[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5080 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 5080

To amend title XVIII to provide for coverage under the Medicare program 
                 of opioid treatment program services.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 23, 2018

 Mr. Holding introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII to provide for coverage under the Medicare program 
                 of opioid treatment program services.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Comprehensive Opioid Management and 
Bundled Addiction Treatment Act of 2018'' or the ``COMBAT Act of 
2018''.

SEC. 2. MEDICARE COVERAGE OF CERTAIN SERVICES FURNISHED BY OPIOID 
              TREATMENT PROGRAMS.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) in subparagraph (FF), by striking at the end ``and'';
            (2) in subparagraph (GG), by inserting at the end ``; 
        and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(HH) opioid treatment program services (as 
                defined in subsection (jjj)).''.
    (b) Opioid Use Disorder Treatment Services and Opioid Treatment 
Program Defined.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended by adding at the end the following new subsection:
    ``(jjj) Opioid Treatment Program Services; Opioid Treatment 
Program.--
            ``(1) Opioid treatment program services.--
                    ``(A) In general.--The term `opioid treatment 
                program services' means items and services described in 
                subparagraph (B) that are furnished as part of 
                medication-assisted treatment for the treatment of 
                opioid use disorder at an opioid treatment program 
                enrolled under section 1866(j).
                    ``(B) Items and services described.--For purposes 
                of subparagraph (A), the items and services described 
                in this subparagraph, with respect to an individual and 
                episode of care, are the following:
                            ``(i) Initial intake and assessment.
                            ``(ii) Integrated and ongoing psychosocial 
                        and medical treatment for opioid use disorder.
                            ``(iii) Additional services, including 
                        urinalysis; medication administration, 
                        dispensing, and monitoring; and screening.
                            ``(iv) One of the following products (or 
                        such other products approved after the date of 
                        the enactment of this subsection by the Food 
                        and Drug Administration for the purpose of 
                        maintenance or detoxification treatment), as 
                        determined appropriate for the individual by an 
                        appropriately licensed clinician for the 
                        treatment of such individual:
                                    ``(I) Methadone products.
                                    ``(II) Buprenorphine products.
                                    ``(III) Naltrexone products.
            ``(2) Opioid treatment program.--The term `opioid treatment 
        program' means an opioid treatment program (as defined in 
        section 8.2 of title 42 of the Code of Federal Regulations, or 
        any successor regulation) that--
                    ``(A) has in effect an opioid treatment program 
                certification (as defined in such section);
                    ``(B) has in effect a certification by the 
                Substance Abuse and Mental Health Services 
                Administration for such a program; and
                    ``(C) is accredited by an accrediting body approved 
                by the Substance Abuse and Mental Health Services 
                Administration.
            ``(3) Medication-assisted treatment.--The term `medication-
        assisted treatment' means the use of medications, in 
        combination with counseling, behavioral therapies, and 
        toxicology testing, to provide a comprehensive approach to the 
        treatment of substance use disorders.''.
    (c) Payment.--
            (1) In general.--Section 1833(a)(1) of the Social Security 
        Act (42 U.S.C. 1395l(a)(1)) is amended--
                    (A) by striking ``and (BB)'' and inserting 
                ``(BB)''; and
                    (B) by inserting before the semicolon at the end 
                the following ``, and (CC) with respect to opioid 
                treatment program services furnished during an episode 
                of care, the amount paid shall be equal to the amount 
                payable in accordance with section 1834(v)''.
            (2) Payment determination.--Section 1834 of the Social 
        Security Act (42 U.S.C. 1395m) is amended by adding at the end 
        the following new subsection:
    ``(v) Opioid Treatment Program Services.--
            ``(1) In general.--The Secretary shall pay under this part 
        to an opioid treatment program (as defined in paragraph (2) of 
        section 1861(jjj)) an amount equal to 120 percent of the 
        bundled payment amount under a subparagraph of paragraph (2) 
        for opioid treatment program services (as defined in paragraph 
        (1) of such section 1861(jjj)) described in such subparagraph 
        that are furnished during the episode of care (beginning not 
        later than January 1, 2019) applicable to such services 
        described in such subparagraph, to an individual by a physician 
        or other practitioner at such program. Such a bundled payment 
        shall be in lieu of any payment that would otherwise be made 
        under this part to such physician or practitioner for 
        furnishing such services.
            ``(2) Payment amounts and episode of care based on 
        medication involved.--Subject to paragraph (3):
                    ``(A) Medication-assisted treatment bundles 
                including methadone.--In the case of opioid treatment 
                program services that include methadone, the bundled 
                payment amount under this subparagraph is the payment 
                amount applied for HCPCS code H0020 and shall be for an 
                episode of care, the duration of which is a week.
                    ``(B) Medication-assisted treatment bundles 
                including buprenorphine.--In the case of opioid 
                treatment program services that include buprenorphine--
                            ``(i) the bundled payment amount under this 
                        subparagraph shall be the amount equal to the 
                        sum of--
                                    ``(I) with respect to services 
                                furnished as part of such bundle, the 
                                payment amount applied for HCPCS code 
                                H0047; and
                                    ``(II) with respect to 
                                buprenorphine administered or dispensed 
                                as part of such bundle, the payment 
                                amount applied for HCPCS code J0571, 
                                J0572, or J0573, determined at an 
                                amount equal to 95 percent of the 
                                average wholesale price of the drug;
                            ``(ii) such bundled payment amount--
                                    ``(I) shall be for an episode of 
                                care, the duration of which is a week; 
                                and
                                    ``(II) shall include payment for 
                                buprenorphine administered during such 
                                episode of care only if the medication 
                                is dispensed or administered by the 
                                opioid treatment program involved; and
                            ``(iii) any claim for payment for such 
                        services, with respect to such a episode of 
                        care, under this subsection shall include the 
                        National Drug Code for Buprenorphine, dosage, 
                        and acquisition costs.
                    ``(C) Medication-assisted treatment bundles 
                including naltrexone.--In the case of opioid treatment 
                program services that include naltrexone--
                            ``(i) the bundled payment amount under this 
                        subparagraph shall be the amount equal to the 
                        sum of--
                                    ``(I) with respect to services 
                                furnished as part of such bundle, the 
                                payment amount applied for HCPCS code 
                                H0047;
                                    ``(II) with respect to the 
                                administration of naltrexone as part of 
                                such bundle, the payment amount applied 
                                for CPT code 96372; and
                                    ``(III) with respect to naltrexone 
                                administered as part of such bundle, 
                                the payment amount applied for HCPCS 
                                code J2315 for the amount of milligrams 
                                used; and
                            ``(ii) such bundled amount shall be for an 
                        episode of care, the duration of which is a 
                        month.
                In carrying out this paragraph, any reference to a 
                HCPCS code or CPT code shall be treated as including a 
                reference to a successor code to the HCPCS code or CPT 
                code, as determined by the Secretary pursuant to 
                rulemaking.
            ``(3) Limitation.--In no case shall the amount determined 
        under a subparagraph of paragraph (2), with respect to opioid 
        treatment services described in a subparagraph of paragraph (2) 
        during an episode of care described in such subparagraph 
        furnished in a count be less than the greater of--
                    ``(A) the rate of payment for comparable services 
                that are paid under State plans under title XIX to 
                opioid treatment programs in such county; or
                    ``(B) the rate of payment under the TRICARE program 
                under chapter 55 of title 10, United States Code, for 
                comparable services paid to opioid treatment programs 
                in such county.''.
    (d) Including Opioid Treatment Programs as Medicare Providers.--
Section 1866(e) of the Social Security Act (42 U.S.C. 1395cc(e)) is 
amended--
            (1) in paragraph (2), by striking at the end ``and'';
            (2) in paragraph (3), by striking the period at the end and 
        inserting ``; and''; and
            (3) by adding at the end the following new paragraph:
            ``(3) opioid treatment programs (as defined in paragraph 
        (2) of section 1861(jjj)), but only with respect to the 
        furnishing of opioid treatment program services (as defined in 
        paragraph (1) of such section).''.
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