[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5796 Engrossed in House (EH)]

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115th CONGRESS
  2d Session
                                H. R. 5796

_______________________________________________________________________

                                 AN ACT


 
To require the Secretary of Health and Human Services to provide grants 
   for eligible entities to provide technical assistance to outlier 
            prescribers of opioids, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Responsible Education Achieves Care 
and Healthy Outcomes for Users' Treatment Act of 2018'' or the ``REACH 
OUT Act of 2018''.

SEC. 2. GRANTS TO PROVIDE TECHNICAL ASSISTANCE TO OUTLIER PRESCRIBERS 
              OF OPIOIDS.

    (a) Grants Authorized.--The Secretary of Health and Human Services 
(in this section referred to as the ``Secretary'') shall, through the 
Centers for Medicare & Medicaid Services, award grants, contracts, or 
cooperative agreements to eligible entities for the purposes described 
in subsection (b).
    (b) Use of Funds.--Grants, contracts, and cooperative agreements 
awarded under subsection (a) shall be used to support eligible entities 
through technical assistance--
            (1) to educate and provide outreach to outlier prescribers 
        of opioids about best practices for prescribing opioids;
            (2) to educate and provide outreach to outlier prescribers 
        of opioids about non-opioid pain management therapies; and
            (3) to reduce the amount of opioid prescriptions prescribed 
        by outlier prescribers of opioids.
    (c) Application.--Each eligible entity seeking to receive a grant, 
contract, or cooperative agreement under subsection (a) shall submit to 
the Secretary an application, at such time, in such manner, and 
containing such information as the Secretary may require.
    (d) Geographic Distribution.--In awarding grants, contracts, and 
cooperative agreements under this section, the Secretary shall 
prioritize establishing technical assistance resources in each State.
    (e) Definitions.--In this section:
            (1) Eligible entity.--The term ``eligible entity'' means--
                    (A) an organization--
                            (i) that has demonstrated experience 
                        providing technical assistance to health care 
                        professionals on a State or regional basis; and
                            (ii) that has at least--
                                    (I) one individual who is a 
                                representative of consumers on its 
                                governing body; and
                                    (II) one individual who is a 
                                representative of health care providers 
                                on its governing body; or
                    (B) an entity that is a quality improvement entity 
                with a contract under part B of title XI of the Social 
                Security Act (42 U.S.C. 1320c et seq.).
            (2) Outlier prescriber of opioids.--The term ``outlier 
        prescriber of opioids'' means 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 (42 U.S.C. 1395w-104(c)(4)(A)) 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 (42 U.S.C. 1395w-101 et seq.) and MA-PD plans under 
        part C of such title (42 U.S.C. 1395w-21 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.
            (3) Prescribers.--The term ``prescriber'' 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.
    (f) Funding.--For purposes of implementing this section, $75 
million shall be available from the Federal Supplementary Medical 
Insurance Trust Fund under section 1841 of the Social Security Act (42 
U.S.C. 1395t), to remain available until expended.

SEC. 3. PROMOTING VALUE IN MEDICAID MANAGED CARE.

    Section 1903(m) of the Social Security Act (42 U.S.C. 1396b(m)) is 
amended by adding at the end the following new paragraph:
    ``(7)(A) With respect to expenditures described in subparagraph (B) 
that are incurred by a State for any fiscal year after fiscal year 2025 
(and before fiscal year 2029), in determining the pro rata share to 
which the United States is equitably entitled under subsection (d)(3), 
the Secretary shall substitute the Federal medical assistance 
percentage that applies for such fiscal year to the State under section 
1905(b) (without regard to any adjustments to such percentage 
applicable under such section or any other provision of law) for the 
percentage that applies to such expenditures under section 1905(y).
    ``(B) Expenditures described in this subparagraph, with respect to 
a fiscal year to which subparagraph (A) applies, are expenditures 
incurred by a State for payment for medical assistance provided to 
individuals described in subclause (VIII) of section 1902(a)(10)(A)(i) 
by a managed care entity, or other specified entity (as defined in 
subparagraph (D)(iii)), that are treated as remittances because the 
State--
            ``(i) has satisfied the requirement of section 438.8 of 
        title 42, Code of Federal Regulations (or any successor 
        regulation), by electing--
                    ``(I) in the case of a State described in 
                subparagraph (C), to apply a minimum medical loss ratio 
                (as defined in subparagraph (D)(ii)) that is at least 
                85 percent but not greater than the minimum medical 
                loss ratio (as so defined) that such State applied as 
                of May 31, 2018; or
                    ``(II) in the case of a State not described in 
                subparagraph (C), to apply a minimum medical loss ratio 
                that is equal to 85 percent; and
            ``(ii) recovered all or a portion of the expenditures as a 
        result of the entity's failure to meet such ratio.
    ``(C) For purposes of subparagraph (B), a State described in this 
subparagraph is a State that as of May 31, 2018, applied a minimum 
medical loss ratio (as calculated under subsection (d) of section 438.8 
of title 42, Code of Federal Regulations (as in effect on June 1, 
2018)) for payment for services provided by entities described in such 
subparagraph under the State plan under this title (or a waiver of the 
plan) that is equal to or greater than 85 percent.
    ``(D) For purposes of this paragraph:
            ``(i) The term `managed care entity' means a medicaid 
        managed care organization described in section 
        1932(a)(1)(B)(i).
            ``(ii) The term `minimum medical loss ratio' means, with 
        respect to a State, a minimum medical loss ratio (as calculated 
        under subsection (d) of section 438.8 of title 42, Code of 
        Federal Regulations (as in effect on June 1, 2018)) for payment 
        for services provided by entities described in subparagraph (B) 
        under the State plan under this title (or a waiver of the 
        plan).
            ``(iii) The term `other specified entity' means--
                    ``(I) a prepaid inpatient health plan, as defined 
                in section 438.2 of title 42, Code of Federal 
                Regulations (or any successor regulation); and
                    ``(II) a prepaid ambulatory health plan, as defined 
                in such section (or any successor regulation).''.

            Passed the House of Representatives June 19, 2018.

            Attest:

                                                                 Clerk.
115th CONGRESS

  2d Session

                               H. R. 5796

_______________________________________________________________________

                                 AN ACT

To require the Secretary of Health and Human Services to provide grants 
   for eligible entities to provide technical assistance to outlier 
            prescribers of opioids, and for other purposes.