)</enum><header>Work plan</header>
<subparagraph commented="no" id="H43D2D6343BF847A9A5FEFC3DE4A692AC"><enum>(A)</enum><header>In general</header><text>Not later than 180 days after the date of enactment of this Act, the Commissioner of Food and Drugs 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 work plan including the proposed allocation of funds appropriated pursuant to the authorization of appropriations under subsection (c) for each of fiscal years 2019 through 2023 and the contents described in subparagraph (B).</text></subparagraph> <subparagraph commented="no" id="H8D42FF633EAB4FF6BA1198F429532689"><enum>(B)</enum><header>Contents</header><text>The work plan submitted under subparagraph (A) shall include—</text>
<clause commented="no" id="HE43B467A2E1144ACAA319C1ADAF9A059"><enum>(i)</enum><text>the amount of money to be obligated or expended out of the Fund in each fiscal year for each program and activity described in subsection (d); and</text></clause> <clause commented="no" id="H6ACB602A37954544A35C9BB64FF76625"><enum>(ii)</enum><text>a description and justification of each such program and activity.</text></clause></subparagraph></paragraph>
<paragraph commented="no" id="H97BA9DB328D94F8F85D8CBFCFEDFF882"><enum>(2)</enum><header>Reports</header>
<subparagraph commented="no" id="H7D924DDAD212461398994711099D1234"><enum>(A)</enum><header>Annual reports</header><text>Not later than October 1 of each of fiscal years 2020 through 2024, the Secretary of Health and Human Services 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 that includes—</text> <clause commented="no" id="H6BC7D0843D824028844422EBC15ADAB5"><enum>(i)</enum><text display-inline="yes-display-inline">the amount of money obligated or expended out of the Fund in the prior fiscal year for each program and activity described in subsection (d);</text></clause>
<clause commented="no" id="HAD28C8A08B5D41A7A0F1F432607D8430"><enum>(ii)</enum><text>a description of all programs and activities using funds provided pursuant to the authorization of appropriations under subsection (c); and</text></clause> <clause commented="no" id="H973E2ED699AA417D9896CFE615E1F4AB"><enum>(iii)</enum><text>how the programs and activities are advancing public health.</text></clause></subparagraph>
<subparagraph commented="no" id="HEFE8C4364D934094B7A2CFFA2CE572E8"><enum>(B)</enum><header>Additional reports</header><text>At the request of the Committee on Health, Education, Labor and Pensions of the Senate or the Committee on Energy and Commerce of the House of Representatives, the Commissioner shall provide an update in the form of testimony and any additional reports to the respective congressional committee regarding the allocation of funding under this section or the description of the programs and activities undertaken with such funding.</text></subparagraph></paragraph></subsection> <subsection commented="no" id="HB01C58FBDE7C4F81AEABD6AA68AD3B1F"><enum>(f)</enum><header>Limitations</header><text display-inline="yes-display-inline">Notwithstanding any transfer authority authorized by this section or any appropriations Act, any funds made available pursuant to the authorization of appropriations under subsection (c) may not be used for any purpose other than the programs and activities described in subsection (d) to strengthen and facilitate the Food and Drug Administration’s efforts to address the opioid and substance use epidemic.</text></subsection>
<subsection commented="no" id="HFBB641E2EC294607AF6C1589AAA14711"><enum>(g)</enum><header>Sunset</header><text>This section shall expire on September 30, 2022, except that—</text> <paragraph id="H92A2AA33DCB24C4B8BDE835B841B9AFC"><enum>(1)</enum><text>this subsection does not apply to reporting under subsection (e)(2); and</text></paragraph>
<paragraph id="H39DBDF40C5D24AB5AE7573426D43C110"><enum>(2)</enum><text>this section shall remain in effect until such time, and to such extent, as may be necessary for the funds transferred by subsection (b)(2) to be fully expended.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section> <section id="H1391CC8DA9C9468D93A3972B5BED792E"><enum>7106.</enum><header>Consideration of potential for misuse and abuse required for drug approval</header> <subsection id="H4CFD811FDF264654A7572732F78209D8"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 505(d) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355(d)</external-xref>) is amended—</text>
<paragraph id="HFB5C3793870F4DBBA5648C8769CC9E3B"><enum>(1)</enum><text display-inline="yes-display-inline">in the first sentence—</text> <subparagraph id="HC64D36B506FE4A7E89F0F13D01C36839"><enum>(A)</enum><text>by striking <quote>or (7)</quote> and inserting <quote>(7)</quote>; and</text></subparagraph>
<subparagraph id="HBEC7F36468CD447F8DB522A25851451B"><enum>(B)</enum><text>by inserting <quote>or (8) if the drug is or contains a controlled substance for which a listing in any schedule is in effect under the Controlled Substances Act or that is permanently scheduled pursuant to section 201 of such Act, on the basis of information submitted to him as part of the application, or upon the basis of any other information before him with respect to such drug, the drug is unsafe for use due to the risks of abuse or misuse or there is insufficient information to show that the drug is safe for use considering such risks;</quote> before <quote>he shall issue an order refusing to approve the application</quote>; and</text></subparagraph></paragraph> <paragraph id="H5EB90EE73D8E43399D8E4ECE7EA24B32"><enum>(2)</enum><text>in the second sentence, by striking <quote>(6)</quote> and inserting <quote>(8)</quote>. <italic></italic></text></paragraph></subsection>
<subsection id="H45FF47FD33744211B514131BEF9B6BC2"><enum>(b)</enum><header>Withdrawal authority</header><text display-inline="yes-display-inline">Section 505(e) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355(e)</external-xref>) is amended in the first sentence—</text> <paragraph id="HDD36082D7CCE46939F5F6317DB070D16"><enum>(1)</enum><text display-inline="yes-display-inline">by striking <quote>or (5)</quote> and inserting <quote>(5)</quote>; and</text></paragraph>
<paragraph id="H07388FAED4994F808CC685F8976CF177"><enum>(2)</enum><text>by inserting the following: <quote>; or (6) that, in the case of a drug that is or contains a controlled substance for which a listing in any schedule is in effect under the Controlled Substances Act or that is permanently scheduled pursuant to section 201 of such Act, on the basis of new information before him with respect to such drug, evaluated together with the information available to him when the application was approved, that the drug is unsafe for use due to the risks of abuse or misuse</quote> after <quote>of a material fact</quote>.</text></paragraph></subsection> <subsection id="HEB351FD2425C48A891DCC5BBBDF51529"><enum>(c)</enum><header>Rule of construction</header><text display-inline="yes-display-inline">Nothing in the amendments made by this section shall be construed to limit or narrow, in any manner, the meaning or application of the provisions of paragraphs (1), (2), (3), (4), (5), and (7) of section 505(d) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355(d)</external-xref>) or paragraphs (1) and (2) of section 505(e) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355(e)</external-xref>). <italic></italic></text></subsection></section></subtitle>
<subtitle id="H0D94276A9F6F47C39EA043329205822B"><enum>L</enum><header>Treatment, Education, and Community Help to Combat Addiction</header>
<section id="HB88DCA57223E4354848E2999ACD27293" section-type="subsequent-section"><enum>7111.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Treatment, Education, and Community Help to Combat Addiction Act of 2018</short-title></quote> or the <quote><short-title>TEACH to Combat Addiction Act of 2018</short-title></quote>.</text></section> <section id="HA04B04011FA8413190687AB0A9014080"><enum>7112.</enum><header>Establishment of Regional Centers of Excellence in Substance Use Disorder Education</header><text display-inline="no-display-inline">Part D of title V of the Public Health Service Act is amended by inserting after section 549 (<external-xref legal-doc="usc" parsable-cite="usc/42/290ee-4">42 U.S.C. 290ee–4</external-xref>) the following new section:</text>
<quoted-block display-inline="no-display-inline" id="HC2F3E42B395E4EC8BCC17A6F43E4CF35" style="OLC">
<section id="H97E5C99656314FF28339395F130F0E33"><enum>550.</enum><header>Regional Centers of Excellence in Substance Use Disorder Education</header>
<subsection id="HB754631A89204596B48432CE05BB7303"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary, in consultation with such other agencies as are appropriate, shall, subject to the availability of appropriations, establish a solicitation process and award cooperative agreements to eligible entities for the designation of such entities as Regional Centers of Excellence in Substance Use Disorder Education and support of such regional centers of excellence to enhance and improve how health professionals are educated in substance use disorder prevention, treatment, and recovery through development, evaluation, and distribution of evidence-based curricula for health profession schools. An eligible entity designated by the Secretary as a Regional Center of Excellence in Substance Use Disorder Education shall carry out the activities described in subsection (b).</text></subsection> <subsection id="H0A3F0EFB1C6B4267A085BAAEBA9644DC"><enum>(b)</enum><header>Selection of centers of excellence</header> <paragraph id="H690EB8CD0A6F4F9B8244481A8455F3C7"><enum>(1)</enum><header>Eligible entities</header><text>To be eligible to receive a cooperative agreement under subsection (a), an entity shall—</text>
<subparagraph id="H38B935C395124E89A2BBD4EAF595AACA"><enum>(A)</enum><text>be an entity specified by the Secretary that offers education to students in various health professions, which may include—</text> <clause id="H2D3D566624C54CCDB9BBBBE138E877B2"><enum>(i)</enum><text>a health system;</text></clause>
<clause id="H2D14D8DA23BD46758BFDE6988A3D97DD"><enum>(ii)</enum><text>a teaching hospital;</text></clause> <clause id="HBFD5F6623C164E06926457810EFF85A6"><enum>(iii)</enum><text>a medical school;</text></clause>
<clause id="H74C173F895114CF39D915615119D3B49"><enum>(iv)</enum><text>a certified behavioral health clinic; or</text></clause> <clause id="HD30008440CFF4BAB99744E0B80E685F6"><enum>(v)</enum><text>any other health profession school, school of public health, or Cooperative Extension Program at institutions of higher education engaged in an aspect of the prevention, treatment, or recovery of substance use disorders;</text></clause></subparagraph>
<subparagraph id="H02974E1E63F44A30B4AA5547B8A697FE"><enum>(B)</enum><text>be accredited by the appropriate educational accreditation body;</text></subparagraph> <subparagraph id="H674F51F9F59B4FDD90FF1B26B78B34CD"><enum>(C)</enum><text display-inline="yes-display-inline">demonstrate an existing strategy, and have in place a plan for continuing such strategy, or a proposed strategy to implement a curriculum based on best practices for substance use disorder prevention, treatment, and recovery;</text></subparagraph>
<subparagraph id="HD28E8DE7435D4C9EBF219957E938456D"><enum>(D)</enum><text display-inline="yes-display-inline">demonstrate community engagement and participation through community partners, including other health profession schools, mental health counselors, social workers, peer recovery specialists, substance use treatment programs, community health centers, physicians’ offices, certified behavioral health clinics, law enforcement, and the business community; and</text></subparagraph> <subparagraph commented="no" id="HFC7EE68D52214F6DA240872D42B25336"><enum>(E)</enum><text>provide to the Secretary such information, at such time, and in such manner, as the Secretary may require.</text></subparagraph></paragraph>
<paragraph id="H0EA61F0BA2DD4AB2B23C48D075349510"><enum>(2)</enum><header>Diversity</header><text display-inline="yes-display-inline">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 diversity.</text></paragraph></subsection> <subsection id="H3A7E5467B5544DD590381FDF387D1E31"><enum>(c)</enum><header>Dissemination of information</header> <paragraph id="HD35239CFD8194E6E94EBEE59A1ED97B0"><enum>(1)</enum><header>Public posting</header><text display-inline="yes-display-inline">The Secretary shall make information provided to the Secretary under subsection (b)(1)(E) publically available on the Internet website of the Department of Health and Human Services.</text></paragraph>
<paragraph id="HB080D3BC30BD47D5BFA04503D594A8F6"><enum>(2)</enum><header>Evaluation</header><text display-inline="yes-display-inline">The Secretary shall evaluate each project carried out by a Regional Center of Excellence in Substance Use Disorder Education under this section and shall disseminate the findings with respect to each such evaluation to appropriate public and private entities.</text></paragraph></subsection> <subsection id="H2AD309F3524541E7BE367AC8B6723367"><enum>(d)</enum><header>Funding</header><text display-inline="yes-display-inline">There is authorized to be appropriated to carry out this section, $4,000,000 for each of fiscal years 2019 through 2023.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section></subtitle>
<subtitle id="HA74C50C2AEA14C07AD0944C6D048851D"><enum>M</enum><header>Guidance from National Mental Health and Substance Use Policy Laboratory</header>
<section id="H78232827779B495FA7466D5812ECD96F" section-type="subsequent-section"><enum>7121.</enum><header>Guidance from National Mental Health and Substance Use Policy Laboratory</header><text display-inline="no-display-inline">Section 501A(b) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/290aa-0">42 U.S.C. 290aa–0(b)</external-xref>) is amended—</text> <paragraph id="HDED2F96ED4BE46D8B66F42FB22ABCACB"><enum>(1)</enum><text>in paragraph (5), by striking <quote>and</quote> at the end;</text></paragraph>
<paragraph id="H182E9C15FA814EF4BAE1DE0EA2CE774B"><enum>(2)</enum><text>in paragraph (6), by striking the period at the end and inserting <quote>; and</quote>; and</text></paragraph> <paragraph id="H1C78B65418BD45E19963E980625EB6D5"><enum>(3)</enum><text>by adding at the end the following:</text>
<quoted-block style="OLC" id="HA50B6D68F4114711BDA3EBEE94D20FC0" display-inline="no-display-inline">
<paragraph id="HFD5A8000E33D41AE866A363996A49561"><enum>(7)</enum><text display-inline="yes-display-inline">issue and periodically update guidance for entities applying for grants from the Substance Abuse and Mental Health Services Administration in order to—</text> <subparagraph id="HD627E6ED56504E28AC7C6FBA41FD9D3C"><enum>(A)</enum><text display-inline="yes-display-inline">encourage the funding of evidence-based practices;</text></subparagraph>
<subparagraph id="H8837A1834BCC4B188437A907A3BF78D1"><enum>(B)</enum><text>encourage the replication of promising or effective practices; and</text></subparagraph> <subparagraph id="H0B8E680B1B52457DA3A901304920ED41"><enum>(C)</enum><text display-inline="yes-display-inline">inform applicants on how to best articulate the rationale for the funding of a program or activity.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section></subtitle>
<subtitle id="H2DB415F9B21D458CACC2EA9C1D3D677D"><enum>N</enum><header>Comprehensive Opioid Recovery Centers</header>
<section id="HD6376A0E3A224C91964EE061D9B8A19D" section-type="subsequent-section"><enum>7131.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Comprehensive Opioid Recovery Centers Act of 2018</short-title></quote>.</text></section> <section id="HFA33B9220D7D4ECC892B490B799798D5" section-type="subsequent-section"><enum>7132.</enum><header>Comprehensive opioid recovery centers</header> <subsection id="HCC538BAD66394C5BA2795DC9717B7124"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Part D of title V of the Public Health Service Act is amended by adding at the end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H99DE8B743B724EAE9F7D6DC4D02E6CB3" style="OLC">
<section id="H5B24A4124620497097D3F227E0D6D4FA"><enum>550.</enum><header>Comprehensive opioid recovery centers</header>
<subsection id="H8F03968879814692A2D3999A78C1DC60"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall award grants on a competitive basis to eligible entities to establish or operate a comprehensive opioid recovery center (referred to in this section as a <quote>Center</quote>).</text></subsection> <subsection id="H8743DEF890844231B129CE49A6AF5F35"><enum>(b)</enum><header>Grant period</header> <paragraph id="HDEF7957EB9474EADA9A605B3FA7B4C5A"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">A grant awarded under subsection (a) shall be for a period not less than 3 years and not more than 5 years.</text></paragraph>
<paragraph id="HD7BA7CA8144345F8A43E6ADB978AE4AD"><enum>(2)</enum><header>Renewal</header><text>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).</text></paragraph></subsection> <subsection commented="no" id="HB029EFE9AEF74382BDFC59B85D0DCFDD"><enum>(c)</enum><header>Minimum number of Centers</header><text display-inline="yes-display-inline">The Secretary shall allocate the amounts made available under subsection (i) in such amounts that not fewer than 10 Centers will be established across the United States.</text></subsection>
<subsection id="HD0384B3063AF4F80B2131FC41A48D6D4"><enum>(d)</enum><header>Application</header><text>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—</text> <paragraph id="HB242FAA068F74B74AD68566E57A7979D"><enum>(1)</enum><text>evidence that such entity carries out, or is capable of coordinating with other entities to carry out, the activities described in subsection (g); and</text></paragraph>
<paragraph id="H66FDE7943ACF43EF8436D3D565B2CB23"><enum>(2)</enum><text>such other information as the Secretary may require.</text></paragraph></subsection> <subsection id="H63694D77EC6E4D6F876689360ED09E45"><enum>(e)</enum><header>Priority</header><text>In awarding grants under subsection (a), the Secretary shall give priority to eligible entities located in a State or Indian country (as defined in section 1151 of title 18, United States Code)—</text>
<paragraph id="HB5D5A99E0D5D42688151D3202D7728E3"><enum>(1)</enum><text>with a high per capita drug overdose mortality rate, as determined by the Director of the Centers for Disease Control and Prevention; or</text></paragraph> <paragraph id="HEE6C985AE6DE4F7CB2B688E3404F5FEF"><enum>(2)</enum><text>based on any other criteria or need, as determined by the Secretary.</text></paragraph></subsection>
<subsection id="H8514CBE02EA3405EB7CCADD58EDB9CAF"><enum>(f)</enum><header>Use of grant funds</header><text>An eligible entity awarded a grant under subsection (a) shall use the grant funds to establish or operate a Center to carry out the activities described in subsection (g).</text></subsection> <subsection id="H498A5AB369B546D4819A9CEBDB700CF8"><enum>(g)</enum><header>Center activities and services</header><text>Each Center shall, at a minimum, carry out the activities described in this subsection. In the case of a Center that determines that a service described in paragraph (2) cannot reasonably be carried out by the Center, such Center shall contract with such other entities as may be necessary to ensure that patients have access to the full range of services described in such paragraph.</text>
<paragraph id="HDAE9F595D6314B448DE14612D9D5EA56"><enum>(1)</enum><header>Community outreach</header><text display-inline="yes-display-inline">Each Center shall carry out the following outreach activities:</text> <subparagraph id="HEECED82DFC6448C089905EE0598F31DA"><enum>(A)</enum><text display-inline="yes-display-inline">Train and supervise outreach staff to work with schools, workplaces, faith-based organizations, State and local health departments, law enforcement, and first responders to ensure that such institutions are aware of the services of the Center.</text></subparagraph>
<subparagraph id="H2A4227211FAC44DAA494AB45017036CE"><enum>(B)</enum><text>Disseminate and make available online evidence-based resources that educate professionals and the public on opioid use disorder and other substance use disorders.</text></subparagraph></paragraph> <paragraph id="HE32E2FB7BBBC4F8C9321642D96FA2B8F"><enum>(2)</enum><header>Treatment and recovery services</header><text display-inline="yes-display-inline">Each Center shall provide the following treatment and recovery services:</text>
<subparagraph id="H7D96AF6808284E9C9D202BE27D7C27D7"><enum>(A)</enum><text display-inline="yes-display-inline">Ensure that intake evaluations meet the clinical needs of patients.</text></subparagraph> <subparagraph id="H9B50612AD28B4A6292E50977FE2DE26C"><enum>(B)</enum><text>Periodically conduct patient assessments to ensure continued and meaningful recovery, as defined by the Assistant Secretary for Mental Health and Substance Use.</text></subparagraph>
<subparagraph id="H390270A30CC84BAE9E75CC8BCAD03407"><enum>(C)</enum><text>Provide the full continuum of treatment services, including—</text> <clause commented="no" id="H3BC031A3F1B1483587B70EEE7A6362E4"><enum>(i)</enum><text display-inline="yes-display-inline">all drugs approved under section 505 of the Federal Food, Drug, and Cosmetic Act and all biological products licensed under section 351 of this Act, including methadone, to treat substance use disorders, including opioid use disorder and alcohol use disorder;</text></clause>
<clause id="HF34ABD26E7814360A71C91434CC8F4F2"><enum>(ii)</enum><text>withdrawal management, which shall include medically supervised detoxification that includes patient evaluation, stabilization, and readiness for and entry into treatment;</text></clause> <clause id="H0AE48C836E2E419C8E78F4AD7C591162"><enum>(iii)</enum><text display-inline="yes-display-inline">counseling and case management, including counseling and recovery services for any possible co-occurring mental illness;</text></clause>
<clause id="H3C5D4B41199944538E889FE1AEBB916B"><enum>(iv)</enum><text>residential rehabilitation;</text></clause> <clause id="H90569F312C6A4654A612719C6B780D41"><enum>(v)</enum><text>recovery housing;</text></clause>
<clause id="HC7A829B305D04B26A8D8456A17057DF6"><enum>(vi)</enum><text>community-based and peer recovery support services;</text></clause> <clause id="H619E89C042BE4123924FF43EAF15F086"><enum>(vii)</enum><text>job training and placement assistance to support reintegration into the workforce; and</text></clause>
<clause id="HF5815A2ECBF04CCD898C57BC66810F11"><enum>(viii)</enum><text>other best practices, as determined by the Secretary.</text></clause></subparagraph> <subparagraph id="HF5F2051239ED4A539E9F256EAE8416D2"><enum>(D)</enum><text>Administer an onsite pharmacy and provide toxicology services.</text></subparagraph>
<subparagraph id="H39C6257337B6459FAC3EB92F9870D52E"><enum>(E)</enum><text>Establish and operate a secure and confidential electronic health information system.</text></subparagraph> <subparagraph id="HCF424AE717AC4000BDCFB68E957A5378"><enum>(F)</enum><text display-inline="yes-display-inline">Offer family support services such as child care, family counseling, and parenting interventions to help stabilize families impacted by substance use disorder.</text></subparagraph></paragraph></subsection>
<subsection id="H8CAEC2D9516D46869953DFD39B78C86C"><enum>(h)</enum><header>Data reporting and program oversight</header><text>With respect to a grant awarded under subsection (a) to an eligible entity for a Center, 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 duration of any renewal period for such grant), the entity shall submit data, as appropriate, to the Secretary regarding—</text> <paragraph id="H816B99CCEAE146E28F6AC11AEE3863C2"><enum>(1)</enum><text>the programs and activities funded by the grant;</text></paragraph>
<paragraph id="H8F11C26C4FEC4B0B863019CC83E2B738"><enum>(2)</enum><text>health outcomes of individuals with a substance use disorder who received services from the Center;</text></paragraph> <paragraph id="HAC2AE201505A4E60A48FE8FE08E18D9D"><enum>(3)</enum><text>the effectiveness of interventions designed, tested, and evaluated by the Center; and</text></paragraph>
<paragraph id="H2862AFE824384C8A82109C4B908CEE4E"><enum>(4)</enum><text>any other information that the Secretary may require for the purpose of—</text> <subparagraph id="H095D382896594F9B8BA8C2194292B3C5"><enum>(A)</enum><text>evaluating the effectiveness of the Center; and</text></subparagraph>
<subparagraph id="HAA17ECD5C60B4EAA9B499A2A8552F0D0"><enum>(B)</enum><text>ensuring that the Center is complying with all the requirements of the grant, including providing the full continuum of services described in subsection (g)(2)(C) and providing drugs and devices for overdose reversal under such subsection.</text></subparagraph></paragraph></subsection> <subsection id="H9679521E5C6847E7B9F59A9B0909464D"><enum>(i)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated $10,000,000 for each of fiscal years 2019 through 2023 for purposes of carrying out this section.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="HCB9FC67D577D4371A9470BEE76A005D1"><enum>(b)</enum><header>Reports to Congress</header>
<paragraph id="HD982FE72C316415EBA52D645BB18090F"><enum>(1)</enum><header>Preliminary report</header><text display-inline="yes-display-inline">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 report that analyzes data submitted under section 550(h) of the Public Health Service Act, as added by subsection (a).</text></paragraph> <paragraph id="HE000556DAF3649BD8EA7660AC4DC2412"><enum>(2)</enum><header>Final report</header><text>Not later than 1 year after submitting the preliminary report required under paragraph (1), the Secretary of Health and Human Services shall submit to Congress a final report that includes—</text>
<subparagraph id="HF8FE987E7D5B4CB884246445EF872A2E"><enum>(A)</enum><text>an evaluation of the effectiveness of comprehensive opioid recovery centers established or operated pursuant to section 550 of the Public Health Service Act, as added by subsection (a);</text></subparagraph> <subparagraph id="HAC8219607B7F4DD5A7816076B66A7398"><enum>(B)</enum><text>recommendations on whether the grant program established under such section 550 should be reauthorized and expanded; and</text></subparagraph>
<subparagraph id="HB07931EA82A54B4785B440CCCA258A45"><enum>(C)</enum><text>standards and best practices for the treatment of substance use disorders, as identified through such grant program.</text></subparagraph></paragraph></subsection></section></subtitle> <subtitle id="HEF600CB61DC14EEC9D6A90C0D0BAEEE3"><enum>O</enum><header>Poison Center Network Enhancement</header> <section id="H0FC4A9BE567B4A0CA5B1C335B1255911" section-type="subsequent-section"><enum>7141.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Poison Center Network Enhancement Act of 2018</short-title></quote>.</text></section>
<section id="H5A2DEBD0CF1A438FBE2DD98851582BB5"><enum>7142.</enum><header>Reauthorization of poison control centers national toll-free number</header><text display-inline="no-display-inline">Section 1271 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300d-71">42 U.S.C. 300d–71</external-xref>) is amended to read as follows:</text> <quoted-block display-inline="no-display-inline" id="H6A7AD21EB184494E8185F3088E92CC1E" style="OLC"> <section id="H4EB926CE82E04CB3B22F7F356B3B90D1"><enum>1271.</enum><header>Establishment and maintenance of the national toll-free number and enhanced communications capabilities</header> <subsection id="H8CC954CDB4FE46FC9628960E0677DC58"><enum>(a)</enum><header>In general</header><text>The Secretary shall provide coordination and assistance to poison control centers for—</text>
<paragraph id="HB746D2789C1A42D4926B928A0C97BA3F"><enum>(1)</enum><text>the development, establishment, implementation, and maintenance of a nationwide toll-free phone number; and</text></paragraph> <paragraph id="H0365A599E7BB472E9A1E9FB5533D1792"><enum>(2)</enum><text>the enhancement of communications capabilities, which may include text capabilities.</text></paragraph></subsection>
<subsection id="H9354B040A06B4533BDC157F53422B436"><enum>(b)</enum><header>Consultation</header><text display-inline="yes-display-inline">The Secretary may consult with nationally recognized professional organizations in the field of poison control to determine the best and most effective means of achieving the goals described in paragraphs (1) and (2) of subsection (a).</text></subsection> <subsection id="H19546A86BA8045DEA41EBC9F32F030B1"><enum>(c)</enum><header>Rule of construction</header><text>In assisting with public health emergencies, responses, or preparedness, nothing in this section shall be construed to restrict the work of poison control centers or the use of their resources by the Secretary or other governmental agencies.</text></subsection>
<subsection id="HDCBD18661EBE4B3F8B59DAF8FFD45A31"><enum>(d)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated to carry out this section $700,000 for each of fiscal years 2019 through 2023.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section> <section id="H1BB5883CE6CC4552AC5870940376E7BA"><enum>7143.</enum><header>Reauthorization of nationwide public awareness campaign to promote poison control center utilization</header><text display-inline="no-display-inline">Section 1272 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300d-72">42 U.S.C. 300d–72</external-xref>) is amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="HB45E3F0748994D53A32A0CD5DE86AE1A" style="OLC">
<section id="H06C0985FF21943FFBB9C953CE7A8937F"><enum>1272.</enum><header>Nationwide public awareness campaign to promote poison control center utilization and their public health emergency response capabilities</header>
<subsection id="HBF538043B9984F88A291BF94A25A641A"><enum>(a)</enum><header>In general</header><text>The Secretary shall—</text> <paragraph id="H0279FDE89A384DB5B0F44660F02AA153"><enum>(1)</enum><text>carry out, and expand upon, a national public awareness campaign to educate the public and health care providers about—</text>
<subparagraph id="H3719F8C99BAE4536A68D35C5E31FFCCE"><enum>(A)</enum><text display-inline="yes-display-inline">poisoning, toxic exposure, and drug misuse prevention; and</text></subparagraph> <subparagraph id="H0D7EE1ED490B4755A1143365FECA25C6"><enum>(B)</enum><text>the availability of poison control center resources in local communities; and</text></subparagraph></paragraph>
<paragraph id="H537E9A481C7540009A17E0DFCDF0F568"><enum>(2)</enum><text>as part of such campaign, highlight the nationwide toll-free number and enhanced communications capabilities supported under section 1271.</text></paragraph></subsection> <subsection id="H58719F2E0B7140ECABD399E7062BB8BA"><enum>(b)</enum><header>Consultation</header><text>In carrying out and expanding upon the national campaign under subsection (a), the Secretary may consult with nationally recognized professional organizations in the field of poison control response for the purpose of determining the best and most effective methods for achieving public awareness.</text></subsection>
<subsection id="H60384EF083214188AFD0C1177830B28E"><enum>(c)</enum><header>Contract with entity</header><text>The Secretary may carry out subsection (a) by entering into contracts with one or more public or private entities, including nationally recognized professional organizations in the field of poison control and national media firms, for the development and implementation of the awareness campaign under subsection (a), which may include—</text> <paragraph id="HCD8A26A4B91B403B8190FDF06ED8FC36"><enum>(1)</enum><text>the development and distribution of poisoning and toxic exposure prevention, poison control center, and public health emergency awareness and response materials;</text></paragraph>
<paragraph id="H6224FC3FC8DB43628E3864AE40BCBD2F"><enum>(2)</enum><text>television, radio, internet, and newspaper public service announcements; and</text></paragraph> <paragraph id="H787B9D5E0862461CB5B3E14836ABF53B"><enum>(3)</enum><text>other means and activities to provide for public and professional awareness and education.</text></paragraph></subsection>
<subsection id="HAADF47520EF7439799DE1CE1E68835A0"><enum>(d)</enum><header>Evaluation</header><text>The Secretary shall—</text> <paragraph id="H97C006CC71CB492A8442E072E969093F"><enum>(1)</enum><text>establish baseline measures and benchmarks to quantitatively evaluate the impact of the nationwide public awareness campaign carried out under this section; and</text></paragraph>
<paragraph id="HACBBE9E10CD143408DCB0229A8FAF8E2"><enum>(2)</enum><text>on a biennial basis, prepare and submit to the appropriate committees of Congress an evaluation of the nationwide public awareness campaign.</text></paragraph></subsection> <subsection id="H0657981A0C1E446E9220836C6975F62E"><enum>(e)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated to carry out this section, $800,000 for each of fiscal years 2019 through 2023.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section id="HDDB7BB72FDEF4FD1BA3B03DD61135F62"><enum>7144.</enum><header>Reauthorization of the poison control center grant program</header><text display-inline="no-display-inline">Section 1273 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300d-73">42 U.S.C. 300d–73</external-xref>) is amended to read as follows:</text> <quoted-block display-inline="no-display-inline" id="HEDE43EC62F3A4564A303F299E02D79E7" style="OLC"> <section id="HFB10F74B97554A189227607D2CD9FAF6"><enum>1273.</enum><header>Maintenance of the poison control center grant program</header> <subsection id="H2387BC9116CF43F9AB368144763501CA"><enum>(a)</enum><header>Authorization of program</header><text>The Secretary shall award grants to poison control centers accredited under subsection (c) (or granted a waiver under subsection (d)) and nationally recognized professional organizations in the field of poison control for the purposes of—</text>
<paragraph id="H48A4F4266F604A349315C1F4801F2A83"><enum>(1)</enum><text>preventing, and providing treatment recommendations for, poisonings and toxic exposures including opioid and drug misuse;</text></paragraph> <paragraph id="H0A71CB6B21F14780839F27F3C1E498B4"><enum>(2)</enum><text>assisting with public health emergencies, responses, and preparedness; and</text></paragraph>
<paragraph id="H2FC887D79C5F424FA9D711FD24B14B25"><enum>(3)</enum><text>complying with the operational requirements needed to sustain the accreditation of the center under subsection (c).</text></paragraph></subsection> <subsection id="HB55A0515AE0C4B6B8801559DDFB3B961"><enum>(b)</enum><header>Additional uses of funds</header><text>In addition to the purposes described in subsection (a), a poison center or professional organization awarded a grant under such subsection may also use amounts received under such grant—</text>
<paragraph id="H9E244E6D7FAB44A39AF6B097F86F93A8"><enum>(1)</enum><text>to research, establish, implement, and evaluate best practices in the United States for poisoning prevention, poison control center outreach, opioid and drug misuse information and response, and public health emergency, response, and preparedness programs;</text></paragraph> <paragraph id="H6D2E08076B8345789B2527208C65FF5E"><enum>(2)</enum><text>to research, develop, implement, revise, and communicate standard patient management guidelines for commonly encountered toxic exposures;</text></paragraph>
<paragraph id="H1847DB422F334EC896E6F4BD192402D9"><enum>(3)</enum><text>to improve national toxic exposure and opioid misuse surveillance by enhancing cooperative activities between poison control centers in the United States and the Centers for Disease Control and Prevention and other governmental agencies;</text></paragraph> <paragraph id="H7C17EEC8ECD7486C838299FC31AE2C32"><enum>(4)</enum><text>to research, improve, and enhance the communications and response capability and capacity of the Nation’s network of poison control centers to facilitate increased access to the centers through the integration and modernization of the current poison control centers communications and data system, including enhancing the network’s telephony, internet, data, and social networking technologies;</text></paragraph>
<paragraph id="H0933724326B64F5296294156E68D0421"><enum>(5)</enum><text>to develop, support, and enhance technology and capabilities of nationally recognized professional organizations in the field of poison control to collect national poisoning, toxic occurrence, and related public health data;</text></paragraph> <paragraph id="HD3DF78D854894637849CDBA194BA9D56"><enum>(6)</enum><text>to develop initiatives to foster the enhanced public health utilization of national poison data collected by such organizations;</text></paragraph>
<paragraph id="H7D5DC965B8384D44AA738C2B4AD10427"><enum>(7)</enum><text>to support and expand the toxicologic expertise within poison control centers; and</text></paragraph> <paragraph id="H73CB355451C4418BACB5D453688EB224"><enum>(8)</enum><text>to improve the capacity of poison control centers to answer high volumes of contacts and internet communications, and to sustain and enhance the poison control center’s network capability to respond during times of national crisis or other public health emergencies.</text></paragraph></subsection>
<subsection id="H3E8597FC32164E52AA35BEE2D446289B"><enum>(c)</enum><header>Accreditation</header><text>Except as provided in subsection (d), the Secretary may award a grant to a poison control center under subsection (a) only if—</text> <paragraph id="H36B0CD103B4449EDBD736DDD37988A51"><enum>(1)</enum><text>the center has been accredited by a nationally recognized professional organization in the field of poison control, and the Secretary has approved the organization as having in effect standards for accreditation that reasonably provide for the protection of the public health with respect to poisoning; or</text></paragraph>
<paragraph id="HD13E559ED1B145A796348470F3242569"><enum>(2)</enum><text>the center has been accredited by a State government, and the Secretary has approved the State government as having in effect standards for accreditation that reasonably provide for the protection of the public health with respect to poisoning.</text></paragraph></subsection> <subsection id="HFA6AAC5BDA0D4F9CB94F60FE0C319B5C"><enum>(d)</enum><header>Waiver of accreditation requirements</header> <paragraph id="H4FAC8194E34C4F6A97941453C9E9E151"><enum>(1)</enum><header>In general</header><text>The Secretary may grant a waiver of the accreditation requirements of subsection (c) with respect to a nonaccredited poison control center that applies for a grant under this section if such center can reasonably demonstrate that the center will obtain such an accreditation within a reasonable period of time as determined appropriate by the Secretary.</text></paragraph>
<paragraph id="HAF74A4D253524CE7B3AE9065582B97AE"><enum>(2)</enum><header>Renewal</header><text>The Secretary may renew a waiver under paragraph (1).</text></paragraph> <paragraph id="HA920BD72AFA04B2BB37BB544EEEB3DCC"><enum>(3)</enum><header>Limitation</header><text display-inline="yes-display-inline">The Secretary may not, after the date of enactment of the Poison Control Network Enhancement Act of 2018, grant to a poison control center waivers or renewals that total more than 5 years.</text></paragraph></subsection>
<subsection id="HF81924B251554CE49EE024940B0E9521"><enum>(e)</enum><header>Supplement not supplant</header><text>Amounts made available to a poison control center under this section shall be used to supplement and not supplant other Federal, State, or local funds provided for such center.</text></subsection> <subsection id="H93A6BFC392D44E11A90E4DFD5DE227E5"><enum>(f)</enum><header>Maintenance of effort</header><text>A poison control center, in utilizing the proceeds of a grant under this section, shall maintain the annual recurring expenditures of the center for its activities at a level that is not less than 80 percent of the average level of such recurring expenditures maintained by the center for the preceding 3 fiscal years for which a grant is received.</text></subsection>
<subsection id="HA31B457A45244F82891DF356EA116D14"><enum>(g)</enum><header>Authorization of appropriations</header><text display-inline="yes-display-inline">There is authorized to be appropriated to carry out this section, $28,600,000 for each of fiscal years 2019 through 2023. The Secretary may utilize an amount not to exceed 6 percent of the amount appropriated pursuant to the preceding sentence for each fiscal year for coordination, dissemination, technical assistance, program evaluation, data activities, and other program administration functions, which are determined by the Secretary to be appropriate for carrying out the program under this section.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section></subtitle> <subtitle id="H1164891145CE429AABCFB6EDA82ED1AC"><enum>P</enum><header>Eliminating Opioid Related Infectious Diseases</header> <section id="HD94A17DB85B143FAB8C4DB330A5AD335" section-type="subsequent-section"><enum>7151.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Eliminating Opioid Related Infectious Diseases Act of 2018</short-title></quote>.</text></section>
<section id="H6FDD51C9F9924DB3839DD5D651AF2207"><enum>7152.</enum><header>Reauthorization and expansion of program of surveillance and education regarding infections associated with illicit drug use and other risk factors</header><text display-inline="no-display-inline">Section 317N of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/247b-15">42 U.S.C. 247b–15</external-xref>) is amended to read as follows:</text> <quoted-block display-inline="no-display-inline" id="HB8088330DEDA475DBB0A004FB55A83A1" style="OLC"> <section id="H849C0F1EAA434D5189893FC39B7B3C73"><enum>317N.</enum><header>Surveillance and education regarding infections associated with illicit drug use and other risk factors</header> <subsection id="H52BBF7DF4A3F4C949B8A4D84B887B373"><enum>(a)</enum><header>In general</header><text>The Secretary may (directly and through grants to public and nonprofit private entities) provide for programs for the following:</text>
<paragraph id="HE2E22EF6FD1246BE8914201435F26ABE" commented="no"><enum>(1)</enum><text display-inline="yes-display-inline">To cooperate with the States and Indian tribes in implementing or maintaining a surveillance system to determine the incidence of infections commonly associated with illicit drug use, including infections commonly associated with injection drug use such as viral hepatitis, human immunodeficiency virus, and infective endocarditis, and to assist the States in determining the prevalence of such infections, which may include the reporting of cases of such infections.</text></paragraph> <paragraph id="H500BBC6B4AEA4813A489CAC855695181"><enum>(2)</enum><text>To identify, counsel, and offer testing to individuals who are at risk of infections as a result of injection drug use, receiving blood transfusions prior to July 1992, or other risk factors.</text></paragraph>
<paragraph id="H40F760D1DCA54160A4156C2AA7AB000D"><enum>(3)</enum><text>To provide appropriate referrals for counseling, testing, and medical treatment of individuals identified under paragraph (2) and to ensure, to the extent practicable, the provision of appropriate follow-up services.</text></paragraph> <paragraph id="HB7FBD55FC0534B9F9DB2D6CA635F9E9F"><enum>(4)</enum><text>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.</text></paragraph>
<paragraph id="H8BBAA5A13C7C4492977FB7875F9D0830"><enum>(5)</enum><text display-inline="yes-display-inline">To improve the education, training, and skills of health professionals in the detection and control of infections and the coordination of treatment of addiction and infectious diseases described in paragraph (1), with priority given to substance use disorder treatment providers, pediatricians and other primary care providers, obstetrician-gynecologists, infectious diseases clinicians, and HIV clinicians.</text></paragraph></subsection> <subsection id="HC86CDC7BD6B74440AAC78B835DCBD538"><enum>(b)</enum><header>Laboratory procedures</header><text display-inline="yes-display-inline">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-laboratory procedures regarding infections described in subsection (a)(1).</text></subsection>
<subsection id="H518CE9318ADA47849A9FEF650AF77DC5"><enum>(c)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section:</text> <paragraph id="H31AB94BE69514CF1918D053F25B7AD02"><enum>(1)</enum><text display-inline="yes-display-inline">The term <quote>Indian tribe</quote> has the meaning given that term in section 4 of the Indian Self-Determination and Education Assistance Act.</text></paragraph>
<paragraph id="HDA462BAB00E34634B9610A215B734CED"><enum>(2)</enum><text display-inline="yes-display-inline">The term <quote>injection drug use</quote> means—</text> <subparagraph id="H020D1687A0334C67934034EEA2337AD3"><enum>(A)</enum><text>intravenous administration of a substance in schedule I under section 202 of the Controlled Substances Act;</text></subparagraph>
<subparagraph id="HE8E4AE1CDDF443E1A9B11DF1A701B9EC"><enum>(B)</enum><text>intravenous administration of a substance in schedule II, III, IV, or V under section 202 of the Controlled Substances Act that has not been approved for intravenous use under—</text> <clause id="HF3C46A1F707F47558029C8BAC505748C"><enum>(i)</enum><text>section 505 of the Federal Food, Drug and Cosmetic Act; or</text></clause>
<clause id="H0EAF701F6B5E4062B7A2F178701DF97F"><enum>(ii)</enum><text>section 351 of the Public Health Service Act; or</text></clause></subparagraph> <subparagraph id="H3CB60F8A349349CA956970C46D96F3AD"><enum>(C)</enum><text>intravenous administration of a substance in schedule II, III, IV, or V under section 202 of the Controlled Substances Act that has not been prescribed to the person using the substance.</text></subparagraph></paragraph></subsection>
<subsection id="HC9A5C4AB33E8415E904D5DEFC7B718D6"><enum>(d)</enum><header>Authorization of appropriations</header><text>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.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section></subtitle> <subtitle id="HCC5E5F928EF441B98E336510B3BD4238"><enum>Q</enum><header>Better Pain Management Through Better Data</header> <section id="HD0E16A8ECD794C30BDA3CA5781353A42" section-type="subsequent-section"><enum>7161.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Better Pain Management Through Better Data Act of 2018</short-title></quote>.</text></section>
<section id="H1F6B0D15B08448578EACCACA81F83B97"><enum>7162.</enum><header>Guidance addressing alternative approaches to data collection and labeling claims for opioid sparing</header>
<subsection id="HA90C7281D952475A8C308664D7452708"><enum>(a)</enum><header>In general</header><text>For purposes of assisting sponsors in collecting and incorporating opioid-sparing data in product labeling, the Secretary of Health and Human Services (referred to in this section as the <quote>Secretary</quote>) shall conduct a public meeting and update or issue one or more guidances in accordance with subsection (b).</text></subsection> <subsection id="H00861C7E2CEC4DBF83C18074C69DA0B0"><enum>(b)</enum><header>Guidance</header> <paragraph id="HE1C6007E87574C11A460FCB561DD5240"><enum>(1)</enum><header>In general</header><text>The Secretary of Health and Human Services, acting through the Commissioner of Food and Drugs, shall update or issue one or more guidances addressing—</text>
<subparagraph id="H1C1FDD9B689E428F8D5E66C12DA11515"><enum>(A)</enum><text display-inline="yes-display-inline">alternative methods for data collection on opioid sparing;</text></subparagraph> <subparagraph id="H3CF0F0E03C9F4D53B852D30FCBA242DE"><enum>(B)</enum><text display-inline="yes-display-inline">alternative methods for inclusion of such data in product labeling; and</text></subparagraph>
<subparagraph id="HF985200E820846278589B6C49CF6E001"><enum>(C)</enum><text display-inline="yes-display-inline">investigations other than clinical trials, including partially controlled studies and objective trials without matched controls such as historically controlled analyses, open-label studies, and meta-analyses, on opioid sparing for inclusion in product labeling.</text></subparagraph></paragraph> <paragraph id="HB2355E1485454BC6893F2385BBADE023"><enum>(2)</enum><header>Contents</header><text>The guidances under paragraph (1) shall address—</text>
<subparagraph id="H3612F11AEC4F4D87A1EEC60CBC1AA5E3"><enum>(A)</enum><text>innovative clinical trial designs for ethically and efficiently collecting data on opioid sparing for inclusion in product labeling;</text></subparagraph> <subparagraph id="HE1C2DCA8A570431F9DEC45D8C8ADC0C9"><enum>(B)</enum><text>primary and secondary endpoints for the reduction of opioid use while maintaining adequate pain control;</text></subparagraph>
<subparagraph id="H361B23A81B4043C79A10A432D37A3704"><enum>(C)</enum><text>use of real world evidence, including patient registries, and patient reported outcomes to support inclusion of opioid-sparing data in product labeling; and</text></subparagraph> <subparagraph id="HE2A7CE0C6449413B9078BC29A4EB30E1"><enum>(D)</enum><text>how sponsors may obtain feedback from the Secretary relating to such issues prior to—</text>
<clause id="HB9C4232F0429473984B20DBB99428821"><enum>(i)</enum><text>commencement of such data collection; or</text></clause> <clause id="H4F0342E2D9D84F35B232AEE361F74A8A"><enum>(ii)</enum><text>the submission of resulting data to the Secretary.</text></clause></subparagraph></paragraph>
<paragraph id="H4770BF7B6EF64D329D25B3C973DDF0CD"><enum>(3)</enum><header>Public meeting</header><text>Prior to updating or issuing the guidances required by paragraph (1), the Secretary shall consult with stakeholders, including representatives of regulated industry, academia, patients, and provider organizations, through a public meeting to be held not later than 12 months after the date of enactment of this Act.</text></paragraph> <paragraph id="H8BA7BAC0BEEF4315914482226E0ED681"><enum>(4)</enum><header>Timing</header><text>The Secretary shall—</text>
<subparagraph id="H27F9481E4DEE481E94016227B661350F"><enum>(A)</enum><text display-inline="yes-display-inline">not later than 12 months after the date of the public meeting required by paragraph (3), update or issue the one or more draft guidances required by paragraph (1); and</text></subparagraph> <subparagraph id="H6BB079C06E25487DA43063B5B433D93A"><enum>(B)</enum><text display-inline="yes-display-inline">not later than 12 months after the date on which the public comment period for such draft guidances closes, finalize such guidances.</text></subparagraph></paragraph></subsection>
<subsection id="HD4A0CCB35FCA48ACBD4E021A33599DBA"><enum>(c)</enum><header>Definition</header><text display-inline="yes-display-inline">In this section:</text> <paragraph id="H3FC29931D31E42DFBA175FEE68E0CE0D"><enum>(1)</enum><text display-inline="yes-display-inline">The terms <term>opioid sparing</term> and <term>opioid-sparing</term> refer to the use of drugs or devices (as defined in section 201 of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/321">21 U.S.C. 321</external-xref>)) that reduce pain while enabling the reduction, replacement, or avoidance of oral opioids.</text></paragraph>
<paragraph id="HC5A364972F9A487BA19A8660896EFECB"><enum>(2)</enum><text>The term <term>Secretary</term> means the Secretary of Health and Human Services.</text></paragraph></subsection></section></subtitle> <subtitle id="H88036AB285E94D5FA7EDEC7D2920436F"><enum>R</enum><header>Special Registration for Telemedicine Clarification</header> <section id="H067FE8C22C704CA085FBD3C8F8E360BD" section-type="subsequent-section"><enum>7171.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Special Registration for Telemedicine Clarification Act of 2018</short-title></quote>.</text></section>
<section id="H889EFF9C62F44A099E2DA03177B4FA5B"><enum>7172.</enum><header>Deadline for interim final regulations for a special registration To engage in the practice of telemedicine</header><text display-inline="no-display-inline">Section 311(h)(2) of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/831">21 U.S.C. 831(h)(2)</external-xref>) is amended by striking <quote>The Attorney General shall, with the concurrence of the Secretary, promulgate regulations</quote> and inserting <quote>Not later than 1 year after the date of enactment of the <short-title>Special Registration for Telemedicine Clarification Act of 2018</short-title>, the Attorney General shall, with the concurrence of the Secretary, promulgate interim final regulations</quote>.</text></section></subtitle> <subtitle id="HC3040551249742819163364B2FDF66EB"><enum>S</enum><header>Peer Support Communities of Recovery</header> <section id="HA19542A684E04070BFE5385CD1C356BE" section-type="subsequent-section"><enum>7181.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Peer Support Communities of Recovery Act</short-title></quote>.</text></section>
<section id="H5D6DEF55B30B497E9F1831FBA588FFDF" section-type="subsequent-section"><enum>7182.</enum><header>Building communities of recovery</header><text display-inline="no-display-inline">Section 547 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/290ee-2">42 U.S.C. 290ee–2</external-xref>) is amended—</text> <paragraph id="H79B04BA97953487A96D18376718448AA"><enum>(1)</enum><text>in subsection (a)—</text>
<subparagraph id="H44A88042275D4874BB8FAE37280AC72B"><enum>(A)</enum><text>in the heading, by striking <quote><header-in-text level="subsection" style="OLC">Definition</header-in-text></quote> and inserting <quote><header-in-text level="subsection" style="OLC">Definitions</header-in-text></quote>;</text></subparagraph> <subparagraph id="H5BD2A52F03B94DC1836D9975CA3B71A5"><enum>(B)</enum><text>in the matter preceding paragraph (1), by striking <quote>In this section, the term <quote>recovery community organization</quote> means an independent nonprofit organization that—</quote> and inserting <quote>In this section:</quote>;</text></subparagraph>
<subparagraph id="H4B078951BCAD418589D6BBFAD496FEBF"><enum>(C)</enum><text>by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively, and moving such subparagraphs (as so redesignated) 2 ems to the right;</text></subparagraph> <subparagraph id="HB134B67F631A45EB982A0A05F99A2978"><enum>(D)</enum><text>by inserting before subparagraph (A) (as so redesignated) the following:</text>
<quoted-block display-inline="no-display-inline" id="H5C64D89164574B0E96821483161D2B12" style="OLC">
<paragraph id="HAB3F6D579F1A4CBBBFF6BF858975C96A"><enum>(1)</enum><header>Recovery community organization</header><text display-inline="yes-display-inline">The term <quote>recovery community organization</quote> means an independent nonprofit organization that—</text></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph> <subparagraph id="HB029FFE682C34B2281F0EEC65BA249D0"><enum>(E)</enum><text>by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H705E7912C64A4D74BCA47DBD7840867B" style="OLC">
<paragraph id="HC04794C0AF924DA4BC3CA708209B10B5"><enum>(2)</enum><header>Eligible entity</header><text display-inline="yes-display-inline">The term <quote>eligible entity</quote> means—</text> <subparagraph id="H589884D2B7334C70A0510A23E1D070AD"><enum>(A)</enum><text display-inline="yes-display-inline">a national nonprofit entity focused on substance use disorder with a network of local affiliates and partners that are geographically and organizationally diverse; or</text></subparagraph>
<subparagraph id="H220009AA86254457881DD4BE945A123D"><enum>(B)</enum><text>a nonprofit organization—</text> <clause id="HDEEDF0496B1C43108C08925A2DE7F189"><enum>(i)</enum><text>focused on substance use disorder;</text></clause>
<clause id="H32399A771695416DA3DAABBE2A951517"><enum>(ii)</enum><text>established by individuals in personal or family recovery; and</text></clause> <clause id="H01541A6DD72840708075541974BBE2EE"><enum>(iii)</enum><text>serving prevention, treatment, recovery, payor, faith-based, and criminal justice stakeholders in the implementation of local addiction and recovery initiatives.</text></clause></subparagraph></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph>
<paragraph id="H18B74581BD8C440AAFCE01E960E69EEB"><enum>(2)</enum><text>in subsection (b)—</text> <subparagraph id="H94EED5662A634F1FAF9865371C276047"><enum>(A)</enum><text>by striking <quote>The Secretary shall award grants to recovery community organizations</quote> and inserting</text>
<quoted-block display-inline="yes-display-inline" id="H42187B2073674FB3B0621E5FCD22DD09" style="OLC"><text>The Secretary—</text> <paragraph id="H574460128E0D482AA3D483E61ABE8222"><enum>(1)</enum><text display-inline="yes-display-inline">shall award grants to recovery community organizations</text></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph>
<subparagraph id="H3F17E613F9ED4F60A5F64CA0BF5E1A4D"><enum>(B)</enum><text>by striking <quote>services.</quote> and inserting <quote>services and allow such organizations to use such grant funds to carry out the activities described in subparagraphs (A) through (C) of subsection (c)(2); and</quote>; and</text></subparagraph> <subparagraph id="H571813D9E0684238AE2C879E2C01EE72"><enum>(C)</enum><text>by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="HDDD431D9A8C640CB85CE7AF86098A2DF" style="OLC">
<paragraph id="HB631C512AF7F42DDAE4B6876E21CC042"><enum>(2)</enum><text display-inline="yes-display-inline">may award grants to eligible entities for purposes of establishing regional technical assistance centers, in accordance with subsection (c)(2)(D).</text></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph> <paragraph id="H8D34B96062F640E9A0CEDDC663D0E20E"><enum>(3)</enum><text>by striking subsection (c);</text></paragraph>
<paragraph id="H7DD7C492B9144345BBC0997F97443555"><enum>(4)</enum><text>by redesignating subsections (d) and (e) as subsections (c) and (d), respectively;</text></paragraph> <paragraph commented="no" id="H675B328EEB63482EAB08F1E69AEA0254"><enum>(5)</enum><text display-inline="yes-display-inline">in subsection (c) (as so redesignated)—</text>
<subparagraph id="HD7EA2307A3B44DD18EA59B714F6CD2E9"><enum>(A)</enum><text>in paragraph (1), by striking <quote>shall be used</quote> and inserting <quote>to a recovery community organization shall be used</quote>;</text></subparagraph> <subparagraph id="H7F769B7F12094DF49FD63969032FF206"><enum>(B)</enum><text>in paragraph (2)—</text>
<clause id="H830F4415E6764E69A135D376D8338B83"><enum>(i)</enum><text display-inline="yes-display-inline">in subparagraph (A), in the matter preceding clause (i), by inserting before <quote>build</quote> the following: <quote>in the case of a grant awarded to a recovery community organization,</quote>;</text></clause> <clause id="H6CF3AE6843E94F7DBE6DE7DAAEE01222"><enum>(ii)</enum><text>in subparagraph (B)—</text>
<subclause id="HC22FA9E509AF4EAC979C197AD3B594CE"><enum>(I)</enum><text>by inserting before <quote>reduce</quote> the following: <quote>in the case of a grant awarded to a recovery community organization,</quote>; and</text></subclause> <subclause id="H97F6CDDA92264C27B947AF26510EE19B"><enum>(II)</enum><text>by striking <quote>and</quote> at the end; </text></subclause></clause>
<clause id="H55AE9C32283E4D85B3F5361A635FBCDA"><enum>(iii)</enum><text display-inline="yes-display-inline">in subparagraph (C)—</text> <subclause id="HABD4849286304FCF9EB3FADC8CE9C0F1"><enum>(I)</enum><text>by inserting before <quote>conduct</quote> the following: <quote>in the case of a grant awarded to a recovery community organization,</quote>; and</text></subclause>
<subclause id="HED88EFC2EC4E4DCE9DC0CF6881CC8CE0"><enum>(II)</enum><text>by striking the period at the end and inserting <quote>; and</quote>; and </text></subclause></clause> <clause id="H929ACA7A852E4C91BA702600A14764B0"><enum>(iv)</enum><text>by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="HF15005C478D54C7AB77431DC56105CE3" style="OLC">
<subparagraph id="H882D2569F3534DD69E92D35C290694E3"><enum>(D)</enum><text display-inline="yes-display-inline">in the case of a grant awarded to an eligible entity, provide for the establishment of regional technical assistance centers to provide regional technical assistance for the following:</text> <clause id="HBF5D19D1F71F423B8CF790A6ADF0DD5D"><enum>(i)</enum><text>Implementation of regionally driven, peer-delivered addiction recovery support services before, during, after, or in conjunction with addiction treatment.</text></clause>
<clause id="HD28760B8A3E743D69E2DE1258E3378CB"><enum>(ii)</enum><text>Establishment of recovery community organizations.</text></clause> <clause id="H4DFCF4E3AD48477FBF7FF63738425428"><enum>(iii)</enum><text>Establishment of recovery community centers.</text></clause></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></clause></subparagraph></paragraph>
<paragraph id="H08844B0A94B84C6080730D0529BAC91F"><enum>(6)</enum><text>in subsection (d) (as so redesignated), by inserting before the period the following: <quote>, and $15,000,000 for each of fiscal years 2019 through 2023</quote>.</text></paragraph></section></subtitle> <subtitle id="H490CD0DC7A5C42BFB637BD0367508541"><enum>T</enum><header>Stop Illicit Drug Importation</header> <section id="HB4B7698661C444CAAA3146E08689E0DC" section-type="subsequent-section"><enum>7191.</enum><header>Short title</header><text display-inline="no-display-inline">This short title may be cited as the <quote><short-title>Stop Illicit Drug Importation Act of 2018</short-title></quote>.</text></section>
<section commented="no" id="H6488784FD9D44897A1B07EFB9B425CAC"><enum>7192.</enum><header>Detention, refusal, and destruction of drugs offered for importation</header>
<subsection id="H3F319D91FF674B718400BE1BB7DE4051" commented="no"><enum>(a)</enum><header>Articles treated as drugs for purposes of importation</header><text display-inline="yes-display-inline">Section 801 of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/381">21 U.S.C. 381</external-xref>) is amended by adding at the end the following:</text> <quoted-block style="OLC" id="H171A21FDDF884389822F7D065D316731" display-inline="no-display-inline"> <subsection id="H03AD4EF57B6B4CFAA4649403231E0835"><enum>(t)</enum><header>Articles treated as drugs for purposes of this section</header> <paragraph id="H89F75C4FBCB14EA6A0C5C3432B1EC439"><enum>(1)</enum><header>Labeled articles</header><text display-inline="yes-display-inline">An article shall not be treated as a drug pursuant to this subsection if—</text>
<subparagraph id="H580CD85BA19A4CC39D4EAB3E99A6247D"><enum>(A)</enum><text>an electronic import entry for such article is submitted using an authorized electronic data interchange system; and</text></subparagraph> <subparagraph id="H0031EAED1AC144BFA6B4A4A62EEB489C"><enum>(B)</enum><text>such article is designated in such system as a drug, device, dietary supplement, or other product that is regulated under this Act.</text></subparagraph></paragraph>
<paragraph id="H96892806712C42E4A51E9881FFDBF3D0"><enum>(2)</enum><header>Articles covered</header><text>Subject to paragraph (1), for purposes of this section, an article described in this paragraph may be treated by the Secretary as a drug if it—</text> <subparagraph id="H244661BAD6C442DD9F10FF322206CCDA"><enum>(A)</enum><text>is or contains an ingredient that is an active ingredient that is contained within—</text>
<clause id="H435225583000470785AA0432B9DF0027"><enum>(i)</enum><text>a drug that has been approved under section 505 of this Act; or</text></clause> <clause id="HFF5E2BB7ACAC49568B9EDC6EE72B1EC9"><enum>(ii)</enum><text>a biological product that has been approved under section 351 of the Public Health Service Act;</text></clause></subparagraph>
<subparagraph id="H947D3A93AD96471A856CC8BB755E9189"><enum>(B)</enum><text>is or contains an ingredient that is an active ingredient in a drug or biological product if—</text> <clause id="H9866A80994F8487A8472AA3A7CC78867"><enum>(i)</enum><text>an investigational use exemption has been authorized for such drug or biological product under section 505(i) of this Act or section 351(a) of the Public Health Service Act;</text></clause>
<clause id="H90D9A489E660496EB4ED5BAFAFD6985F"><enum>(ii)</enum><text>substantial clinical investigation has been instituted for such drug or biological product; and</text></clause> <clause id="H5F5A9B8147A045318EB7A86535F7854D"><enum>(iii)</enum><text><italic></italic>the existence of such clinical investigation has been made public; or</text></clause></subparagraph>
<subparagraph id="H5B4F84B8CAD34EBFA1B66C4CEC4FE9FE"><enum>(C)</enum><text>is or contains 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 subparagraph (A) or (B).</text></subparagraph></paragraph> <paragraph id="HBA2C98E3BFD84F4CA9A74BF4CEC1D32A"><enum>(3)</enum><header>Effect</header><text>Except to the extent that an article may be treated as a drug pursuant to paragraph (2), this subsection shall not be construed as bearing on or being relevant to the question of whether any article is a drug as defined in section 201(g).</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection commented="no" id="HCD4D12F31332484385C999D062F56A61"><enum>(b)</enum><header>Articles of concern</header>
<paragraph commented="no" id="H5BB93A71C8444514A848962FAD82331C"><enum>(1)</enum><header>Delivery by Treasury to HHS</header><text>The first sentence of section 801(a) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/381">21 U.S.C. 381(a)</external-xref>) is amended by striking <quote>and cosmetics</quote> and inserting <quote>cosmetics, and potential articles of concern (as defined in subsection (u))</quote>.</text></paragraph> <paragraph commented="no" id="H8A18A8EBEB0742A29D550EC768756ED4"><enum>(2)</enum><header>Refused admission</header><text display-inline="yes-display-inline">The third sentence of section 801(a) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/381">21 U.S.C. 381(a)</external-xref>) is amended by striking <quote>then such article shall be refused admission</quote> and inserting <quote>or (5) such article is an article of concern (as defined in subsection (u)), or (6) such article is a drug that is being imported or offered for import in violation of section 301(cc), then such article shall be refused admission</quote>.</text></paragraph>
<paragraph commented="no" id="HAE583A3C6BA548AC9387EDF46FD5B904"><enum>(3)</enum><header>Definition of article of concern</header><text display-inline="yes-display-inline">Section 801 of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/381">21 U.S.C. 381</external-xref>), as amended, is further amended by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="H0F9AEB99BEED4F93B6A5DB8044376ACA" style="OLC"> <subsection commented="no" id="HEF9F83BC18584876B363F1860EDB9707"><enum>(u)</enum><header>Article of concern defined</header><text display-inline="yes-display-inline">For purposes of subsection (a), the term <term>article of concern</term> means an article that is or contains a drug or other substance—</text>
<paragraph commented="no" id="H1836FB3781204961B85A631DC40DCF95"><enum>(1)</enum><text>for which, during the 24-month period prior to the article being imported or offered for import, the Secretary of Health and Human Services—</text> <subparagraph commented="no" id="H7E0C07721F7E4404ACC8AB1D152EE5D1"><enum>(A)</enum><text>has requested that, based on a determination that the drug or other substance appears to meet the requirements for temporary or permanent scheduling pursuant to section 201 of the Controlled Substances Act, the Attorney General initiate the process to control the drug or other substance in accordance with such Act; or</text></subparagraph>
<subparagraph commented="no" id="H49746FEF4ECB41BF8A222C63E2A2120C"><enum>(B)</enum><text display-inline="yes-display-inline">has, following the publication by the Attorney General of a notice in the Federal Register of the intention to issue an order temporarily scheduling such drug or substance in schedule I of section 202 of the Controlled Substances Act pursuant to section 201(h) of such Act, made a determination that such article presents an imminent hazard to public safety; and</text></subparagraph></paragraph> <paragraph commented="no" id="HB51D1FA6122E406B98E243A4810E4CC1"><enum>(2)</enum><text>with respect to which the Attorney General has not—</text>
<subparagraph commented="no" id="H26EA9E3C7C5F4624A8096B3BD5422257"><enum>(A)</enum><text>scheduled the drug or other substance under such Act; or</text></subparagraph> <subparagraph commented="no" id="H206C34F1037449C18F06DA897BE193AE"><enum>(B)</enum><text>notified the Secretary of Health and Human Services that the Attorney General has made a determination not to schedule the drug or other substance under such Act.</text></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection></section>
<section commented="no" id="HCB60B4C8F5BA4DC4A9825CA4A31C81BD"><enum>7193.</enum><header>Seizure</header><text display-inline="no-display-inline">Section 304(b) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/334">21 U.S.C. 334(b)</external-xref>) is amended by striking the first sentence and inserting the following: <quote>The article, equipment, or other thing proceeded against shall be liable to seizure by process pursuant to the libel, and the procedure in cases under this section shall conform, as nearly as may be, to the procedure in admiralty rather than the procedure used for civil asset forfeiture proceedings set forth in section 983 of title 18, United States Code. On demand of either party any issue of fact joined in any such a case brought under this section shall be tried by jury. A seizure brought under this section is not governed by Rule G of the Supplemental Rules of Admiralty or Maritime Claims and Asset Forfeiture Actions. Exigent circumstances shall be deemed to exist for all seizures brought under this section, and in such cases, the summons and arrest warrant shall be issued by the clerk of the court without court review. </quote>.</text></section> <section commented="no" id="HFC8D716DA336480A88C67CCB79B2D547"><enum>7194.</enum><header>Debarring violative individuals or companies</header> <subsection commented="no" id="H69FFFE41881E4DC49DA20A1C0E8469AB"><enum>(a)</enum><header>Prohibited act</header><text display-inline="yes-display-inline">Section 301(cc) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/331">21 U.S.C. 331(cc)</external-xref>) is amended—</text>
<paragraph id="H62E79B6C067246C4BCFD7B1EFD672152"><enum>(1)</enum><text>by inserting after <quote>an article of food</quote> the following: <quote>or a drug</quote>; and</text></paragraph> <paragraph id="H8B5434034FD04BF58D744F4E131AD5E5"><enum>(2)</enum><text>by inserting after <quote>a person debarred</quote> the following: <quote>from such activity</quote>.</text></paragraph></subsection>
<subsection commented="no" id="H777AE2C348B94F6298A1998ADDB2A9A0"><enum>(b)</enum><header>Debarment</header><text display-inline="yes-display-inline">Section 306(b) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/335a">21 U.S.C. 335a(b)</external-xref>) is amended—</text> <paragraph commented="no" id="H474752520EBB478FA29BA9887328A658"><enum>(1)</enum><text>in paragraph (1)—</text>
<subparagraph commented="no" id="H036FA059E0AA436598AABBC5C7B6F58B"><enum>(A)</enum><text>in the matter preceding subparagraph (A), by striking <quote>paragraph (2)</quote> and inserting <quote>paragraph (2) or (3)</quote>;</text></subparagraph> <subparagraph commented="no" id="H8A6FD67AC7C443E98ED3E62A3CB5C030"><enum>(B)</enum><text>in subparagraph (B), by striking <quote>or</quote> at the end;</text></subparagraph>
<subparagraph commented="no" id="H02F135C276D342F5B11A9DB73A9716AE"><enum>(C)</enum><text>in subparagraph (C), by striking the period at the end and inserting <quote>, or</quote>; and</text></subparagraph> <subparagraph commented="no" id="H421A8B0AA0364470819D13EDD39FC933"><enum>(D)</enum><text>by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="HAA4B2832CFB94562B2EA57E8D73BD4B8" style="OLC">
<subparagraph commented="no" id="HF9AC2BD99BCF43ACAA1FDA3ECF80657C"><enum>(D)</enum><text display-inline="yes-display-inline">a person from importing or offering to import into the United States—</text> <clause commented="no" id="HE025CA1C0FA8484DA1D1FCA1A0252EB4"><enum>(i)</enum><text display-inline="yes-display-inline">a controlled substance as defined in section 102(6) of the Controlled Substances Act; or</text></clause>
<clause commented="no" id="HDFD6D2496AF1444CB12286E89A9E709D"><enum>(ii)</enum><text>any drug, if such drug is declared to be valued at an amount that is $2,500 or less (or such higher amount as the Secretary of the Treasury may set by regulation pursuant to section 498(a)(1) of the Tariff Act of 1930), or if such drug is entering the United States by mail.</text></clause></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph> <paragraph commented="no" id="HCACCCE3E3D014AFFB94B0EAFB7075871"><enum>(2)</enum><text>in paragraph (3)—</text>
<subparagraph id="HF2F83F5C362D4D70AED192A8426D6F24"><enum>(A)</enum><text>in the paragraph heading after <quote><header-in-text level="paragraph" style="OLC">food</header-in-text></quote> by inserting <quote><header-in-text level="paragraph" style="OLC">or drug</header-in-text></quote>;</text></subparagraph> <subparagraph id="H6E43194914804892B22200985DD662F8"><enum>(B)</enum><text>by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, and moving the indentation of each such clause 2 ems to the right;</text></subparagraph>
<subparagraph id="H73C338DB66F54E05B0EE7281E931DCBC"><enum>(C)</enum><text>after making the amendments required by subparagraph (B), by striking <quote>A person is subject</quote> and inserting the following:</text> <quoted-block display-inline="no-display-inline" id="H25235C0C46B24B138101B274DBE1F7D8" style="OLC"> <subparagraph id="H980C2F21B86846E2B3A197399A0A1D0D"><enum>(A)</enum><header>Food</header><text display-inline="yes-display-inline">A person is subject</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph>
<subparagraph id="HF953BDB686374DD09011FE90B5E09C8B"><enum>(D)</enum><text>by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="HA578CEB7196D4B0B931E9715550596C5" style="OLC"> <subparagraph commented="no" id="H075A458625994326B6A43ED8D4E2E932"><enum>(B)</enum><header>Importation of drugs</header><text>A person is subject to debarment under paragraph (1)(D) if—</text>
<clause commented="no" id="H8D6AB352C3244C60A70FA0E5ADBCE2C3"><enum>(i)</enum><text>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); or</text></clause> <clause commented="no" id="H709B3C3724EF4E4E92E8E6BD10E1C60B"><enum>(ii)</enum><text>the person has engaged in a pattern of importing or offering for import articles of drug that are—</text>
<subclause id="H5EB3DFC2211B4822B2DB576C3FCF6C2D"><enum>(I)</enum>
<item id="HFC11D10617B54CD8A420EF09FEDBF645" display-inline="yes-display-inline"><enum>(aa)</enum><text>adulterated, misbranded, or in violation of section 505; and</text></item> <item id="HB248C6D9669C442984A8F402DE48CAC1" indent="up1"><enum>(bb)</enum><text>present a threat of serious adverse health consequences or death to humans or animals; or</text></item></subclause>
<subclause commented="no" id="H46B5858D8D9644DD872846222151947B"><enum>(II)</enum><text>controlled substances whose importation is prohibited pursuant to section 401(m) of the Tariff Act of 1930.</text></subclause></clause></subparagraph> <subparagraph id="H9D01492213C743AEB2B3D18B397B193A"><enum>(C)</enum><header>Definition</header><text display-inline="yes-display-inline">For purposes of subparagraph (B), the term <quote>pattern of importing or offering for import articles of drug</quote> means importing or offering for import articles of drug described in subclause (I) or (II) of subparagraph (B)(ii) in an amount, frequency, or dosage that is inconsistent with personal or household use by the importer.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph></subsection></section></subtitle>
<subtitle id="H13909CFB5FF343B4BFA308EA78329BBB"><enum>U</enum><header>Creating Opportunities that Necessitate New and Enhanced Connections That Improve Opioid Navigation Strategies</header>
<section id="HCC33FA0DEE9341A780F670E0900961A1" section-type="subsequent-section"><enum>7201.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Creating Opportunities that Necessitate New and Enhanced Connections That Improve Opioid Navigation Strategies Act of 2018</short-title></quote> or the <quote><short-title>CONNECTIONS Act</short-title></quote>.</text></section> <section id="H9777EA234FAC4E038F4C2198072609AA" section-type="subsequent-section"><enum>7202.</enum><header>Preventing overdoses of controlled substances</header><text display-inline="no-display-inline">Part P of title III of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/280g">42 U.S.C. 280g</external-xref> et seq.) is amended by adding at the end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="HE38903D18A214706A505C8F8ED9375E0" style="OLC">
<section id="HF61733AA33F7476CB1B7C6C05C2E7117"><enum>399V–7.</enum><header>Preventing overdoses of controlled substances</header>
<subsection id="H38882A90AADC425FB687748B2F34371E"><enum>(a)</enum><header>Evidence-Based prevention grants</header>
<paragraph id="H11D8FD6CA0BF4187B740A8F74A32E963"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">The Director of the Centers for Disease Control and Prevention may—</text> <subparagraph id="H32E54149CB6A4289AE9F3F852D86CAB9"><enum>(A)</enum><text>to the extent practicable, carry out any evidence-based prevention activity described in paragraph (2);</text></subparagraph>
<subparagraph id="HB3AF6BFBC66144A7910A7F7434B90BFF"><enum>(B)</enum><text>provide training and technical assistance to States, localities, and Indian tribes for purposes of carrying out any such activity; and</text></subparagraph> <subparagraph id="HC9AC95AF4EEB4E8BAD7A1DE3EE7E7693"><enum>(C)</enum><text>award grants to States, localities, and Indian tribes for purposes of carrying out any such activity.</text></subparagraph></paragraph>
<paragraph id="H16088AB7DB9045B69021E2DAC5A2BAD8"><enum>(2)</enum><header>Evidence-based prevention activities</header><text>An evidence-based prevention activity described in this paragraph is any of the following activities:</text> <subparagraph id="H939B5F54BF8E47A586C99258BF15A35A"><enum>(A)</enum><text>With respect to a State, improving the efficiency and use of the State prescription drug monitoring program by—</text>
<clause id="HE09C5789EA8F4E6C962F8A52C205F40F"><enum>(i)</enum><text>encouraging all authorized users (as specified by the State) to register with and use the program and making the program easier to use;</text></clause> <clause id="HFBA5817778F145AAACB1227BA15DB913"><enum>(ii)</enum><text>enabling such users to access any updates to information collected by the program in as close to real-time as possible;</text></clause>
<clause id="HDEF49D7848C241EB8D74FAB624C06983"><enum>(iii)</enum><text>providing for a mechanism for the program to automatically flag any potential misuse or abuse of controlled substances and any detection of inappropriate prescribing practices relating to such substances;</text></clause> <clause id="H9F8523D95ABA4B80B7B99EB19866DF6A"><enum>(iv)</enum><text>enhancing interoperability between the program and any electronic health records system, including by integrating the use of electronic health records into the program for purposes of improving clinical decisionmaking;</text></clause>
<clause id="H2179DC951BFD4527A9C871C16AFE0E6F"><enum>(v)</enum><text>continually updating program capabilities to respond to technological innovation for purposes of appropriately addressing a controlled substance overdose epidemic as such epidemic may occur and evolve;</text></clause> <clause id="H0BC3168B9C604CEDB20FEAF7FE1F451B"><enum>(vi)</enum><text>facilitating data sharing between the program and the prescription drug monitoring programs of neighboring States; and</text></clause>
<clause commented="no" id="HC54B823107AE4E2D8A9B468FA16898E5"><enum>(vii)</enum><text>meeting the purpose of the program established under section 399O, as described in section 399O(a).</text></clause></subparagraph> <subparagraph id="H73612BF974B349CCA3E9ACE902F9EC7D"><enum>(B)</enum><text>Achieving community or health system interventions through activities such as—</text>
<clause id="H082239D57AF34D0DB49864AEE9304122"><enum>(i)</enum><text>establishing or improving controlled substances prescribing interventions for insurers and health systems;</text></clause> <clause id="H7871A54D3ACF4111A1BF4002AA8A8CA4"><enum>(ii)</enum><text>enhancing the use of evidence-based controlled substances prescribing guidelines across sectors and health care settings; and</text></clause>
<clause id="H135A0D95C72A497193111B4AB86A9AEB"><enum>(iii)</enum><text>implementing strategies to align the prescription of controlled substances with the guidelines described in clause (ii).</text></clause></subparagraph> <subparagraph id="H588134FCED9F4165B7BE131835999558"><enum>(C)</enum><text>Evaluating interventions to better understand what works to prevent overdoses, including those involving prescription and illicit controlled substances.</text></subparagraph>
<subparagraph id="H3165481ED7CB4AD2A2744F2B66C8EBFB"><enum>(D)</enum><text>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.</text></subparagraph></paragraph></subsection> <subsection id="H819EDD1A477345CAAB0562FF9DE66B1B"><enum>(b)</enum><header>Enhanced surveillance of controlled substance overdose grants</header> <paragraph id="H6CF866F51C9C44E7821570D140B6CDD1"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">The Director of the Centers for Disease Control and Prevention may—</text>
<subparagraph id="HA101A71A8A60468CBC9F17EFCFF0404B"><enum>(A)</enum><text>to the extent practicable, carry out any controlled substance overdose surveillance activity described in paragraph (2);</text></subparagraph> <subparagraph display-inline="no-display-inline" id="H6D1F3E089E47421CA2EA54F8BAE702D7"><enum>(B)</enum><text>provide training and technical assistance to States for purposes of carrying out any such activity;</text></subparagraph>
<subparagraph id="H234CEE6BC9AB428EBCDDB2A1C5E591A4"><enum>(C)</enum><text>award grants to States for purposes of carrying out any such activity; and</text></subparagraph> <subparagraph commented="no" id="HCD1E3F66B85344C0994F8D88D3620F02"><enum>(D)</enum><text>coordinate with the Assistant Secretary for Mental Health and Substance Use to collect data pursuant to section 505(d)(1)(A) (relating to the number of individuals admitted to the emergency rooms of hospitals as a result of the abuse of alcohol or other drugs).</text></subparagraph></paragraph>
<paragraph id="H071CB1AD1A484CFF99561B050085F22B"><enum>(2)</enum><header>Controlled substance overdose surveillance activities</header><text>A controlled substance overdose surveillance activity described in this paragraph is any of the following activities:</text> <subparagraph id="HCDCCC4BD563D4A6D8F084A88F9591F3B"><enum>(A)</enum><text>Enhancing the timeliness of reporting data to the public, including data on fatal and nonfatal overdoses of controlled substances.</text></subparagraph>
<subparagraph id="H0EDE6BA30F95456BACE02AD6C6A25A21"><enum>(B)</enum><text>Enhancing comprehensiveness of data on controlled substances overdoses by collecting information on such overdoses from appropriate sources such as toxicology reports, autopsy reports, death scene investigations, and other risk factors.</text></subparagraph> <subparagraph id="HE93F4F95FEC041CD8A15103C8817B98E"><enum>(C)</enum><text>Using data to help identify risk factors associated with controlled substances overdoses.</text></subparagraph>
<subparagraph id="H9A837D09B9164EF293EAA05B26E3B6A5"><enum>(D)</enum><text>With respect to a State, supporting entities involved in providing information to inform efforts within the State, such as by coroners and medical examiners, to improve accurate testing and reporting of causes and contributing factors to controlled substances overdoses.</text></subparagraph> <subparagraph id="HBF5A863E1AB249ACBC2DE95CAE521E30"><enum>(E)</enum><text>Working to enable information sharing regarding controlled substances overdoses among data sources.</text></subparagraph></paragraph></subsection>
<subsection id="HBA4B09ED63A84242A2402EAED7CBD676"><enum>(c)</enum><header>Definitions</header><text>In this section:</text> <paragraph id="H333149BA897B413DBD70D25213BF6DEF"><enum>(1)</enum><header>Controlled substance</header><text>The term <term>controlled substance</term> has the meaning given that term in section 102 of the Controlled Substances Act.</text></paragraph>
<paragraph commented="no" id="HF06AD66430D84EC498E2E3AED9D88FFC"><enum>(2)</enum><header>Indian tribe</header><text>The term <term>Indian tribe</term> has the meaning given that term in section 4 of the Indian Self-Determination and Education Assistance Act.</text></paragraph></subsection> <subsection id="H85D5661DE34845C2B462DEAF935F19FF"><enum>(d)</enum><header>Authorization of appropriations</header><text>For purposes of carrying out this section and section 399O, there is authorized to be appropriated $486,000,000 for each of fiscal years 2019 through 2023.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section id="H7860BAFCFBA74781B908F21DDD68EBBF"><enum>7203.</enum><header>Prescription drug monitoring program</header><text display-inline="no-display-inline">Section 399O of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/280g-3">42 U.S.C. 280g–3</external-xref>) is amended to read as follows:</text> <quoted-block display-inline="no-display-inline" id="HFCDD57CC688D495085932F76968CBADE" style="OLC"> <section id="HABF2895BC3D14047AF488CD7E3A63ADC"><enum>399O.</enum><header>Prescription drug monitoring program</header> <subsection id="H68887971C3FA488D81D6E57E7EF97EC0"><enum>(a)</enum><header>Program</header> <paragraph id="H5F9FD15B9B904400BEFC292DDBB173AA"><enum>(1)</enum><header>In general</header><text>Each fiscal year, the Secretary, in consultation with the Director of National Drug Control Policy, acting through the Director of the Centers for Disease Control and Prevention, the Assistant Secretary for Mental Health and Substance Use, and the National Coordinator for Health Information Technology, shall support States for the purpose of improving the efficiency and use of PDMPs, including—</text>
<subparagraph id="HE30C53398B324793AA5FFB6DF7AD44D4"><enum>(A)</enum><text>establishment and implementation of a PDMP;</text></subparagraph> <subparagraph id="HAB6324BDD1E041D3B0E15A11F71FE454"><enum>(B)</enum><text>maintenance of a PDMP;</text></subparagraph>
<subparagraph id="H1D7F7122FBE14173A1E989354185C077"><enum>(C)</enum><text>improvements to a PDMP by—</text> <clause id="HED253EFFD4E0436599B9B601910C333C"><enum>(i)</enum><text>enhancing functional components to work toward—</text>
<subclause id="H4620FB77ABAE47B18B6D7F4BFC18454F"><enum>(I)</enum><text>universal use of PDMPs among providers and their delegates, to the extent that State laws allow, within a State;</text></subclause> <subclause id="H363C390F7BC342C38AD3D03666B257D5"><enum>(II)</enum><text>more timely inclusion of data within a PDMP;</text></subclause>
<subclause id="HFAD272A802484508BC0ACAC5AEAF0D59"><enum>(III)</enum><text>active management of the PDMP, in part by sending proactive or unsolicited reports to providers to inform prescribing; and</text></subclause> <subclause id="HBC78800769A54CF696F47AD99D408C32"><enum>(IV)</enum><text>ensuring the highest level of ease in use and access of PDMPs by providers and their delegates, to the extent that State laws allow;</text></subclause></clause>
<clause id="H22D79E8B31C743ADBE4D35B84B18563B"><enum>(ii)</enum><text>improving the intrastate interoperability of PDMPs by—</text> <subclause id="HAEADB9D4CFD94F178A61DAA9D6EF6046"><enum>(I)</enum><text>making PDMPs more actionable by integrating PDMPs within electronic health records and health information technology infrastructure; and</text></subclause>
<subclause id="H1A2FCC5AF5E94ADB93F19ACCF65F5C19"><enum>(II)</enum><text>linking PDMP data to other data systems within the State, including—</text> <item id="H2C81FE13AA0E4F369EE400A921A92066"><enum>(aa)</enum><text>the data of pharmacy benefit managers, medical examiners and coroners, and the State’s Medicaid program;</text></item>
<item id="H16D3C87D9330457AA763C1DAB9804277"><enum>(bb)</enum><text>worker’s compensation data; and</text></item> <item id="HAF8145EC7F8D46A580B5DBD0634BA25F"><enum>(cc)</enum><text>prescribing data of providers of the Department of Veterans Affairs and the Indian Health Service within the State;</text></item></subclause></clause>
<clause id="H8A94EDB8D0824FAFAF128EB3112E2716"><enum>(iii)</enum><text>improving the interstate interoperability of PDMPs through—</text> <subclause id="H2CD9944C461C4B079F4A8E8667CAF071"><enum>(I)</enum><text>sharing of dispensing data in near-real time across State lines; and</text></subclause>
<subclause id="H146E4F151A9B4E22AF21D0A10F7E64A7"><enum>(II)</enum><text>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</text></subclause></clause> <clause id="H327FBACCC35842B0A82C86933E558B2F"><enum>(iv)</enum><text>improving the ability to include treatment availability resources and referral capabilities within the PDMP.</text></clause></subparagraph></paragraph>
<paragraph id="H61693EF231104E0986ED486A8C60F124"><enum>(2)</enum><header>State legislation</header><text>As a condition on the receipt of support under this section, the Secretary shall require a State to demonstrate that the State has enacted legislation or regulations—</text> <subparagraph id="HD6F978B77FD7459E961B2384D5EF3DEE"><enum>(A)</enum><text>to provide for the implementation of the PDMP; and</text></subparagraph>
<subparagraph id="HBD7CC7CAA3B544758BD6B52DAC9F03B0"><enum>(B)</enum><text>to permit the imposition of appropriate penalties for the unauthorized use and disclosure of information maintained by the PDMP.</text></subparagraph></paragraph></subsection> <subsection id="H3A76819E7ABF4EDD9836EEDA82E0BD02"><enum>(b)</enum><header>PDMP strategies</header><text>The Secretary shall encourage a State, in establishing, improving, or maintaining a PDMP, to implement strategies that improve—</text>
<paragraph id="H65AE9DA3768B49619E0F0347930F8622"><enum>(1)</enum><text>the reporting of dispensing in the State of a controlled substance to an ultimate user so the reporting occurs not later than 24 hours after the dispensing event;</text></paragraph> <paragraph id="H058C289FC5E146B295F29C2CC9728E53"><enum>(2)</enum><text>the consultation of the PDMP by each prescribing practitioner, or their designee, in the State before initiating treatment with a controlled substance, or any substance as required by the State to be reported to the PDMP, and over the course of ongoing treatment for each prescribing event;</text></paragraph>
<paragraph id="H41F5624F53504CAC8DE21297A05B04D9"><enum>(3)</enum><text>the consultation of the PDMP before dispensing a controlled substance, or any substance as required by the State to be reported to the PDMP;</text></paragraph> <paragraph id="HBAB22852647C47D0B309A3D6FA1C14B7"><enum>(4)</enum><text>the proactive notification to a practitioner when patterns indicative of controlled substance misuse by a patient, including opioid misuse, are detected;</text></paragraph>
<paragraph id="H41E1ABE3C966423191ECB2FFB606D0A2"><enum>(5)</enum><text>the availability of data in the PDMP to other States, as allowable under State law; and</text></paragraph> <paragraph id="H49FBCB338F754783BACA4DFB7B58F75C"><enum>(6)</enum><text>the availability of nonidentifiable information to the Centers for Disease Control and Prevention for surveillance, epidemiology, statistical research, or educational purposes.</text></paragraph></subsection>
<subsection id="HC66F37839AC749FCA9212779606EDA31"><enum>(c)</enum><header>Drug misuse and abuse</header><text>In consultation with practitioners, dispensers, and other relevant and interested stakeholders, a State receiving support under this section—</text> <paragraph id="H6B6C905F7EBD42A2BA90F053B4806AEF"><enum>(1)</enum><text>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; and</text></paragraph>
<paragraph id="H4558A6CC53AB4B2981424E1FE5A2DEC7"><enum>(2)</enum><text>may, to the extent permitted under State law, notify the appropriate authorities responsible for carrying out drug diversion investigations if the State determines that information in the PDMP maintained by the State indicates an unlawful diversion or abuse of a controlled substance.</text></paragraph></subsection> <subsection id="H2B9410D72C25404BB52EE8D4D027930B"><enum>(d)</enum><header>Evaluation and reporting</header><text>As a condition on receipt of support under this section, the State shall report on interoperability 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.</text></subsection>
<subsection id="HC38AA89E14E6426B876274768C87767E"><enum>(e)</enum><header>Evaluation and reporting</header><text>A State receiving support under this section shall provide the Secretary with aggregate nonidentifiable information, as permitted by State law, to enable the Secretary—</text> <paragraph id="H067A2E095A784393B13F1C2CA8B30953"><enum>(1)</enum><text>to evaluate the success of the State’s program in achieving the purpose described in subsection (a); or</text></paragraph>
<paragraph id="H1B8BDA6BCB124B1D9974029A8068D666"><enum>(2)</enum><text>to prepare and submit to the Congress the report required by subsection (i)(2).</text></paragraph></subsection> <subsection id="H4FF7F41525FD408198188A13F84D977B"><enum>(f)</enum><header>Education and access to the monitoring system</header><text>A State receiving support under this section shall take steps to—</text>
<paragraph id="H4751951BF9304AE689DFA5722E8AA394"><enum>(1)</enum><text>facilitate prescribers and dispensers, and their delegates, as permitted by State law, to use the PDMP, to the extent practicable; and</text></paragraph> <paragraph id="HAD7C0F2E73FD42B6B96F314D3E1F23A2"><enum>(2)</enum><text>educate prescribers and dispensers, and their delegates on the benefits of the use of PDMPs.</text></paragraph></subsection>
<subsection id="HA5519C5F01284AECAD3DA34AB962C7C3"><enum>(g)</enum><header>Electronic format</header><text>The Secretary may issue guidelines specifying a uniform electronic format for the reporting, sharing, and disclosure of information pursuant to PDMPs.</text></subsection> <subsection id="H39C092D0EF0E41A1B7CDF524D4F4131A"><enum>(h)</enum><header>Rules of construction</header> <paragraph id="H1265F7E8906745C99BC24345B7FA2F1C"><enum>(1)</enum><header>Functions otherwise authorized by law</header><text>Nothing in this section shall be construed to restrict the ability of any authority, including any local, State, or Federal law enforcement, narcotics control, licensure, disciplinary, or program authority, to perform functions otherwise authorized by law.</text></paragraph>
<paragraph id="HD81B495263174487B98EA86CC6D01C5A"><enum>(2)</enum><header>Additional privacy protections</header><text>Nothing in this section shall be construed as preempting any State from imposing any additional privacy protections.</text></paragraph> <paragraph id="H5BE0C3F6EAF34A99804210F7CEBE2C47"><enum>(3)</enum><header>Federal privacy requirements</header><text>Nothing in this section shall be construed to supersede any Federal privacy or confidentiality requirement, including the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (<external-xref legal-doc="public-law" parsable-cite="pl/104/191">Public Law 104–191</external-xref>; 110 Stat. 2033) and section 543 of this Act.</text></paragraph>
<paragraph id="H027593693F16473686FB6CB6E3E192BE"><enum>(4)</enum><header>No Federal private cause of action</header><text>Nothing in this section shall be construed to create a Federal private cause of action.</text></paragraph></subsection> <subsection id="H73EE2D952B8145F5BE8F606BEA0E112B"><enum>(i)</enum><header>Progress report</header><text>Not later than 3 years after the date of enactment of the CONNECTIONS Act, the Secretary shall—</text>
<paragraph id="HFDCFB4CC1355404881190820FDF5EBAF"><enum>(1)</enum><text>complete a study that—</text> <subparagraph id="H896F0C67362F4C72907DE8410A68C5ED"><enum>(A)</enum><text>determines the progress of States in establishing and implementing PDMPs consistent with this section;</text></subparagraph>
<subparagraph id="H895CE4AB99C14A5FB336104E5B8FDD2A"><enum>(B)</enum><text>provides an analysis of the extent to which the operation of PDMPs has—</text> <clause id="HE11C331AA0894D92AA96A6FA5DEDA8EB"><enum>(i)</enum><text>reduced inappropriate use, abuse, diversion of, and overdose with, controlled substances;</text></clause>
<clause id="H84D051358B90485E9E5278A652BE6A03"><enum>(ii)</enum><text>established or strengthened initiatives to ensure linkages to substance use disorder treatment services; or</text></clause> <clause id="H54C4113DF30F4D5985510A9D8E426B70"><enum>(iii)</enum><text display-inline="yes-display-inline">affected patient access to appropriate care in States operating PDMPs;</text></clause></subparagraph>
<subparagraph id="H99C68D4F46834AC6B4994DE65465EB0B"><enum>(C)</enum><text>determine the progress of States in achieving interstate interoperability and intrastate interoperability of PDMPs, including an assessment of technical, legal, and financial barriers to such progress and recommendations for addressing these barriers;</text></subparagraph> <subparagraph id="H8C3397653DCC4B188CF6DBE7B31D0D06"><enum>(D)</enum><text>determines the progress of States in implementing near real-time electronic PDMPs;</text></subparagraph>
<subparagraph id="HDFD05C76438F45B5AEC3FEEF5CBC98BB"><enum>(E)</enum><text>provides an analysis of the privacy protections in place for the information reported to the PDMP in each State receiving support under this section and any recommendations of the Secretary for additional Federal or State requirements for protection of this information;</text></subparagraph> <subparagraph id="HFB36F403281344A9BD0EA93BCD221F47"><enum>(F)</enum><text>determines the progress of States 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 identifiable data; and</text></subparagraph>
<subparagraph id="H2A7D5690542147F182471D992A9683AC"><enum>(G)</enum><text>evaluates the penalties that States 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</text></subparagraph></paragraph> <paragraph id="H4429E78B24C34F1B916E38B74276E8D0"><enum>(2)</enum><text>submit a report to the Congress on the results of the study.</text></paragraph></subsection>
<subsection id="HCE475E77DF73434890E938BA47201A3B"><enum>(j)</enum><header>Advisory council</header>
<paragraph id="H71B4837CCCF54E7FA4803B9958A6DEA6"><enum>(1)</enum><header>Establishment</header><text>A State may establish an advisory council to assist in the establishment, improvement, or maintenance of a PDMP consistent with this section.</text></paragraph> <paragraph id="HC1634DDFC7884173822CBF14D3C36EBA"><enum>(2)</enum><header>Limitation</header><text>A State may not use Federal funds for the operations of an advisory council to assist in the establishment, improvement, or maintenance of a PDMP.</text></paragraph>
<paragraph id="HCE5AD177E9FA4776B8A4034BA1C8D1B5"><enum>(3)</enum><header>Sense of Congress</header><text display-inline="yes-display-inline">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 should consult with appropriate professional boards and other interested parties.</text></paragraph></subsection> <subsection id="HC4CD345801794B71BE764FB0C60D5510"><enum>(k)</enum><header>Definitions</header><text>For purposes of this section:</text>
<paragraph id="H4469746FE96541DE8AF3225BA3724E7E"><enum>(1)</enum><text>The term <term>controlled substance</term> means a controlled substance (as defined in section 102 of the Controlled Substances Act) in schedule II, III, or IV of section 202 of such Act.</text></paragraph> <paragraph id="HF4135575E9464A488C6950A759245BA7"><enum>(2)</enum><text>The term <term>dispense</term> means to deliver a controlled substance 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.</text></paragraph>
<paragraph id="HFE2B6115F089410D80A61BFD54EC8296"><enum>(3)</enum><text>The term <term>dispenser</term> means a physician, pharmacist, or other person that dispenses a controlled substance to an ultimate user.</text></paragraph> <paragraph id="H9DC43331573F43229A36AF1289880936"><enum>(4)</enum><text>The term <term>interstate interoperability</term> with respect to a PDMP means the ability of the PDMP to electronically share reported information with another State if the information concerns 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.</text></paragraph>
<paragraph id="H914B04D35CF142A4A157237DF7532C52"><enum>(5)</enum><text display-inline="yes-display-inline">The term <term>intrastate interoperability</term> 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.</text></paragraph> <paragraph id="H6CE49B172CBA4FDA876476937D324551"><enum>(6)</enum><text>The term <term>nonidentifiable information</term> means information that does not identify a practitioner, dispenser, or an ultimate user and with respect to which there is no reasonable basis to believe that the information can be used to identify a practitioner, dispenser, or an ultimate user.</text></paragraph>
<paragraph id="H999F6F87EC8649828F0A47BDF2A548F2"><enum>(7)</enum><text>The term <term>PDMP</term> means a prescription drug monitoring program that is State-controlled.</text></paragraph> <paragraph id="H4970E1DCB7E64D03A0BBD58334E01637"><enum>(8)</enum><text>The term <term>practitioner</term> 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 professional practice or research.</text></paragraph>
<paragraph id="H092B806E8E6744E79FB8C455B78C53EE"><enum>(9)</enum><text>The term <term>State</term> means each of the 50 States, the District of Columbia, and any commonwealth or territory of the United States.</text></paragraph> <paragraph id="H1B404C5B58FF4AD7AF371095CFEA4822"><enum>(10)</enum><text>The term <term>ultimate user</term> 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.</text></paragraph>
<paragraph id="H58C072E803AA49FEB85E56FADDB3927D"><enum>(11)</enum><text>The term <term>clinical workflow</term> 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.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section></subtitle> <subtitle id="H7F1C8C3CE61E45B78EB3FB6EB8792F6B"><enum>V</enum><header>Securing Opioids and Unused Narcotics with Deliberate Disposal and Packaging</header> <section id="H439BB3F972DB43D588EF735EB12A7A0A" section-type="subsequent-section"><enum>7211.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Securing Opioids and Unused Narcotics with Deliberate Disposal and Packaging Act of 2018</short-title></quote> or the <quote><short-title>SOUND Disposal and Packaging Act</short-title></quote>.</text></section>
<section id="HC4BE5496CBD64F6F92A3E0ED2E7E29A7" section-type="subsequent-section"><enum>7212.</enum><header>Improved technologies, controls, or measures with respect to the packaging or disposal of certain drugs</header>
<subsection id="HEE14E47F4F0747B8BB5C1F8D170F77FF"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Chapter V of the Federal Food, Drug, and Cosmetic Act is amended by inserting after section 505–1 (<external-xref legal-doc="usc" parsable-cite="usc/21/355-1">21 U.S.C. 355–1</external-xref>) the following new section:</text> <quoted-block display-inline="no-display-inline" id="H94310AA5A7CE40DB880B27E26703D20D" style="OLC"> <section id="HAF679F23BACE4CC195A6A9F071AE6876"><enum>505–2.</enum><header>Safety-enhancing packaging and disposal features</header> <subsection id="H53BCC83EC2714E5EAAE6C67D28D9E452"><enum>(a)</enum><header>Orders</header> <paragraph id="HA4F7616626E14304A2A93391DA937505"><enum>(1)</enum><header>In general</header><text>The Secretary may issue an order requiring the holder of a covered application to implement or modify one or more technologies, controls, or measures with respect to the packaging or disposal of one or more drugs identified in the covered application, if the Secretary determines such technologies, controls, or measures to be appropriate to help mitigate the risk of abuse or misuse of such drug or drugs, which may include by reducing the availability of unused drugs.</text></paragraph>
<paragraph id="HF28B51FEB9AF4B149651D2D1AFA91761"><enum>(2)</enum><header>Prior consultation</header><text>The Secretary may not issue an order under paragraph (1) unless the Secretary has consulted with relevant stakeholders, through a public meeting, workshop, or otherwise, about matters that are relevant to the subject of the order.</text></paragraph> <paragraph commented="no" id="HD9024BA173A7437DBBA374831300A09A"><enum>(3)</enum><header>Assuring access and minimizing burden</header><text display-inline="yes-display-inline">Technologies, controls, or measures required under paragraph (1) shall—</text>
<subparagraph commented="no" id="H8862E77A3EBD4377BC4EB766A58BCFC2"><enum>(A)</enum><text display-inline="yes-display-inline">be commensurate with the specific risk of abuse or misuse of the drug listed in the covered application;</text></subparagraph> <subparagraph commented="no" id="HA55E97EEA9CC4D10A6186FE540BBF8AF"><enum>(B)</enum><text>considering such risk, not be unduly burdensome on patient access to the drug, considering in particular any available evidence regarding the expected or demonstrated public health impact of such technologies, controls, or measures; and</text></subparagraph>
<subparagraph commented="no" id="HFECF6B991443490E90A11FB200FC3F89"><enum>(C)</enum><text>reduce the risk of abuse or misuse of such drug.</text></subparagraph></paragraph> <paragraph id="HCD0DF394DEBB4B50BA051A3FFF376FC5"><enum>(4)</enum><header>Order contents</header><text>An order issued under paragraph (1) may—</text>
<subparagraph id="H0D44F1D504CB448CB8A4EEC25FDE5B20"><enum>(A)</enum><text>provide for a range of options for implementing or modifying the technologies, controls, or measures required to be implemented by such order; and</text></subparagraph> <subparagraph id="HEB4AE67D984948CBA33473C21C8857CD"><enum>(B)</enum><text>incorporate by reference standards regarding packaging or disposal set forth in an official compendium, established by a nationally or internationally recognized standard development organization, or described on the public website of the Food and Drug Administration, so long as the order includes the rationale for incorporation of such standard.</text></subparagraph></paragraph>
<paragraph id="H64A4D74A9AF84A1C91ECAE9044937A0A"><enum>(5)</enum><header>Orders applicable to drug class</header><text>When a concern about the risk of abuse or misuse of a drug relates to a pharmacological class, the Secretary may, after consultation with relevant stakeholders, issue an order under paragraph (1) which applies to the pharmacological class.</text></paragraph></subsection> <subsection id="HBB3F9B67234D4A0E9CCB6132850DC7B2"><enum>(b)</enum><header>Compliance</header><text display-inline="yes-display-inline">The holder of a covered application shall—</text>
<paragraph id="HD8A78BE2306D4D85B9C2F6F424146AA2"><enum>(1)</enum><text display-inline="yes-display-inline">submit a supplement containing proposed changes to the covered application to comply with an order issued under subsection (a) not later than—</text> <subparagraph id="H11AE679FE020428ABAE5D97C9FDF0C8F"><enum>(A)</enum><text>180 calendar days after the date on which the order is issued; or</text></subparagraph>
<subparagraph id="H343DD1743D714AF68B7AE513412BF99E"><enum>(B)</enum>
<clause commented="no" display-inline="yes-display-inline" id="HFF7DF53328A04CEDBC5481AE84DF946D"><enum>(i)</enum><text>such longer time period as specified by the Secretary in such order; or</text></clause> <clause commented="no" id="HA689FBF6455946AD896969155D9870CE" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">if a request for an alternative date is submitted by the holder of such application not later than 60 calendar days after the date on which such order is issued—</text>
<subclause commented="no" id="H1D1AF1BB234F4CE89EE6E7BA47AEF84F"><enum>(I)</enum><text>such requested alternative date if agreed to by the Secretary; or</text></subclause> <subclause commented="no" id="HB307B15D4A0A4BD99D8FE3503851B6B7"><enum>(II)</enum><text>another date as specified by the Secretary; and</text></subclause></clause></subparagraph></paragraph>
<paragraph id="H21FD99D485954CD1AC6C5C942D49B43F"><enum>(2)</enum><text>implement the changes approved pursuant to such supplement not later than the later of—</text> <subparagraph id="HB4578885331147DABF019754373C32BE"><enum>(A)</enum><text>90 calendar days after the date on which the supplement is approved; or</text></subparagraph>
<subparagraph id="H594DA95593B04695B52EA542BF6F1A29"><enum>(B)</enum><text>the end of such longer period as is—</text> <clause id="H98CAEB2F0FF342CA99E6D613461ED756"><enum>(i)</enum><text>determined to be appropriate by the Secretary; or</text></clause>
<clause id="HF49340882639455091A02F921164D196"><enum>(ii)</enum><text display-inline="yes-display-inline">approved by the Secretary pursuant to a request by the holder of the covered application that explains why such longer period is needed, including to satisfy any other applicable Federal statutory or regulatory requirements.</text></clause></subparagraph></paragraph></subsection> <subsection id="H9A8E7C4B49E641DE8699A17ED000EB5A"><enum>(c)</enum><header>Alternative measures</header><text display-inline="yes-display-inline">The holder of the covered application may propose, and the Secretary shall approve, technologies, controls, or measures regarding packaging, storage, or disposal other than those specified in the applicable order issued under subsection (a), if such technologies, controls, or measures are supported by data and information demonstrating that such alternative technologies, controls, or measures can be expected to mitigate the risk of abuse or misuse of the drug or drugs involved, including by reducing the availability of unused drugs, to at least the same extent as the technologies, controls, or measures specified in such order.</text></subsection>
<subsection id="H4D567825F41044E7B93E5EF33CD1D0A8"><enum>(d)</enum><header>Dispute resolution</header><text display-inline="yes-display-inline">If a dispute arises in connection with a supplement submitted under subsection (b), the holder of the covered application may appeal a determination made with respect to such supplement using applicable dispute resolution procedures specified by the Secretary in regulations or guidance.</text></subsection> <subsection id="H1DB5FDD3EC094AE8BBD5DFDB398AFB08"><enum>(e)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section—</text>
<paragraph id="H2A1DDC3CEE5A4B9591C94131CDA5D24C"><enum>(1)</enum><text>the term <term>covered application</term> means an application submitted under subsection (b) or (j) of section 505 for approval under such section or an application submitted under section 351 of Public Health Service Act for approval under such section, with respect to a drug that is or contains an opioid for which a listing in schedule II or III (on a temporary or permanent basis) is in effect under section 202 of the Controlled Substances Act; and</text></paragraph> <paragraph id="H5E7E876B974043C8BBC3F619F32E71D4"><enum>(2)</enum><text display-inline="yes-display-inline">the term <term>relevant stakeholders</term> may include scientific experts within the drug manufacturing industry; brand and generic drug manufacturers; standard development organizations; wholesalers and distributors; payers; health care providers; pharmacists; pharmacies; manufacturers; poison centers; and representatives of the National Institute on Drug Abuse, the National Institutes of Health, the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, the Drug Enforcement Agency, the Consumer Product Safety Commission, individuals who specialize in treating addiction, and patient and caregiver groups.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H8A348EA6482742358570B36A94351A63"><enum>(b)</enum><header>Prohibited acts</header><text>Section 501 of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/351">21 U.S.C. 351</external-xref>) is amended by inserting after paragraph (j) the following:</text> <quoted-block display-inline="no-display-inline" id="HABE286E879284AEEA95E4E8A45C138C9" style="OLC"> <subsection id="H831E9425208B43AFA988F9C88DC33861"><enum>(k)</enum><text display-inline="yes-display-inline">If it is a drug approved under a covered application (as defined in section 505–2(e)), the holder of which does not meet the requirements of paragraphs (1) and (2) of subsection (b) of such section.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H748CA29D2AC94CAAA8443BA856944901"><enum>(c)</enum><header>Required content of an abbreviated new drug application</header><text display-inline="yes-display-inline">Section 505(j)(2)(A) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355(j)(2)(A)</external-xref>) is amended—</text> <paragraph id="HC2E48191A06A4A31A377CDCC556D0AE4"><enum>(1)</enum><text>in clause (vii)(IV), by striking <quote>and</quote> at the end;</text></paragraph>
<paragraph id="H6B145391F05E41EA8987FE53F2B14A03"><enum>(2)</enum><text>in clause (viii), by striking the period at the end and inserting <quote>; and</quote>; and</text></paragraph> <paragraph id="H28C77760F38140AE9495D8C51137AFF6"><enum>(3)</enum><text>by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H7F7D300002C949DC9D0F6A853F6F71A3" style="OLC">
<clause id="H7044E559C3E74E119233FE8B26898064" indent="up2"><enum>(ix)</enum><text display-inline="yes-display-inline">if the drug is or contains an opioid for which a listing in schedule II or III (on a temporary or permanent basis) is in effect under section 202 of the Controlled Substances Act, information to show that the applicant has proposed technologies, controls, or measures related to the packaging or disposal of the drug that provide protections comparable to those provided by the technologies, controls, or measures required for the applicable listed drug under section 505–2, if applicable.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> <subsection id="HF120CE050FA241009768D6AE4F6A7A6A"><enum>(d)</enum><header>Grounds for refusing To approve an abbreviated new drug application</header><text display-inline="yes-display-inline">Section 505(j)(4) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355(j)(4)</external-xref>), is amended—</text>
<paragraph id="HB36102985E15438D971EB93F84373815"><enum>(1)</enum><text>in subparagraph (J), by striking <quote>or</quote> at the end;</text></paragraph> <paragraph id="HC1B134C82EDC4DC49C520FD84FF11B56"><enum>(2)</enum><text>in subparagraph (K), by striking the period at the end and inserting <quote>; or</quote>; and</text></paragraph>
<paragraph id="H48296BDDE51A4FD1A0B7C0F5BE404292"><enum>(3)</enum><text>by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="HA494ACC1D867450CA107850A982CEFE1" style="OLC"> <subparagraph id="HE4161D84A00049EEAF33C4AC688EB122"><enum>(L)</enum><text display-inline="yes-display-inline">if the drug is a drug described in paragraph (2)(A)(ix) and the applicant has not proposed technologies, controls, or measures related to the packaging or disposal of such drug that the Secretary determines provide protections comparable to those provided by the technologies, controls, or measures required for the applicable listed drug under section 505–2.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection>
<subsection id="H06F881EB1F8F4E9E861071D3A93683CA"><enum>(e)</enum><header>Rules of construction</header>
<paragraph id="HAB7210339CD04989A4EC205C0FD02468"><enum>(1)</enum><text>Any labeling describing technologies, controls, or measures related to packaging or disposal intended to mitigate the risk of abuse or misuse of a drug product that is subject to an abbreviated new drug application, including labeling describing differences from the reference listed drug resulting from the application of section 505–2 of the Federal Food, Drug, and Cosmetic Act, as added by subsection (a), shall not be construed—</text> <subparagraph id="H3F73D7BBE89D425BA15D9554DE78866D"><enum>(A)</enum><text>as changes to labeling not permissible under clause (v) of section 505(j)(2)(A) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355(j)(2)(A)</external-xref>), or a change in the conditions of use prescribed, recommended, or suggested in the labeling proposed for the new drug under clause (i) of such section; or</text></subparagraph>
<subparagraph id="H74C3B2F255944BEFA1489406537DC6AE"><enum>(B)</enum><text>to preclude approval of an abbreviated new drug application under subparagraph (B) or (G) of section 505(j)(4) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355(j)(4)</external-xref>).</text></subparagraph></paragraph> <paragraph id="H28F08194FBD34D9F93EF0BA614E28F5B"><enum>(2)</enum><text>For a covered application that is an application submitted under subsection (j) of section 505 of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355</external-xref>), subsection (j)(2)(A) of such section 505 shall not be construed to limit the type of data or information the Secretary of Health and Human Services may request or consider in connection with making any determination under section 505–2.</text></paragraph></subsection>
<subsection id="H2E60620DF7FD46759BABAA81EB1062AD"><enum>(f)</enum><header>GAO report</header><text>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 the Congress a report containing—</text> <paragraph id="H0C1AA14D7C1449C7B71B6602CA4F7458"><enum>(1)</enum><text>a description of available evidence, if any, on the effectiveness of site-of-use, in-home controlled substance disposal products and packaging technologies;</text></paragraph>
<paragraph id="HED7437DB97C945C38C677ADA3325648D"><enum>(2)</enum><text>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, are made available to the public and barriers to the use of such disposal products;</text></paragraph> <paragraph id="H36C78DA35AF540D5A25379936803AD85"><enum>(3)</enum><text>identification of ways in which packaging technologies are made available to the public and barriers to the use of such technologies;</text></paragraph>
<paragraph id="HC1B9E0DA9BE6431C8A456E35ACE4D4F6"><enum>(4)</enum><text>a description of Federal oversight, if any, of site-of-use, in-home controlled substance disposal products, including—</text> <subparagraph id="HF92A7AE13B5C4E1C8698696EE5CB1280"><enum>(A)</enum><text>identification of the Federal agencies that oversee such products;</text></subparagraph>
<subparagraph id="H9CB98E81FFC549F4807073D839007892"><enum>(B)</enum><text>identification of the methods of disposal of controlled substances recommended by these agencies for site-of-use, in-home disposal; and</text></subparagraph> <subparagraph id="H69D319F2DA2A4E9580FD7490C7E33D5B"><enum>(C)</enum><text>a description of the effectiveness of such recommendations at preventing the diversion of legally prescribed controlled substances;</text></subparagraph></paragraph>
<paragraph id="H35E68DE01F48476DA32F2FC71CCBF123"><enum>(5)</enum><text>a description of Federal oversight, if any, of controlled substance packaging technologies, including—</text> <subparagraph id="H738F13F86F24422DBDB85578DC2FF80C"><enum>(A)</enum><text>identification of the Federal agencies that oversee such technologies;</text></subparagraph>
<subparagraph id="HC9A45F6B7275490EB24E1FCA0ECD4E13"><enum>(B)</enum><text>identification of the technologies recommended by these agencies, including unit dose packaging, packaging that provides a set duration, or other packaging systems that may mitigate abuse or misuse; and</text></subparagraph> <subparagraph id="HDC61E8CD81AD4BFB81670B363A6797CE"><enum>(C)</enum><text>a description of the effectiveness of such recommendations at preventing the diversion of legally prescribed controlled substances; and</text></subparagraph></paragraph>
<paragraph id="HC6FF8825E7F4493891F18F15F476FB88"><enum>(6)</enum><text>recommendations on—</text> <subparagraph id="HE3F32232E172409AA460553C42AED8C2"><enum>(A)</enum><text>whether site-of-use, in-home controlled substance disposal products and packaging technologies require Federal oversight and, if so, which agencies should be responsible for such oversight and, as applicable, approval of such products or technologies; and</text></subparagraph>
<subparagraph id="H3CAAD52F31E34B2FAF6ACA910B727EAD"><enum>(B)</enum><text>the potential role of the Federal Government in evaluating such products to ensure product efficacy.</text></subparagraph></paragraph></subsection></section></subtitle> <subtitle id="H0B89797AC1C146749E85D6F2C2F85CA0"><enum>W</enum><header>Postapproval study requirements</header> <section id="HC856DFCBEC114A7E937F82FCE2D5ABD5" section-type="subsequent-section"><enum>7221.</enum><header>Postapproval study requirements</header> <subsection id="HEF988DE7921444C9BD124C213867E859"><enum>(a)</enum><header>Purposes of study</header><text display-inline="yes-display-inline">Section 505(o)(3)(B) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355(o)(3)(B)</external-xref>) is amended by adding at the end the following:</text>
<quoted-block style="OLC" id="H56EC967EA4ED428DAF3E0445189F6DDA" display-inline="no-display-inline">
<clause id="H001A4E65056C43289CB864452694056A" commented="no"><enum>(iv)</enum><text display-inline="yes-display-inline">To assess a potential reduction in effectiveness of the drug for the conditions of use prescribed, recommended, or suggested in the labeling thereof if—</text> <subclause id="H0FB20B2FBADF493BB3AE3030B99172A8" commented="no"><enum>(I)</enum><text display-inline="yes-display-inline">the drug involved—</text>
<item id="HD86FFA0153F244208591C83B4B110F61" commented="no"><enum>(aa)</enum><text>is or contains a substance for which a listing in any schedule is in effect (on a temporary or permanent basis) under section 201 of the Controlled Substances Act; or</text></item> <item id="HB0F627AB6A9947258611E64273FF6D5F" commented="no"><enum>(bb)</enum><text>is a drug that has not been approved under this section or licensed under section 351 of the Public Health Service Act, for which an application for such approval or licensure is pending or anticipated, and for which the Secretary provides notice to the sponsor that the Secretary intends to issue a scientific and medical evaluation and recommend controls under the Controlled Substances Act; and</text></item></subclause>
<subclause id="H8389F6F9DAA34DFE91068C021DCC47E1" commented="no"><enum>(II)</enum><text display-inline="yes-display-inline">the potential reduction in effectiveness could result in the benefits of the drug no longer outweighing the risks.</text></subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="HC4ACE2AEA9384DB0B8C71896B35B00BA"><enum>(b)</enum><header>Establishment of requirement</header><text display-inline="yes-display-inline">Section 505(o)(3)(C) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355(o)(3)(C)</external-xref>) is amended by striking <quote>such requirement</quote> and all that follows through <quote>safety information.</quote> and inserting the following: </text>
<quoted-block style="OLC" id="HD32E2C92ED1F432D87FDA67544481C65" display-inline="yes-display-inline"><text display-inline="yes-display-inline">such requirement—</text> <clause id="H3B7731CC7EA941F5AED21ED2458C1704"><enum>(i)</enum><text display-inline="yes-display-inline">in the case of a purpose described in clause (i), (ii), or (iii) of subparagraph (B), only if the Secretary becomes aware of new safety information; and</text></clause>
<clause id="HDCADE23F3F5C4DAEBB8DBC3AC4B5AFD2"><enum>(ii)</enum><text display-inline="yes-display-inline">in the case of a purpose described in clause (iv) of such subparagraph, if the Secretary determines that new effectiveness information exists.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="H68DDBD1632814E73BCE549BEACD35590"><enum>(c)</enum><header>Applicability</header><text display-inline="yes-display-inline">Section 505(o)(3) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355(o)(3)</external-xref>) is amended by adding at the end the following new subparagraph: </text>
<quoted-block style="OLC" id="HB63AEF0EDBDF4DC99A50763A632241F9" display-inline="no-display-inline">
<subparagraph id="HFCEFD378F2F24C18AA47F5317B56DB21"><enum>(G)</enum><header>Applicability</header><text display-inline="yes-display-inline">The conduct of a study or clinical trial required pursuant to this paragraph for the purpose specified in subparagraph (B)(iv) shall not be considered a new clinical investigation for the purpose of a period of exclusivity under clause (iii) or (iv) of subsection (c)(3)(E) or clause (iii) or (iv) of subsection (j)(5)(F).</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="HA717AFC9763C48E088C3D9360B177DB9"><enum>(d)</enum><header>New effectiveness information defined</header><text display-inline="yes-display-inline">Section 505(o)(2) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355(o)(2)</external-xref>) is amended by adding at the end the following new subparagraph: </text>
<quoted-block style="OLC" id="H57F61EB8F5AD4659A8B1CC2D8D16D40F" display-inline="no-display-inline">
<subparagraph id="H18225338BC914B99A83AE4127F1EBAF2"><enum>(D)</enum><header>New effectiveness information</header><text display-inline="yes-display-inline">The term <term>new effectiveness information</term>, with respect to a drug that is or contains a controlled substance for which a listing in any schedule is in effect (on a temporary or permanent basis) under section 201 of the Controlled Substances Act, means new information about the effectiveness of the drug, including a new analysis of existing information, derived from—</text> <clause id="H16ED29E10CCC4EF2B3946F4C8E62CFAE"><enum>(i)</enum><text>a clinical trial; an adverse event report; a postapproval study or clinical trial (including a study or clinical trial under paragraph (3));</text></clause>
<clause id="HA5A321C906E5449594921D3EE4E31FE3"><enum>(ii)</enum><text>peer-reviewed biomedical literature;</text></clause> <clause id="H40089BB737CA46E08497FBE58BA280DF"><enum>(iii)</enum><text>data derived from the postmarket risk identification and analysis system under subsection (k); or</text></clause>
<clause id="HCB3D15C505174BA18B9225AD83A19528"><enum>(iv)</enum><text>other scientific data determined to be appropriate by the Secretary.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="HA1127C7EA03D441FBF053EED1C24CC20"><enum>(e)</enum><header>Conforming amendments with respect to labeling changes</header><text display-inline="yes-display-inline">Section 505(o)(4) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355(o)(4)</external-xref>) is amended—</text>
<paragraph id="H9012F8F6BE814CAAB6F73992B63AD05C"><enum>(1)</enum><text>in subparagraph (A)—</text> <subparagraph id="H126FD9CF72D54D4C99BD6E9AEF106B1B"><enum>(A)</enum><text>in the heading, by inserting <quote><header-in-text level="subparagraph" style="OLC">or new effectiveness</header-in-text></quote> after <quote><header-in-text level="subparagraph" style="OLC">safety</header-in-text></quote>;</text></subparagraph>
<subparagraph id="H8B1489C82F6541B88CDF8695BA1BFB44"><enum>(B)</enum><text>by striking <quote>safety information</quote> and inserting <quote>new safety information or new effectiveness information such</quote>; and</text></subparagraph> <subparagraph id="H675ACFBF352948EEB25BBDD48A07EBA2"><enum>(C)</enum><text>by striking <quote>believes should be</quote> and inserting <quote>believes changes should be made to</quote>;</text></subparagraph></paragraph>
<paragraph id="HF586BB36509D49269E2C38D1E3E21E7C"><enum>(2)</enum><text display-inline="yes-display-inline">in subparagraph (B)(i)—</text> <subparagraph id="H03F3B7FF13184DD386868AABCF8F7039"><enum>(A)</enum><text>by striking <quote>new safety information</quote> and by inserting <quote>new safety information or new effectiveness information</quote>; and</text></subparagraph>
<subparagraph id="H0AAA485212E64F71940C69C36679DCED"><enum>(B)</enum><text>by inserting <quote>indications,</quote> after <quote>boxed warnings,</quote>;</text></subparagraph></paragraph> <paragraph id="H39F12956DCC44110A7686B9BC8772555"><enum>(3)</enum><text>in subparagraph (C), by inserting <quote>or new effectiveness information</quote> after <quote>safety information</quote>; and</text></paragraph>
<paragraph id="H64DCD93DFD1446BBBE0A4D827218D3B4"><enum>(4)</enum><text display-inline="yes-display-inline">in subparagraph (E), by inserting <quote>or new effectiveness information</quote> after <quote>safety information</quote>.</text></paragraph></subsection> <subsection id="H582786E8DE4143D2AD7378EAE4A83A85"><enum>(f)</enum><header>Rule of construction</header><text display-inline="yes-display-inline">Nothing in the amendments made by this section shall be construed to alter, in any manner, the meaning or application of the provisions of paragraph (3) of section 505(o) of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355(o)</external-xref>) with respect to the authority of the Secretary of Health and Human Services to require a postapproval study or clinical trial for a purpose specified in clauses (i) through (iii) of subparagraph (B) of such paragraph (3) or paragraph (4) of such section 505(o) with respect to the Secretary’s authority to require safety labeling changes. <italic></italic></text></subsection></section></subtitle>
<enum>VIII</enum><header>Miscellaneous</header>
<subtitle id="HEF43D8C9F5664CD7A53BE1EDC808B4A7"><enum>A</enum><header>Synthetics Trafficking and Overdose Prevention</header>
<section id="H33FF907AB090426AA79FDA2AC652FD83" section-type="subsequent-section"><enum>8001.</enum><header>Short title; table of contents</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Synthetics Trafficking and Overdose Prevention Act of 2018</short-title></quote> or <quote>STOP Act of 2018</quote>.</text></section> <section id="H0DDB0229DC9C4DE0B4CB7A7F9C1AF8B5"><enum>8002.</enum><header>Customs fees</header> <subsection id="H4C5DB10D60B84F7AB1E3B3E389313AB2"><enum>(a)</enum><header>In general</header><text>Section 13031(b)(9) of the Consolidated Omnibus Budget Reconciliation Act of 1985 (<external-xref legal-doc="usc" parsable-cite="usc/19/58c">19 U.S.C. 58c(b)(9)</external-xref>) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H3C276374D19340F4B71FE60B6D3CACA6" style="OLC">
<subparagraph id="H252B7E3C77D44BD9A14DF7C5D839463D" indent="up1"><enum>(D)</enum>
<clause commented="no" display-inline="yes-display-inline" id="H01E0B85EC4AE40FD83EDF7E5A5B6241D"><enum>(i)</enum><text>With respect to the processing of items that are sent to the United States through the international postal network by <quote>Inbound Express Mail service</quote> or <quote>Inbound EMS</quote> (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:</text> <subclause id="H40F4E22132B043FBA8BF2D50266B2708" indent="up1"><enum>(I)</enum><text>$1 per Inbound EMS item.</text></subclause>
<subclause id="H62FAF336979B4F5E8A6779A98927331F" indent="up1"><enum>(II)</enum><text>If an Inbound EMS item is formally entered, the fee provided for under subsection (a)(9), if applicable.</text></subclause></clause> <clause id="H5B7467809A6A431887359AC93AA858F2" indent="up1"><enum>(ii)</enum><text>Notwithstanding section 451 of the Tariff Act of 1930 (<external-xref legal-doc="usc" parsable-cite="usc/19/1451">19 U.S.C. 1451</external-xref>), the payments required by clause (i), as allocated pursuant to clause (iii)(I), shall be the only payments required for reimbursement of U.S. Customs and Border Protection for customs services provided in connection with the processing of an Inbound EMS item.</text></clause>
<clause id="HC027063F17DE4B1DB3CC62E91E15F788" indent="up1"><enum>(iii)</enum>
<subclause commented="no" display-inline="yes-display-inline" id="HAD3B5FDC903F4798B49E95CDBA0287A8"><enum>(I)</enum><text display-inline="yes-display-inline">The payments required by clause (i)(I) shall be allocated as follows:</text> <item id="HA43C89CC882345E086D8ABB2D8B4EC3A" indent="up1"><enum>(aa)</enum><text>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.</text></item>
<item id="HBC06D716B44546A7925011F0A59A27DD" indent="up1"><enum>(bb)</enum><text>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.</text></item></subclause> <subclause id="HEE6E5E7932D448E481C44D8CC6687C59" indent="up1"><enum>(II)</enum><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/19/1524">19 U.S.C. 1524</external-xref>), be deposited in the Customs User Fee Account and used to directly 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.</text></subclause>
<subclause id="H920F570517364EE19D157501160CB4F7" indent="up1"><enum>(III)</enum><text>Payments retained by the Postal Service under subclause (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.</text></subclause></clause> <clause id="HC4816E121B1B4D1F916376CA010EDFF4" indent="up1"><enum>(iv)</enum><text>Beginning in fiscal year 2021, the Secretary, in consultation 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.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H71A57779DF7A45BD811AB808308498E1"><enum>(b)</enum><header>Conforming amendments</header><text>Section 13031(a) of the Consolidated Omnibus Budget Reconciliation Act of 1985 (<external-xref legal-doc="usc" parsable-cite="usc/19/58c">19 U.S.C. 58c(a)</external-xref>) is amended—</text> <paragraph commented="no" display-inline="no-display-inline" id="HBCF82F36996048BA9813E983AFAF3B4A"><enum>(1)</enum><text display-inline="yes-display-inline">in paragraph (6), by inserting <quote>(other than an item subject to a fee under subsection (b)(9)(D))</quote> after <quote>customs officer</quote>; and</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H2C5186AC1E214753A9D9E7655D102CFC"><enum>(2)</enum><text>in paragraph (10)—</text> <subparagraph id="H88B4A4F3433C46DE8037787E38C78ECC"><enum>(A)</enum><text>in subparagraph (C), in the matter preceding clause (i), by inserting <quote>(other than Inbound EMS items described in subsection (b)(9)(D))</quote> after <quote>release</quote>; and</text></subparagraph>
<subparagraph id="HFB20C2742BFC4DEFAEF73F70B435AE44"><enum>(B)</enum><text>in the flush at the end, by inserting <quote>or of Inbound EMS items described in subsection (b)(9)(D),</quote> after <quote>(C),</quote>.</text></subparagraph></paragraph></subsection> <subsection id="HFA4AFDCAFFDC4AA689909BA795D34CE3"><enum>(c)</enum><header>Effective date</header><text>The amendments made by this section shall take effect on January 1, 2020.</text></subsection></section>
<section id="H9F2D60B0A8A843BEBC9D1C3D33BFFEF3"><enum>8003.</enum><header>Mandatory advance electronic information for postal shipments</header>
<subsection id="H35F52912A10E4072B78B6B0BB3D51A81"><enum>(a)</enum><header>Mandatory advance electronic information</header>
<paragraph id="HF8337F42281D43E2B0A34A2C6A427F8A"><enum>(1)</enum><header>In general</header><text>Section 343(a)(3)(K) of the Trade Act of 2002 (<external-xref legal-doc="public-law" parsable-cite="pl/107/210">Public Law 107–210</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/19/2071">19 U.S.C. 2071</external-xref> note) is amended to read as follows:</text> <quoted-block display-inline="no-display-inline" id="HD9AD55F09F13472FBCD49C20032A3132" style="OLC"> <subparagraph id="HF40C5DF8A4FC47BAA45B65960EC6A512"><enum>(K)</enum> <clause commented="no" display-inline="yes-display-inline" id="H81C257BAF842402CB8DAB55C2F79FF73"><enum>(i)</enum><text>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.</text></clause>
<clause id="H3C272C72F5E94393AF815D1DED4FA876" indent="up1"><enum>(ii)</enum><text>In prescribing regulations under clause (i), the Secretary shall impose requirements for the transmission to the Commissioner of information described in paragraphs (1) and (2) for mail shipments described in clause (i) that are comparable to the requirements for the transmission of such information imposed on similar non-mail shipments of cargo, taking into account the parameters set forth in subparagraphs (A) through (J).</text></clause> <clause commented="no" display-inline="no-display-inline" id="HE06AC9CC206E48DAA2FF8319D6FC1055" indent="up1"><enum>(iii)</enum><text display-inline="yes-display-inline">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 as practicable in relation to the transportation of the shipment, consistent with subparagraph (H).</text></clause>
<clause id="HD341CD12A7E94A93ABE4CCEA66F5B08C" indent="up1"><enum>(iv)</enum><text>Regulations prescribed under clause (i) shall allow for the requirements for the transmission to the Commissioner of information described in paragraphs (1) and (2) for mail shipments described in clause (i) to be implemented in phases, as appropriate, by—</text> <subclause id="HAD91A0BE811A44A6A4E05253CE65E6B3"><enum>(I)</enum><text>setting incremental targets for increasing the percentage of such shipments for which information is required to be transmitted to the Commissioner; and</text></subclause>
<subclause id="HE340E5DC9887464197B8966573F9138C"><enum>(II)</enum><text>taking into consideration—</text> <item id="H8860AED4D49040DF81A6FA025E8FFC98"><enum>(aa)</enum><text>the risk posed by such shipments;</text></item>
<item id="HA7D0461267A04E80B383F491B64B053E"><enum>(bb)</enum><text>the volume of mail shipped to the United States by or through a particular country; and</text></item> <item id="HCDBE0EF37949499A990E953E1C8E4DAF"><enum>(cc)</enum><text>the capacities of foreign postal operators to provide that information to the Postal Service.</text></item></subclause></clause>
<clause id="H87149F3C76F6491B8F6127055CF39F29" indent="up1"><enum>(v)</enum>
<subclause commented="no" display-inline="yes-display-inline" id="H027CA0D8D6124DA4B93972AA744A84CB"><enum>(I)</enum><text display-inline="yes-display-inline">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).</text></subclause> <subclause id="HB55A8A0475F54057BF5304CD52D0D1A4" indent="up1"><enum>(II)</enum><text>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—</text>
<item id="H6E35702CD12D40E7A36297A7E4829A21"><enum>(aa)</enum><text>assessing the reasons for the failure to meet those requirements; and</text></item> <item id="H035CBC23E3884F32976C83D436EC4344"><enum>(bb)</enum><text>identifying recommendations to improve the collection by the Postal Service of the information described in paragraphs (1) and (2).</text></item></subclause></clause>
<clause id="HB552801B79E6445291F8DD8040CB6F15" indent="up1"><enum>(vi)(I)</enum><text display-inline="yes-display-inline">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).</text> <subclause id="H1E8D9BC2596A4A20BA8008C50561E4C5" indent="up1"><enum>(II)</enum><text display-inline="yes-display-inline">The Commissioner, in consultation with the Postmaster 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—</text>
<item id="HC55351A4F96D4E07AD9CC8A0A8F95F87"><enum>(aa)</enum><text>does not have the capacity to collect and transmit such information;</text></item> <item id="HE31AA8E045C64496A7E54AC27105DBCB"><enum>(bb)</enum><text>represents a low risk for mail shipments that violate relevant United States laws and regulations; and</text></item>
<item id="H3889CB61C79D400198B0D37BDA4A2317"><enum>(cc)</enum><text>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.</text></item></subclause> <subclause id="H5D01CC668867472DBABF970C055A1106" indent="up1"><enum>(III)</enum><text display-inline="yes-display-inline">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 described in subclause (I). If, at any time, the Commissioner determines that a country no longer meets the requirements under subclause (II), the Commissioner may not further exclude the country from the requirement described in subclause (I). </text></subclause>
<subclause id="H089E39078AEC4D25B9562D738DD98BF2" indent="up1"><enum>(IV)</enum><text>The Commissioner shall, on an annual basis, submit to the appropriate congressional committees—</text> <item id="HC89127958A7A4C3BBF7A127334133D1A"><enum>(aa)</enum><text display-inline="yes-display-inline">a list of countries with respect to which the Commissioner has made a determination under subclause (II) to exclude the countries from the requirement described in subclause (I); and</text></item>
<item id="HA026E5CC00984EF784E674E8F92B1823"><enum>(bb)</enum><text>information used to support such determination with respect to such countries.</text></item></subclause></clause> <clause id="HF6F5FC66EBF14ADD83044A137FA51521" indent="up1"><enum>(vii)</enum> <subclause id="HFCCC4C296FDC464B890B077B695464E2" display-inline="yes-display-inline"><enum>(I)</enum><text display-inline="yes-display-inline">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).</text></subclause>
<subclause id="H2FAA99A3E5174A93A270544A283E2732" indent="up1"><enum>(II)</enum><text display-inline="yes-display-inline">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, seizure, controlled delivery or other law enforcement initiatives, or correction of the failure to provide the information described in paragraphs (1) and (2) with respect to the shipments.</text></subclause></clause> <clause id="HCD62E6224C1D4B1F80282EC75BA41EC4" indent="up1"><enum>(viii)</enum><text>Nothing in this subparagraph shall be construed to limit the authority of the Secretary to obtain information relating to international mail shipments from private carriers or other appropriate parties.</text></clause>
<clause id="H201A5989C91C4218B323170C2481D79D" indent="up1"><enum>(ix)</enum><text>In this subparagraph, the term <term>appropriate congressional committees</term> means—</text> <subclause id="H493F94C33E464E95A9AB4ACD36D2D7D7"><enum>(I)</enum><text>the Committee on Finance and the Committee on Homeland Security and Governmental Affairs of the Senate; and</text></subclause>
<subclause id="H20BA986C83314715AF663F8523FB0F8F"><enum>(II)</enum><text>the Committee on Ways and Means, the Committee on Oversight and Government Reform, and the Committee on Homeland Security of the House of Representatives.</text></subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph> <paragraph id="HC31602AC286A4B889E48718DA0749DB6"><enum>(2)</enum><header>Joint strategic plan on mandatory advance information</header><text>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—</text>
<subparagraph id="HEB481485D7A3415BA6ED18311A546984"><enum>(A)</enum><text>the transmission of information as required by section 343(a)(3)(K) of the Trade Act of 2002, as amended by paragraph (1); and</text></subparagraph> <subparagraph id="HC7BA58C84F834F66822E8434AE589F05"><enum>(B)</enum><text>the presentation by the Postal Service to U.S. Customs and Border Protection of all mail targeted by U.S. Customs and Border Protection for inspection.</text></subparagraph></paragraph></subsection>
<subsection id="HBBEBB5709C1D4C65832D51599CD0E1A1"><enum>(b)</enum><header>Capacity building</header>
<paragraph id="H6289DCD1AEE5482EA1B7318853B17901"><enum>(1)</enum><header>In general</header><text>Section 343(a) of the Trade Act of 2002 (<external-xref legal-doc="public-law" parsable-cite="pl/107/210">Public Law 107–210</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/19/2071">19 U.S.C. 2071</external-xref> note) is amended by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="H4E87007536FC4756A4F8AA3E9EFC9BCB" style="OLC"> <paragraph id="H427A1A70B13F4275B235A5D261E5F54F"><enum>(5)</enum><header>Capacity building</header> <subparagraph id="H4CD77424AD1B4B6FA34BA74CB11B88E1"><enum>(A)</enum><header>In general</header><text>The Secretary, with the concurrence of the Secretary of State, and in coordination with the Postmaster General and the heads of other Federal agencies, as appropriate, may provide technical assistance, equipment, technology, and training to enhance the capacity of foreign postal operators—</text>
<clause id="H1AA9B51502354E818941559749237C64"><enum>(i)</enum><text>to gather and provide the information required by paragraph (3)(K); and</text></clause> <clause id="H411AE3B1ABE544C591B992CAAAE3B648"><enum>(ii)</enum><text>to otherwise gather and provide postal shipment information related to—</text>
<subclause id="H9B2253B26D854A25A0ED0936FE1CE9F3"><enum>(I)</enum><text>terrorism;</text></subclause> <subclause id="HFC62BBA324F74C1997C27864072EBB74"><enum>(II)</enum><text>items the importation or introduction of which into the United States is prohibited or restricted, including controlled substances; and</text></subclause>
<subclause id="HE66DE539C8F04E4C879D719172739828"><enum>(III)</enum><text>such other concerns as the Secretary determines appropriate.</text></subclause></clause></subparagraph> <subparagraph id="H58E14332825B4FF1830D9B9244D0BFA0"><enum>(B)</enum><header>Provision of equipment and technology</header><text>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 technology.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph>
<paragraph id="H078BCBDD37894DC3A71425F14DEB2852"><enum>(2)</enum><header>Joint strategic plan on capacity building</header><text>Not later than 1 year after the date of the enactment of this Act, the Secretary of Homeland Security and the Postmaster General shall, in consultation with the Secretary of State, jointly develop and submit to the appropriate congressional committees a joint strategic plan—</text> <subparagraph id="H15FEC695B12B487DBA0EEA28B99CCED6"><enum>(A)</enum><text>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);</text></subparagraph>
<subparagraph id="H03C26F2A3017417DAFABE143D78EBA49"><enum>(B)</enum><text>describing plans for future capacity building efforts; and</text></subparagraph> <subparagraph id="HDBD6FD5121084B9A9CC25D53A5BDCCB0"><enum>(C)</enum><text>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.</text></subparagraph></paragraph></subsection>
<subsection id="H65F05D5390FA45F6B31ACAF043F70C19"><enum>(c)</enum><header>Report and consultations by Secretary of Homeland Security and Postmaster General</header>
<paragraph id="H67B4468D74DA4BB7854ADCB41601B597"><enum>(1)</enum><header>Report</header><text>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 compliance with that subparagraph that includes the following:</text> <subparagraph id="H686869EBDD4944F2989F9D5F1D1253C6"><enum>(A)</enum><text>An assessment of the status of the regulations required to be promulgated under that subparagraph.</text></subparagraph>
<subparagraph id="H80284799924E4580BFD8C6434DA3E7D8"><enum>(B)</enum><text>An update regarding new and existing agreements reached with foreign postal operators for the transmission of the information required by that subparagraph.</text></subparagraph> <subparagraph id="HCBC03678349E4106B6A01C1BC3F742B6"><enum>(C)</enum><text>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.</text></subparagraph>
<subparagraph id="H750A6760739B49A2A8169B328E0753F2"><enum>(D)</enum><text>A summary of the progress made in achieving the transmission of that information for the percentage of shipments required by that subparagraph.</text></subparagraph> <subparagraph id="H2E4BD6AB045A43F88FCDFF6BCFE8D634"><enum>(E)</enum><text>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.</text></subparagraph>
<subparagraph id="HE9B1DF3051CA427F8AB408EF2EC971CB"><enum>(F)</enum><text>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.</text></subparagraph> <subparagraph id="H8F3A4BDB16E04872BB11D08E9701F3FC"><enum>(G)</enum><text>A summary of the use of technology to detect illicit synthetic opioids and other illegal substances in international mail parcels and planned acquisitions and advancements in such technology.</text></subparagraph>
<subparagraph id="H43EB2B287F1D47EFAE950A0F45D37FE2"><enum>(H)</enum><text>Such other information as the Secretary of Homeland Security and the Postmaster General consider appropriate with respect to obtaining the transmission of information required by that subparagraph.</text></subparagraph></paragraph> <paragraph id="HB299C0AC7E0045A487F8F8F9ACC08593"><enum>(2)</enum><header>Consultations</header><text display-inline="yes-display-inline">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 General shall provide briefings to the appropriate congressional committees on the progress made in achieving the transmission of that information for that percentage of shipments.</text></paragraph></subsection>
<subsection id="H2BEBD2D43CC6436BA6BCA0B89543EF2A"><enum>(d)</enum><header>Government Accountability Office report</header><text>Not later than June 30, 2019, the Comptroller General of the United States shall submit to the appropriate congressional committees a report—</text> <paragraph id="H9DD9EAD7CA6C4982B55361D4957D6793"><enum>(1)</enum><text>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;</text></paragraph>
<paragraph id="H0CDCBD0AF3BB428DB7235E756D1258E4"><enum>(2)</enum><text>assessing the quality of the information received from foreign postal operators for targeting purposes;</text></paragraph> <paragraph id="HC3EAF36A829D41B183AF169859582D75"><enum>(3)</enum><text>assessing the specific percentage of targeted mail presented by the Postal Service to U.S. Customs and Border Protection for inspection;</text></paragraph>
<paragraph id="HF46BB391DBDB4FCE881B572593B96338"><enum>(4)</enum><text>describing the costs of collecting the information required by such subparagraph (K) from foreign postal operators and the costs of implementing the use of that information;</text></paragraph> <paragraph id="H9B35080DFC5A489DA3CD4634C08D854C"><enum>(5)</enum><text>assessing the benefits of receiving that information with respect to international mail shipments;</text></paragraph>
<paragraph id="H2EAC3431FA41412DAF1BD92228AD47BE"><enum>(6)</enum><text>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</text></paragraph> <paragraph id="H5E55DC6FED25406E827C5239EC8B46EF"><enum>(7)</enum><text>identifying recommendations, including recommendations 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 international mail would be improved by—</text>
<subparagraph id="HF37244AF239046A398717A21ED8E5725"><enum>(A)</enum><text>requiring the Postal Service to serve as the consignee for international mail shipments containing goods; or</text></subparagraph> <subparagraph id="HE0A77768B1EB4BE9814B5B20E0C5099A"><enum>(B)</enum><text>designating a customs broker to act as an importer of record for international mail shipments containing goods.</text></subparagraph></paragraph></subsection>
<subsection commented="no" id="HCFAD06164A0042A1BAA9843B9A3B0A73"><enum>(e)</enum><header>Technical correction</header><text>Section 343 of the Trade Act of 2002 (<external-xref legal-doc="public-law" parsable-cite="pl/107/210">Public Law 107–210</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/19/2071">19 U.S.C. 2071</external-xref> note) is amended in the section heading by striking <quote><header-in-text level="section" style="OLC">advanced</header-in-text></quote> and inserting <quote><header-in-text level="section" style="OLC">advance</header-in-text></quote>.</text></subsection> <subsection id="H792DA8E9D9EE4E70B5E86C8838BC534A"><enum>(f)</enum><header>Appropriate congressional committees defined</header><text>In this section, the term <term>appropriate congressional committees</term> means—</text>
<paragraph id="H1C2DF39752E34100AEE321A45672D9D0"><enum>(1)</enum><text>the Committee on Finance and the Committee on Homeland Security and Governmental Affairs of the Senate; and</text></paragraph> <paragraph id="HFAFF60FBA7974E1389FFCEE84119BAC3"><enum>(2)</enum><text>the Committee on Ways and Means, the Committee on Oversight and Government Reform, and the Committee on Homeland Security of the House of Representatives.</text></paragraph></subsection></section>
<section id="HD9C7963C82FA4C3F8BA8F1AFF339C65A"><enum>8004.</enum><header>International postal agreements</header>
<subsection id="H654BE5D09EFA4FF2B33D05784456FFF0" commented="no"><enum>(a)</enum><header>Existing agreements</header>
<paragraph id="H2F248F1DC6B84F028BBF53770466DBD4"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">In the event that any provision of this subtitle, or any amendment made by this Act, 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.</text></paragraph> <paragraph id="H8B68F8838339467CBCF8E137FF9D9EDE" commented="no"><enum>(2)</enum><header>Rule of construction</header><text>Nothing in this subsection shall be construed to permit delay in the implementation of this subtitle or any amendment made by this subtitle.</text></paragraph></subsection>
<subsection commented="no" id="H0F93D9567BFB44EA9EE7F19F2DBC4125"><enum>(b)</enum><header>Future agreements</header>
<paragraph commented="no" id="H2B98C42C5C0442E38B441653F97E94EB"><enum>(1)</enum><header>Consultations</header><text>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)).</text></paragraph> <paragraph commented="no" id="H3552220D50A045398EA8F334BAE91C3D"><enum>(2)</enum><header>Expedited negotiation of new agreement</header><text>To the extent that any new postal treaty, convention, or other international 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.</text></paragraph></subsection></section>
<section id="H4B1E5D5EA7CD4B6E9F2E0A7E5BDFE99D"><enum>8005.</enum><header>Cost recoupment</header>
<subsection id="H7C7A070AD9DA4ACF8EFF0252C046FAFB"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The United States Postal Service shall, to the extent practicable and otherwise recoverable by law, ensure 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.</text></subsection> <subsection id="HAB8066D2E3E8424FBD20C17813DB4243"><enum>(b)</enum><header>Costs not considered revenue</header><text display-inline="yes-display-inline">The recovery of costs under subsection (a) shall not be deemed revenue for purposes of subchapter I and II of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/39/36">chapter 36</external-xref> of title 39, United States Code, or regulations prescribed under that chapter.</text></subsection></section>
<section id="H2B861E64CFA646B0837B266704CD41B4"><enum>8006.</enum><header>Development of technology to detect illicit narcotics</header>
<subsection id="HC3284E5008094599AE5193B2898D9DCE"><enum>(a)</enum><header>In general</header><text>The Postmaster General and the Commissioner 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 substances entering the United States by mail.</text></subsection> <subsection id="H311D2C3C288846B09A4746DD0C09816D"><enum>(b)</enum><header>Outreach to private sector</header><text>The Postmaster General and the Commissioner shall conduct outreach to private sector entities to gather information regarding the current state of technology 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.</text></subsection></section>
<section id="HFD9A63B250C14511832A9DF38A786071"><enum>8007.</enum><header>Civil penalties for postal shipments</header><text display-inline="no-display-inline">Section 436 of the Tariff Act of 1930 (<external-xref legal-doc="usc" parsable-cite="usc/19/1436">19 U.S.C. 1436</external-xref>) is amended by adding at the end the following new subsection:</text> <quoted-block style="OLC" id="HB226743D71D9421F855AF318339810B7" display-inline="no-display-inline"> <subsection id="H466ED06A4C7046F1856AEFF0D55C3AD9"><enum>(e)</enum><header>Civil penalties for postal shipments</header> <paragraph id="H1CF93E83DC6D40968910664DC3180FA3"><enum>(1)</enum><header>Civil penalty</header><text display-inline="yes-display-inline">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.</text></paragraph>
<paragraph id="H8384467569B24647AA208FFB34DA82E9" commented="no"><enum>(2)</enum><header>Modification of civil penalty</header>
<subparagraph id="H93306D2C97A74DCDB3B5B57E9E5552A7"><enum>(A)</enum><header>In general</header><text>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—</text> <clause id="H6819015E85A14B7D92A90C9C96BDDB42" commented="no"><enum>(i)</enum><text>has a low error rate in compliance with section 343(a)(3)(K) of the Trade Act of 2002;</text></clause>
<clause id="H99568BAA4B40459E9018BA982D51746D" commented="no"><enum>(ii)</enum><text display-inline="yes-display-inline">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</text></clause> <clause id="HA02B50AD7A9A41FEB8127CCECB498B0E" commented="no"><enum>(iii)</enum><text display-inline="yes-display-inline">has taken remedial action to prevent future violations of section 343(a)(3)(K)(vii)(I) of the Trade Act of 2002.</text></clause></subparagraph>
<subparagraph id="H121DF4FD83404C5197C600727E6FFBE5" commented="no"><enum>(B)</enum><header>Written notification</header><text display-inline="yes-display-inline">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).</text></subparagraph></paragraph> <paragraph id="HFC2855763E264763A394023D7B6E937B"><enum>(3)</enum><header>Ongoing lack of compliance</header><text display-inline="yes-display-inline">If U.S. Customs and Border Protection determines that the United States Postal Service—</text>
<subparagraph id="H4AE2E50BD5884AE29A0837D7437CA7BC"><enum>(A)</enum><text display-inline="yes-display-inline">has repeatedly committed violations of section 343(a)(3)(K)(vii)(I) of the Trade Act of 2002,</text></subparagraph> <subparagraph id="H111E04578E4746068C1376343EAB2C5A"><enum>(B)</enum><text display-inline="yes-display-inline">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</text></subparagraph>
<subparagraph id="H5A7D9CFFC1FC4D50A287C7535097EEE5"><enum>(C)</enum><text display-inline="yes-display-inline">has an increasing error rate in compliance with section 343(a)(3)(K) of the Trade Act of 2002,</text></subparagraph><continuation-text continuation-text-level="paragraph">civil penalties may be imposed against the United States Postal Service until corrective action, satisfactory to U.S. Customs and Border Protection, is taken.</continuation-text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></section> <section id="H9FA437282A9844EEA1490E292321DF6D"><enum>8008.</enum><header>Report on violations of arrival, reporting, entry, and clearance requirements and falsity or lack of manifest</header> <subsection id="H66EB9B34F7984132BCA78D8EFA745B2E"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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 (<external-xref legal-doc="usc" parsable-cite="usc/19/1436">19 U.S.C. 1436</external-xref>), as amended by section 8007, and section 584 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/19/1584">19 U.S.C. 1584</external-xref>) that occurred during the previous year.</text></subsection>
<subsection id="H0D4F58D5F7184954987270A1BE658746"><enum>(b)</enum><header>Information described</header><text>The information described in this subsection is the following:</text> <paragraph id="H6A30ED0CF94A495297ABB3A37CE121C8"><enum>(1)</enum><text display-inline="yes-display-inline">The name and address of the violator.</text></paragraph>
<paragraph id="H6A573A8D27C9470EB5155A1FDC4880CB"><enum>(2)</enum><text>The specific violation that was committed.</text></paragraph> <paragraph id="H365468DF69AF469B9F9D64F8A01FA67C"><enum>(3)</enum><text>The location or port of entry through which the items were transported.</text></paragraph>
<paragraph id="H3FD2928153584252AE288EE8D87B62FB"><enum>(4)</enum><text>An inventory of the items seized, including a description of the items and the quantity seized.</text></paragraph> <paragraph id="H1621EF93935646A1917EB9ADC395CFD9"><enum>(5)</enum><text>The location from which the items originated.</text></paragraph>
<paragraph id="H7E130CC296F54197AE9E477D97D81B61"><enum>(6)</enum><text>The entity responsible for the apprehension or seizure, organized by location or port of entry.</text></paragraph> <paragraph id="H1B3C46D08E6D4D25BBEDDA570579F6A3"><enum>(7)</enum><text>The amount of penalties assessed by U.S. Customs and Border Protection, organized by name of the violator and location or port of entry.</text></paragraph>
<paragraph id="H1E93D4B4C68B4C18B80EC2B72003039D"><enum>(8)</enum><text>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.</text></paragraph> <paragraph id="H5B33B6768EF843639E1BF5D354B262F8"><enum>(9)</enum><text>The rationale for negotiating lower penalties, organized by name of the violator and location or port of entry.</text></paragraph></subsection>
<subsection id="H586327771DC74A039F83A77645D36F5A"><enum>(c)</enum><header>Appropriate congressional committees defined</header><text>In this section, the term <term>appropriate congressional committees</term> means—</text> <paragraph id="H7319BDE0BA69409A8CEA7920F53FF517"><enum>(1)</enum><text>the Committee on Finance and the Committee on Homeland Security and Governmental Affairs of the Senate; and</text></paragraph>
<paragraph id="HFF74CF20B4B94052B33BF6850A90D142"><enum>(2)</enum><text>the Committee on Ways and Means, the Committee on Oversight and Government Reform, and the Committee on Homeland Security of the House of Representatives.</text></paragraph></subsection></section> <section id="HCC78041049E14D2FADD1BEA4C92E9109"><enum>8009.</enum><header>Effective date; regulations</header> <subsection id="H5D902F45DBD24A9D974782FE15DA503F"><enum>(a)</enum><header>Effective date</header><text>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.</text></subsection>
<subsection id="H4D41B69BCA4C46FC9005D7B7B613E50F"><enum>(b)</enum><header>Regulations</header><text>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.</text></subsection></section></subtitle> <subtitle id="HD767B2D4CC5C4513AE1485B464F1738C"><enum>B</enum><header>Recognizing Early Childhood Trauma Related to Substance Abuse</header> <section id="HFBDCCEF675C5478AB605E929B5EDFECF" section-type="subsequent-section"><enum>8011.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Recognizing Early Childhood Trauma Related to Substance Abuse Act of 2018</short-title></quote>.</text></section>
<section id="HC50D6FB287E74C9D8559ECE4EECE3E6A"><enum>8012.</enum><header>Recognizing Early Childhood Trauma Related to Substance Abuse</header>
<subsection id="HB06208D6C25843E9AB3209A023537B07"><enum>(a)</enum><header>Dissemination of information</header><text>The Secretary of Health and Human Services shall disseminate information, resources, and, if requested, technical assistance to early childhood care and education providers and professionals working with young children on—</text> <paragraph id="H313EC202C96145EDA9D211C244AAFF4B"><enum>(1)</enum><text>ways to properly recognize children who may be impacted by trauma related to substance abuse by a family member or other adult; and</text></paragraph>
<paragraph id="H41D3BA5EE28D4AC5BB04AA166D2783F5"><enum>(2)</enum><text>how to respond appropriately in order to provide for the safety and well-being of young children and their families.</text></paragraph></subsection> <subsection id="HCA79E4B2E0DB47D8B0B9B60A6BD568AC"><enum>(b)</enum><header>Goals</header><text>The information, resources, and technical assistance provided under subsection (a) shall—</text>
<paragraph id="H1AB9B4BE25474707B77E1589801E0CFC"><enum>(1)</enum><text display-inline="yes-display-inline">educate early childhood care and education providers and professionals working with young children on understanding and identifying the early signs and risk factors of children who might be impacted by trauma due to exposure to substance abuse;</text></paragraph> <paragraph id="H0BCB0EE1C6544B51B8EE7A8773B738AA"><enum>(2)</enum><text>suggest age-appropriate communication tools, procedures, and practices for trauma-informed care, including ways to prevent or mitigate the effects of trauma;</text></paragraph>
<paragraph id="H37D1F20CF7CE42B48A5167890F5FF4C8"><enum>(3)</enum><text>provide options for responding to children impacted by trauma due to exposure to substance abuse that consider the needs of the child and family, including recommending resources and referrals for evidence-based services to support such family; and</text></paragraph> <paragraph id="H85845ACD9742483281369F0BF668ECDE"><enum>(4)</enum><text>promote whole-family and multi-generational approaches to prevent separation and support re-unification of families whenever possible and in the best interest of the child.</text></paragraph></subsection>
<subsection id="H182AA7C77FA742AC81B3083A6AD1E65E"><enum>(c)</enum><header>Rule of construction</header><text>Such information, resources, and if applicable, technical assistance, shall not be construed to amend the requirements under—</text> <paragraph id="H7236BDEC62C24820B44C58A63F7AA375"><enum>(1)</enum><text display-inline="yes-display-inline">the Child Care and Development Block Grant Act of 1990 (<external-xref legal-doc="usc" parsable-cite="usc/42/9858">42 U.S.C. 9858</external-xref> et seq.);</text></paragraph>
<paragraph id="H4EAEF4DA23794995ACC4E223FDE1FD17"><enum>(2)</enum><text display-inline="yes-display-inline">the Head Start Act (<external-xref legal-doc="usc" parsable-cite="usc/42/9831">42 U.S.C. 9831</external-xref> et seq.); or</text></paragraph> <paragraph id="HE114350F0BEC4D76880B4ACC55D84E46"><enum>(3)</enum><text>the Individuals with Disabilities Education Act (<external-xref legal-doc="usc" parsable-cite="usc/20/1400">20 U.S.C. 1400</external-xref> et seq.).</text></paragraph></subsection></section></subtitle>
<subtitle id="H50145386A0FE4950B3323AD8ABF14D34"><enum>C</enum><header>Assisting States’ Implementation of Plans of Safe Care</header>
<section id="H6D4843C0597043088B8FA8D3F9074B19" section-type="subsequent-section"><enum>8021.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Assisting States’ Implementation of Plans of Safe Care Act</short-title></quote>.</text></section> <section id="H44CF89F2E9BF41F7BBA6B7FE91CFF088"><enum>8022.</enum><header>Assisting States with implementation of plans of safe care</header> <subsection id="H67FD4A99249F401E96FB7397827C4651"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services shall provide written guidance and, if appropriate, technical assistance to support States in complying with, and implementing, subsections (b)(2)(B)(iii) and (d)(18) of section 106 of the Child Abuse Prevention and Treatment Act (<external-xref legal-doc="usc" parsable-cite="usc/42/5106a">42 U.S.C. 5106a</external-xref>) in order to promote better protections for young children and family-centered responses.</text></subsection>
<subsection id="HD9B0F16724C04E58BB89C31FFD12FBDB"><enum>(b)</enum><header>Requirements</header><text>The guidance and technical assistance shall—</text> <paragraph id="H31ED853E6A014C03B4253AB02FAE5EA8"><enum>(1)</enum><text>enhance States’ understanding of requirements and flexibilities under the law, including clarifying key terms;</text></paragraph>
<paragraph id="H6B674A187A1B4EBF9D01A36AEB7CC97E"><enum>(2)</enum><text>address State-identified challenges with developing, implementing, and monitoring plans of safe care;</text></paragraph> <paragraph id="H8CA9B5FB47504B13AD5B8B78A64CC283"><enum>(3)</enum><text>disseminate best practices related to developing and implementing plans of safe care, including differential response, collaboration and coordination, and identification and delivery of services, while recognizing needs of different populations and varying community approaches across States;</text></paragraph>
<paragraph id="HD2BBC6BEC2434B8FBACDCF0212722DFC"><enum>(4)</enum><text>support collaboration between health care providers, social service agencies, public health agencies, and the child welfare system, to promote a family-centered treatment approach;</text></paragraph> <paragraph id="HC698DA5B79BE40D187ADF5CD50705D15"><enum>(5)</enum><text>prevent separation and support reunification of families if in the best interests of the child;</text></paragraph>
<paragraph id="HF89D393F3ED24383BAA20F85C03D5C60"><enum>(6)</enum><text display-inline="yes-display-inline">recommend treatment approaches for serving infants, pregnant women, and postpartum women whose infants may be affected by substance use that are designed to keep infants with their mothers and families whenever appropriate, including recommendations to encourage pregnant women to receive health and other support services during pregnancy;</text></paragraph> <paragraph id="H3741F2C2A1D5499F9B16A4579C7B088F"><enum>(7)</enum><text>support State efforts to develop technology systems to manage and monitor implementation of plans of safe care; and</text></paragraph>
<paragraph id="H680F6ABE22794B2A8DD99B4587668B1A"><enum>(8)</enum><text>help States improve the long-term safety and well-being of young children and their families.</text></paragraph></subsection> <subsection id="HAF4215ACB5354B9E83FE1EF0A41E9B4E"><enum>(c)</enum><header>Construction</header><text>The guidance and technical assistance shall not be construed to amend the requirements of the Child Abuse Prevention and Treatment Act (<external-xref legal-doc="usc" parsable-cite="usc/42/5101">42 U.S.C. 5101</external-xref> et seq.).</text></subsection>
<subsection id="HBC43DA5B78944CBDA79CC2EED661B872"><enum>(d)</enum><header>Definition</header><text display-inline="yes-display-inline">For purposes of this section, the term <quote>State</quote> has the meaning given such term in section 3 of the Child Abuse Prevention and Treatment Act (<external-xref legal-doc="usc" parsable-cite="usc/42/5101">42 U.S.C. 5101</external-xref> note).</text></subsection></section></subtitle> <subtitle id="H17CB85987C1B4ED7B6EF50DE01796A6A"><enum>D</enum><header>Improving the Federal Response to Families Impacted by Substance Use Disorder</header> <section id="H159A83C29AD74ED285299C041896B7AD" section-type="subsequent-section"><enum>8031.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Improving the Federal Response to Families Impacted by Substance Use Disorder Act</short-title></quote>.</text></section>
<section id="HADCE5946DEF64DF0BE8F9B1B33080436"><enum>8032.</enum><header>Interagency Task Force to Improve the Federal Response to Families Impacted by Substance Use Disorders</header>
<subsection id="HC24C70B0A1D74F2FA285E06A07DA4541"><enum>(a)</enum><header>Establishment</header><text display-inline="yes-display-inline">There is established a task force, to be known as the <quote>Interagency Task Force to Improve the Federal Response to Families Impacted by Substance Use Disorders</quote> (in this section referred to as “Task Force”).</text></subsection> <subsection id="H9D3476B602184C1BAA57C1BD165C19ED"><enum>(b)</enum><header>Responsibilities</header><text display-inline="yes-display-inline">The Task Force—</text>
<paragraph id="H0998C02D5B5342638DC3523A5D85CDC3"><enum>(1)</enum><text>shall identify, evaluate, and recommend ways in which Federal agencies can better coordinate responses to substance use disorders and the opioid crisis; and</text></paragraph> <paragraph id="H9C14D06B695B4CF99A02465D02D08930"><enum>(2)</enum><text>shall carry out the additional duties described in subsection (d).</text></paragraph></subsection>
<subsection id="HDB0EADFA367F4DA9BDEFA53460A2DC79"><enum>(c)</enum><header>Membership</header>
<paragraph id="H89EE76FF20C54108B3B61E04F6046D92"><enum>(1)</enum><header>Number and appointment</header><text display-inline="yes-display-inline">The Task Force shall be composed of 12 Federal officials having responsibility for, or administering programs related to, the duties of the Task Force. The Secretary of Health and Human Services, the Secretary of Education, the Secretary of Agriculture, and the Secretary of Labor shall each appoint two members to the Task Force from among the Federal officials employed by the Department of which they are the head. Additional Federal agency officials appointed by the Secretary of Health and Human Services shall fill the remaining positions of the Task Force.</text></paragraph> <paragraph id="H1204576CFFE542228EBE662D639F01EC"><enum>(2)</enum><header>Chairperson</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services shall designate a Federal official employed by the Department of Health and Human Services to serve as the chairperson of the Task Force.</text></paragraph>
<paragraph id="HF6FA932F59F7463D899B813FCACE8C19"><enum>(3)</enum><header>Deadline for appointment</header><text display-inline="yes-display-inline">Each member shall be appointed to the Task Force not later than 60 days after the date of the enactment of this Act.</text></paragraph> <paragraph id="H38502CF1EF8B4B3887D0A39E2AEEDA02"><enum>(4)</enum><header>Additional agency input</header><text>The Task Force may seek input from other Federal agencies and offices with experience, expertise, or information relevant in responding to the opioid crisis.</text></paragraph>
<paragraph commented="no" id="HDCB1B940032B4433BBC32D4AF55DC9B7"><enum>(5)</enum><header>Vacancies</header><text display-inline="yes-display-inline">A vacancy in the Task Force shall be filled in the manner in which the original appointment was made.</text></paragraph> <paragraph commented="no" id="HC96EC0BBEEB24D2A83E021EA03507B9B"><enum>(6)</enum><header>Prohibition of compensation</header><text display-inline="yes-display-inline">Members of the Task Force may not receive pay, allowances, or benefits by reason of their service on the Task Force.</text></paragraph></subsection>
<subsection id="H178893A90C14427E84CF939B8855B86C"><enum>(d)</enum><header>Duties</header><text display-inline="yes-display-inline">The Task Force shall carry out the following duties:</text> <paragraph id="HDBF0EBFA555B4BCEA7071BD9E073F5F6"><enum>(1)</enum><text display-inline="yes-display-inline">Solicit input from stakeholders, including frontline service providers, medical professionals, educators, mental health professionals, researchers, experts in infant, child, and youth trauma, child welfare professionals, and the public, in order to inform the activities of the Task Force.</text></paragraph>
<paragraph id="HAB324A7E8E4748E58FB1752FCBB2A9AB"><enum>(2)</enum><text display-inline="yes-display-inline">Develop a strategy on how the Task Force and participating Federal agencies will collaborate, prioritize, and implement a coordinated Federal approach with regard to responding to substance use disorders, including opioid misuse, that shall include—</text> <subparagraph id="H92061D9F3F8A423688A51CD2C884EE01"><enum>(A)</enum><text>identifying options for the coordination of 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 abuse disorders, including opioid misuse; and</text></subparagraph>
<subparagraph id="H6B3A1211D3FB4606A4577C7089639BD7"><enum>(B)</enum><text>other ways to improve coordination, planning, and communication within and across Federal agencies, offices, and programs, to better serve children and families impacted by substance use disorders, including opioid misuse.</text></subparagraph></paragraph> <paragraph id="H8F6D4E54A5F64C3DA542BD045FEB19FD"><enum>(3)</enum><text display-inline="yes-display-inline">Based off the strategy developed under paragraph (2), evaluate and recommend opportunities for local- and State-level partnerships, professional development, or best practices that—</text>
<subparagraph id="HB9BEC7D1626A4E4E8A9E9D50777E7EE1"><enum>(A)</enum><text>are designed to quickly identify and refer children and families, as appropriate, who have experienced or are at risk of experiencing exposure to substance abuse;</text></subparagraph> <subparagraph id="H4E901106A57B451A87FDC228CDF0C5B9"><enum>(B)</enum><text>utilize and develop partnerships with early childhood education programs, local social services organizations, and health care services aimed at preventing or mitigating the effects of exposure to substance use disorders, including opioid misuse;</text></subparagraph>
<subparagraph id="H53BB68B2682B43E5862765FFFB464F00"><enum>(C)</enum><text display-inline="yes-display-inline">offer community-based prevention activities, including educating families and children on the effects of exposure to substance use disorders, including opioid misuse, and how to build resilience and coping skills to mitigate those effects;</text></subparagraph> <subparagraph id="H5340AD7441DF430C860D3847EBAA1010"><enum>(D)</enum><text display-inline="yes-display-inline">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 substance use disorders, including opioid misuse; and</text></subparagraph>
<subparagraph id="H6E468631B65242AC965BF0FC0F31F9D2"><enum>(E)</enum><text display-inline="yes-display-inline">are designed to prevent separation and support reunification of families if in the best interest of the child.</text></subparagraph></paragraph> <paragraph id="H7C1B5B68BB2E413FA667A31E76AD0577"><enum>(4)</enum><text display-inline="yes-display-inline">In fulfilling the requirements of paragraphs (2) and (3), consider evidence-based, evidence-informed, and promising best practices related to identifying, referring, and supporting children and families at risk of experiencing exposure to substance abuse or experiencing substance use disorder, including opioid misuse, including—</text>
<subparagraph id="H58E953A0A6A54B579B13BB985F1925AD"><enum>(A)</enum><text display-inline="yes-display-inline">prevention strategies for those at risk of experiencing or being exposed to substance abuse, including misuse of opioids;</text></subparagraph> <subparagraph id="H4FE13483C326444FA937146B4E11B19D"><enum>(B)</enum><text>whole-family and multi-generational approaches;</text></subparagraph>
<subparagraph id="H9BE1541CFCB148B382B9C7FC2AE32E49"><enum>(C)</enum><text>community-based initiatives;</text></subparagraph> <subparagraph id="HD6BE117AE46D4808A368FA7B0B8FECCC"><enum>(D)</enum><text>referral to, and implementation of, trauma-informed practices and supports; and</text></subparagraph>
<subparagraph id="H99CC84A88EE14FC9BA5056F42C164014"><enum>(E)</enum><text>multi-generational practices that assist parents, foster parents, and kinship and other caregivers</text></subparagraph></paragraph></subsection> <subsection commented="no" id="H63D98BBFC3CD4298A0A962A72383BDDB"><enum>(e)</enum><header>FACA</header><text display-inline="yes-display-inline">The Federal Advisory Committee Act (<external-xref legal-doc="usc-appendix" parsable-cite="usc-appendix/5/2">5 U.S.C. App. 2</external-xref>) shall not apply to the Task Force.</text></subsection>
<subsection id="H5D4655D916AD4506826E8F2649695E61"><enum>(f)</enum><header>Action plan; reports</header><text display-inline="yes-display-inline">The Task Force—</text> <paragraph id="H2499FC7F37E2487DBCAC5A5C723BB6AC"><enum>(1)</enum><text display-inline="yes-display-inline">shall prepare a detailed action plan to be implemented by participating Federal agencies to create a collaborative, coordinated response to the opioid crisis, which shall include—</text>
<subparagraph id="HE79A5AFA3A2F452FBACAA42622B2E366"><enum>(A)</enum><text>relevant information identified and collected under subsection (d);</text></subparagraph> <subparagraph id="H568C784024F34A849F2413DBBA375F25"><enum>(B)</enum><text>a proposed timeline for implementing recommendations and efforts identified under subsection (d); and</text></subparagraph>
<subparagraph id="H4BF5538D1A9D499494BDA750DA738D70"><enum>(C)</enum><text display-inline="yes-display-inline">a description of how other Federal agencies and offices with experience, expertise, or information relevant in responding to the opioid crisis that have provided input under subsection (c)(4) will be participating in the coordinated approach;</text></subparagraph></paragraph> <paragraph id="H4643F896466C4F77BF8D83B6A625440C"><enum>(2)</enum><text display-inline="yes-display-inline">shall submit to the Congress a report describing the action plan prepared under paragraph (1), including, where applicable, identification of any recommendations included in such plan that require additional legislative authority to implement; and</text></paragraph>
<paragraph id="H5CA323A6E70E47089503F8B111581C5C"><enum>(3)</enum><text display-inline="yes-display-inline">shall submit a report to the Governors describing the opportunities for local- and State-level partnerships, professional development, or best practices recommended under subsection (d)(3).</text></paragraph></subsection> <subsection id="H16FAEDA352AF44E8A6C59DFBB6EA72C6"><enum>(g)</enum><header>Dissemination</header> <paragraph id="H188170CC857147A6A4AA52CD39043F7D"><enum>(1)</enum><header>In general</header><text>The action plan and reports required under subsection (f) shall be—</text>
<subparagraph id="H93AA16E059954AD19A3D1DDF63AF89B2"><enum>(A)</enum><text display-inline="yes-display-inline">disseminated widely, including among the participating Federal agencies and the Governors; and</text></subparagraph> <subparagraph id="HC03E2F745D1A49A3B55CF14E9DCFD3E0"><enum>(B)</enum><text>be made publicly available online in an accessible format.</text></subparagraph></paragraph>
<paragraph id="HB5C8C2EC58594FF3A2E13DE33619EF6E"><enum>(2)</enum><header>Deadline</header><text display-inline="yes-display-inline">The action plan and reports required under subsection (f) may be released on separate dates but shall be released not later than 9 months after the date of the enactment of this Act.</text></paragraph></subsection> <subsection commented="no" id="H61265B5832D940A5931E433255A9195C"><enum>(h)</enum><header>Termination</header><text display-inline="yes-display-inline">The Task Force shall terminate 30 days after the dissemination of the action plan and reports under subsection (g).</text></subsection>
<subsection commented="no" id="H1E13AE8BEE1C487886A8C982909C3E67"><enum>(i)</enum><header>Funding</header><text display-inline="yes-display-inline">The administrative expenses of the Task Force shall be paid out of existing Department of Health and Human Services funds or appropriations.</text></subsection> <subsection commented="no" id="HEC0F6EEC2A15476DA434F959E77D4497"><enum>(j)</enum><header>Definitions</header><text display-inline="yes-display-inline">For purposes of this section:</text>
<paragraph display-inline="no-display-inline" id="H5BBA62E3E7A447B39DEA366A50FDB0FC"><enum>(1)</enum><text>The term <quote>Governor</quote> means the chief executive officer of a State.</text></paragraph> <paragraph id="HF7B6AFFA57014E91B6D83BBBFD3B22A0"><enum>(2)</enum><text>The term <quote>participating Federal agencies</quote> means all the Executive agencies (as defined in section 105 of title 5, United States Code) whose officials have been appointed to the Task Force.</text></paragraph>
<paragraph id="HEEF04A740A154F728ACB86F38E1797F5"><enum>(3)</enum><text display-inline="yes-display-inline">The term <quote>State</quote> means each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands.</text></paragraph></subsection></section></subtitle> <subtitle id="H670CA285EFC340F4A6FFF59421A4D3A7"><enum>E</enum><header>Establishment of an Advisory Committee on Opioids and the Workplace</header> <section id="HBAE86BBAD9304DE5953C38ACB20F59E2" section-type="subsequent-section"><enum>8041.</enum><header>Establishment of an Advisory Committee on Opioids and the Workplace</header> <subsection id="HCF533BCB02A34812BBF2F18261C64BC9"><enum>(a)</enum><header>Establishment</header><text display-inline="yes-display-inline">Not later than 90 days after enactment of this Act, the Secretary of Labor shall establish an Advisory Committee on Opioids and the Workplace (referred to in this subtitle as the <quote>Advisory Committee</quote>) to advise the Secretary on actions the Department of Labor can take to provide informational resources and best practices on how to appropriately address the impact of opioid abuse on the workplace and support workers abusing opioids.</text></subsection>
<subsection id="H85CF771D032049399E21AFB64E737C9A"><enum>(b)</enum><header>Membership</header>
<paragraph id="HB892F31D96B944D0BF80EC60E212905A"><enum>(1)</enum><header>Composition</header><text display-inline="yes-display-inline">The Secretary of Labor shall appoint as members of the Advisory Committee 19 individuals with expertise in employment, workplace health programs, human resources, substance use disorder, and other relevant fields. The Advisory Committee shall be composed as follows:</text> <subparagraph id="H741D8DD6163A4BB69591E8D9788DC7A1"><enum>(A)</enum><text display-inline="yes-display-inline">Four of the members shall be individuals representative of employers or other organizations representing employers.</text></subparagraph>
<subparagraph id="H7BB160F1717945C686BA1A9DE2F44945"><enum>(B)</enum><text display-inline="yes-display-inline">Four of the members shall be individuals representative of workers or other organizations representing workers, of which at least two must be representatives designated by labor organizations.</text></subparagraph> <subparagraph id="HF40DFAF5CC5449CDA1F2DA4B12AE4A08"><enum>(C)</enum><text display-inline="yes-display-inline">Three of the members shall be individuals representative of health benefit plans, employee assistance plan providers, workers’ compensation program administrators, and workplace safety and health professionals.</text></subparagraph>
<subparagraph id="HF968237050DB4A4AAB4511D5A106EBA4"><enum>(D)</enum><text display-inline="yes-display-inline">Eight of the members shall be individuals representative of substance abuse treatment and recovery experts, including medical doctors, licensed addiction therapists, and scientific and academic researchers, of which one individual may be a representative of a local or State government agency that oversees or coordinates programs that address substance use disorder.</text></subparagraph></paragraph> <paragraph id="H6B5381135DD746E28241790A17CEBBFF"><enum>(2)</enum><header>Chair</header><text>From the members appointed under paragraph (1), the Secretary of Labor shall appoint a chairperson.</text></paragraph>
<paragraph id="H5639ED830ECE4990952DCC7DB9101846"><enum>(3)</enum><header>Terms</header><text display-inline="yes-display-inline">Each member of the Advisory Committee shall serve for a term of 3 years. A member appointed to fill a vacancy shall be appointed only for the remainder of such term.</text></paragraph> <paragraph id="H2967E06019414D0B915703C40A80D940"><enum>(4)</enum><header>Quorum</header><text>A majority of members of the Advisory Committee shall constitute a quorum and action shall be taken only by a majority vote of the members.</text></paragraph>
<paragraph id="H9407FFA8692D4298B8183FD0EB2995CE"><enum>(5)</enum><header>Voting</header><text>The Advisory Committee shall establish voting procedures.</text></paragraph> <paragraph id="H7FC2BD977BD840FEB4FC721BE118072D"><enum>(6)</enum><header>No compensation</header><text>Members of the Advisory Committee shall serve without compensation.</text></paragraph>
<paragraph id="H6080F6FBF1174195A33281511AB89D69"><enum>(7)</enum><header>Disclosure</header><text>Every member of the Advisory Committee must disclose the entity, if applicable, that he or she is representing.</text></paragraph></subsection> <subsection id="HF6D90C00C1934384A59BC070DCD8AED2"><enum>(c)</enum><header>Duties</header> <paragraph id="H995DCB5905CB45CB8B2D84693D1FFEC0"><enum>(1)</enum><header>Advisement</header> <subparagraph id="H65E950A716044221BB04CEFE7F16C0D7"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">The Advisory Committee established under subsection (a) shall advise the Secretary of Labor on actions the Department of Labor can take to provide informational resources and best practices on how to appropriately address the impact of opioid abuse on the workplace and support workers abusing opioids.</text></subparagraph>
<subparagraph id="H3C16054283EB4EB49A6E27BDC0325464"><enum>(B)</enum><header>Considerations</header><text>In providing such advice, the Advisory Committee shall take into account—</text> <clause id="H7D2D6F2C7C524DE49062103D5EDE41FC"><enum>(i)</enum><text display-inline="yes-display-inline">evidence-based and other employer substance abuse policies and best practices regarding opioid use or abuse, including benefits provided by employee assistance programs or other employer-provided benefits, programs, or resources;</text></clause>
<clause id="H63BF0FF4B47D42998B67AD8B25249C6F"><enum>(ii)</enum><text>the effect of opioid use or abuse on the safety of the workplace as well as policies and procedures addressing workplace safety and health;</text></clause> <clause id="HE2A442A3FEFA41B49E36A2328FD4007B"><enum>(iii)</enum><text display-inline="yes-display-inline">the impact of opioid abuse on productivity and absenteeism, and assessments of model human resources policies that support workers abusing opioids, such as policies that facilitate seeking and receiving treatment and returning to work;</text></clause>
<clause id="H1DCBC7EA8FEA4148B37F9AE029EB79DB"><enum>(iv)</enum><text display-inline="yes-display-inline">the extent to which alternative pain management treatments other than opioids are or should be covered by employer-sponsored health plans;</text></clause> <clause id="H6E2C528660DB4BE991241A58FF569C0F"><enum>(v)</enum><text display-inline="yes-display-inline">the legal requirements protecting employee privacy and health information in the workplace, as well as the legal requirements related to nondiscrimination;</text></clause>
<clause id="HE359949214FA480AB0C9F5713AEB46AE"><enum>(vi)</enum><text display-inline="yes-display-inline">potential interactions of opioid abuse with other substance use disorders;</text></clause> <clause id="H100036DFCD4D41648DFDE6F75D2033D7"><enum>(vii)</enum><text>any additional benefits or resources available to an employee abusing opioids that promote retaining employment or reentering the workforce;</text></clause>
<clause id="H2DF14695D64446D9A5888C3795B09697"><enum>(viii)</enum><text display-inline="yes-display-inline">evidence-based initiatives that engage employers, employees, and community leaders to promote early identification of opioid abuse, intervention, treatment, and recovery;</text></clause> <clause id="H1C91B905926A46F197F389633C01CD79"><enum>(ix)</enum><text display-inline="yes-display-inline">workplace policies regarding opioid abuse that reduce stigmatization among fellow employees and management; and</text></clause>
<clause id="HE711301ACAA64582A786618A6C029150"><enum>(x)</enum><text display-inline="yes-display-inline">the legal requirements of the Mental Health Parity and Addiction Equity Act and other laws related to health coverage of substance abuse and mental health services and medications.</text></clause></subparagraph></paragraph> <paragraph id="H719129B5F4D84325804BD3C5C4457F82"><enum>(2)</enum><header>Report</header><text display-inline="yes-display-inline">Prior to its termination as provided in subsection (j), the Advisory Committee shall issue a report to the Secretary of Labor and to the Committee on Education and the Workforce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate, detailing successful programs and policies involving workplace resources and benefits, including recommendations or examples of best practices for how employers can support and respond to employees impacted by opioid abuse.</text></paragraph></subsection>
<subsection id="HBE8BEA4F8D764CE6B18D88D443202313"><enum>(d)</enum><header>Meetings</header><text>The Advisory Committee shall meet at least twice a year at the call of the chairperson.</text></subsection> <subsection id="H63BAD347FA3946B885CC3918CAC43346"><enum>(e)</enum><header>Staff support</header><text display-inline="yes-display-inline">The Secretary of Labor shall make available staff necessary for the Advisory Committee to carry out its responsibilities.</text></subsection>
<subsection id="HECF1AC064B5B49858FC989229230857A"><enum>(f)</enum><header>Federal Advisory Committee Act</header><text display-inline="yes-display-inline">The Federal Advisory Committee Act shall apply to the Advisory Committee established under this subtitle.</text></subsection> <subsection id="H8596B374F245490BA8ECCF3C7F0A5EB7"><enum>(g)</enum><header>No appropriated funds</header><text display-inline="yes-display-inline">No additional funds are authorized to be appropriated to carry out this subtitle. Expenses of the Advisory Committee shall be paid with funds otherwise appropriated to Departmental Management within the Department of Labor.</text></subsection>
<subsection id="H83C2FF67639C497BBA089C5C3AD8AAD6"><enum>(h)</enum><header>Ex officio</header><text display-inline="yes-display-inline">Three nonvoting representatives from agencies within the Department of Health and Human Services whose responsibilities include opioid prescribing guidelines, workplace safety, and monitoring of substance abuse and prevention programs shall be appointed by the Secretary of Labor and designated as ex officio members.</text></subsection> <subsection id="HF0A7967042EE4E478A48358E9B84C68A"><enum>(i)</enum><header>Agenda</header><text display-inline="yes-display-inline">The Secretary of Labor or a representative of the Secretary shall consult with the Chair in establishing the agenda for Committee meetings.</text></subsection>
<subsection id="H0BF9FE6AFBC34C4DB2AA1F81E8A16C9D"><enum>(j)</enum><header>Termination</header><text display-inline="yes-display-inline">The Advisory Committee established under this subtitle shall terminate 3 years after the date of enactment of this Act.</text></subsection></section></subtitle> <subtitle id="H90C22CB99AD44A7885E1203C497ACA00"><enum>F</enum><header>Veterans Treatment Court Improvement</header> <section id="H9BC379533BFB44368DC26C3A2C7558C5" section-type="subsequent-section"><enum>8051.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Veterans Treatment Court Improvement Act of 2018</short-title></quote>.</text></section>
<section id="H6AB532610BAC491B9B360FE6D1F10411"><enum>8052.</enum><header>Hiring by Department of Veterans Affairs of additional Veterans Justice Outreach Specialists</header>
<subsection id="HBE35A2AE9976485FA563CAC0A0C1E1CB"><enum>(a)</enum><header>Hiring of additional Veterans Justice Outreach Specialists</header>
<paragraph id="HC52855D1EB644DCA923FB27B21FF3242"><enum>(1)</enum><header>In general</header><text>Not later than 1 year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall hire not fewer than 50 Veterans Justice Outreach Specialists and place each such Veterans Justice Outreach Specialist at an eligible Department of Veterans Affairs medical center in accordance with this section.</text></paragraph> <paragraph id="HE7967407F6C74144869400AB98294854"><enum>(2)</enum><header>Requirements</header><text>The Secretary shall ensure that each Veterans Justice Outreach Specialist employed under paragraph (1)—</text>
<subparagraph id="H5E0DCD20444F4D1CAF48084EEC2011AA"><enum>(A)</enum><text>serves, either exclusively or in addition to other duties, as part of a justice team in a veterans treatment court or other veteran-focused court; and</text></subparagraph> <subparagraph id="H369DBFB1F8A14EACA200E0FF107F977A"><enum>(B)</enum><text>otherwise meets Department hiring guidelines for Veterans Justice Outreach Specialists.</text></subparagraph></paragraph></subsection>
<subsection id="HAAB5BA8BFD7746E4A75EFD0C769B8E48"><enum>(b)</enum><header>Eligible Department of Veterans Affairs medical centers</header><text>For purposes of this section, an eligible Department of Veterans Affairs medical center is any Department of Veterans Affairs medical center that—</text> <paragraph id="H80F5F17D220541A4BFF7EB5E9F51EF12"><enum>(1)</enum><text>complies with all Department guidelines and regulations for placement of a Veterans Justice Outreach Specialist;</text></paragraph>
<paragraph id="HA0038090486040369495CAF0FBF2A55E"><enum>(2)</enum><text>works within a local criminal justice system with justice-involved veterans;</text></paragraph> <paragraph id="HB50A28AE84BD4517937CC001D12AA53F"><enum>(3)</enum><text>maintains an affiliation with one or more veterans treatment courts or other veteran-focused courts; and</text></paragraph>
<paragraph id="HC8E995591D6A47E98CAEC11FF5AEAF1E"><enum>(4)</enum><text>either—</text> <subparagraph id="HD0FBF6CAC62F42E1B137BB65B695A553"><enum>(A)</enum><text>routinely provides Veterans Justice Outreach Specialists to serve as part of a justice team in a veterans treatment court or other veteran-focused court; or</text></subparagraph>
<subparagraph id="H4B6449675D9E4F51A08C667368D4F8B3"><enum>(B)</enum><text>establishes a plan that is approved by the Secretary to provide Veterans Justice Outreach Specialists employed under subsection (a)(1) to serve as part of a justice team in a veterans treatment court or other veteran-focused court.</text></subparagraph></paragraph></subsection> <subsection id="HF192C4851329430DB2E1EF6B02749897"><enum>(c)</enum><header>Placement priority</header><text>The Secretary shall prioritize the placement of Veterans Justice Outreach Specialists employed under subsection (a)(1) at eligible Department of Veterans Affairs medical centers that have or intend to establish an affiliation, for the purpose of carrying out the Veterans Justice Outreach Program, with a veterans treatment court, or other veteran-focused court, that—</text>
<paragraph id="HFAA86F02BAD3473695041F13DA631BDF"><enum>(1)</enum><text>was established on or after the date of the enactment of this Act; or</text></paragraph> <paragraph id="H7279336B1745443AA97FAA4FD6A85F4B"><enum>(2)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="HA1412D225C834BE69814700F5790B9D4"><enum>(A)</enum><text>was established before the date of the enactment of this Act; and</text></subparagraph>
<subparagraph id="HBBC473048C604C8C904C5A03A7B85CE2" indent="up1"><enum>(B)</enum><text>is not fully staffed with Veterans Justice Outreach Specialists.</text></subparagraph></paragraph></subsection> <subsection id="H069A1A0906074EFAB1BB288287E91222"><enum>(d)</enum><header>Reports</header> <paragraph id="H1BA32F56014741EB9195F00BCD061AE9"><enum>(1)</enum><header>Report by Secretary of Veterans Affairs</header> <subparagraph id="H0D18B48E1D1742C7810BB11809B3528D"><enum>(A)</enum><header>In general</header><text>Not later than 1 year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to Congress a report on the implementation of this section and its effect on the Veterans Justice Outreach Program.</text></subparagraph>
<subparagraph id="HD0034533B5E7481698D3581B17A70492"><enum>(B)</enum><header>Contents</header><text>The report submitted under paragraph (1) shall include the following:</text> <clause id="HD838BB57755C42338881574E803F6D7D"><enum>(i)</enum><text>The status of the efforts of the Secretary to hire Veterans Justice Outreach Specialists pursuant to subsection (a)(1), including the total number of Veterans Justice Outreach Specialists hired by the Secretary pursuant to such subsection and the number that the Secretary expects to hire pursuant to such subsection.</text></clause>
<clause id="HCDF2B7638640448B8CF915A7A63C8B7F"><enum>(ii)</enum><text>The total number of Veterans Justice Outreach Specialists assigned to each Department of Veterans Affairs medical center that participates in the Veterans Justice Outreach Program, including the number of Veterans Justice Outreach Specialists hired under subsection (a)(1) disaggregated by Department of Veterans Affairs medical center.</text></clause> <clause id="H2920D1A62B864418A9C1F83F986F76A5"><enum>(iii)</enum><text>The total number of eligible Department of Veterans Affairs medical centers that sought placement of a Veterans Justice Outreach Specialist under subsection (a)(1), how many Veterans Justice Outreach Specialists each such center sought, and how many of such medical centers received no placement of a Veterans Justice Outreach Specialist under subsection (a)(1).</text></clause>
<clause id="H43FEBF970CFC4AFDA596AA3650A19A0D"><enum>(iv)</enum><text display-inline="yes-display-inline">For each eligible Department of Veterans Affairs medical center—</text> <subclause id="H42B9CC4F296D4895B5872E14053F0CA6"><enum>(I)</enum><text>the number of justice-involved veterans who were served or are expected to be served by a Veterans Justice Outreach Specialist hired under subsection (a)(1); and</text></subclause>
<subclause id="HB195EEFE605A44B2B5C4D51F04317D00"><enum>(II)</enum><text display-inline="yes-display-inline">the number of justice-involved veterans who do not have access to a Veterans Justice Outreach Specialist.</text></subclause></clause></subparagraph></paragraph> <paragraph id="H7883C36900DD485D89A4A3A93463FE82"><enum>(2)</enum><header>Report by Comptroller General of the United States</header> <subparagraph id="HDB7DC50348164578937DDA7EEC72D9C0"><enum>(A)</enum><header>In general</header><text>Not later than 3 years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the implementation of this section and the effectiveness of the Veterans Justice Outreach Program.</text></subparagraph>
<subparagraph id="H4F0170F3876D4F5CA75D214F7C113D79"><enum>(B)</enum><header>Contents</header><text>The report required by subparagraph (A) shall include the following:</text> <clause id="HF95ED491C1F7499EBE12150846F3F9D3"><enum>(i)</enum><text>An assessment of whether the Secretary has fulfilled the Secretary's obligations under this section.</text></clause>
<clause id="H4800060CCC854731862803582223951A"><enum>(ii)</enum><text>The number of veterans who are served by Veterans Justice Outreach Specialists hired under subsection (a)(1), disaggregated by demographics (including discharge status).</text></clause> <clause id="H74C99A23400B4BDC91F194D10C83C721"><enum>(iii)</enum><text>An identification of any subgroups of veterans who underutilize services provided under laws administered by the Secretary, including an assessment of whether these veterans have access to Veterans Justice Outreach Specialists under the Veterans Justice Outreach Program.</text></clause>
<clause id="HABBF28FDF4BC42B4966F1AFC74DD4C47"><enum>(iv)</enum><text>Such recommendations as the Comptroller General may have for the Secretary to improve the effectiveness of the Veterans Justice Outreach Program.</text></clause></subparagraph></paragraph></subsection> <subsection id="H81023794D4A74B93BC501555026731A8"><enum>(e)</enum><header>Definitions</header><text>In this section:</text>
<paragraph id="H5C21503AC74249BC9015BAA83AA8F948"><enum>(1)</enum><header>Justice team</header><text>The term <term>justice team</term> means the group of individuals, which may include a judge, court coordinator, prosecutor, public defender, treatment provider, probation or other law enforcement officer, program mentor, and Veterans Justice Outreach Specialist, who assist justice-involved veterans in a veterans treatment court or other veteran-focused court.</text></paragraph> <paragraph id="H0149F82909E2479A8123B5D60EAC59EC"><enum>(2)</enum><header>Justice-involved veteran</header><text>The term <term>justice-involved veteran</term> means a veteran with active, ongoing, or recent contact with some component of a local criminal justice system.</text></paragraph>
<paragraph id="H465784A49E2A4A51B6E4E7CBFCA88FE6"><enum>(3)</enum><header>Local criminal justice system</header><text>The term <term>local criminal justice system</term> means law enforcement, jails, prisons, and Federal, State, and local courts.</text></paragraph> <paragraph id="HBE92BCBC790C4BA7AE809D7F6DAA43B6"><enum>(4)</enum><header>Veterans Justice Outreach Program</header><text>The term <term>Veterans Justice Outreach Program</term> means the program through which the Department of Veterans Affairs identifies justice-involved veterans and provides such veterans with access to Department services.</text></paragraph>
<paragraph id="H1A9DD2962CBF40A4B3654B28190FEA09"><enum>(5)</enum><header>Veterans Justice Outreach Specialist</header><text>The term <term>Veterans Justice Outreach Specialist</term> means an employee of the Department of Veterans Affairs who serves as a liaison between the Department and the local criminal justice system on behalf of a justice-involved veteran.</text></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="H0C17DDD80D56404690F13D3BF3ADA9DE"><enum>(6)</enum><header>Veterans treatment court</header><text>The term <term>veterans treatment court</term> means a State or local court that is participating in the veterans treatment court program (as defined in section 2991(i)(1) of the Omnibus Crime Control and Safe Streets Act of 1968 (<external-xref legal-doc="usc" parsable-cite="usc/42/3797aa">42 U.S.C. 3797aa(i)(1)</external-xref>)).</text></paragraph></subsection></section></subtitle>
<subtitle id="H32D244636BFC4707BAC987FD919F0BFC"><enum>G</enum><header>Peer support counseling program for women veterans</header>
<section id="HD9E3796AB3464FC19D328A5229947A5E" section-type="subsequent-section"><enum>8061.</enum><header>Peer support counseling program for women veterans</header>
<subsection id="H01CA832A000543B491712732448DA1C2"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1720F(j) of title 38, United States Code, is amended by adding at the end the following new paragraph:</text> <quoted-block display-inline="no-display-inline" id="H2BF6066A5DD6443BADFAFE87496E279A" style="USC"> <paragraph id="HFCAFC05A481A4D36AF942E6CE255CB23" indent="up1"><enum>(4)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="H9DFC1AD7DD68403EBA455D6D3B8F9F9B"><enum>(A)</enum><text display-inline="yes-display-inline">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—</text>
<clause id="H7323C8CB3D4D42E0B2912C53058B66A1" indent="up1"><enum>(i)</enum><text>female gender-specific issues and services;</text></clause> <clause id="HEF09F010A77B493BB3EF39188C48205E" indent="up1"><enum>(ii)</enum><text>the provision of information about services and benefits provided under laws administered by the Secretary; or</text></clause>
<clause id="HD933D904E89C42459846AD16462A83D9" indent="up1"><enum>(iii)</enum><text>employment mentoring.</text></clause></subparagraph> <subparagraph id="H320898E1650D454A9F23BCC62C9AF3FF" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">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 homeless, or are otherwise at increased risk of suicide, as determined by the Secretary.</text></subparagraph>
<subparagraph id="HA0E93E4B0BE94A9F9BC32EB70ED91432" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">The Secretary shall conduct outreach to inform women veterans about the program and the assistance available under this paragraph.</text></subparagraph> <subparagraph id="HA80DB921AA3B4E5CAEBF317CA2E2DFE5" indent="up1"><enum>(D)</enum><text>In carrying out this paragraph, the Secretary shall coordinate with such community organizations, State and local governments, institutions of higher education, chambers of commerce, local business organizations, organizations that provide legal assistance, and other organizations as the Secretary considers appropriate.</text></subparagraph>
<subparagraph id="HCAC45577BAAA499B9BBA408FF857A776" indent="up1"><enum>(E)</enum><text display-inline="yes-display-inline">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 (<external-xref legal-doc="usc" parsable-cite="usc/38/1712A">38 U.S.C. 1712A</external-xref> note). </text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="HAC372B5F4A8C42D1B69C1AD5304D3360"><enum>(b)</enum><header>Funding</header><text display-inline="yes-display-inline">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.</text></subsection>
<subsection id="H907676363F404D7594ED87D9B6EC779A"><enum>(c)</enum><header>Report to Congress</header><text>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 counseling program under section 1720F(j) of title 38, United States Code, as amended by this section. Such report shall include—</text> <paragraph id="HD7F02F0CB5304D1FBB32B0591BF584DE"><enum>(1)</enum><text>the number of peer support counselors in the program;</text></paragraph>
<paragraph id="HFC7123D8B7BB418B8B6ECD0BC3BD1524"><enum>(2)</enum><text>an assessment of the effectiveness of the program; and</text></paragraph> <paragraph id="H9F12BCB5C6004AAF8D2750B0B42D7140"><enum>(3)</enum><text>a description of the oversight of the program.</text></paragraph></subsection></section></subtitle>
<subtitle id="HF1D2660BA2BD4597BB19D7D44764431C"><enum>H</enum><header>Treating Barriers to Prosperity</header>
<section id="H07EB3B5850FD4F77A909343B0CA3E5F3" section-type="subsequent-section"><enum>8071.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Treating Barriers to Prosperity Act of 2018</short-title></quote>.</text></section> <section id="H2B973776D1FC42B69536F25A95D58279"><enum>8072.</enum><header>Drug abuse mitigation initiative</header> <subsection id="H57CB5B61A6FA472A97D6DD2025013A46"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline"><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/40/145">Chapter 145</external-xref> of title 40, United States Code, is amended by inserting after <external-xref legal-doc="usc" parsable-cite="usc/40/14509">section 14509</external-xref> the following:</text>
<quoted-block display-inline="no-display-inline" id="H1E581B2463B742079E8BA9525A7EBD1F" style="USC">
<section id="H725BD52A0C5E400DA749E87B7F850484"><enum>14510.</enum><header>Drug abuse mitigation initiative</header>
<subsection id="H2AAA78D5106C4C6E8C0F039A8B3DC482"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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—</text> <paragraph id="H70BD943525754AEBB0B1DB4C9A3900EC"><enum>(1)</enum><text display-inline="yes-display-inline">to facilitate the sharing of best practices among States, counties, and other experts in the region with respect to reducing such abuse;</text></paragraph>
<paragraph id="H7AF606EF727D46D199031DC959A1C2EE"><enum>(2)</enum><text display-inline="yes-display-inline">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;</text></paragraph> <paragraph id="HA65D23FF13C84FE98EB066A0210872AF"><enum>(3)</enum><text display-inline="yes-display-inline">to attract and retain relevant health care services, businesses, and workers; and</text></paragraph>
<paragraph id="H0718D704B3CF4A60AB9288EB13BC1BC8"><enum>(4)</enum><text display-inline="yes-display-inline">to develop relevant infrastructure, including broadband infrastructure that supports the use of telemedicine.</text></paragraph></subsection> <subsection id="H9584498E23A2427E9F2664740743A8CC"><enum>(b)</enum><header>Limitation on available amounts</header><text>Of the cost of any activity eligible for a grant under this section—</text>
<paragraph id="HC0CA1BD686BA47969F733A213101A6CD"><enum>(1)</enum><text>not more than 50 percent may be provided from amounts appropriated to carry out this section; and</text></paragraph> <paragraph id="H544C83697A54441BAC64D4CCB3C6EC9E"><enum>(2)</enum><text>notwithstanding paragraph (1)—</text>
<subparagraph id="H3A2532EC4B544C27A4DFFCB9E60B76C7"><enum>(A)</enum><text>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</text></subparagraph> <subparagraph id="HA059B0E8A9954205B584262F1FE2D912"><enum>(B)</enum><text>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.</text></subparagraph></paragraph></subsection>
<subsection id="HBFF3307A680E47ED987B0A4AA6E4C80C"><enum>(c)</enum><header>Sources of assistance</header><text>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—</text> <paragraph id="H44855005723C45D6B21ADE49903A5950"><enum>(1)</enum><text>under any other Federal program (subject to the availability of subsequent appropriations); or</text></paragraph>
<paragraph id="HCD4EAD92270F42AA89238DEF3AD39318"><enum>(2)</enum><text>from any other source.</text></paragraph></subsection> <subsection id="H11148ADD9CF7499CBE066A5DF222E6F5"><enum>(d)</enum><header>Federal share</header><text>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.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H35F946AEF69640BB997A631DA61B794F"><enum>(b)</enum><header>Clerical amendment</header><text>The analysis for <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/40/145">chapter 145</external-xref> of title 40, United States Code, is amended by inserting after the item relating to <external-xref legal-doc="usc" parsable-cite="usc/40/14509">section 14509</external-xref> the following:</text> <quoted-block display-inline="no-display-inline" id="HC4963613922B41E58F3522A2DB4FD4D9" style="USC"> <toc regeneration="no-regeneration"> <toc-entry level="section">14510. Drug abuse mitigation initiative.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section></subtitle> <subtitle id="HE8BC93F382364A33BAFBBB6493F1F45F"><enum>I</enum><header>Supporting Grandparents Raising Grandchildren</header> <section id="H196C0D55DFC94DA4A46EF7A23D2DDAC0" section-type="subsequent-section"><enum>8081.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>Supporting Grandparents Raising Grandchildren Act</short-title></quote>.</text></section>
<section id="H3F2CB021F1CF457783E5838DFE85122C"><enum>8082.</enum><header>Findings</header><text display-inline="no-display-inline">Congress finds the following:</text> <paragraph id="HE416B45B4073468B9BC7DB04983C2B94"><enum>(1)</enum><text>More than 2,500,000 grandparents in the United States are the primary caretaker of their grandchildren, and experts report that such numbers are increasing as the opioid epidemic expands.</text></paragraph>
<paragraph id="H347A0A7CD61D45759414EA3537792E7D"><enum>(2)</enum><text>Between 2009 and 2016, the incidence of parental alcohol or other drug use as a contributing factor for children’s out-of-home placement rose from 25.4 to 37.4 percent.</text></paragraph> <paragraph id="H8B3DE3E8EA04427F814A5D9FCA0FED61"><enum>(3)</enum><text>When children cannot remain safely with their parents, placement with relatives is preferred over placement in foster care with nonrelatives because placement with relatives provides stability for children and helps them maintain family connections.</text></paragraph>
<paragraph id="H400A467AFEA64EBD87452B31DFFC9CA8"><enum>(4)</enum><text>The number of foster children placed with a grandparent or other relative increased from 24 percent in 2006 to 32 percent in 2016, according to data from the Department of Health and Human Services.</text></paragraph> <paragraph id="H80534977388C45F2BCE2C4ABEF4D1DDA"><enum>(5)</enum><text>Grandparents' lives are enhanced by caring for their grandchildren; the overwhelming majority of grandparents report experiencing significant benefits in serving as their grandchildren’s primary caregivers. </text></paragraph>
<paragraph id="H146E63BD2AF74D5181B5A48A7670A2D3"><enum>(6)</enum><text>Providing full-time care to their grandchildren may decrease grandparents’ ability to address their own physical and mental health needs and personal well-being.</text></paragraph> <paragraph id="HEEE37AADB3184F93881FCEBE6B1FCFD8"><enum>(7)</enum><text>Grandparents would benefit from better coordination and dissemination of information and resources available to support them in their caregiving responsibilities. </text></paragraph></section>
<section id="H3B24FA57E0B94BB4AB38506657AFACAB"><enum>8083.</enum><header>Advisory Council To Support Grandparents Raising Grandchildren</header>
<subsection id="H16C61CCC7DE245FCA4A1A3870FF3F3C6"><enum>(a)</enum><header>Establishment</header><text display-inline="yes-display-inline">There is established an Advisory Council to Support Grandparents Raising Grandchildren.</text></subsection> <subsection id="H932AE1E3ACB24189A9ADBA96457385B1"><enum>(b)</enum><header>Membership</header> <paragraph id="HEEF6F46EA64347E392375F2E03236A43"><enum>(1)</enum><header>In general</header><text>The Advisory Council shall be composed of the following members, or their designee:</text>
<subparagraph id="H292E3F6CE2604AC8B5C1F6EA44CF9257"><enum>(A)</enum><text>The Secretary of Health and Human Services. </text></subparagraph> <subparagraph id="H9E8BB2C916FB493F944959F826FC01C6"><enum>(B)</enum><text>The Secretary of Education.</text></subparagraph>
<subparagraph id="H27766CBADA8D48A69B202A8A274C75E6"><enum>(C)</enum><text>The Administrator of the Administration for Community Living.</text></subparagraph> <subparagraph id="HBFE6B73D1FE64718B5118011D02D3D50"><enum>(D)</enum><text>The Director of the Centers for Disease Control and Prevention.</text></subparagraph>
<subparagraph id="HB16AB96D79E34749B79D0AECBD2D30DB"><enum>(E)</enum><text>The Assistant Secretary for Mental Health and Substance Use. </text></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="H385525A9E78948FF8569B0F394EE7C88"><enum>(F)</enum><text>The Assistant Secretary for the Administration for Children and Families.</text></subparagraph>
<subparagraph id="HBE38BAE3C5BA4CBCBB98D8E56D56826A"><enum>(G)</enum><text>A grandparent raising a grandchild.</text></subparagraph> <subparagraph id="HD4C5EEF78E9841E194514E37C9294570"><enum>(H)</enum><text>An older relative caregiver of children. </text></subparagraph>
<subparagraph id="HA2DABA8AA1BF45E29AA83042E98792C2"><enum>(I)</enum><text>As appropriate, the head of other Federal departments, or agencies, identified by the Secretary of Health and Human Services as having responsibilities, or administering programs, relating to current issues affecting grandparents or other older relatives raising children. </text></subparagraph></paragraph> <paragraph id="H354D4CB4128541F08810A889835DC50B"><enum>(2)</enum><header>Lead agency</header><text>The Department of Health and Human Services shall be the lead agency for the Advisory Council. </text></paragraph></subsection>
<subsection id="H3E03FAF556784993BE1F5EDFEA2AB208"><enum>(c)</enum><header>Duties</header>
<paragraph id="H0F35497C55D6416293043FAD156E5FFD"><enum>(1)</enum><header>In general</header>
<subparagraph id="H187FF4611BD643E992DB1EA27480C3EB"><enum>(A)</enum><header>Information</header><text>The Advisory Council shall identify, promote, coordinate, and disseminate to the public information, resources, and the best practices available to help grandparents and other older relatives—</text> <clause id="HC7B2E73A1DC54BE381C8F0A5F68E946F"><enum>(i)</enum><text>meet the health, educational, nutritional, and other needs of the children in their care; and</text></clause>
<clause id="H2C1AEF903B91480F83BBB9BEE5230ECE"><enum>(ii)</enum><text>maintain their own physical and mental health and emotional well-being. </text></clause></subparagraph> <subparagraph id="H94E6A40B428C4BD9B85438DD032EBC10"><enum>(B)</enum><header>Opioids</header><text display-inline="yes-display-inline">In carrying out the duties described in subparagraph (A), the Advisory Council shall consider the needs of those affected by the opioid crisis.</text></subparagraph>
<subparagraph id="H32721C6437F64A45BA0B74108DCF5D56"><enum>(C)</enum><header>Native Americans</header><text>In carrying out the duties described in subparagraph (A), the Advisory Council shall consider the needs of members of Native American tribes.</text></subparagraph></paragraph> <paragraph id="HF1EE5840932444E6A3DDCB3F761577A6"><enum>(2)</enum><header>Report</header> <subparagraph id="H0CE4AC844C4F412BAEA5BFF8227E86F9"><enum>(A)</enum><header>In general</header><text>Not later than 180 days after the date of enactment of this Act, the Advisory Council shall submit a report to—</text>
<clause id="H20620B1C69E84851BF33DACEB567A68D"><enum>(i)</enum><text>the appropriate committees;</text></clause> <clause id="H6A5882C44198480E87144CD188BFE8AC"><enum>(ii)</enum><text>the State agencies that are responsible for carrying out family caregiver programs; and </text></clause>
<clause id="HB094E632D36D4A95AF2098F280F77D07"><enum>(iii)</enum><text>the public online in an accessible format.</text></clause></subparagraph> <subparagraph id="HD591D2564DEF4B89ACADB44A0DDA1411"><enum>(B)</enum><header>Report format</header><text>The report shall include—</text>
<clause id="H74FF29E7184B434D94D38371763B39CF"><enum>(i)</enum><text>best practices, resources, and other useful information for grandparents and other older relatives raising children identified under paragraph (1)(A) including, if applicable, any information related to the needs of children who have been impacted by the opioid epidemic;</text></clause> <clause id="HCE1B7959F64F4CFE9F7409E371E93668"><enum>(ii)</enum><text>an identification of any gaps in items under clause (i); and </text></clause>
<clause id="H8A6A67D47B984D3B9DF2E338344C1735"><enum>(iii)</enum><text>where applicable, identification of any additional Federal legislative authority necessary to implement the activities described in clause (i) and (ii).</text></clause></subparagraph></paragraph> <paragraph id="H3C601F0223DB4095BD1C2523957C75B4" display-inline="no-display-inline"><enum>(3)</enum><header>Follow-up report</header><text>Not later than 2 years after the date on which the report required under paragraph (2)(A) is submitted, the Advisory Council shall submit a follow-up report that includes the information identified in paragraph (2)(B) to—</text>
<subparagraph id="H947A2CF2D60F430BBA55E70694643DEA"><enum>(A)</enum><text>the appropriate committees; </text></subparagraph> <subparagraph id="H4D80361927DE4958ABB413EAC559E3F4"><enum>(B)</enum><text>the State agencies that are responsible for carrying out family caregiver programs; and</text></subparagraph>
<subparagraph id="HE8C366C09D404B62AC115147F06CFE18"><enum>(C)</enum><text>the public online in an accessible format. </text></subparagraph></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="HAB1D4B1CB3C94F42B21C27BEBB391B91"><enum>(4)</enum><header display-inline="yes-display-inline">Public input</header> <subparagraph id="H441006876C29443B9C2CA4D11A82750F"><enum>(A)</enum><header>In general</header><text>The Advisory Council shall establish a process for public input to inform the development of, and provide updates to, the best practices, resources, and other information described in paragraph (1) that shall include—</text>
<clause id="H8BB6B33A7BDE4496B09782D797DD111F"><enum>(i)</enum><text>outreach to States, local entities, and organizations that provide information to, or support for, grandparents or other older relatives raising children; and</text></clause> <clause id="HF37499F4949847F6A04692DBDD855B07"><enum>(ii)</enum><text>outreach to grandparents and other older relatives with experience raising children.</text></clause></subparagraph>
<subparagraph id="H9378DE35ED9844AD8676579ADA424E4C"><enum>(B)</enum><header>Nature of outreach</header><text>Such outreach shall ask individuals to provide input on—</text> <clause id="H6845822890D74FA79BFA3E804959A54C"><enum>(i)</enum><text>information, resources, and best practices available, including identification of any gaps and unmet needs; and </text></clause>
<clause id="H69BECC27B0904DD7BD2B697258F1324B"><enum>(ii)</enum><text>recommendations that would help grandparents and other older relatives better meet the health, educational, nutritional, and other needs of the children in their care, as well as maintain their own physical and mental health and emotional well-being. </text></clause></subparagraph></paragraph></subsection> <subsection id="HB65CBF291B2043078EECA0FB4FB6995A"><enum>(d)</enum><header>FACA</header><text>The Advisory Council shall be exempt from the requirements of the Federal Advisory Committee Act (5 U.S.C. App.). </text></subsection>
<subsection id="HCA250F094CB24B29ADE7CAF44C977B80"><enum>(e)</enum><header>Funding</header><text>No additional funds are authorized to be appropriated to carry out this subtitle.</text></subsection> <subsection id="HDCC0AAC4CC694438BB39CDDC8A1900E8"><enum>(f)</enum><header>Sunset</header><text>The Advisory Council shall terminate on the date that is 3 years after the date of enactment of this Act.</text></subsection></section>
<section id="HBF71FB6E436A4661BA49088B999F8B58"><enum>8084.</enum><header>Definitions</header><text display-inline="no-display-inline">In this subtitle:</text> <paragraph id="H504B772D7E6D4F4C91F1852B3BA547FD"><enum>(1)</enum><header>Advisory Council</header><text display-inline="yes-display-inline">In this subtitle, the term <quote>Advisory Council</quote> means the Advisory Council to Support Grandparents Raising Grandchildren that is established under section 8083.</text></paragraph>
<paragraph id="H72C7BF30BBD54A979AB6161CEF1B55C0"><enum>(2)</enum><header>Appropriate committees</header><text display-inline="yes-display-inline">In this subtitle, the term <term>appropriate committees</term> means the following:</text> <subparagraph id="H8F6E6570FB284B79B35BA82E79C48051"><enum>(A)</enum><text display-inline="yes-display-inline">The Special Committee on Aging of the Senate.</text></subparagraph>
<subparagraph id="H46A42D762E5C4E4DAB296164379E2A97"><enum>(B)</enum><text>The Committee on Health, Education, Labor, and Pensions of the Senate.</text></subparagraph> <subparagraph id="H379D8854E9494F7CBA689F8AE952F645"><enum>(C)</enum><text display-inline="yes-display-inline">The Committee on Education and the Workforce of the House of Representatives.</text></subparagraph>
<subparagraph id="HAC598E080600478991685802207AB49A"><enum>(D)</enum><text>The Committee on Energy and Commerce of the House of Representatives.</text></subparagraph></paragraph></section></subtitle> <subtitle id="H0C46F93416DA419B8396BA81BF0DD771"><enum>J</enum><header>Reauthorizing and Extending Grants for Recovery from Opioid Use Programs</header> <section id="H4B9718A3708D43E7B0E8FD962F5447EA" section-type="subsequent-section"><enum>8091.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote>Reauthorizing and Extending Grants for Recovery from Opioid Use Programs Act of 2018</quote> or the <quote>REGROUP Act of 2018</quote>.</text></section>
<section id="HF6902D0B0FD3492BAFCADB06EDFAE477"><enum>8092.</enum><header>Reauthorization of the comprehensive opioid abuse grant program</header><text display-inline="no-display-inline">Section 1001(a)(27) of the Omnibus Crime Control and Safe Streets Act of 1968 (<external-xref legal-doc="usc" parsable-cite="usc/34/10261">34 U.S.C. 10261(a)(27)</external-xref>) is amended by striking <quote>through 2021</quote> and inserting <quote>and 2018, and $330,000,000 for each of fiscal years 2019 through 2023</quote>. </text></section></subtitle> <enum>IX</enum><header>SITSA Act</header> <section id="HFB68F8E887C24B3D8488AF43C3EBCB1A"><enum>9001.</enum><header>Short title</header><text display-inline="no-display-inline">This title may be cited as the <quote><short-title>Stop the Importation and Trafficking of Synthetic Analogues Act of 2017</short-title></quote> or the <quote>SITSA Act</quote>.</text></section>
<section id="H7B42A229D6B947C29BF31F74BF0DDDC8"><enum>9002.</enum><header>Establishment of schedule A</header><text display-inline="no-display-inline">Section 202 of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/812">21 U.S.C. 812</external-xref>) is amended—</text> <paragraph id="H4BCE228EDC4E4E5795227FA7BE9658BD"><enum>(1)</enum><text>in subsection (a), by striking <quote>five schedules of controlled substances, to be known as schedules I, II, III, IV, and V</quote> and inserting <quote>six schedules of controlled substances, to be known as schedules I, II, III, IV, V, and A</quote>;</text></paragraph>
<paragraph id="HF37F37001C2D4A5491426C7A68FF9AC9"><enum>(2)</enum><text>in subsection (b), by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="H2A28FF2BC08B44D99CE078B94B921459" style="OLC"> <paragraph commented="no" display-inline="no-display-inline" id="H645DDADEB6D343D5A1BE162AF4C09FA9" indent="up1"><enum>(6)</enum><header display-inline="yes-display-inline">Schedule A</header> <subparagraph commented="no" display-inline="no-display-inline" id="HD3A61CAAA8A0471BAFD637DB19E0A2C7"><enum>(A)</enum><header>In general</header><text>The drug or substance—</text>
<clause commented="no" display-inline="no-display-inline" id="H9EA1C44C31C1404BA4E9650D1FA863BC"><enum>(i)</enum><text>has—</text> <subclause commented="no" display-inline="no-display-inline" id="H1BECFF92AA6F4193B9463A2F788035B2"><enum>(I)</enum><text>a chemical structure that is substantially similar to the chemical structure of a controlled substance in schedule I, II, III, IV, or V; and</text></subclause>
<subclause commented="no" display-inline="no-display-inline" id="HC77FEA9592764A10843A2EE4386C0D37"><enum>(II)</enum><text>an actual or predicted stimulant, depressant, or hallucinogenic effect on the central nervous system that is substantially similar to or greater than the stimulant, depressant, or hallucinogenic effect on the central nervous system of a controlled substance in schedule I, II, III, IV, or V; and</text></subclause></clause> <clause commented="no" display-inline="no-display-inline" id="HAF877AC928DF49CC925D3F3EEC5F13E2"><enum>(ii)</enum><text>is not—</text>
<subclause commented="no" display-inline="no-display-inline" id="H7B9D26430D024E5BA09084222CBEC406"><enum>(I)</enum><text>listed or otherwise included in any other schedule in this section or by regulation of the Attorney General; and</text></subclause> <subclause commented="no" display-inline="no-display-inline" id="H32D405E972424672828260349BCF59CC"><enum>(II)</enum><text>with respect to a particular person, subject to an exemption that is in effect for investigational use, for that person, under section 505 of the Federal Food, Drug, and Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/355">21 U.S.C. 355</external-xref>) to the extent conduct with respect to such substance is pursuant to such exemption.</text></subclause></clause></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HE5196B9E750D4FC9AF8A5B483CDF3AD4"><enum>(B)</enum><header>Predicted stimulant, depressant, or hallucinogenic effect</header><text>For purpose of this paragraph, a predicted stimulant, depressant, or hallucinogenic effect on the central nervous system may be based on—</text> <clause id="H9479FB02FEEB4B79B257E5B35AD6AA47"><enum>(i)</enum><text display-inline="yes-display-inline">the chemical structure and—</text>
<subclause id="HC09825B53C58435C952550AADF5535C8"><enum>(I)</enum><text display-inline="yes-display-inline">the structure activity relationships; or</text></subclause> <subclause id="H7436D784C5464EF0B27C4A41F8912DD9"><enum>(II)</enum><text>binding receptor assays and other relevant scientific information about the substance; </text></subclause></clause>
<clause id="H92B63727FBB1450095CA677EB13B9C80"><enum>(ii)</enum>
<subclause commented="no" display-inline="yes-display-inline" id="H7AAFD95C00ED4F69869EB37A8C44CB34"><enum>(I)</enum><text>the current or relative potential for abuse of the substance; and</text></subclause> <subclause id="HF28489CF169E4B3693781A0368943571" indent="up1"><enum>(II)</enum><text>the clandestine importation, manufacture, or distribution, or diversion from legitimate channels, of the substance; or</text></subclause></clause>
<clause id="HCBE57E200C914D6097721A2DA28E7581"><enum>(iii)</enum><text>the capacity of the substance to cause a state of dependence, including physical or psychological dependence that is similar to or greater than that of a controlled substance in schedule I, II, III, IV, or V.</text></clause></subparagraph></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph> <paragraph id="HF7FF2E3916754D38B5BE50E9CD320240"><enum>(3)</enum><text display-inline="yes-display-inline">in subsection (c), in the matter preceding schedule I, by striking <quote>IV, and V</quote> and inserting <quote>IV, V, and A</quote>.</text></paragraph></section>
<section id="H81D22588227D47ECBC145DD77CE9EF77"><enum>9003.</enum><header>Temporary and permanent scheduling of schedule A substances</header><text display-inline="no-display-inline">Section 201 of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/811">21 U.S.C. 811</external-xref>) is amended by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="HF08F598B10E54221A954C45AF770481E" style="traditional"> <subsection id="HAA44DE5DEC90412C8A65B7D3FB7C3752"><enum>(k)</enum><header>Temporary and permanent scheduling of schedule A substances</header> <paragraph id="HBCDB316F27BC4E9D89250709B2E6ACCB"><enum>(1)</enum><text>The Attorney General may issue a temporary order adding a drug or substance to schedule A if the Attorney General finds that—</text>
<subparagraph id="H4ED0092EE9ED44F6A64297C137EEEB47"><enum>(A)</enum><text>the drug or other substance satisfies the criteria for being considered a schedule A substance; and</text></subparagraph> <subparagraph id="H9B8002A8C61B444EABE95E1CC1991D1C"><enum>(B)</enum><text>adding such drug or substance to schedule A will assist in preventing abuse of the drug or other substance.</text></subparagraph></paragraph>
<paragraph id="HE00259F5ACC14569B4C354595291380F"><enum>(2)</enum><text>A temporary scheduling order issued under paragraph (1) shall not take effect until 30 days after the date of the publication by the Attorney General of a notice in the Federal Register of the intention to issue such order and the grounds upon which such order is to be issued. The temporary scheduling order shall expire not later than 5 years after the date it becomes effective, except that the Attorney General may, during the pendency of proceedings under paragraph (5), extend the temporary scheduling order for up to 180 days.</text></paragraph> <paragraph id="H69132A51E3D24AD8B41937BE536333E3"><enum>(3)</enum><text>A temporary scheduling order issued under paragraph (1) shall be vacated upon the issuance of a permanent order issued under paragraph (5) with regard to the same substance, or upon the subsequent issuance of any scheduling order under this section.</text></paragraph>
<paragraph commented="no" id="H2BBA9A843CF34293AEBC98FB7E292584"><enum>(4)</enum><text>A temporary scheduling order issued under paragraph (1) shall not be subject to judicial review.</text></paragraph> <paragraph id="H7AE30411369B42FFACEF4890D28F03A2" display-inline="no-display-inline"><enum>(5)</enum> <subparagraph id="H50ACAC93DBE7482893F94FA7543DA16E" display-inline="yes-display-inline"><enum>(A)</enum><text>Beginning no earlier than 3 years after issuing an order temporarily scheduling a drug or other substance under this subsection, the Attorney General may, by rule, issue a permanent order adding a drug or other substance to schedule A if such drug or substance satisfies the criteria for being considered a controlled substance in schedule A under this subsection, except as provided in subparagraph (B).</text></subparagraph>
<subparagraph id="H28F54C2C47A24333BC9C543368832C2B" indent="up1"><enum>(B)</enum><text>If the Secretary has determined, based on relevant scientific studies and necessary data requested by the Secretary and gathered by the Attorney General, that a drug or other substance that has been temporarily placed in schedule A does not have sufficient potential for abuse to warrant control in any schedule, and so advises the Attorney General in writing, the Attorney General may not issue a permanent scheduling order under subparagraph (A) and shall, within 30 days of receiving the Secretary’s advice issue an order immediately terminating the temporary scheduling order. </text></subparagraph></paragraph> <paragraph id="HB7CE37663B1547F4B0EADB6347276FA6"><enum>(6)</enum><text display-inline="yes-display-inline">Before initiating proceedings under paragraph (1), the Attorney General shall transmit notice of a temporary order proposed to be issued to the Secretary of Health and Human Services. In issuing an order under paragraph (1), the Attorney General shall take into consideration any comments submitted by the Secretary of Health and Human Services in response to a notice transmitted pursuant to this paragraph.</text></paragraph>
<paragraph id="HD9530F1B436C4866B26A7317BCA62FAE"><enum>(7)</enum><text>On the date of the publication of a notice in the Federal Register pursuant to paragraph (2), the Attorney General shall transmit the same notice to Congress. The temporary scheduling order shall take effect according to paragraph (2), except that the temporary scheduling order may be disapproved by an Act of Congress within 180 days from the date of publication of the notice in the Federal Register.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></section> <section commented="no" id="H3E9D5F06FFBC45E0851973E7421EDC9A"><enum>9004.</enum><header>Penalties</header> <subsection commented="no" id="H0ED9C61ED1A94B13B0BF040A883D3098"><enum>(a)</enum><header>Controlled Substances Act</header><text>The Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/801">21 U.S.C. 801</external-xref> et seq.) is amended—</text>
<paragraph commented="no" id="HFA2CB7E635EE4CB88D5E134211BCB888"><enum>(1)</enum><text>in section 401(b)(1) (<external-xref legal-doc="usc" parsable-cite="usc/21/841">21 U.S.C. 841(b)(1)</external-xref>), by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="HB9E654376B274C3E91EAC84DB8391912" style="OLC"> <subparagraph id="HAA55EB3DD89747C7A772CEB9BEE91D9D" indent="up2"><enum>(F)</enum> <clause commented="no" display-inline="yes-display-inline" id="H442DFD584B6D4384A25C6FC91D18B22F"><enum>(i)</enum><text>In the case of any controlled substance in schedule A, such person shall be sentenced to a term of imprisonment of not more than 10 years and if death or serious bodily injury results from the use of such substance shall be sentenced to a term of imprisonment of not more than 15 years, a fine not to exceed the greater of that authorized in accordance with the provisions of title 18, United States Code, or $500,000 if the defendant is an individual or $2.5 million if the defendant is other than an individual, or both.</text></clause>
<clause id="HDC54BA3C3E7D4AB6AEDFE38E66D65369" indent="up1"><enum>(ii)</enum><text>If any person commits such a violation after a prior conviction for a felony drug offense has become final, such person shall be sentenced to a term of imprisonment of not more than 20 years and if death or serious bodily injury results from the use of such substance shall be sentenced to a term of imprisonment of not more than 30 years, a fine not to exceed the greater of twice that authorized in accordance with the provisions of title 18, United States Code, or $1 million if the defendant is an individual or $5 million if the defendant is other than an individual, or both.</text></clause> <clause id="H80F7DF39A0D348DF8F33F5D50515DE06" indent="up1"><enum>(iii)</enum><text>Any sentence imposing a term of imprisonment under this subparagraph shall, in the absence of such a prior conviction, impose a term of supervised release of not less than 2 years in addition to such term of imprisonment and shall, if there was such a prior conviction, impose a term of supervised release of not less than 4 years in addition to such term of imprisonment.</text></clause></subparagraph><after-quoted-block>; </after-quoted-block></quoted-block></paragraph>
<paragraph commented="no" id="HB7E42D67F60843539262F337A4DC87A7"><enum>(2)</enum><text>in section 403(a) (<external-xref legal-doc="usc" parsable-cite="usc/21/843">21 U.S.C. 843(a)</external-xref>)—</text> <subparagraph commented="no" id="H79CE8E55DE014FC3873E0A4C03874CCB"><enum>(A)</enum><text>in paragraph (8), by striking <quote>or</quote> at the end;</text></subparagraph>
<subparagraph commented="no" id="HF8C8AE068C704BD0B7ED63706E6571C3"><enum>(B)</enum><text>in paragraph (9), by striking the period at the end and inserting <quote>; or</quote>; and</text></subparagraph> <subparagraph commented="no" id="H4C8C2F68D406457083FF835978D33F56"><enum>(C)</enum><text>by inserting after paragraph (9) the following:</text>
<quoted-block display-inline="no-display-inline" id="H64839A2B9840412DA346BDF45D1E141E" style="OLC">
<paragraph id="H7E4103F9123D4316867A63DC8CB05562"><enum>(10)</enum><text>to export a substance in violation of the controlled substance laws of the country to which the substance is exported.</text></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph> <paragraph commented="no" id="H9212584A5F3B4D9C940A9D3C71C81EC0"><enum>(3)</enum><text>in section 404 (<external-xref legal-doc="usc" parsable-cite="usc/21/844">21 U.S.C. 844</external-xref>), by inserting after subsection (a) the following:</text>
<quoted-block display-inline="no-display-inline" id="H0010B4F8617B4CBC8F83314D9EF33DF8" style="OLC">
<subsection id="H24D6818EB63B4C94AA78ED3CE145D19A"><enum>(b)</enum><text>A person shall not be subject to a criminal or civil penalty under this title or under any other Federal law solely for possession of a schedule A controlled substance.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> <subsection commented="no" id="H0D071B30530C41E799A582BF1965E84B"><enum>(b)</enum><header>Controlled Substances Import and Export Act</header><text>Section 1010(b) of the Controlled Substances Import and Export Act (<external-xref legal-doc="usc" parsable-cite="usc/21/960">21 U.S.C. 960(b)</external-xref>) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H4468DC122C53480CA40B7068C866DA3F" style="OLC">
<paragraph id="H88732E18140D4131B50409679C0913EC" indent="up1"><enum>(8)</enum><text>In the case of a violation under subsection (a) involving a controlled substance in schedule A, the person committing such violation shall be sentenced to a term of imprisonment of not more than 20 years and if death or serious bodily injury results from the use of such substance shall be sentenced to a term of imprisonment of not more than life, a fine not to exceed the greater of that authorized in accordance with the provisions of title 18, United States Code, or $1 million if the defendant is an individual or $5 million if the defendant is other than an individual, or both. If any person commits such a violation after a prior conviction for a felony drug offense has become final, such person shall be sentenced to a term of imprisonment of not more than 30 years and if death or serious bodily injury results from the use of such substance shall be sentenced to not more than life imprisonment, a fine not to exceed the greater of twice that authorized in accordance with the provisions of title 18, United States Code, or $2 million if the defendant is an individual or $10 million if the defendant is other than an individual, or both. Notwithstanding section 3583 of title 18, United States Code, any sentence imposing a term of imprisonment under this paragraph shall, in the absence of such a prior conviction, impose a term of supervised release of not less than 3 years in addition to such term of imprisonment and shall, if there was such a prior conviction, impose a term of supervised release of not less than 6 years in addition to such term of imprisonment. Notwithstanding the prior sentence, and notwithstanding any other provision of law, the court shall not place on probation or suspend the sentence of any person sentenced under the provisions of this paragraph which provide for a mandatory term of imprisonment if death or serious bodily injury results.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section> <section id="H5F5E46E0EF03464D881D7014EC7685EA"><enum>9005.</enum><header>False labeling of schedule A controlled substances</header> <subsection id="H866BC4B1543649A6BA3C1E4F4C6F1D3B"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 305 of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/825">21 U.S.C. 825</external-xref>) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H2A6C6C1E46E341349EC9BDF3914C0295" style="OLC">
<subsection commented="no" display-inline="no-display-inline" id="H5A4D67A55401487195EA78ADA8B1A42E"><enum>(f)</enum><header display-inline="yes-display-inline">False labeling of schedule A controlled substances</header>
<paragraph commented="no" display-inline="no-display-inline" id="H1E5153B7938A405B85630DF5D393C033"><enum>(1)</enum><text display-inline="yes-display-inline">It shall be unlawful to import, export, manufacture, distribute, dispense, or possess with intent to manufacture, distribute, or dispense, a schedule A substance or product containing a schedule A substance, unless the substance or product bears a label clearly identifying a schedule A substance or product containing a schedule A substance by the nomenclature used by the International Union of Pure and Applied Chemistry (IUPAC).</text></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="HC685ED2B844048A087740211E786782E"><enum>(2)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="HD247061ADA304D9D8EB1436632163EA4"><enum>(A)</enum><text display-inline="yes-display-inline">A product described in subparagraph (B) is exempt from the International Union of Pure and Applied Chemistry nomenclature requirement of this subsection if such product is labeled in the manner required under the Federal Food, Drug, and Cosmetic Act.</text></subparagraph>
<subparagraph commented="no" id="HE5D2339CFF35420D85730472DE6F07C0" indent="up1"><enum>(B)</enum><text>A product is described in this subparagraph if the product—</text> <clause commented="no" id="H88C83352E65744DF96A07CF9DA7C2FE8"><enum>(i)</enum><text>is the subject of an approved application as described in section 505(b) or (j) of the Federal Food, Drug, and Cosmetic Act; or</text></clause>
<clause commented="no" id="H589B191E1ACC463C97C535532623F9FA"><enum>(ii)</enum><text>is exempt from the provisions of section 505 of such Act relating to new drugs because—</text> <subclause commented="no" id="H8C40C8E166AE45709C777E94869B4C0A"><enum>(I)</enum><text>it is intended solely for investigational use as described in section 505(i) of such Act; and</text></subclause>
<subclause commented="no" id="H32AC63C9636B440ABAF461FD2C91E3A0"><enum>(II)</enum><text>such product is being used exclusively for purposes of a clinical trial that is the subject of an effective investigational new drug application.</text></subclause></clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="HB9CA81C4EF9E4D9EBC742193C2132AAA"><enum>(b)</enum><header>Penalties</header><text>Section 402 of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/842">21 U.S.C. 842</external-xref>) is amended—</text>
<paragraph id="H83777025C9D94FCF99AC0570FD828B2D"><enum>(1)</enum><text>in subsection (a)(16), by inserting <quote>or subsection (f)</quote> after <quote>subsection (e)</quote>; and</text></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="H675DA62762094CD28C7939D637DB5E35"><enum>(2)</enum><text>in subsection (c)(1)(D), by inserting <quote>or a schedule A substance</quote> after <quote>anabolic steroid</quote>.</text></paragraph></subsection></section>
<section id="H1D06A99389704EF3B05F58DD4EE29A41"><enum>9006.</enum><header>Registration requirements for handlers of schedule A substances</header>
<subsection id="H48E44EE307AF42B8A036AE33BC8DDF6D"><enum>(a)</enum><header>Controlled Substances Act</header><text display-inline="yes-display-inline">Section 303 of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/823">21 U.S.C. 823</external-xref>) is amended by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="HF427CFDA904246E1BD6F6628E7F1B0E5" style="OLC"> <subsection commented="no" display-inline="no-display-inline" id="H6F43015ACE7848F88F7EB366F58DF67C"><enum>(k)</enum> <paragraph commented="no" display-inline="yes-display-inline" id="HC129256A9A8242A8946F7D5469A5D16B"><enum>(1)</enum><text display-inline="yes-display-inline">The Attorney General shall register an applicant to manufacture schedule A substances if—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HB97270FB67284290945A353082503C2F" indent="up1"><enum>(A)</enum><text display-inline="yes-display-inline">the applicant demonstrates that the schedule A substances will be used for research, analytical, or industrial purposes approved by the Attorney General; and</text></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="H42AC5B6FFC19448A93A28B1B5A8184C4" indent="up1"><enum>(B)</enum><text>the Attorney General determines that such registration is consistent with the public interest and with the United States obligations under international treaties, conventions, or protocols in effect on the date of enactment of this subsection.</text></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HFA02E2BCC66E4A939BA99959E5D6D793" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">In determining the public interest under paragraph (1)(B), the Attorney General shall consider—</text> <subparagraph id="H69EF0EAF16814DA2A3AE8F006FDB7018"><enum>(A)</enum><text>maintenance of effective controls against diversion of particular controlled substances and any controlled substance in schedule A compounded therefrom into other than legitimate medical, scientific, research, or industrial channels, by limiting the importation and bulk manufacture of such controlled substances to a number of establishments which can produce an adequate and uninterrupted supply of these substances under adequately competitive conditions for legitimate medical, scientific, research, and industrial purposes;</text></subparagraph>
<subparagraph id="H08CFD287BDF44748B12EA0308DCB3C0B"><enum>(B)</enum><text>compliance with applicable State and local law;</text></subparagraph> <subparagraph id="HE753A1219A9948E0977B3AE851A01928"><enum>(C)</enum><text>promotion of technical advances in the art of manufacturing substances described in subparagraph (A) and the development of new substances;</text></subparagraph>
<subparagraph id="H7CA79FFA50364241BD45594F23A6444E"><enum>(D)</enum><text>prior conviction record of applicant under Federal and State laws relating to the manufacture, distribution, or dispensing of substances described in paragraph (A);</text></subparagraph> <subparagraph commented="no" id="H112CC7B205D04155A03230255BD805EA"><enum>(E)</enum><text>past experience in the manufacture of controlled substances, and the existence in the establishment of effective control against diversion; and</text></subparagraph>
<subparagraph id="H0F1A238E2AD74005AD3C8E0E5207619A"><enum>(F)</enum><text>such other factors as may be relevant to and consistent with the public health and safety.</text></subparagraph></paragraph> <paragraph id="H4EE30A183012463CB0F44B7C1AAC9226" indent="up1"><enum>(3)</enum><text>If an applicant is registered to manufacture controlled substances in schedule I or II under subsection (a), the applicant shall not be required to apply for a separate registration under this subsection.</text></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H8ED0082675AA4455B909FEA908BEA5A2"><enum>(l)</enum>
<paragraph commented="no" display-inline="yes-display-inline" id="H667510D047D740B6A9FA8C234572375D"><enum>(1)</enum><text display-inline="yes-display-inline">The Attorney General shall register an applicant to distribute schedule A substances—</text> <subparagraph commented="no" display-inline="no-display-inline" id="H0D0A56DFE00C4CEDB8CFEC44DE746C65" indent="up1"><enum>(A)</enum><text>if the applicant demonstrates that the schedule A substances will be used for research, analytical, or industrial purposes approved by the Attorney General; and</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H3BF57BB7BC004D3D9A22244C329A627C" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">unless the Attorney General determines that the issuance of such registration is inconsistent with the public interest.</text></subparagraph></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="H1795341B3DAA4E7C86746936A6D10B2C" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">In determining the public interest under paragraph (1)(B), the Attorney General shall consider—</text>
<subparagraph id="H9486EFD6C7CE40228DE7F070D1216BEC"><enum>(A)</enum><text>maintenance of effective control against diversion of particular controlled substances into other than legitimate medical, scientific, and industrial channels;</text></subparagraph> <subparagraph id="HB1F458F8A94A4069BA22E9E8DECE1F42"><enum>(B)</enum><text>compliance with applicable State and local law;</text></subparagraph>
<subparagraph id="HC513ECB6F30D4F08A85426262AF92B9F"><enum>(C)</enum><text>prior conviction record of applicant under Federal or State laws relating to the manufacture, distribution, or dispensing of substances described in subparagraph (A);</text></subparagraph> <subparagraph id="HEE846699A98444FE8D4B27FB811F3184"><enum>(D)</enum><text>past experience in the distribution of controlled substances; and</text></subparagraph>
<subparagraph id="HCFE5B3F6E07B426C9C1D34422BAE45AE"><enum>(E)</enum><text>such other factors as may be relevant to and consistent with the public health and safety.</text></subparagraph></paragraph> <paragraph id="H32FB8E7195C94137ABED9271159BD678" indent="up1"><enum>(3)</enum><text>If an applicant is registered to distribute a controlled substance in schedule I or II under subsection (b), the applicant shall not be required to apply for a separate registration under this subsection.</text></paragraph></subsection>
<subsection commented="no" id="HDA7ED3AB4E7C410BA73708593CE0BCFF"><enum>(m)</enum>
<paragraph commented="no" display-inline="yes-display-inline" id="HA6637E7B2400497F921EEDFB34DA4CFF"><enum>(1)</enum>
<subparagraph id="H98E457F837034637905A0FD978B214A9" display-inline="yes-display-inline"><enum>(A)</enum><text>Not later than 90 days after the date on which a substance is placed in schedule A, any practitioner who was engaged in research on the substance before the placement of the substance in schedule A and any manufacturer or distributor who was handling the substance before the placement of the substance in schedule A shall register with the Attorney General. </text></subparagraph></paragraph></subsection> <subsection id="H5E7273B7C27E4CB4872E643C07F33602"><enum>(B)</enum> <paragraph id="HF73A1E0939264893AB54D4075DD2906B" display-inline="yes-display-inline"><enum>(i)</enum><text>If an applicant described in subparagraph (A) is registered pursuant to subsection (f) to conduct research with a controlled substance in schedule I or II on the date on which another substance is placed in schedule A, the applicant may, subject to clause (iii), conduct research with that other controlled substance in schedule A while the application for registration pursuant to subparagraph (A) is pending.</text></paragraph>
<paragraph id="H63133D4437594833ABACA4CB872EBC05" indent="up1"><enum>(ii)</enum><text>If an applicant described in subparagraph (A) is registered pursuant to subsection (f) as described in clause (i) to conduct research with a controlled substance in schedule III, IV, or V on the date on which another substance is placed in schedule A, the applicant may, subject to clause (iii), conduct research with that other controlled substance in schedule A while the application for registration pursuant to subparagraph (A) is pending, provided the substance for which the applicant is registered to conduct research is in the same schedule as, or a less-restricted schedule than, the controlled substance whose similarity in chemical structure and actual or predicted effect to the controlled substance in schedule A formed the basis for placement of the substance in schedule A, as set forth in the order published in the Federal Register placing the substance in schedule A.</text></paragraph> <paragraph id="HC4A21BD8690943DCB0A9FE18B143C540" indent="up1"><enum>(iii)</enum><text>The permission to conduct research pursuant to clause (i) or clause (ii) is conditional on the applicant's complying with the registration and other requirements for controlled substances in schedule A.</text></paragraph>
<paragraph id="H3BDD29177D944307B85D9DDD072DCC9B" indent="up1"><enum>(iv)</enum><text>This subparagraph does not apply to applicants registered pursuant to subsection (f) whose authorization to conduct research with any controlled substances is limited to doing so as a coincident activity pursuant to applicable regulations of the Attorney General.</text></paragraph> <paragraph commented="no" id="HAD4F860C5A9144A39AFFC79E1191C5E7" indent="up1"><enum>(2)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="HC18C7ED9205F418691CA1A4A512DAE70"><enum>(A)</enum><text>Not later than 60 days after the date on which the Attorney General receives an application for registration to conduct research on a schedule A substance, the Attorney General shall—</text>
<clause commented="no" id="H4728B9BD4DAE48048D8CC2C16A33D57E" indent="up1"><enum>(i)</enum><text>grant, or initiate proceedings under section 304(c) to deny, the application; or</text></clause> <clause commented="no" id="HBF1A068A25544BAFA8DA8BA725352077" indent="up1"><enum>(ii)</enum><text>request supplemental information from the applicant.</text></clause></subparagraph>
<subparagraph commented="no" id="HF4DF21AE75C446FF8B7745D0F1163D2D" indent="up1"><enum>(B)</enum><text>Not later than 30 days after the date on which the Attorney General receives supplemental information requested under subparagraph (A)(ii) in connection with an application described in subparagraph (A), the Attorney General shall grant or deny the application.</text></subparagraph></paragraph></subsection> <subsection id="H2FB2FB4EF11047E880A01D3A69646296"><enum>(n)</enum> <paragraph id="H173FD58772D34A32BF2BD0E8EA1D6954" display-inline="yes-display-inline"><enum>(1)</enum><text display-inline="yes-display-inline">The Attorney General shall register a scientific investigator or a qualified research institution to conduct research with controlled substances in schedule A in accordance with this subsection. In evaluating applications for such registration, the Attorney General shall apply the criteria set forth in subsection (f) of this section that apply to practitioners seeking a registration to conduct research with a schedule I controlled substance, except that the applicant shall not be required to submit a research protocol.</text></paragraph>
<paragraph id="HF6EBD865CF434D64AB5FD7990871C23D" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">If the applicant is not currently registered under subsection (f) to conduct research with a schedule I controlled substance, the Attorney General shall refer the application to the Secretary, who shall determine whether the applicant will be engaged in bona fide research and is qualified to conduct such research. The 60-day period under subsection (m)(2)(A) shall be tolled during the period beginning on the date on which the Attorney General refers an application to the Secretary under this paragraph, and ending on the date on which the Secretary submits a determination related to such referral to the Attorney General.</text></paragraph> <paragraph id="H7D356E1BD4E547FA829D31DD7CC7F0FB" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">An applicant who meets the criteria under subsection (m)(1)(B) with respect to a particular schedule A controlled substance shall be considered qualified to conduct research with that substance. The Attorney General shall modify such applicant’s registration to include such schedule A controlled substance in accordance with this paragraph. The applicant shall notify the Attorney General of his intent to conduct research with a controlled substance in schedule A. Upon receiving such notification, the Attorney General shall modify the practitioner’s existing registration to authorize research with schedule A controlled substances, unless the Attorney General determines that the registration modification would be inconsistent with the public interest based on the criteria of subsection (f).</text></paragraph>
<paragraph id="HEFF80EAAA21A4C48A87A43BE5B51FBBF" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">Registrations issued under this subsection to a qualified research institution will apply to all agents and employees of that institution acting within the scope of their professional practice.</text></paragraph> <paragraph id="HF46CA97129A0459F945E757140E0015C" indent="up1"><enum>(5)</enum><text display-inline="yes-display-inline">At least 30 days prior to conducting any research with a controlled substance in schedule A, the registrant shall provide the Attorney General with written notification of the following:</text>
<subparagraph id="HEA39D4EA3A6C4D64BC21E6ACA5E864EC"><enum>(A)</enum><text display-inline="yes-display-inline">The name of and drug code for each substance.</text></subparagraph> <subparagraph id="H2484E36CD5A949AD95A05267B878527D"><enum>(B)</enum><text>The name of each individual with access to each substance.</text></subparagraph>
<subparagraph id="H90EE4B2D8FAC4713855AA680FB35571C"><enum>(C)</enum><text>The amount of each substance.</text></subparagraph> <subparagraph id="H8357AE2A718E45D68F40D2E3C1CEC30E"><enum>(D)</enum><text>Other similar information the Attorney General may require.</text></subparagraph></paragraph>
<paragraph id="H4E3B39B058824B0084A4FE22910343D2" indent="up1"><enum>(6)</enum><text display-inline="yes-display-inline">The quantity of a schedule A controlled substance possessed by a person registered under this subsection shall be appropriate for the research being conducted, subject to the additional limitations set forth in this paragraph. To reduce the risk of diversion, the Attorney General may establish limitations on the quantity of schedule A controlled substances that may be manufactured or possessed for purposes of research under this subsection and shall publish such limitations on the website of the Drug Enforcement Administration. A person registered under this subsection may, based on legitimate research needs, apply to the Attorney General to manufacture or possess an amount greater than that so specified by the Attorney General. The Attorney General shall specify the manner in which such applications shall be submitted. The Attorney General shall act on an application filed under this subparagraph within 30 days of receipt of such application. If the Attorney General fails to act within 30 days, the registrant shall be allowed to manufacture and possess up to the amount requested. The Attorney General shall have the authority to reverse the increase for cause.</text></paragraph> <paragraph id="H1AD855E3836548D79F0C89B9E0396EAC" indent="up1"><enum>(7)</enum><text display-inline="yes-display-inline">The Attorney General shall by regulation specify the manner in which applications for registration under this subsection shall be submitted.</text></paragraph>
<paragraph id="H5ABEB7EE25294A9DB5D93A61DA3FE3F8" indent="up1"><enum>(8)</enum><text display-inline="yes-display-inline">Registrants authorized under this subsection may manufacture and possess schedule A controlled substances up to the approved amounts only for use in their own research setting or institution. Manufacturing for use in any other setting or institution shall require a manufacturer’s registration under section 303(a). </text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="H193247D2CABA44399782F72D4C759E57"><enum>(b)</enum><header>Controlled Substances Import and Export Act</header><text>Section 1008 of the Controlled Substances Import and Export Act (<external-xref legal-doc="usc" parsable-cite="usc/21/958">21 U.S.C. 958</external-xref>) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H9F3CF78AE86240E7BC3A510F8E727B08" style="OLC">
<subsection commented="no" display-inline="no-display-inline" id="H9AD945AAB2F24E3A961D670933FAB40F"><enum>(j)</enum>
<paragraph commented="no" display-inline="yes-display-inline" id="H12E057F638E4423E8F11303FC86EDCD4"><enum>(1)</enum><text display-inline="yes-display-inline">The Attorney General shall register an applicant to import or export a schedule A substance if—</text> <subparagraph commented="no" display-inline="no-display-inline" id="HCBA2ECE48C354E5AB08A6CDB767DB830" indent="up1"><enum>(A)</enum><text display-inline="yes-display-inline">the applicant demonstrates that the schedule A substances will be used for research, analytical, or industrial purposes approved by the Attorney General; and</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HF6D7B297707F4685B9727B27D22DF952" indent="up1"><enum>(B)</enum><text>the Attorney General determines that such registration is consistent with the public interest and with the United States obligations under international treaties, conventions, or protocols in effect on the date of enactment of this subsection.</text></subparagraph></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="H364B22ECE2644059AA519EF04CCFA9EC" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">In determining the public interest under paragraph (1)(B), the Attorney General shall consider the factors described in subparagraphs (A) through (F) of section 303(k)(2).</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H2076629182894D8C9847DEE28A962ED8" indent="up1"><enum>(3)</enum><text>If an applicant is registered to import or export a controlled substance in schedule I or II under subsection (a), the applicant shall not be required to apply for a separate registration under this subsection.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section> <section commented="no" id="H393721F8A0BE49F49257AD6FDC3EFB83"><enum>9007.</enum><header>Additional conforming amendments</header> <subsection commented="no" id="HAE883C850879405E9EA60DCCA0BDCF16"><enum>(a)</enum><header>Controlled Substances Act</header><text>The Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/801">21 U.S.C. 801</external-xref> et seq.) is amended—</text>
<paragraph id="H35F3BF19601940ADBB30C085A09250E5"><enum>(1)</enum><text>in section 303(c) (<external-xref legal-doc="usc" parsable-cite="usc/21/823">21 U.S.C. 823(c)</external-xref>)—</text> <subparagraph id="H85446709769B4F36AD7B4B710709F348"><enum>(A)</enum><text>by striking <quote>subsections (a) and (b)</quote> and inserting <quote>subsection (a), (b), (k), or (l)</quote>; and</text></subparagraph>
<subparagraph id="H5F939402B0D64AD983A1271AAD4806E0"><enum>(B)</enum><text>by striking <quote>schedule I or II</quote> and inserting <quote>schedule I, II, or A</quote>;</text></subparagraph></paragraph> <paragraph id="HE8285997137F439C8F4538862735BA33"><enum>(2)</enum><text>in section 306 (<external-xref legal-doc="usc" parsable-cite="usc/21/826">21 U.S.C. 826</external-xref>)—</text>
<subparagraph id="H459BF82ED2264BF09976EC89E8ABC6A4"><enum>(A)</enum><text>in subsection (a), in the first sentence, by striking <quote>schedules I and II</quote> and inserting <quote>schedules I, II, and A</quote>;</text></subparagraph> <subparagraph id="HC5A04387AE2343F69EF3861514D0677C"><enum>(B)</enum><text>in subsection (b), in the second sentence, by striking <quote>schedule I or II</quote> and inserting <quote>schedule I, II, or A</quote>;</text></subparagraph>
<subparagraph id="HF3DA9A3B338541CF97CC021D2D4A3FCD"><enum>(C)</enum><text>in subsection (c), in the first sentence, by striking <quote>schedules I and II</quote> and inserting <quote>schedules I, II, and A</quote>;</text></subparagraph> <subparagraph id="HB50310541FE74FD49D0D6DA6854BB1C7"><enum>(D)</enum><text>in subsection (d), in the first sentence, by striking <quote>schedule I or II</quote> and inserting <quote>schedule I, II, or A</quote>;</text></subparagraph>
<subparagraph id="H1A168EB0FB6449688183E7F710AC832D"><enum>(E)</enum><text>in subsection (e), in the first sentence, by striking <quote>schedule I or II</quote> and inserting <quote>schedule I, II, or A</quote>; and</text></subparagraph> <subparagraph id="HEF18FE0CED53478997FB8E4872D0F9FF"><enum>(F)</enum><text>in subsection (f), in the first sentence, by striking <quote>schedules I and II</quote> and inserting <quote>schedules I, II, and A</quote>;</text></subparagraph></paragraph>
<paragraph id="HBAF7F7E72F204AA6B16FA7B1943802D8"><enum>(3)</enum><text>in section 308(a) (<external-xref legal-doc="usc" parsable-cite="usc/21/828">21 U.S.C. 828(a)</external-xref>), by striking <quote>schedule I or II</quote> and inserting <quote>schedule I, II, or A</quote>;</text></paragraph> <paragraph id="H23EB8EE479EB40ACAA4C7C32A30C74B4"><enum>(4)</enum><text>in section 402(b) (<external-xref legal-doc="usc" parsable-cite="usc/21/842">21 U.S.C. 842(b)</external-xref>), in the matter preceding paragraph (1), by striking <quote>schedule I or II</quote> and inserting <quote>schedule I, II, or A</quote>;</text></paragraph>
<paragraph id="HDFD8403F75E2479A90BB7B67B5A6F572"><enum>(5)</enum><text>in section 403(a)(1) (<external-xref legal-doc="usc" parsable-cite="usc/21/843">21 U.S.C. 843(a)(1)</external-xref>), by striking <quote>schedule I or II</quote> and inserting <quote>schedule I, II, or A</quote>; and</text></paragraph> <paragraph id="H6DB33951F0FF4F308987398E506D215A"><enum>(6)</enum><text>in section 511(f) (<external-xref legal-doc="usc" parsable-cite="usc/21/881">21 U.S.C. 881(f)</external-xref>), by striking <quote>schedule I or II</quote> each place it appears and inserting <quote>schedule I, II, or A</quote>.</text></paragraph></subsection>
<subsection commented="no" id="HD70896351CF8473F88DFDE9E111FFA4B"><enum>(b)</enum><header>Controlled Substances Import Export Act</header><text display-inline="yes-display-inline">The Controlled Substances Import and Export Act (<external-xref legal-doc="usc" parsable-cite="usc/21/951">21 U.S.C. 951</external-xref> et seq.) is amended—</text> <paragraph id="H3D22C9C67C064F6196FB9D70D91AE9E9"><enum>(1)</enum><text>in section 1002(a) (<external-xref legal-doc="usc" parsable-cite="usc/21/952">21 U.S.C. 952(a)</external-xref>)—</text>
<subparagraph id="H8CBDCF154F1E439C908FB45C0983DB70"><enum>(A)</enum><text>in the matter preceding paragraph (1), by striking <quote>schedule I or II</quote> and inserting <quote>schedule I, II, or A</quote>; and</text></subparagraph> <subparagraph id="H015EE9E3FDE74797A6BED6A516086FBA"><enum>(B)</enum><text>in paragraph (2), by striking <quote>schedule I or II</quote> and inserting <quote>schedule I, II, or A</quote>;</text></subparagraph></paragraph>
<paragraph id="HC6DBABCCD647469AB4A9A9BE0BFD1E60"><enum>(2)</enum><text>in section 1003 (<external-xref legal-doc="usc" parsable-cite="usc/21/953">21 U.S.C. 953</external-xref>)—</text> <subparagraph id="H9EA7DC35BDBE40509AB50AEEE33D4C77"><enum>(A)</enum><text>in subsection (c), in the matter preceding paragraph (1), by striking <quote>schedule I or II</quote> and inserting <quote>schedule I, II, or A</quote>; and</text></subparagraph>
<subparagraph id="H6B11EBD2B98C47739AD478BD5B7637C7"><enum>(B)</enum><text>in subsection (d), by striking <quote>schedule I or II</quote> and inserting <quote>schedule I, II, or A</quote>;</text></subparagraph></paragraph> <paragraph id="HD45265A647BE4708B4177651237B9084"><enum>(3)</enum><text>in section 1004(1) (<external-xref legal-doc="usc" parsable-cite="usc/21/954">21 U.S.C. 954(1)</external-xref>), by striking <quote>schedule I</quote> and inserting <quote>schedule I or A</quote>;</text></paragraph>
<paragraph id="H63A5578E27BF4738A1E5928BA81459F0"><enum>(4)</enum><text>in section 1005 (<external-xref legal-doc="usc" parsable-cite="usc/21/955">21 U.S.C. 955</external-xref>), by striking <quote>schedule I or II</quote> and inserting <quote>schedule I, II, or A</quote>; and</text></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="H113D0224705042699270841D317CE337"><enum>(5)</enum><text display-inline="yes-display-inline">in section 1009(a) (<external-xref legal-doc="usc" parsable-cite="usc/21/959">21 U.S.C. 959(a)</external-xref>), by striking <quote>schedule I or II</quote> and inserting <quote>schedule I, II, or A</quote>.</text></paragraph></subsection></section>
<section id="HEA8C5BC4DEC34377BF0EC1A70E83619D"><enum>9008.</enum><header>Controlled substance analogues</header><text display-inline="no-display-inline">Section 102 of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/802">21 U.S.C. 802</external-xref>) is amended—</text> <paragraph id="HD772A4854F904D03846343C03FA0C4D1"><enum>(1)</enum><text>in paragraph (6), by striking <quote>or V</quote> and inserting <quote>V, or A</quote>;</text></paragraph>
<paragraph id="HA92714F7CE1749EE862731C1A81D0B61"><enum>(2)</enum><text>in paragraph (14)—</text> <subparagraph id="H72D6497216854D49AE8275F304FD647D"><enum>(A)</enum><text>by striking <quote>schedule I(c) and</quote> and inserting <quote>schedule I(c), schedule A, and</quote>; and</text></subparagraph>
<subparagraph id="HCC3BE4646BA448FC9DC1E0C45DA4C3F7"><enum>(B)</enum><text>by striking <quote>schedule I(c),</quote> and inserting <quote>schedule I(c) and schedule A,</quote>; and</text></subparagraph></paragraph> <paragraph id="H1FD9DE12D31E415E992487C4C80A81EB"><enum>(3)</enum><text>in paragraph (32)(A), by striking <quote>(32)(A)</quote> and all that follows through clause (iii) and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="H18A6AA45C5044D14A9B349D111139CBE" style="OLC">
<paragraph id="HB34846DCA8234814A4F27EE8FE8DE611" indent="up1"><enum>(32)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H7F2C6D0651B3421B8C013E8DB000099D"><enum>(A)</enum><text>Except as provided in subparagraph (C), the term <term>controlled substance analogue</term> means a substance whose chemical structure is substantially similar to the chemical structure of a controlled substance in schedule I or II—</text> <clause id="HDC3A79CBE4A847B28E9E9578F8F01B5D" indent="up1"><enum>(i)</enum><text>which has a stimulant, depressant, or hallucinogenic effect on the central nervous system that is substantially similar to or greater than the stimulant, depressant, or hallucinogenic effect on the central nervous system of a controlled substance in schedule I or II; or</text></clause>
<clause commented="no" display-inline="no-display-inline" id="HDADDDC4CC0A24530A98907135A9435BA" indent="up1"><enum>(ii)</enum><text>with respect to a particular person, which such person represents or intends to have a stimulant, depressant, or hallucinogenic effect on the central nervous system that is substantially similar to or greater than the stimulant, depressant, or hallucinogenic effect on the central nervous system of a controlled substance in schedule I or II.</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section> <section id="H4690CFFB75174DBE9EF9348FA2CB4D80"><enum>9009.</enum><header>Rules of construction</header><text display-inline="no-display-inline">Nothing in this title, or the amendments made by this title, may be construed to limit—</text>
<paragraph id="HA6CB8BE997834431A5D3081A928C4B1B"><enum>(1)</enum><text>the prosecution of offenses involving controlled substance analogues under the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/801">21 U.S.C. 801</external-xref> et seq.); or</text></paragraph> <paragraph id="H97469C3436FF420AB1998F9C221972B7"><enum>(2)</enum><text>the authority of the Attorney General to temporarily or permanently schedule, reschedule, or decontrol controlled substances under provisions of section 201 of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/811">21 U.S.C. 811</external-xref>) that are in effect on the day before the date of enactment of this title.</text></paragraph></section>
<section id="HD44AE3565E5B4BB4B259E392A64C1498"><enum>9010.</enum><header>Study by Comptroller General</header><text display-inline="no-display-inline">Not later than 2 years after the date of enactment of this title, the Comptroller General of the United States shall complete a study and submit a report to the Committees on the Judiciary of the House of Representatives and of the Senate regarding the costs associated with the amendments made by section 4, including—</text> <paragraph id="HD3348155E71C4219B025DC4692F79AE7"><enum>(1)</enum><text>the annual amounts expended by Federal agencies in carrying out the amendments; </text></paragraph>
<paragraph id="HE2EEE50C4A6A49628D3FAB30D5804A83"><enum>(2)</enum><text display-inline="yes-display-inline">the costs associated with arrests, trials, convictions, imprisonment, or imposition of other sanctions in accordance with the amendments; and</text></paragraph> <paragraph id="H91E9F4C64E0247E99B7739E40E85B27D"><enum>(3)</enum><text>the impact (including the fiscal impact) of the amendments on existing correctional facilities and the likelihood that those amendments will create a need for additional capacity for housing prisoners. </text></paragraph></section>
<section id="HAC403AA48B9E4F079FC72DFF3E7FFC57" display-inline="no-display-inline" section-type="subsequent-section"><enum>9011.</enum><header>Report on controlled substance analogues sold by means of the Internet</header><text display-inline="no-display-inline">Not later than 1 year after the date of the enactment of this title, and annually thereafter, the Administrator of the Drug Enforcement Administration shall make publicly available on the website of the Drug Enforcement Administration a report on, for the previous year, the lawful and unlawful sale of controlled substance analogues (as defined in section 102 of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/802">21 U.S.C. 802</external-xref>)) by means of the Internet, including the following information:</text> <paragraph id="H8068462C9AF049C1A7E97337AC4C5593"><enum>(1)</enum><text>The types of controlled substance analogues that were sold, and the number of sales for each such substance.</text></paragraph>
<paragraph id="H9384F2B350FB488B87A2D5AE57D62C68"><enum>(2)</enum><text display-inline="yes-display-inline">The name of each person, entity, or Internet site, whether in the United States or abroad, that knowingly or intentionally delivers, distributes, or dispenses, or offers or attempts to deliver, distribute, or dispense, a controlled substance analogue by means of the Internet, whether lawfully or unlawfully.</text></paragraph> <paragraph id="HCD213F52A73647E6A0AF96EB53003F4F"><enum>(3)</enum><text display-inline="yes-display-inline">An estimate of the total revenue for all of the vendors described in paragraph (2) for all of the sales described in paragraph (1).</text></paragraph></section>
<section id="H734289D3FF6A47E99A378808402DD4FF" section-type="subsequent-section"><enum>9012.</enum><header>Controlled substance analogues</header><text display-inline="no-display-inline">Section 203 of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/813">21 U.S.C. 813</external-xref>) is amended—</text> <paragraph id="HE2BB23E67D7C4523894E9E9DFE7901AD"><enum>(1)</enum><text>by striking <quote>A controlled</quote> and inserting <quote>(a) <header-in-text level="subsection" style="OLC">In general</header-in-text>.—A controlled</quote>; and</text></paragraph>
<paragraph id="HAE250FC1B5434A1BAFB63EFC9B257911"><enum>(2)</enum><text>by adding at the end the following:</text> <quoted-block style="OLC" display-inline="no-display-inline" id="HE3C094E3B8534F6CACAC8E5259333866"> <subsection id="HDA539EC2C89B42E18EF8030E172C251F"><enum>(b)</enum><header>Determination</header><text>In determining whether a controlled substance analogue was intended for human consumption under subsection (a), the following factors may be considered, along with any other relevant factors:</text>
<paragraph id="H622F50CD4F11447982E9C611663A361D"><enum>(1)</enum><text>The marketing, advertising, and labeling of the substance.</text></paragraph> <paragraph id="HA47665594EFE405FB2B66C16240CC9EB"><enum>(2)</enum><text>The known efficacy or usefulness of the substance for the marketed, advertised or labeled purpose.</text></paragraph>
<paragraph id="H3D56025EE2AF48028FDEE46F4F746B32"><enum>(3)</enum><text>The difference between the price at which the substance is sold and the price at which the substance it is purported to be or advertised as is normally sold.</text></paragraph> <paragraph id="H23348A5401EF47A584223FAD8A836D21"><enum>(4)</enum><text>The diversion of the substance from legitimate channels and the clandestine importation, manufacture, or distribution of the substance.</text></paragraph>
<paragraph id="HA8BBF13F03AE43F6AA1460D87A874E28"><enum>(5)</enum><text>Whether the defendant knew or should have known the substance was intended to be consumed by injection, inhalation, ingestion, or any other immediate means.</text></paragraph> <paragraph id="HBD94DD5B43DF46C1885F730F57A42191"><enum>(6)</enum><text display-inline="yes-display-inline">Any controlled substance analogue that is manufactured, formulated, sold, distributed, or marketed with the intent to avoid the provisions of existing drug laws.</text></paragraph></subsection>
<subsection id="H0DAC42CB214C43FABF8172A42D24C405" commented="no" display-inline="no-display-inline"><enum>(c)</enum><header>Limitation</header><text>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.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section> <enum>X</enum><header>THRIVE Act</header> <section id="H9DE7451E328B4EEF85C4884CE36FCBD1"><enum>10001.</enum><header>Short title</header><text display-inline="no-display-inline">This title may be cited as the <quote><short-title>Transitional Housing for Recovery in Viable Environments Demonstration Program Act</short-title></quote> or the <quote><short-title>THRIVE Act</short-title></quote>.</text></section>
<section id="HE6BCE273F25C42C9BA65D426786E1E44" section-type="subsequent-section"><enum>10002.</enum><header>Demonstration program to study the impact of using rental vouchers for supportive housing for individuals recovering from opioid use disorders or other substance use disorders</header><text display-inline="no-display-inline">Section 8(o) of the United States Housing Act of 1937 (<external-xref legal-doc="usc" parsable-cite="usc/42/1437f">42 U.S.C. 1437f(o)</external-xref>) is amended by adding at the end the following new paragraph:</text> <quoted-block id="HBE04390F2D604D8F8AA9DA9C31B3F9C5"> <paragraph id="H272840A0FD2B49908D37D1119092557E"><enum>(21)</enum><header>Rental Voucher Demonstration Program for supportive housing for individuals recovering from opioid use disorders or other substance use disorders</header> <subparagraph id="H595A58305CB1442980781D44D5ED7ED5"><enum>(A)</enum><header>Establishment</header><text display-inline="yes-display-inline">The Secretary shall establish a demonstration program under which the Secretary shall set aside, allocate, and distribute directly to eligible entities, from amounts made available for rental assistance under this subsection, the amounts specified in subparagraph (B) for an eligible entity to provide a voucher for such assistance to a covered individual through a supportive housing program that provides treatment for opioid use disorders or other substance use disorders (as applicable), coordination with workforce development providers, and such assistance, as determined by the entity.</text></subparagraph>
<subparagraph id="H518D7709B8EA42FDA2A2FB1CB72BCBC4"><enum>(B)</enum><header>Amount</header><text display-inline="yes-display-inline">The amount specified in this subparagraph is, for fiscal year 2019, the amount necessary to provide the lesser of—</text> <clause id="HD320829396774C76A70154007720939C"><enum>(i)</enum><text>0.5 percent of the total number of vouchers renewed under this subsection during the fiscal year ending immediately before the date of the enactment of this paragraph; or</text></clause>
<clause id="HA3EA5970BE034C97AD12A61AF3A82FAD"><enum>(ii)</enum><text>10,000 vouchers.</text></clause></subparagraph> <subparagraph id="H20AF31F91E0F4915A42817B0EEDC764A"><enum>(C)</enum><header>Criteria for eligible entities</header><text display-inline="yes-display-inline">An eligible entity shall—</text>
<clause id="H1E8D88CFDE6D4A159CFC0A72DD5938FD"><enum>(i)</enum><text>provide an evidence-based treatment program and demonstrate the ability to coordinate with workforce development providers for individuals recovering from an opioid use disorder or other substance use disorder, as applicable, that meet standards established by the Secretary; and</text></clause> <clause id="H499B10D7066648289E6CA4FEECADA181"><enum>(ii)</enum><text>demonstrate prior experience administering rental assistance vouchers, demonstrate prior experience administering supportive housing programs under the McKinney-Vento Homeless Act, or demonstrate a partnership with a public housing agency or a housing program of a State, unit of local government, or Indian tribe (as such term is defined in section 4 of the Native American Housing and Self-Determination Act of 1996 (<external-xref legal-doc="usc" parsable-cite="usc/25/4103">25 U.S.C. 4103</external-xref>)) that ensures effective administration of rental assistance vouchers.</text></clause></subparagraph>
<subparagraph id="H794BC84D7457409C9543E37B9C13A31F"><enum>(D)</enum><header>Application</header><text display-inline="yes-display-inline">To receive a rental assistance voucher under this paragraph, an eligible entity shall submit an application to the Secretary that shall include—</text> <clause id="H6CBB468288AC4E348519CC9125C4748C"><enum>(i)</enum><text>a description of the terms of treatment program, coordination with workforce development providers, and rental assistance to be provided to a covered individual, and assurances that such description shall be communicated to covered individuals that receive vouchers pursuant to the demonstration program established under this paragraph;</text></clause>
<clause id="HBBDCAC5A7C2A4E729233151721F7A166"><enum>(ii)</enum><text>a transitional plan that begins on the date on which a covered individual completes the treatment program of the eligible entity that includes information on additional treatment, coordination with workforce development opportunities, and housing resources and services available to such covered individual; and</text></clause> <clause id="HB9D5C1C41072495B946B1CB54232228D"><enum>(iii)</enum><text display-inline="yes-display-inline">evidence sufficient to demonstrate that the local government having jurisdiction over the location of any supportive housing facility to be used by the eligible entity in connection with the demonstration program under this paragraph permits such facilities in such location.</text></clause></subparagraph>
<subparagraph id="H3D44673C67E84C8C903EE8737AB680C0"><enum>(E)</enum><header>Selection</header><text display-inline="yes-display-inline">In selecting eligible entities to receive rental assistance vouchers under this paragraph, the Secretary shall—</text> <clause id="H57539475CBA8451F8791A500D377D5D9"><enum>(i)</enum><text>ensure that such eligible entities—</text>
<subclause id="HF17AA2A5E4954EC0B7CDE098D4731E6F"><enum>(I)</enum><text>are diverse;</text></subclause> <subclause id="HA8A79B2D94E543A28600D59A2D366999"><enum>(II)</enum><text>represent an appropriate balance of eligible entities located in urban and rural areas, including tribal communities;</text></subclause>
<subclause id="H539134CBA96049F2AAB3BF7777FCA49C"><enum>(III)</enum><text display-inline="yes-display-inline">have adequate resources for treatment, recovery, and supportive services;</text></subclause> <subclause id="H1560117DC19C4897BB9CDCDE50D14458"><enum>(IV)</enum><text>fully comply with the Fair Housing Act (<external-xref legal-doc="usc" parsable-cite="usc/42/3601">42 U.S.C. 3601</external-xref> et seq.) and the Civil Rights Act of 1964 (<external-xref legal-doc="usc" parsable-cite="usc/42/2000a">42 U.S.C. 2000a</external-xref> et seq.);</text></subclause>
<subclause id="H7FF7CF69B08E42AEB7C63798398F905B" display-inline="no-display-inline"><enum>(V)</enum><text display-inline="yes-display-inline">appropriately reflect the impact that opioids are having in tribal communities; and</text></subclause> <subclause id="HD0E8085247F941AA92FBB15AFD92B77E"><enum>(VI)</enum><text display-inline="yes-display-inline">provide supportive and transitional housing programs in diverse geographic regions with high rates of mortality due to opioid use disorders or other substance use disorders, as applicable, based on data of the Centers for Disease Control and Prevention; and</text></subclause></clause>
<clause id="H5E3BFBBF19304A18A372A0CD71899A0F"><enum>(ii)</enum><text display-inline="yes-display-inline">consider, in consultation with the Secretary of Health and Human Services and the Secretary of Labor—</text> <subclause id="H742F3A1C8482438A8BC343ED74778ED4"><enum>(I)</enum><text display-inline="yes-display-inline">the success of each recipient eligible entity at helping individuals complete the treatment program of the eligible entity and refrain from illicit opioid or other substance usage, as applicable;</text></subclause>
<subclause id="H52633367A9B5469AA2B8648D2FF7204C"><enum>(II)</enum><text display-inline="yes-display-inline">the coordination with workforce development providers by the eligible entity;</text></subclause> <subclause id="H7692E676BB9C457796BC91C477712F83"><enum>(III)</enum><text>the percentage of participants in unsubsidized employment during the second and fourth calendar quarter after exit from the program; and</text></subclause>
<subclause id="H8CBA3F1919F7481E94F41EC425EFA51B"><enum>(IV)</enum><text display-inline="yes-display-inline">the percentage of participants in the treatment program of the eligible entity that do not relapse into opioid or other substance usage, as applicable.</text></subclause></clause></subparagraph> <subparagraph id="H97B0186C214545CF81BB229808EB9B15"><enum>(F)</enum><header>Reissuance of voucher</header><text display-inline="yes-display-inline">Upon termination of the provision of rental assistance through a voucher to a covered individual, the eligible entity that initially offered such voucher may use such voucher to provide rental assistance to another covered individual.</text></subparagraph>
<subparagraph id="H1FA5A410E0C24B479DAEB7335F20CF20"><enum>(G)</enum><header>Duration</header><text display-inline="yes-display-inline">The Secretary shall not make rental assistance available under this paragraph after the expiration of the 5-year period beginning on the date of the enactment of this paragraph.</text></subparagraph> <subparagraph id="HA0A3180D858A419C8EA7E47F94B8ED30"><enum>(H)</enum><header>Waivers</header><text display-inline="yes-display-inline">The Secretary may, through publication of a notice in the Federal Register, waive or specify alternative requirements for any provision of statue or regulation governing the use of vouchers under this subsection (except for requirements relating to fair housing, nondiscrimination, labor standards, or the environment) upon a finding by the Secretary that such waiver or alternative requirement is necessary for the purposes of this paragraph.</text></subparagraph>
<subparagraph commented="no" id="HBC3F37B31A914CAC81B7F853A2D88B7C"><enum>(I)</enum><header>Reports</header>
<clause id="H63B408B1035E4FF0A32D3F1B7B9F8482"><enum>(i)</enum><header>By the eligible entity</header><text display-inline="yes-display-inline">An eligible entity that receives a rental assistance voucher under this paragraph shall submit to the Secretary—</text> <subclause id="H0DDA38D73C9E4A558AEC026F6B019F93"><enum>(I)</enum><text>annually, the transitional plan described in subparagraph (D)(ii) and information on each covered individual’s housing upon termination of the provision of rental assistance through a voucher to such covered individual in a manner that protects the privacy of such covered individual; and</text></subclause>
<subclause id="H58E94DF9CC704E8DB781630700FA8D40"><enum>(II)</enum><text>not later than 4 years after the date of the enactment of this paragraph, a plan describing the treatment and housing options for any covered individual assisted by such voucher who will not have completed the program before the day that is 5 years after such date of enactment.</text></subclause></clause> <clause id="HF1312EA8BF614206BB48C750DD165F12"><enum>(ii)</enum><header>By the Secretary</header><text>The Secretary shall submit to Congress a report that analyzes the impact of rental assistance provided under this paragraph—</text>
<subclause commented="no" id="H03F1758AA599448DA9210B6010638B44"><enum>(I)</enum><text display-inline="yes-display-inline">not later than 2 years after the date of the enactment of this paragraph; and</text></subclause> <subclause commented="no" id="H27293ABE9DA742DB8F1B3541DF168C75"><enum>(II)</enum><text display-inline="yes-display-inline">not later than 4 years after the date of the enactment of this paragraph.</text></subclause></clause></subparagraph>
<subparagraph id="H44B9AA611B6043EA8D230ED217E50B25"><enum>(J)</enum><header>Definitions</header><text>In this paragraph:</text> <clause id="H9D5E97839D5141858D87BD1AF4821E55"><enum>(i)</enum><header>Eligible entity</header><text display-inline="yes-display-inline">The term <term>eligible entity</term> means a tribally designated housing entity (as such term is defined in section 4 of the Native American Housing and Self-Determination Act of 1996 (<external-xref legal-doc="usc" parsable-cite="usc/24/4103">24 U.S.C. 4103</external-xref>)), or a nonprofit organization, that meets the criteria described under subparagraph (C).</text></clause>
<clause id="HCF5D07D5002A44E4902CC7677CEA7AE6"><enum>(ii)</enum><header>Covered individual</header><text display-inline="yes-display-inline">The term <term>covered individual</term> means an individual recovering from an opioid use disorder or other substance use disorder.</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></section> <section id="HC0083EAFB88F4604B7E4CD58B84F5801"><enum>10003.</enum><header>Repeal of Rental Voucher Demonstration Program</header><text display-inline="no-display-inline">Effective the day that is 5 years after the date of the enactment of this title, paragraph (21) of section 8(o) of the United States Housing Act of 1937 (<external-xref legal-doc="usc" parsable-cite="usc/42/1437f">42 U.S.C. 1437f(o)</external-xref>), as added by this title, is repealed.</text></section>
<section id="H206032E01494422D8678506DD1FE6BC5"><enum>10004.</enum><header>Demonstration Close-Out</header><text display-inline="no-display-inline">An eligible entity that provided vouchers for rental assistance under paragraph (21) of section 8(o) of the United States Housing Act of 1937 (<external-xref legal-doc="usc" parsable-cite="usc/42/1437f">42 U.S.C. 1437f(o)</external-xref>), as added by this title, shall return any such vouchers to the Secretary of Housing and Urban Development not later than the day that is 5 years after the date of the enactment of this title for use only for renewals of expiring contracts for such assistance.</text></section> <section id="HA01809FF1D0A47B4955E02F5D92520DC"><enum>10005.</enum><header>No additional funds authorized</header><text display-inline="no-display-inline">No additional funds are authorized to be appropriated to carry out the requirements of this title and the amendments made by this title. Such requirements shall be carried out using amounts otherwise authorized to be appropriated.</text></section>
<enum>XI</enum><header>IMD CARE Act</header>
<section id="H55D1D503FC094F568A2AC3A8CE4CB560"><enum>11001.</enum><header>Short title</header><text display-inline="no-display-inline">This title may be cited as the <quote>Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act</quote> or the <quote>IMD CARE Act</quote>.</text></section> <section id="H8F89E28052714DDC8633C46411216E97" section-type="subsequent-section"><enum>11002.</enum><header>Medicaid State plan option to provide services for certain individuals with targeted SUDs in institutions for mental diseases</header><text display-inline="no-display-inline">Section 1915 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396n">42 U.S.C. 1396n</external-xref>) is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="HE96974D5D51D47C4BCDF8B0C6E7EB390" style="OLC">
<subsection id="H93B2AB289AC14977855A22A804156226"><enum>(l)</enum><header>State plan option To provide services for certain individuals in institutions for mental diseases</header>
<paragraph commented="no" id="HAC762D9C40CE4B11BB4F4ED94BA31BE5"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">With respect to calendar quarters beginning during the period beginning January 1, 2019, and ending December 31, 2023, a State may elect, through a State plan amendment, to, notwithstanding section 1905(a), provide medical assistance for services furnished in institutions for mental diseases and for other medically necessary services furnished to eligible individuals with targeted SUDs, in accordance with the requirements of this subsection.</text></paragraph> <paragraph commented="no" id="H1CD82070194C43D9BAD193B4509B0DE5"><enum>(2)</enum><header>Payments</header> <subparagraph commented="no" id="H1DB55F29C42F48B89FCCD9D4BF0090A3"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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 with a targeted SUD who is a patient in an 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.</text></subparagraph>
<subparagraph commented="no" id="H49F75622B1014CA2914E77A927F3E077"><enum>(B)</enum><header>Clarification</header><text>Payment made under this paragraph for expenditures under a State plan amendment under this subsection with respect to services described in paragraph (1) furnished to an eligible individual with a targeted SUD shall not affect payment that would otherwise be made under section 1903(a) for expenditures under the State plan (or waiver of such plan) for medical assistance for such individual.</text></subparagraph></paragraph> <paragraph id="HD0CC698022E7421AB3DBB72F5B5F07B8"><enum>(3)</enum><header>Information required in State plan amendment</header> <subparagraph id="H1255B9D5F93F435AA1B58DB0C99A8E81"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">A State electing to provide medical assistance pursuant to this subsection shall include with the submission of the State plan amendment under paragraph (1) to the Secretary—</text>
<clause id="HAEE77A59E9444612B8C37CCAC94D60EA"><enum>(i)</enum><text>a plan on how the State will improve access to outpatient care during the period of the State plan amendment, including a description of—</text> <subclause id="H1C2FB5F366A64E44A4258E2D10DB04F3"><enum>(I)</enum><text display-inline="yes-display-inline">the process by which eligible individuals with targeted SUDs will make the transition from receiving inpatient services in an institution for mental diseases to appropriate outpatient care; and</text></subclause>
<subclause commented="no" id="HA4C24FF3649040F4877EBBCBD312B6A9"><enum>(II)</enum><text>the process the State will undertake to ensure eligible individuals with targeted SUDs are provided care in the most integrated setting appropriate to the needs of the individuals; and</text></subclause></clause> <clause id="HB7838A7F46BC4257A752F975FF6FA342"><enum>(ii)</enum><text>a description of how the State plan amendment ensures an appropriate clinical screening of eligible individuals with targeted SUDs, including assessments to determine level of care and length of stay recommendations based upon the multidimensional assessment criteria of the American Society of Addiction Medicine and to determine the appropriate setting for such care.</text></clause></subparagraph>
<subparagraph id="HB8AA4BE92DF74F75A1E18C1CDB7448DF"><enum>(B)</enum><header>Report</header><text>Not later than the sooner of December 31, 2024, or 1 year after the date of the termination of a State plan amendment under this subsection, the State shall submit to the Secretary a report that includes at least—</text> <clause id="H094245CEF2FB45FC900CE498A8083CB6"><enum>(i)</enum><text display-inline="yes-display-inline">the number of eligible individuals with targeted SUDs who received services pursuant to such State plan amendment;</text></clause>
<clause id="HF129D944A22D4821A2F791E2036673FA"><enum>(ii)</enum><text>the length of the stay of each such individual in an institution for mental diseases;</text></clause> <clause id="H4F94E55465184B068EADF15A0A1ADF35"><enum>(iii)</enum><text>the type of outpatient treatment, including medication-assisted treatment, each such individual received after being discharged from such institution;</text></clause>
<clause id="HB6D2CBC6B39B41739E84448F3DC7783A"><enum>(iv)</enum><text display-inline="yes-display-inline">the number of eligible individuals with any co-occuring disorders who received services pursuant to such State plan amendment and the co-occuring disorders from which they suffer; and</text></clause> <clause id="H9C32093A98A943EFBC8CFDA820CB6201"><enum>(v)</enum><text>information regarding the effects of a State plan amendment on access to community care for individuals suffering from a mental disease other than substance use disorder.</text></clause></subparagraph></paragraph>
<paragraph id="H843A65FB5E5240F494A9A3DAEBE1BCCE"><enum>(4)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this subsection:</text> <subparagraph id="H8066754E9A044A1CA1E05507CF3E076B"><enum>(A)</enum><header>Eligible individual with a targeted SUD</header><text>The term <term>eligible individual with a targeted SUD</term> means an individual who—</text>
<clause id="H70968A51442E4B528479A026E87D2CE7"><enum>(i)</enum><text>with respect to a State, is enrolled for medical assistance under the State plan (or a waiver of such plan);</text></clause> <clause id="H8CCBF383DA0D41D895A5CEF6228476C1"><enum>(ii)</enum><text>is at least 21 years of age;</text></clause>
<clause id="H6F574D259E384E58872E615DC9CF9BF7"><enum>(iii)</enum><text>has not attained 65 years of age; and</text></clause> <clause id="H2FD577F8163047DFB3FCFCCE3594EDFB"><enum>(iv)</enum><text>has been diagnosed with at least one targeted SUD.</text></clause></subparagraph>
<subparagraph id="HB2D3B585A8FE4CD8BE52A76AFEF8AE7C"><enum>(B)</enum><header>Institution for mental diseases</header><text>The term <term>institution for mental diseases</term> has the meaning given such term in section 1905(i).</text></subparagraph> <subparagraph id="HD981FE508EF143418F106E342C54A9FD"><enum>(C)</enum><header>Opioid prescription pain reliever</header><text display-inline="yes-display-inline">The term <quote>opioid prescription pain reliever</quote> includes hydrocodone products, oxycodone products, tramadol products, codeine products, morphine products, fentanyl products, buprenorphine products, oxymorphone products, meperidine products, hydromorphone products, methadone, and any other prescription pain reliever identified by the Assistant Secretary for Mental Health and Substance Use.</text></subparagraph>
<subparagraph id="H91EDD5110C864A4B8CAA43850E932198"><enum>(D)</enum><header>Other medically necessary services</header><text>The term <quote>other medically necessary services</quote> means, with respect to an eligible individual with a targeted SUD who is a patient in an institution for mental diseases, items and services that are provided to such individual outside of such institution to the extent that such items and services would be treated as medical assistance for such individual if such individual were not a patient in such institution.</text></subparagraph> <subparagraph id="H204E7EAF35384A928786D5E16B0D9A0B"><enum>(E)</enum><header>Targeted SUD</header> <clause id="HD9F4F37530C64E6E81276C04C5906BE6"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">The term <quote>targeted SUD</quote> means an opioid use disorder or a cocaine use disorder.</text></clause>
<clause id="H83D920B3141C48F1906846A29683E59B"><enum>(ii)</enum><header>Cocaine use disorder</header><text>The term <quote>cocaine use disorder</quote> means a disorder that meets the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (or a successor edition), for either dependence or abuse for cocaine, including cocaine base (commonly referred to as <quote>crack cocaine</quote>).</text></clause> <clause id="H9E415446BD054757AC1A1828DFCF083E"><enum>(iii)</enum><header>Opioid use disorder</header><text>The term <quote>opioid use disorder</quote> means a disorder that meets the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (or a successor edition), for heroin use disorder or pain reliever use disorder (including with respect to opioid prescription pain relievers).</text></clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section id="H15519C004F564F2099D681D0E34C8DB4"><enum>11003.</enum><header>Promoting value in Medicaid managed care</header><text display-inline="no-display-inline">Section 1903(m) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396b">42 U.S.C. 1396b(m)</external-xref>) is amended by adding at the end the following new paragraph:</text> <quoted-block id="HFA599A0648A846748739FAFE1A698ABE" style="OLC"> <paragraph id="H3230B350B00C4BD4B68D1A6F36F15858" indent="up1"><enum>(7)</enum> <subparagraph id="H1C795E5C635C4F5A96C0DBE2711D69AD" display-inline="yes-display-inline"><enum>(A)</enum><text display-inline="yes-display-inline">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).</text></subparagraph>
<subparagraph id="H35EFC1440096439BB4487A65B72E06AA" indent="up1"><enum>(B)</enum><text>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—</text> <clause id="H8578002E987449D8B85BBE5B312BB9E2"><enum>(i)</enum><text>has satisfied the requirement of section 438.8 of title 42, Code of Federal Regulations (or any successor regulation), by electing—</text>
<subclause id="H0A013A5EC9C64AA69AF56475DBEFDCE9"><enum>(I)</enum><text display-inline="yes-display-inline">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</text></subclause> <subclause id="HEDE0B5F809AB41B49B7775305684322E"><enum>(II)</enum><text display-inline="yes-display-inline">in the case of a State not described in subparagraph (C), to apply a minimum medical loss ratio that is equal to 85 percent; and</text></subclause></clause>
<clause id="HFAB8DBD3950B4E9BB7F0C0FF2B5A6681"><enum>(ii)</enum><text>recovered all or a portion of the expenditures as a result of the entity’s failure to meet such ratio.</text></clause></subparagraph> <subparagraph id="H6849CDEF577B4DC49DB8CB4793171ECD" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph id="H9CFF257920C943BBA68DF733C14EE373" indent="up1"><enum>(D)</enum><text>For purposes of this paragraph:</text> <clause id="H2612EC1804B44166864265F8B162946E"><enum>(i)</enum><text display-inline="yes-display-inline">The term <quote>managed care entity</quote> means a medicaid managed care organization described in section 1932(a)(1)(B)(i).</text></clause>
<clause id="HBCC9237E92394155A072A7BE59B487F1"><enum>(ii)</enum><text display-inline="yes-display-inline">The term <quote>minimum medical loss ratio</quote> 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).</text></clause> <clause id="H1C4769C46E4C4BFCA8A4E0B61955067B"><enum>(iii)</enum><text>The term <quote>other specified entity</quote> means—</text>
<subclause id="HA193F61D5AC64415BBB9456038F7F14A"><enum>(I)</enum><text display-inline="yes-display-inline">a prepaid inpatient health plan, as defined in section 438.2 of title 42, Code of Federal Regulations (or any successor regulation); and</text></subclause> <subclause id="H00FBFD1F99FA4DC6ABCC1ABB2E2B933A"><enum>(II)</enum><text display-inline="yes-display-inline">a prepaid ambulatory health plan, as defined in such section (or any successor regulation).</text></subclause></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></section>
Passed the House of Representatives June 22, 2018.Karen L. Haas,Clerk.