[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5801 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 5801

     To amend title XIX of the Social Security Act to provide for 
    requirements under the Medicaid program relating to the use of 
qualified prescription drug monitoring programs and prescribing certain 
                         controlled substances.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 15, 2018

Mr. Griffith (for himself and Mr. Fitzpatrick) introduced the following 
    bill; which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
     To amend title XIX of the Social Security Act to provide for 
    requirements under the Medicaid program relating to the use of 
qualified prescription drug monitoring programs and prescribing certain 
                         controlled substances.

    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 ``Medicaid Providers Are Required To 
Note Experiences in Record Systems to Help In-need Patients Act'' or 
the ``Medicaid PARTNERSHIP Act''.

SEC. 2. REQUIREMENTS UNDER THE MEDICAID PROGRAM RELATING TO QUALIFIED 
              PRESCRIPTION DRUG MONITORING PROGRAMS AND PRESCRIBING 
              CERTAIN CONTROLLED SUBSTANCES.

    Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is 
amended by inserting after section 1943 the following new section:

``SEC. 1944. REQUIREMENTS RELATING TO QUALIFIED PRESCRIPTION DRUG 
              MONITORING PROGRAMS AND PRESCRIBING CERTAIN CONTROLLED 
              SUBSTANCES.

    ``(a) In General.--Beginning October 1, 2021, a State shall, 
subject to subsection (d), require each covered provider to check 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.
    ``(b) Qualified Prescription Drug Monitoring Program Described.--A 
qualified prescription drug monitoring program described in this 
subsection is, with respect to a State, a prescription drug monitoring 
program administered by the State that, at a minimum, satisfies each of 
the following criteria:
            ``(1) The program facilitates access by a covered provider 
        to, at a minimum, the following information with respect to a 
        covered individual, in as close to real-time as possible:
                    ``(A) Information regarding the prescription drug 
                history of a covered individual with respect to 
                controlled substances.
                    ``(B) The number and type of controlled substances 
                prescribed to and filled for the covered individual 
                during at least the most recent 12-month period.
                    ``(C) The name, location, and contact information 
                (or other identifying number selected by the State, 
                such as a national provider identifier issued by the 
                National Plan and Provider Enumeration System of the 
                Centers for 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.
            ``(2) 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.
            ``(3) The program has in place a data sharing agreement 
        with the State Medicaid program that allows, at a minimum, 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 for purposes of improving health care 
        outcomes of individuals enrolled in the State plan (or waiver 
        of such plan) and monitoring and preventing fraud, waste, and 
        abuse.
    ``(c) Application of Privacy Rules Clarification.--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 (42 U.S.C. 1320d-2 
note), related to the sharing of data under subsection (b) in the same 
manner as the Secretary is required under subparagraph (J) of section 
1860D-4(c)(5) to clarify privacy requirements related to the sharing of 
data described in such subparagraph.
    ``(d) Ensuring Access.--In order to ensure reasonable access to 
health care, the Secretary may waive the application of the requirement 
under subsection (a), with respect to a State, in the case of natural 
disasters and similar situations, and in the case of the provision of 
emergency services (as defined for purposes of section 1860D-
4(c)(5)(D)(ii)(II)).
    ``(e) Reports.--
            ``(1) State reports.--Each State shall include in the 
        annual report submitted to the Secretary under section 
        1927(g)(3)(D), beginning with such reports submitted for 2023, 
        information including, at a minimum, the following information 
        for the most recent 12-month period:
                    ``(A) The percentage of covered providers (as 
                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.
                    ``(B) Aggregate trends with respect to prescribing 
                controlled substances such as--
                            ``(i) the number of pill counts and dosage 
                        for controlled substances;
                            ``(ii) the number and dosage of controlled 
                        substances prescribed per covered individual; 
                        and
                            ``(iii) the types of controlled substances 
                        prescribed, including the dates of such 
                        prescriptions, the supplies authorized 
                        (including the duration of such supplies), and 
                        the period of validity of such prescriptions, 
                        in different populations (such as individuals 
                        who are elderly, individuals with disabilities, 
                        and individuals who are enrolled under both 
                        this title and title XVIII).
                    ``(C) Whether or not the State requires (and a 
                detailed explanation as to why the State does or does 
                not require) pharmacists to check the prescription drug 
                history of a covered individual through a qualified 
                drug management program before dispensing a controlled 
                substance to such individual.
            ``(2) Report by cms.--Not later than October 1, 2023, the 
        Administrator of the Centers for Medicare & Medicaid Services 
        shall publish on the publicly available website of the Centers 
        for Medicare & Medicaid Services a report including the 
        following information:
                    ``(A) Guidance for States on how States can 
                increase the percentage of covered providers who use 
                qualified prescription drug monitoring programs 
                described in subsection (b).
                    ``(B) 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.
    ``(f) Increase to Federal Matching Rate for Certain Expenditures 
Relating to Qualified Prescription Drug Management Programs.--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) through 
(3) of subsection (b) if the State (in this subsection referred to as 
the `administering State') 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.
    ``(g) Rule of Construction.--Nothing in this section prevents a 
State from requiring pharmacists to check the prescription drug history 
of covered individuals through a qualified drug management program 
before dispensing controlled substances to such individuals.
    ``(h) Definitions.--In this section:
            ``(1) Controlled substance.--The term `controlled 
        substance' 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.
            ``(2) Covered individual.--The term `covered individual' 
        means, with respect to a State, an individual who is enrolled 
        in the State plan (or under a waiver of such plan). Such term 
        does not include an individual who--
                    ``(A) is receiving--
                            ``(i) hospice or palliative care; or
                            ``(ii) treatment for cancer;
                    ``(B) is a resident of a long-term care facility, 
                of a facility described in section 1905(d), or of 
                another facility for which frequently abused drugs are 
                dispensed for residents through a contract with a 
                single pharmacy; or
                    ``(C) the State elects to treat as exempted from 
                such term.
            ``(3) Covered provider.--
                    ``(A) In general.--The term `covered provider' 
                means, subject to subparagraph (B), with respect to a 
                State, a health care provider who is participating 
                under the State plan (or waiver of the State plan) and 
                licensed, registered, or otherwise permitted by the 
                State to prescribe a controlled substance (or the 
                designee of such provider).
                    ``(B) Exceptions.--
                            ``(i) In general.--Beginning October 1, 
                        2021, for purposes of this section, such term 
                        does not include a health care provider 
                        included in any type of health care provider 
                        determined by the Secretary to be exempt from 
                        application of this section under clause (ii).
                            ``(ii) Exceptions process.--Not later than 
                        October 1, 2020, the Secretary, after 
                        consultation with the National Association of 
                        Medicaid Directors, national health care 
                        provider associations, Medicaid beneficiary 
                        advocates, and advocates for individuals with 
                        rare 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 `covered provider' 
                        for purposes of this section.''.

SEC. 3. GUIDANCE.

    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.

SEC. 4. DEVELOPMENT OF MODEL STATE PRACTICES.

    (a) In General.--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 
section 1944(b)(3) of the Social Security Act, as added by section 2, 
for the following purposes:
            (1) Monitoring and preventing fraud, waste, and abuse.
            (2) Improving health care for individuals enrolled in a 
        State plan under title XIX of such Act (or waiver of such plan) 
        who--
                    (A) transition in and out of coverage under such 
                title;
                    (B) may have sources of health care coverage in 
                addition to coverage under such title; or
                    (C) pay for prescription drugs with cash.
            (3) Any other purposes specified by the Secretary.
    (b) Elements of Model Practices.--The model practices described in 
subsection (a)--
            (1) may 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
            (2) shall include any appropriate beneficiary protections 
        and privacy guidelines.
    (c) Consultation.--In developing model practices under this 
section, 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.

SEC. 5. REPORT BY COMPTROLLER GENERAL.

    Not later than October 1, 2020, the Comptroller General of the 
United States shall issue a report examining the operation of 
prescription drug monitoring programs administered by States, including 
data security and access standards used by such programs.
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