[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6 Engrossed Amendment House (EAH)]

<DOC>
                In the House of Representatives, U. S.,

                                                    September 28, 2018.
    Resolved, That the House agree to the amendment of the Senate to 
the bill (H.R. 6) entitled ``An Act to provide for opioid use disorder 
prevention, recovery, and treatment, and for other purposes.'', with 
the following

                  HOUSE AMENDMENT TO SENATE AMENDMENT:

            In lieu of the matter proposed to be inserted by the Senate 
      amendment, insert the following

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--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) Table of Contents.--The table of contents of 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. Medicaid drug review and utilization.
Sec. 1005. 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. 1006. Medicaid health homes for substance-use-disorder Medicaid 
                            enrollees.
Sec. 1007. Caring recovery for infants and babies.
Sec. 1008. Peer support enhancement and evaluation review.
Sec. 1009. Medicaid substance use disorder treatment via telehealth.
Sec. 1010. Enhancing patient access to non-opioid treatment options.
Sec. 1011. Assessing barriers to opioid use disorder treatment.
Sec. 1012. Help for moms and babies.
Sec. 1013. Securing flexibility to treat substance use disorders.
Sec. 1014. MACPAC study and report on MAT utilization controls under 
                            State Medicaid programs.
Sec. 1015. Opioid addiction treatment programs enhancement.
Sec. 1016. Better data sharing to combat the opioid crisis.
Sec. 1017. Report on innovative State initiatives and strategies to 
                            provide housing-related services and 
                            supports to individuals struggling with 
                            substance use disorders under Medicaid.
Sec. 1018. Technical assistance and support for innovative State 
                            strategies to provide housing-related 
                            supports under Medicaid.

       TITLE II--MEDICARE PROVISIONS TO ADDRESS THE OPIOID CRISIS

Sec. 2001. Expanding the use of telehealth services for the treatment 
                            of opioid use disorder and other substance 
                            use disorders.
Sec. 2002. Comprehensive screenings for seniors.
Sec. 2003. Every prescription conveyed securely.
Sec. 2004. Requiring prescription drug plan sponsors under Medicare to 
                            establish drug management programs for at-
                            risk beneficiaries.
Sec. 2005. Medicare coverage of certain services furnished by opioid 
                            treatment programs.
Sec. 2006. Encouraging appropriate prescribing under Medicare for 
                            victims of opioid overdose.
Sec. 2007. Automatic escalation to external review under a Medicare 
                            part D drug management program for at-risk 
                            beneficiaries.
Sec. 2008. Suspension of payments by Medicare prescription drug plans 
                            and MA-PD plans pending investigations of 
                            credible allegations of fraud by 
                            pharmacies.

           TITLE III--FDA AND CONTROLLED SUBSTANCE PROVISIONS

                       Subtitle A--FDA Provisions

                         Chapter 1--In General

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

     Chapter 2--Stop Counterfeit Drugs by Regulating and Enhancing 
                            Enforcement Now

Sec. 3011. Short title.
Sec. 3012. Notification, nondistribution, and recall of controlled 
                            substances.
Sec. 3013. Single source pattern of imported illegal drugs.
Sec. 3014. Strengthening FDA and CBP coordination and capacity.

                Chapter 3--Stop Illicit Drug Importation

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

   Chapter 4--Securing Opioids and Unused Narcotics With Deliberate 
                         Disposal and Packaging

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

               Chapter 5--Postapproval Study Requirements

Sec. 3041. Clarifying FDA postmarket authorities.

              Subtitle B--Controlled Substance Provisions

    Chapter 1--More Flexibility With Respect to Medication-Assisted 
                   Treatment for Opioid Use Disorders

Sec. 3201. Allowing for more flexibility with respect to medication-
                            assisted treatment for opioid use 
                            disorders.
Sec. 3202. Medication-assisted treatment for recovery from substance 
                            use disorder.
Sec. 3203. Grants to enhance access to substance use disorder 
                            treatment.
Sec. 3204. Delivery of a controlled substance by a pharmacy to be 
                            administered by injection or implantation.

  Chapter 2--Empowering Pharmacists in the Fight Against Opioid Abuse

Sec. 3211. Short title.
Sec. 3212. Programs and materials for training on certain circumstances 
                            under which a pharmacist may decline to 
                            fill a prescription.

             Chapter 3--Safe Disposal of Unused Medication

Sec. 3221. Short title.
Sec. 3222. Disposal of controlled substances of a hospice patient by 
                            employees of a qualified hospice program.
Sec. 3223. GAO study and report on hospice safe drug management.

     Chapter 4--Special Registration for Telemedicine Clarification

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

      Chapter 5--Synthetic Abuse and Labeling of Toxic Substances

Sec. 3241. Controlled substance analogues.

              Chapter 6--Access to Increased Drug Disposal

Sec. 3251. Short title.
Sec. 3252. Definitions.
Sec. 3253. Authority to make grants.
Sec. 3254. Application.
Sec. 3255. Use of grant funds.
Sec. 3256. Eligibility for grant.
Sec. 3257. Duration of grants.
Sec. 3258. Accountability and oversight.
Sec. 3259. Duration of program.
Sec. 3260. Authorization of appropriations.

           Chapter 7--Using Data To Prevent Opioid Diversion

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

                     Chapter 8--Opioid Quota Reform

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

                  Chapter 9--Preventing Drug Diversion

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

                           TITLE IV--OFFSETS

Sec. 4001. Promoting value in Medicaid managed care.
Sec. 4002. Requiring reporting by group health plans of prescription 
                            drug coverage information for purposes of 
                            identifying primary payer situations under 
                            the Medicare program.
Sec. 4003. Additional religious exemption from health coverage 
                            responsibility requirement.
Sec. 4004. Modernizing the reporting of biological and biosimilar 
                            products.

                   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 and Substance Use Disorder 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.

                        Subtitle F--IMD CARE Act

Sec. 5051. Short title.
Sec. 5052. State option to provide Medicaid coverage for certain 
                            individuals with substance use disorders 
                            who are patients in certain institutions 
                            for mental diseases.

                 Subtitle G--Medicaid Improvement Fund

Sec. 5061. Medicaid Improvement Fund.

                  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. Medicare opioid safety education.

                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. Commit to opioid medical prescriber accountability and 
                            safety for seniors.
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. Dr. Todd Graham 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--Providing Reliable Options for Patients and Educational 
                               Resources

Sec. 6101. Short title.
Sec. 6102. Requiring Medicare Advantage plans and part D prescription 
                            drug plans to include information on risks 
                            associated with opioids and coverage of 
                            nonpharmacological therapies and nonopioid 
                            medications or devices used to treat pain.
Sec. 6103. Requiring Medicare Advantage plans and prescription drug 
                            plans to provide information on the safe 
                            disposal of prescription drugs.
Sec. 6104. Revising measures used under the Hospital Consumer 
                            Assessment of Healthcare Providers and 
                            Systems survey relating to pain management.

         Subtitle L--Fighting the Opioid Epidemic With Sunshine

Sec. 6111. Fighting the opioid epidemic with sunshine.

                  TITLE VII--PUBLIC HEALTH PROVISIONS

                   Subtitle A--Awareness and Training

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

  Subtitle B--Pilot Program for Public Health Laboratories To Detect 
                  Fentanyl and Other Synthetic Opioids

Sec. 7011. Pilot program for public health laboratories to detect 
                            fentanyl and other synthetic opioids.

         Subtitle C--Indexing Narcotics, Fentanyl, and Opioids

Sec. 7021. Establishment of substance use disorder information 
                            dashboard.
Sec. 7022. Interdepartmental Substance Use Disorders Coordinating 
                            Committee.
Sec. 7023. National milestones to measure success in curtailing the 
                            opioid crisis.
Sec. 7024. Study on prescribing limits.

          Subtitle D--Ensuring Access to Quality Sober Living

Sec. 7031. National recovery housing best practices.

              Subtitle E--Advancing Cutting Edge Research

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

                        Subtitle F--Jessie's Law

Sec. 7051. Inclusion of opioid addiction history in patient records.
Sec. 7052. Communication with families during emergencies.
Sec. 7053. Development and dissemination of model training programs for 
                            substance use disorder patient records.

           Subtitle G--Protecting Pregnant Women and Infants

Sec. 7061. Report on addressing maternal and infant health in the 
                            opioid crisis.
Sec. 7062. Protecting moms and infants.
Sec. 7063. Early interventions for pregnant women and infants.
Sec. 7064. Prenatal and postnatal health.
Sec. 7065. Plans of safe care.

         Subtitle H--Substance Use Disorder Treatment Workforce

Sec. 7071. Loan repayment program for substance use disorder treatment 
                            workforce.
Sec. 7072. Clarification regarding service in schools and other 
                            community-based settings.
Sec. 7073. Programs for health care workforce.

       Subtitle I--Preventing Overdoses While in Emergency Rooms

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

    Subtitle J--Alternatives to Opioids in the Emergency Department

Sec. 7091. Emergency department alternatives to opioids demonstration 
                            program.

    Subtitle K--Treatment, Education, and Community Help To Combat 
                               Addiction

Sec. 7101. Establishment of regional centers of excellence in substance 
                            use disorder education.
Sec. 7102. Youth prevention and recovery.

 Subtitle L--Information From National Mental Health and Substance Use 
                           Policy Laboratory

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

           Subtitle M--Comprehensive Opioid Recovery Centers

Sec. 7121. Comprehensive opioid recovery centers.

                    Subtitle N--Trauma-Informed Care

Sec. 7131. CDC surveillance and data collection for child, youth, and 
                            adult trauma.
Sec. 7132. Task force to develop best practices for trauma-informed 
                            identification, referral, and support.
Sec. 7133. National Child Traumatic Stress Initiative.
Sec. 7134. Grants to improve trauma support services and mental health 
                            care for children and youth in educational 
                            settings.
Sec. 7135. Recognizing early childhood trauma related to substance 
                            abuse.

       Subtitle O--Eliminating Opioid Related Infectious Diseases

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

            Subtitle P--Peer Support Communities of Recovery

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

 Subtitle Q--Creating Opportunities That Necessitate New and Enhanced 
         Connections That Improve Opioid Navigation Strategies

Sec. 7161. Preventing overdoses of controlled substances.
Sec. 7162. Prescription drug monitoring program.

   Subtitle R--Review of Substance Use Disorder Treatment Providers 
                       Receiving Federal Funding

Sec. 7171. Review of substance use disorder treatment providers 
                            receiving Federal funding.

                  Subtitle S--Other Health Provisions

Sec. 7181. State response to the opioid abuse crisis.
Sec. 7182. Report on investigations regarding parity in mental health 
                            and substance use disorder benefits.
Sec. 7183. CAREER Act.

                       TITLE VIII--MISCELLANEOUS

       Subtitle A--Synthetics Trafficking and Overdose Prevention

Sec. 8001. Short title.
Sec. 8002. Customs fees.
Sec. 8003. Mandatory advance electronic information for postal 
                            shipments.
Sec. 8004. International postal agreements.
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--Opioid Addiction Recovery Fraud Prevention

Sec. 8021. Short title.
Sec. 8022. Definitions.
Sec. 8023. Unfair or deceptive acts or practices with respect to 
                            substance use disorder treatment service 
                            and products.

  Subtitle C--Addressing Economic and Workforce Impacts of the Opioid 
                                 Crisis

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

     Subtitle D--Peer Support Counseling Program for Women Veterans

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

              Subtitle E--Treating Barriers to Prosperity

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

   Subtitle F--Pilot Program to Help Individuals in Recovery From a 
              Substance Use Disorder Become Stably Housed

Sec. 8071. Pilot program to help individuals in recovery from a 
                            substance use disorder become stably 
                            housed.

                       Subtitle G--Human Services

Sec. 8081. Supporting family-focused residential treatment.
Sec. 8082. Improving recovery and reunifying families.
Sec. 8083. Building capacity for family-focused residential treatment.

Subtitle H--Reauthorizing and Extending Grants for Recovery From Opioid 
                              Use Programs

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

          Subtitle I--Fighting Opioid Abuse in Transportation

Sec. 8101. Short title.
Sec. 8102. Alcohol and controlled substance testing of mechanical 
                            employees.
Sec. 8103. Department of Transportation public drug and alcohol testing 
                            database.
Sec. 8104. GAO report on Department of Transportation's collection and 
                            use of drug and alcohol testing data.
Sec. 8105. Transportation Workplace Drug and Alcohol Testing Program; 
                            addition of fentanyl and other substances.
Sec. 8106. Status reports on hair testing guidelines.
Sec. 8107. Mandatory Guidelines for Federal Workplace Drug Testing 
                            Programs using Oral Fluid.
Sec. 8108. Electronic recordkeeping.
Sec. 8109. Status reports on Commercial Driver's License Drug and 
                            Alcohol Clearinghouse.

             Subtitle J--Eliminating Kickbacks in Recovery

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

                 Subtitle K--Substance Abuse Prevention

Sec. 8201. Short title.
Sec. 8202. Reauthorization of the Office of National Drug Control 
                            Policy.
Sec. 8203. Reauthorization of the Drug-Free Communities Program.
Sec. 8204. Reauthorization of the National Community Anti-Drug 
                            Coalition Institute.
Sec. 8205. Reauthorization of the High-Intensity Drug Trafficking Area 
                            Program.
Sec. 8206. Reauthorization of drug court program.
Sec. 8207. Drug court training and technical assistance.
Sec. 8208. Drug overdose response strategy.
Sec. 8209. Protecting law enforcement officers from accidental 
                            exposure.
Sec. 8210. COPS Anti-Meth Program.
Sec. 8211. COPS anti-heroin task force program.
Sec. 8212. Comprehensive Addiction and Recovery Act education and 
                            awareness.
Sec. 8213. Reimbursement of substance use disorder treatment 
                            professionals.
Sec. 8214. Sobriety Treatment and Recovery Teams (START).
Sec. 8215. Provider education.
Sec. 8216. Definitions.
Sec. 8217. Amendments to administration of the Office.
Sec. 8218. Emerging threats committee, plan, and media campaign.
Sec. 8219. Drug interdiction.
Sec. 8220. GAO Audit.
Sec. 8221. National Drug Control Strategy.
Sec. 8222. Technical and conforming amendments to the Office of 
                            National Drug Control Policy 
                            Reauthorization Act of 1998.

                     Subtitle L--Budgetary Effects

Sec. 8231. Budgetary effect.

       TITLE I--MEDICAID PROVISIONS TO ADDRESS THE OPIOID CRISIS

SEC. 1001. AT-RISK YOUTH MEDICAID PROTECTION.

    (a) In General.--Section 1902 of the Social Security Act (42 U.S.C. 
1396a) is amended--
            (1) in subsection (a)--
                    (A) by striking ``and'' at the end of paragraph 
                (82);
                    (B) by striking the period at the end of paragraph 
                (83) and inserting ``; and''; and
                    (C) by inserting after paragraph (83) the following 
                new paragraph:
            ``(84) provide that--
                    ``(A) 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;
                    ``(B) 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
                    ``(C) 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.''; and
            (2) by adding at the end the following new subsection:
    ``(nn) Juvenile; Eligible Juvenile; Public Institution.--For 
purposes of subsection (a)(84) and this subsection:
            ``(1) Juvenile.--The term `juvenile' means an individual 
        who is--
                    ``(A) under 21 years of age; or
                    ``(B) described in subsection (a)(10)(A)(i)(IX).
            ``(2) Eligible juvenile.--The term `eligible juvenile' 
        means a juvenile who is an inmate of a public institution and 
        who--
                    ``(A) was determined eligible for medical 
                assistance under the State plan immediately before 
                becoming an inmate of such a public institution; or
                    ``(B) is determined eligible for such medical 
                assistance while an inmate of a public institution.
            ``(3) Inmate of a public institution.--The term `inmate of 
        a public institution' has the meaning given such term for 
        purposes of applying the subdivision (A) following paragraph 
        (30) of section 1905(a), taking into account the exception in 
        such subdivision for a patient of a medical institution.''.
    (b) No Change in Exclusion From Medical Assistance for Inmates of 
Public Institutions.--Nothing in this section shall be construed as 
changing the exclusion from medical assistance under the subdivision 
(A) following paragraph (30) of section 1905(a) of the Social Security 
Act (42 U.S.C. 1396d(a)), as redesignated by section 1006(b)(2)(B) of 
this Act, including any applicable restrictions on a State submitting 
claims for Federal financial participation under title XIX of such Act 
for such assistance.
    (c) No Change in Continuity of Eligibility Before Adjudication or 
Sentencing.--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.
    (d) Effective Date.--
            (1) In general.--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.
            (2) Rule for changes requiring state legislation.--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.

SEC. 1002. HEALTH INSURANCE FOR FORMER FOSTER YOUTH.

    (a) Coverage Continuity for Former Foster Care Children up to Age 
26.--
            (1) In general.--Section 1902(a)(10)(A)(i)(IX) of the 
        Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)(IX)) is 
        amended--
                    (A) in item (bb), by striking ``are not described 
                in or enrolled under'' and inserting ``are not 
                described in and are not enrolled under'';
                    (B) in item (cc), by striking ``responsibility of 
                the State'' and inserting ``responsibility of a 
                State''; and
                    (C) in item (dd), by striking ``the State plan 
                under this title or under a waiver of the'' and 
                inserting ``a State plan under this title or under a 
                waiver of such a''.
            (2) Effective date.--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.
    (b) Guidance.--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--
            (1) on best practices for--
                    (A) removing barriers and ensuring streamlined, 
                timely access to Medicaid coverage for former foster 
                youth up to age 26; and
                    (B) conducting outreach and raising awareness among 
                such youth regarding Medicaid coverage options for such 
                youth; and
            (2) which shall include examples of States that have 
        successfully extended Medicaid coverage to former foster youth 
        up to age 26.

SEC. 1003. DEMONSTRATION PROJECT TO INCREASE SUBSTANCE USE PROVIDER 
              CAPACITY UNDER THE MEDICAID PROGRAM.

    Section 1903 of the Social Security Act (42 U.S.C. 1396b) is 
amended by adding at the end the following new subsection:
    ``(aa) Demonstration Project To Increase Substance Use Provider 
Capacity.--
            ``(1) In general.--Not later than the date that is 180 days 
        after the date of the enactment of this subsection, 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--
                    ``(A) for the first 18-month period of such 
                project, award planning grants described in paragraph 
                (3); and
                    ``(B) for the remaining 36-month period of such 
                project, provide to each State selected under paragraph 
                (4) payments in accordance with paragraph (5).
            ``(2) Purpose.--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:
                    ``(A) 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.
                    ``(B) 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.
                    ``(C) 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--
                            ``(i) 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;
                            ``(ii) 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
                            ``(iii) are qualified under applicable 
                        State law to provide substance use disorder 
                        treatment or recovery services.
                    ``(D) 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--
                            ``(i) 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;
                            ``(ii) 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);
                            ``(iii) adolescents and young adults 
                        between the ages of 12 and 21 enrolled under 
                        the State plan (or a waiver of such plan); or
                            ``(iv) American Indian and Alaska Native 
                        individuals enrolled under the State plan (or a 
                        waiver of such plan).
            ``(3) Planning grants.--
                    ``(A) In general.--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).
                    ``(B) Selection.--In selecting States for purposes 
                of this paragraph, the Secretary shall--
                            ``(i) select States that have a State plan 
                        (or waiver of the State plan) approved under 
                        this title;
                            ``(ii) select States in a manner that 
                        ensures geographic diversity; and
                            ``(iii) 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.
                    ``(C) Activities described.--Activities described 
                in this subparagraph are, with respect to a State, each 
                of the following:
                            ``(i) 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:
                                    ``(I) An estimate of the number of 
                                individuals enrolled under the State 
                                plan (or a waiver of such plan) who 
                                have a substance use disorder.
                                    ``(II) 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).
                                    ``(III) 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).
                                    ``(IV) 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.
                            ``(ii) 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.
                    ``(D) Funding.--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.
            ``(4) Post-planning states.--
                    ``(A) In general.--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).
                    ``(B) Selection.--In selecting States for purposes 
                of this paragraph, the Secretary shall--
                            ``(i) select States that received a 
                        planning grant under paragraph (3);
                            ``(ii) 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;
                            ``(iii) select States in a manner that 
                        ensures geographic diversity; and
                            ``(iv) 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.
                    ``(C) Applications.--
                            ``(i) In general.--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:
                                    ``(I) 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).
                                    ``(II) 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.
                                    ``(III) 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:
                                            ``(aa) 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.
                                            ``(bb) 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.
                                            ``(cc) Milestones and 
                                        timeliness for implementing 
                                        activities set forth in the 
                                        plan.
                                            ``(dd) Specific measurable 
                                        targets for increasing the 
                                        substance use disorder 
                                        treatment and recovery provider 
                                        network under the State plan 
                                        (or a waiver of such plan).
                                    ``(IV) 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.
                                    ``(V) The expected financial impact 
                                of the demonstration project under this 
                                subsection on the State.
                                    ``(VI) A description of all funding 
                                sources available to the State to 
                                provide substance use disorder 
                                treatment or recovery services in the 
                                State.
                                    ``(VII) 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.
                                    ``(VIII) 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.
                            ``(ii) Consultation.--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.
            ``(5) Payment.--
                    ``(A) In general.--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.
                    ``(B) Qualified sums defined.--For purposes of 
                subparagraph (A), the term `qualified sums' 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 
                disorder 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 disorder treatment or recovery services.
                    ``(C) Non-duplication of payment.--In the case that 
                payment is made under subparagraph (A) with respect to 
                expenditures for substance use disorder 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.
            ``(6) Reports.--
                    ``(A) State reports.--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 disorder treatment or 
                recovery services for which payment is made to the 
                State under this subsection, on the following:
                            ``(i) The specific activities with respect 
                        to which payment under this subsection was 
                        provided.
                            ``(ii) 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.
                            ``(iii) 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.
                            ``(iv) Other matters as determined by the 
                        Secretary.
                    ``(B) CMS reports.--
                            ``(i) Initial report.--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--
                                    ``(I) the States awarded planning 
                                grants under paragraph (3);
                                    ``(II) the criteria used in such 
                                selection; and
                                    ``(III) the activities carried out 
                                by such States under such planning 
                                grants.
                            ``(ii) Interim report.--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--
                                    ``(I) on activities carried out 
                                under the demonstration project under 
                                this subsection;
                                    ``(II) 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;
                                    ``(III) with a description of the 
                                strengths and limitations of such 
                                demonstration project; and
                                    ``(IV) with a plan for the 
                                sustainability of such project.
                            ``(iii) Final report.--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--
                                    ``(I) providing updates on the 
                                matters reported in the interim report 
                                under clause (ii);
                                    ``(II) including a description of 
                                any changes made with respect to the 
                                demonstration project under this 
                                subsection after the submission of such 
                                interim report; and
                                    ``(III) evaluating such 
                                demonstration project.
                    ``(C) AHRQ report.--Not later than 3 years after 
                the date of the enactment of this subsection, the 
                Director of the Agency for Healthcare Research and 
                Quality, in 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).
            ``(7) Data sharing and best practices.--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.
            ``(8) CMS funding.--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.''.

SEC. 1004. MEDICAID DRUG REVIEW AND UTILIZATION.

    (a) Medicaid Drug Utilization Review.--
            (1) State plan requirement.--Section 1902(a) of the Social 
        Security Act (42 U.S.C. 1396a(a)), as amended by section 1001, 
        is further amended--
                    (A) in paragraph (83), at the end, by striking 
                ``and'';
                    (B) in paragraph (84), at the end, by striking the 
                period and inserting ``; and''; and
                    (C) by inserting after paragraph (84) the following 
                new paragraph:
            ``(85) provide that the State is in compliance with the 
        drug review and utilization requirements under subsection 
        (oo)(1).''.
            (2) Drug review and utilization requirements.--Section 1902 
        of the Social Security Act (42 U.S.C. 1396a), as amended by 
        section 1001, is further amended by adding at the end the 
        following new subsection:
    ``(oo) Drug Review and Utilization Requirements.--
            ``(1) In general.--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:
                    ``(A) Claims review limitations.--
                            ``(i) In general.--The State has in place--
                                    ``(I) 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;
                                    ``(II) 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
                                    ``(III) 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--
                                            ``(aa) benzodiazepines; or
                                            ``(bb) antipsychotics.
                            ``(ii) Managed care entities.--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.
                            ``(iii) Rules of construction.--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).
                    ``(B) Program to monitor antipsychotic medications 
                by children.--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.
                    ``(C) Fraud and abuse identification.--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.
                    ``(D) Reports.--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.
                    ``(E) Clarification.--Nothing shall prevent a State 
                from satisfying the requirement--
                            ``(i) 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;
                            ``(ii) described in subparagraph (B) by 
                        having a program described in such subparagraph 
                        that was in place before such date; or
                            ``(iii) described in subparagraph (C) by 
                        having a process described in such subparagraph 
                        that was in place before such date.
            ``(2) Annual report by secretary.--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).
            ``(3) Exceptions.--
                    ``(A) Certain individuals exempted.--The drug 
                review and utilization requirements under this 
                subsection shall not apply with respect to an 
                individual who--
                            ``(i) is receiving--
                                    ``(I) hospice or palliative care; 
                                or
                                    ``(II) treatment for cancer;
                            ``(ii) 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
                            ``(iii) the State elects to treat as 
                        exempted from such requirements.
                    ``(B)  Exception relating to ensuring access.--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)).''.
            (3) Managed care entities.--Section 1932 of the Social 
        Security Act (42 U.S.C. 1396u-2) is amended by adding at the 
        end the following new subsection:
    ``(i) Drug Utilization Review Activities and Requirements.--
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, 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.''.
    (b) Identifying and Addressing Inappropriate Prescribing and 
Billing Practices Under Medicaid.--
            (1) In general.--Section 1927(g) of the Social Security Act 
        (42 U.S.C. 1396r-8(g)) is amended--
                    (A) in paragraph (1)(A)--
                            (i) by striking ``of section 
                        1903(i)(10)(B)'' and inserting ``of section 
                        1902(a)(54)'';
                            (ii) by striking ``, by not later than 
                        January 1, 1993,'';
                            (iii) by inserting after ``gross overuse,'' 
                        the following: ``excessive utilization,''; and
                            (iv) by striking ``or inappropriate or 
                        medically unnecessary care'' and inserting 
                        ``inappropriate or medically unnecessary care, 
                        or prescribing or billing practices that 
                        indicate abuse or excessive utilization''; and
                    (B) in paragraph (2)(B)--
                            (i) by inserting after ``gross overuse,'' 
                        the following: ``excessive utilization,''; and
                            (ii) by striking ``or inappropriate or 
                        medically unnecessary care'' and inserting 
                        ``inappropriate or medically unnecessary care, 
                        or prescribing or billing practices that 
                        indicate abuse or excessive utilization''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall take effect with respect to retrospective drug use 
        reviews conducted on or after October 1, 2020.

SEC. 1005. 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.

    (a) Guidance.--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--
            (1) best practices from States with respect to innovative 
        or evidenced-based payment models that focus on prevention, 
        screening, treatment, plans of safe care, and postdischarge 
        services for mothers and fathers with substance use disorders 
        and babies with neonatal abstinence syndrome that improve care 
        and clinical outcomes;
            (2) 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;
            (3) guidance and technical assistance to State Medicaid 
        agencies regarding additional flexibilities and incentives 
        related to screening, prevention, and postdischarge services, 
        including parenting supports, and infant-caregiver bonding, 
        including breastfeeding when it is appropriate; and
            (4) guidance regarding suggested terminology and ICD codes 
        to identify infants with neonatal abstinence syndrome and 
        neonatal opioid withdrawal syndrome, which could include 
        opioid-exposure, opioid withdrawal not requiring 
        pharmacotherapy, and opioid withdrawal requiring 
        pharmacotherapy.
    (b) GAO Study.--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.

SEC. 1006. MEDICAID HEALTH HOMES FOR SUBSTANCE-USE-DISORDER MEDICAID 
              ENROLLEES.

    (a) Extension of Enhanced FMAP for Certain Health Homes for 
Individuals With Substance Use Disorders.--Section 1945(c) of the 
Social Security Act (42 U.S.C. 1396w-4(c)) is amended--
            (1) in paragraph (1), by inserting ``subject to paragraph 
        (4),'' after ``except that,''; and
            (2) by adding at the end the following new paragraph:
            ``(4) Special rule relating to substance use disorder 
        health homes.--
                    ``(A) In general.--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.
                    ``(B) Report requirements.--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:
                            ``(i) The quality of health care provided 
                        to such individuals, with a focus on outcomes 
                        relevant to the recovery of each such 
                        individual.
                            ``(ii) The access of such individuals to 
                        health care.
                            ``(iii) The total expenditures of such 
                        individuals for health care.
                For purposes of this subparagraph, the Secretary shall 
                specify all applicable measures for determining 
                quality, access, and expenditures.
                    ``(C) Best practices.--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.
                    ``(D) Definitions.--For purposes of this paragraph:
                            ``(i) SUD-eligible individuals.--The term 
                        `SUD-eligible individual' means, with respect 
                        to a State, an individual who satisfies all of 
                        the following:
                                    ``(I) The individual is an eligible 
                                individual with chronic conditions.
                                    ``(II) The individual is an 
                                individual with a substance use 
                                disorder.
                                    ``(III) 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.
                            ``(ii) SUD-focused state plan amendment.--
                        The term `SUD-focused State plan amendment' 
                        means a State plan amendment under this section 
                        that is designed to provide health home 
                        services primarily to SUD-eligible 
                        individuals.''.
    (b) Requirement for State Medicaid Plans To Provide Coverage for 
Medication-Assisted Treatment.--
            (1) Requirement for state medicaid plans to provide 
        coverage for medication-assisted treatment.--Section 
        1902(a)(10)(A) of the Social Security Act (42 U.S.C. 
        1396a(a)(10)(A)) is amended, in the matter preceding clause 
        (i), by striking ``and (28)'' and inserting ``(28), and (29)''.
            (2) Inclusion of medication-assisted treatment as medical 
        assistance.--Section 1905(a) of the Social Security Act (42 
        U.S.C. 1396d(a)) is amended--
                    (A) in paragraph (28), by striking ``and'' at the 
                end;
                    (B) by redesignating paragraph (29) as paragraph 
                (30); and
                    (C) by inserting after paragraph (28) the following 
                new paragraph:
            ``(29) 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''.
            (3) Medication-assisted treatment defined; waivers.--
        Section 1905 of the Social Security Act (42 U.S.C. 1396d) is 
        amended by adding at the end the following new subsection:
    ``(ee) Medication-Assisted Treatment.--
            ``(1) Definition.--For purposes of subsection (a)(29), the 
        term `medication-assisted treatment'--
                    ``(A) means all drugs approved under section 505 of 
                the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
                355), including methadone, and all biological products 
                licensed under section 351 of the Public Health Service 
                Act (42 U.S.C. 262) to treat opioid use disorders; and
                    ``(B) includes, with respect to the provision of 
                such drugs and biological products, counseling services 
                and behavioral therapy.
            ``(2) Exception.--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).''.
            (4) Effective date.--
                    (A) In general.--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.
                    (B) Exception for state legislation.--In the case 
                of a State plan under title XIX of the Social Security 
                Act (42 U.S.C. 1396 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.

SEC. 1007. CARING RECOVERY FOR INFANTS AND BABIES.

    (a) State Plan Amendment.--Section 1902(a) of the Social Security 
Act (42 U.S.C. 1396a(a)), as amended by sections 1001 and 1004, is 
further amended--
            (1) in paragraph (84)(C), by striking ``and'' after the 
        semicolon;
            (2) in paragraph (85), by striking the period at the end 
        and inserting ``; and''; and
            (3) by inserting after paragraph (85), the following new 
        paragraph:
            ``(86) provide, at the option of the State, for making 
        medical assistance available on an inpatient or outpatient 
        basis at a residential pediatric recovery center (as defined in 
        subsection (pp)) to infants with neonatal abstinence 
        syndrome.''.
    (b) Residential Pediatric Recovery Center Defined.--Section 1902 of 
such Act (42 U.S.C. 1396a), as amended by sections 1001 and 1004, is 
further amended by adding at the end the following new subsection:
    ``(pp) Residential Pediatric Recovery Center Defined.--
            ``(1) In general.--For purposes of section 1902(a)(86), the 
        term `residential pediatric recovery center' means a center or 
        facility that furnishes items and services for which medical 
        assistance is available under the State plan to infants with 
        the diagnosis of neonatal abstinence syndrome without any other 
        significant medical risk factors.
            ``(2) Counseling and services.--A residential pediatric 
        recovery center may offer counseling and other services to 
        mothers (and other appropriate family members and caretakers) 
        of infants receiving treatment at such centers if such services 
        are otherwise covered under the State plan under this title or 
        under a waiver of such plan. Such other services may include 
        the following:
                    ``(A) Counseling or referrals for services.
                    ``(B) Activities to encourage caregiver-infant 
                bonding.
                    ``(C) Training on caring for such infants.''.
    (c) Effective Date.--The amendments made by this section take 
effect on the date of enactment of this Act and shall apply to medical 
assistance furnished on or after that date, without regard to final 
regulations to carry out such amendments being promulgated as of such 
date.

SEC. 1008. PEER SUPPORT ENHANCEMENT AND EVALUATION REVIEW.

    (a) In General.--Not later than 2 years after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to the Committee on Energy and Commerce of the House of 
Representatives, the Committee on Finance of the Senate, and the 
Committee on Health, Education, Labor and Pensions of the Senate a 
report on the provision of peer support services under the Medicaid 
program.
    (b) Content of Report.--
            (1) In general.--The report required under subsection (a) 
        shall include the following information:
                    (A) Information on State coverage of peer support 
                services under Medicaid, including--
                            (i) the mechanisms through which States may 
                        provide such coverage, including through 
                        existing statutory authority or through 
                        waivers;
                            (ii) the populations to which States have 
                        provided such coverage;
                            (iii) the payment models, including any 
                        alternative payment models, used by States to 
                        pay providers of such services; and
                            (iv) where available, information on 
                        Federal and State spending under Medicaid for 
                        peer support services.
                    (B) Information on selected State experiences in 
                providing medical assistance for peer support services 
                under State Medicaid plans and whether States measure 
                the effects of providing such assistance with respect 
                to--
                            (i) improving access to behavioral health 
                        services;
                            (ii) improving early detection, and 
                        preventing worsening, of behavioral health 
                        disorders;
                            (iii) reducing chronic and comorbid 
                        conditions; and
                            (iv) reducing overall health costs.
            (2) Recommendations.--The report required under subsection 
        (a) shall include recommendations, including recommendations 
        for such legislative and administrative actions related to 
        improving services, including peer support services, and access 
        to peer support services under Medicaid as the Comptroller 
        General of the United States determines appropriate.

SEC. 1009. MEDICAID SUBSTANCE USE DISORDER TREATMENT VIA TELEHEALTH.

    (a) Definitions.--In this section:
            (1) Comptroller general.--The term ``Comptroller General'' 
        means the Comptroller General of the United States.
            (2) School-based health center.--The term ``school-based 
        health center'' has the meaning given that term in section 
        2110(c)(9) of the Social Security Act (42 U.S.C. 1397jj(c)(9)).
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (4) Underserved area.--The term ``underserved area'' means 
        a health professional shortage area (as defined in section 
        332(a)(1)(A) of the Public Health Service Act (42 U.S.C. 
        254e(a)(1)(A))) and a medically underserved area (according to 
        a designation under section 330(b)(3)(A) of the Public Health 
        Service Act (42 U.S.C. 254b(b)(3)(A))).
    (b) Guidance to States Regarding Federal Reimbursement for 
Furnishing Services and Treatment for Substance Use Disorders Under 
Medicaid Using Services Delivered Via Telehealth, Including in School-
Based Health Centers.--Not later than 1 year after the date of 
enactment of this Act, the Secretary, acting through the Administrator 
of the Centers for Medicare & Medicaid Services, shall issue guidance 
to States on the following:
            (1) State options for Federal reimbursement of expenditures 
        under Medicaid for furnishing services and treatment for 
        substance use disorders, including assessment, medication-
        assisted treatment, counseling, medication management, and 
        medication adherence with prescribed medication regimes, using 
        services delivered via telehealth. Such guidance shall also 
        include guidance on furnishing services and treatments that 
        address the needs of high-risk individuals, including at least 
        the following groups:
                    (A) American Indians and Alaska Natives.
                    (B) Adults under the age of 40.
                    (C) Individuals with a history of non-fatal 
                overdose.
                    (D) Individuals with a co-occurring serious mental 
                illness and substance use disorder.
            (2) State options for Federal reimbursement of expenditures 
        under Medicaid for education directed to providers serving 
        Medicaid beneficiaries with substance use disorders using the 
        hub and spoke model, through contracts with managed care 
        entities, through administrative claiming for disease 
        management activities, and under Delivery System Reform 
        Incentive Payment (``DSRIP'') programs.
            (3) State options for Federal reimbursement of expenditures 
        under Medicaid for furnishing services and treatment for 
        substance use disorders for individuals enrolled in Medicaid in 
        a school-based health center using services delivered via 
        telehealth.
    (c) GAO Evaluation of Children's Access to Services and Treatment 
for Substance Use Disorders Under Medicaid.--
            (1) Study.--The Comptroller General shall evaluate 
        children's access to services and treatment for substance use 
        disorders under Medicaid. The evaluation shall include an 
        analysis of State options for improving children's access to 
        such services and treatment and for improving outcomes, 
        including by increasing the number of Medicaid providers who 
        offer services or treatment for substance use disorders in a 
        school-based health center using services delivered via 
        telehealth, particularly in rural and underserved areas. The 
        evaluation shall include an analysis of Medicaid provider 
        reimbursement rates for services and treatment for substance 
        use disorders.
            (2) Report.--Not later than 1 year after the date of 
        enactment of this Act, the Comptroller General shall submit to 
        Congress a report containing the results of the evaluation 
        conducted under paragraph (1), together with recommendations 
        for such legislation and administrative action as the 
        Comptroller General determines appropriate.
    (d) Report on Reducing Barriers to Using Services Delivered Via 
Telehealth and Remote Patient Monitoring for Pediatric Populations 
Under Medicaid.--
            (1) In general.--Not later than 1 year after the date of 
        enactment of this Act, the Secretary, acting through the 
        Administrator of the Centers for Medicare & Medicaid Services, 
        shall issue a report to the Committee on Finance of the Senate 
        and the Committee on Energy and Commerce of the House of 
        Representatives identifying best practices and potential 
        solutions for reducing barriers to using services delivered via 
        telehealth to furnish services and treatment for substance use 
        disorders among pediatric populations under Medicaid. The 
        report shall include--
                    (A) analyses of the best practices, barriers, and 
                potential solutions for using services delivered via 
                telehealth to diagnose and provide services and 
                treatment for children with substance use disorders, 
                including opioid use disorder; and
                    (B) identification and analysis of the differences, 
                if any, in furnishing services and treatment for 
                children with substance use disorders using services 
                delivered via telehealth and using services delivered 
                in person, such as, and to the extent feasible, with 
                respect to--
                            (i) utilization rates;
                            (ii) costs;
                            (iii) avoidable inpatient admissions and 
                        readmissions;
                            (iv) quality of care; and
                            (v) patient, family, and provider 
                        satisfaction.
            (2) Publication.--The Secretary shall publish the report 
        required under paragraph (1) on a public internet website of 
        the Department of Health and Human Services.

SEC. 1010. ENHANCING PATIENT ACCESS TO NON-OPIOID TREATMENT OPTIONS.

    Not later than January 1, 2019, the Secretary of Health and Human 
Services, acting through the Administrator of the Centers for Medicare 
& Medicaid Services, shall issue 1 or more final guidance documents, or 
update existing guidance documents, to States regarding mandatory and 
optional items and services that may be provided under a State plan 
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), or 
under a waiver of such a plan, for non-opioid treatment and management 
of pain, including, but not limited to, evidence-based, non-opioid 
pharmacological therapies and non-pharmacological therapies.

SEC. 1011. ASSESSING BARRIERS TO OPIOID USE DISORDER TREATMENT.

    (a) Study.--
            (1) In general.--The Comptroller General of the United 
        States (in this section referred to as the ``Comptroller 
        General'') shall conduct a study regarding the barriers to 
        providing medication used in the treatment of substance use 
        disorders under Medicaid distribution models such as the ``buy-
        and-bill'' model, and options for State Medicaid programs to 
        remove or reduce such barriers. The study shall include 
        analyses of each of the following models of distribution of 
        substance use disorder treatment medications, particularly 
        buprenorphine, naltrexone, and buprenorphine-naloxone 
        combinations:
                    (A) The purchasing, storage, and administration of 
                substance use disorder treatment medications by 
                providers.
                    (B) The dispensing of substance use disorder 
                treatment medications by pharmacists.
                    (C) The ordering, prescribing, and obtaining 
                substance use disorder treatment medications on demand 
                from specialty pharmacies by providers.
            (2) Requirements.--For each model of distribution specified 
        in paragraph (1), the Comptroller General shall evaluate how 
        each model presents barriers or could be used by selected State 
        Medicaid programs to reduce the barriers related to the 
        provision of substance use disorder treatment by examining what 
        is known about the effects of the model of distribution on--
                    (A) Medicaid beneficiaries' access to substance use 
                disorder treatment medications;
                    (B) the differential cost to the program between 
                each distribution model for medication-assisted 
                treatment; and
                    (C) provider willingness to provide or prescribe 
                substance use disorder treatment medications.
    (b) Report.--Not later than 15 months after the date of the 
enactment of this Act, the Comptroller General shall submit to Congress 
a report containing the results of the study conducted under subsection 
(a), together with recommendations for such legislation and 
administrative action as the Comptroller General determines 
appropriate.

SEC. 1012. HELP FOR MOMS AND BABIES.

    (a) Medicaid State Plan.--Section 1905(a) of the Social Security 
Act (42 U.S.C. 1396d(a)), as amended by section 1006, is further 
amended by adding at the end the following new sentence: ``In the case 
of a woman who is eligible for medical assistance on the basis of being 
pregnant (including through the end of the month in which the 60-day 
period beginning on the last day of her pregnancy ends), who is a 
patient in an institution for mental diseases for purposes of receiving 
treatment for a substance use disorder, and who was enrolled for 
medical assistance under the State plan immediately before becoming a 
patient in an institution for mental diseases or who becomes eligible 
to enroll for such medical assistance while such a patient, the 
exclusion from the definition of `medical assistance' set forth in the 
subdivision (B) following paragraph (30) of the first sentence of this 
subsection shall not be construed as prohibiting Federal financial 
participation for medical assistance for items or services that are 
provided to the woman outside of the institution.''.
    (b) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendment made by subsection (a) shall take effect on the date 
        of enactment of this Act.
            (2) Rule for changes requiring state legislation.--In the 
        case of a State plan 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 amendment 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.

SEC. 1013. SECURING FLEXIBILITY TO TREAT SUBSTANCE USE DISORDERS.

    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) Payment shall be made under this title to a State for 
expenditures for capitation payments described in section 438.6(e) of 
title 42, Code of Federal Regulations (or any successor regulation).''.

SEC. 1014. MACPAC STUDY AND REPORT ON MAT UTILIZATION CONTROLS UNDER 
              STATE MEDICAID PROGRAMS.

    (a) Study.--The Medicaid and CHIP Payment and Access Commission 
shall conduct a study and analysis of utilization control policies 
applied to medication-assisted treatment for substance use disorders 
under State Medicaid programs, including policies and procedures 
applied both in fee-for-service Medicaid and in risk-based managed care 
Medicaid, which shall--
            (1) include an inventory of such utilization control 
        policies and related protocols for ensuring access to medically 
        necessary treatment;
            (2) determine whether managed care utilization control 
        policies and procedures for medication-assisted treatment for 
        substance use disorders are consistent with section 
        438.210(a)(4)(ii) of title 42, Code of Federal Regulations; and
            (3) identify policies that--
                    (A) limit an individual's access to medication-
                assisted treatment for a substance use disorder by 
                limiting the quantity of medication-assisted treatment 
                prescriptions, or the number of refills for such 
                prescriptions, available to the individual as part of a 
                prior authorization process or similar utilization 
                protocols; and
                    (B) apply without evaluating individual instances 
                of fraud, waste, or abuse.
    (b) Report.--Not later than 1 year after the date of the enactment 
of this Act, the Medicaid and CHIP Payment and Access Commission shall 
make publicly available a report containing the results of the study 
conducted under subsection (a).

SEC. 1015. OPIOID ADDICTION TREATMENT PROGRAMS ENHANCEMENT.

    (a) T-MSIS Substance Use Disorder Data Book.--
            (1) In general.--Not later than the date that is 12 months 
        after the date of enactment of this Act, the Secretary of 
        Health and Human Services (in this section referred to as the 
        ``Secretary'') shall publish on the public website of the 
        Centers for Medicare & Medicaid Services a report with 
        comprehensive data on the prevalence of substance use disorders 
        in the Medicaid beneficiary population and services provided 
        for the treatment of substance use disorders under Medicaid.
            (2) Content of report.--The report required under paragraph 
        (1) shall include, at a minimum, the following data for each 
        State (including, to the extent available, for the District of 
        Columbia, Puerto Rico, the United States Virgin Islands, Guam, 
        the Northern Mariana Islands, and American Samoa):
                    (A) The number and percentage of individuals 
                enrolled in the State Medicaid plan or waiver of such 
                plan in each of the major enrollment categories (as 
                defined in a public letter from the Medicaid and CHIP 
                Payment and Access Commission to the Secretary) who 
                have been diagnosed with a substance use disorder and 
                whether such individuals are enrolled under the State 
                Medicaid plan or a waiver of such plan, including the 
                specific waiver authority under which they are 
                enrolled, to the extent available.
                    (B) A list of the substance use disorder treatment 
                services by each major type of service, such as 
                counseling, medication-assisted treatment, peer 
                support, residential treatment, and inpatient care, for 
                which beneficiaries in each State received at least 1 
                service under the State Medicaid plan or a waiver of 
                such plan.
                    (C) The number and percentage of individuals with a 
                substance use disorder diagnosis enrolled in the State 
                Medicaid plan or waiver of such plan who received 
                substance use disorder treatment services under such 
                plan or waiver by each major type of service under 
                subparagraph (B) within each major setting type, such 
                as outpatient, inpatient, residential, and other home-
                based and community-based settings.
                    (D) The number of services provided under the State 
                Medicaid plan or waiver of such plan per individual 
                with a substance use disorder diagnosis enrolled in 
                such plan or waiver for each major type of service 
                under subparagraph (B).
                    (E) The number and percentage of individuals 
                enrolled in the State Medicaid plan or waiver, by major 
                enrollment category, who received substance use 
                disorder treatment through--
                            (i) a medicaid managed care entity (as 
                        defined in section 1932(a)(1)(B) of the Social 
                        Security Act (42 U.S.C. 1396u-2(a)(1)(B))), 
                        including the number of such individuals who 
                        received such assistance through a prepaid 
                        inpatient health plan or a prepaid ambulatory 
                        health plan;
                            (ii) a fee-for-service payment model; or
                            (iii) an alternative payment model, to the 
                        extent available.
                    (F) The number and percentage of individuals with a 
                substance use disorder who receive substance use 
                disorder treatment services in an outpatient or home-
                based and community-based setting after receiving 
                treatment in an inpatient or residential setting, and 
                the number of services received by such individuals in 
                the outpatient or home-based and community-based 
                setting.
            (3) Annual updates.--The Secretary shall issue an updated 
        version of the report required under paragraph (1) not later 
        than January 1 of each calendar year through 2024.
            (4) Use of t-msis data.--The report required under 
        paragraph (1) and updates required under paragraph (3) shall--
                    (A) use data and definitions from the Transformed 
                Medicaid Statistical Information System (``T-MSIS'') 
                data set that is no more than 12 months old on the date 
                that the report or update is published; and
                    (B) as appropriate, include a description with 
                respect to each State of the quality and completeness 
                of the data and caveats describing the limitations of 
                the data reported to the Secretary by the State that is 
                sufficient to communicate the appropriate uses for the 
                information.
    (b) Making T-MSIS Data on Substance Use Disorders Available to 
Researchers.--
            (1) In general.--The Secretary shall publish in the Federal 
        Register a system of records notice for the data specified in 
        paragraph (2) for the Transformed Medicaid Statistical 
        Information System, in accordance with section 552a(e)(4) of 
        title 5, United States Code. The notice shall outline policies 
        that protect the security and privacy of the data that, at a 
        minimum, meet the security and privacy policies of SORN 09-70-
        0541 for the Medicaid Statistical Information System.
            (2) Required data.--The data covered by the systems of 
        records notice required under paragraph (1) shall be sufficient 
        for researchers and States to analyze the prevalence of 
        substance use disorders in the Medicaid beneficiary population 
        and the treatment of substance use disorders under Medicaid 
        across all States (including the District of Columbia, Puerto 
        Rico, the United States Virgin Islands, Guam, the Northern 
        Mariana Islands, and American Samoa), forms of treatment, and 
        treatment settings.
            (3) Initiation of data-sharing activities.--Not later than 
        January 1, 2019, the Secretary shall initiate the data-sharing 
        activities outlined in the notice required under paragraph (1).

SEC. 1016. BETTER DATA SHARING TO COMBAT THE OPIOID CRISIS.

    (a) In General.--Section 1903(m) of the Social Security Act (42 
U.S.C. 1396b(m)), as amended by section 1013, is further amended by 
adding at the end the following new paragraph:
    ``(8)(A) The State agency administering the State plan under this 
title may have reasonable access, as determined by the State, to 1 or 
more prescription drug monitoring program databases administered or 
accessed by the State to the extent the State agency is permitted to 
access such databases under State law.
    ``(B) Such State agency may facilitate reasonable access, as 
determined by the State, to 1 or more prescription drug monitoring 
program databases administered or accessed by the State, to same extent 
that the State agency is permitted under State law to access such 
databases, for--
            ``(i) any provider enrolled under the State plan to provide 
        services to Medicaid beneficiaries; and
            ``(ii) any managed care entity (as defined under section 
        1932(a)(1)(B)) that has a contract with the State under this 
        subsection or under section 1905(t)(3).
    ``(C) Such State agency may share information in such databases, to 
the same extent that the State agency is permitted under State law to 
share information in such databases, with--
            ``(i) any provider enrolled under the State plan to provide 
        services to Medicaid beneficiaries; and
            ``(ii) any managed care entity (as defined under section 
        1932(a)(1)(B)) that has a contract with the State under this 
        subsection or under section 1905(t)(3).''.
    (b) Security and Privacy.--All applicable State and Federal 
security and privacy protections and laws shall apply to any State 
agency, individual, or entity accessing 1 or more prescription drug 
monitoring program databases or obtaining information in such databases 
in accordance with section 1903(m)(8) of the Social Security Act (as 
added by subsection (a)).
    (c) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of enactment of this Act.

SEC. 1017. REPORT ON INNOVATIVE STATE INITIATIVES AND STRATEGIES TO 
              PROVIDE HOUSING-RELATED SERVICES AND SUPPORTS TO 
              INDIVIDUALS STRUGGLING WITH SUBSTANCE USE DISORDERS UNDER 
              MEDICAID.

    (a) In General.--Not later than 1 year after the date of enactment 
of this Act, the Secretary of Health and Human Services shall issue a 
report to Congress describing innovative State initiatives and 
strategies for providing housing-related services and supports under a 
State Medicaid program to individuals with substance use disorders who 
are experiencing or at risk of experiencing homelessness.
    (b) Content of Report.--The report required under subsection (a) 
shall describe the following:
            (1) Existing methods and innovative strategies developed 
        and adopted by State Medicaid programs that have achieved 
        positive outcomes in increasing housing stability among 
        Medicaid beneficiaries with substance use disorders who are 
        experiencing or at risk of experiencing homelessness, including 
        Medicaid beneficiaries with substance use disorders who are--
                    (A) receiving treatment for substance use disorders 
                in inpatient, residential, outpatient, or home-based 
                and community-based settings;
                    (B) transitioning between substance use disorder 
                treatment settings; or
                    (C) living in supportive housing or another model 
                of affordable housing.
            (2) Strategies employed by Medicaid managed care 
        organizations, primary care case managers, hospitals, 
        accountable care organizations, and other care coordination 
        providers to deliver housing-related services and supports and 
        to coordinate services provided under State Medicaid programs 
        across different treatment settings.
            (3) Innovative strategies and lessons learned by States 
        with Medicaid waivers approved under section 1115 or 1915 of 
        the Social Security Act (42 U.S.C. 1315, 1396n), including--
                    (A) challenges experienced by States in designing, 
                securing, and implementing such waivers or plan 
                amendments;
                    (B) how States developed partnerships with other 
                organizations such as behavioral health agencies, State 
                housing agencies, housing providers, health care 
                services agencies and providers, community-based 
                organizations, and health insurance plans to implement 
                waivers or State plan amendments; and
                    (C) how and whether States plan to provide Medicaid 
                coverage for housing-related services and supports in 
                the future, including by covering such services and 
                supports under State Medicaid plans or waivers.
            (4) Existing opportunities for States to provide housing-
        related services and supports through a Medicaid waiver under 
        sections 1115 or 1915 of the Social Security Act (42 U.S.C. 
        1315, 1396n) or through a State Medicaid plan amendment, such 
        as the Assistance in Community Integration Service pilot 
        program, which promotes supportive housing and other housing-
        related supports under Medicaid for individuals with substance 
        use disorders and for which Maryland has a waiver approved 
        under such section 1115 to conduct the program.
            (5) Innovative strategies and partnerships developed and 
        implemented by State Medicaid programs or other entities to 
        identify and enroll eligible individuals with substance use 
        disorders who are experiencing or at risk of experiencing 
        homelessness in State Medicaid programs.

SEC. 1018. TECHNICAL ASSISTANCE AND SUPPORT FOR INNOVATIVE STATE 
              STRATEGIES TO PROVIDE HOUSING-RELATED SUPPORTS UNDER 
              MEDICAID.

    (a) In General.--The Secretary of Health and Human Services shall 
provide technical assistance and support to States regarding the 
development and expansion of innovative State strategies (including 
through State Medicaid demonstration projects) to provide housing-
related supports and services and care coordination services under 
Medicaid to individuals with substance use disorders.
    (b) Report.--Not later than 180 days after the date of enactment of 
this Act, the Secretary shall issue a report to Congress detailing a 
plan of action to carry out the requirements of subsection (a).

       TITLE II--MEDICARE PROVISIONS TO ADDRESS THE OPIOID CRISIS

SEC. 2001. EXPANDING THE USE OF TELEHEALTH SERVICES FOR THE TREATMENT 
              OF OPIOID USE DISORDER AND OTHER SUBSTANCE USE DISORDERS.

    (a) In General.--Section 1834(m) of the Social Security Act (42 
U.S.C. 1395m(m)) is amended--
            (1) in paragraph (2)(B)--
                    (A) in clause (i), in the matter preceding 
                subclause (I), by striking ``clause (ii)'' and 
                inserting ``clause (ii) and paragraph (6)(C)''; and
                    (B) in clause (ii), in the heading, by striking 
                ``for home dialysis therapy'';
            (2) in paragraph (4)(C)--
                    (A) in clause (i), by striking ``paragraph (6)'' 
                and inserting ``paragraphs (5), (6), and (7)''; and
                    (B) in clause (ii)(X), by inserting ``or telehealth 
                services described in paragraph (7)'' before the period 
                at the end; and
            (3) by adding at the end the following new paragraph:
            ``(7) Treatment of substance use disorder services 
        furnished through telehealth.--The geographic requirements 
        described in paragraph (4)(C)(i) shall not apply with respect 
        to telehealth services furnished on or after July 1, 2019, to 
        an eligible telehealth individual with a substance use disorder 
        diagnosis for purposes of treatment of such disorder or co-
        occurring mental health disorder, as determined by the 
        Secretary, at an originating site described in paragraph 
        (4)(C)(ii) (other than an originating site described in 
        subclause (IX) of such paragraph).''.
    (b) Implementation.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') may implement the 
amendments made by this section by interim final rule.
    (c) Report.--
            (1) In general.--Not later than 5 years after the date of 
        the enactment of this Act, the Secretary shall submit to 
        Congress a report on the impact of the implementation of the 
        amendments made by this section with respect to telehealth 
        services under section 1834(m) of the Social Security Act (42 
        U.S.C. 1395m(m)) on--
                    (A) the utilization of health care items and 
                services under title XVIII of such Act (42 U.S.C. 1395 
                et seq.) related to substance use disorders, including 
                emergency department visits; and
                    (B) health outcomes related to substance use 
                disorders, such as opioid overdose deaths.
            (2) Funding.--For purposes of carrying out paragraph (1), 
        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.

SEC. 2002. COMPREHENSIVE SCREENINGS FOR SENIORS.

    (a) Initial Preventive Physical Examination.--Section 1861(ww) of 
the Social Security Act (42 U.S.C. 1395x(ww)) is amended--
            (1) in paragraph (1)--
                    (A) by striking ``paragraph (2) and'' and inserting 
                ``paragraph (2),''; and
                    (B) by inserting ``and the furnishing of a review 
                of any current opioid prescriptions (as defined in 
                paragraph (4)),'' after ``upon the agreement with the 
                individual,''; and
            (2) in paragraph (2)--
                    (A) by redesignating subparagraph (N) as 
                subparagraph (O); and
                    (B) by inserting after subparagraph (M) the 
                following new subparagraph:
                    ``(N) Screening for potential substance use 
                disorders.''; and
            (3) by adding at the end the following new paragraph:
    ``(4) For purposes of paragraph (1), the term `a review of any 
current opioid prescriptions' means, with respect to an individual 
determined to have a current prescription for opioids--
            ``(A) a review of the potential risk factors to the 
        individual for opioid use disorder;
            ``(B) an evaluation of the individual's severity of pain 
        and current treatment plan;
            ``(C) the provision of information on non-opioid treatment 
        options; and
            ``(D) a referral to a specialist, as appropriate.''.
    (b) Annual Wellness Visit.--Section 1861(hhh)(2) of the Social 
Security Act (42 U.S.C. 1395x(hhh)(2)) is amended--
            (1) by redesignating subparagraph (G) as subparagraph (I); 
        and
            (2) by inserting after subparagraph (F) the following new 
        subparagraphs:
                    ``(G) Screening for potential substance use 
                disorders and referral for treatment as appropriate.
                    ``(H) The furnishing of a review of any current 
                opioid prescriptions (as defined in subsection 
                (ww)(4)).''.
    (c) Rule of Construction.--Nothing in the amendments made by 
subsection (a) or (b) 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 or an annual wellness visit.
    (d) Effective Date.--The amendments made by this section shall 
apply to examinations and visits furnished on or after January 1, 2020.

SEC. 2003. EVERY PRESCRIPTION CONVEYED SECURELY.

    (a) In General.--Section 1860D-4(e) of the Social Security Act (42 
U.S.C. 1395w-104(e)) is amended by adding at the end the following:
            ``(7) Requirement of e-prescribing for controlled 
        substances.--
                    ``(A) In general.--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).
                    ``(B) Exception for certain circumstances.--The 
                Secretary shall, through rulemaking, specify 
                circumstances and processes by which the Secretary may 
                waive the requirement under subparagraph (A), with 
                respect to a covered part D drug, including in the case 
                of--
                            ``(i) a prescription issued when the 
                        practitioner and dispensing pharmacy are the 
                        same entity;
                            ``(ii) a prescription issued that cannot be 
                        transmitted electronically under the most 
                        recently implemented version of the National 
                        Council for Prescription Drug Programs SCRIPT 
                        Standard;
                            ``(iii) a prescription issued by a 
                        practitioner who received a waiver or a renewal 
                        thereof for a period of time as determined by 
                        the Secretary, not to exceed one year, from the 
                        requirement to use electronic prescribing 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;
                            ``(iv) 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;
                            ``(v) a prescription issued by a 
                        practitioner prescribing a drug under a 
                        research protocol;
                            ``(vi) 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;
                            ``(vii) a prescription issued by a 
                        practitioner--
                                    ``(I) for an individual who 
                                receives hospice care under this title; 
                                and
                                    ``(II) that is not covered under 
                                the hospice benefit under this title; 
                                and
                            ``(viii) a prescription issued by a 
                        practitioner for an individual who is--
                                    ``(I) a resident of a nursing 
                                facility (as defined in section 
                                1919(a)); and
                                    ``(II) dually eligible for benefits 
                                under this title and title XIX.
                    ``(C) Dispensing.--(i) 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).
                    ``(ii) 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.
                    ``(iii) Nothing in this paragraph shall be 
                construed as affecting the ability of an individual who 
                is being prescribed a covered part D drug to designate 
                a particular pharmacy to dispense the covered part D 
                drug to the extent consistent with the requirements 
                under subsection (b)(1) and under this paragraph.
                    ``(D) Enforcement.--The Secretary shall, through 
                rulemaking, have authority to enforce and specify 
                appropriate penalties for non-compliance with the 
                requirement under subparagraph (A).''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to coverage of drugs prescribed on or after January 1, 2021.
    (c) Update of Biometric Component of Multifactor Authentication.--
Not later than 1 year after the date of enactment of this Act, the 
Attorney General shall update the requirements for the biometric 
component of multifactor authentication with respect to electronic 
prescriptions of controlled substances.

SEC. 2004. REQUIRING PRESCRIPTION DRUG PLAN SPONSORS UNDER MEDICARE TO 
              ESTABLISH DRUG MANAGEMENT PROGRAMS FOR AT-RISK 
              BENEFICIARIES.

    Section 1860D-4(c) of the Social Security Act (42 U.S.C. 1395w-
104(c)) is amended--
            (1) in paragraph (1), by inserting after subparagraph (E) 
        the following new subparagraph:
                    ``(F) With respect to plan years beginning on or 
                after January 1, 2022, a drug management program for 
                at-risk beneficiaries described in paragraph (5).''; 
                and
            (2) in paragraph (5)(A), by inserting ``(and for plan years 
        beginning on or after January 1, 2022, a PDP sponsor shall)'' 
        after ``A PDP sponsor may''.

SEC. 2005. 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 use disorder treatment 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 Use Disorder Treatment Services; Opioid Treatment 
Program.--
            ``(1) Opioid use disorder treatment services.--The term 
        `opioid use disorder treatment services' means items and 
        services that are furnished by an opioid treatment program for 
        the treatment of opioid use disorder, including--
                    ``(A) 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;
                    ``(B) dispensing and administration of such 
                medications, if applicable;
                    ``(C) substance use counseling by a professional to 
                the extent authorized under State law to furnish such 
                services;
                    ``(D) individual and group therapy with a physician 
                or psychologist (or other mental health professional to 
                the extent authorized under State law);
                    ``(E) toxicology testing, and
                    ``(F) other items and services that the Secretary 
                determines are appropriate (but in no event to include 
                meals or transportation).
            ``(2) Opioid treatment program.--The term `opioid treatment 
        program' means an entity that is 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) is enrolled under section 1866(j);
                    ``(B) has in effect a certification by the 
                Substance Abuse and Mental Health Services 
                Administration for such a program;
                    ``(C) is accredited by an accrediting body approved 
                by the Substance Abuse and Mental Health Services 
                Administration; and
                    ``(D) meets such additional conditions as the 
                Secretary may find necessary to ensure--
                            ``(i) the health and safety of individuals 
                        being furnished services under such program; 
                        and
                            ``(ii) the effective and efficient 
                        furnishing of such services.''.
    (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 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''.
            (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:
    ``(w) Opioid Use Disorder Treatment Services.--
            ``(1) In general.--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.
            ``(2) Considerations.--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 
        chapter 55 of title 10 of the United States Code.
            ``(3) Annual updates.--The Secretary shall provide an 
        update each year to the bundled payment amounts under this 
        subsection.''.
    (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 (1), by striking at the end ``and'';
            (2) in paragraph (2), 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 use disorder treatment services (as 
        defined in paragraph (1) of such section).''.

SEC. 2006. ENCOURAGING APPROPRIATE PRESCRIBING UNDER MEDICARE FOR 
              VICTIMS OF OPIOID OVERDOSE.

    Section 1860D-4(c)(5)(C) of the Social Security Act (42 U.S.C. 
1395w-104(c)(5)(C)) is amended--
            (1) in clause (i), in the matter preceding subclause (I), 
        by striking ``For purposes'' and inserting ``Except as provided 
        in clause (v), for purposes''; and
            (2) by adding at the end the following new clause:
                            ``(v) Treatment of enrollees with a history 
                        of opioid-related overdose.--
                                    ``(I) In general.--For plan years 
                                beginning not later than January 1, 
                                2021, a part D eligible individual who 
                                is not an exempted individual described 
                                in clause (ii) and who is identified 
                                under this clause as a part D eligible 
                                individual with a history of opioid-
                                related overdose (as defined by the 
                                Secretary) shall be included as a 
                                potentially at-risk beneficiary for 
                                prescription drug abuse under the drug 
                                management program under this 
                                paragraph.
                                    ``(II) Identification and notice.--
                                For purposes of this clause, the 
                                Secretary shall--
                                            ``(aa) identify part D 
                                        eligible individuals with a 
                                        history of opioid-related 
                                        overdose (as so defined); and
                                            ``(bb) notify the PDP 
                                        sponsor of the prescription 
                                        drug plan in which such an 
                                        individual is enrolled of such 
                                        identification.''.

SEC. 2007. AUTOMATIC ESCALATION TO EXTERNAL REVIEW UNDER A MEDICARE 
              PART D DRUG MANAGEMENT PROGRAM FOR AT-RISK BENEFICIARIES.

    (a) In General.--Section 1860D-4(c)(5) of the Social Security Act 
(42 U.S.C. 1395ww-10(c)(5)) is amended--
            (1) in subparagraph (B), in each of clauses (ii)(III) and 
        (iii)(IV), by striking ``and the option of an automatic 
        escalation to external review'' and inserting ``, including 
        notice that if on reconsideration a PDP sponsor affirms its 
        denial, in whole or in part, the case shall be automatically 
        forwarded to the independent, outside entity contracted with 
        the Secretary for review and resolution''; and
            (2) in subparagraph (E), by striking ``and the option'' and 
        all that follows and inserting the following: ``and if on 
        reconsideration a PDP sponsor affirms its denial, in whole or 
        in part, the case shall be automatically forwarded to the 
        independent, outside entity contracted with the Secretary for 
        review and resolution.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply beginning not later January 1, 2021.

SEC. 2008. SUSPENSION OF PAYMENTS BY MEDICARE PRESCRIPTION DRUG PLANS 
              AND MA-PD PLANS PENDING INVESTIGATIONS OF CREDIBLE 
              ALLEGATIONS OF FRAUD BY PHARMACIES.

    (a) In General.--Section 1860D-12(b) of the Social Security Act (42 
U.S.C. 1395w-112(b)) is amended by adding at the end the following new 
paragraph:
            ``(7) Suspension of payments pending investigation of 
        credible allegations of fraud by pharmacies.--
                    ``(A) In general.--Section 1862(o)(1) 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 section 
                applies with respect to the Secretary, a provider of 
                services or supplier, and payments to such provider of 
                services or supplier under this title. A PDP sponsor 
                shall notify the Secretary regarding the imposition of 
                any payment suspension pursuant to the previous 
                sentence, such as through the secure internet website 
                portal (or other successor technology) established 
                under section 1859(i).
                    ``(B) Rule of construction.--Nothing in this 
                paragraph shall be construed as limiting the authority 
                of a PDP sponsor to conduct postpayment review.''.
    (b) Application to MA-PD Plans.--Section 1857(f)(3) of the Social 
Security Act (42 U.S.C. 1395w-27(f)(3)) is amended by adding at the end 
the following new subparagraph:
                    ``(D) Suspension of payments pending investigation 
                of credible allegations of fraud by pharmacies.--
                Section 1860D-12(b)(7).''.
    (c) Conforming Amendment.--Section 1862(o)(3) of the Social 
Security Act (42 U.S.C. 1395y(o)(3)) is amended by inserting ``, 
section 1860D-12(b)(7) (including as applied pursuant to section 
1857(f)(3)(D)),'' after ``this subsection''.
    (d) Clarification Relating to Credible Allegation of Fraud.--
Section 1862(o) of the Social Security Act (42 U.S.C. 1395y(o)) is 
amended by adding at the end the following new paragraph:
            ``(4) Credible allegation of fraud.--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.''.
    (e) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2020.

           TITLE III--FDA AND CONTROLLED SUBSTANCE PROVISIONS

                       Subtitle A--FDA Provisions

                         CHAPTER 1--IN GENERAL

SEC. 3001. CLARIFYING FDA REGULATION OF NON-ADDICTIVE PAIN PRODUCTS.

    (a) Public Meetings.--Not later than one year after the date of 
enactment of this Act, the Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), 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 acute or chronic pain or 
addiction, which may include--
            (1) the manner by which the Secretary may incorporate the 
        risks of misuse and abuse of a controlled substance (as defined 
        in section 102 of the Controlled Substances Act (21 U.S.C. 
        802)) into the risk benefit assessments under subsections (d) 
        and (e) of section 505 of the Federal Food, Drug, and Cosmetic 
        Act (21 U.S.C. 355), section 510(k) of such Act (21 U.S.C. 
        360(k)), or section 515(c) of such Act (21 U.S.C. 360e(c)), as 
        applicable;
            (2) the application of novel clinical trial designs 
        (consistent with section 3021 of the 21st Century Cures Act 
        (Public Law 114-255)), use of real world evidence (consistent 
        with section 505F of the Federal Food, Drug, and Cosmetic Act 
        (21 U.S.C. 355g)), and use of patient experience data 
        (consistent with section 569C of the Federal Food, Drug, and 
        Cosmetic Act (21 U.S.C. 360bbb-8c)) for the development of non-
        addictive medical products intended to treat pain or addiction;
            (3) the evidentiary standards and the development of 
        opioid-sparing data for inclusion in the labeling of medical 
        products intended to treat acute or chronic pain; and
            (4) the application of eligibility criteria under sections 
        506 and 515B of the Federal Food, Drug, and Cosmetic Act (21 
        U.S.C. 356, 360e-3) for non-addictive medical products intended 
        to treat pain or addiction.
    (b) Guidance.--Not less than one 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--
            (1) how the Food and Drug Administration may apply sections 
        506 and 515B of the Federal Food, Drug, and Cosmetic Act (21 
        U.S.C. 356, 360e-3) to non-addictive medical products intended 
        to treat pain or addiction, including the circumstances under 
        which the Secretary--
                    (A) may apply the eligibility criteria under such 
                sections 506 and 515B to non-addictive medical products 
                intended to treat pain or addiction;
                    (B) considers the risk of addiction of controlled 
                substances approved to treat pain when establishing 
                unmet medical need; and
                    (C) considers pain, pain control, or pain 
                management in assessing whether a disease or condition 
                is a serious or life-threatening disease or condition;
            (2) 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;
            (3) the manner in which the Food and Drug Administration 
        will assess evidence to support the inclusion of opioid-sparing 
        data in the labeling of non-addictive medical products intended 
        to treat acute or chronic pain, including--
                    (A) alternative data collection methodologies, 
                including the use of novel clinical trial designs 
                (consistent with section 3021 of the 21st Century Cures 
                Act (Public Law 114-255)) and real world evidence 
                (consistent with section 505F of the Federal Food, 
                Drug, and Cosmetic Act (21 U.S.C. 355g)), including 
                patient registries and patient reported outcomes, as 
                appropriate, to support product labeling;
                    (B) ethical considerations of exposing subjects to 
                controlled substances in clinical trials to develop 
                opioid-sparing data and considerations on data 
                collection methods that reduce harm, which may include 
                the reduction of opioid use as a clinical benefit;
                    (C) endpoints, including primary, secondary, and 
                surrogate endpoints, to evaluate the reduction of 
                opioid use;
                    (D) best practices for communication between 
                sponsors and the agency on the development of data 
                collection methods, including the initiation of data 
                collection; and
                    (E) the appropriate format in which to submit such 
                data results to the Secretary; and
            (4) the circumstances under which the Food and Drug 
        Administration considers misuse and abuse of a controlled 
        substance (as defined in section 102 of the Controlled 
        Substances Act (21 U.S.C. 802)) in making the risk benefit 
        assessment under paragraphs (2) and (4) of subsection (d) of 
        section 505 of the Federal Food, Drug, and Cosmetic Act (21 
        U.S.C. 355) and in finding that a drug is unsafe under 
        paragraph (1) or (2) of subsection (e) of such section.
    (c) Definitions.--In this section--
            (1) the term ``medical product'' means a drug (as defined 
        in section 201(g)(1) of the Federal Food, Drug, and Cosmetic 
        Act (21 U.S.C. 321(g)(1))), biological product (as defined in 
        section 351(i) of the Public Health Service Act (42 U.S.C. 
        262(i))), or device (as defined in section 201(h) of the 
        Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(h))); and
            (2) the term ``opioid-sparing'' means reducing, replacing, 
        or avoiding the use of opioids or other controlled substances 
        intended to treat acute or chronic pain.

SEC. 3002. EVIDENCE-BASED OPIOID ANALGESIC PRESCRIBING GUIDELINES AND 
              REPORT.

    (a) Guidelines.--The Commissioner of Food and Drugs shall develop 
evidence-based opioid analgesic prescribing guidelines for the 
indication-specific treatment of acute pain only for the relevant 
therapeutic areas where such guidelines do not exist.
    (b) Public Input.--In developing the guidelines under subsection 
(a), the Commissioner of Food and Drugs shall--
            (1) consult with stakeholders, which may include conducting 
        a public meeting of medical professional societies (including 
        any State-based societies), health care providers, State 
        medical boards, medical specialties including pain medicine 
        specialty societies, patient groups, pharmacists, academic or 
        medical research entities, and other entities with experience 
        in health care, as appropriate;
            (2) collaborate with the Director of the Centers for 
        Disease Control and Prevention, as applicable and appropriate, 
        and other Federal agencies with relevant expertise as 
        appropriate; and
            (3) provide for a notice and comment period consistent with 
        section 701(h) of the Federal Food, Drug, and Cosmetic Act (21 
        U.S.C. 371(h)) for the submission of comments by the public.
    (c) Report.--Not later than 1 year after the date of enactment of 
this Act, or, if earlier, at the time the guidelines under subsection 
(a) are finalized, 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 Food and Drug Administration will 
utilize the guidelines under subsection (a) to protect the public 
health and a description of the public health need with respect to each 
such indication-specific treatment guideline.
    (d) Updates.--The Commissioner of Food and Drugs shall 
periodically--
            (1) update the guidelines under subsection (a), informed by 
        public input described in subsection (b); and
            (2) submit to the committees specified in subsection (c) 
        and post on the public website of the Food and Drug 
        Administration an updated report under such subsection.
    (e) Statement To Accompany Guidelines and Recommendations.--The 
Commissioner of Food and Drugs shall ensure that opioid analgesic 
prescribing guidelines and other recommendations developed under this 
section are accompanied by a clear statement that such guidelines or 
recommendations, as applicable--
            (1) are intended to help inform clinical decisionmaking by 
        prescribers and patients; and
            (2) are not intended to be used 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.

     CHAPTER 2--STOP COUNTERFEIT DRUGS BY REGULATING AND ENHANCING 
                            ENFORCEMENT NOW

SEC. 3011. SHORT TITLE.

    This chapter may be cited as the ``Stop Counterfeit Drugs by 
Regulating and Enhancing Enforcement Now Act'' or the ``SCREEN Act''.

SEC. 3012. NOTIFICATION, NONDISTRIBUTION, AND RECALL OF CONTROLLED 
              SUBSTANCES.

    (a) Prohibited Acts.--Section 301 of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 331) is amended by adding at the end the 
following:
    ``(eee) The failure to comply with any order issued under section 
569D.''.
    (b) Notification, Nondistribution, and Recall of Controlled 
Substances.--Subchapter E of chapter V of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 360bbb et seq.) is amended by adding at the end 
the following:

``SEC. 569D. NOTIFICATION, NONDISTRIBUTION, AND RECALL OF CONTROLLED 
              SUBSTANCES.

    ``(a) Order To Cease Distribution and Recall.--
            ``(1) In general.--If the Secretary determines there is a 
        reasonable probability that a controlled substance would cause 
        serious adverse health consequences or death, the Secretary 
        may, after providing the appropriate person with an opportunity 
        to consult with the agency, issue an order requiring 
        manufacturers, importers, distributors, or pharmacists, who 
        distribute such controlled substance to immediately cease 
        distribution of such controlled substance.
            ``(2) Hearing.--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 whether adequate evidence 
        exists to justify an amendment to the order, and what actions 
        are required by such amended order pursuant to subparagraph 
        (3).
            ``(3) Order resolution.--After an order is issued according 
        to the process under paragraphs (1) and (2), the Secretary 
        shall, except as provided in paragraph (4)--
                    ``(A) vacate the order, if the Secretary determines 
                that inadequate grounds exist to support the actions 
                required by the order;
                    ``(B) continue the order ceasing distribution of 
                the controlled substance until a date specified in such 
                order; or
                    ``(C) amend the order to require a recall of the 
                controlled substance, including any requirements to 
                notify appropriate persons, a timetable for the recall 
                to occur, and a schedule for updates to be provided to 
                the Secretary regarding such recall.
            ``(4) Risk assessment.--If the Secretary determines that 
        the risk of recalling a controlled substance presents a greater 
        health risk than the health risk of not recalling such 
        controlled substance from use, an amended order under 
        subparagraph (B) or (C) of paragraph (3) shall not include 
        either a recall order for, or an order to cease distribution 
        of, such controlled substance, as applicable.
            ``(5) Action following order.--Any person who is subject to 
        an order pursuant to subparagraph (B) or (C) of paragraph (3) 
        shall immediately cease distribution of or recall, as 
        applicable, the controlled substance and provide notification 
        as required by such order.
    ``(b) Notice to Persons Affected.--If the Secretary determines 
necessary, the Secretary may require the person subject to an order 
pursuant to paragraph (1) or an amended order pursuant to subparagraph 
(B) or (C) of paragraph (3) to provide either a notice of a recall 
order for, or an order to cease distribution of, such controlled 
substance, as applicable, under this section to appropriate persons, 
including persons who manufacture, distribute, import, or offer for 
sale such product that is the subject of an order and to the public. In 
providing such notice, the Secretary may use the assistance of health 
professionals who prescribed or dispensed such controlled substances.
    ``(c) Nondelegation.--An order described in subsection (a)(3) 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 
or an official senior to such Director.
    ``(d) Savings Clause.--Nothing contained in this section shall be 
construed as limiting--
            ``(1) the authority of the Secretary to issue an order to 
        cease distribution of, or to recall, any drug under any other 
        provision of this Act or the Public Health Service Act; or
            ``(2) 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.''.
    (c) Controlled Substances Subject to Refusal.--The third sentence 
of section 801(a) of the Federal Food, Drug, and Cosmetic Act (21 
U.S.C. 381(a)) is amended by inserting ``, or is a controlled substance 
subject to an order under section 569D'' before ``, or (4)''.
    (d) Effective Date.--Sections 301(eee) and 569D of the Federal 
Food, Drug, and Cosmetic Act, as added by subsections (a) and (b), 
shall be effective beginning on the date of enactment of this Act.

SEC. 3013. SINGLE SOURCE PATTERN OF IMPORTED ILLEGAL DRUGS.

    Section 801 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
381), as amended by section 3012, is further amended by adding at the 
end the following:
    ``(t) Single Source Pattern of Imported Illegal Drugs.--If the 
Secretary determines that a person subject to debarment as a result of 
engaging in a pattern of importing or offering for import controlled 
substances or drugs as described in section 306(b)(3)(D), and such 
pattern is identified by the Secretary as being offered for import from 
the same manufacturer, distributor, or importer, the Secretary may by 
order determine all drugs being offered for import from such person as 
adulterated or misbranded, unless such person can provide evidence 
otherwise.''.

SEC. 3014. STRENGTHENING FDA AND CBP COORDINATION AND CAPACITY.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), acting through the 
Commissioner of Food and Drugs, shall coordinate with the Secretary of 
Homeland Security to carry out activities related to customs and border 
protection and in response to illegal controlled substances and drug 
imports, including at sites of import (such as international mail 
facilities), that will provide improvements to such facilities, 
technologies, and inspection capacity. Such Secretaries may carry out 
such activities through a memorandum of understanding between the Food 
and Drug Administration and the U.S. Customs and Border Protection.
    (b) FDA Import Facilities and Inspection Capacity.--
            (1) In general.--In carrying out this section, the 
        Secretary shall, in collaboration with the Secretary of 
        Homeland Security and the Postmaster General of the United 
        States Postal Service, provide that import facilities in which 
        the Food and Drug Administration operates or carries out 
        activities related to drug imports within the international 
        mail facilities include--
                    (A) facility upgrades and improved capacity in 
                order to increase and improve inspection and detection 
                capabilities, which may include, as the Secretary 
                determines appropriate--
                            (i) improvements to facilities, such as 
                        upgrades or renovations, and support for the 
                        maintenance of existing import facilities and 
                        sites to improve coordination between Federal 
                        agencies;
                            (ii) improvements in equipment and 
                        information technology enhancement to identify 
                        unapproved, counterfeit, or other unlawful 
                        controlled substances for destruction;
                            (iii) the construction of, or upgrades to, 
                        laboratory capacity for purposes of detection 
                        and testing of imported goods;
                            (iv) upgrades to the security of import 
                        facilities; and
                            (v) innovative technology and equipment to 
                        facilitate improved and near-real-time 
                        information sharing between the Food and Drug 
                        Administration, the Department of Homeland 
                        Security, and the United States Postal Service; 
                        and
                    (B) innovative technology, including controlled 
                substance detection and testing equipment and other 
                applicable technology, in order to collaborate with the 
                U.S. Customs and Border Protection to share near-real-
                time information, including information about test 
                results, as appropriate.
            (2) Innovative technology.--Any technology used in 
        accordance with paragraph (1)(B) shall be interoperable with 
        technology used by other relevant Federal agencies, including 
        the U.S. Customs and Border Protection, as the Secretary 
        determines appropriate and practicable.
    (c) Report.--Not later than 6 months after the date of enactment of 
this Act, the Secretary, in consultation with the Secretary of Homeland 
Security and the Postmaster General of the United States Postal 
Service, shall report to the Committee on Energy and Commerce and the 
Committee on Homeland Security of the House of Representatives and the 
Committee on Health, Education, Labor, and Pensions and the Committee 
on Homeland Security and Governmental Affairs of the Senate on the 
implementation of this section, including a summary of progress made 
toward near-real-time information sharing and the interoperability of 
such technologies.

                CHAPTER 3--STOP ILLICIT DRUG IMPORTATION

SEC. 3021. SHORT TITLE.

    This chapter may be cited as the ``Stop Illicit Drug Importation 
Act of 2018''.

SEC. 3022. RESTRICTING ENTRANCE OF ILLICIT DRUGS.

    (a) Food and Drug Administration and U.S. Customs and Border 
Protection Cooperation.--
            (1) In general.--The Secretary of Health and Human Services 
        (referred to in this section as the ``Secretary''), acting 
        through the Commissioner of Food and Drugs and in consultation 
        with the U.S. Customs and Border Protection, shall develop and 
        periodically update a mutually agreed upon list of the 
        controlled substances that the Secretary will refer to U.S. 
        Customs and Border Protection, unless the Secretary and U.S. 
        Customs and Border Protection agree otherwise, when such 
        substances are offered for import via international mail and 
        appear to violate the Controlled Substances Act (21 U.S.C. 801 
        et seq.), the Controlled Substances Import and Export Act (21 
        U.S.C. 951 et seq.), the Federal Food, Drug, and Cosmetic Act 
        (21 U.S.C. 301 et seq.), or any other applicable law. The 
        Secretary shall transfer controlled substances on such list to 
        the U.S. Customs and Border Protection. If the Secretary 
        identifies additional packages that appear to be the same as 
        such package containing a controlled substance, such additional 
        packages may also be transferred to U.S. Customs and Border 
        Protection. The U.S. Customs and Border Protection shall 
        receive such packages consistent with the requirements of the 
        Controlled Substances Act (21 U.S.C. 801 et seq.).
            (2) Report.--Not later than 9 months after the date of 
        enactment of this Act, the Secretary, acting through the 
        Commissioner of Food and Drugs and in consultation with the 
        Secretary of Homeland Security, shall report to the Committee 
        on Energy and Commerce of the House of Representatives and the 
        Committee on Health, Education, Labor, and Pensions of the 
        Senate on the implementation of this section.
    (b) Debarment, Temporary Denial of Approval, and Suspension.--
            (1) Prohibited act.--Section 301(cc) of the Federal Food, 
        Drug, and Cosmetic Act (21 U.S.C. 331(cc)) is amended--
                    (A) by inserting ``or a drug'' after ``food''; and
                    (B) by inserting ``from such activity'' after 
                ``person debarred''.
            (2) Debarment.--Section 306(b) of the Federal Food, Drug, 
        and Cosmetic Act (21 U.S.C. 335a(b)) is amended--
                    (A) in paragraph (1)--
                            (i) in the matter preceding subparagraph 
                        (A), by inserting ``or (3)'' after ``paragraph 
                        (2)'';
                            (ii) in subparagraph (A), by striking the 
                        comma at the end and inserting a semicolon;
                            (iii) in subparagraph (B), by striking ``, 
                        or'' and inserting a semicolon;
                            (iv) in subparagraph (C), by striking the 
                        period and inserting ``; or''; and
                            (v) by adding at the end the following:
                    ``(D) a person from importing or offering for 
                import into the United States a drug.'';
                    (B) in paragraph (3)--
                            (i) in the heading, by inserting ``or 
                        drug'' after ``Food'';
                            (ii) in subparagraph (A), by striking ``; 
                        or'' and inserting a semicolon;
                            (iii) in subparagraph (B), by striking the 
                        period and inserting a semicolon; and
                            (iv) by adding at the end the following:
                    ``(C) 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);
                    ``(D) the person has engaged in a pattern of 
                importing or offering for import--
                            ``(i) controlled substances that are 
                        prohibited from importation under section 
                        401(m) of the Tariff Act of 1930 (19 U.S.C. 
                        1401(m)); or
                            ``(ii) adulterated or misbranded drugs that 
                        are--
                                    ``(I) not designated in an 
                                authorized electronic data interchange 
                                system as a product that is regulated 
                                by the Secretary; or
                                    ``(II) knowingly or intentionally 
                                falsely designated in an authorized 
                                electronic data interchange system as a 
                                product that is regulated by the 
                                Secretary.''; and
                    (C) by adding at the end the following:
            ``(5) Definition.--For purposes of paragraph (3)(D), the 
        term `pattern of importing or offering for import' means 
        importing or offering for import a drug described in clause (i) 
        or (ii) of paragraph (3)(D) in an amount, frequency, or dosage 
        that is inconsistent with personal or household use by the 
        importer.''.
    (c) Imports and Exports.--Section 801(a) of the Federal Food, Drug, 
and Cosmetic Act (21 U.S.C. 381(a)), as amended, is further amended--
            (1) by striking ``, then such article shall be refused 
        admission'' inserting ``or (5) such article is being imported 
        or offered for import in violation of section 301(cc), then any 
        such article described in any of clauses (1) through (5) shall 
        be refused admission'';
            (2) by inserting ``If it appears from the examination of 
        such samples or otherwise that the article is a counterfeit 
        drug, such article shall be refused admission.'' before ``With 
        respect to an article of food, if importation''; and
            (3) by striking ``Clause (2) of the third sentence'' and 
        all that follows through the period at the end and inserting 
        the following: ``Neither clause (2) nor clause (5) of the third 
        sentence of this subsection shall be construed to prohibit the 
        admission of narcotic drugs, the importation of which is 
        permitted under the Controlled Substances Import and Export 
        Act.''.
    (d) Certain Illicit Articles.--Section 801 of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 381), as amended, is amended by 
adding at the end the following--
    ``(u) Illicit Articles Containing Active Pharmaceutical 
Ingredients.--
            ``(1) In general.--For purposes of this section, an article 
        that is being imported or offered for import into the United 
        States may be treated by the Secretary as a drug if the 
        article--
                    ``(A) is not--
                            ``(i) accompanied by an electronic import 
                        entry for such article submitted using an 
                        authorized electronic data interchange system; 
                        and
                            ``(ii) designated in such a system as an 
                        article regulated by the Secretary (which may 
                        include regulation as a drug, a device, a 
                        dietary supplement, or other product that is 
                        regulated under this Act); and
                    ``(B) is an ingredient that presents significant 
                public health concern and is, or contains--
                            ``(i) an active ingredient in a drug--
                                    ``(I) that is approved under 
                                section 505 or licensed under section 
                                351 of the Public Health Service Act; 
                                or
                                    ``(II) for which--
                                            ``(aa) an investigational 
                                        use exemption has been 
                                        authorized under section 505(i) 
                                        of this Act or section 351(a) 
                                        of the Public Health Service 
                                        Act; and
                                            ``(bb) a substantial 
                                        clinical investigation has been 
                                        instituted, and such 
                                        investigation has been made 
                                        public; or
                            ``(ii) 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 
                        subclause (I) or (II) of clause (i).
            ``(2) Effect.--This subsection shall not be construed to 
        bear upon any determination of whether an article is a drug 
        within the meaning of section 201(g), other than for the 
        purposes described in paragraph (1).''.

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

SEC. 3031. SHORT TITLE.

    This chapter may be cited as the ``Securing Opioids and Unused 
Narcotics with Deliberate Disposal and Packaging Act of 2018'' or the 
``SOUND Disposal and Packaging Act''.

SEC. 3032. SAFETY-ENHANCING PACKAGING AND DISPOSAL FEATURES.

     (a) Deliberate Disposal and Packaging Elements of Strategy.--
Section 505-1(e) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
355-1(e)) is amended by adding at the end the following:
            ``(4) Packaging and disposal.--The Secretary may require a 
        risk evaluation mitigation strategy for a drug for which there 
        is a serious risk of an adverse drug experience described in 
        subparagraph (B) or (C) of subsection (b)(1), taking into 
        consideration the factors described in subparagraphs (C) and 
        (D) of subsection (f)(2) and in consultation with other 
        relevant Federal agencies with authorities over drug disposal 
        packaging, which may include requiring that--
                    ``(A) the drug be made available for dispensing to 
                certain patients in unit dose packaging, packaging that 
                provides a set duration, or another packaging system 
                that the Secretary determines may mitigate such serious 
                risk; or
                    ``(B) the drug be dispensed to certain patients 
                with a safe disposal packaging or safe disposal system 
                for purposes of rendering drugs nonretrievable (as 
                defined in section 1300.05 of title 21, Code of Federal 
                Regulations (or any successor regulation)) if the 
                Secretary determines that such safe disposal packaging 
                or system may mitigate such serious risk and is 
                sufficiently available.''.
    (b) Assuring Access and Minimizing Burden.--Section 505-1(f)(2)(C) 
of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355-1(f)(2)(C)) 
is amended--
            (1) in clause (i) by striking ``and'' at the end; and
            (2) by adding at the end the following:
                            ``(iii) patients with functional 
                        limitations; and''.
    (c) Application to Abbreviated New Drug Applications.--Section 505-
1(i) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355-1(i)) 
is amended--
            (1) in paragraph (1)--
                    (A) by redesignating subparagraph (B) as 
                subparagraph (C); and
                    (B) inserting after subparagraph (A) the following:
                    ``(B) A packaging or disposal requirement, if 
                required under subsection (e)(4) for the applicable 
                listed drug.''; and
            (2) in paragraph (2)--
                    (A) in subparagraph (A), by striking ``and'' at the 
                end;
                    (B) by redesignating subparagraph (B) as 
                subparagraph (C); and
                    (C) by inserting after subparagraph (A) the 
                following:
                    ``(B) shall permit packaging systems and safe 
                disposal packaging or safe disposal systems that are 
                different from those required for the applicable listed 
                drug under subsection (e)(4); and''.
    (d) GAO Report.--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 Congress a report containing--
            (1) a description of available evidence, if any, on the 
        effectiveness of site-of-use, in-home controlled substance 
        disposal products and packaging technologies;
            (2) an evaluation of existing reference standards with 
        respect to controlled substance disposal products and packaging 
        technologies, including any such standards established by a 
        standards development organization, and how such standards 
        should be considered in ensuring effectiveness of such products 
        and technologies;
            (3) 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 
        (21 U.S.C. 801 et seq.), are made available to the public and 
        any barriers to the use of such disposal products;
            (4) identification of ways in which packaging technologies 
        are made available to the public and any barriers to the use of 
        such technologies;
            (5) a description of current Federal oversight, if any, of 
        site-of-use, in-home controlled substance disposal products, 
        including--
                    (A) identification of the Federal agencies that 
                oversee such products;
                    (B) identification of the methods of disposal of 
                controlled substances recommended by such agencies for 
                site-of-use, in-home disposal; and
                    (C) a description of the effectiveness of such 
                recommendations at preventing the diversion of legally 
                prescribed controlled substances;
            (6) a description of current Federal oversight, if any, of 
        controlled substance packaging technologies, including--
                    (A) identification of the Federal agencies that 
                oversee such technologies;
                    (B) identification of the technologies recommended 
                by such agencies, including unit dose packaging, 
                packaging that provides a set duration, and other 
                packaging systems that may mitigate abuse or misuse; 
                and
                    (C) a description of the effectiveness of such 
                recommendations at preventing the diversion of legally 
                prescribed controlled substances; and
            (7) recommendations, as appropriate, on--
                    (A) whether site-of-use, in-home controlled 
                substance disposal products and packaging technologies 
                require Federal oversight and, if so, which agency or 
                agencies should be responsible for such oversight and, 
                as applicable, review of such products or technologies; 
                and
                    (B) whether there are applicable standards that 
                should be considered to ensure the effectiveness of 
                such products.

               CHAPTER 5--POSTAPPROVAL STUDY REQUIREMENTS

SEC. 3041. CLARIFYING FDA POSTMARKET AUTHORITIES.

    (a) Definition of Adverse Drug Experience.--Section 505-1(b)(1)(E) 
of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355-1(b)(1)(E)) 
is amended by striking ``of the drug'' and inserting ``of the drug, 
which may include reduced effectiveness under the conditions of use 
prescribed in the labeling of such drug, but which may not include 
reduced effectiveness that is in accordance with such labeling''.
    (b) Safety Labeling Changes.--Section 505(o)(4) of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 355(o)(4)) is amended--
            (1) in subparagraph (A) by--
                    (A) striking ``Safety information'' and inserting 
                ``Safety or new effectiveness information''; and
                    (B) by striking ``If the Secretary becomes'' and 
                all that follows through ``in the labeling of the 
                drug'' and inserting ``If the Secretary becomes aware 
                of new information, including any new safety 
                information or information related to reduced 
                effectiveness, that the Secretary determines should be 
                included in the labeling of the drug'';
            (2) in clause (i) of subparagraph (B), by inserting before 
        the semicolon ``, or new effectiveness information'';
            (3) in subparagraph (C) by striking ``safety information'' 
        and inserting ``safety or new effectiveness information''; and
            (4) in subparagraph (E) by striking ``safety information'' 
        and inserting ``safety or new effectiveness information''.
    (c) Guidance.--Not less than one year after the date of enactment 
of this Act, the Secretary of Health and Human Services shall issue 
guidance regarding the circumstances under which the Food and Drug 
Administration may require postmarket studies or clinical trials to 
assess the potential reduction in effectiveness of a drug and how such 
reduction in effectiveness could result in a change to the benefits of 
the drug and the risks to the patient. Such guidance shall also address 
how the Food and Drug Administration may apply this section and the 
amendments made thereby with respect to circumstances under which the 
Food and Drug Administration may require postmarket studies or clinical 
trials and safety labeling changes related to the use of controlled 
substances for acute or chronic pain.

              Subtitle B--Controlled Substance Provisions

    CHAPTER 1--MORE FLEXIBILITY WITH RESPECT TO MEDICATION-ASSISTED 
                   TREATMENT FOR OPIOID USE DISORDERS

SEC. 3201. ALLOWING FOR MORE FLEXIBILITY WITH RESPECT TO MEDICATION-
              ASSISTED TREATMENT FOR OPIOID USE DISORDERS.

    (a) Conforming Applicable Number.--Subclause (II) of section 
303(g)(2)(B)(iii) of the Controlled Substances Act (21 U.S.C. 
823(g)(2)(B)(iii)) is amended to read as follows:
            ``(II) The applicable number is--
                    ``(aa) 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;
                    ``(bb) 100 if the practitioner holds additional 
                credentialing, as defined in section 8.2 of title 42, 
                Code of Federal Regulations (or successor regulations);
                    ``(cc) 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)); or
                    ``(dd) 275 if the practitioner meets the 
                requirements specified in sections 8.610 through 8.655 
                of title 42, Code of Federal Regulations (or successor 
                regulations).''.
    (b) Eliminating Any Time Limitation for Nurse Practitioners and 
Physician Assistants To Become Qualifying Practitioners.--Clause (iii) 
of section 303(g)(2)(G) of the Controlled Substances Act (21 U.S.C. 
823(g)(2)(G)) is amended--
            (1) in subclause (I), by striking ``or'' at the end; and
            (2) by amending subclause (II) to read as follows:
                    ``(II) a qualifying other practitioner, as defined 
                in clause (iv), who is a nurse practitioner or 
                physician assistant; or''.
    (c) Imposing a Time Limitation for Clinical Nurse Specialists, 
Certified Registered Nurse Anesthetists, and Certified Nurse Midwifes 
To Become Qualifying Practitioners.--Clause (iii) of section 
303(g)(2)(G) of the Controlled Substances Act (21 U.S.C. 823(g)(2)(G)), 
as amended by subsection (b), is further amended by adding at the end 
the following:
                    ``(III) 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.''.
    (d) Definition of Qualifying Other Practitioner.--Section 
303(g)(2)(G)(iv) of the Controlled Substances Act (21 U.S.C. 
823(g)(2)(G)(iv)) is amended by striking ``nurse practitioner or 
physician assistant'' each place it appears and inserting ``nurse 
practitioner, clinical nurse specialist, certified registered nurse 
anesthetist, certified nurse midwife, or physician assistant''.
    (e) Report by Secretary.--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 (21 U.S.C. 823(g)(2)(G)(iii))) 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--
            (1) the average frequency with which qualifying 
        practitioners see their patients;
            (2) 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;
            (3) the frequency of toxicology testing, including the 
        average frequency with which random toxicology testing is 
        administered;
            (4) the average monthly patient caseload for each type of 
        qualifying practitioner;
            (5) the treatment retention rates for patients;
            (6) overdose and mortality rates; and
            (7) any available information regarding the diversion of 
        drugs by patients receiving such treatment from such a 
        qualifying practitioner.

SEC. 3202. MEDICATION-ASSISTED TREATMENT FOR RECOVERY FROM SUBSTANCE 
              USE DISORDER.

    (a) Waivers for Maintenance Treatment or Detoxification.--Section 
303(g)(2)(G)(ii) of the Controlled Substances Act (21 U.S.C. 
823(g)(2)(G)(ii)) is amended by adding at the end the following:
            ``(VIII) The physician graduated in good standing from an 
        accredited school of allopathic medicine or osteopathic 
        medicine in the United States during the 5-year period 
        immediately preceding the date on which the physician submits 
        to the Secretary a written notification under subparagraph (B) 
        and successfully completed a comprehensive allopathic or 
        osteopathic medicine curriculum or accredited medical residency 
        that--
                    ``(aa) included not less than 8 hours of training 
                on treating and managing opioid-dependent patients; and
                    ``(bb) included, at a minimum--
                            ``(AA) the training described in items (aa) 
                        through (gg) of subclause (IV); and
                            ``(BB) training with respect to any other 
                        best practice the Secretary determines should 
                        be included in the curriculum, which may 
                        include training on pain management, including 
                        assessment and appropriate use of opioid and 
                        non-opioid alternatives.''.
    (b) Treatment for Children.--The Secretary of Health and Human 
Services shall consider ways to ensure that an adequate number of 
qualified practitioners, as defined in subparagraph (G)(ii) of section 
303(g)(2) of the Controlled Substances Act (21 U.S.C. 823(g)(2)), who 
have a specialty in pediatrics or the treatment of children or 
adolescents, are granted a waiver under such section 303(g)(2) to treat 
children and adolescents with substance use disorders.
    (c) Technical Amendment.--Section 102(24) of the Controlled 
Substances Act (21 U.S.C. 802(24)) is amended by striking ``Health, 
Education, and Welfare'' and inserting ``Health and Human Services''.

SEC. 3203. GRANTS TO ENHANCE ACCESS TO SUBSTANCE USE DISORDER 
              TREATMENT.

    (a) In General.--The Secretary of Health and Human Services shall 
establish a grant program under which the Secretary may make grants to 
accredited schools of allopathic medicine or osteopathic medicine and 
teaching hospitals located in the United States to support the 
development of curricula that meet the requirements under subclause 
(VIII) of section 303(g)(2)(G)(ii) of the Controlled Substances Act, as 
added by section 3202(a) of this Act.
    (b) Authorization of Appropriations.--There is authorized to be 
appropriated, for grants under subsection (a), $4,000,000 for each of 
fiscal years 2019 through 2023.

SEC. 3204. DELIVERY OF A CONTROLLED SUBSTANCE BY A PHARMACY TO BE 
              ADMINISTERED BY INJECTION OR IMPLANTATION.

    (a) In General.--The Controlled Substances Act is amended by 
inserting after section 309 (21 U.S.C. 829) the following:

``delivery of a controlled substance by a pharmacy to an administering 
                              practitioner

    ``Sec. 309A.  (a) In General.--Notwithstanding section 102(10), a 
pharmacy may deliver a controlled substance to a practitioner in 
accordance with a prescription that meets the requirements of this 
title and the regulations issued by the Attorney General under this 
title, for the purpose of administering the controlled substance by the 
practitioner if--
            ``(1) the controlled substance is delivered by the pharmacy 
        to the prescribing practitioner or the practitioner 
        administering the controlled substance, as applicable, at the 
        location listed on the practitioner's certificate of 
        registration issued under this title;
            ``(2) the controlled substance is to be administered for 
        the purpose of maintenance or detoxification treatment under 
        section 303(g)(2) and--
                    ``(A) the practitioner who issued the prescription 
                is a qualifying practitioner authorized under, and 
                acting within the scope of that section; and
                    ``(B) the controlled substance is to be 
                administered by injection or implantation;
            ``(3) the pharmacy and the practitioner are authorized to 
        conduct the activities specified in this section under the law 
        of the State in which such activities take place;
            ``(4) the prescription is not issued to supply any 
        practitioner with a stock of controlled substances for the 
        purpose of general dispensing to patients;
            ``(5) except as provided in subsection (b), the controlled 
        substance is to be administered only to the patient named on 
        the prescription not later than 14 days after the date of 
        receipt of the controlled substance by the practitioner; and
            ``(6) notwithstanding any exceptions under section 307, the 
        prescribing practitioner, and the practitioner administering 
        the controlled substance, as applicable, maintain complete and 
        accurate records of all controlled substances delivered, 
        received, administered, or otherwise disposed of under this 
        section, including the persons to whom controlled substances 
        were delivered and such other information as may be required by 
        regulations of the Attorney General.
    ``(b) Modification of Number of Days Before Which Controlled 
Substance Shall Be Administered.--
            ``(1) Initial 2-year period.--During the 2-year period 
        beginning on the date of enactment of this section, the 
        Attorney General, in coordination with the Secretary, may 
        reduce the number of days described in subsection (a)(5) if the 
        Attorney General determines that such reduction will--
                    ``(A) reduce the risk of diversion; or
                    ``(B) protect the public health.
            ``(2) Modifications after submission of report.--After the 
        date on which the report described in section 3204(b) of the 
        SUPPORT for Patients and Communities Act is submitted, the 
        Attorney General, in coordination with the Secretary, may 
        modify the number of days described in subsection (a)(5).
            ``(3) Minimum number of days.--Any modification under this 
        subsection shall be for a period of not less than 7 days.''.
    (b) Study and Report.--Not later than 2 years after the date of 
enactment of this section, the Comptroller General of the United States 
shall conduct a study and submit to Congress a report on access to and 
potential diversion of controlled substances administered by injection 
or implantation.
    (c) Technical and Conforming Amendment.--The table of contents for 
the Comprehensive Drug Abuse Prevention and Control Act of 1970 is 
amended by inserting after the item relating to section 309 the 
following:

``Sec. 309A. Delivery of a controlled substance by a pharmacy to an 
                            administering practitioner.''.

  CHAPTER 2--EMPOWERING PHARMACISTS IN THE FIGHT AGAINST OPIOID ABUSE

SEC. 3211. SHORT TITLE.

    This chapter may be cited as the ``Empowering Pharmacists in the 
Fight Against Opioid Abuse Act''.

SEC. 3212. PROGRAMS AND MATERIALS FOR TRAINING ON CERTAIN CIRCUMSTANCES 
              UNDER WHICH A PHARMACIST MAY DECLINE TO FILL A 
              PRESCRIPTION.

    (a) In General.--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, Commissioner of Food and Drugs, Director of the Centers 
for Disease Control and Prevention, and Assistant Secretary for Mental 
Health and Substance Use, shall develop and disseminate, as 
appropriate, materials for pharmacists, health care providers, and 
patients on--
            (1) circumstances under which a pharmacist may, consistent 
        with section 309 of the Controlled Substances Act (21 U.S.C. 
        829) 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 of 
        doubtful, questionable, or suspicious origin; and
            (2) other Federal requirements pertaining to declining to 
        fill a prescription under such circumstances, including the 
        partial fill of prescriptions for certain controlled 
        substances.
    (b) Materials Included.--In developing materials under subsection 
(a), the Secretary of Health and Human Services shall include 
information for--
            (1) pharmacists on how to decline to fill a prescription 
        and actions to take after declining to fill a prescription; and
            (2) other health care practitioners and the public on a 
        pharmacist's ability to decline to fill prescriptions in 
        certain circumstances and a description of those circumstances 
        (as described in the materials developed under subsection 
        (a)(1)).
    (c) Stakeholder Input.--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, including individuals with 
chronic pain.

             CHAPTER 3--SAFE DISPOSAL OF UNUSED MEDICATION

SEC. 3221. SHORT TITLE.

    This chapter may be cited as the ``Safe Disposal of Unused 
Medication Act''.

SEC. 3222. DISPOSAL OF CONTROLLED SUBSTANCES OF A HOSPICE PATIENT BY 
              EMPLOYEES OF A QUALIFIED HOSPICE PROGRAM.

    (a) In General.--Subsection (g) of section 302 of the Controlled 
Substances Act (21 U.S.C. 822) is amended by adding at the end the 
following:
    ``(5)(A) 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 so long as such disposal occurs onsite in accordance with all 
applicable Federal, State, Tribal, and local law and--
            ``(i) the disposal occurs after the death of a person 
        receiving hospice care;
            ``(ii) the controlled substance is expired; or
            ``(iii)(I) the employee is--
                            ``(aa) the physician of the person 
                        receiving hospice care; and
                            ``(bb) registered under section 303(f); and
                    ``(II) the hospice patient no longer requires the 
                controlled substance because the plan of care of the 
                hospice patient has been modified.
    ``(B) For the purposes of this paragraph:
            ``(i) The terms `hospice care' and `hospice program' have 
        the meanings given to those terms in section 1861(dd) of the 
        Social Security Act.
            ``(ii) The term `employee of a qualified hospice program' 
        means a physician, physician assistant, nurse, or other person 
        who--
                    ``(I) is employed by, or pursuant to arrangements 
                made by, a qualified hospice program;
                    ``(II)(aa) is licensed to perform medical or 
                nursing services by the jurisdiction in which the 
                person receiving hospice care was located; and
                    ``(bb) is acting within the scope of such 
                employment in accordance with applicable State law; and
                    ``(III) 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.
            ``(iii) The term `qualified hospice program' means a 
        hospice program that--
                    ``(I) 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;
                    ``(II) at the time when the controlled substances 
                are first ordered--
                            ``(aa) provides a copy of the written 
                        policies and procedures to the patient or 
                        patient representative and family;
                            ``(bb) 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
                            ``(cc) documents in the patient's clinical 
                        record that the written policies and procedures 
                        were provided and discussed; and
                    ``(III) at the time following the disposal of the 
                controlled substances--
                            ``(aa) documents in the patient's clinical 
                        record the type of controlled substance, 
                        dosage, route of administration, and quantity 
                        so disposed; and
                            ``(bb) the time, date, and manner in which 
                        that disposal occurred.''.
    (b) Guidance.--The Attorney General may issue guidance to hospice 
programs (as defined in paragraph (5) of section 302(g) of the 
Controlled Substances Act (21 U.S.C. 822(g)), as added by subsection 
(a)) to assist the programs in satisfying the requirements under such 
paragraph (5).
    (c) Rule of Construction Relating to State and Local Law.--Nothing 
in this section or the amendments made by this section shall be 
construed to prevent a State or local government from imposing 
additional controls or restrictions relating to the regulation of the 
disposal of controlled substances in hospice care or hospice programs.

SEC. 3223. GAO STUDY AND REPORT ON HOSPICE SAFE DRUG MANAGEMENT.

    (a) Study.--
            (1) In general.--The Comptroller General of the United 
        States (in this section referred to as the ``Comptroller 
        General'') shall conduct a study on the requirements applicable 
        to, and challenges of, hospice programs with regard to the 
        management and disposal of controlled substances in the home of 
        an individual.
            (2) Contents.--In conducting the study under paragraph (1), 
        the Comptroller General shall include--
                    (A) an overview of any challenges encountered by 
                selected hospice programs regarding the disposal of 
                controlled substances, such as opioids, in a home 
                setting, including any key changes in policies, 
                procedures, or best practices for the disposal of 
                controlled substances over time; and
                    (B) a description of Federal requirements, 
                including requirements under the Medicare program, for 
                hospice programs regarding the disposal of controlled 
                substances in a home setting, and oversight of 
                compliance with those requirements.
    (b) Report.--Not later than 18 months after the date of enactment 
of this Act, the Comptroller General shall submit to Congress a report 
containing the results of the study conducted under subsection (a), 
together with recommendations, if any, for such legislation and 
administrative action as the Comptroller General determines 
appropriate.

     CHAPTER 4--SPECIAL REGISTRATION FOR TELEMEDICINE CLARIFICATION

SEC. 3231. SHORT TITLE.

    This chapter may be cited as the ``Special Registration for 
Telemedicine Clarification Act of 2018''.

SEC. 3232. REGULATIONS RELATING TO A SPECIAL REGISTRATION FOR 
              TELEMEDICINE.

    Section 311(h)(2) of the Controlled Substances Act (21 U.S.C. 
831(h)(2)) is amended to read as follows:
            ``(2) Regulations.--Not later than 1 year after the date of 
        enactment of the SUPPORT for Patients and Communities Act, in 
        consultation with the Secretary, the Attorney General shall 
        promulgate final regulations specifying--
                    ``(A) the limited circumstances in which a special 
                registration under this subsection may be issued; and
                    ``(B) the procedure for obtaining a special 
                registration under this subsection.''.

      CHAPTER 5--SYNTHETIC ABUSE AND LABELING OF TOXIC SUBSTANCES

SEC. 3241. CONTROLLED SUBSTANCE ANALOGUES.

    Section 203 of the Controlled Substances Act (21 U.S.C. 813) is 
amended--
            (1) by striking ``A controlled'' and inserting ``(a) In 
        General.--A controlled''; and
            (2) by adding at the end the following:
    ``(b) Determination.--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:
            ``(1) The marketing, advertising, and labeling of the 
        substance.
            ``(2) The known efficacy or usefulness of the substance for 
        the marketed, advertised, or labeled purpose.
            ``(3) 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.
            ``(4) The diversion of the substance from legitimate 
        channels and the clandestine importation, manufacture, or 
        distribution of the substance.
            ``(5) Whether the defendant knew or should have known the 
        substance was intended to be consumed by injection, inhalation, 
        ingestion, or any other immediate means.
            ``(6) Any controlled substance analogue that is 
        manufactured, formulated, sold, distributed, or marketed with 
        the intent to avoid the provisions of existing drug laws.
    ``(c) Limitation.--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.''.

              CHAPTER 6--ACCESS TO INCREASED DRUG DISPOSAL

SEC. 3251. SHORT TITLE.

    This chapter may be cited as the ``Access to Increased Drug 
Disposal Act of 2018''.

SEC. 3252. DEFINITIONS.

    In this chapter--
            (1) the term ``Attorney General'' means the Attorney 
        General, acting through the Assistant Attorney General for the 
        Office of Justice Programs;
            (2) the term ``authorized collector'' means a narcotic 
        treatment program, a hospital or clinic with an on-site 
        pharmacy, a retail pharmacy, or a reverse distributor, that is 
        authorized as a collector under section 1317.40 of title 21, 
        Code of Federal Regulations (or any successor regulation);
            (3) the term ``covered grant'' means a grant awarded under 
        section 3003; and
            (4) the term ``eligible collector'' means a person who is 
        eligible to be an authorized collector.

SEC. 3253. AUTHORITY TO MAKE GRANTS.

    The Attorney General shall award grants to States to enable the 
States to increase the participation of eligible collectors as 
authorized collectors.

SEC. 3254. APPLICATION.

    A State desiring a covered grant shall submit to the Attorney 
General an application that, at a minimum--
            (1) identifies the single State agency that oversees 
        pharmaceutical care and will be responsible for complying with 
        the requirements of the grant;
            (2) details a plan to increase participation rates of 
        eligible collectors as authorized collectors; and
            (3) describes how the State will select eligible collectors 
        to be served under the grant.

SEC. 3255. USE OF GRANT FUNDS.

    A State that receives a covered grant, and any subrecipient of the 
grant, may use the grant amounts only for the costs of installation, 
maintenance, training, purchasing, and disposal of controlled 
substances associated with the participation of eligible collectors as 
authorized collectors.

SEC. 3256. ELIGIBILITY FOR GRANT.

    The Attorney General shall award a covered grant to 5 States, not 
less than 3 of which shall be States in the lowest quartile of States 
based on the participation rate of eligible collectors as authorized 
collectors, as determined by the Attorney General.

SEC. 3257. DURATION OF GRANTS.

    The Attorney General shall determine the period of years for which 
a covered grant is made to a State.

SEC. 3258. ACCOUNTABILITY AND OVERSIGHT.

    A State that receives a covered grant shall submit to the Attorney 
General a report, at such time and in such manner as the Attorney 
General may reasonably require, that--
            (1) lists the ultimate recipients of the grant amounts;
            (2) describes the activities undertaken by the State using 
        the grant amounts; and
            (3) contains performance measures relating to the 
        effectiveness of the grant, including changes in the 
        participation rate of eligible collectors as authorized 
        collectors.

SEC. 3259. DURATION OF PROGRAM.

    The Attorney General may award covered grants for each of the first 
5 fiscal years beginning after the date of enactment of this Act.

SEC. 3260. AUTHORIZATION OF APPROPRIATIONS.

    There is authorized to be appropriated to the Attorney General such 
sums as may be necessary to carry out this chapter.

           CHAPTER 7--USING DATA TO PREVENT OPIOID DIVERSION

SEC. 3271. SHORT TITLE.

    This chapter may be cited as the ``Using Data To Prevent Opioid 
Diversion Act of 2018''.

SEC. 3272. PURPOSE.

    (a) In General.--The purpose of this chapter is to provide drug 
manufacturers and distributors with access to anonymized information 
through the Automated Reports and Consolidated Orders System to help 
drug manufacturers and distributors identify, report, and stop 
suspicious orders of opioids and reduce diversion rates.
    (b) Rule of Construction.--Nothing in this chapter should be 
construed to absolve a drug manufacturer, drug distributor, or other 
Drug Enforcement Administration registrant from the responsibility of 
the manufacturer, distributor, or other registrant to--
            (1) identify, stop, and report suspicious orders; or
            (2) maintain effective controls against diversion in 
        accordance with section 303 of the Controlled Substances Act 
        (21 U.S.C. 823) or any successor law or associated regulation.

SEC. 3273. AMENDMENTS.

    (a) Records and Reports of Registrants.--Section 307 of the 
Controlled Substances Act (21 U.S.C. 827) is amended--
            (1) by redesignating subsections (f), (g), and (h) as 
        subsections (g), (h), and (i), respectively;
            (2) by inserting after subsection (e) the following:
    ``(f)(1) The Attorney General shall, not less frequently than 
quarterly, make the following information available to manufacturer and 
distributor registrants through the Automated Reports and Consolidated 
Orders System, or any subsequent automated system developed by the Drug 
Enforcement Administration to monitor selected controlled substances:
            ``(A) The total number of distributor registrants that 
        distribute controlled substances to a pharmacy or practitioner 
        registrant, aggregated by the name and address of each pharmacy 
        and practitioner registrant.
            ``(B) The total quantity and type of opioids distributed, 
        listed by Administration Controlled Substances Code Number, to 
        each pharmacy and practitioner registrant described in 
        subparagraph (A).
    ``(2) The information required to be made available under paragraph 
(1) shall be made available not later than the 30th day of the first 
month following the quarter to which the information relates.
    ``(3)(A) All registered manufacturers and distributors shall be 
responsible for reviewing the information made available by the 
Attorney General under this subsection.
    ``(B) In determining whether to initiate proceedings under this 
title against a registered manufacturer or distributor based on the 
failure of the registrant to maintain effective controls against 
diversion or otherwise comply with the requirements of this title or 
the regulations issued thereunder, the Attorney General may take into 
account that the information made available under this subsection was 
available to the registrant.''; and
            (3) by inserting after subsection (i), as so redesignated, 
        the following:
    ``(j) All of the reports required under this section shall be 
provided in an electronic format.''.
    (b) Cooperative Arrangements.--Section 503 of the Controlled 
Substances Act (21 U.S.C. 873) is amended by striking subsection (c) 
and inserting the following:
    ``(c)(1) The Attorney General shall, once every 6 months, prepare 
and make available to regulatory, licensing, attorneys general, and law 
enforcement agencies of States a standardized report containing 
descriptive and analytic information on the actual distribution 
patterns, as gathered through the Automated Reports and Consolidated 
Orders System, or any subsequent automated system, pursuant to section 
307 and which includes detailed amounts, outliers, and trends of 
distributor and pharmacy registrants, in such States for the controlled 
substances contained in schedule II, which, in the discretion of the 
Attorney General, are determined to have the highest abuse.
    ``(2) If the Attorney General publishes the report described in 
paragraph (1) once every 6 months as required under paragraph (1), 
nothing in this subsection shall be construed to bring an action in any 
court to challenge the sufficiency of the information or to compel the 
Attorney General to produce any documents or reports referred to in 
this subsection.''.
    (c) Civil and Criminal Penalties.--Section 402 of the Controlled 
Substances Act (21 U.S.C. 842) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (15), by striking ``or'' at the 
                end;
                    (B) in paragraph (16), by striking the period at 
                the end and inserting ``; or''; and
                    (C) by inserting after paragraph (16) the 
                following:
            ``(17) in the case of a registered manufacturer or 
        distributor of opioids, to fail to review the most recent 
        information, directly related to the customers of the 
        manufacturer or distributor, made available by the Attorney 
        General in accordance with section 307(f).''; and
            (2) in subsection (c)--
                    (A) in paragraph (1), by striking subparagraph (B) 
                and inserting the following:
    ``(B)(i) Except as provided in clause (ii), in the case of a 
violation of paragraph (5), (10), or (17) of subsection (a), the civil 
penalty shall not exceed $10,000.
    ``(ii) In the case of a violation described in clause (i) committed 
by a registered manufacturer or distributor of opioids and related to 
the reporting of suspicious orders for opioids, failing to maintain 
effective controls against diversion of opioids, or failing to review 
the most recent information made available by the Attorney General in 
accordance with section 307(f), the penalty shall not exceed 
$100,000.''; and
                    (B) in paragraph (2)--
                            (i) in subparagraph (A), by inserting ``or 
                        (D)'' after ``subparagraph (B)''; and
                            (ii) by adding at the end the following:
    ``(D) In the case of a violation described in subparagraph (A) that 
was a violation of paragraph (5), (10), or (17) of subsection (a) 
committed by a registered manufacturer or distributor of opioids that 
relates to the reporting of suspicious orders for opioids, failing to 
maintain effective controls against diversion of opioids, or failing to 
review the most recent information made available by the Attorney 
General in accordance with section 307(f), the criminal fine under 
title 18, United States Code, shall not exceed $500,000.''.

SEC. 3274. REPORT.

    Not later than 1 year after the date of enactment of this Act, the 
Attorney General shall submit to Congress a report that provides 
information about how the Attorney General is using data in the 
Automation of Reports and Consolidated Orders System to identify and 
stop suspicious activity, including whether the Attorney General is 
looking at aggregate orders from individual pharmacies to multiple 
distributors that in total are suspicious, even if no individual order 
rises to the level of a suspicious order to a given distributor.

                     CHAPTER 8--OPIOID QUOTA REFORM

SEC. 3281. SHORT TITLE.

    This chapter may be cited as the ``Opioid Quota Reform Act''.

SEC. 3282. STRENGTHENING CONSIDERATIONS FOR DEA OPIOID QUOTAS.

    (a) In General.--Section 306 of the Controlled Substances Act (21 
U.S.C. 826) is amended--
            (1) in subsection (a)--
                    (A) by inserting ``(1)'' after ``(a)'';
                    (B) in the second sentence, by striking 
                ``Production'' and inserting ``Except as provided in 
                paragraph (2), production''; and
                    (C) by adding at the end the following:
    ``(2) The Attorney General may, if the Attorney General determines 
it will assist in avoiding the overproduction, shortages, or diversion 
of a controlled substance, establish an aggregate or individual 
production quota under this subsection, or a procurement quota 
established by the Attorney General by regulation, in terms of 
pharmaceutical dosage forms prepared from or containing the controlled 
substance.'';
            (2) in subsection (b), in the first sentence, by striking 
        ``production'' and inserting ``manufacturing'';
            (3) in subsection (c), by striking ``October'' and 
        inserting ``December''; and
            (4) by adding at the end the following:
    ``(i)(1)(A) In establishing any quota under this section, or any 
procurement quota established by the Attorney General by regulation, 
for fentanyl, oxycodone, hydrocodone, oxymorphone, or hydromorphone (in 
this subsection referred to as a `covered controlled substance'), the 
Attorney General shall estimate the amount of diversion of the covered 
controlled substance that occurs in the United States.
    ``(B) In estimating diversion under this paragraph, the Attorney 
General--
            ``(i) shall consider information the Attorney General, in 
        consultation with the Secretary of Health and Human Services, 
        determines reliable on rates of overdose deaths and abuse and 
        overall public health impact related to the covered controlled 
        substance in the United States; and
            ``(ii) may take into consideration whatever other sources 
        of information the Attorney General determines reliable.
    ``(C) After estimating the amount of diversion of a covered 
controlled substance, the Attorney General shall make appropriate quota 
reductions, as determined by the Attorney General, from the quota the 
Attorney General would have otherwise established had such diversion 
not been considered.
    ``(2)(A) For any year for which the approved aggregate production 
quota for a covered controlled substance is higher than the approved 
aggregate production quota for the covered controlled substance for the 
previous year, the Attorney General, in consultation with the Secretary 
of Health and Human Services, shall include in the final order an 
explanation of why the public health benefits of increasing the quota 
clearly outweigh the consequences of having an increased volume of the 
covered controlled substance available for sale, and potential 
diversion, in the United States.
    ``(B) Not later than 1 year after the date of enactment of this 
subsection, and every year thereafter, the Attorney General shall 
submit to the Committee on the Judiciary, the Committee on Health, 
Education, Labor, and Pensions, and the Committee on Appropriations of 
the Senate and the Committee on the Judiciary, the Committee on Energy 
and Commerce, and the Committee on Appropriations of the House of 
Representatives the following information with regard to each covered 
controlled substance:
            ``(i) An anonymized count of the total number of 
        manufacturers issued individual manufacturing quotas that year 
        for the covered controlled substance.
            ``(ii) An anonymized count of how many such manufacturers 
        were issued an approved manufacturing quota that was higher 
        than the quota issued to that manufacturer for the covered 
        controlled substance in the previous year.
    ``(3) Not later than 1 year after the date of enactment of this 
subsection, the Attorney General shall submit to Congress a report on 
how the Attorney General, when fixing and adjusting production and 
manufacturing quotas under this section for covered controlled 
substances, will--
            ``(A) take into consideration changes in the accepted 
        medical use of the covered controlled substances; and
            ``(B) work with the Secretary of Health and Human Services 
        on methods to appropriately and anonymously estimate the type 
        and amount of covered controlled substances that are submitted 
        for collection from approved drug collection receptacles, mail-
        back programs, and take-back events.''.
    (b) Conforming Change.--The Law Revision Counsel is directed to 
amend the heading for subsection (b) of section 826 of title 21, United 
States Code, by striking ``Production'' and inserting 
``Manufacturing''.

                  CHAPTER 9--PREVENTING DRUG DIVERSION

SEC. 3291. SHORT TITLE.

    This chapter may be cited as the ``Preventing Drug Diversion Act of 
2018''.

SEC. 3292. IMPROVEMENTS TO PREVENT DRUG DIVERSION.

    (a) Definition.--Section 102 of the Controlled Substances Act (21 
U.S.C. 802) is amended by adding at the end the following:
            ``(57) The term `suspicious order' may include, but is not 
        limited to--
                    ``(A) an order of a controlled substance of unusual 
                size;
                    ``(B) an order of a controlled substance deviating 
                substantially from a normal pattern; and
                    ``(C) orders of controlled substances of unusual 
                frequency.''.
    (b) Suspicious Orders.--Part C of the Controlled Substances Act (21 
U.S.C. 821 et seq.) is amended by adding at the end the following:

``SEC. 312. SUSPICIOUS ORDERS.

    ``(a) Reporting.--Each registrant shall--
            ``(1) design and operate a system to identify suspicious 
        orders for the registrant;
            ``(2) ensure that the system designed and operated under 
        paragraph (1) by the registrant complies with applicable 
        Federal and State privacy laws; and
            ``(3) upon discovering a suspicious order or series of 
        orders, notify the Administrator of the Drug Enforcement 
        Administration and the Special Agent in Charge of the Division 
        Office of the Drug Enforcement Administration for the area in 
        which the registrant is located or conducts business.
    ``(b) Suspicious Order Database.--
            ``(1) In general.--Not later than 1 year after the date of 
        enactment of this section, the Attorney General shall establish 
        a centralized database for collecting reports of suspicious 
        orders.
            ``(2) Satisfaction of reporting requirements.--If a 
        registrant reports a suspicious order to the centralized 
        database established under paragraph (1), the registrant shall 
        be considered to have complied with the requirement under 
        subsection (a)(3) to notify the Administrator of the Drug 
        Enforcement Administration and the Special Agent in Charge of 
        the Division Office of the Drug Enforcement Administration for 
        the area in which the registrant is located or conducts 
        business.
    ``(c) Sharing Information With the States.--
            ``(1) In general.--The Attorney General shall prepare and 
        make available information regarding suspicious orders in a 
        State, including information in the database established under 
        subsection (b)(1), to the point of contact for purposes of 
        administrative, civil, and criminal oversight relating to the 
        diversion of controlled substances for the State, as designated 
        by the Governor or chief executive officer of the State.
            ``(2) Timing.--The Attorney General shall provide 
        information in accordance with paragraph (1) within a 
        reasonable period of time after obtaining the information.
            ``(3) Coordination.--In establishing the process for the 
        provision of information under this subsection, the Attorney 
        General shall coordinate with States to ensure that the 
        Attorney General has access to information, as permitted under 
        State law, possessed by the States relating to prescriptions 
        for controlled substances that will assist in enforcing Federal 
        law.''.
    (c) Reports to Congress.--
            (1) Definition.--In this subsection, the term ``suspicious 
        order'' has the meaning given that term in section 102 of the 
        Controlled Substances Act, as amended by this chapter.
            (2) One-time report.--Not later than 1 year after the date 
        of enactment of this Act, the Attorney General shall submit to 
        Congress a report on the reporting of suspicious orders, which 
        shall include--
                    (A) a description of the centralized database 
                established under section 312 of the Controlled 
                Substances Act, as added by this section, to collect 
                reports of suspicious orders;
                    (B) a description of the system and reports 
                established under section 312 of the Controlled 
                Substances Act, as added by this section, to share 
                information with States;
                    (C) information regarding how the Attorney General 
                used reports of suspicious orders before the date of 
                enactment of this Act and after the date of enactment 
                of this Act, including how the Attorney General 
                received the reports and what actions were taken in 
                response to the reports; and
                    (D) descriptions of the data analyses conducted on 
                reports of suspicious orders to identify, analyze, and 
                stop suspicious activity.
            (3) Additional reports.--Not later than 1 year after the 
        date of enactment of this Act, and annually thereafter until 
        the date that is 5 years after the date of enactment of this 
        Act, the Attorney General shall submit to Congress a report 
        providing, for the previous year--
                    (A) the number of reports of suspicious orders;
                    (B) a summary of actions taken in response to 
                reports, in the aggregate, of suspicious orders; and
                    (C) a description of the information shared with 
                States based on reports of suspicious orders.
            (4) One-time gao report.--Not later than 1 year after the 
        date of enactment of this Act, the Comptroller General of the 
        United States, in consultation with the Administrator of the 
        Drug Enforcement Administration, shall submit to Congress a 
        report on the reporting of suspicious orders, which shall 
        include an evaluation of the utility of real-time reporting of 
        potential suspicious orders of opioids on a national level 
        using computerized algorithms, including the extent to which 
        such algorithms--
                    (A) would help ensure that potentially suspicious 
                orders are more accurately captured, identified, and 
                reported in real time to suppliers before orders are 
                filled;
                    (B) may produce false positives of suspicious order 
                reports that could result in market disruptions for 
                legitimate orders of opioids; and
                    (C) would reduce the overall length of an 
                investigation that prevents the diversion of suspicious 
                orders of opioids.

                           TITLE IV--OFFSETS

SEC. 4001. PROMOTING VALUE IN MEDICAID MANAGED CARE.

    Section 1903(m) of the Social Security Act (42 U.S.C. 1396b(m)), as 
amended by sections 1013 and 1016, is further amended by adding at the 
end the following new paragraph:
    ``(9)(A) 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).
    ``(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).''.

SEC. 4002. REQUIRING REPORTING BY GROUP HEALTH PLANS OF PRESCRIPTION 
              DRUG COVERAGE INFORMATION FOR PURPOSES OF IDENTIFYING 
              PRIMARY PAYER SITUATIONS UNDER THE MEDICARE PROGRAM.

    Clause (i) of section 1862(b)(7)(A) of the Social Security Act (42 
U.S.C. 1395y(b)(7)(A)) is amended to read as follows:
                            ``(i) 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--
                                    ``(I) a primary plan to the program 
                                under this title; or
                                    ``(II) 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''.

SEC. 4003. ADDITIONAL RELIGIOUS EXEMPTION FROM HEALTH COVERAGE 
              RESPONSIBILITY REQUIREMENT.

    (a) In General.--Section 5000A(d)(2)(A) of the Internal Revenue 
Code of 1986 is amended to read as follows:
                    ``(A) Religious conscience exemptions.--
                            ``(i) In general.--Such term shall not 
                        include any individual for any month if such 
                        individual has in effect an exemption under 
                        section 1311(d)(4)(H) of the Patient Protection 
                        and Affordable Care Act which certifies that--
                                    ``(I) such individual is a member 
                                of a recognized religious sect or 
                                division thereof which is described in 
                                section 1402(g)(1), and is adherent of 
                                established tenets or teachings of such 
                                sect or division as described in such 
                                section; or
                                    ``(II) such individual is a member 
                                of a religious sect or division thereof 
                                which is not described in section 
                                1402(g)(1), who relies solely on a 
                                religious method of healing, and for 
                                whom the acceptance of medical health 
                                services would be inconsistent with the 
                                religious beliefs of the individual.
                            ``(ii) Special rules.--
                                    ``(I) Medical health services 
                                defined.--For purposes of this 
                                subparagraph, the term `medical health 
                                services' does not include routine 
                                dental, vision and hearing services, 
                                midwifery services, vaccinations, 
                                necessary medical services provided to 
                                children, services required by law or 
                                by a third party, and such other 
                                services as the Secretary of Health and 
                                Human Services may provide in 
                                implementing section 1311(d)(4)(H) of 
                                the Patient Protection and Affordable 
                                Care Act.
                                    ``(II) Attestation required.--
                                Clause (i)(II) shall apply to an 
                                individual for months in a taxable year 
                                only if the information provided by the 
                                individual under section 1411(b)(5)(A) 
                                of such Act includes an attestation 
                                that the individual has not received 
                                medical health services during the 
                                preceding taxable year.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to taxable years beginning after December 31, 2018.
    (c) Construction.--Nothing in the amendment made by subsection (a) 
shall preempt any State law requiring the provision of medical 
treatment for children, especially those who are seriously ill.

SEC. 4004. MODERNIZING THE REPORTING OF BIOLOGICAL AND BIOSIMILAR 
              PRODUCTS.

    Subtitle B of title XI of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Public Law 108-173) is 
amended--
            (1) in section 1111, as amended by section 3(1) of the 
        Patient Right to Know Drug Prices Act--
                    (A) in the paragraph (3) inserted by such section 
                3(1), by striking ``an application'' and inserting ``a 
                biosimilar biological product application'';
                    (B) in the paragraph (4) inserted by such section 
                3(1), by inserting ``application'' before ``under 
                section 351(k) of the Public Health Service Act'';
                    (C) in the paragraph (5) inserted by such section 
                3(1), by striking ``for licensure of a biological 
                product under section 351(k) of the Public Health 
                Service Act'' and inserting ``under section 351(k) of 
                the Public Health Service Act for licensure of a 
                biological product as biosimilar to, or interchangeable 
                with, a reference product'';
                    (D) in paragraph (7), as redesignated and amended 
                by such section 3(1), by striking ``or under section 
                351(a) of the Public Health Service Act'' and inserting 
                ``or the owner, or exclusive licensee, of a patent 
                included in a list provided under section 351(l)(3) of 
                the Public Health Service Act''; and
                    (E) in the paragraph (12) added by such section 
                3(1), by striking ``means a brand name drug for which a 
                license is in effect under section 351(a)'' and 
                inserting ``has the meaning given such term in section 
                351(i)''; and
            (2) in section 1112, as amended by section 3(2) of the 
        Patient Right to Know Drug Prices Act--
                    (A) in subsection (a)--
                            (i) in paragraph (1), by striking ``for 
                        which a statement under section 
                        351(l)(3)(B)(ii)(I) of the Public Health 
                        Service Act has been provided'';
                            (ii) in paragraph (2)--
                                    (I) in subparagraph (C)(i), by 
                                striking ``brand name'' and inserting 
                                ``listed''; and
                                    (II) by amending clause (ii) of 
                                subparagraph (C) to read as follows:
                            ``(ii) any of the time periods referred to 
                        in section 351(k)(6) of the Public Health 
                        Service Act as such period applies to such 
                        biosimilar biological product application or to 
                        any other biosimilar biological product 
                        application based on the same reference 
                        product.'';
                    (B) in subsection (b)--
                            (i) in the subsection heading, by inserting 
                        ``or Biosimilar Biological Product Applicant'' 
                        after ``Applicant'';
                            (ii) in paragraph (1)(B), by striking the 
                        first sentence and inserting the following: ``A 
                        biosimilar biological product applicant that 
                        has submitted a biosimilar biological product 
                        application that references a reference product 
                        and another biosimilar biological product 
                        applicant that has submitted a biosimilar 
                        biological product application that references 
                        the same reference product shall each file the 
                        agreement in accordance with subsection (c).''; 
                        and
                            (iii) in paragraph (2)--
                                    (I) by striking ``2 generic drug 
                                applicants'' and inserting ``2 or more 
                                generic drug applicants''; and
                                    (II) by striking ``or an agreement 
                                between 2 biosimilar biological product 
                                applicants regarding the 1-year period 
                                referred to in section 351(k)(6)(A) of 
                                the Public Health Service Act as it 
                                applies to the biosimilar biological 
                                product applications with which the 
                                agreement is concerned'' and inserting 
                                ``, an agreement between 2 or more 
                                biosimilar biological product 
                                applicants regarding a time period 
                                referred to in section 351(k)(6) of the 
                                Public Health Service Act as it applies 
                                to the biosimilar biological product, 
                                or an agreement between 2 or more 
                                biosimilar biological product 
                                applicants regarding the manufacture, 
                                marketing, or sale of a biosimilar 
                                biological product''; and
                    (C) in subsection (c)(2), by inserting ``were 
                entered into within 30 days of,'' after ``condition 
                for,''.

                   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.

    Section 1139B of the Social Security Act (42 U.S.C. 1320b-9b) is 
amended--
            (1) in subsection (b)--
                    (A) in paragraph (3)--
                            (i) by striking ``Not later than January 1, 
                        2013'' and inserting the following:
                    ``(A) Voluntary reporting.--Not later than January 
                1, 2013''; and
                            (ii) by adding at the end the following:
                    ``(B) Mandatory reporting with respect to 
                behavioral health measures.--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.''; and
                    (B) in paragraph (5), by adding at the end the 
                following new subparagraph:
                    ``(C) Behavioral health measures.--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.''; and
            (2) in subsection (d)(1)(A)--
                    (A) by striking ``the such plan'' and inserting 
                ``such plan''; and
                    (B) by striking ``subsection (a)(5)'' and inserting 
                ``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))''.

                Subtitle B--Medicaid IMD Additional Info

SEC. 5011. SHORT TITLE.

    This subtitle may be cited as the ``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'' or the ``Medicaid IMD 
ADDITIONAL INFO Act''.

SEC. 5012. MACPAC EXPLORATORY STUDY AND REPORT ON INSTITUTIONS FOR 
              MENTAL DISEASES REQUIREMENTS AND PRACTICES UNDER 
              MEDICAID.

    (a) In General.--Not later than January 1, 2020, the Medicaid and 
CHIP Payment and Access Commission established under section 1900 of 
the Social Security Act (42 U.S.C. 1396) 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 (42 U.S.C. 1396 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):
            (1) A description of such institutions for mental diseases 
        in each such State, including at a minimum--
                    (A) the number of such institutions in the State;
                    (B) the facility type of such institutions in the 
                State; and
                    (C) any coverage limitations under each such State 
                plan (or waiver) on scope, duration, or frequency of 
                such services.
            (2) With respect to each such institution for mental 
        diseases in each such State, a description of--
                    (A) such services provided at such institution;
                    (B) the process, including any timeframe, used by 
                such institution to clinically assess and reassess such 
                individuals; and
                    (C) the discharge process used by such institution, 
                including any care continuum of relevant services or 
                facilities provided or used in such process.
            (3) A description of--
                    (A) any Federal waiver that each such State has for 
                such institutions and the Federal statutory authority 
                for such waiver; and
                    (B) any other Medicaid funding sources used by each 
                such State for funding such institutions, such as 
                supplemental payments.
            (4) 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.
            (5) 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.
            (6) If determined appropriate by the Commission, 
        recommendations for policies and actions by Congress and the 
        Centers for Medicare & Medicaid Services, such as on 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.
    (b) Stakeholder Input.--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.
    (c) Definitions.--In this section:
            (1) Representative sample of states.--The term 
        ``representative sample of States'' means a non-probability 
        sample in which at least two States are selected based on the 
        knowledge and professional judgment of the selector.
            (2) State.--The term ``State'' means each of the 50 States, 
        the District of Columbia, and any commonwealth or territory of 
        the United States.
            (3) Institution for mental diseases.--The term 
        ``institution for mental diseases'' has the meaning given such 
        term in section 435.1010 of title 42, Code of Federal 
        Regulations, or any successor regulation.

    Subtitle C--CHIP Mental Health and Substance Use Disorder Parity

SEC. 5021. SHORT TITLE.

    This subtitle may be cited as the ``CHIP Mental Health and 
Substance Use Disorder Parity Act''.

SEC. 5022. ENSURING ACCESS TO MENTAL HEALTH AND SUBSTANCE USE DISORDER 
              SERVICES FOR CHILDREN AND PREGNANT WOMEN UNDER THE 
              CHILDREN'S HEALTH INSURANCE PROGRAM.

    (a) In General.--Section 2103(c)(1) of the Social Security Act (42 
U.S.C. 1397cc(c)(1)) is amended by adding at the end the following new 
subparagraph:
                    ``(E) Mental health and substance use disorder 
                services (as defined in paragraph (5)).''.
    (b) Mental Health and Substance Use Disorder Services.--
            (1) In general.--Section 2103(c) of the Social Security Act 
        (42 U.S.C. 1397cc(c)) is amended--
                    (A) by redesignating paragraphs (5), (6), (7), and 
                (8) as paragraphs (6), (7), (8), and (9), respectively; 
                and
                    (B) by inserting after paragraph (4) the following 
                new paragraph:
            ``(5) Mental health and substance use disorder services.--
        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 pregnant women (as defined 
        in section 2112(d)) shall--
                    ``(A) 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
                    ``(B) be delivered in a culturally and 
                linguistically appropriate manner.''.
            (2) Conforming amendments.--
                    (A) Section 2103(a) of the Social Security Act (42 
                U.S.C. 1397cc(a)) is amended, in the matter before 
                paragraph (1), by striking ``paragraphs (5), (6), and 
                (7)'' and inserting ``paragraphs (5), (6), (7), and 
                (8)''.
                    (B) Section 2110(a) of the Social Security Act (42 
                U.S.C. 1397jj(a)) is amended--
                            (i) in paragraph (18), by striking 
                        ``substance abuse'' each place it appears and 
                        inserting ``substance use''; and
                            (ii) in paragraph (19), by striking 
                        ``substance abuse'' and inserting ``substance 
                        use''.
                    (C) Section 2110(b)(5)(A)(i) of the Social Security 
                Act (42 U.S.C. 1397jj(b)(5)(A)(i)) is amended by 
                striking ``subsection (c)(5)'' and inserting 
                ``subsection (c)(6)''.
    (c) Assuring Access to Care.--Section 2102(a)(7)(B) of the Social 
Security Act (42 U.S.C. 1397bb(c)(2)) is amended by striking ``section 
2103(c)(5)'' and inserting ``paragraphs (5) and (6) of section 
2103(c)''.
    (d) Mental Health Services Parity.--Subparagraph (A) of paragraph 
(7) of section 2103(c) of the Social Security Act (42 U.S.C. 1397cc(c)) 
(as redesignated by subsection (b)(1)) is amended to read as follows:
                    ``(A) In general.--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.''.
    (e) Effective Date.--
            (1) In general.--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.
            (2) Exception for state legislation.--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.

                      Subtitle D--Medicaid Reentry

SEC. 5031. SHORT TITLE.

    This subtitle may be cited as the ``Medicaid Reentry Act''.

SEC. 5032. PROMOTING STATE INNOVATIONS TO EASE TRANSITIONS INTEGRATION 
              TO THE COMMUNITY FOR CERTAIN INDIVIDUALS.

    (a) Stakeholder Group Development of Best Practices; State Medicaid 
Program Innovation.--
            (1) Stakeholder group best practices.--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--
                    (A) 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
                    (B) 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.
            (2) State medicaid program innovation.--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.
    (b) Guidance on Innovative Service Delivery Systems Demonstration 
Project Opportunities.--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 (42 U.S.C. 1315) 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--
            (1) 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
            (2) providing health care services for such individuals 
        during such period.
    (c) Rule of Construction.--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.

                    Subtitle E--Medicaid Partnership

SEC. 5041. SHORT TITLE.

    This subtitle 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. 5042. MEDICAID PROVIDERS ARE REQUIRED TO NOTE EXPERIENCES IN 
              RECORD SYSTEMS TO HELP IN-NEED PATIENTS.

    (a) 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.--Subject to subsection (d), beginning October 1, 
2021, a State--
            ``(1) shall 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; and
            ``(2) in the case that such a provider is not able to 
        conduct such a check despite a good faith effort by such 
        provider--
                    ``(A) shall require the provider to document such 
                good faith effort, including the reasons why the 
                provider was not able to conduct the check; and
                    ``(B) may require the provider to submit, upon 
                request, such documentation to the State.
    ``(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.
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 that has a contract to manage the pharmaceutical 
benefit with respect to individuals enrolled in the State plan (or 
under a 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.
    ``(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 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)).
    ``(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 quantity of daily morphine 
                        milligram equivalents prescribed for controlled 
                        substances;
                            ``(ii) the number and quantity of daily 
                        morphine milligram equivalents prescribed for 
                        controlled substances 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 
                prescription drug monitoring program described in 
                subsection (b) before dispensing a controlled substance 
                to such individual.
                    ``(D) An accounting of any data or privacy breach 
                of a qualified prescription drug monitoring program 
                described in subsection (b), the number of covered 
                individuals impacted by each such breach, and a 
                description of the steps the State has taken to address 
                each such breach, including, to the extent required by 
                State or Federal law or otherwise determined 
                appropriate by the State, alerting any such impacted 
                individual and law enforcement of the breach.
            ``(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 FMAP and Federal Matching Rates for Certain 
Expenditures Relating to Qualified Prescription Drug Monitoring 
Programs.--
            ``(1) In general.--With respect to a State that meets the 
        condition described in paragraph (2) and any quarter occurring 
        during fiscal year 2019 or fiscal year 2020, the Federal 
        medical assistance percentage or Federal matching rate that 
        would otherwise apply to such State under section 1903(a) for 
        such quarter, with respect to expenditures by the State for 
        activities under the State plan (or a waiver of such plan) to 
        design, develop, or implement a prescription drug monitoring 
        program (and to make connections to such program) that 
        satisfies the criteria described in paragraphs (1) and (2) of 
        subsection (b), shall be equal to 100 percent.
            ``(2) Condition.--The condition described in this 
        paragraph, with respect to a State, is that the State (in this 
        paragraph 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 monitoring 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.
    ``(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 prescription drug monitoring 
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.''.
    (b) 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.
    (c) Development of Model State Practices.--
            (1) 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 the matter 
        following paragraph (2) of section 1944(b) of the Social 
        Security Act, as added by subsection (a), for the following 
        purposes:
                    (A) Monitoring and preventing fraud, waste, and 
                abuse.
                    (B) Improving health care for individuals enrolled 
                in a State plan under title XIX of such Act (or under a 
                waiver of such plan) who--
                            (i) transition in and out of coverage under 
                        such title;
                            (ii) may have sources of health care 
                        coverage in addition to coverage under such 
                        title; or
                            (iii) pay for prescription drugs with cash.
                    (C) Any other purposes specified by the Secretary.
            (2) Elements of model practices.--The model practices 
        described in paragraph (1)--
                    (A) 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
                    (B) shall include any appropriate beneficiary 
                protections and privacy guidelines.
            (3) Consultation.--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.
    (d) 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.

                        Subtitle F--IMD CARE Act

SEC. 5051. SHORT TITLE.

    This title may be cited as the ``Individuals in Medicaid Deserve 
Care that is Appropriate and Responsible in its Execution Act'' or the 
``IMD CARE Act''.

SEC. 5052. STATE OPTION TO PROVIDE MEDICAID COVERAGE FOR CERTAIN 
              INDIVIDUALS WITH SUBSTANCE USE DISORDERS WHO ARE PATIENTS 
              IN CERTAIN INSTITUTIONS FOR MENTAL DISEASES.

    (a) In General.--Title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.), as amended by preceding sections of this Act, is further 
amended--
            (1) in section 1905(a), in the subdivision (B) that follows 
        paragraph (30), by inserting ``(except in the case of services 
        provided under a State plan amendment described in section 
        1915(l))'' before the period; and
            (2) in section 1915, by adding at the end the following new 
        subsection:
    ``(l) State Plan Amendment Option to Provide Medical Assistance for 
Certain Individuals Who Are Patients in Certain Institutions for Mental 
Diseases.--
            ``(1) In general.--With respect to calendar quarters 
        beginning during the period beginning October 1, 2019, and 
        ending September 30, 2023, a State may elect, through a State 
        plan amendment, to provide medical assistance for items and 
        services furnished to an eligible individual who is a patient 
        in an eligible institution for mental diseases in accordance 
        with the requirements of this subsection.
            ``(2) Payments.--Subject to paragraphs (3) and (4), 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 who is a patient 
        in an eligible 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.
            ``(3) Maintenance of effort.--
                    ``(A) In general.--As a condition for a State 
                receiving payments under section 1903(a) for medical 
                assistance provided in accordance with this subsection, 
                the State shall (during the period in which it so 
                furnished such medical assistance through a State plan 
                amendment under this subsection) maintain on an annual 
                basis a level of funding expended by the State (and 
                political subdivisions thereof) other than under this 
                title from non-Federal funds for--
                            ``(i) items and services furnished to 
                        eligible individuals who are patients in 
                        eligible institutions for mental diseases that 
                        is not less than the level of such funding for 
                        such items and services for the most recently 
                        ended fiscal year as of the date of enactment 
                        of this subsection or, if higher, for the most 
                        recently ended fiscal year as of the date the 
                        State submits a State plan amendment to the 
                        Secretary to provide such medical assistance in 
                        accordance with this subsection; and
                            ``(ii) items and services (including 
                        services described in subparagraph (B)) 
                        furnished to eligible individuals in outpatient 
                        and community-based settings that is not less 
                        than the level of such funding for such items 
                        and services for the most recently ended fiscal 
                        year as of the date of enactment of this 
                        subsection or, if higher, for the most recently 
                        ended fiscal year as of the date the State 
                        submits a State plan amendment to the Secretary 
                        to provide such medical assistance in 
                        accordance with this subsection.
                    ``(B) Services described.--For purposes of 
                subparagraph (A)(ii), services described in this 
                subparagraph are the following:
                            ``(i) Outpatient and community-based 
                        substance use disorder treatment.
                            ``(ii) Evidence-based recovery and support 
                        services.
                            ``(iii) Clinically-directed therapeutic 
                        treatment to facilitate recovery skills, 
                        relapse prevention, and emotional coping 
                        strategies.
                            ``(iv) Outpatient medication-assisted 
                        treatment, related therapies, and pharmacology.
                            ``(v) Counseling and clinical monitoring.
                            ``(vi) Outpatient withdrawal management and 
                        related treatment designed to alleviate acute 
                        emotional, behavioral, cognitive, or biomedical 
                        distress resulting from, or occurring with, an 
                        individual's use of alcohol and other drugs.
                            ``(vii) Routine monitoring of medication 
                        adherence.
                            ``(viii) Other outpatient and community-
                        based services for the treatment of substance 
                        use disorders, as designated by the Secretary.
                    ``(C) State reporting requirement.--
                            ``(i) In general.--Prior to approval of a 
                        State plan amendment under this subsection, as 
                        a condition for a State receiving payments 
                        under section 1903(a) for medical assistance 
                        provided in accordance with this subsection, 
                        the State shall report to the Secretary, in 
                        accordance with the process established by the 
                        Secretary under clause (ii), the information 
                        deemed necessary by the Secretary under such 
                        clause.
                            ``(ii) Process.--Not later than the date 
                        that is 8 months after the date of enactment of 
                        this subsection, the Secretary shall establish 
                        a process for States to report to the 
                        Secretary, at such time and in such manner as 
                        the Secretary deems appropriate, such 
                        information as the Secretary deems necessary to 
                        verify a State's compliance with subparagraph 
                        (A).
            ``(4) Ensuring a continuum of services.--
                    ``(A) In general.--As a condition for a State 
                receiving payments under section 1903(a) for medical 
                assistance provided in accordance with this subsection, 
                the State shall carry out each of the requirements 
                described in subparagraphs (B) through (D).
                    ``(B) Notification.--Prior to approval of a State 
                plan amendment under this subsection, the State shall 
                notify the Secretary of how the State will ensure that 
                eligible individuals receive appropriate evidence-based 
                clinical screening prior to being furnished with items 
                and services in an eligible institution for mental 
                diseases, including initial and periodic assessments to 
                determine the appropriate level of care, length of 
                stay, and setting for such care for each individual.
                    ``(C) Outpatient services; inpatient and 
                residential services.--
                            ``(i) Outpatient services.--The State 
                        shall, at a minimum, provide medical assistance 
                        for services that could otherwise be covered 
                        under the State plan, consistent with each of 
                        the following outpatient levels of care:
                                    ``(I) Early intervention for 
                                individuals who, for a known reason, 
                                are at risk of developing substance-
                                related problems and for individuals 
                                for whom there is not yet sufficient 
                                information to document a diagnosable 
                                substance use disorder.
                                    ``(II) Outpatient services for less 
                                than 9 hours per week for adults, and 
                                for less than 6 hours per week for 
                                adolescents, for recovery or 
                                motivational enhancement therapies and 
                                strategies.
                                    ``(III) Intensive outpatient 
                                services for 9 hours or more per week 
                                for adults, and for 6 hours or more per 
                                week for adolescents, to treat 
                                multidimensional instability.
                                    ``(IV) Partial hospitalization 
                                services for 20 hours or more per week 
                                for adults and adolescents to treat 
                                multidimensional instability that does 
                                not require 24-hour care.
                            ``(ii) Inpatient and residential 
                        services.--The State shall provide medical 
                        assistance for services that could otherwise be 
                        covered under the State plan, consistent with 
                        at least 2 of the following inpatient and 
                        residential levels of care:
                                    ``(I) Clinically managed, low-
                                intensity residential services that 
                                provide adults and adolescents with 24-
                                hour living support and structure with 
                                trained personnel and at least 5 hours 
                                of clinical service per week per 
                                individual.
                                    ``(II) Clinically managed, 
                                population-specific, high-intensity 
                                residential services that provide 
                                adults with 24-hour care with trained 
                                counselors to stabilize 
                                multidimensional imminent danger along 
                                with less intense milieu and group 
                                treatment for those with cognitive or 
                                other impairments unable to use full 
                                active milieu or therapeutic community.
                                    ``(III) Clinically managed, medium-
                                intensity residential services for 
                                adolescents, and clinically managed, 
                                high-intensity residential services for 
                                adults, that provide 24-hour care with 
                                trained counselors to stabilize 
                                multidimensional imminent danger and 
                                preparation for outpatient treatment.
                                    ``(IV) Medically monitored, high-
                                intensity inpatient services for 
                                adolescents, and medically monitored, 
                                intensive inpatient services withdrawal 
                                management for adults, that provide 24-
                                hour nursing care, make physicians 
                                available for significant problems in 
                                Dimensions 1, 2, or 3, and provide 
                                counseling services 16 hours per day.
                                    ``(V) Medically managed, intensive 
                                inpatient services for adolescents and 
                                adults that provide 24-hour nursing 
                                care and daily physician care for 
                                severe, unstable problems in Dimensions 
                                1, 2 or 3.
                    ``(D) Transition of care.--In order to ensure an 
                appropriate transition for an eligible individual from 
                receiving care in an eligible institution for mental 
                diseases to receiving care at a lower level of clinical 
                intensity within the continuum of care (including 
                outpatient services), the State shall ensure that--
                            ``(i) a placement in such eligible 
                        institution for mental diseases would allow for 
                        an eligible individual's successful transition 
                        to the community, considering such factors as 
                        proximity to an individual's support network 
                        (such as family members, employment, and 
                        counseling and other services near an 
                        individual's residence); and
                            ``(ii) all eligible institutions for mental 
                        diseases that furnish items and services to 
                        individuals for which medical assistance is 
                        provided under the State plan--
                                    ``(I) are able to provide care at 
                                such lower level of clinical intensity; 
                                or
                                    ``(II) have an established 
                                relationship with another facility or 
                                provider that is able to provide care 
                                at such lower level of clinical 
                                intensity and accepts patients 
                                receiving medical assistance under this 
                                title under which the eligible 
                                institution for mental diseases may 
                                arrange for individuals to receive such 
                                care from such other facility or 
                                provider.
            ``(5) Application to managed care.--Payments for, and 
        limitations to, medical assistance furnished in accordance with 
        this subsection shall be in addition to and shall not be 
        construed to limit or supersede the ability of States to make 
        monthly capitation payments to managed care organizations for 
        individuals receiving treatment in institutions for mental 
        diseases in accordance with section 438.6(e) of title 42, Code 
        of Federal Regulations (or any successor regulation).
            ``(6) Other medical assistance.--The provision of medical 
        assistance for items and services furnished to an eligible 
        individual who is a patient in an eligible institution for 
        mental diseases in accordance with the requirements of this 
        subsection shall not prohibit Federal financial participation 
        for medical assistance for items or services that are provided 
        to such eligible individual in or away from the eligible 
        institution for mental disease during any period in which the 
        eligible individual is receiving items or services in 
        accordance with this subsection.
            ``(7) Definitions.--In this subsection:
                    ``(A) Dimensions 1, 2, or 3.--The term `Dimensions 
                1, 2, or 3' has the meaning given that term for 
                purposes of the publication of the American Society of 
                Addiction Medicine entitled `The ASAM Criteria: 
                Treatment Criteria for Addictive Substance-Related, and 
                Co-Occurring Conditions, 2013'.
                    ``(B) Eligible individual.--The term `eligible 
                individual' means an individual who--
                            ``(i) with respect to a State, is enrolled 
                        for medical assistance under the State plan or 
                        a waiver of such plan;
                            ``(ii) is at least 21 years of age;
                            ``(iii) has not attained 65 years of age; 
                        and
                            ``(iv) has at least 1 substance use 
                        disorder.
                    ``(C) Eligible institution for mental diseases.--
                The term `eligible institution for mental diseases' 
                means an institution for mental diseases that--
                            ``(i) follows reliable, evidence-based 
                        practices; and
                            ``(ii) offers at least 2 forms of 
                        medication-assisted treatment for substance use 
                        disorders on site, including, in the case of 
                        medication-assisted treatment for opioid use 
                        disorder, at least 1 antagonist and 1 partial 
                        agonist.
                    ``(D) Institution for mental diseases.--The term 
                `institution for mental diseases' has the meaning given 
                that term in section 1905(i).''.
    (b) Rule of Construction.--Nothing in the amendments made by 
subsection (a) shall be construed as encouraging a State to place an 
individual in an inpatient or a residential care setting where a home 
or community-based care setting would be more appropriate for the 
individual, or as preventing a State from conducting or pursuing a 
demonstration project under section 1115 of the Social Security Act to 
improve access to, and the quality of, substance use disorder treatment 
for eligible populations.

                 Subtitle G--Medicaid Improvement Fund

SEC. 5061. MEDICAID IMPROVEMENT FUND.

    Section 1941(b)(1) of the Social Security Act (42 U.S.C. 1396w-
1(b)(1)) is amended by striking ``$0'' and inserting ``$31,000,000''.

                  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.

    Section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 
1315a(b)(2)(B)) is amended by adding at the end the following new 
clause:
                            ``(xxv) 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))).''.

                   Subtitle B--Abuse Deterrent Access

SEC. 6011. SHORT TITLE.

    This subtitle may be cited at the ``Abuse Deterrent Access Act of 
2018''.

SEC. 6012. STUDY ON ABUSE-DETERRENT OPIOID FORMULATIONS ACCESS BARRIERS 
              UNDER MEDICARE.

    (a) In General.--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--
            (1) 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; and
            (2) the effectiveness of abuse-deterrent opioid 
        formulations in preventing opioid abuse or misuse; the impact 
        of the use of abuse-deterrent opioid formulations on the use or 
        abuse of other prescription or illicit opioids (including 
        changes in deaths from such opioids); and other public health 
        consequences of the use of abuse-deterrent opioid formulations, 
        such as an increase in rates of human immunodeficiency virus.
    (b) Definition of Abuse-Deterrent Opioid Formulation.--In this 
section, the term ``abuse-deterrent opioid formulation'' 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.

              Subtitle C--Medicare Opioid Safety Education

SEC. 6021. MEDICARE OPIOID SAFETY EDUCATION.

    (a) In General.--Section 1804 of the Social Security Act (42 U.S.C. 
1395b-2) is amended by adding at the end the following new subsection:
    ``(d) The notice provided under subsection (a) shall include--
            ``(1) references to educational resources regarding opioid 
        use and pain management;
            ``(2) a description of categories of alternative, non-
        opioid pain management treatments covered under this title; and
            ``(3) a suggestion for the beneficiary to talk to a 
        physician regarding opioid use and pain management.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to notices distributed prior to each Medicare open enrollment 
period beginning after January 1, 2019.

                Subtitle D--Opioid Addiction Action Plan

SEC. 6031. SHORT TITLE.

    This subtitle may be cited as the ``Opioid Addiction Action Plan 
Act''.

SEC. 6032. ACTION PLAN ON RECOMMENDATIONS FOR CHANGES UNDER MEDICARE 
              AND MEDICAID TO PREVENT OPIOIDS ADDICTIONS AND ENHANCE 
              ACCESS TO MEDICATION-ASSISTED TREATMENT.

    (a) In General.--Not later than January 1, 2020, the Secretary of 
Health and Human Services (in this section referred to as the 
``Secretary''), 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 (Public Law 114-198), 
shall develop an action plan as described in subsection (b).
    (b) Action Plan Components.--The action plan shall include a review 
by the Secretary of Medicare and Medicaid payment and coverage policies 
that may be viewed as potential obstacles to an effective response to 
the opioid crisis, and recommendations, as determined appropriate by 
the Secretary, on the following:
            (1) A review of payment and coverage policies under the 
        Medicare program under title XVIII of the Social Security Act 
        and the Medicaid program under title XIX of such Act, including 
        a review of coverage and payment under such programs of all 
        medication-assisted treatment approved by the Food and Drug 
        Administration related to the treatment of opioid use disorder 
        and other therapies that manage chronic and acute pain and 
        treat and minimize risk of opioid misuse and abuse, including 
        in such review, payment under the Medicare prospective payment 
        system for inpatient hospital services under section 1886(d) of 
        such Act (42 U.S.C. 1395ww(d)) and the Medicare prospective 
        payment system for hospital outpatient department services 
        under section 1833(t) of such Act (42 U.S.C. 1395I(t)), to 
        determine whether those payment policies resulted in incentives 
        or disincentives that have contributed to the opioid crisis.
            (2) Recommendations for payment and service delivery models 
        to be tested as appropriate 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 use disorder and other therapies that manage chronic 
        and acute pain and treat and minimize risk of opioid misuse and 
        abuse.
            (3) Recommendations for data collection that could 
        facilitate research and policy-making regarding prevention of 
        opioid use disorder as well as data that would aid the 
        Secretary in making coverage and payment decisions under the 
        Medicare and Medicaid programs related to the access to 
        appropriate opioid dependence treatments.
            (4) A review of Medicare and Medicaid beneficiaries' access 
        to the full range of medication-assisted treatment approved by 
        the Food and Drug Administration for the treatment of opioid 
        use disorder and other therapies that manage chronic and acute 
        pain and treat and minimize risk of opioid misuse and abuse, 
        including access of beneficiaries residing in rural or 
        medically underserved communities.
            (5) A review of payment and coverage policies under the 
        Medicare program and the Medicaid program related 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, including barriers to patient access.
    (c) Stakeholder Meetings.--
            (1) In general.--Beginning not later than 3 months after 
        the date of the enactment of this section, the Secretary shall 
        convene a public stakeholder meeting to solicit public comment 
        on the components of the action plan described in subsection 
        (b).
            (2) Participants.--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.
    (d) Request for Information.--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.
    (e) Report to Congress.--Not later than June 1, 2020, the Secretary 
shall submit to Congress, and make public, a report that includes--
            (1) a summary of the results of the Secretary's review and 
        any recommendations under the action plan;
            (2) the Secretary's planned next steps with respect to the 
        action plan; and
            (3) 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.
    (f) Definition of Medication-Assisted Treatment.--In this section, 
the term ``medication-assisted treatment'' includes opioid treatment 
programs, behavioral therapy, and medications to treat substance abuse 
disorder.

 Subtitle E--Advancing High Quality Treatment for Opioid Use Disorders 
                              in Medicare

SEC. 6041. SHORT TITLE.

    This subtitle may be cited as the ``Advancing High Quality 
Treatment for Opioid Use Disorders in Medicare Act''.

SEC. 6042. OPIOID USE DISORDER TREATMENT DEMONSTRATION PROGRAM.

    Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by inserting after section 1866E (42 U.S.C. 1395cc-5) the 
following new section:

``SEC. 1866F. OPIOID USE DISORDER TREATMENT DEMONSTRATION PROGRAM.

    ``(a) Implementation of 4-Year Demonstration Program.--
            ``(1) In general.--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 `Program') 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.
            ``(2) Opioid use disorder treatment services.--For purposes 
        of this section, the term `opioid use disorder treatment 
        services'--
                    ``(A) 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
                    ``(B) includes--
                            ``(i) medication-assisted treatment;
                            ``(ii) treatment planning;
                            ``(iii) psychiatric, psychological, or 
                        counseling services (or any combination of such 
                        services), as appropriate;
                            ``(iv) social support services, as 
                        appropriate; and
                            ``(v) care management and care coordination 
                        services, including coordination with other 
                        providers of services and suppliers not on an 
                        opioid use disorder care team.
    ``(b) Program Design.--
            ``(1) In general.--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:
                    ``(A) Reduces hospitalizations and emergency 
                department visits.
                    ``(B) Increases use of medication-assisted 
                treatment for opioid use disorders.
                    ``(C) Improves health outcomes of individuals with 
                opioid use disorders, including by reducing the 
                incidence of infectious diseases (such as hepatitis C 
                and HIV).
                    ``(D) Does not increase the total spending on items 
                and services under this title.
                    ``(E) Reduces deaths from opioid overdose.
                    ``(F) Reduces the utilization of inpatient 
                residential treatment.
            ``(2) Consultation.--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.
    ``(c) Participants; Opioid Use Disorder Care Teams.--
            ``(1) Participants.--
                    ``(A) Definition.--In this section, the term 
                `participant' means an entity or individual--
                            ``(i) that is otherwise enrolled under this 
                        title and that is--
                                    ``(I) a physician (as defined in 
                                section 1861(r)(1));
                                    ``(II) a group practice comprised 
                                of at least one physician described in 
                                subclause (I);
                                    ``(III) a hospital outpatient 
                                department;
                                    ``(IV) a federally qualified health 
                                center (as defined in section 
                                1861(aa)(4));
                                    ``(V) a rural health clinic (as 
                                defined in section 1861(aa)(2));
                                    ``(VI) a community mental health 
                                center (as defined in section 
                                1861(ff)(3)(B));
                                    ``(VII) a clinic certified as a 
                                certified community behavioral health 
                                clinic pursuant to section 223 of the 
                                Protecting Access to Medicare Act of 
                                2014; or
                                    ``(VIII) any other individual or 
                                entity specified by the Secretary;
                            ``(ii) that applied for and was selected to 
                        participate in the Program pursuant to an 
                        application and selection process established 
                        by the Secretary; and
                            ``(iii) 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.
                    ``(B) Preference.--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.
            ``(2) Opioid use disorder care teams.--
                    ``(A) In general.--For purposes of this section, 
                the term `opioid use disorder care team' means a team 
                of health care practitioners established by a 
                participant described in paragraph (1)(A) that--
                            ``(i) shall include--
                                    ``(I) at least one physician (as 
                                defined in section 1861(r)(1)) 
                                furnishing primary care services or 
                                addiction treatment services to an 
                                applicable beneficiary; and
                                    ``(II) at least one eligible 
                                practitioner (as defined in paragraph 
                                (3)), who may be a physician who meets 
                                the criterion in subclause (I); and
                            ``(ii) may include other practitioners 
                        licensed under State law to furnish 
                        psychiatric, psychological, counseling, and 
                        social services to applicable beneficiaries.
                    ``(B) Requirements for receipt of payment under 
                program.--In order to receive payments under subsection 
                (e), each participant in the Program shall--
                            ``(i) furnish opioid use disorder treatment 
                        services through opioid use disorder care teams 
                        to applicable beneficiaries who agree to 
                        receive the services;
                            ``(ii) meet minimum criteria, as 
                        established by the Secretary; and
                            ``(iii) 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--
                                    ``(I) monitor and evaluate the 
                                Program;
                                    ``(II) determine if minimum 
                                criteria are met under clause (ii); and
                                    ``(III) determine the incentive 
                                payment under subsection (e).
            ``(3) Eligible practitioner defined.--For purposes of this 
        section, the term `eligible practitioner' means a physician or 
        other health care practitioner, such as a nurse practitioner, 
        that--
                    ``(A) is enrolled under section 1866(j)(1);
                    ``(B) is authorized to prescribe or dispense 
                narcotic drugs to individuals for maintenance treatment 
                or detoxification treatment; and
                    ``(C) 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.
    ``(d) Participation of Applicable Beneficiaries.--
            ``(1) Applicable beneficiary defined.--In this section, the 
        term `applicable beneficiary' means an individual who--
                    ``(A) is entitled to, or enrolled for, benefits 
                under part A and enrolled for benefits under part B;
                    ``(B) is not enrolled in a Medicare Advantage plan 
                under part C;
                    ``(C) has a current diagnosis for an opioid use 
                disorder; and
                    ``(D) meets such other criteria as the Secretary 
                determines appropriate.
        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).
            ``(2) Voluntary beneficiary participation; limitation on 
        number of beneficiaries.--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.
            ``(3) Services.--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.
            ``(4) Beneficiary access to services.--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.
    ``(e) Payments.--
            ``(1) Per applicable beneficiary per month care management 
        fee.--
                    ``(A) In general.--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.
                    ``(B) Payment amounts.--In carrying out 
                subparagraph (A), the Secretary may--
                            ``(i) consider payments otherwise payable 
                        under this title for opioid use disorder 
                        treatment services and the needs of applicable 
                        beneficiaries;
                            ``(ii) 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;
                            ``(iii) 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; and
                            ``(iv) 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.
                    ``(C) No duplicate payment.--The Secretary shall 
                make payments under this paragraph to only one 
                participant for services furnished to an applicable 
                beneficiary during a calendar month.
            ``(2) Incentive payments.--
                    ``(A) In general.--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).
                    ``(B) Criteria.--
                            ``(i) In general.--Criteria described in 
                        subparagraph (A) may include consideration of 
                        the following:
                                    ``(I) Patient engagement and 
                                retention in treatment.
                                    ``(II) Evidence-based medication-
                                assisted treatment.
                                    ``(III) Other criteria established 
                                by the Secretary.
                            ``(ii) Required consultation and 
                        consideration.--In determining criteria 
                        described in subparagraph (A), the Secretary 
                        shall--
                                    ``(I) consult with stakeholders, 
                                including clinicians in the primary 
                                care community and in the field of 
                                addiction medicine; and
                                    ``(II) consider existing clinical 
                                guidelines for the treatment of opioid 
                                use disorders.
                    ``(C) No duplicate payment.--The Secretary shall 
                ensure that no duplicate payments under this paragraph 
                are made with respect to an applicable beneficiary.
    ``(f) Multipayer Strategy.--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.
    ``(g) Evaluation.--
            ``(1) In general.--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.
            ``(2) Reports.--The Secretary shall submit to Congress--
                    ``(A) 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
                    ``(B) a report with respect to the final evaluation 
                under paragraph (1) not later than 6 years after such 
                date.
    ``(h) Funding.--
            ``(1) Administrative funding.--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.
            ``(2) Care management fees and incentives.--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.
            ``(3) Availability.--Amounts transferred under this 
        subsection for a fiscal year shall be available until expended.
    ``(i) Waivers.--The Secretary may waive any provision of this title 
as may be necessary to carry out the Program under this section.''.

 Subtitle F--Responsible Education Achieves Care and Healthy Outcomes 
                          for Users' Treatment

SEC. 6051. SHORT TITLE.

    This subtitle 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. 6052. 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, with respect to a period, a 
        prescriber identified by the Secretary under subparagraph 
        (D)(ii) of section 1860D-4(c)(4) of the Social Security Act (42 
        U.S.C. 1395w-104(c)(4)), as added by section 6065 of this Act, 
        to be an outlier prescriber of opioids for such period.
            (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, 
$75,000,000 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.

        Subtitle G--Preventing Addiction for Susceptible Seniors

SEC. 6061. SHORT TITLE.

    This subtitle may be cited as the ``Preventing Addiction for 
Susceptible Seniors Act of 2018'' or the ``PASS Act of 2018''.

SEC. 6062. ELECTRONIC PRIOR AUTHORIZATION FOR COVERED PART D DRUGS.

    Section 1860D-4(e)(2) of the Social Security Act (42 U.S.C. 1395w-
104(e)(2)) is amended by adding at the end the following new 
subparagraph:
                    ``(E) Electronic prior authorization.--
                            ``(i) In general.--Not later than January 
                        1, 2021, the program shall provide for the 
                        secure electronic transmission of--
                                    ``(I) 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
                                    ``(II) a response, in accordance 
                                with this subparagraph, from such PDP 
                                sponsor or Medicare Advantage 
                                organization, respectively, to such 
                                professional.
                            ``(ii) Electronic transmission.--
                                    ``(I) Exclusions.--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).
                                    ``(II) Standards.--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.
                                    ``(III) Application.--
                                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.''.

SEC. 6063. PROGRAM INTEGRITY TRANSPARENCY MEASURES UNDER MEDICARE PARTS 
              C AND D.

    (a) In General.--Section 1859 of the Social Security Act (42 U.S.C. 
1395w-28) is amended by adding at the end the following new subsection:
    ``(i) Program Integrity Transparency Measures.--
            ``(1) Program integrity portal.--
                    ``(A) In general.--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)--
                            ``(i) the referral by such plans of 
                        substantiated or suspicious activities, as 
                        defined by the Secretary, of a provider of 
                        services (including a prescriber) or supplier 
                        related to fraud, waste, and abuse for 
                        initiating or assisting investigations 
                        conducted by the eligible entity; and
                            ``(ii) data sharing among such MA plans, 
                        prescription drug plans, and the Secretary.
                    ``(B) Required uses of portal.--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):
                            ``(i) Providers of services and suppliers 
                        that have been referred pursuant to 
                        subparagraph (A)(i) during the previous 12-
                        month period.
                            ``(ii) 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.
                            ``(iii) 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.
                            ``(iv) 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 or suspicious activities of 
                        fraud, waste, or abuse of a provider of 
                        services (including a prescriber) or supplier, 
                        if such provider (including a prescriber) 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.
                    ``(C) Rulemaking.--For purposes of this paragraph, 
                the Secretary shall, through rulemaking, specify what 
                constitutes substantiated or suspicious activities of 
                fraud, waste, and abuse, using guidance such as what is 
                provided in the Medicare Program Integrity Manual 4.8. 
                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.
                    ``(D) HIPAA compliant information only.--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.
            ``(2) Quarterly reports.--Beginning not later than 2 years 
        after the date of the 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--
                    ``(A) include administrative actions, pertinent 
                information related to opioid overprescribing, and 
                other data determined appropriate by the Secretary in 
                consultation with stakeholders; and
                    ``(B) be anonymized information submitted by plans 
                without identifying the source of such information.
            ``(3) Clarification.--Nothing in this subsection shall 
        preclude or otherwise affect referrals to the Inspector General 
        of the Department of Health and Human Services or other law 
        enforcement entities.''.
    (b) Contract Requirement to Communicate Plan Corrective Actions 
Against Opioids Over-prescribers.--Section 1857(e) of the Social 
Security Act (42 U.S.C. 1395w-27(e)) is amended by adding at the end 
the following new paragraph:
            ``(5) Communicating plan corrective actions against opioids 
        over-prescribers.--
                    ``(A) In general.--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, credible evidence of suspicious 
                activities of a provider of services (including a 
                prescriber) or supplier related to fraud, and other 
                actions taken by such plans related to inappropriate 
                prescribing of opioids.
                    ``(B) Process.--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).
                    ``(C) Regulations.--For purposes of this paragraph, 
                including as applied under section 1860D-12(b)(3)(D), 
                the Secretary shall, pursuant to rulemaking--
                            ``(i) specify a definition for the term 
                        `inappropriate prescribing' and a method for 
                        determining if a provider of services 
                        prescribes inappropriate prescribing; and
                            ``(ii) establish the process described in 
                        subparagraph (B) and the types of information 
                        that shall be submitted through such 
                        process.''.
    (c) Reference Under Part D to Program Integrity Transparency 
Measures.--Section 1860D-4 of the Social Security Act (42 U.S.C. 1395w-
104) is amended by adding at the end the following new subsection:
    ``(m) Program Integrity Transparency Measures.--For program 
integrity transparency measures applied with respect to prescription 
drug plan and MA plans, see section 1859(i).''.

SEC. 6064. EXPANDING ELIGIBILITY FOR MEDICATION THERAPY MANAGEMENT 
              PROGRAMS UNDER PART D.

    Section 1860D-4(c)(2)(A)(ii) of the Social Security Act (42 U.S.C. 
1395w-104(c)(2)(A)(ii)) is amended--
            (1) by redesignating subclauses (I) through (III) as items 
        (aa) through (cc), respectively, and adjusting the margins 
        accordingly;
            (2) by striking ``are part D eligible individuals who--'' 
        and inserting ``are the following:
                                    ``(I) Part D eligible individuals 
                                who--''; and
            (3) by adding at the end the following new subclause:
                                    ``(II) Beginning January 1, 2021, 
                                at-risk beneficiaries for prescription 
                                drug abuse (as defined in paragraph 
                                (5)(C)).''.

SEC. 6065. COMMIT TO OPIOID MEDICAL PRESCRIBER ACCOUNTABILITY AND 
              SAFETY FOR SENIORS.

    Section 1860D-4(c)(4) of the Social Security Act (42 U.S.C. 1395w-
104(c)(4)) is amended by adding at the end the following new 
subparagraph:
                    ``(D) Notification and additional requirements with 
                respect to outlier prescribers of opioids.--
                            ``(i) Notification.--Not later than January 
                        1, 2021, 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 as specified in 
                        accordance with clause (iii).
                            ``(ii) Identification of outlier 
                        prescribers of opioids.--
                                    ``(I) In general.--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 thresholds established under 
                                subclause (II), identify prescribers 
                                that are outlier opioids prescribers 
                                for a period of time specified by the 
                                Secretary.
                                    ``(II) Establishment of 
                                thresholds.--For purposes of subclause 
                                (I) and subject to subclause (III), the 
                                Secretary shall, after consultation 
                                with stakeholders, establish 
                                thresholds, 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.
                                    ``(III) Exclusions.--The following 
                                shall not be included in the analysis 
                                for identifying outlier prescribers of 
                                opioids under this clause:
                                            ``(aa) Claims for covered 
                                        part D drugs for part D 
                                        eligible individuals who are 
                                        receiving hospice care under 
                                        this title.
                                            ``(bb) Claims for covered 
                                        part D drugs for part D 
                                        eligible individuals who are 
                                        receiving oncology services 
                                        under this title.
                                            ``(cc) Prescribers who are 
                                        the subject of an investigation 
                                        by the Centers for Medicare & 
                                        Medicaid Services or the 
                                        Inspector General of the 
                                        Department of Health and Human 
                                        Services.
                            ``(iii) Contents of notification.--The 
                        Secretary shall include the following 
                        information in the notifications provided under 
                        clause (i):
                                    ``(I) Information on how such 
                                prescriber compares to other 
                                prescribers within the same specialty 
                                and geographic area.
                                    ``(II) Information on opioid 
                                prescribing guidelines, based on input 
                                from stakeholders, that may include the 
                                Centers for Disease Control and 
                                Prevention guidelines for prescribing 
                                opioids for chronic pain and guidelines 
                                developed by physician organizations.
                                    ``(III) Other information 
                                determined appropriate by the 
                                Secretary.
                            ``(iv) Modifications and expansions.--
                                    ``(I) Frequency.--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 and changes in opioid 
                                prescribing utilization and trends.
                                    ``(II) Expansion to other 
                                prescriptions.--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.
                            ``(v) Additional requirements for 
                        persistent outlier prescribers.--In the case of 
                        a prescriber who the Secretary determines is 
                        persistently identified under clause (ii) as an 
                        outlier prescriber of opioids, the following 
                        shall apply:
                                    ``(I) Such prescriber may be 
                                required to enroll in the program under 
                                this title under section 1866(j) if 
                                such prescriber is not otherwise 
                                required to enroll, but only after 
                                other appropriate remedies have been 
                                provided, such as the provision of 
                                education funded through section 6052 
                                of the SUPPORT for Patients and 
                                Communities Act, for a period 
                                determined by the Secretary as 
                                sufficient to correct the prescribing 
                                patterns that lead to identification of 
                                such prescriber as a persistent outlier 
                                prescriber of opioids. The Secretary 
                                shall determine the length of the 
                                period for which such prescriber is 
                                required to maintain such enrollment, 
                                which shall be the minimum period 
                                necessary to correct such prescribing 
                                patterns.
                                    ``(II) Not less frequently than 
                                annually (and in a form and manner 
                                determined appropriate by the 
                                Secretary), the Secretary, consistent 
                                with clause(iv)(I), shall communicate 
                                information on such prescribers to 
                                sponsors of a prescription drug plan 
                                and Medicare Advantage organizations 
                                offering an MA-PD plan.
                            ``(vi) Public availability of 
                        information.--The Secretary shall make 
                        aggregate information under this subparagraph 
                        available on the internet website of the 
                        Centers for Medicare & Medicaid Services. Such 
                        information shall be in a form and manner 
                        determined appropriate by the Secretary and 
                        shall not identify any specific prescriber. In 
                        carrying out this clause, the Secretary shall 
                        consult with interested stakeholders.
                            ``(vii) Opioids defined.--For purposes of 
                        this subparagraph, the term `opioids' has such 
                        meaning as specified by the Secretary.
                            ``(viii) Other activities.--Nothing in this 
                        subparagraph shall preclude the Secretary from 
                        conducting activities that provide prescribers 
                        with information as to how they compare to 
                        other prescribers that are in addition to the 
                        activities under this subparagraph, including 
                        activities that were being conducted as of the 
                        date of the enactment of this subparagraph.''.

SEC. 6066. NO ADDITIONAL FUNDS AUTHORIZED.

    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.

   Subtitle H--Expanding Oversight of Opioid Prescribing and Payment

SEC. 6071. SHORT TITLE.

    This subtitle may be cited as the ``Expanding Oversight of Opioid 
Prescribing and Payment Act of 2018''.

SEC. 6072. MEDICARE PAYMENT ADVISORY COMMISSION REPORT ON OPIOID 
              PAYMENT, ADVERSE INCENTIVES, AND DATA UNDER THE MEDICARE 
              PROGRAM.

    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:
            (1) 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.
            (2) The identification of incentives under the hospital 
        inpatient prospective payment system under section 1886 of the 
        Social Security Act (42 U.S.C. 1395ww) and incentives under the 
        hospital outpatient prospective payment system under section 
        1833(t) of such Act (42 U.S.C. 1395l(t)) 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.
            (3) 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.

SEC. 6073. NO ADDITIONAL FUNDS AUTHORIZED.

    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.

  Subtitle I--Dr. Todd Graham Pain Management, Treatment, and Recovery

SEC. 6081. SHORT TITLE.

    This subtitle may be cited as the ``Dr. Todd Graham Pain 
Management, Treatment, and Recovery Act of 2018''.

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.

    (a) Outpatient Prospective Payment System.--Section 1833(t) of the 
Social Security Act (42 U.S.C. 1395l(t)) is amended by adding at the 
end the following new paragraph:
            ``(22) Review and revisions of payments for non-opioid 
        alternative treatments.--
                    ``(A) In general.--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--
                            ``(i) 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;
                            ``(ii) may, as the Secretary determines 
                        appropriate, conduct subsequent reviews of such 
                        payments; and
                            ``(iii) 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.
                    ``(B) Priority.--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.
                    ``(C) Revisions.--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).
                    ``(D) Rules of construction.--Nothing in this 
                paragraph shall be construed to preclude the 
                Secretary--
                            ``(i) from conducting a demonstration 
                        before making the revisions described in 
                        subparagraph (C); or
                            ``(ii) 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.''.
    (b) Ambulatory Surgical Centers.--Section 1833(i) of the Social 
Security Act (42 U.S.C. 1395l(i)) is amended by adding at the end the 
following new paragraph:
    ``(8) 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).''.

SEC. 6083. EXPANDING ACCESS UNDER THE MEDICARE PROGRAM TO ADDICTION 
              TREATMENT IN FEDERALLY QUALIFIED HEALTH CENTERS AND RURAL 
              HEALTH CLINICS.

    (a) Federally Qualified Health Centers.--Section 1834(o) of the 
Social Security Act (42 U.S.C. 1395m(o)) is amended by adding at the 
end the following new paragraph:
            ``(3) Additional payments for certain fqhcs with physicians 
        or other practitioners receiving data 2000 waivers.--
                    ``(A) In general.--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.
                    ``(B) Application.--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.
                    ``(C) Requirements.--For purposes of subparagraph 
                (A), the requirements described in this subparagraph, 
                with respect to a physician or practitioner, are the 
                following:
                            ``(i) 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).
                            ``(ii) The physician or practitioner first 
                        receives a waiver under section 303(g) of the 
                        Controlled Substances Act on or after January 
                        1, 2019.
                    ``(D) Funding.--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.''.
    (b) Rural Health Clinic.--Section 1833 of the Social Security Act 
(42 U.S.C. 1395l) is amended--
            (1) by redesignating the subsection (z) relating to medical 
        review of spinal subluxation services as subsection (aa); and
            (2) by adding at the end the following new subsection:
    ``(bb) Additional Payments for Certain Rural Health Clinics With 
Physicians or Practitioners Receiving DATA 2000 Waivers.--
            ``(1) In general.--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.
            ``(2) Application.--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.
            ``(3) Requirements.--For purposes of paragraph (1), the 
        requirements described in this paragraph, with respect to a 
        physician or practitioner, are the following:
                    ``(A) 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).
                    ``(B) The physician or practitioner first receives 
                a waiver under section 303(g) of the Controlled 
                Substances Act on or after January 1, 2019.
            ``(4) Funding.--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.''.

SEC. 6084. STUDYING THE AVAILABILITY OF SUPPLEMENTAL BENEFITS DESIGNED 
              TO TREAT OR PREVENT SUBSTANCE USE DISORDERS UNDER 
              MEDICARE ADVANTAGE PLANS.

    (a) In General.--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 ``Secretary'') 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 (42 
U.S.C. 1395w-22(a)(3)(A))) 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 (42 U.S.C. 1395w-28(b)(6))) offered to 
individuals entitled to medical assistance under title XIX of such Act 
and other such Medicare Advantage plans.
    (b) Consultation.--The Secretary shall develop the report described 
in subsection (a) in consultation with relevant stakeholders, 
including--
            (1) individuals entitled to benefits under part A or 
        enrolled under part B of title XVIII of the Social Security 
        Act;
            (2) entities who advocate on behalf of such individuals;
            (3) Medicare Advantage organizations;
            (4) pharmacy benefit managers; and
            (5) providers of services and suppliers (as such terms are 
        defined in section 1861 of such Act (42 U.S.C. 1395x)).
    (c) Contents.--The report described in subsection (a) shall include 
an analysis on the following:
            (1) The extent to which plans described in such subsection 
        offer supplemental health care benefits relating to coverage 
        of--
                    (A) 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
                    (B) non-opioid alternatives for the treatment of 
                pain.
            (2) 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).
            (3) The impact, if any, of increasing the applicable rebate 
        percentage determined under section 1854(b)(1)(C) of the Social 
        Security Act (42 U.S.C. 1395w-24(b)(1)(C)) 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.
            (4) Potential ways to improve upon such coverage or to 
        incentivize such plans to offer additional supplemental health 
        care benefits relating to such coverage.

SEC. 6085. CLINICAL PSYCHOLOGIST SERVICES MODELS UNDER THE CENTER FOR 
              MEDICARE AND MEDICAID INNOVATION; GAO STUDY AND REPORT.

    (a) CMI Models.--Section 1115A(b)(2)(B) of the Social Security Act 
(42 U.S.C. 1315a(b)(2)(B)), as amended by section 6001, is further 
amended by adding at the end the following new clauses:
                            ``(xxvi) 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)).
                            ``(xxvii) 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)).''.
    (b) GAO Study and Report.--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:
            (1) Information about services furnished by psychiatrists, 
        clinical psychologists, and other professionals.
            (2) 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 (42 U.S.C. 
        1395x(ii)) and ways that the provision of such information 
        could be improved.

SEC. 6086. DR. TODD GRAHAM PAIN MANAGEMENT STUDY.

    (a) In General.--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.
    (b) Consultation.--In developing the report described in subsection 
(a), the Secretary shall consult with--
            (1) relevant agencies within the Department of Health and 
        Human Services;
            (2) licensed and practicing osteopathic and allopathic 
        physicians, behavioral health practitioners, physician 
        assistants, nurse practitioners, dentists, pharmacists, and 
        other providers of health services;
            (3) providers and suppliers of services (as such terms are 
        defined in section 1861 of the Social Security Act (42 U.S.C. 
        1395x));
            (4) substance abuse and mental health professional 
        organizations;
            (5) pain management professional organizations and advocacy 
        entities, including individuals who personally suffer chronic 
        pain;
            (6) medical professional organizations and medical 
        specialty organizations;
            (7) licensed health care providers who furnish alternative 
        pain management services;
            (8) organizations with expertise in the development of 
        innovative medical technologies for pain management;
            (9) beneficiary advocacy organizations; and
            (10) other organizations with expertise in the assessment, 
        diagnosis, treatment, and management of pain, as determined 
        appropriate by the Secretary.
    (c) Contents.--The report described in subsection (a) shall include 
the following:
            (1) An analysis of payment and coverage under title XVIII 
        of the Social Security Act with respect to the following:
                    (A) 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.
                    (B) Evidence-based treatments and technologies that 
                monitor substance use withdrawal and prevent overdoses 
                of opioids.
                    (C) Evidence-based treatments and technologies that 
                treat substance use disorders.
                    (D) Items and services furnished by practitioners 
                through a multi-disciplinary treatment model for pain 
                management, including the patient-centered medical 
                home.
                    (E) 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.
            (2) An evaluation of the following:
                    (A) 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 (E) of paragraph 
                (1).
                    (B) 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.
                    (C) 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.
            (3) 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 ``Va/DoD Clinical Practice Guideline for Opioid 
        Therapy for Chronic Pain'' 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.
            (4) The options described in subsection (d).
            (5) The impact analysis described in subsection (e).
    (d) Options.--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:
            (1) 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.
            (2) 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.
            (3) 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.
            (4) 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.
            (5) Educating providers on risks of coadministration of 
        opioids and other drugs, particularly benzodiazepines.
            (6) 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.
            (7) 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.
            (8) Creating a beneficiary education tool on alternatives 
        to opioids for chronic pain management.
    (e) Impact Analysis.--The impact analysis described in this 
subsection consists of an analysis of any potential effects 
implementing the options described in subsection (d) would have--
            (1) on expenditures under the Medicare program; and
            (2) on preventing or reducing opioid addiction for 
        individuals receiving benefits under the Medicare program.

        Subtitle J--Combating Opioid Abuse for Care in Hospitals

SEC. 6091. SHORT TITLE.

    This subtitle may be cited as the ``Combating Opioid Abuse for Care 
in Hospitals Act of 2018'' or the ``COACH Act of 2018''.

SEC. 6092. DEVELOPING GUIDANCE ON PAIN MANAGEMENT AND OPIOID USE 
              DISORDER PREVENTION FOR HOSPITALS RECEIVING PAYMENT UNDER 
              PART A OF THE MEDICARE PROGRAM.

    (a) In General.--Not later than July 1, 2019, the Secretary of 
Health and Human Services (in this section referred to as the 
``Secretary'') 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 (42 U.S.C. 1395c et seq.) on pain management strategies and opioid 
use disorder prevention strategies with respect to individuals entitled 
to benefits under such part.
    (b) Consultation.--In developing the guidance described in 
subsection (a), the Secretary shall consult with relevant stakeholders, 
including--
            (1) medical professional organizations;
            (2) providers and suppliers of services (as such terms are 
        defined in section 1861 of the Social Security Act (42 U.S.C. 
        1395x));
            (3) health care consumers or groups representing such 
        consumers; and
            (4) other entities determined appropriate by the Secretary.
    (c) Contents.--The guidance described in subsection (a) shall 
include, with respect to hospitals and individuals described in such 
subsection, the following:
            (1) Best practices regarding evidence-based screening and 
        practitioner education initiatives relating to screening and 
        treatment protocols for opioid use disorder, including--
                    (A) methods to identify such individuals at-risk of 
                opioid use disorder, including risk stratification;
                    (B) ways to prevent, recognize, and treat opioid 
                overdoses; and
                    (C) resources available to such individuals, such 
                as opioid treatment programs, peer support groups, and 
                other recovery programs.
            (2) 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--
                    (A) the adverse effects of prolonged opioid use;
                    (B) non-opioid, evidence-based, non-pharmacological 
                pain management treatments;
                    (C) monitoring programs for individuals who have 
                been prescribed opioids; and
                    (D) the prescribing of naloxone along with an 
                initial opioid prescription.
            (3) 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)).
            (4) A notification template developed by the Secretary, for 
        use as appropriate, for such individuals who are prescribed an 
        opioid that--
                    (A) 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;
                    (B) highlights multimodal and evidence-based non-
                opioid alternatives for pain management;
                    (C) encourages such individuals to talk to their 
                health care providers about such alternatives;
                    (D) 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;
                    (E) is worded in an easily understandable manner 
                and made available in multiple languages determined 
                appropriate by the Secretary; and
                    (F) includes any other information determined 
                appropriate by the Secretary.
            (5) Best practices for such hospital to track opioid 
        prescribing trends by practitioners furnishing items and 
        services at such hospital, including--
                    (A) 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;
                    (B) guidance on checking the medical records of 
                such individuals against information included in 
                prescription drug monitoring programs;
                    (C) strategies to reduce long-term opioid 
                prescriptions; and
                    (D) methods to identify such practitioners who may 
                be over-prescribing opioids.
            (6) 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.

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.

    Section 1890A of the Social Security Act (42 U.S.C. 1395aaa-1) is 
amended by adding at the end the following new subsection:
    ``(g) Technical Expert Panel Review of Opioid and Opioid Use 
Disorder Quality Measures.--
            ``(1) In general.--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.
            ``(2) Review and assessment.--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--
                    ``(A) review quality measures that relate to 
                opioids and opioid use disorders, including existing 
                measures and those under development;
                    ``(B) 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
                    ``(C) 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).
            ``(3) Consideration of measures by secretary.--The 
        Secretary shall consider--
                    ``(A) 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
                    ``(B) 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).
            ``(4) Prioritization of measure development.--The Secretary 
        shall prioritize for measure development the gaps in quality 
        measures identified under paragraph (2)(B).
            ``(5) Prioritization of measure endorsement.--The 
        Secretary--
                    ``(A) during the period beginning on the date of 
                the enactment of this subsection and ending on December 
                31, 2023, shall prioritize the endorsement of measures 
                relating to opioids and opioid use disorders by the 
                entity with a contract under subsection (a) of section 
                1890 in connection with endorsement of measures 
                described in subsection (b)(2) of such section; and
                    ``(B) on and after January 1, 2024, may prioritize 
                the endorsement of such measures by such entity.''.

SEC. 6094. TECHNICAL EXPERT PANEL ON REDUCING SURGICAL SETTING OPIOID 
              USE; DATA COLLECTION ON PERIOPERATIVE OPIOID USE.

    (a) Technical Expert Panel on Reducing Surgical Setting Opioid 
Use.--
            (1) In general.--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:
                    (A) 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.
                    (B) Shared decision making with patients and 
                families on pain management, including a review of 
                payment to ensure payment under the Medicare program 
                under title XVIII of the Social Security Act accounts 
                for time spent on shared decision making.
                    (C) Education on the safe use, storage, and 
                disposal of opioids.
                    (D) Prevention of opioid misuse and abuse after 
                discharge.
                    (E) 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.
            (2) Report.--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.
    (b) Data Collection on Perioperative Opioid Use.--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:
            (1) The diagnosis-related group codes identified by the 
        Secretary as having the highest volume of surgeries.
            (2) 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--
                    (A) surgical volumes, practices, and opioid 
                prescribing patterns;
                    (B) opioid consumption, including--
                            (i) perioperative days of therapy;
                            (ii) average daily dose at the hospital, 
                        including dosage greater than 90 milligram 
                        morphine equivalent;
                            (iii) post-discharge prescriptions and 
                        other combination drugs that are used before 
                        intervention and after intervention;
                            (iv) quantity and duration of opioid 
                        prescription at discharge; and
                            (v) quantity consumed and number of 
                        refills;
                    (C) regional anesthesia and analgesia practices, 
                including pre-surgical and post-surgical injections;
                    (D) naloxone reversal;
                    (E) post-operative respiratory failure;
                    (F) information about storage and disposal; and
                    (G) such other information as the Secretary may 
                specify.
            (3) 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.

SEC. 6095. REQUIRING THE POSTING AND PERIODIC UPDATE OF OPIOID 
              PRESCRIBING GUIDANCE FOR MEDICARE BENEFICIARIES.

    (a) In General.--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 ``Secretary'') 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 (42 U.S.C. 1395c et seq.) 
or enrolled under part B of such title of such Act (42 U.S.C. 1395j et 
seq.).
    (b) Update of Guidance.--
            (1) Periodic update.--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.
            (2) Consultation.--The entities specified in this paragraph 
        are the following:
                    (A) Medical professional organizations.
                    (B) Providers and suppliers of services (as such 
                terms are defined in section 1861 of the Social 
                Security Act (42 U.S.C. 1395x)).
                    (C) Health care consumers or groups representing 
                such consumers.
                    (D) Other entities determined appropriate by the 
                Secretary.

  Subtitle K--Providing Reliable Options for Patients and Educational 
                               Resources

SEC. 6101. SHORT TITLE.

    This subtitle may be cited as the ``Providing Reliable Options for 
Patients and Educational Resources Act of 2018'' or the ``PROPER Act of 
2018''.

SEC. 6102. REQUIRING MEDICARE ADVANTAGE PLANS AND PART D PRESCRIPTION 
              DRUG PLANS TO INCLUDE INFORMATION ON RISKS ASSOCIATED 
              WITH OPIOIDS AND COVERAGE OF NONPHARMACOLOGICAL THERAPIES 
              AND NONOPIOID MEDICATIONS OR DEVICES USED TO TREAT PAIN.

    Section 1860D-4(a)(1) of the Social Security Act (42 U.S.C. 1395w-
104(a)(1)) is amended--
            (1) in subparagraph (A), by inserting ``, subject to 
        subparagraph (C),'' before ``including'';
            (2) in subparagraph (B), by adding at the end the following 
        new clause:
                            ``(vi) For plan year 2021 and each 
                        subsequent plan year, subject to subparagraph 
                        (C), with respect to the treatment of pain--
                                    ``(I) the risks associated with 
                                prolonged opioid use; and
                                    ``(II) coverage of 
                                nonpharmacological therapies, devices, 
                                and nonopioid medications--
                                            ``(aa) in the case of an 
                                        MA-PD plan under part C, under 
                                        such plan; and
                                            ``(bb) in the case of a 
                                        prescription drug plan, under 
                                        such plan and under parts A and 
                                        B.''; and
            (3) by adding at the end the following new subparagraph:
                    ``(C) Targeted provision of information.--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.''.

SEC. 6103. REQUIRING MEDICARE ADVANTAGE PLANS AND PRESCRIPTION DRUG 
              PLANS TO PROVIDE INFORMATION ON THE SAFE DISPOSAL OF 
              PRESCRIPTION DRUGS.

    (a) Medicare Advantage.--Section 1852 of the Social Security Act 
(42 U.S.C. 1395w-22) is amended by adding at the end the following new 
subsection:
    ``(n) Provision of Information Relating to the Safe Disposal of 
Certain Prescription Drugs.--
            ``(1) In general.--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.
            ``(2) Criteria.--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.''.
    (b) Prescription Drug Plans.--Section 1860D-4(c)(2)(B) of the 
Social Security Act (42 U.S.C. 1395w-104(c)(2)(B)) is amended--
            (1) by striking ``may include elements that promote'';
            (2) by redesignating clauses (i) through (iii) as 
        subclauses (I) through (III) and adjusting the margins 
        accordingly;
            (3) by inserting before subclause (I), as so redesignated, 
        the following new clause:
                            ``(i) may include elements that promote--
                        '';
            (4) in subclause (III), as so redesignated, by striking the 
        period at the end and inserting ``; and''; and
            (5) by adding at the end the following new clause:
                            ``(ii) with respect to plan years beginning 
                        on or after January 1, 2021, shall provide 
                        for--
                                    ``(I) 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
                                    ``(II) cost-effective means by 
                                which an enrollee may so safely dispose 
                                of such drugs.''.

SEC. 6104. REVISING MEASURES USED UNDER THE HOSPITAL CONSUMER 
              ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS SURVEY 
              RELATING TO PAIN MANAGEMENT.

    (a) Restriction on the Use of Pain Questions in HCAHPS.--Section 
1886(b)(3)(B)(viii) of the Social Security Act (42 U.S.C. 
1395ww(b)(3)(B)(viii)) is amended by adding at the end the following 
new subclause:
    ``(XII)(aa) With respect to a Hospital Consumer Assessment of 
Healthcare Providers and Systems survey (or a successor survey) 
conducted on or after January 1, 2020, 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.
    ``(bb) 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 or 2019 about communication by hospital staff with an 
individual about such individual's pain.''.
    (b) Restriction on Use of 2018 and 2019 Pain Questions in the 
Hospital Value-based Purchasing Program.--Section 1886(o)(2)(B) of the 
Social Security Act (42 U.S.C. 1395ww(o)(2)(B)) is amended by adding at 
the end the following new clause:
                            ``(iii) HCAHPS pain questions.--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 or 2019 about communication by hospital 
                        staff with an individual about the individual's 
                        pain.''.

         Subtitle L--Fighting the Opioid Epidemic With Sunshine

SEC. 6111. FIGHTING THE OPIOID EPIDEMIC WITH SUNSHINE.

    (a) Inclusion of Information Regarding Payments to Additional 
Practitioners.--
            (1) In general.--Section 1128G(e)(6) of the Social Security 
        Act (42 U.S.C. 1320a-7h(e)(6)) is amended--
                    (A) in subparagraph (A), by adding at the end the 
                following new clauses:
                            ``(iii) A physician assistant, nurse 
                        practitioner, or clinical nurse specialist (as 
                        such terms are defined in section 1861(aa)(5)).
                            ``(iv) A certified registered nurse 
                        anesthetist (as defined in section 
                        1861(bb)(2)).
                            ``(v) A certified nurse-midwife (as defined 
                        in section 1861(gg)(2)).''; and
                    (B) in subparagraph (B), by inserting ``, physician 
                assistant, nurse practitioner, clinical nurse 
                specialist, certified nurse anesthetist, or certified 
                nurse-midwife'' after ``physician''.
            (2) Effective date.--The amendments made by this subsection 
        shall apply with respect to information required to be 
        submitted under section 1128G of the Social Security Act (42 
        U.S.C. 1320a-7h) on or after January 1, 2022.
    (b) Sunset of Exclusion of National Provider Identifier of Covered 
Recipient in Information Made Publicly Available.--Section 
1128G(c)(1)(C)(viii) of the Social Security Act (42 U.S.C. 1320a-
7h(c)(1)(C)(viii)) is amended by striking ``does not contain'' and 
inserting ``in the case of information made available under this 
subparagraph prior to January 1, 2022, does not contain''.
    (c) Administration.--Chapter 35 of title 44, United States Code, 
shall not apply to this section or the amendments made by this section.

                  TITLE VII--PUBLIC HEALTH PROVISIONS

                   Subtitle A--Awareness and Training

SEC. 7001. REPORT ON EFFECTS ON PUBLIC HEALTH OF SYNTHETIC DRUG USE.

    (a) In General.--Not later than 3 years after the date of the 
enactment of this Act, the Secretary of Health and Human Services, in 
coordination with the Surgeon General of the Public Health Service, 
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 a report on the health effects of new 
psychoactive substances, including synthetic drugs, used by adolescents 
and young adults.
    (b) New Psychoactive Substance Defined.--For purposes of subsection 
(a), the term ``new psychoactive substance'' means a controlled 
substance analogue (as defined in section 102(32) of the Controlled 
Substances Act (21 U.S.C. 802(32)).

SEC. 7002. FIRST RESPONDER TRAINING.

    Section 546 of the Public Health Service Act (42 U.S.C. 290ee-1) is 
amended--
            (1) in subsection (c)--
                    (A) in paragraph (2), by striking ``and'' at the 
                end;
                    (B) in paragraph (3), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following:
            ``(4) train and provide resources for first responders and 
        members of other key community sectors on safety around 
        fentanyl, carfentanil, and other dangerous licit and illicit 
        drugs to protect themselves from exposure to such drugs and 
        respond appropriately when exposure occurs.'';
            (2) in subsection (d), by striking ``and mechanisms for 
        referral to appropriate treatment for an entity receiving a 
        grant under this section'' and inserting ``mechanisms for 
        referral to appropriate treatment, and safety around fentanyl, 
        carfentanil, and other dangerous licit and illicit drugs'';
            (3) in subsection (f)--
                    (A) in paragraph (3), by striking ``and'' at the 
                end;
                    (B) in paragraph (4), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following:
            ``(5) the number of first responders and members of other 
        key community sectors trained on safety around fentanyl, 
        carfentanil, and other dangerous licit and illicit drugs.'';
            (4) by redesignating subsection (g) as subsection (h);
            (5) by inserting after subsection (f) the following:
    ``(g) Other Key Community Sectors.--In this section, the term 
`other key community sectors' includes substance use disorder treatment 
providers, emergency medical services agencies, agencies and 
organizations working with prison and jail populations and offender 
reentry programs, health care providers, harm reduction groups, 
pharmacies, community health centers, tribal health facilities, and 
mental health providers.''; and
            (6) in subsection (h), as so redesignated, by striking 
        ``$12,000,000 for each of fiscal years 2017 through 2021'' and 
        inserting ``$36,000,000 for each of fiscal years 2019 through 
        2023''.

  Subtitle B--Pilot Program for Public Health Laboratories To Detect 
                  Fentanyl and Other Synthetic Opioids

SEC. 7011. PILOT PROGRAM FOR PUBLIC HEALTH LABORATORIES TO DETECT 
              FENTANYL AND OTHER SYNTHETIC OPIOIDS.

    (a) Grants.--The Secretary of Health and Human Services (referred 
to in this section as the ``Secretary'') shall award grants to, or 
enter into cooperative agreements with, Federal, State, and local 
agencies to improve coordination between public health laboratories and 
laboratories operated by law enforcement agencies, such as Customs and 
Border Protection and the Drug Enforcement Administration, to improve 
detection of synthetic opioids, including fentanyl and its analogues, 
as described in subsection (b).
    (b) Detection Activities.--The Secretary, in consultation with the 
Director of the National Institute of Standards and Technology, the 
Director of the Centers for Disease Control and Prevention, the 
Attorney General of the United States, and the Administrator of the 
Drug Enforcement Administration, shall, for purposes of this section, 
develop or identify--
            (1) best practices for safely handling and testing 
        synthetic opioids, including fentanyl and its analogues, 
        including with respect to reference materials, instrument 
        calibration, and quality control protocols;
            (2) reference materials and quality control standards 
        related to synthetic opioids, including fentanyl and its 
        analogues, to enhance--
                    (A) clinical diagnostics;
                    (B) postmortem data collection; and
                    (C) portable testing equipment utilized by law 
                enforcement and public health officials; and
            (3) procedures for the identification of new and emerging 
        synthetic opioid formulations and procedures for reporting 
        those findings to appropriate law enforcement agencies and 
        Federal, State, and local public health laboratories and health 
        departments, as appropriate.
    (c) Laboratories.--The Secretary shall require recipients of grants 
or cooperative agreements under subsection (a) to--
            (1) follow the best practices established under subsection 
        (b) and have the appropriate capabilities to provide laboratory 
        testing of controlled substances, such as synthetic fentanyl, 
        and biospecimens for the purposes of aggregating and reporting 
        public health information to Federal, State, and local public 
        health officials, laboratories, and other entities the 
        Secretary deems appropriate;
            (2) work with law enforcement agencies and public health 
        authorities, as practicable;
            (3) provide early warning information to Federal, State, 
        and local law enforcement agencies and public health 
        authorities regarding trends or other data related to the 
        supply of synthetic opioids, including fentanyl and its 
        analogues;
            (4) provide biosurveillance capabilities with respect to 
        identifying trends in adverse health outcomes associated with 
        non-fatal exposures; and
            (5) provide diagnostic testing, as appropriate and 
        practicable, for non-fatal exposures of emergency personnel, 
        first responders, and other individuals.
    (d) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $15,000,000 for each of fiscal 
years 2019 through 2023.

         Subtitle C--Indexing Narcotics, Fentanyl, and Opioids

SEC. 7021. ESTABLISHMENT OF SUBSTANCE USE DISORDER INFORMATION 
              DASHBOARD.

    Title XVII of the Public Health Service Act (42 U.S.C. 300u et 
seq.) is amended by adding at the end the following new section:

``SEC. 1711. ESTABLISHMENT OF SUBSTANCE USE DISORDER INFORMATION 
              DASHBOARD.

    ``(a) In General.--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, on the Internet website of 
the Department of Health and Human Services, a public information 
dashboard that--
            ``(1) provides links to information on programs within the 
        Department of Health and Human Services related to the 
        reduction of opioid and other substance use disorders;
            ``(2) provides access, to the extent practicable and 
        appropriate, to publicly available data, which may include data 
        from agencies within the Department of Health and Human 
        Services and--
                    ``(A) other Federal agencies;
                    ``(B) State, local, and Tribal governments;
                    ``(C) nonprofit organizations;
                    ``(D) law enforcement;
                    ``(E) medical experts;
                    ``(F) public health educators; and
                    ``(G) research institutions regarding prevention, 
                treatment, recovery, and other services for opioid and 
                other substance use disorders;
            ``(3) provides data on substance use disorder prevention 
        and treatment strategies in different regions of and 
        populations in the United States;
            ``(4) identifies information on alternatives to controlled 
        substances for pain management, such as approaches studied by 
        the National Institutes of Health Pain Consortium, the National 
        Center for Complimentary and Integrative Health, and other 
        institutes and centers at the National Institutes of Health, as 
        appropriate; and
            ``(5) identifies guidelines and best practices for health 
        care providers regarding treatment of substance use disorders.
    ``(b) Controlled Substance Defined.--In this section, the term 
`controlled substance' has the meaning given that term in section 102 
of the Controlled Substances Act (21 U.S.C. 802).''.

SEC. 7022. INTERDEPARTMENTAL SUBSTANCE USE DISORDERS COORDINATING 
              COMMITTEE.

    (a) Establishment.--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 ``Secretary'') shall, in coordination 
with the Director of National Drug Control Policy, establish a 
committee, to be known as the Interdepartmental Substance Use Disorders 
Coordinating Committee (in this section referred to as the 
``Committee''), to coordinate Federal activities related to substance 
use disorders.
    (b) Membership.--
            (1) Federal members.--The Committee shall be composed of 
        the following Federal representatives, or the designees of such 
        representatives:
                    (A) The Secretary, who shall serve as the Chair of 
                the Committee.
                    (B) The Attorney General of the United States.
                    (C) The Secretary of Labor.
                    (D) The Secretary of Housing and Urban Development.
                    (E) The Secretary of Education.
                    (F) The Secretary of Veterans Affairs.
                    (G) The Commissioner of Social Security.
                    (H) The Assistant Secretary for Mental Health and 
                Substance Use.
                    (I) The Director of National Drug Control Policy.
                    (J) Representatives of other Federal agencies that 
                support or conduct activities or programs related to 
                substance use disorders, as determined appropriate by 
                the Secretary.
            (2) Non-federal members.--The Committee shall include a 
        minimum of 15 non-Federal members appointed by the Secretary, 
        of which--
                    (A) at least two such members shall be an 
                individual who has received treatment for a diagnosis 
                of a substance use disorder;
                    (B) at least two such members shall be a director 
                of a State substance abuse agency;
                    (C) at least two such members shall be a 
                representative of a leading research, advocacy, or 
                service organization for adults with substance use 
                disorder;
                    (D) at least two such members shall--
                            (i) be a physician, licensed mental health 
                        professional, advance practice registered 
                        nurse, or physician assistant; and
                            (ii) have experience in treating 
                        individuals with substance use disorders;
                    (E) at least one such member shall be a substance 
                use disorder treatment professional who provides 
                treatment services at a certified opioid treatment 
                program;
                    (F) 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;
                    (G) 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;
                    (H) at least one such member shall be a State-
                certified substance use disorder peer support 
                specialist;
                    (I) at least one such member shall be a drug court 
                judge or a judge with experience in adjudicating cases 
                related to substance use disorder;
                    (J) at least one such member shall be a public 
                safety officer with extensive experience in interacting 
                with adults with a substance use disorder; and
                    (K) at least one such member shall be an individual 
                with experience providing services for homeless 
                individuals with a substance use disorder.
    (c) Terms.--
            (1) In general.--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.
            (2) Vacancies.--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.
    (d) Meetings.--The Committee shall meet not fewer than two times 
each year.
    (e) Duties.--The Committee shall--
            (1) identify areas for improved coordination of activities, 
        if any, related to substance use disorders, including research, 
        services, supports, and prevention activities across all 
        relevant Federal agencies;
            (2) identify and provide to the Secretary recommendations 
        for improving Federal programs for the prevention and treatment 
        of, and recovery from, substance use disorders, including by 
        expanding access to prevention, treatment, and recovery 
        services;
            (3) analyze substance use disorder prevention and treatment 
        strategies in different regions of 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;
            (4) make recommendations to the Secretary regarding any 
        appropriate changes with respect to the activities and 
        strategies described in paragraphs (1) through (3);
            (5) make recommendations to the Secretary regarding public 
        participation in decisions relating to substance use disorders 
        and the process by which public feedback can be better 
        integrated into such decisions; and
            (6) make recommendations to ensure that substance use 
        disorder research, services, supports, and prevention 
        activities of the Department of Health and Human Services and 
        other Federal agencies are not unnecessarily duplicative.
    (f) Annual Report.--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 Internet website of the 
Department of Health and Human Services, which may include the public 
information dashboard established under section 1711 of the Public 
Health Service Act, as added by section 7021, a report summarizing the 
activities carried out by the Committee pursuant to subsection (e), 
including any findings resulting from such activities.
    (g) Working Groups.--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.
    (h) Federal Advisory Committee Act.--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.
    (i) Sunset.--The Committee shall terminate on the date that is 6 
years after the date on which the Committee is established under 
subsection (a).

SEC. 7023. NATIONAL MILESTONES TO MEASURE SUCCESS IN CURTAILING THE 
              OPIOID CRISIS.

    (a) In General.--Not later than 180 days after the date of 
enactment of this Act, the Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), in coordination 
with the Administrator of the Drug Enforcement Administration and the 
Director of the Office of National Drug Control Policy, shall develop 
or identify existing national indicators (referred to in this section 
as the ``national milestones'') to measure success in curtailing the 
opioid crisis, with the goal of significantly reversing the incidence 
and prevalence of opioid misuse and abuse, and opioid-related morbidity 
and mortality in the United States within 5 years of such date of 
enactment.
    (b) National Milestones to End the Opioid Crisis.--The national 
milestones under subsection (a) shall include the following:
            (1) Not fewer than 10 indicators or metrics to accurately 
        and expediently measure progress in meeting the goal described 
        in subsection (a), which shall, as appropriate, include, 
        indicators or metrics related to--
                    (A) the number of fatal and non-fatal opioid 
                overdoses;
                    (B) the number of emergency room visits related to 
                opioid misuse and abuse;
                    (C) the number of individuals in sustained recovery 
                from opioid use disorder;
                    (D) the number of infections associated with 
                illicit drug use, such as HIV, viral hepatitis, and 
                infective endocarditis, and available capacity for 
                treating such infections;
                    (E) the number of providers prescribing medication-
                assisted treatment for opioid use disorders, including 
                in primary care settings, community health centers, 
                jails, and prisons;
                    (F) the number of individuals receiving treatment 
                for opioid use disorder; and
                    (G) additional indicators or metrics, as 
                appropriate, such as metrics pertaining to specific 
                populations, including women and children, American 
                Indians and Alaskan Natives, individuals living in 
                rural and non-urban areas, and justice-involved 
                populations, that would further clarify the progress 
                made in addressing the opioid crisis.
            (2) A reasonable goal, such as a percentage decrease or 
        other specified metric, that signifies progress in meeting the 
        goal described in subsection (a), and annual targets to help 
        achieve that goal.
    (c) Consideration of Other Substance Use Disorders.--In developing 
the national milestones under subsection (b), the Secretary shall, as 
appropriate, consider other substance use disorders in addition to 
opioid use disorder.
    (d) Extension of Period.--If the Secretary determines that the goal 
described in subsection (a) will not be achieved with respect to any 
indicator or metric established under subsection (b)(2) within 5 years 
of the date of enactment of this Act, the Secretary may extend the 
timeline for meeting such goal with respect to that indicator or 
metric. The Secretary shall include with any such extension a rationale 
for why additional time is needed and information on whether 
significant changes are needed in order to achieve such goal with 
respect to the indicator or metric.
    (e) Annual Status Update.--Not later than one year after the date 
of enactment of this Act, the Secretary shall make available on the 
Internet website of the Department of Health and Human Services, and 
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, an update on the progress, including expected progress 
in the subsequent year, in achieving the goals detailed in the national 
milestones. Each such update shall include the progress made in the 
first year or since the previous report, as applicable, in meeting each 
indicator or metric in the national milestones.

SEC. 7024. STUDY ON PRESCRIBING LIMITS.

    Not later than 2 years after the date of enactment of this Act, the 
Secretary of Health and Human Services, in consultation with the 
Attorney General of the United States, 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 on the 
impact of Federal and State laws and regulations that limit the length, 
quantity, or dosage of opioid prescriptions. Such report shall 
address--
            (1) the impact of such limits on--
                    (A) the incidence and prevalence of overdose 
                related to prescription opioids;
                    (B) the incidence and prevalence of overdose 
                related to illicit opioids;
                    (C) the prevalence of opioid use disorders;
                    (D) medically appropriate use of, and access to, 
                opioids, including any impact on travel expenses and 
                pain management outcomes for patients, whether such 
                limits are associated with significantly higher rates 
                of negative health outcomes, including suicide, and 
                whether the impact of such limits differs based on the 
                clinical indication for which opioids are prescribed;
            (2) whether such limits lead to a significant increase in 
        burden for prescribers of opioids or prescribers of treatments 
        for opioid use disorder, including any impact on patient access 
        to treatment, and whether any such burden is mitigated by any 
        factors such as electronic prescribing or telemedicine; and
            (3) the impact of such limits on diversion or misuse of any 
        controlled substance in schedule II, III, or IV of section 
        202(c) of the Controlled Substances Act (21 U.S.C. 812(c)).

          Subtitle D--Ensuring Access to Quality Sober Living

SEC. 7031. NATIONAL RECOVERY HOUSING BEST PRACTICES.

    Part D of title V of the Public Health Service Act (42 U.S.C. 290dd 
et seq.) is amended by adding at the end the following new section:

``SEC. 550. NATIONAL RECOVERY HOUSING BEST PRACTICES.

    ``(a) Best Practices for Operating Recovery Housing.--
            ``(1) In general.--The Secretary, in consultation with the 
        individuals and entities specified in paragraph (2), shall 
        identify or facilitate the development of best practices, which 
        may include model laws for implementing suggested minimum 
        standards, for operating recovery housing.
            ``(2) Consultation.--In carrying out the activities 
        described in paragraph (1), the Secretary shall consult with, 
        as appropriate--
                    ``(A) relevant divisions of the Department of 
                Health and Human Services, including the Substance 
                Abuse and Mental Health Services Administration, the 
                Office of Inspector General, the Indian Health Service, 
                and the Centers for Medicare & Medicaid Services;
                    ``(B) the Secretary of Housing and Urban 
                Development;
                    ``(C) directors or commissioners, as applicable, of 
                State health departments, tribal health departments, 
                State Medicaid programs, and State insurance agencies;
                    ``(D) representatives of health insurance issuers;
                    ``(E) national accrediting entities and reputable 
                providers of, and analysts of, recovery housing 
                services, including Indian tribes, tribal 
                organizations, and tribally designated housing entities 
                that provide recovery housing services, as applicable;
                    ``(F) individuals with a history of substance use 
                disorder; and
                    ``(G) other stakeholders identified by the 
                Secretary.
    ``(b) Identification of Fraudulent Recovery Housing Operators.--
            ``(1) In general.--The Secretary, in consultation with the 
        individuals and entities described in paragraph (2), shall 
        identify or facilitate the development of common indicators 
        that could be used to identify potentially fraudulent recovery 
        housing operators.
            ``(2) Consultation.--In carrying out the activities 
        described in paragraph (1), the Secretary shall consult with, 
        as appropriate, the individuals and entities specified in 
        subsection (a)(2) and the Attorney General of the United 
        States.
            ``(3) Requirements.--
                    ``(A) Practices for identification and reporting.--
                In carrying out the activities described in paragraph 
                (1), the Secretary shall consider how law enforcement, 
                public and private payers, and the public can best 
                identify and report fraudulent recovery housing 
                operators.
                    ``(B) Factors to be considered.--In carrying out 
                the activities described in paragraph (1), the 
                Secretary shall identify or develop indicators, which 
                may include indicators related to--
                            ``(i) unusual billing practices;
                            ``(ii) average lengths of stays;
                            ``(iii) excessive levels of drug testing 
                        (in terms of cost or frequency); and
                            ``(iv) unusually high levels of recidivism.
    ``(c) Dissemination.--The Secretary shall, as appropriate, 
disseminate the best practices identified or developed under subsection 
(a) and the common indicators identified or developed under subsection 
(b) to--
            ``(1) State agencies, which may include the provision of 
        technical assistance to State agencies seeking to adopt or 
        implement such best practices;
            ``(2) Indian tribes, tribal organizations, and tribally 
        designated housing entities;
            ``(3) the Attorney General of the United States;
            ``(4) the Secretary of Labor;
            ``(5) the Secretary of Housing and Urban Development;
            ``(6) State and local law enforcement agencies;
            ``(7) health insurance issuers;
            ``(8) recovery housing entities; and
            ``(9) the public.
    ``(d) Requirements.--In carrying out the activities described in 
subsections (a) and (b), the Secretary, in consultation with 
appropriate individuals and entities described in subsections (a)(2) 
and (b)(2), shall consider how recovery housing is able to support 
recovery and prevent relapse, recidivism, or overdose (including 
overdose death), including by improving access and adherence to 
treatment, including medication-assisted treatment.
    ``(e) Rule of Construction.--Nothing in this section shall be 
construed to provide the Secretary with the authority to require States 
to adhere to minimum standards in the State oversight of recovery 
housing.
    ``(f) Definitions.--In this section:
            ``(1) The term `recovery housing' means a shared living 
        environment free from alcohol and illicit drug use and centered 
        on peer support and connection to services that promote 
        sustained recovery from substance use disorders.
            ``(2) The terms `Indian tribe' and `tribal organization' 
        have the meanings given those terms in section 4 of the Indian 
        Self-Determination and Education Assistance Act (25 U.S.C. 
        5304).
            ``(3) The term `tribally designated housing entity' has the 
        meaning given that term in section 4 of the Native American 
        Housing Assistance and Self-Determination Act of 1996 (25 
        U.S.C. 4103).
    ``(g) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $3,000,000 for the period of 
fiscal years 2019 through 2021.''.

              Subtitle E--Advancing Cutting Edge Research

SEC. 7041. UNIQUE RESEARCH INITIATIVES.

    Section 402(n)(1) of the Public Health Service Act (42 U.S.C. 
282(n)(1)) is amended--
            (1) in subparagraph (A), by striking ``or'';
            (2) in subparagraph (B), by striking the period and 
        inserting ``; or''; and
            (3) by adding at the end the following:
                    ``(C) 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.''.

SEC. 7042. PAIN RESEARCH.

    Section 409J(b) of the Public Health Service Act (42 U.S.C. 
284q(b)) is amended--
            (1) in paragraph (5)--
                    (A) in subparagraph (A), by striking ``and 
                treatment of pain and diseases and disorders associated 
                with pain'' and inserting ``treatment, and management 
                of pain and diseases and disorders associated with 
                pain, including information on best practices for the 
                utilization of non-pharmacologic treatments, non-
                addictive medical products, and other drugs or devices 
                approved or cleared by the Food and Drug 
                Administration'';
                    (B) in subparagraph (B), by striking ``on the 
                symptoms and causes of pain;'' and inserting the 
                following: ``on--
                            ``(i) the symptoms and causes of pain, 
                        including the identification of relevant 
                        biomarkers and screening models and the 
                        epidemiology of acute and chronic pain;
                            ``(ii) the diagnosis, prevention, 
                        treatment, and management of acute and chronic 
                        pain, including with respect to non-
                        pharmacologic treatments, non-addictive medical 
                        products, and other drugs or devices approved 
                        or cleared by the Food and Drug Administration; 
                        and
                            ``(iii) risk factors for, and early warning 
                        signs of, substance use disorders in 
                        populations with acute and chronic pain; and''; 
                        and
                    (C) by striking subparagraphs (C) through (E) and 
                inserting the following:
                    ``(C) make recommendations to the Director of NIH--
                            ``(i) to ensure that the activities of the 
                        National Institutes of Health and other Federal 
                        agencies are free of unnecessary duplication of 
                        effort;
                            ``(ii) on how best to disseminate 
                        information on pain care and epidemiological 
                        data related to acute and chronic pain; and
                            ``(iii) on how to expand partnerships 
                        between public entities and private entities to 
                        expand collaborative, cross-cutting 
                        research.'';
            (2) by redesignating paragraph (6) as paragraph (7); and
            (3) by inserting after paragraph (5) the following:
            ``(6) Report.--The Secretary shall ensure that 
        recommendations and actions taken by the Director with respect 
        to the topics discussed at the meetings described in paragraph 
        (4) are included in appropriate reports to Congress.''.

                        Subtitle F--Jessie's Law

SEC. 7051. INCLUSION OF OPIOID ADDICTION HISTORY IN PATIENT RECORDS.

    (a) Best Practices.--
            (1) In general.--Not later than 1 year after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services (in this section referred to as the ``Secretary''), 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--
                    (A) 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;
                    (B) what constitutes the patient's request for the 
                purpose described in subparagraph (A); and
                    (C) the process and methods by which the 
                information should be so displayed.
            (2) Dissemination.--The Secretary shall disseminate the 
        best practices developed under paragraph (1) to health care 
        providers and State agencies.
    (b) Requirements.--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:
            (1) The potential for addiction relapse or overdose, 
        including overdose death, when opioid medications are 
        prescribed to a patient recovering from opioid use disorder.
            (2) 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.
            (3) 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.
            (4) The importance of a variety of appropriate medical 
        professionals, including physicians, nurses, and pharmacists, 
        having access to information described in this section when 
        prescribing or dispensing opioid medication, consistent with 
        Federal and State laws and regulations.
            (5) 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.
            (6) All applicable Federal and State laws and regulations.

SEC. 7052. COMMUNICATION WITH FAMILIES DURING EMERGENCIES.

    (a)  Promoting Awareness of Authorized Disclosures During 
Emergencies.--The Secretary of Health and Human Services shall annually 
notify 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.
    (b) Use of Material.--For the purposes of carrying out subsection 
(a), the Secretary of Health and Human Services may use material 
produced under section 7053 of this Act or section 11004 of the 21st 
Century Cures Act (42 U.S.C. 1320d-2 note).

SEC. 7053. DEVELOPMENT AND DISSEMINATION OF MODEL TRAINING PROGRAMS FOR 
              SUBSTANCE USE DISORDER PATIENT RECORDS.

    (a) Initial Programs and Materials.--Not later than 1 year after 
the date of the enactment of this Act, the Secretary of Health and 
Human Services (in this section referred to as the ``Secretary''), in 
consultation with appropriate experts, shall identify the following 
model programs and materials (or if no such programs or materials 
exist, recognize private or public entities to develop and disseminate 
such programs and materials):
            (1) Model programs and materials for training health care 
        providers (including physicians, emergency medical personnel, 
        psychiatrists, psychologists, counselors, therapists, nurse 
        practitioners, physician assistants, behavioral health 
        facilities and clinics, care managers, and hospitals, including 
        individuals such as general counsels or regulatory compliance 
        staff who are responsible for establishing provider privacy 
        policies) concerning the permitted uses and disclosures, 
        consistent with the standards and regulations governing the 
        privacy and security of substance use disorder patient records 
        promulgated by the Secretary under section 543 of the Public 
        Health Service Act (42 U.S.C. 290dd-2) for the confidentiality 
        of patient records.
            (2) Model programs and materials for training patients and 
        their families regarding their rights to protect and obtain 
        information under the standards and regulations described in 
        paragraph (1).
    (b) Requirements.--The model programs and materials described in 
paragraphs (1) and (2) of subsection (a) shall address circumstances 
under which disclosure of substance use disorder patient records is 
needed to--
            (1) facilitate communication between substance use disorder 
        treatment providers and other health care providers to promote 
        and provide the best possible integrated care;
            (2) avoid inappropriate prescribing that can lead to 
        dangerous drug interactions, overdose, or relapse; and
            (3) notify and involve families and caregivers when 
        individuals experience an overdose.
    (c) Periodic Updates.--The Secretary shall--
            (1) periodically review and update the model program and 
        materials identified or developed under subsection (a); and
            (2) disseminate such updated programs and materials to the 
        individuals described in subsection (a)(1).
    (d) Input of Certain Entities.--In identifying, reviewing, or 
updating the model programs and materials under this section, the 
Secretary shall solicit the input of relevant stakeholders.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section--
            (1) $4,000,000 for fiscal year 2019;
            (2) $2,000,000 for each of fiscal years 2020 and 2021; and
            (3) $1,000,000 for each of fiscal years 2022 and 2023.

           Subtitle G--Protecting Pregnant Women and Infants

SEC. 7061. REPORT ON ADDRESSING MATERNAL AND INFANT HEALTH IN THE 
              OPIOID CRISIS.

    (a) In General.--Not later than 18 months 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, the Indian Health Service, and the 
Substance Abuse and Mental Health Services Administration, shall 
develop and 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--
            (1) information on opioid, non-opioid, and non-
        pharmacologic pain management practices during pregnancy and 
        after pregnancy;
            (2) recommendations for increasing public awareness and 
        education about substance use disorders, including opioid use 
        disorders, during and after pregnancy, including available 
        treatment resources in urban and rural areas;
            (3) recommendations to prevent, identify, and reduce 
        substance use disorders, including opioid use disorders, during 
        pregnancy to improve care for pregnant women with substance use 
        disorders and their infants; and
            (4) an identification of areas in need of further research 
        with respect to acute and chronic pain management during and 
        after pregnancy.
    (b) No Additional Funds.--No additional funds are authorized to be 
appropriated for purposes of carrying out subsection (a).

SEC. 7062. PROTECTING MOMS AND INFANTS.

    (a) Report.--
            (1) In general.--Not later than 60 days after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services (referred to in this section as the ``Secretary'') 
        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, and make available to the 
        public on the Internet website of the Department of Health and 
        Human Services, a report regarding the implementation of the 
        recommendations in the strategy relating to prenatal opioid 
        use, including neonatal abstinence syndrome, developed pursuant 
        to section 2 of the Protecting Our Infants Act of 2015 (Public 
        Law 114-91). Such report shall include--
                    (A) an update on the implementation of the 
                recommendations in the strategy, including information 
                regarding the agencies involved in the implementation; 
                and
                    (B) information on additional funding or authority 
                the Secretary requires, if any, to implement the 
                strategy, which may include authorities needed to 
                coordinate implementation of such strategy across the 
                Department of Health and Human Services.
            (2) Periodic updates.--The Secretary shall periodically 
        update the report under paragraph (1).
    (b) Residential Treatment Programs for Pregnant and Postpartum 
Women.--Section 508(s) of the Public Health Service Act (42 U.S.C. 
290bb-1(s)) is amended by striking ``$16,900,000 for each of fiscal 
years 2017 through 2021'' and inserting ``$29,931,000 for each of 
fiscal years 2019 through 2023''.

SEC. 7063. EARLY INTERVENTIONS FOR PREGNANT WOMEN AND INFANTS.

    (a) Development of Educational Materials by Center for Substance 
Abuse Prevention.--Section 515(b) of the Public Health Service Act (42 
U.S.C. 290bb-21(b)) is amended--
            (1) in paragraph (13), by striking ``and'' at the end;
            (2) in paragraph (14), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(15) in consultation with relevant stakeholders and in 
        collaboration with the Director of the Centers for Disease 
        Control and Prevention, develop educational materials for 
        clinicians to use with pregnant women for shared decision 
        making regarding pain management and the prevention of 
        substance use disorders during pregnancy.''.
    (b) Guidelines and Recommendations by Center for Substance Abuse 
Treatment.--Section 507(b) of the Public Health Service Act (42 U.S.C. 
290bb(b)) is amended--
            (1) in paragraph (13), by striking ``and'' at the end;
            (2) in paragraph (14), by striking the period at the end 
        and inserting a semicolon; and
            (3) by adding at the end the following:
            ``(15) in cooperation with the Secretary, implement and 
        disseminate, as appropriate, the recommendations in the report 
        entitled `Protecting Our Infants Act: Final Strategy' issued by 
        the Department of Health and Human Services in 2017; and''.
    (c) Support of Partnerships by Center for Substance Abuse 
Treatment.--Section 507(b) of the Public Health Service Act (42 U.S.C. 
290bb(b)), as amended by subsection (b), is further amended by adding 
at the end the following:
            ``(16) in cooperation with relevant stakeholders, and 
        through public-private partnerships, encourage education about 
        substance use disorders for pregnant women and health care 
        providers who treat pregnant women and babies.''.

SEC. 7064. PRENATAL AND POSTNATAL HEALTH.

    Section 317L of the Public Health Service Act (42 U.S.C. 247b-13) 
is amended--
            (1) in subsection (a)--
                    (A) by amending paragraph (1) to read as follows:
            ``(1) to collect, analyze, and make available data on 
        prenatal smoking and alcohol and other substance abuse and 
        misuse, including--
                    ``(A) data on--
                            ``(i) the incidence, prevalence, and 
                        implications of such activities; and
                            ``(ii) the incidence and prevalence of 
                        implications and outcomes, including neonatal 
                        abstinence syndrome and other maternal and 
                        child health outcomes associated with such 
                        activities; and
                    ``(B) additional information or data, as 
                appropriate, on family health history, medication 
                exposures during pregnancy, demographic information, 
                such as race, ethnicity, geographic location, and 
                family history, and other relevant information, to 
                inform such analysis;'';
                    (B) in paragraph (2)--
                            (i) by striking ``prevention of'' and 
                        inserting ``prevention and long-term outcomes 
                        associated with''; and
                            (ii) by striking ``illegal drug use'' and 
                        inserting ``other substance abuse and misuse'';
                    (C) in paragraph (3), by striking ``and cessation 
                programs; and'' and inserting ``, treatment, and 
                cessation programs;'';
                    (D) in paragraph (4), by striking ``illegal drug 
                use.'' and inserting ``other substance abuse and 
                misuse; and''; and
                    (E) by adding at the end the following:
            ``(5) to issue public reports on the analysis of data 
        described in paragraph (1), including analysis of--
                    ``(A) long-term outcomes of children affected by 
                neonatal abstinence syndrome;
                    ``(B) health outcomes associated with prenatal 
                smoking, alcohol, and substance abuse and misuse; and
                    ``(C) relevant studies, evaluations, or information 
                the Secretary determines to be appropriate.'';
            (2) in subsection (b), by inserting ``tribal entities,'' 
        after ``local governments,'';
            (3) by redesignating subsection (c) as subsection (d);
            (4) by inserting after subsection (b) the following:
    ``(c) Coordinating Activities.--To carry out this section, the 
Secretary may--
            ``(1) provide technical and consultative assistance to 
        entities receiving grants under subsection (b);
            ``(2) ensure a pathway for data sharing between States, 
        tribal entities, and the Centers for Disease Control and 
        Prevention;
            ``(3) ensure data collection under this section is 
        consistent with applicable State, Federal, and Tribal privacy 
        laws; and
            ``(4) coordinate with the National Coordinator for Health 
        Information Technology, as appropriate, to assist States and 
        Tribes in implementing systems that use standards recognized by 
        such National Coordinator, as such recognized standards are 
        available, in order to facilitate interoperability between such 
        systems and health information technology systems, including 
        certified health information technology.''; and
            (5) in subsection (d), as so redesignated, by striking 
        ``2001 through 2005'' and inserting ``2019 through 2023''.

SEC. 7065. PLANS OF SAFE CARE.

    (a) In General.--Section 105(a) of the Child Abuse Prevention and 
Treatment Act (42 U.S.C. 5106(a)) is amended by adding at the end the 
following:
            ``(7) Grants to states to improve and coordinate their 
        response to ensure the safety, permanency, and well-being of 
        infants affected by substance use.--
                    ``(A) Program authorized.--The Secretary is 
                authorized to make grants to States for the purpose of 
                assisting child welfare agencies, social services 
                agencies, substance use disorder treatment agencies, 
                hospitals with labor and delivery units, medical staff, 
                public health and mental health agencies, and maternal 
                and child health agencies to facilitate collaboration 
                in developing, updating, implementing, and monitoring 
                plans of safe care described in section 
                106(b)(2)(B)(iii). Section 112(a)(2) shall not apply to 
                the program authorized under this paragraph.
                    ``(B) Distribution of funds.--
                            ``(i) Reservations.--Of the amounts made 
                        available to carry out subparagraph (A), the 
                        Secretary shall reserve--
                                    ``(I) no more than 3 percent for 
                                the purposes described in subparagraph 
                                (G); and
                                    ``(II) up to 3 percent for grants 
                                to Indian Tribes and tribal 
                                organizations to address the needs of 
                                infants born with, and identified as 
                                being affected by, substance abuse or 
                                withdrawal symptoms resulting from 
                                prenatal drug exposure or a fetal 
                                alcohol spectrum disorder and their 
                                families or caregivers, which to the 
                                extent practicable, shall be consistent 
                                with the uses of funds described under 
                                subparagraph (D).
                            ``(ii) Allotments to states and 
                        territories.--The Secretary shall allot the 
                        amount made available to carry out subparagraph 
                        (A) that remains after application of clause 
                        (i) to each State that applies for such a 
                        grant, in an amount equal to the sum of--
                                    ``(I) $500,000; and
                                    ``(II) an amount that bears the 
                                same relationship to any funds made 
                                available to carry out subparagraph (A) 
                                and remaining after application of 
                                clause (i), as the number of live 
                                births in the State in the previous 
                                calendar year bears to the number of 
                                live births in all States in such year.
                            ``(iii) Ratable reduction.--If the amount 
                        made available to carry out subparagraph (A) is 
                        insufficient to satisfy the requirements of 
                        clause (ii), the Secretary shall ratably reduce 
                        each allotment to a State.
                    ``(C) Application.--A State desiring a grant under 
                this paragraph shall submit an application to the 
                Secretary at such time and in such manner as the 
                Secretary may require. Such application shall include--
                            ``(i) a description of--
                                    ``(I) the impact of substance use 
                                disorder in such State, including with 
                                respect to the substance or class of 
                                substances with the highest incidence 
                                of abuse in the previous year in such 
                                State, including--
                                            ``(aa) the prevalence of 
                                        substance use disorder in such 
                                        State;
                                            ``(bb) the aggregate rate 
                                        of births in the State of 
                                        infants affected by substance 
                                        abuse or withdrawal symptoms or 
                                        a fetal alcohol spectrum 
                                        disorder (as determined by 
                                        hospitals, insurance claims, 
                                        claims submitted to the State 
                                        Medicaid program, or other 
                                        records), if available and to 
                                        the extent practicable; and
                                            ``(cc) the number of 
                                        infants identified, for whom a 
                                        plan of safe care was 
                                        developed, and for whom a 
                                        referral was made for 
                                        appropriate services, as 
                                        reported under section 
                                        106(d)(18);
                                    ``(II) the challenges the State 
                                faces in developing, implementing, and 
                                monitoring plans of safe care in 
                                accordance with section 
                                106(b)(2)(B)(iii);
                                    ``(III) the State's lead agency for 
                                the grant program and how that agency 
                                will coordinate with relevant State 
                                entities and programs, including the 
                                child welfare agency, the substance use 
                                disorder treatment agency, hospitals 
                                with labor and delivery units, health 
                                care providers, the public health and 
                                mental health agencies, programs funded 
                                by the Substance Abuse and Mental 
                                Health Services Administration that 
                                provide substance use disorder 
                                treatment for women, the State Medicaid 
                                program, the State agency administering 
                                the block grant program under title V 
                                of the Social Security Act (42 U.S.C. 
                                701 et seq.), the State agency 
                                administering the programs funded under 
                                part C of the Individuals with 
                                Disabilities Education Act (20 U.S.C. 
                                1431 et seq.), the maternal, infant, 
                                and early childhood home visiting 
                                program under section 511 of the Social 
                                Security Act (42 U.S.C. 711), the State 
                                judicial system, and other agencies, as 
                                determined by the Secretary, and Indian 
                                Tribes and tribal organizations, as 
                                appropriate, to implement the 
                                activities under this paragraph;
                                    ``(IV) how the State will monitor 
                                local development and implementation of 
                                plans of safe care, in accordance with 
                                section 106(b)(2)(B)(iii)(II), 
                                including how the State will monitor to 
                                ensure plans of safe care address 
                                differences between substance use 
                                disorder and medically supervised 
                                substance use, including for the 
                                treatment of a substance use disorder;
                                    ``(V) if applicable, how the State 
                                plans to utilize funding authorized 
                                under part E of title IV of the Social 
                                Security Act (42 U.S.C. 670 et seq.) to 
                                assist in carrying out any plan of safe 
                                care, including such funding authorized 
                                under section 471(e) of such Act (as in 
                                effect on October 1, 2018) for mental 
                                health and substance abuse prevention 
                                and treatment services and in-home 
                                parent skill-based programs and funding 
                                authorized under such section 472(j) 
                                (as in effect on October 1, 2018) for 
                                children with a parent in a licensed 
                                residential family-based treatment 
                                facility for substance abuse; and
                                    ``(VI) an assessment of the 
                                treatment and other services and 
                                programs available in the State to 
                                effectively carry out any plan of safe 
                                care developed, including 
                                identification of needed treatment, and 
                                other services and programs to ensure 
                                the well-being of young children and 
                                their families affected by substance 
                                use disorder, such as programs carried 
                                out under part C of the Individuals 
                                with Disabilities Education Act (20 
                                U.S.C. 1431 et seq.) and comprehensive 
                                early childhood development services 
                                and programs such as Head Start 
                                programs;
                            ``(ii) a description of how the State plans 
                        to use funds for activities described in 
                        subparagraph (D) for the purposes of ensuring 
                        State compliance with requirements under 
                        clauses (ii) and (iii) of section 106(b)(2)(B); 
                        and
                            ``(iii) an assurance that the State will 
                        comply with requirements to refer a child 
                        identified as substance-exposed to early 
                        intervention services as required pursuant to a 
                        grant under part C of the Individuals with 
                        Disabilities Education Act (20 U.S.C. 1431 et 
                        seq.).
                    ``(D) Uses of funds.--Funds awarded to a State 
                under this paragraph may be used for the following 
                activities, which may be carried out by the State 
                directly, or through grants or subgrants, contracts, or 
                cooperative agreements:
                            ``(i) Improving State and local systems 
                        with respect to the development and 
                        implementation of plans of safe care, which--
                                    ``(I) shall include parent and 
                                caregiver engagement, as required under 
                                section 106(b)(2)(B)(iii)(I), regarding 
                                available treatment and service 
                                options, which may include resources 
                                available for pregnant, perinatal, and 
                                postnatal women; and
                                    ``(II) may include activities such 
                                as--
                                            ``(aa) developing policies, 
                                        procedures, or protocols for 
                                        the administration or 
                                        development of evidence-based 
                                        and validated screening tools 
                                        for infants who may be affected 
                                        by substance use withdrawal 
                                        symptoms or a fetal alcohol 
                                        spectrum disorder and pregnant, 
                                        perinatal, and postnatal women 
                                        whose infants may be affected 
                                        by substance use withdrawal 
                                        symptoms or a fetal alcohol 
                                        spectrum disorder;
                                            ``(bb) improving 
                                        assessments used to determine 
                                        the needs of the infant and 
                                        family;
                                            ``(cc) improving ongoing 
                                        case management services;
                                            ``(dd) improving access to 
                                        treatment services, which may 
                                        be prior to the pregnant 
                                        woman's delivery date; and
                                            ``(ee) keeping families 
                                        safely together when it is in 
                                        the best interest of the child.
                            ``(ii) Developing policies, procedures, or 
                        protocols in consultation and coordination with 
                        health professionals, public and private health 
                        facilities, and substance use disorder 
                        treatment agencies to ensure that--
                                    ``(I) appropriate notification to 
                                child protective services is made in a 
                                timely manner, as required under 
                                section 106(b)(2)(B)(ii);
                                    ``(II) a plan of safe care is in 
                                place, in accordance with section 
                                106(b)(2)(B)(iii), before the infant is 
                                discharged from the birth or health 
                                care facility; and
                                    ``(III) such health and related 
                                agency professionals are trained on how 
                                to follow such protocols and are aware 
                                of the supports that may be provided 
                                under a plan of safe care.
                            ``(iii) Training health professionals and 
                        health system leaders, child welfare workers, 
                        substance use disorder treatment agencies, and 
                        other related professionals such as home 
                        visiting agency staff and law enforcement in 
                        relevant topics including--
                                    ``(I) State mandatory reporting 
                                laws established under section 
                                106(b)(2)(B)(i) and the referral and 
                                process requirements for notification 
                                to child protective services when child 
                                abuse or neglect reporting is not 
                                mandated;
                                    ``(II) the co-occurrence of 
                                pregnancy and substance use disorder, 
                                and implications of prenatal exposure;
                                    ``(III) the clinical guidance about 
                                treating substance use disorder in 
                                pregnant and postpartum women;
                                    ``(IV) appropriate screening and 
                                interventions for infants affected by 
                                substance use disorder, withdrawal 
                                symptoms, or a fetal alcohol spectrum 
                                disorder and the requirements under 
                                section 106(b)(2)(B)(iii); and
                                    ``(V) appropriate multigenerational 
                                strategies to address the mental health 
                                needs of the parent and child together.
                            ``(iv) Establishing partnerships, 
                        agreements, or memoranda of understanding 
                        between the lead agency and other entities 
                        (including health professionals, health 
                        facilities, child welfare professionals, 
                        juvenile and family court judges, substance use 
                        and mental disorder treatment programs, early 
                        childhood education programs, maternal and 
                        child health and early intervention 
                        professionals (including home visiting 
                        providers), peer-to-peer recovery programs such 
                        as parent mentoring programs, and housing 
                        agencies) to facilitate the implementation of, 
                        and compliance with, section 106(b)(2) and 
                        clause (ii) of this subparagraph, in areas 
                        which may include--
                                    ``(I) developing a comprehensive, 
                                multi-disciplinary assessment and 
                                intervention process for infants, 
                                pregnant women, and their families who 
                                are affected by substance use disorder, 
                                withdrawal symptoms, or a fetal alcohol 
                                spectrum disorder, that includes 
                                meaningful engagement with and takes 
                                into account the unique needs of each 
                                family and addresses differences 
                                between medically supervised substance 
                                use, including for the treatment of 
                                substance use disorder, and substance 
                                use disorder;
                                    ``(II) ensuring that treatment 
                                approaches for serving infants, 
                                pregnant women, and perinatal and 
                                postnatal women whose infants may be 
                                affected by substance use, withdrawal 
                                symptoms, or a fetal alcohol spectrum 
                                disorder, are designed to, where 
                                appropriate, keep infants with their 
                                mothers during both inpatient and 
                                outpatient treatment; and
                                    ``(III) increasing access to all 
                                evidence-based medication-assisted 
                                treatment approved by the Food and Drug 
                                Administration, behavioral therapy, and 
                                counseling services for the treatment 
                                of substance use disorders, as 
                                appropriate.
                            ``(v) Developing and updating systems of 
                        technology for improved data collection and 
                        monitoring under section 106(b)(2)(B)(iii), 
                        including existing electronic medical records, 
                        to measure the outcomes achieved through the 
                        plans of safe care, including monitoring 
                        systems to meet the requirements of this Act 
                        and submission of performance measures.
                    ``(E) Reporting.--Each State that receives funds 
                under this paragraph, for each year such funds are 
                received, shall submit a report to the Secretary, 
                disaggregated by geographic location, economic status, 
                and major racial and ethnic groups, except that such 
                disaggregation shall not be required if the results 
                would reveal personally identifiable information on, 
                with respect to infants identified under section 
                106(b)(2)(B)(ii)--
                            ``(i) the number who experienced removal 
                        associated with parental substance use;
                            ``(ii) the number who experienced removal 
                        and subsequently are reunified with parents, 
                        and the length of time between such removal and 
                        reunification;
                            ``(iii) the number who are referred to 
                        community providers without a child protection 
                        case;
                            ``(iv) the number who receive services 
                        while in the care of their birth parents;
                            ``(v) the number who receive post-
                        reunification services within 1 year after a 
                        reunification has occurred; and
                            ``(vi) the number who experienced a return 
                        to out-of-home care within 1 year after 
                        reunification.
                    ``(F) Secretary's report to congress.--The 
                Secretary shall submit an annual report to the 
                Committee on Health, Education, Labor, and Pensions and 
                the Committee on Appropriations of the Senate and the 
                Committee on Education and the Workforce and the 
                Committee on Appropriations of the House of 
                Representatives that includes the information described 
                in subparagraph (E) and recommendations or observations 
                on the challenges, successes, and lessons derived from 
                implementation of the grant program.
                    ``(G) Assisting states' implementation.--The 
                Secretary shall use the amount reserved under 
                subparagraph (B)(i)(I) to provide written guidance and 
                technical assistance to support States in complying 
                with and implementing this paragraph, which shall 
                include--
                            ``(i) technical assistance, including 
                        programs of in-depth technical assistance, to 
                        additional States, territories, and Indian 
                        Tribes and tribal organizations in accordance 
                        with the substance-exposed infant initiative 
                        developed by the National Center on Substance 
                        Abuse and Child Welfare;
                            ``(ii) guidance on the requirements of this 
                        Act with respect to infants born with and 
                        identified as being affected by substance use 
                        or withdrawal symptoms or fetal alcohol 
                        spectrum disorder, as described in clauses (ii) 
                        and (iii) of section 106(b)(2)(B), including 
                        by--
                                    ``(I) enhancing States' 
                                understanding of requirements and 
                                flexibilities under the law, including 
                                by clarifying key terms;
                                    ``(II) addressing state-identified 
                                challenges with developing, 
                                implementing, and monitoring plans of 
                                safe care, including those reported 
                                under subparagraph (C)(i)(II);
                                    ``(III) disseminating best 
                                practices on implementation of plans of 
                                safe care, on such topics as 
                                differential response, collaboration 
                                and coordination, and identification 
                                and delivery of services for different 
                                populations, while recognizing needs of 
                                different populations and varying 
                                community approaches across States; and
                                    ``(IV) helping States improve the 
                                long-term safety and well-being of 
                                young children and their families;
                            ``(iii) supporting State efforts to develop 
                        information technology systems to manage plans 
                        of safe care; and
                            ``(iv) preparing the Secretary's report to 
                        Congress described in subparagraph (F).
                    ``(H) Sunset.--The authority under this paragraph 
                shall sunset on September 30, 2023.''.
    (b) Repeal.--The Abandoned Infants Assistance Act of 1988 (42 
U.S.C. 5117aa et seq.) is repealed.

         Subtitle H--Substance Use Disorder Treatment Workforce

SEC. 7071. LOAN REPAYMENT PROGRAM FOR SUBSTANCE USE DISORDER TREATMENT 
              WORKFORCE.

    Title VII of the Public Health Service Act is amended--
            (1) by redesignating part F as part G; and
            (2) by inserting after part E (42 U.S.C. 294n et seq.) the 
        following:

          ``PART F--SUBSTANCE USE DISORDER TREATMENT WORKFORCE

``SEC. 781. LOAN REPAYMENT PROGRAM FOR SUBSTANCE USE DISORDER TREATMENT 
              WORKFORCE.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall carry out a 
program under which--
            ``(1) 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
            ``(2) the individuals each agree to the requirements of 
        service in substance use disorder treatment employment, as 
        described in subsection (d).
    ``(b) Payments.--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:
            ``(1) Service in a shortage area.--The Secretary shall 
        pay--
                    ``(A) for each year of obligated service by an 
                individual pursuant to an agreement under subsection 
                (a), \1/6\ 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
                    ``(B) for completion of the sixth and final year of 
                such service, the remainder of such principal and 
                interest.
            ``(2) Maximum amount.--The total amount of payments under 
        this section to any individual shall not exceed $250,000.
    ``(c) Eligible Loans.--The loans eligible for repayment under this 
section are each of the following:
            ``(1) Any loan for education or training for a substance 
        use disorder treatment employment.
            ``(2) Any loan under part E of title VIII (relating to 
        nursing student loans).
            ``(3) Any Federal Direct Stafford Loan, Federal Direct PLUS 
        Loan, 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).
            ``(4) Any Federal Perkins Loan under part E of title I of 
        the Higher Education Act of 1965.
            ``(5) Any other Federal loan as determined appropriate by 
        the Secretary.
    ``(d) Requirements of Service.--Any individual receiving payments 
under this program as required by an agreement under subsection (a) 
shall agree to an annual commitment to full-time employment, with no 
more than 1 year passing between any 2 years of covered employment, in 
substance use disorder treatment employment in the United States in--
            ``(1) a Mental Health Professional Shortage Area, as 
        designated under section 332; or
            ``(2) 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.
    ``(e) Ineligibility for Double Benefits.--No borrower may, for the 
same service, receive a reduction of loan obligations or a loan 
repayment under both--
            ``(1) this section; and
            ``(2) 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.
    ``(f) Breach.--
            ``(1) Liquidated damages formula.--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).
            ``(2) Limitation.--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.
    ``(g) Additional Criteria.--The Secretary--
            ``(1) 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
            ``(2) shall give notice to the committees specified in 
        subsection (h) of any criteria and rules so established.
    ``(h) Report to Congress.--Not later than 5 years after the date of 
enactment of this section, 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--
            ``(1) the number and location of borrowers who have 
        qualified for loan repayments under this section; and
            ``(2) 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).
    ``(i) Definition.--In this section:
            ``(1) The terms `Indian tribe' and `tribal organization' 
        have the meanings given those terms in section 4 of the Indian 
        Self-Determination and Education Assistance Act.
            ``(2) The term `municipality' means a city, town, or other 
        public body created by or pursuant to State law, or an Indian 
        tribe.
            ``(3) The term `substance use disorder treatment 
        employment' means full-time employment (including a 
        fellowship)--
                    ``(A) where the primary intent and function of the 
                position is the direct treatment or recovery support of 
                patients with or in recovery from a substance use 
                disorder, including master's level social workers, 
                psychologists, counselors, marriage and family 
                therapists, psychiatric mental health practitioners, 
                occupational therapists, psychology doctoral interns, 
                and behavioral health paraprofessionals and physicians, 
                physician assistants, and nurses, who are licensed or 
                certified in accordance with applicable State and 
                Federal laws; and
                    ``(B) 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 an Indian tribe or 
                tribal organization, Federal medical facility, or any 
                other facility as determined appropriate for purposes 
                of this section by the Secretary.
    ``(j) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $25,000,000 for each of fiscal 
years 2019 through 2023.''.

SEC. 7072. CLARIFICATION REGARDING SERVICE IN SCHOOLS AND OTHER 
              COMMUNITY-BASED SETTINGS.

    Subpart III of part D of title III of the Public Health Service Act 
(42 U.S.C. 254l et seq.) is amended by adding at the end the following:

``SEC. 338N. CLARIFICATION REGARDING SERVICE IN SCHOOLS AND OTHER 
              COMMUNITY-BASED SETTINGS.

    ``(a) Schools and Community-based Settings.--An entity to which a 
participant in the Scholarship Program or the Loan Repayment Program 
(referred to in this section as a `participant') is assigned under 
section 333 may direct such participant to provide service as a 
behavioral or mental health professional at a school or other 
community-based setting located in a health professional shortage area.
    ``(b) Obligated Service.--
            ``(1) In general.--Any service described in subsection (a) 
        that a participant provides may count towards such 
        participant's completion of any obligated service requirements 
        under the Scholarship Program or the Loan Repayment Program, 
        subject to any limitation imposed under paragraph (2).
            ``(2) Limitation.--The Secretary may impose a limitation on 
        the number of hours of service described in subsection (a) that 
        a participant may credit towards completing obligated service 
        requirements, provided that the limitation allows a member to 
        credit service described in subsection (a) for not less than 50 
        percent of the total hours required to complete such obligated 
        service requirements.
    ``(c) Rule of Construction.--The authorization under subsection (a) 
shall be notwithstanding any other provision of this subpart or subpart 
II.''.

SEC. 7073. PROGRAMS FOR HEALTH CARE WORKFORCE.

    (a) Program for Education and Training in Pain Care.--Section 759 
of the Public Health Service Act (42 U.S.C. 294i) is amended--
            (1) in subsection (a), by striking ``hospices, and other 
        public and private entities'' and inserting ``hospices, tribal 
        health programs (as defined in section 4 of the Indian Health 
        Care Improvement Act), and other public and nonprofit private 
        entities'';
            (2) in subsection (b)--
                    (A) in the matter preceding paragraph (1), by 
                striking ``award may be made under subsection (a) only 
                if the applicant for the award agrees that the program 
                carried out with the award will include'' and inserting 
                ``entity receiving an award under this section shall 
                develop a comprehensive education and training plan 
                that includes'';
                    (B) in paragraph (1)--
                            (i) by inserting ``preventing,'' after 
                        ``diagnosing,''; and
                            (ii) by inserting ``non-addictive medical 
                        products and non-pharmacologic treatments and'' 
                        after ``including'';
                    (C) in paragraph (2)--
                            (i) by inserting ``Federal, State, and 
                        local'' after ``applicable''; and
                            (ii) by striking ``the degree to which'' 
                        and all that follows through ``effective pain 
                        care'' and inserting ``opioids'';
                    (D) in paragraph (3), by inserting ``, integrated, 
                evidence-based pain management, and, as appropriate, 
                non-pharmacotherapy'' before the semicolon;
                    (E) in paragraph (4), by striking ``; and'' and 
                inserting ``;''; and
                    (F) by striking paragraph (5) and inserting the 
                following:
            ``(5) recent findings, developments, and advancements in 
        pain care research and the provision of pain care, which may 
        include non-addictive medical products and non-pharmacologic 
        treatments intended to treat pain; and
            ``(6) the dangers of opioid abuse and misuse, detection of 
        early warning signs of opioid use disorders (which may include 
        best practices related to screening for opioid use disorders, 
        training on screening, brief intervention, and referral to 
        treatment), and safe disposal options for prescription 
        medications (including such options provided by law enforcement 
        or other innovative deactivation mechanisms).'';
            (3) in subsection (d), by inserting ``prevention,'' after 
        ``diagnosis,''; and
            (4) in subsection (e), by striking ``2010 through 2012'' 
        and inserting ``2019 through 2023''.
    (b) Mental and Behavioral Health Education and Training Program.--
Section 756 of the Public Health Service Act (42 U.S.C. 294e-1) is 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by inserting ``, trauma,'' 
                after ``focus on child and adolescent mental health''; 
                and
                    (B) in paragraphs (2) and (3), by inserting 
                ``trauma-informed care and'' before ``substance use 
                disorder prevention and treatment services''; and
            (2) in subsection (f), by striking ``2018 through 2022'' 
        and inserting ``2019 through 2023''.

       Subtitle I--Preventing Overdoses While in Emergency Rooms

SEC. 7081. PROGRAM TO SUPPORT COORDINATION AND CONTINUATION OF CARE FOR 
              DRUG OVERDOSE PATIENTS.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall identify or 
facilitate the development of best practices for--
            (1) emergency treatment of known or suspected drug 
        overdose;
            (2) the use of recovery coaches, as appropriate, to 
        encourage individuals who experience a non-fatal overdose to 
        seek treatment for substance use disorder and to support 
        coordination and continuation of care;
            (3) coordination and continuation of care and treatment, 
        including, as appropriate, through referrals, of individuals 
        after a drug overdose; and
            (4) the provision or prescribing of overdose reversal 
        medication, as appropriate.
    (b) Grant Establishment and Participation.--
            (1) In general.--The Secretary shall award grants on a 
        competitive basis to eligible entities to support 
        implementation of voluntary programs for care and treatment of 
        individuals after a drug overdose, as appropriate, which may 
        include implementation of the best practices described in 
        subsection (a).
            (2) Eligible entity.--In this section, the term ``eligible 
        entity'' means--
                    (A) a State substance abuse agency;
                    (B) an Indian Tribe or tribal organization; or
                    (C) an entity that offers treatment or other 
                services for individuals in response to, or following, 
                drug overdoses or a drug overdose, such as an emergency 
                department, in consultation with a State substance 
                abuse agency.
            (3) Application.--An eligible entity desiring a grant under 
        this section shall submit an application to the Secretary, at 
        such time and in such manner as the Secretary may require, that 
        includes--
                    (A) evidence that such eligible entity carries out, 
                or is capable of contracting and coordinating with 
                other community entities to carry out, the activities 
                described in paragraph (4);
                    (B) evidence that such eligible entity will work 
                with a recovery community organization to recruit, 
                train, hire, mentor, and supervise recovery coaches and 
                fulfill the requirements described in paragraph (4)(A); 
                and
                    (C) such additional information as the Secretary 
                may require.
            (4) Use of grant funds.--An eligible entity awarded a grant 
        under this section shall use such grant funds to--
                    (A) hire or utilize recovery coaches to help 
                support recovery, including by--
                            (i) connecting patients to a continuum of 
                        care services, such as--
                                    (I) treatment and recovery support 
                                programs;
                                    (II) programs that provide non-
                                clinical recovery support services;
                                    (III) peer support networks;
                                    (IV) recovery community 
                                organizations;
                                    (V) health care providers, 
                                including physicians and other 
                                providers of behavioral health and 
                                primary care;
                                    (VI) education and training 
                                providers;
                                    (VII) employers;
                                    (VIII) housing services; and
                                    (IX) child welfare agencies;
                            (ii) providing education on overdose 
                        prevention and overdose reversal to patients 
                        and families, as appropriate;
                            (iii) providing follow-up services for 
                        patients after an overdose to ensure continued 
                        recovery and connection to support services;
                            (iv) collecting and evaluating outcome data 
                        for patients receiving recovery coaching 
                        services; and
                            (v) providing other services the Secretary 
                        determines necessary to help ensure continued 
                        connection with recovery support services, 
                        including culturally appropriate services, as 
                        applicable;
                    (B) establish policies and procedures, pursuant to 
                Federal and State law, that address the provision of 
                overdose reversal medication, the administration of all 
                drugs or devices approved or cleared under the Federal 
                Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) 
                and all biological products licensed under section 351 
                of the Public Health Service Act (42 U.S.C. 262) to 
                treat substance use disorder, and subsequent 
                continuation of, or referral to, evidence-based 
                treatment for patients with a substance use disorder 
                who have experienced a non-fatal drug overdose, in 
                order to support long-term treatment, prevent relapse, 
                and reduce recidivism and future overdose; and
                    (C) 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 and from treatment 
                facilities.
            (5) Additional permissible uses.--In addition to the uses 
        described in paragraph (4), a grant awarded under this section 
        may be used, directly or through contractual arrangements, to 
        provide--
                    (A) all drugs or devices approved or cleared under 
                the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 
                et seq.) and all biological products licensed under 
                section 351 of the Public Health Service Act (42 U.S.C. 
                262) to treat substance use disorders or reverse 
                overdose, pursuant to Federal and State law;
                    (B) withdrawal and detoxification services that 
                include patient evaluation, stabilization, and 
                preparation for treatment of substance use disorder, 
                including treatment described in subparagraph (A), as 
                appropriate; or
                    (C) mental health services provided by a certified 
                professional who is licensed and qualified by 
                education, training, or experience to assess the 
                psychosocial background of patients, to contribute to 
                the appropriate treatment plan for patients with 
                substance use disorder, and to monitor patient 
                progress.
            (6) Preference.--In awarding grants under this section, the 
        Secretary shall give preference to eligible entities that meet 
        any or all of the following criteria:
                    (A) The eligible entity is a critical access 
                hospital (as defined in section 1861(mm)(1) of the 
                Social Security Act (42 U.S.C. 1395x(mm)(1))), a low 
                volume hospital (as defined in section 
                1886(d)(12)(C)(i) of such Act (42 U.S.C. 
                1395ww(d)(12)(C)(i))), a sole community hospital (as 
                defined in section 1886(d)(5)(D)(iii) of such Act (42 
                U.S.C. 1395ww(d)(5)(D)(iii))), or a hospital that 
                receives disproportionate share hospital payments under 
                section 1886(d)(5)(F) of the Social Security Act (42 
                U.S.C. 1395ww(d)(5)(F)).
                    (B) The eligible entity is located in a State with 
                an age-adjusted rate of drug overdose deaths that is 
                above the national overdose mortality rate, as 
                determined by the Director of the Centers for Disease 
                Control and Prevention, or under the jurisdiction of an 
                Indian Tribe with an age-adjusted rate of drug overdose 
                deaths that is above the national overdose mortality 
                rate, as determined through appropriate mechanisms as 
                determined by the Secretary in consultation with Indian 
                Tribes.
                    (C) The eligible entity demonstrates that recovery 
                coaches will be placed in both health care settings and 
                community settings.
            (7) Period of grant.--A grant awarded to an eligible entity 
        under this section shall be for a period of not more than 5 
        years.
    (c) Definitions.--In this section:
            (1) Indian tribe; tribal organization.--The terms ``Indian 
        Tribe'' and ``tribal organization'' have the meanings given the 
        terms ``Indian tribe'' and ``tribal organization'' in section 4 
        of the Indian Self-Determination and Education Assistance Act 
        (25 U.S.C. 5304).
            (2) Recovery coach.--the term ``recovery coach'' means an 
        individual--
                    (A) with knowledge of, or experience with, recovery 
                from a substance use disorder; and
                    (B) who has completed training from, and is 
                determined to be in good standing by, a recovery 
                services organization capable of conducting such 
                training and making such determination.
            (3) Recovery community organization.--The term ``recovery 
        community organization'' has the meaning given such term in 
        section 547(a) of the Public Health Service Act (42 U.S.C. 
        290ee-2(a)).
    (d) Reporting Requirements.--
            (1) Reports by grantees.--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--
                    (A) the number of individuals treated by the entity 
                for non-fatal overdoses, including the number of non-
                fatal overdoses where overdose reversal medication was 
                administered;
                    (B) the number of individuals administered 
                medication-assisted treatment by the entity;
                    (C) the number of individuals referred by the 
                entity 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; and
                    (D) the frequency and number of patients with 
                reoccurrences, including readmissions for non-fatal 
                overdoses and evidence of relapse related to substance 
                use disorder.
            (2) Report by secretary.--Not later than 5 years after the 
        date of enactment of this Act, the Secretary shall submit to 
        Congress a report that includes an evaluation of the 
        effectiveness of the grant program carried out under this 
        section with respect to long term health outcomes of the 
        population of individuals who have experienced a drug overdose, 
        the percentage of patients treated or referred to treatment by 
        grantees, and the frequency and number of patients who 
        experienced relapse, were readmitted for treatment, or 
        experienced another overdose.
    (e) Privacy.--The requirements of this section, including with 
respect to data reporting and program oversight, shall be subject to 
all applicable Federal and State privacy laws.
    (f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $10,000,000 for each of fiscal 
years 2019 through 2023.

    Subtitle J--Alternatives to Opioids in the Emergency Department

SEC. 7091. EMERGENCY DEPARTMENT ALTERNATIVES TO OPIOIDS DEMONSTRATION 
              PROGRAM.

    (a) Demonstration Program Grants.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary'') shall carry 
        out a demonstration program for purposes of awarding grants to 
        hospitals and emergency departments, including freestanding 
        emergency departments, to develop, implement, enhance, or study 
        alternatives to opioids for pain management in such settings.
            (2) Eligibility.--To be eligible to receive a grant under 
        paragraph (1), 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.
            (3) Geographic distribution.--In awarding grants under this 
        section, the Secretary shall seek to ensure geographical 
        distribution among grant recipients.
            (4) Use of funds.--Grants under paragraph (1) shall be used 
        to--
                    (A) target treatment approaches for painful 
                conditions frequently treated in such settings;
                    (B) train providers and other hospital personnel on 
                protocols or best practices related to the use and 
                prescription of opioids and alternatives to opioids for 
                pain management in the emergency department; and
                    (C) develop or continue strategies to provide 
                alternatives to opioids, as appropriate.
    (b) Additional Demonstration Program.--The Secretary may carry out 
a demonstration program similar to the program under subsection (a) for 
other acute care settings.
    (c) Consultation.--The Secretary shall implement a process for 
recipients of grants under subsection (a) or (b) to share evidence-
based and best practices and promote consultation with persons having 
robust knowledge, including emergency departments and physicians that 
have successfully implemented programs that use alternatives to opioids 
for pain management, as appropriate, such as approaches studied through 
the National Center for Complimentary and Integrative Health or other 
institutes and centers at the National Institutes of Health, as 
appropriate. The Secretary shall offer to each recipient of a grant 
under subsection (a) or (b) technical assistance as necessary.
    (d) Technical Assistance.--The Secretary shall identify or 
facilitate the development of best practices on alternatives to opioids 
for pain management and provide technical assistance to hospitals and 
other acute care settings on alternatives to opioids for pain 
management. The technical assistance provided shall be for the purpose 
of--
            (1) utilizing information from recipients of a grant under 
        subsection (a) or (b) that have successfully implemented 
        alternatives to opioids programs;
            (2) identifying or facilitating the development of best 
        practices on the use of alternatives to opioids, which may 
        include pain-management strategies that involve non-addictive 
        medical products, non-pharmacologic treatments, and 
        technologies or techniques to identify patients at risk for 
        opioid use disorder;
            (3) identifying or facilitating the development of best 
        practices on the use of alternatives to opioids that target 
        common painful conditions and include certain patient 
        populations, such as geriatric patients, pregnant women, and 
        children; and
            (4) disseminating information on the use of alternatives to 
        opioids to providers in acute care settings, which may include 
        emergency departments, outpatient clinics, critical access 
        hospitals, Federally qualified health centers, Indian Health 
        Service health facilities, and tribal hospitals.
    (e) Report to the Secretary.--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 all applicable State 
and Federal privacy laws--
            (1) a description of and specific information about the 
        opioid alternative pain management programs, including the 
        demographic characteristics of patients who were treated with 
        an alternative pain management protocol, implemented in 
        hospitals, emergency departments, and other acute care 
        settings;
            (2) data on the opioid alternative pain management 
        strategies used, including the number of opioid prescriptions 
        written--
                    (A) during a baseline period before the program 
                began; or
                    (B) at various stages of the program; and
            (3) data on patients who were eventually prescribed opioids 
        after alternative pain management protocols and treatments were 
        utilized; and
            (4) any other information the Secretary determines 
        appropriate.
    (f) Report to Congress.--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--
            (1) the number of applications received and the number 
        funded;
            (2) a summary of the reports described in subsection (e), 
        including data that allows for comparison of programs; and
            (3) recommendations for broader implementation of pain 
        management strategies that encourage the use of alternatives to 
        opioids in hospitals, emergency departments, or other acute 
        care settings.
    (g) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $10,000,000 for each of fiscal 
years 2019 through 2021.

    Subtitle K--Treatment, Education, and Community Help To Combat 
                               Addiction

SEC. 7101. ESTABLISHMENT OF REGIONAL CENTERS OF EXCELLENCE IN SUBSTANCE 
              USE DISORDER EDUCATION.

    Part D of title V of the Public Health Service Act, as amended by 
section 7031, is further amended by adding at the end the following new 
section:

``SEC. 551. REGIONAL CENTERS OF EXCELLENCE IN SUBSTANCE USE DISORDER 
              EDUCATION.

    ``(a) In General.--The Secretary, in consultation with appropriate 
agencies, shall award cooperative agreements to eligible entities for 
the designation of such entities as Regional Centers of Excellence in 
Substance Use Disorder Education for purposes of improving health 
professional training resources with respect to substance use disorder 
prevention, treatment, and recovery.
    ``(b) Eligibility.--To be eligible to receive a cooperative 
agreement under subsection (a), an entity shall--
            ``(1) be an accredited entity that offers education to 
        students in various health professions, which may include--
                    ``(A) a teaching hospital;
                    ``(B) a medical school;
                    ``(C) a certified behavioral health clinic; or
                    ``(D) any other health professions school, school 
                of public health, or Cooperative Extension Program at 
                institutions of higher education, as defined in section 
                101 of the Higher Education Act of 1965, engaged in the 
                prevention, treatment, or recovery of substance use 
                disorders;
            ``(2) demonstrate community engagement and partnerships 
        with community stakeholders, including entities that train 
        health professionals, mental health counselors, social workers, 
        peer recovery specialists, substance use treatment programs, 
        community health centers, physician offices, certified 
        behavioral health clinics, research institutions, and law 
        enforcement; and
            ``(3) submit to the Secretary an application containing 
        such information, at such time, and in such manner, as the 
        Secretary may require.
    ``(c) Activities.--An entity receiving an award under this section 
shall develop, evaluate, and distribute evidence-based resources 
regarding the prevention and treatment of, and recovery from, substance 
use disorders. Such resources may include information on--
            ``(1) the neurology and pathology of substance use 
        disorders;
            ``(2) advancements in the treatment of substance use 
        disorders;
            ``(3) techniques and best practices to support recovery 
        from substance use disorders;
            ``(4) strategies for the prevention and treatment of, and 
        recovery from substance use disorders across patient 
        populations; and
            ``(5) other topic areas that are relevant to the objectives 
        described in subsection (a).
    ``(d) Geographic Distribution.--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 distribution.
    ``(e) Evaluation.--The Secretary shall evaluate each project 
carried out by an entity receiving an award under this section and 
shall disseminate the findings with respect to each such evaluation to 
appropriate public and private entities.
    ``(f) Funding.--There is authorized to be appropriated to carry out 
this section, $4,000,000 for each of fiscal years 2019 through 2023.''.

SEC. 7102. YOUTH PREVENTION AND RECOVERY.

    (a)  Substance Abuse Treatment Services for Children, Adolescents, 
and Young Adults.--Section 514 of the Public Health Service Act (42 
U.S.C. 290bb-7) is amended--
            (1) in the section heading, by striking ``children and 
        adolescents'' and inserting ``children, adolescents, and young 
        adults'';
            (2) in subsection (a)(2), by striking ``children, 
        including'' and inserting ``children, adolescents, and young 
        adults, including''; and
            (3) by striking ``children and adolescents'' each place it 
        appears and inserting ``children, adolescents, and young 
        adults''.
    (b) Resource Center.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'', except as otherwise 
provided), in consultation with the Secretary of Education and other 
heads of agencies, including the Assistant Secretary for Mental Health 
and Substance Use and the Administrator of the Health Resources and 
Services Administration, as appropriate, shall establish a resource 
center to provide technical support to recipients of grants under 
subsection (c).
    (c) Youth Prevention and Recovery Initiative.--
            (1) In general.--The Secretary, in consultation with the 
        Secretary of Education, shall administer a program to provide 
        support for communities to support the prevention of, treatment 
        of, and recovery from, substance use disorders for children, 
        adolescents, and young adults.
            (2) Definitions.--In this subsection:
                    (A) Eligible entity.--The term ``eligible entity'' 
                means--
                            (i) a local educational agency that is 
                        seeking to establish or expand substance use 
                        prevention or recovery support services at one 
                        or more high schools;
                            (ii) a State educational agency;
                            (iii) an institution of higher education 
                        (or consortia of such institutions), which may 
                        include a recovery program at an institution of 
                        higher education;
                            (iv) a local board or one-stop operator;
                            (v) a nonprofit organization with 
                        appropriate expertise in providing services or 
                        programs for children, adolescents, or young 
                        adults, excluding a school;
                            (vi) a State, political subdivision of a 
                        State, Indian tribe, or tribal organization; or
                            (vii) a high school or dormitory serving 
                        high school students that receives funding from 
                        the Bureau of Indian Education.
                    (B) Foster care.--The term ``foster care'' has the 
                meaning given such term in section 1355.20(a) of title 
                45, Code of Federal Regulations (or any successor 
                regulations).
                    (C) High school.--The term ``high school'' has the 
                meaning given such term in section 8101 of the 
                Elementary and Secondary Education Act of 1965 (20 
                U.S.C. 7801).
                    (D) Homeless youth.--The term ``homeless youth'' 
                has the meaning given the term ``homeless children or 
                youths'' in section 725 of the McKinney-Vento Homeless 
                Assistance Act (42 U.S.C. 11434a).
                    (E) Indian tribe; tribal organization.--The terms 
                ``Indian tribe'' and ``tribal organization'' have the 
                meanings given such terms in section 4 of the Indian 
                Self-Determination and Education Assistance Act (25 
                U.S.C. 5304).
                    (F) Institution of higher education.--The term 
                ``institution of higher education'' has the meaning 
                given such term in section 101 of the Higher Education 
                Act of 1965 (20 U.S.C. 1001) and includes a 
                ``postsecondary vocational institution'' as defined in 
                section 102(c) of such Act (20 U.S.C. 1002(c)).
                    (G) Local educational agency.--The term ``local 
                educational agency'' has the meaning given such term in 
                section 8101 of the Elementary and Secondary Education 
                Act of 1965 (20 U.S.C. 7801).
                    (H) Local board; one-stop operator.--The terms 
                ``local board'' and ``one-stop operator'' have the 
                meanings given such terms in section 3 of the Workforce 
                Innovation and Opportunity Act (29 U.S.C. 3102).
                    (I) Out-of-school youth.--The term ``out-of-school 
                youth'' has the meaning given such term in section 
                129(a)(1)(B) of the Workforce Innovation and 
                Opportunity Act (29 U.S.C. 3164(a)(1)(B)).
                    (J) Recovery program.--The term ``recovery 
                program'' means a program--
                            (i) to help children, adolescents, or young 
                        adults who are recovering from substance use 
                        disorders to initiate, stabilize, and maintain 
                        healthy and productive lives in the community; 
                        and
                            (ii) that includes peer-to-peer support 
                        delivered by individuals with lived experience 
                        in recovery, and communal activities to build 
                        recovery skills and supportive social networks.
                    (K) State educational agency.--The term ``State 
                educational agency'' has the meaning given such term in 
                section 8101 of the Elementary and Secondary Education 
                Act (20 U.S.C. 7801).
            (3) Best practices.--The Secretary, in consultation with 
        the Secretary of Education, shall--
                    (A) identify or facilitate the development of 
                evidence-based best practices for prevention of 
                substance misuse and abuse by children, adolescents, 
                and young adults, including for specific populations 
                such as youth in foster care, homeless youth, out-of-
                school youth, and youth who are at risk of or have 
                experienced trafficking that address--
                            (i) primary prevention;
                            (ii) appropriate recovery support services;
                            (iii) appropriate use of medication-
                        assisted treatment for such individuals, if 
                        applicable, and ways of overcoming barriers to 
                        the use of medication-assisted treatment in 
                        such population; and
                            (iv) efficient and effective communication, 
                        which may include the use of social media, to 
                        maximize outreach efforts;
                    (B) disseminate such best practices to State 
                educational agencies, local educational agencies, 
                schools and dormitories funded by the Bureau of Indian 
                Education, institutions of higher education, recovery 
                programs at institutions of higher education, local 
                boards, one-stop operators, family and youth homeless 
                providers, and nonprofit organizations, as appropriate;
                    (C) conduct a rigorous evaluation of each grant 
                funded under this subsection, particularly its impact 
                on the indicators described in paragraph (7)(B); and
                    (D) provide technical assistance for grantees under 
                this subsection.
            (4) Grants authorized.--The Secretary, in consultation with 
        the Secretary of Education, shall award 3-year grants, on a 
        competitive basis, to eligible entities to enable such 
        entities, in coordination with Indian tribes, if applicable, 
        and State agencies responsible for carrying out substance use 
        disorder prevention and treatment programs, to carry out 
        evidence-based programs for--
                    (A) prevention of substance misuse and abuse by 
                children, adolescents, and young adults, which may 
                include primary prevention;
                    (B) recovery support services for children, 
                adolescents, and young adults, which may include 
                counseling, job training, linkages to community-based 
                services, family support groups, peer mentoring, and 
                recovery coaching; or
                    (C) treatment or referrals for treatment of 
                substance use disorders, which may include the use of 
                medication-assisted treatment, as appropriate.
            (5) Special consideration.--In awarding grants under this 
        subsection, the Secretary shall give special consideration to 
        the unique needs of tribal, urban, suburban, and rural 
        populations.
            (6) Application.--To be eligible for a grant under this 
        subsection, an entity shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary may require. Such application 
        shall include--
                    (A) a description of--
                            (i) the impact of substance use disorders 
                        in the population that will be served by the 
                        grant program;
                            (ii) how the eligible entity has solicited 
                        input from relevant stakeholders, which may 
                        include faculty, teachers, staff, families, 
                        students, and experts in substance use disorder 
                        prevention, treatment, and recovery in 
                        developing such application;
                            (iii) the goals of the proposed project, 
                        including the intended outcomes;
                            (iv) how the eligible entity plans to use 
                        grant funds for evidence-based activities, in 
                        accordance with this subsection to prevent, 
                        provide recovery support for, or treat 
                        substance use disorders amongst such 
                        individuals, or a combination of such 
                        activities; and
                            (v) how the eligible entity will 
                        collaborate with relevant partners, which may 
                        include State educational agencies, local 
                        educational agencies, institutions of higher 
                        education, juvenile justice agencies, 
                        prevention and recovery support providers, 
                        local service providers, including substance 
                        use disorder treatment programs, providers of 
                        mental health services, youth serving 
                        organizations, family and youth homeless 
                        providers, child welfare agencies, and primary 
                        care providers, in carrying out the grant 
                        program; and
                    (B) an assurance that the eligible entity will 
                participate in the evaluation described in paragraph 
                (3)(C).
            (7) Reports to the secretary.--Each eligible entity awarded 
        a grant under this subsection shall submit to the Secretary a 
        report at such time and in such manner as the Secretary may 
        require. Such report shall include--
                    (A) a description of how the eligible entity used 
                grant funds, in accordance with this subsection, 
                including the number of children, adolescents, and 
                young adults reached through programming; and
                    (B) a description, including relevant data, of how 
                the grant program has made an impact on the intended 
                outcomes described in paragraph (6)(A)(iii), 
                including--
                            (i) indicators of student success, which, 
                        if the eligible entity is an educational 
                        institution, shall include student well-being 
                        and academic achievement;
                            (ii) substance use disorders amongst 
                        children, adolescents, and young adults, 
                        including the number of overdoses and deaths 
                        amongst children, adolescents, and young adults 
                        served by the grant during the grant period; 
                        and
                            (iii) other indicators, as the Secretary 
                        determines appropriate.
            (8) Report to congress.--The Secretary shall, not later 
        than October 1, 2022, submit a report to the Committee on 
        Health, Education, Labor, and Pensions of the Senate and the 
        Committee on Energy and Commerce and the Committee on Education 
        and the Workforce of the House of Representatives a report 
        summarizing the effectiveness of the grant program under this 
        subsection, based on the information submitted in reports 
        required under paragraph (7).
            (9) Authorization of appropriations.--There is authorized 
        to be appropriated $10,000,000 to carry out this subsection for 
        each of fiscal years 2019 through 2023.

 Subtitle L--Information From National Mental Health and Substance Use 
                           Policy Laboratory

SEC. 7111. INFORMATION FROM NATIONAL MENTAL HEALTH AND SUBSTANCE USE 
              POLICY LABORATORY.

    Section 501A(b) of the Public Health Service Act (42 U.S.C. 290aa-
0(b)) is amended--
            (1) in paragraph (5)(C), by striking ``; and'' at the end 
        and inserting a semicolon;
            (2) by redesignating paragraph (6) as paragraph (7); and
            (3) by inserting after paragraph (5) the following:
            ``(6) issue and periodically update information for 
        entities applying for grants or cooperative agreements from the 
        Substance Abuse and Mental Health Services Administration in 
        order to--
                    ``(A) encourage the implementation and replication 
                of evidence-based practices; and
                    ``(B) provide technical assistance to applicants 
                for funding, including with respect to justifications 
                for such programs and activities; and''.

           Subtitle M--Comprehensive Opioid Recovery Centers

SEC. 7121. COMPREHENSIVE OPIOID RECOVERY CENTERS.

    (a) In General.--Part D of title V of the Public Health Service Act 
(42 U.S.C. 290dd et seq.), as amended by sections 7031 and 7101, is 
further amended by adding at the end the following new section:

``SEC. 552. COMPREHENSIVE OPIOID RECOVERY CENTERS.

    ``(a) In General.--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 
`Center'). A Center may be a single entity or an integrated delivery 
network.
    ``(b) Grant Period.--
            ``(1) In general.--A grant awarded under subsection (a) 
        shall be for a period of not less than 3 years and not more 
        than 5 years.
            ``(2) Renewal.--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).
    ``(c) Minimum Number of Centers.--The Secretary shall allocate the 
amounts made available under subsection (j) such that not fewer than 10 
grants may be awarded. Not more than one grant shall be made to 
entities in a single State for any one period.
    ``(d) Application.--
            ``(1) Eligible entity.--An entity is eligible for a grant 
        under this section if the entity offers treatment and other 
        services for individuals with a substance use disorder.
            ``(2) Submission of application.--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--
                    ``(A) evidence that such entity carries out, or is 
                capable of coordinating with other entities to carry 
                out, the activities described in subsection (g); and
                    ``(B) such other information as the Secretary may 
                require.
    ``(e) Priority.--In awarding grants under subsection (a), the 
Secretary shall give priority to eligible entities--
            ``(1) located in a State with an age-adjusted rate of drug 
        overdose deaths that is above the national overdose mortality 
        rate, as determined by the Director of the Centers for Disease 
        Control and Prevention; or
            ``(2) serving an Indian Tribe (as defined in section 4 of 
        the Indian Self-Determination and Education Assistance Act) 
        with an age-adjusted rate of drug overdose deaths that is above 
        the national overdose mortality rate, as determined through 
        appropriate mechanisms determined by the Secretary in 
        consultation with Indian Tribes.
    ``(f) Preference.--In awarding grants under subsection (a), the 
Secretary may give preference to eligible entities utilizing 
technology-enabled collaborative learning and capacity building models, 
including such models as defined in section 2 of the Expanding Capacity 
for Health Outcomes Act (Public Law 114-270; 130 Stat. 1395), to 
conduct the activities described in this section.
    ``(g) Center Activities.--Each Center shall, at a minimum, carry 
out the following activities directly, through referral, or through 
contractual arrangements, which may include carrying out such 
activities through technology-enabled collaborative learning and 
capacity building models described in subsection (f):
            ``(1) Treatment and recovery services.--Each Center shall--
                    ``(A) Ensure that intake, evaluations, and periodic 
                patient assessments meet the individualized clinical 
                needs of patients, including by reviewing patient 
                placement in treatment settings to support meaningful 
                recovery.
                    ``(B) Provide the full continuum of treatment 
                services, including--
                            ``(i) all drugs and devices approved or 
                        cleared under the Federal Food, Drug, and 
                        Cosmetic Act and all biological products 
                        licensed under section 351 of this Act to treat 
                        substance use disorders or reverse overdoses, 
                        pursuant to Federal and State law;
                            ``(ii) medically supervised withdrawal 
                        management, that includes patient evaluation, 
                        stabilization, and readiness for and entry into 
                        treatment;
                            ``(iii) counseling provided by a program 
                        counselor or other certified professional who 
                        is licensed and qualified by education, 
                        training, or experience to assess the 
                        psychological and sociological background of 
                        patients, to contribute to the appropriate 
                        treatment plan for the patient, and to monitor 
                        patient progress;
                            ``(iv) treatment, as appropriate, for 
                        patients with co-occurring substance use and 
                        mental disorders;
                            ``(v) testing, as appropriate, for 
                        infections commonly associated with illicit 
                        drug use;
                            ``(vi) residential rehabilitation, and 
                        outpatient and intensive outpatient programs;
                            ``(vii) recovery housing;
                            ``(viii) community-based and peer recovery 
                        support services;
                            ``(ix) job training, job placement 
                        assistance, and continuing education assistance 
                        to support reintegration into the workforce; 
                        and
                            ``(x) other best practices to provide the 
                        full continuum of treatment and services, as 
                        determined by the Secretary.
                    ``(C) Ensure that all programs covered by the 
                Center include medication-assisted treatment, as 
                appropriate, and do not exclude individuals receiving 
                medication-assisted treatment from any service.
                    ``(D) Periodically conduct patient assessments to 
                support sustained and clinically significant recovery, 
                as defined by the Assistant Secretary for Mental Health 
                and Substance Use.
                    ``(E) Provide onsite access to medication, as 
                appropriate, and toxicology services; for purposes of 
                carrying out this section.
                    ``(F) Operate a secure, confidential, and 
                interoperable electronic health information system.
                    ``(G) Offer family support services such as child 
                care, family counseling, and parenting interventions to 
                help stabilize families impacted by substance use 
                disorder, as appropriate.
            ``(2) Outreach.--Each Center shall carry out outreach 
        activities regarding the services offered through the Centers, 
        which may include--
                    ``(A) training and supervising outreach staff, as 
                appropriate, to work with State and local health 
                departments, health care providers, the Indian Health 
                Service, State and local educational agencies, schools 
                funded by the Indian Bureau of Education, institutions 
                of higher education, State and local workforce 
                development boards, State and local community action 
                agencies, public safety officials, first responders, 
                Indian Tribes, child welfare agencies, as appropriate, 
                and other community partners and the public, including 
                patients, to identify and respond to community needs;
                    ``(B) ensuring that the entities described in 
                subparagraph (A) are aware of the services of the 
                Center; and
                    ``(C) disseminating and making publicly available, 
                including through the internet, evidence-based 
                resources that educate professionals and the public on 
                opioid use disorder and other substance use disorders, 
                including co-occurring substance use and mental 
                disorders.
    ``(h) Data Reporting and Program Oversight.--With respect to a 
grant awarded under subsection (a), 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--
            ``(1) the programs and activities funded by the grant;
            ``(2) health outcomes of the population of individuals with 
        a substance use disorder who received services from the Center, 
        evaluated by an independent program evaluator through the use 
        of outcomes measures, as determined by the Secretary;
            ``(3) the retention rate of program participants; and
            ``(4) any other information that the Secretary may require 
        for the purpose of--ensuring that the Center is complying with 
        all the requirements of the grant, including providing the full 
        continuum of services described in subsection (g)(1)(B).
    ``(i) Privacy.--The provisions of this section, including with 
respect to data reporting and program oversight, shall be subject to 
all applicable Federal and State privacy laws.
    ``(j) Authorization of Appropriations.--There is authorized to be 
appropriated $10,000,000 for each of fiscal years 2019 through 2023 for 
purposes of carrying out this section.''.
    (b) Reports to Congress.--
            (1) Preliminary report.--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 552(h) of the Public 
        Health Service Act, as added by subsection (a).
            (2) Final report.--Not later than 2 years 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--
                    (A) an evaluation of the effectiveness of the 
                comprehensive services provided by the Centers 
                established or operated pursuant to section 552 of the 
                Public Health Service Act, as added by subsection (a), 
                with respect to health outcomes of the population of 
                individuals with substance use disorder who receive 
                services from the Center, which shall include an 
                evaluation of the effectiveness of services for 
                treatment and recovery support and to reduce relapse, 
                recidivism, and overdose; and
                    (B) recommendations, as appropriate, regarding ways 
                to improve Federal programs related to substance use 
                disorders, which may include dissemination of best 
                practices for the treatment of substance use disorders 
                to health care professionals.

                    Subtitle N--Trauma-Informed Care

SEC. 7131. CDC SURVEILLANCE AND DATA COLLECTION FOR CHILD, YOUTH, AND 
              ADULT TRAUMA.

    (a) Data Collection.--The Director of the Centers for Disease 
Control and Prevention (referred to in this section as the 
``Director'') may, in cooperation with the States, collect and report 
data on adverse childhood experiences through the Behavioral Risk 
Factor Surveillance System, the Youth Risk Behavior Surveillance 
System, and other relevant public health surveys or questionnaires.
    (b) Timing.--The collection of data under subsection (a) may occur 
biennially.
    (c) Data From Rural Areas.--The Director shall encourage each State 
that participates in collecting and reporting data under subsection (a) 
to collect and report data from rural areas within such State, in order 
to generate a statistically reliable representation of such areas.
    (d) Data From Tribal Areas.--The Director may, in cooperation with 
Indian Tribes (as defined in section 4 of the Indian Self-Determination 
and Education Assistance Act) and pursuant to a written request from an 
Indian Tribe, provide technical assistance to such Indian Tribe to 
collect and report data on adverse childhood experiences through the 
Behavioral Risk Factor Surveillance System, the Youth Risk Behavior 
Surveillance System, or another relevant public health survey or 
questionnaire.
    (e) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $2,000,000 for each of fiscal 
years 2019 through 2023.

SEC. 7132. TASK FORCE TO DEVELOP BEST PRACTICES FOR TRAUMA-INFORMED 
              IDENTIFICATION, REFERRAL, AND SUPPORT.

    (a) Establishment.--There is established a task force, to be known 
as the Interagency Task Force on Trauma-Informed Care (in this section 
referred to as the ``task force'') that shall identify, evaluate, and 
make recommendations regarding--
            (1) best practices with respect to children and youth, and 
        their families as appropriate, who have experienced or are at 
        risk of experiencing trauma; and
            (2) ways in which Federal agencies can better coordinate to 
        improve the Federal response to families impacted by substance 
        use disorders and other forms of trauma.
    (b) Membership.--
            (1) Composition.--The task force shall be composed of the 
        heads of the following Federal departments and agencies, or 
        their designees:
                    (A) The Centers for Medicare & Medicaid Services.
                    (B) The Substance Abuse and Mental Health Services 
                Administration.
                    (C) The Agency for Healthcare Research and Quality.
                    (D) The Centers for Disease Control and Prevention.
                    (E) The Indian Health Service.
                    (F) The Department of Veterans Affairs.
                    (G) The National Institutes of Health.
                    (H) The Food and Drug Administration.
                    (I) The Health Resources and Services 
                Administration.
                    (J) The Department of Defense.
                    (K) The Office of Minority Health of the Department 
                of Health and Human Services.
                    (L) The Administration for Children and Families.
                    (M) The Office of the Assistant Secretary for 
                Planning and Evaluation of the Department of Health and 
                Human Services.
                    (N) The Office for Civil Rights of the Department 
                of Health and Human Services.
                    (O) The Office of Juvenile Justice and Delinquency 
                Prevention of the Department of Justice.
                    (P) The Office of Community Oriented Policing 
                Services of the Department of Justice.
                    (Q) The Office on Violence Against Women of the 
                Department of Justice.
                    (R) The National Center for Education Evaluation 
                and Regional Assistance of the Department of Education.
                    (S) The National Center for Special Education 
                Research of the Institute of Education Science.
                    (T) The Office of Elementary and Secondary 
                Education of the Department of Education.
                    (U) The Office for Civil Rights of the Department 
                of Education.
                    (V) The Office of Special Education and 
                Rehabilitative Services of the Department of Education.
                    (W) The Bureau of Indian Affairs of the Department 
                of the Interior.
                    (X) The Veterans Health Administration of the 
                Department of Veterans Affairs.
                    (Y) The Office of Special Needs Assistance Programs 
                of the Department of Housing and Urban Development.
                    (Z) The Office of Head Start of the Administration 
                for Children and Families.
                    (AA) The Children's Bureau of the Administration 
                for Children and Families.
                    (BB) The Bureau of Indian Education of the 
                Department of the Interior.
                    (CC) Such other Federal agencies as the Secretaries 
                determine to be appropriate.
            (2) Date of appointments.--The heads of Federal departments 
        and agencies shall appoint the corresponding members of the 
        task force not later than 60 days after the date of enactment 
        of this Act.
            (3) Chairperson.--The task force shall be chaired by the 
        Assistant Secretary for Mental Health and Substance Use, or the 
        Assistant Secretary's designee.
    (c) Task Force Duties.--The task force shall--
            (1) solicit input from stakeholders, including frontline 
        service providers, educators, mental health professionals, 
        researchers, experts in infant, child, and youth trauma, child 
        welfare professionals, and the public, in order to inform the 
        activities under paragraph (2); and
            (2) identify, evaluate, make recommendations, and update 
        such recommendations not less than annually, to the general 
        public, the Secretary of Education, the Secretary of Health and 
        Human Services, the Secretary of Labor, the Secretary of the 
        Interior, the Attorney General, and other relevant cabinet 
        Secretaries, and Congress regarding--
                    (A) a set of evidence-based, evidence-informed, and 
                promising best practices with respect to--
                            (i) prevention strategies for individuals 
                        at risk of experiencing or being exposed to 
                        trauma, including trauma as a result of 
                        exposure to substance use;
                            (ii) the identification of infants, 
                        children and youth, and their families as 
                        appropriate, who have experienced or are at 
                        risk of experiencing trauma;
                            (iii) the expeditious referral to and 
                        implementation of trauma-informed practices and 
                        supports that prevent and mitigate the effects 
                        of trauma, which may include whole-family and 
                        multi-generational approaches; and
                            (iv) community based or multi-generational 
                        practices that support children and their 
                        families;
                    (B) a national strategy on how the task force and 
                member agencies will collaborate, prioritize options 
                for, and implement a coordinated approach, which may 
                include--
                            (i) data sharing;
                            (ii) providing support to infants, 
                        children, and youth, and their families as 
                        appropriate, who have experienced or are at 
                        risk of experiencing trauma;
                            (iii) identifying options for coordinating 
                        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 use or 
                        other trauma, including trauma related to 
                        substance use; and
                            (iv) 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; and
                    (C) existing Federal authorities at the Department 
                of Education, Department of Health and Human Services, 
                Department of Justice, Department of Labor, Department 
                of the Interior, and other relevant agencies, and 
                specific Federal grant programs to disseminate best 
                practices on, provide training in, or deliver services 
                through, trauma-informed practices, and disseminate 
                such information--
                            (i) in writing to relevant program offices 
                        at such agencies to encourage grant applicants 
                        in writing to use such funds, where 
                        appropriate, for trauma-informed practices; and
                            (ii) to the general public through the 
                        internet website of the task force.
    (d) Best Practices.--In identifying, evaluating, and recommending 
the set of best practices under subsection (c), the task force shall--
            (1) include guidelines for providing professional 
        development and education for front-line services providers, 
        including school personnel, early childhood education program 
        providers, providers from child- or youth-serving 
        organizations, housing and homeless providers, primary and 
        behavioral health care providers, child welfare and social 
        services providers, juvenile and family court personnel, health 
        care providers, individuals who are mandatory reporters of 
        child abuse or neglect, trained nonclinical providers 
        (including peer mentors and clergy), and first responders, in--
                    (A) understanding and identifying early signs and 
                risk factors of trauma in infants, children, and youth, 
                and their families as appropriate, including through 
                screening processes and services;
                    (B) providing practices to prevent and mitigate the 
                impact of trauma, including by fostering safe and 
                stable environments and relationships; and
                    (C) developing and implementing policies, 
                procedures, or systems that--
                            (i) are designed to quickly refer infants, 
                        children, youth, and their families as 
                        appropriate, who have experienced or are at 
                        risk of experiencing trauma to the appropriate 
                        trauma-informed screening and support and age-
                        appropriate treatment, and to ensure such 
                        infants, children, youth, and family members 
                        receive such support;
                            (ii) utilize and develop partnerships with 
                        early childhood education programs, local 
                        social services organizations, such as 
                        organizations serving youth, and clinical 
                        mental health or other health care providers 
                        with expertise in providing support services 
                        and age-appropriate trauma-informed and 
                        evidence-based treatment aimed at preventing or 
                        mitigating the effects of trauma;
                            (iii) educate children and youth to--
                                    (I) understand and identify the 
                                signs, effects, or symptoms of trauma; 
                                and
                                    (II) build the resilience and 
                                coping skills to mitigate the effects 
                                of experiencing trauma;
                            (iv) promote and support multi-generational 
                        practices that assist parents, foster parents, 
                        and kinship and other caregivers in accessing 
                        resources related to, and developing 
                        environments conducive to, the prevention and 
                        mitigation of trauma; and
                            (v) collect and utilize data from 
                        screenings, referrals, or the provision of 
                        services and supports to evaluate outcomes and 
                        improve processes for trauma-informed services 
                        and supports that are culturally sensitive, 
                        linguistically appropriate, and specific to age 
                        ranges and sex, as applicable;
            (2) recommend best practices that are designed to avoid 
        unwarranted custody loss or criminal penalties for parents or 
        guardians in connection with infants, children, and youth who 
        have experienced or are at risk of experiencing trauma; and
            (3) recommend opportunities for local- and State-level 
        partnerships that--
                    (A) are designed to quickly identify and refer 
                children and families, as appropriate, who have 
                experienced or are at risk of experiencing exposure to 
                trauma, including related to substance use;
                    (B) 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 
                trauma, including related to substance use;
                    (C) offer community-based prevention activities, 
                including educating families and children on the 
                effects of exposure to trauma, such as trauma related 
                to substance use, and how to build resilience and 
                coping skills to mitigate those effects;
                    (D) 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 trauma, including related to substance use; 
                and
                    (E) are designed to prevent separation and support 
                reunification of families if in the best interest of 
                the child.
    (e) Operating Plan.--Not later than 120 days after the date of 
enactment of this Act, the task force shall hold the first meeting. Not 
later than 2 years after such date of enactment, the task force shall 
submit to the Secretary of Education, Secretary of Health and Human 
Services, Secretary of Labor, Secretary of the Interior, the Attorney 
General, and Congress an operating plan for carrying out the activities 
of the task force described in subsection (c)(2). Such operating plan 
shall include--
            (1) a list of specific activities that the task force plans 
        to carry out for purposes of carrying out duties described in 
        subsection (c)(2), which may include public engagement;
            (2) a plan for carrying out the activities under subsection 
        (c)(2);
            (3) a list of members of the task force and other 
        individuals who are not members of the task force that may be 
        consulted to carry out such activities;
            (4) an explanation of Federal agency involvement and 
        coordination needed to carry out such activities, including any 
        statutory or regulatory barriers to such coordination;
            (5) a budget for carrying out such activities;
            (6) a proposed timeline for implementing recommendations 
        and efforts identified under subsection (c); and
            (7) other information that the task force determines 
        appropriate as related to its duties.
    (f) Final Report.--Not later than 3 years after the date of the 
first meeting of the task force, the task force shall submit to the 
general public, Secretary of Education, Secretary of Health and Human 
Services, Secretary of Labor, Secretary of the Interior, the Attorney 
General, other relevant cabinet Secretaries, the Committee on Energy 
and Commerce and the Committee on Education and the Workforce of the 
House of Representatives and the Committee on Health, Education, Labor, 
and Pensions of the Senate, and Congress, a final report containing all 
of the findings and recommendations required under this section, and 
shall make such report available online in an accessible format.
    (g) Additional Reports.--In addition to the final report under 
subsection (f). the task force shall submit--
            (1) a report to Congress identifying any recommendations 
        identified under subsection (c) that require additional 
        legislative authority to implement; and
            (2) a report to the Governors describing the opportunities 
        for local- and State-level partnerships, professional 
        development, or best practices recommended under subsection 
        (d)(3).
    (h) Definitions.--In this section--
            (1) the term ``early childhood education program'' has the 
        meaning given such term in section 103 of the Higher Education 
        Act of 1965 (20 U.S.C. 1003);
            (2) The term ``Governor'' means the chief executive officer 
        of a State; and
            (3) the term ``State'' 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.
    (i) Sunset.--The task force shall sunset on the date that is 60 
days after the submission of the final report under subsection (f), but 
not later than September 30, 2023.

SEC. 7133. NATIONAL CHILD TRAUMATIC STRESS INITIATIVE.

    Section 582(j) of the Public Health Service Act (42 U.S.C. 290hh-
1(j)) (relating to grants to address the problems of persons who 
experience violence-related stress) is amended by striking 
``$46,887,000 for each of fiscal years 2018 through 2022'' and 
inserting ``$63,887,000 for each of fiscal years 2019 through 2023''.

SEC. 7134. GRANTS TO IMPROVE TRAUMA SUPPORT SERVICES AND MENTAL HEALTH 
              CARE FOR CHILDREN AND YOUTH IN EDUCATIONAL SETTINGS.

    (a) Grants, Contracts, and Cooperative Agreements Authorized.--The 
Secretary, in coordination with the Assistant Secretary for Mental 
Health and Substance Use, is authorized to award grants to, or enter 
into contracts or cooperative agreements with, State educational 
agencies, local educational agencies, Indian Tribes (as defined in 
section 4 of the Indian Self-Determination and Education Assistance 
Act) or their tribal educational agencies, a school operated by the 
Bureau of Indian Education, a Regional Corporation, or a Native 
Hawaiian educational organization, for the purpose of increasing 
student access to evidence-based trauma support services and mental 
health care by developing innovative initiatives, activities, or 
programs to link local school systems with local trauma-informed 
support and mental health systems, including those under the Indian 
Health Service.
    (b) Duration.--With respect to a grant, contract, or cooperative 
agreement awarded or entered into under this section, the period during 
which payments under such grant, contract or agreement are made to the 
recipient may not exceed 4 years.
    (c) Use of Funds.--An entity that receives a grant, contract, or 
cooperative agreement under this section shall use amounts made 
available through such grant, contract, or cooperative agreement for 
evidence-based activities, which shall include any of the following:
            (1) Collaborative efforts between school-based service 
        systems and trauma-informed support and mental health service 
        systems to provide, develop, or improve prevention, screening, 
        referral, and treatment and support services to students, such 
        as providing trauma screenings to identify students in need of 
        specialized support.
            (2) To implement schoolwide positive behavioral 
        interventions and supports, or other trauma-informed models of 
        support.
            (3) To provide professional development to teachers, 
        teacher assistants, school leaders, specialized instructional 
        support personnel, and mental health professionals that--
                    (A) fosters safe and stable learning environments 
                that prevent and mitigate the effects of trauma, 
                including through social and emotional learning;
                    (B) improves school capacity to identify, refer, 
                and provide services to students in need of trauma 
                support or behavioral health services; or
                    (C) reflects the best practices for trauma-informed 
                identification, referral, and support developed by the 
                Task Force under section 7132.
            (4) Services at a full-service community school that 
        focuses on trauma-informed supports, which may include a full-
        time site coordinator, or other activities consistent with 
        section 4625 of the Elementary and Secondary Education Act of 
        1965 (20 U.S.C. 7275).
            (5) Engaging families and communities in efforts to 
        increase awareness of child and youth trauma, which may include 
        sharing best practices with law enforcement regarding trauma-
        informed care and working with mental health professionals to 
        provide interventions, as well as longer term coordinated care 
        within the community for children and youth who have 
        experienced trauma and their families.
            (6) To provide technical assistance to school systems and 
        mental health agencies.
            (7) To evaluate the effectiveness of the program carried 
        out under this section in increasing student access to 
        evidence-based trauma support services and mental health care.
            (8) To establish partnerships with or provide subgrants to 
        Head Start agencies (including Early Head Start agencies), 
        public and private preschool programs, child care programs 
        (including home-based providers), or other entities described 
        in subsection (a), to include such entities described in this 
        paragraph in the evidence-based trauma initiatives, activities, 
        support services, and mental health systems established under 
        this section in order to provide, develop, or improve 
        prevention, screening, referral, and treatment and support 
        services to young children and their families.
    (d) Applications.--To be eligible to receive a grant, contract, or 
cooperative agreement under this section, an entity described in 
subsection (a) shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the Secretary 
may reasonably require, which shall include the following:
            (1) A description of the innovative initiatives, 
        activities, or programs to be funded under the grant, contract, 
        or cooperative agreement, including how such program will 
        increase access to evidence-based trauma support services and 
        mental health care for students, and, as applicable, the 
        families of such students.
            (2) A description of how the program will provide 
        linguistically appropriate and culturally competent services.
            (3) A description of how the program will support students 
        and the school in improving the school climate in order to 
        support an environment conducive to learning.
            (4) An assurance that--
                    (A) persons providing services under the grant, 
                contract, or cooperative agreement are adequately 
                trained to provide such services; and
                    (B) teachers, school leaders, administrators, 
                specialized instructional support personnel, 
                representatives of local Indian Tribes or tribal 
                organizations as appropriate, other school personnel, 
                and parents or guardians of students participating in 
                services under this section will be engaged and 
                involved in the design and implementation of the 
                services.
            (5) A description of how the applicant will support and 
        integrate existing school-based services with the program in 
        order to provide mental health services for students, as 
        appropriate.
            (6) A description of the entities in the community with 
        which the applicant will partner or to which the applicant will 
        provide subgrants in accordance with subsection (c)(8).
    (e) Interagency Agreements.--
            (1) Local interagency agreements.--To ensure the provision 
        of the services described in subsection (c), a recipient of a 
        grant, contract, or cooperative agreement under this section, 
        or their designee, shall establish a local interagency 
        agreement among local educational agencies, agencies 
        responsible for early childhood education programs, Head Start 
        agencies (including Early Head Start agencies), juvenile 
        justice authorities, mental health agencies, child welfare 
        agencies, and other relevant agencies, authorities, or entities 
        in the community that will be involved in the provision of such 
        services.
            (2) Contents.--In ensuring the provision of the services 
        described in subsection (c), the local interagency agreement 
        shall specify with respect to each agency, authority, or entity 
        that is a party to such agreement--
                    (A) the financial responsibility for the services;
                    (B) the conditions and terms of responsibility for 
                the services, including quality, accountability, and 
                coordination of the services; and
                    (C) the conditions and terms of reimbursement among 
                such agencies, authorities, or entities, including 
                procedures for dispute resolution.
    (f) Evaluation.--The Secretary shall reserve not more than 3 
percent of the funds made available under subsection (l) for each 
fiscal year to--
            (1) conduct a rigorous, independent evaluation of the 
        activities funded under this section; and
            (2) disseminate and promote the utilization of evidence-
        based practices regarding trauma support services and mental 
        health care.
    (g) Distribution of Awards.--The Secretary shall ensure that 
grants, contracts, and cooperative agreements awarded or entered into 
under this section are equitably distributed among the geographical 
regions of the United States and among tribal, urban, suburban, and 
rural populations.
    (h) Rule of Construction.--Nothing in this section shall be 
construed--
            (1) to prohibit an entity involved with a program carried 
        out under this section from reporting a crime that is committed 
        by a student to appropriate authorities; or
            (2) to prevent Federal, State, and tribal law enforcement 
        and judicial authorities from exercising their responsibilities 
        with regard to the application of Federal, tribal, and State 
        law to crimes committed by a student.
    (i) Supplement, Not Supplant.--Any services provided through 
programs carried out under this section shall supplement, and not 
supplant, existing mental health services, including any special 
education and related services provided under the Individuals with 
Disabilities Education Act (20 U.S.C. 1400 et seq.).
    (j) Consultation With Indian Tribes.--In carrying out subsection 
(a), the Secretary shall, in a timely manner, meaningfully consult with 
Indian Tribes and their representatives to ensure notice of 
eligibility.
    (k) Definitions.--In this section:
            (1) Elementary school.--The term ``elementary school'' has 
        the meaning given such term in section 8101 of the Elementary 
        and Secondary Education Act of 1965 (20 U.S.C. 7801).
            (2) Evidence-based.--The term ``evidence-based'' has the 
        meaning given such term in section 8101(21)(A)(i) of the 
        Elementary and Secondary Education Act of 1965 (20 U.S.C. 
        7801(21)(A)(i)).
            (3) Native hawaiian educational organization.--The term 
        ``Native Hawaiian educational organization'' has the meaning 
        given such term in section 6207 of the Elementary and Secondary 
        Education Act of 1965 (20 U.S.C. 7517).
            (4) Local educational agency.--The term ``local educational 
        agency'' has the meaning given such term in section 8101 of the 
        Elementary and Secondary Education Act of 1965 (20 U.S.C. 
        7801).
            (5) Regional corporation.--The term ``Regional 
        Corporation'' has the meaning given the term in section 3 of 
        the Alaska Native Claims Settlement Act (43 U.S.C. 1602)).
            (6) School.--The term ``school'' means a public elementary 
        school or public secondary school.
            (7) School leader.--The term ``school leader'' has the 
        meaning given such term in section 8101 of the Elementary and 
        Secondary Education Act of 1965 (20 U.S.C. 7801).
            (8) Secondary school.--The term ``secondary school'' has 
        the meaning given such term in section 8101 of the Elementary 
        and Secondary Education Act of 1965 (20 U.S.C. 7801).
            (9) Secretary.--The term ``Secretary'' means the Secretary 
        of Education.
            (10) Specialized instructional support personnel.--The term 
        ``specialized instructional support personnel'' has the meaning 
        given such term in section 8101 of the Elementary and Secondary 
        Education Act of 1965 (20 U.S.C. 7801).
            (11) State educational agency.--The term ``State 
        educational agency'' has the meaning given such term in section 
        8101 of the Elementary and Secondary Education Act of 1965 (20 
        U.S.C. 7801).
    (l) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $50,000,000 for each of fiscal 
years 2019 through 2023.

SEC. 7135. RECOGNIZING EARLY CHILDHOOD TRAUMA RELATED TO SUBSTANCE 
              ABUSE.

    (a) Dissemination of Information.--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--
            (1) ways to properly recognize children who may be impacted 
        by trauma, including trauma related to substance use by a 
        family member or other adult; and
            (2) how to respond appropriately in order to provide for 
        the safety and well-being of young children and their families.
    (b) Goals.--The information, resources, and technical assistance 
provided under subsection (a) shall--
            (1) 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, including trauma due to 
        exposure to substance use;
            (2) suggest age-appropriate communication tools, 
        procedures, and practices for trauma-informed care, including 
        ways to prevent or mitigate the effects of trauma;
            (3) provide options for responding to children impacted by 
        trauma, including due to exposure to substance use, that 
        consider the needs of the child and family, including 
        recommending resources and referrals for evidence-based 
        services to support such family; and
            (4) promote whole-family and multi-generational approaches 
        to keep families safely together when it is in the best 
        interest of the child.
    (c) Coordination.--The Secretary of Health and Human Services shall 
coordinate with the task force to develop best practices for trauma-
informed identification, referral, and support authorized under section 
7132 in disseminating the information, resources, and technical 
assistance described under subsection (b).
    (d) Rule of Construction.--Such information, resources, and if 
applicable, technical assistance, shall not be construed to amend the 
requirements under--
            (1) the Child Care and Development Block Grant Act of 1990 
        (42 U.S.C. 9858 et seq.);
            (2) the Head Start Act (42 U.S.C. 9831 et seq.); or
            (3) the Individuals with Disabilities Education Act (20 
        U.S.C. 1400 et seq.).

       Subtitle O--Eliminating Opioid Related Infectious Diseases

SEC. 7141. REAUTHORIZATION AND EXPANSION OF PROGRAM OF SURVEILLANCE AND 
              EDUCATION REGARDING INFECTIONS ASSOCIATED WITH ILLICIT 
              DRUG USE AND OTHER RISK FACTORS.

    Section 317N of the Public Health Service Act (42 U.S.C. 247b-15) 
is amended to read as follows:

``SEC. 317N. SURVEILLANCE AND EDUCATION REGARDING INFECTIONS ASSOCIATED 
              WITH ILLICIT DRUG USE AND OTHER RISK FACTORS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, may (directly or 
through grants to public and nonprofit private entities) provide for 
programs for the following:
            ``(1) To cooperate with States and Indian tribes in 
        implementing or maintaining a national system to determine the 
        incidence of infections commonly associated with illicit 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.
            ``(2) To identify, counsel, and offer testing to 
        individuals who are at risk of infections described in 
        paragraph (1) resulting from illicit drug use, receiving blood 
        transfusions prior to July 1992, or other risk factors.
            ``(3) 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.
            ``(4) 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.
            ``(5) To improve the education, training, and skills of 
        health professionals in the detection and control of infections 
        described in paragraph (1), including to improve coordination 
        of treatment of substance use disorders and infectious 
        diseases, with priority given to substance use disorder 
        treatment providers, pediatricians and other primary care 
        providers, obstetrician-gynecologists, and infectious disease 
        clinicians, including HIV clinicians.
    ``(b) Laboratory Procedures.--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).
    ``(c) Definition.--In this section, the term `Indian tribe' has the 
meaning given that term in section 4 of the Indian Self-Determination 
and Education Assistance Act.
    ``(d) Authorization of Appropriations.--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.''.

            Subtitle P--Peer Support Communities of Recovery

SEC. 7151. BUILDING COMMUNITIES OF RECOVERY.

    Section 547 of the Public Health Service Act (42 U.S.C. 290ee-2) is 
amended to read as follows:

``SEC. 547. BUILDING COMMUNITIES OF RECOVERY.

    ``(a) Definition.--In this section, the term `recovery community 
organization' means an independent nonprofit organization that--
            ``(1) mobilizes resources within and outside of the 
        recovery community, which may include through a peer support 
        network, to increase the prevalence and quality of long-term 
        recovery from substance use disorders; and
            ``(2) is wholly or principally governed by people in 
        recovery for substance use disorders who reflect the community 
        served.
    ``(b) Grants Authorized.--The Secretary shall award grants to 
recovery community organizations to enable such organizations to 
develop, expand, and enhance recovery services.
    ``(c) Federal Share.--The Federal share of the costs of a program 
funded by a grant under this section may not exceed 85 percent.
    ``(d) Use of Funds.--Grants awarded under subsection (b)--
            ``(1) shall be used to develop, expand, and enhance 
        community and statewide recovery support services; and
            ``(2) may be used to--
                    ``(A) build connections between recovery networks, 
                including between recovery community organizations and 
                peer support networks, and with other recovery support 
                services, including--
                            ``(i) behavioral health providers;
                            ``(ii) primary care providers and 
                        physicians;
                            ``(iii) educational and vocational schools;
                            ``(iv) employers;
                            ``(v) housing services;
                            ``(vi) child welfare agencies; and
                            ``(vii) other recovery support services 
                        that facilitate recovery from substance use 
                        disorders, including non-clinical community 
                        services;
                    ``(B) reduce stigma associated with substance use 
                disorders; and
                    ``(C) conduct outreach on issues relating to 
                substance use disorders and recovery, including--
                            ``(i) identifying the signs of substance 
                        use disorder;
                            ``(ii) the resources available to 
                        individuals with substance use disorder and to 
                        families of an individual with a substance use 
                        disorder, including programs that mentor and 
                        provide support services to children;
                            ``(iii) the resources available to help 
                        support individuals in recovery; and
                            ``(iv) related medical outcomes of 
                        substance use disorders, the potential of 
                        acquiring an infection commonly associated with 
                        illicit drug use, and neonatal abstinence 
                        syndrome among infants exposed to opioids 
                        during pregnancy.
    ``(e) Special Consideration.--In carrying out this section, the 
Secretary shall give special consideration to the unique needs of rural 
areas, including areas with an age-adjusted rate of drug overdose 
deaths that is above the national average and areas with a shortage of 
prevention and treatment services.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $5,000,000 for each of fiscal 
years 2019 through 2023.''.

SEC. 7152. PEER SUPPORT TECHNICAL ASSISTANCE CENTER.

    Title V of the Public Health Service Act (42 U.S.C. 290dd et seq.) 
is amended by inserting after section 547 the following:

``SEC. 547A. PEER SUPPORT TECHNICAL ASSISTANCE CENTER.

    ``(a) Establishment.--The Secretary, acting through the Assistant 
Secretary, shall establish or operate a National Peer-Run Training and 
Technical Assistance Center for Addiction Recovery Support (referred to 
in this section as the `Center').
    ``(b) Functions.--The Center established under subsection (a) shall 
provide technical assistance and support to recovery community 
organizations and peer support networks, including such assistance and 
support related to--
            ``(1) training on identifying--
                    ``(A) signs of substance use disorder;
                    ``(B) resources to assist individuals with a 
                substance use disorder, or resources for families of an 
                individual with a substance use disorder; and
                    ``(C) best practices for the delivery of recovery 
                support services;
            ``(2) the provision of translation services, 
        interpretation, or other such services for clients with limited 
        English speaking proficiency;
            ``(3) data collection to support research, including for 
        translational research;
            ``(4) capacity building; and
            ``(5) evaluation and improvement, as necessary, of the 
        effectiveness of such services provided by recovery community 
        organizations.
    ``(c) Best Practices.--The Center established under subsection (a) 
shall periodically issue best practices for use by recovery community 
organizations and peer support networks.
    ``(d) Recovery Community Organization.--In this section, the term 
`recovery community organization' has the meaning given such term in 
section 547.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $1,000,000 for each of fiscal 
years 2019 through 2023.''.

 Subtitle Q--Creating Opportunities That Necessitate New and Enhanced 
         Connections That Improve Opioid Navigation Strategies

SEC. 7161. PREVENTING OVERDOSES OF CONTROLLED SUBSTANCES.

    (a) In General.--Part J of title III of the Public Health Service 
Act (42 U.S.C. 280b et seq.) is amended by inserting after section 392 
(42 U.S.C. 280b-1) the following:

``SEC. 392A. PREVENTING OVERDOSES OF CONTROLLED SUBSTANCES.

    ``(a) Evidence-Based Prevention Grants.--
            ``(1) In general.--The Director of the Centers for Disease 
        Control and Prevention may--
                    ``(A) to the extent practicable, carry out and 
                expand any evidence-based prevention activities 
                described in paragraph (2);
                    ``(B) provide training and technical assistance to 
                States, localities, and Indian tribes for purposes of 
                carrying out such activity; and
                    ``(C) award grants to States, localities, and 
                Indian tribes for purposes of carrying out such 
                activity.
            ``(2) Evidence-based prevention activities.--An evidence-
        based prevention activity described in this paragraph is any of 
        the following activities:
                    ``(A) Improving the efficiency and use of a new or 
                currently operating prescription drug monitoring 
                program, including by--
                            ``(i) encouraging all authorized users (as 
                        specified by the State or other entity) to 
                        register with and use the program;
                            ``(ii) enabling such users to access any 
                        updates to information collected by the program 
                        in as close to real-time as possible;
                            ``(iii) improving the ease of use of such 
                        program;
                            ``(iv) providing for a mechanism for the 
                        program to notify authorized users of any 
                        potential misuse or abuse of controlled 
                        substances and any detection of inappropriate 
                        prescribing or dispensing practices relating to 
                        such substances;
                            ``(v) encouraging the analysis of 
                        prescription drug monitoring data for purposes 
                        of providing de-identified, aggregate reports 
                        based on such analysis to State public health 
                        agencies, State substance abuse agencies, State 
                        licensing boards, and other appropriate State 
                        agencies, as permitted under applicable Federal 
                        and State law and the policies of the 
                        prescription drug monitoring program and not 
                        containing any protected health information, to 
                        prevent inappropriate prescribing, drug 
                        diversion, or abuse and misuse of controlled 
                        substances, and to facilitate better 
                        coordination among agencies;
                            ``(vi) enhancing interoperability between 
                        the program and any health information 
                        technology (including certified health 
                        information technology), including by 
                        integrating program data into such technology;
                            ``(vii) updating program capabilities to 
                        respond to technological innovation for 
                        purposes of appropriately addressing the 
                        occurrence and evolution of controlled 
                        substance overdoses;
                            ``(viii) facilitating and encouraging data 
                        exchange between the program and the 
                        prescription drug monitoring programs of other 
                        States;
                            ``(ix) enhancing data collection and 
                        quality, including improving patient matching 
                        and proactively monitoring data quality;
                            ``(x) providing prescriber and dispenser 
                        practice tools, including prescriber practice 
                        insight reports for practitioners to review 
                        their prescribing patterns in comparison to 
                        such patterns of other practitioners in the 
                        specialty; and
                            ``(xi) meeting the purpose of the program 
                        established under section 399O, as described in 
                        section 399O(a).
                    ``(B) Promoting community or health system 
                interventions.
                    ``(C) Evaluating interventions to prevent 
                controlled substance overdoses.
                    ``(D) 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.
            ``(3) Additional grants.--The Director may award grants to 
        States, localities, and Indian Tribes--
                    ``(A) to carry out innovative projects for grantees 
                to rapidly respond to controlled substance misuse, 
                abuse, and overdoses, including changes in patterns of 
                controlled substance use; and
                    ``(B) for any other evidence-based activity for 
                preventing controlled substance misuse, abuse, and 
                overdoses as the Director determines appropriate.
            ``(4) Research.--The Director, in coordination with the 
        Assistant Secretary for Mental Health and Substance Use and the 
        National Mental Health and Substance Use Policy Laboratory 
        established under section 501A, as appropriate and applicable, 
        may conduct studies and evaluations to address substance use 
        disorders, including preventing substance use disorders or 
        other related topics the Director determines appropriate.
    ``(b) Enhanced Controlled Substance Overdose Data Collection, 
Analysis, and Dissemination Grants.--
            ``(1) In general.--The Director of the Centers for Disease 
        Control and Prevention may--
                    ``(A) to the extent practicable, carry out any 
                controlled substance overdose data collection 
                activities described in paragraph (2);
                    ``(B) provide training and technical assistance to 
                States, localities, and Indian tribes for purposes of 
                carrying out such activity;
                    ``(C) award grants to States, localities, and 
                Indian tribes for purposes of carrying out such 
                activity; and
                    ``(D) 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 emergency departments 
                as a result of the abuse of alcohol or other drugs).
            ``(2) Controlled substance overdose data collection and 
        analysis activities.--A controlled substance overdose data 
        collection, analysis, and dissemination activity described in 
        this paragraph is any of the following activities:
                    ``(A) Improving the timeliness of reporting data to 
                the public, including data on fatal and nonfatal 
                overdoses of controlled substances.
                    ``(B) Enhancing the comprehensiveness of controlled 
                substance overdose data by collecting information on 
                such overdoses from appropriate sources such as 
                toxicology reports, autopsy reports, death scene 
                investigations, and emergency departments.
                    ``(C) Modernizing the system for coding causes of 
                death related to controlled substance overdoses to use 
                an electronic-based system.
                    ``(D) Using data to help identify risk factors 
                associated with controlled substance overdoses.
                    ``(E) Supporting entities involved in providing 
                information on controlled substance overdoses, such as 
                coroners, medical examiners, and public health 
                laboratories to improve accurate testing and 
                standardized reporting of causes and contributing 
                factors to controlled substances overdoses and analysis 
                of various opioid analogues to controlled substance 
                overdoses.
                    ``(F) Working to enable and encourage the access, 
                exchange, and use of information regarding controlled 
                substance overdoses among data sources and entities.
    ``(c) Definitions.--In this section:
            ``(1) Controlled substance.--The term `controlled 
        substance' has the meaning given that term in section 102 of 
        the Controlled Substances Act.
            ``(2) Indian tribe.--The term `Indian tribe' has the 
        meaning given that term in section 4 of the Indian Self-
        Determination and Education Assistance Act.
    ``(d) Authorization of Appropriations.--For purposes of carrying 
out this section, section 399O of this Act, and section 102 of the 
Comprehensive Addiction and Recovery Act of 2016 (Public Law 114-198), 
there is authorized to be appropriated $496,000,000 for each of fiscal 
years 2019 through 2023.''.
    (b) Education and Awareness.--Section 102 of the Comprehensive 
Addiction and Recovery Act of 2016 (Public Law 114-198) is amended--
            (1) by amending subsection (a) to read as follows:
    ``(a) In General.--The Secretary of Health and Human Services, 
acting through the Director of the Centers for Disease Control and 
Prevention and in coordination with the heads of other departments and 
agencies, shall advance education and awareness regarding the risks 
related to misuse and abuse of opioids, as appropriate, which may 
include developing or improving existing programs, conducting 
activities, and awarding grants that advance the education and 
awareness of--
            ``(1) the public, including patients and consumers--
                    ``(A) generally; and
                    ``(B) regarding such risks related to unused 
                opioids and the dispensing options under section 309(f) 
                of the Controlled Substances Act, as applicable; and
            ``(2) providers, which may include--
                    ``(A) providing for continuing education on 
                appropriate prescribing practices;
                    ``(B) education related to applicable State or 
                local prescriber limit laws, information on the use of 
                non-addictive alternatives for pain management, and the 
                use of overdose reversal drugs, as appropriate;
                    ``(C) disseminating and improving the use of 
                evidence-based opioid prescribing guidelines across 
                relevant health care settings, as appropriate, and 
                updating guidelines as necessary;
                    ``(D) implementing strategies, such as best 
                practices, to encourage and facilitate the use of 
                prescriber guidelines, in accordance with State and 
                local law;
                    ``(E) disseminating information to providers about 
                prescribing options for controlled substances, 
                including such options under section 309(f) of the 
                Controlled Substances Act, as applicable; and
                    ``(F) disseminating information, as appropriate, on 
                the National Pain Strategy developed by or in 
                consultation with the Assistant Secretary for Health; 
                and
            ``(3) other appropriate entities.''; and
            (2) in subsection (b)--
                    (A) by striking ``opioid abuse'' each place such 
                term appears and inserting ``opioid misuse and abuse''; 
                and
                    (B) in paragraph (2), by striking ``safe disposal 
                of prescription medications and other'' and inserting 
                ``non-addictive treatment options, safe disposal 
                options for prescription medications, and other 
                applicable''.

SEC. 7162. PRESCRIPTION DRUG MONITORING PROGRAM.

    Section 399O of the Public Health Service Act (42 U.S.C. 280g-3) is 
amended to read as follows:

``SEC. 399O. PRESCRIPTION DRUG MONITORING PROGRAM.

    ``(a) Program.--
            ``(1) In general.--Each fiscal year, the Secretary, acting 
        through the Director of the Centers for Disease Control and 
        Prevention, in coordination with the heads of other departments 
        and agencies as appropriate, shall support States or localities 
        for the purpose of improving the efficiency and use of PDMPs, 
        including--
                    ``(A) establishment and implementation of a PDMP;
                    ``(B) maintenance of a PDMP;
                    ``(C) improvements to a PDMP by--
                            ``(i) enhancing functional components to 
                        work toward--
                                    ``(I) universal use of PDMPs among 
                                providers and their delegates, to the 
                                extent that State laws allow;
                                    ``(II) more timely inclusion of 
                                data within a PDMP;
                                    ``(III) active management of the 
                                PDMP, in part by sending proactive or 
                                unsolicited reports to providers to 
                                inform prescribing; and
                                    ``(IV) ensuring the highest level 
                                of ease in use of and access to PDMPs 
                                by providers and their delegates, to 
                                the extent that State laws allow;
                            ``(ii) in consultation with the Office of 
                        the National Coordinator for Health Information 
                        Technology, improving the intrastate 
                        interoperability of PDMPs by--
                                    ``(I) making PDMPs more actionable 
                                by integrating PDMPs within electronic 
                                health records and health information 
                                technology infrastructure; and
                                    ``(II) linking PDMP data to other 
                                data systems within the State, 
                                including--
                                            ``(aa) the data of pharmacy 
                                        benefit managers, medical 
                                        examiners and coroners, and the 
                                        State's Medicaid program;
                                            ``(bb) worker's 
                                        compensation data; and
                                            ``(cc) prescribing data of 
                                        providers of the Department of 
                                        Veterans Affairs and the Indian 
                                        Health Service within the 
                                        State;
                            ``(iii) in consultation with the Office of 
                        the National Coordinator for Health Information 
                        Technology, improving the interstate 
                        interoperability of PDMPs through--
                                    ``(I) sharing of dispensing data in 
                                near-real time across State lines; and
                                    ``(II) 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
                            ``(iv) improving the ability to include 
                        treatment availability resources and referral 
                        capabilities within the PDMP.
            ``(2) Legislation.--As a condition on the receipt of 
        support under this section, the Secretary shall require a State 
        or locality to demonstrate that it has enacted legislation or 
        regulations--
                    ``(A) to provide for the implementation of the 
                PDMP; and
                    ``(B) to permit the imposition of appropriate 
                penalties for the unauthorized use and disclosure of 
                information maintained by the PDMP.
    ``(b) PDMP Strategies.--The Secretary shall encourage a State or 
locality, in establishing, improving, or maintaining a PDMP, to 
implement strategies that improve--
            ``(1) the reporting of dispensing in the State or locality 
        of a controlled substance to an ultimate user so the reporting 
        occurs not later than 24 hours after the dispensing event;
            ``(2) the consultation of the PDMP by each prescribing 
        practitioner, or their designee, in the State or locality 
        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;
            ``(3) the consultation of the PDMP before dispensing a 
        controlled substance, or any substance as required by the State 
        to be reported to the PDMP;
            ``(4) the proactive notification to a practitioner when 
        patterns indicative of controlled substance misuse by a 
        patient, including opioid misuse, are detected;
            ``(5) the availability of data in the PDMP to other States, 
        as allowable under State law; and
            ``(6) the availability of nonidentifiable information to 
        the Centers for Disease Control and Prevention for 
        surveillance, epidemiology, statistical research, or 
        educational purposes.
    ``(c) Drug Misuse and Abuse.--In consultation with practitioners, 
dispensers, and other relevant and interested stakeholders, a State 
receiving support under this section--
            ``(1) 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;
            ``(2) 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;
            ``(3) may conduct analyses of controlled substance program 
        data for purposes of providing appropriate State agencies with 
        aggregate reports based on such analyses in as close to real-
        time as practicable, regarding prescription patterns flagged as 
        potentially presenting a risk of misuse, abuse, addiction, 
        overdose, and other aggregate information, as appropriate and 
        in compliance with applicable Federal and State laws and 
        provided that such reports shall not include protected health 
        information; and
            ``(4) may access information about prescriptions, such as 
        claims data, to ensure that such prescribing and dispensing 
        history is updated in as close to real-time as practicable, in 
        compliance with applicable Federal and State laws and provided 
        that such information shall not include protected health 
        information.
    ``(d) Evaluation and Reporting.--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.
    ``(e) Evaluation and Reporting.--A State receiving support under 
this section shall provide the Secretary with aggregate nonidentifiable 
information, as permitted by State law, to enable the Secretary--
            ``(1) to evaluate the success of the State's program in 
        achieving the purpose described in subsection (a); or
            ``(2) to prepare and submit to the Congress the report 
        required by subsection (i)(2).
    ``(f) Education and Access to the Monitoring System.--A State 
receiving support under this section shall take steps to--
            ``(1) facilitate prescribers and dispensers, and their 
        delegates, as permitted by State law, to use the PDMP, to the 
        extent practicable; and
            ``(2) educate prescribers and dispensers, and their 
        delegates on the benefits of the use of PDMPs.
    ``(g) Electronic Format.--The Secretary may issue guidelines 
specifying a uniform electronic format for the reporting, sharing, and 
disclosure of information pursuant to PDMPs. To the extent possible, 
such guidelines shall be consistent with standards recognized by the 
Office of the National Coordinator for Health Information Technology.
    ``(h) Rules of Construction.--
            ``(1) Functions otherwise authorized by law.--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.
            ``(2) Additional privacy protections.--Nothing in this 
        section shall be construed as preempting any State from 
        imposing any additional privacy protections.
            ``(3) Federal privacy requirements.--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 (Public Law 104-191; 
        110 Stat. 2033) and section 543 of this Act.
            ``(4) No federal private cause of action.--Nothing in this 
        section shall be construed to create a Federal private cause of 
        action.
    ``(i) Progress Report.--Not later than 3 years after the date of 
enactment of this section, the Secretary shall--
            ``(1) complete a study that--
                    ``(A) determines the progress of grantees in 
                establishing and implementing PDMPs consistent with 
                this section;
                    ``(B) provides an analysis of the extent to which 
                the operation of PDMPs has--
                            ``(i) reduced inappropriate use, abuse, 
                        diversion of, and overdose with, controlled 
                        substances;
                            ``(ii) established or strengthened 
                        initiatives to ensure linkages to substance use 
                        disorder treatment services; or
                            ``(iii) affected patient access to 
                        appropriate care in States operating PDMPs;
                    ``(C) determine the progress of grantees 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;
                    ``(D) determines the progress of grantees in 
                implementing near real-time electronic PDMPs;
                    ``(E) provides an analysis of the privacy 
                protections in place for the information reported to 
                the PDMP in each State or locality receiving support 
                under this section and any recommendations of the 
                Secretary for additional Federal or State requirements 
                for protection of this information;
                    ``(F) determines the progress of States or 
                localities 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
                    ``(G) evaluates the penalties that States or 
                localities 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
            ``(2) submit a report to the Congress on the results of the 
        study.
    ``(j) Advisory Council.--
            ``(1) Establishment.--A State or locality may establish an 
        advisory council to assist in the establishment, improvement, 
        or maintenance of a PDMP consistent with this section.
            ``(2) Limitation.--A State or locality may not use Federal 
        funds for the operations of an advisory council to assist in 
        the establishment, improvement, or maintenance of a PDMP.
            ``(3) Sense of congress.--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 
        or locality should consult with appropriate professional boards 
        and other interested parties.
    ``(k) Definitions.--For purposes of this section:
            ``(1) The term `controlled substance' 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.
            ``(2) The term `dispense' 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.
            ``(3) The term `dispenser' means a physician, pharmacist, 
        or other person that dispenses a controlled substance to an 
        ultimate user.
            ``(4) The term `interstate interoperability' 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.
            ``(5) The term `intrastate interoperability' 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.
            ``(6) The term `nonidentifiable information' 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.
            ``(7) The term `PDMP' means a prescription drug monitoring 
        program that is State-controlled.
            ``(8) The term `practitioner' 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.
            ``(9) The term `State' means each of the 50 States, the 
        District of Columbia, and any commonwealth or territory of the 
        United States.
            ``(10) The term `ultimate user' 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.
            ``(11) The term `clinical workflow' 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.''.

   Subtitle R--Review of Substance Use Disorder Treatment Providers 
                       Receiving Federal Funding

SEC. 7171. REVIEW OF SUBSTANCE USE DISORDER TREATMENT PROVIDERS 
              RECEIVING FEDERAL FUNDING.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall conduct a review 
of entities that receive Federal funding for the provision of substance 
use disorder treatment services. The review shall include:
            (1) The length of time the entity has provided substance 
        use disorder treatment services and the geographic area served 
        by the entity.
            (2) A detailed analysis of the patient population served by 
        the entity, including but not limited to the number of 
        patients, types of diagnosed substance use disorders and the 
        demographic information of such patients, including sex, race, 
        ethnicity, and socioeconomic status.
            (3) Detailed information on the types of substance use 
        disorders for which the entity has the experience, capability, 
        and capacity to provide such services.
            (4) An analysis of how the entity handles patients 
        requiring treatment for a substance use disorder that the 
        organization is not able to treat.
            (5) An analysis of what is needed in order to improve the 
        entity's ability to meet the addiction treatment needs of the 
        communities served by that entity.
            (6) 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 to 
        treat individuals with methamphetamine, cocaine, including 
        crack cocaine, heroin, opioid, and other substance use 
        disorders.
    (b) Report.--Not later than 2 years 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).

                  Subtitle S--Other Health Provisions

SEC. 7181. STATE RESPONSE TO THE OPIOID ABUSE CRISIS.

    (a) In General.--Section 1003 of the 21st Century Cures Act (Public 
Law 114-255) is amended--
            (1) in subsection (a)--
                    (A) by striking ``the authorization of 
                appropriations under subsection (b) to carry out the 
                grant program described in subsection (c)'' and 
                inserting ``subsection (h) to carry out the grant 
                program described in subsection (b)''; and
                    (B) by inserting ``and Indian Tribes'' after 
                ``States'';
            (2) by striking subsection (b);
            (3) by redesignating subsections (c) through (e) as 
        subsections (b) through (d), respectively;
            (4) by redesignating subsection (f) as subsection (j);
            (5) in subsection (b), as so redesignated--
                    (A) in paragraph (1)--
                            (i) in the paragraph heading, by inserting 
                        ``and tribal'' after ``State'';
                            (ii) by striking ``States for the purpose 
                        of addressing the opioid abuse crisis within 
                        such States'' and inserting ``States and Indian 
                        Tribes for the purpose of addressing the opioid 
                        abuse crisis within such States and Indian 
                        Tribes'';
                            (iii) by inserting ``or Indian Tribes'' 
                        after ``preference to States''; and
                            (iv) by inserting before the period of the 
                        second sentence ``or other Indian Tribes, as 
                        applicable''; and
                    (B) in paragraph (2)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``to a State'';
                            (ii) in subparagraph (A), by striking 
                        ``Improving State'' and inserting 
                        ``Establishing or improving'';
                            (iii) in subparagraph (C), by inserting 
                        ``preventing diversion of controlled 
                        substances,'' after ``treatment programs,''; 
                        and
                            (iv) in subparagraph (E), by striking ``as 
                        the State determines appropriate, related to 
                        addressing the opioid abuse crisis within the 
                        State'' and inserting ``as the State or Indian 
                        Tribe determines appropriate, related to 
                        addressing the opioid abuse crisis within the 
                        State or Indian Tribe, including directing 
                        resources in accordance with local needs 
                        related to substance use disorders'';
            (6) in subsection (c), as so redesignated, by striking 
        ``subsection (c)'' and inserting ``subsection (b)'';
            (7) in subsection (d), as so redesignated--
                    (A) in the matter preceding paragraph (1), by 
                striking ``the authorization of appropriations under 
                subsection (b)'' and inserting ``subsection (h)''; and
                    (B) in paragraph (1), by striking ``subsection 
                (c)'' and inserting ``subsection (b)''; and
            (8) by inserting after subsection (d), as so redesignated, 
        the following:
    ``(e) Indian Tribes.--
            ``(1) Definition.--For purposes of this section, the term 
        `Indian Tribe' has the meaning given the term `Indian tribe' in 
        section 4 of the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 5304).
            ``(2) Appropriate mechanisms.--The Secretary, in 
        consultation with Indian Tribes, shall identify and establish 
        appropriate mechanisms for Tribes to demonstrate or report the 
        information as required under subsections (b), (c), and (d).
    ``(f) Report to Congress.--Not later than 1 year after the date on 
which amounts are first awarded after the date of enactment of this 
subsection, pursuant to subsection (b), and annually thereafter, the 
Secretary 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 summarizing the information 
provided to the Secretary in reports made pursuant to subsection (c), 
including the purposes for which grant funds are awarded under this 
section and the activities of such grant recipients.
    ``(g) Technical Assistance.--The Secretary, including through the 
Tribal Training and Technical Assistance Center of the Substance Abuse 
and Mental Health Services Administration, shall provide State agencies 
and Indian Tribes, as applicable, with technical assistance concerning 
grant application and submission procedures under this section, award 
management activities, and enhancing outreach and direct support to 
rural and underserved communities and providers in addressing the 
opioid crisis.
    ``(h) Authorization of Appropriations.--For purposes of carrying 
out the grant program under subsection (b), there is authorized to be 
appropriated $500,000,000 for each of fiscal years 2019 through 2021, 
to remain available until expended.
    ``(i) Set Aside.--Of the amounts made available for each fiscal 
year to award grants under subsection (b) for a fiscal year, 5 percent 
of such amount for such fiscal year shall be made available to Indian 
Tribes, and up to 15 percent of such amount for such fiscal year may be 
set aside for States with the highest age-adjusted rate of drug 
overdose death based on the ordinal ranking of States according to the 
Director of the Centers for Disease Control and Prevention.''.
    (b) Conforming Amendment.--Section 1004(c) of the 21st Century 
Cures Act (Public Law 114-255) is amended by striking ``, the FDA 
Innovation Account, or the Account For the State Response to the Opioid 
Abuse Crisis'' and inserting ``or the FDA Innovation Account''.

SEC. 7182. REPORT ON INVESTIGATIONS REGARDING PARITY IN MENTAL HEALTH 
              AND SUBSTANCE USE DISORDER BENEFITS.

    (a) In General.--Section 13003 of the 21st Century Cures Act 
(Public Law 114-255) is amended--
            (1) in subsection (a)--
                    (A) by striking ``with findings of any serious 
                violation regarding'' and inserting ``concerning''; and
                    (B) by inserting ``and the Committee on Education 
                and the Workforce'' after ``Energy and Commerce''; and
            (2) in subsection (b)(1)--
                    (A) by inserting ``complaints received and number 
                of'' before ``closed''; and
                    (B) by inserting before the period ``, and, for 
                each such investigation closed, which agency conducted 
                the investigation, whether the health plan that is the 
                subject of the investigation is fully insured or not 
                fully insured and a summary of any coordination between 
                the applicable State regulators and the Department of 
                Labor, the Department of Health and Human Services, or 
                the Department of the Treasury, and references to any 
                guidance provided by the agencies addressing the 
                category of violation committed''.
    (b) Applicability.--The amendments made by subsection (a) shall 
apply with respect to the second annual report required under such 
section 13003 and each such annual report thereafter.

SEC. 7183. CAREER ACT.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), in consultation 
with the Secretary of Labor, shall continue or establish a program to 
support individuals in substance use disorder treatment and recovery to 
live independently and participate in the workforce.
    (b) Grants Authorized.--In carrying out the activities under this 
section, the Secretary shall, on a competitive basis, award grants for 
a period of not more than 5 years to entities to enable such entities 
to carry out evidence-based programs to help individuals in substance 
use disorder treatment and recovery to live independently and 
participate in the workforce. Such entities shall coordinate, as 
applicable, with Indian tribes or tribal organizations (as applicable), 
State boards and local boards (as defined in section 3 of the Workforce 
Innovation and Opportunity Act (29 U.S.C. 3102), lead State agencies 
with responsibility for a workforce investment activity (as defined in 
such section 3), and State agencies responsible for carrying out 
substance use disorder prevention and treatment programs.
    (c) Priority.--
            (1) In general.--In awarding grants under this section, the 
        Secretary shall give priority based on the State in which the 
        entity is located. Priority shall be given among States 
        according to a formula based on the rates described in 
        paragraph (2) and weighted as described in paragraph (3).
            (2) Rates.--The rates described in this paragraph are the 
        following:
                    (A) The amount by which the rate of drug overdose 
                deaths in the State, adjusted for age, is above the 
                national overdose mortality rate, as determined by the 
                Director of the Centers for Disease Control and 
                Prevention.
                    (B) The amount by which the rate of unemployment 
                for the State, based on data provided by the Bureau of 
                Labor Statistics for the preceding 5 calendar years for 
                which there is available data, is above the national 
                average.
                    (C) The amount by which rate of labor force 
                participation in the State, based on data provided by 
                the Bureau of Labor Statistics for the preceding 5 
                calendar years for which there is available data, is 
                below the national average.
            (3) Weighting.--The rates described in paragraph (2) shall 
        be weighted as follows:
                    (A) The rate described in paragraph (2)(A) shall be 
                weighted 70 percent.
                    (B) The rate described in paragraph (2)(B) shall be 
                weighted 15 percent.
                    (C) The rate described in paragraph (2)(C) shall be 
                weighted 15 percent.
    (d) Preference.--In awarding grants under this section, the 
Secretary shall give preference to entities located in areas within 
States with the greatest need, with such need based on the highest 
mortality rate related to substance use disorder.
    (e) Definitions.--In this section:
            (1) Eligible entity.--The term ``eligible entity'' means an 
        entity that offers treatment or recovery services for 
        individuals with substance use disorders, and partners with one 
        or more local or State stakeholders, which may include local 
        employers, community organizations, the local workforce 
        development board, local and State governments, and Indian 
        Tribes or tribal organizations, to support recovery, 
        independent living, and participation in the workforce.
            (2) Indian tribes; tribal organization.--The terms ``Indian 
        Tribe'' and ``tribal organization'' have the meanings given the 
        terms ``Indian tribe'' and ``tribal organization'' in section 4 
        of the Indian Self-Determination and Education Assistance Act 
        (25 U.S.C. 5304).
            (3) State.--The term ``State'' includes only the several 
        States and the District of Columbia.
    (f) Applications.--An eligible entity shall submit an application 
at such time and in such manner as the Secretary may require. In 
submitting an application, the entity shall demonstrate the ability to 
partner with local stakeholders, which may include local employers, 
community stakeholders, the local workforce development board, local 
and State governments, and Indian Tribes or tribal organizations, as 
applicable, to--
            (1) identify gaps in the workforce due to the prevalence of 
        substance use disorders;
            (2) in coordination with statewide employment and training 
        activities, including coordination and alignment of activities 
        carried out by entities provided grant funds under section 
        8041, help individuals in recovery from a substance use 
        disorder transition into the workforce, including by providing 
        career services, training services as described in paragraph 
        (2) of section 134(c) of the Workforce Innovation and 
        Opportunity Act (29 U.S.C. 3174(c)), and related services 
        described in section 134(a)(3) of such Act (42 U.S.C. 3174(a)); 
        and
            (3) assist employers with informing their employees of the 
        resources, such as resources related to substance use disorders 
        that are available to their employees.
    (g) Use of Funds.--An entity receiving a grant under this section 
shall use the funds to conduct one or more of the following activities:
            (1) Hire case managers, care coordinators, providers of 
        peer recovery support services, as described in section 547(a) 
        of the Public Health Service Act (42 U.S.C. 290ee-2(a)), or 
        other professionals, as appropriate, to provide services that 
        support treatment, recovery, and rehabilitation, and prevent 
        relapse, recidivism, and overdose, including by encouraging--
                    (A) the development and strengthening of daily 
                living skills; and
                    (B) the use of counseling, care coordination, and 
                other services, as appropriate, to support recovery 
                from substance use disorders.
            (2) Implement or utilize innovative technologies, which may 
        include the use of telemedicine.
            (3) In coordination with the lead State agency with 
        responsibility for a workforce investment activity or local 
        board described in subsection (b), provide--
                    (A) short-term prevocational training services; and
                    (B) training services that are directly linked to 
                the employment opportunities in the local area or the 
                planning region.
    (h) Support for State Strategy.--An eligible entity shall include 
in its application under subsection (f) information describing how the 
services and activities proposed in such application are aligned with 
the State, outlying area, or Tribal strategy, as applicable, for 
addressing issues described in such application and how such entity 
will coordinate with existing systems to deliver services as described 
in such application.
    (i) Data Reporting and Program Oversight.--Each eligible entity 
awarded a grant under this section shall submit to the Secretary a 
report at such time and in such manner as the Secretary may require. 
Such report shall include a description of--
            (1) the programs and activities funded by the grant;
            (2) outcomes of the population of individuals with a 
        substance use disorder the grantee served through activities 
        described in subsection (g); and
            (3) any other information that the Secretary may require 
        for the purpose of ensuring that the grantee is complying with 
        all of the requirements of the grant.
    (j) Reports to Congress.--
            (1) Preliminary report.--Not later than 2 years after the 
        end of the first year of the grant period under this section, 
        the Secretary shall submit to Congress a preliminary report 
        that analyzes reports submitted under subsection (i).
            (2) Final report.--Not later than 2 years after submitting 
        the preliminary report required under paragraph (1), the 
        Secretary shall submit to Congress a final report that 
        includes--
                    (A) a description of how the grant funding was 
                used, including the number of individuals who received 
                services under subsection (g)(3) and an evaluation of 
                the effectiveness of the activities conducted by the 
                grantee with respect to outcomes of the population of 
                individuals with substance use disorder who receive 
                services from the grantee; and
                    (B) recommendations related to best practices for 
                health care professionals to support individuals in 
                substance use disorder treatment or recovery to live 
                independently and participate in the workforce.
    (k) Authorization of Appropriations.--There is authorized to be 
appropriated $5,000,000 for each of fiscal years 2019 through 2023 for 
purposes of carrying out this section.

                       TITLE VIII--MISCELLANEOUS

       Subtitle A--Synthetics Trafficking and Overdose Prevention

SEC. 8001. SHORT TITLE.

    This subtitle may be cited as the ``Synthetics Trafficking and 
Overdose Prevention Act of 2018'' or ``STOP Act of 2018''.

SEC. 8002. CUSTOMS FEES.

    (a) In General.--Section 13031(b)(9) of the Consolidated Omnibus 
Budget Reconciliation Act of 1985 (19 U.S.C. 58c(b)(9)) is amended by 
adding at the end the following:
            ``(D)(i) With respect to the processing of items that are 
        sent to the United States through the international postal 
        network by `Inbound Express Mail service' or `Inbound EMS' (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:
                    ``(I) $1 per Inbound EMS item.
                    ``(II) If an Inbound EMS item is formally entered, 
                the fee provided for under subsection (a)(9), if 
                applicable.
            ``(ii) Notwithstanding section 451 of the Tariff Act of 
        1930 (19 U.S.C. 1451), 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.
            ``(iii)(I) The payments required by clause (i)(I) shall be 
        allocated as follows:
                    ``(aa) 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.
                    ``(bb) 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.
            ``(II) 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 (19 U.S.C. 1524), 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.
            ``(III) 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.
            ``(iv) 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.''.
    (b) Conforming Amendments.--Section 13031(a) of the Consolidated 
Omnibus Budget Reconciliation Act of 1985 (19 U.S.C. 58c(a)) is 
amended--
            (1) in paragraph (6), by inserting ``(other than an item 
        subject to a fee under subsection (b)(9)(D))'' after ``customs 
        officer''; and
            (2) in paragraph (10)--
                    (A) in subparagraph (C), in the matter preceding 
                clause (i), by inserting ``(other than Inbound EMS 
                items described in subsection (b)(9)(D))'' after 
                ``release''; and
                    (B) in the flush at the end, by inserting ``or of 
                Inbound EMS items described in subsection (b)(9)(D),'' 
                after ``(C),''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on January 1, 2020.

SEC. 8003. MANDATORY ADVANCE ELECTRONIC INFORMATION FOR POSTAL 
              SHIPMENTS.

    (a) Mandatory Advance Electronic Information.--
            (1) In general.--Section 343(a)(3)(K) of the Trade Act of 
        2002 (Public Law 107-210; 19 U.S.C. 2071 note) is amended to 
        read as follows:
                    ``(K)(i) 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.
                    ``(ii) 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).
                    ``(iii) 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).
                    ``(iv) 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--
                            ``(I) setting incremental targets for 
                        increasing the percentage of such shipments for 
                        which information is required to be transmitted 
                        to the Commissioner; and
                            ``(II) taking into consideration--
                                    ``(aa) the risk posed by such 
                                shipments;
                                    ``(bb) the volume of mail shipped 
                                to the United States by or through a 
                                particular country; and
                                    ``(cc) the capacities of foreign 
                                postal operators to provide that 
                                information to the Postal Service.
                    ``(v)(I) 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).
                    ``(II) 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--
                            ``(aa) assessing the reasons for the 
                        failure to meet those requirements; and
                            ``(bb) identifying recommendations to 
                        improve the collection by the Postal Service of 
                        the information described in paragraphs (1) and 
                        (2).
                    ``(vi)(I) 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).
                    ``(II) 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--
                            ``(aa) does not have the capacity to 
                        collect and transmit such information;
                            ``(bb) represents a low risk for mail 
                        shipments that violate relevant United States 
                        laws and regulations; and
                            ``(cc) 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.
                    ``(III) 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).
                    ``(IV) The Commissioner shall, on an annual basis, 
                submit to the appropriate congressional committees--
                            ``(aa) 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
                            ``(bb) information used to support such 
                        determination with respect to such countries.
                    ``(vii)(I) 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).
                    ``(II) 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.
                    ``(viii) 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.
                    ``(ix) In this subparagraph, the term `appropriate 
                congressional committees' means--
                            ``(I) the Committee on Finance and the 
                        Committee on Homeland Security and Governmental 
                        Affairs of the Senate; and
                            ``(II) the Committee on Ways and Means, the 
                        Committee on Oversight and Government Reform, 
                        and the Committee on Homeland Security of the 
                        House of Representatives.''.
            (2) Joint strategic plan on mandatory advance 
        information.--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--
                    (A) the transmission of information as required by 
                section 343(a)(3)(K) of the Trade Act of 2002, as 
                amended by paragraph (1); and
                    (B) 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.
    (b) Capacity Building.--
            (1) In general.--Section 343(a) of the Trade Act of 2002 
        (Public Law 107-210; 19 U.S.C. 2071 note) is amended by adding 
        at the end the following:
            ``(5) Capacity building.--
                    ``(A) In general.--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--
                            ``(i) to gather and provide the information 
                        required by paragraph (3)(K); and
                            ``(ii) to otherwise gather and provide 
                        postal shipment information related to--
                                    ``(I) terrorism;
                                    ``(II) items the importation or 
                                introduction of which into the United 
                                States is prohibited or restricted, 
                                including controlled substances; and
                                    ``(III) such other concerns as the 
                                Secretary determines appropriate.
                    ``(B) Provision of equipment and technology.--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.''.
            (2) Joint strategic plan on capacity building.--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--
                    (A) 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);
                    (B) describing plans for future capacity building 
                efforts; and
                    (C) 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.
    (c) Report and Consultations by Secretary of Homeland Security and 
Postmaster General.--
            (1) Report.--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:
                    (A) An assessment of the status of the regulations 
                required to be promulgated under that subparagraph.
                    (B) An update regarding new and existing agreements 
                reached with foreign postal operators for the 
                transmission of the information required by that 
                subparagraph.
                    (C) 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.
                    (D) A summary of the progress made in achieving the 
                transmission of that information for the percentage of 
                shipments required by that subparagraph.
                    (E) 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.
                    (F) 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.
                    (G) 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.
                    (H) 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.
            (2) Consultations.--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.
    (d) Government Accountability Office Report.--Not later than June 
30, 2019, the Comptroller General of the United States shall submit to 
the appropriate congressional committees a report--
            (1) 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;
            (2) assessing the quality of the information received from 
        foreign postal operators for targeting purposes;
            (3) assessing the specific percentage of targeted mail 
        presented by the Postal Service to U.S. Customs and Border 
        Protection for inspection;
            (4) 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;
            (5) assessing the benefits of receiving that information 
        with respect to international mail shipments;
            (6) 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
            (7) 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--
                    (A) requiring the Postal Service to serve as the 
                consignee for international mail shipments containing 
                goods; or
                    (B) designating a customs broker to act as an 
                importer of record for international mail shipments 
                containing goods.
    (e) Technical Correction.--Section 343 of the Trade Act of 2002 
(Public Law 107-210; 19 U.S.C. 2071 note) is amended in the section 
heading by striking ``advanced'' and inserting ``advance''.
    (f) Appropriate Congressional Committees Defined.--In this section, 
the term ``appropriate congressional committees'' means--
            (1) the Committee on Finance and the Committee on Homeland 
        Security and Governmental Affairs of the Senate; and
            (2) the Committee on Ways and Means, the Committee on 
        Oversight and Government Reform, and the Committee on Homeland 
        Security of the House of Representatives.

SEC. 8004. INTERNATIONAL POSTAL AGREEMENTS.

    (a) Existing Agreements.--
            (1) In general.--In the event that any provision of this 
        subtitle, or any amendment made by this subtitle, 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.
            (2) Rule of construction.--Nothing in this subsection shall 
        be construed to permit delay in the implementation of this 
        subtitle or any amendment made by this subtitle.
    (b) Future Agreements.--
            (1) Consultations.--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)).
            (2) Expedited negotiation of new agreement.--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.

SEC. 8005. COST RECOUPMENT.

    (a) In General.--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.
    (b) Costs Not Considered Revenue.--The recovery of costs under 
subsection (a) shall not be deemed revenue for purposes of subchapter I 
and II of chapter 36 of title 39, United States Code, or regulations 
prescribed under that chapter.

SEC. 8006. DEVELOPMENT OF TECHNOLOGY TO DETECT ILLICIT NARCOTICS.

    (a) In General.--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.
    (b) Outreach to Private Sector.--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.

SEC. 8007. CIVIL PENALTIES FOR POSTAL SHIPMENTS.

    Section 436 of the Tariff Act of 1930 (19 U.S.C. 1436) is amended 
by adding at the end the following new subsection:
    ``(e) Civil Penalties for Postal Shipments.--
            ``(1) Civil penalty.--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.
            ``(2) Modification of civil penalty.--
                    ``(A) In general.--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--
                            ``(i) has a low error rate in compliance 
                        with section 343(a)(3)(K) of the Trade Act of 
                        2002;
                            ``(ii) 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
                            ``(iii) has taken remedial action to 
                        prevent future violations of section 
                        343(a)(3)(K)(vii)(I) of the Trade Act of 2002.
                    ``(B) Written notification.--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).
            ``(3) Ongoing lack of compliance.--If U.S. Customs and 
        Border Protection determines that the United States Postal 
        Service--
                    ``(A) has repeatedly committed violations of 
                section 343(a)(3)(K)(vii)(I) of the Trade Act of 2002,
                    ``(B) 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
                    ``(C) has an increasing error rate in compliance 
                with section 343(a)(3)(K) of the Trade Act of 2002,
        civil penalties may be imposed against the United States Postal 
        Service until corrective action, satisfactory to U.S. Customs 
        and Border Protection, is taken.''.

SEC. 8008. REPORT ON VIOLATIONS OF ARRIVAL, REPORTING, ENTRY, AND 
              CLEARANCE REQUIREMENTS AND FALSITY OR LACK OF MANIFEST.

    (a) In General.--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 
(19 U.S.C. 1436), as amended by section 8007, and section 584 of such 
Act (19 U.S.C. 1584) that occurred during the previous year.
    (b) Information Described.--The information described in this 
subsection is the following:
            (1) The name and address of the violator.
            (2) The specific violation that was committed.
            (3) The location or port of entry through which the items 
        were transported.
            (4) An inventory of the items seized, including a 
        description of the items and the quantity seized.
            (5) The location from which the items originated.
            (6) The entity responsible for the apprehension or seizure, 
        organized by location or port of entry.
            (7) The amount of penalties assessed by U.S. Customs and 
        Border Protection, organized by name of the violator and 
        location or port of entry.
            (8) 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.
            (9) The rationale for negotiating lower penalties, 
        organized by name of the violator and location or port of 
        entry.
    (c) Appropriate Congressional Committees Defined.--In this section, 
the term ``appropriate congressional committees'' means--
            (1) the Committee on Finance and the Committee on Homeland 
        Security and Governmental Affairs of the Senate; and
            (2) the Committee on Ways and Means, the Committee on 
        Oversight and Government Reform, and the Committee on Homeland 
        Security of the House of Representatives.

SEC. 8009. EFFECTIVE DATE; REGULATIONS.

    (a) Effective Date.--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.
    (b) Regulations.--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.

         Subtitle B--Opioid Addiction Recovery Fraud Prevention

SEC. 8021. SHORT TITLE.

    This subtitle may be cited as the ``Opioid Addiction Recovery Fraud 
Prevention Act of 2018''.

SEC. 8022. DEFINITIONS.

    For purposes of this subtitle only, and not be construed or applied 
as to challenge or affect the characterization, definition, or 
treatment under any other statute, regulation, or rule:
            (1) Substance use disorder treatment product.--The term 
        ``substance use disorder treatment product'' means a product 
        for use or marketed for use in the treatment, cure, or 
        prevention of a substance use disorder, including an opioid use 
        disorder.
            (2) Substance use disorder treatment service.--The term 
        ``substance use disorder treatment service'' means a service 
        that purports to provide referrals to treatment, treatment, or 
        recovery housing for people diagnosed with, having, or 
        purporting to have a substance use disorder, including an 
        opioid use disorder.

SEC. 8023. UNFAIR OR DECEPTIVE ACTS OR PRACTICES WITH RESPECT TO 
              SUBSTANCE USE DISORDER TREATMENT SERVICE AND PRODUCTS.

    (a) Unlawful Activity.--It is unlawful to engage in an unfair or 
deceptive act or practice with respect to any substance use disorder 
treatment service or substance use disorder treatment product.
    (b) Enforcement by the Federal Trade Commission.--
            (1) Unfair or deceptive acts or practices.--A violation of 
        subsection (a) shall be treated as a violation of a rule under 
        section 18 of the Federal Trade Commission Act (15 U.S.C. 57a) 
        regarding unfair or deceptive acts or practices.
            (2) Powers of the federal trade commission.--
                    (A) In general.--The Federal Trade Commission shall 
                enforce this section in the same manner, by the same 
                means, and with the same jurisdiction, powers, and 
                duties as though all applicable terms and provisions of 
                the Federal Trade Commission Act (15 U.S.C. 41 et seq.) 
                were incorporated into and made a part of this section.
                    (B) Privileges and immunities.--Any person who 
                violates subsection (a) shall be subject to the 
                penalties and entitled to the privileges and immunities 
                provided in the Federal Trade Commission Act as though 
                all applicable terms and provisions of the Federal 
                Trade Commission Act (15 U.S.C. 41 et seq.) were 
                incorporated and made part of this section.
    (c) Authority Preserved.--Nothing in this subtitle shall be 
construed to limit the authority of the Federal Trade Commission or the 
Food and Drug Administration under any other provision of law.

  Subtitle C--Addressing Economic and Workforce Impacts of the Opioid 
                                 Crisis

SEC. 8041. ADDRESSING ECONOMIC AND WORKFORCE IMPACTS OF THE OPIOID 
              CRISIS.

    (a) Definitions.--Except as otherwise expressly provided, in this 
section:
            (1) WIOA definitions.--The terms ``core program'', 
        ``individual with a barrier to employment'', ``local area'', 
        ``local board'', ``one-stop operator'', ``outlying area'', 
        ``State'', ``State board'', and ``supportive services'' have 
        the meanings given the terms in section 3 of the Workforce 
        Innovation and Opportunity Act (29 U.S.C. 3102).
            (2) Education provider.--The term ``education provider'' 
        means--
                    (A) an institution of higher education, as defined 
                in section 101 of the Higher Education Act of 1965 (20 
                U.S.C. 1001); or
                    (B) a postsecondary vocational institution, as 
                defined in section 102(c) of such Act (20 U.S.C. 
                1002(c)).
            (3) Eligible entity.--The term ``eligible entity'' means--
                    (A) a State workforce agency;
                    (B) an outlying area; or
                    (C) a Tribal entity.
            (4) Participating partnership.--The term ``participating 
        partnership'' means a partnership--
                    (A) evidenced by a written contract or agreement; 
                and
                    (B) including, as members of the partnership, a 
                local board receiving a subgrant under subsection (d) 
                and 1 or more of the following:
                            (i) The eligible entity.
                            (ii) A treatment provider.
                            (iii) An employer or industry organization.
                            (iv) An education provider.
                            (v) A legal service or law enforcement 
                        organization.
                            (vi) A faith-based or community-based 
                        organization.
                            (vii) Other State or local agencies, 
                        including counties or local governments.
                            (viii) Other organizations, as determined 
                        to be necessary by the local board.
                            (ix) Indian Tribes or tribal organizations.
            (5) Program participant.--The term ``program participant'' 
        means an individual who--
                    (A) is a member of a population of workers 
                described in subsection (e)(2) that is served by a 
                participating partnership through the pilot program 
                under this section; and
                    (B) enrolls with the applicable participating 
                partnership to receive any of the services described in 
                subsection (e)(3).
            (6) Provider of peer recovery support services.--The term 
        ``provider of peer recovery support services'' means a provider 
        that delivers peer recovery support services through an 
        organization described in section 547(a) of the Public Health 
        Service Act (42 U.S.C. 290ee-2(a)).
            (7) Secretary.--The term ``Secretary'' means the Secretary 
        of Labor.
            (8) State workforce agency.--The term ``State workforce 
        agency'' means the lead State agency with responsibility for 
        the administration of a program under chapter 2 or 3 of 
        subtitle B of title I of the Workforce Innovation and 
        Opportunity Act (29 U.S.C. 3161 et seq., 3171 et seq.).
            (9) Substance use disorder.--The term ``substance use 
        disorder'' has the meaning given such term by the Assistant 
        Secretary for Mental Health and Substance Use.
            (10) Treatment provider.--The term ``treatment provider''--
                    (A) means a health care provider that--
                            (i) offers services for treating substance 
                        use disorders and is licensed in accordance 
                        with applicable State law to provide such 
                        services; and
                            (ii) accepts health insurance for such 
                        services, including coverage under title XIX of 
                        the Social Security Act (42 U.S.C. 1396 et 
                        seq.); and
                    (B) may include--
                            (i) a nonprofit provider of peer recovery 
                        support services;
                            (ii) a community health care provider;
                            (iii) a Federally qualified health center 
                        (as defined in section 1861(aa) of the Social 
                        Security Act (42 U.S.C. 1395x));
                            (iv) an Indian health program (as defined 
                        in section 3 of the Indian Health Care 
                        Improvement Act (25 U.S.C. 1603)), including an 
                        Indian health program that serves an urban 
                        center (as defined in such section); and
                            (v) a Native Hawaiian health center (as 
                        defined in section 12 of the Native Hawaiian 
                        Health Care Improvement Act (42 U.S.C. 11711)).
            (11) Tribal entity.--The term ``Tribal entity'' includes 
        any Indian Tribe, tribal organization, Indian-controlled 
        organization serving Indians, Native Hawaiian organization, or 
        Alaska Native entity, as such terms are defined or used in 
        section 166 of the Workforce Innovation and Opportunity Act (29 
        U.S.C. 3221).
    (b) Pilot Program and Grants Authorized.--
            (1) In general.--The Secretary, in consultation with the 
        Secretary of Health and Human Services, shall carry out a pilot 
        program to address economic and workforce impacts associated 
        with a high rate of a substance use disorder. In carrying out 
        the pilot program, the Secretary shall make grants, on a 
        competitive basis, to eligible entities to enable such entities 
        to make subgrants to local boards to address the economic and 
        workforce impacts associated with a high rate of a substance 
        use disorder.
            (2) Grant amounts.--The Secretary shall make each such 
        grant in an amount that is not less than $500,000, and not more 
        than $5,000,000, for a fiscal year.
    (c) Grant Applications.--
            (1) In general.--An eligible entity applying for a grant 
        under this section shall submit an application to the Secretary 
        at such time and in such form and manner as the Secretary may 
        reasonably require, including the information described in this 
        subsection.
            (2) Significant impact on community by opioid and substance 
        use disorder-related problems.--
                    (A) Demonstration.--An eligible entity shall 
                include in the application--
                            (i) information that demonstrates 
                        significant impact on the community by problems 
                        related to opioid abuse or another substance 
                        use disorder, by--
                                    (I) identifying the counties, 
                                communities, regions, or local areas 
                                that have been significantly impacted 
                                and will be served through the grant 
                                (each referred to in this section as a 
                                ``service area''); and
                                    (II) demonstrating for each such 
                                service area, an increase equal to or 
                                greater than the national increase in 
                                such problems, between--
                                            (aa) 1999; and
                                            (bb) 2016 or the latest 
                                        year for which data are 
                                        available; and
                            (ii) a description of how the eligible 
                        entity will prioritize support for 
                        significantly impacted service areas described 
                        in clause (i)(I).
                    (B) Information.--To meet the requirements 
                described in subparagraph (A)(i)(II), the eligible 
                entity may use information including data on--
                            (i) the incidence or prevalence of opioid 
                        abuse and other substance use disorders;
                            (ii) the age-adjusted rate of drug overdose 
                        deaths, as determined by the Director of the 
                        Centers for Disease Control and Prevention;
                            (iii) the rate of non-fatal 
                        hospitalizations related to opioid abuse or 
                        other substance use disorders;
                            (iv) the number of arrests or convictions, 
                        or a relevant law enforcement statistic, that 
                        reasonably shows an increase in opioid abuse or 
                        another substance use disorder; or
                            (v) in the case of an eligible entity 
                        described in subsection (a)(3)(C), other 
                        alternative relevant data as determined 
                        appropriate by the Secretary.
                    (C) Support for state strategy.--The eligible 
                entity may include in the application information 
                describing how the proposed services and activities are 
                aligned with the State, outlying area, or Tribal 
                strategy, as applicable, for addressing problems 
                described in subparagraph (A) in specific service areas 
                or across the State, outlying area, or Tribal land.
            (3) Economic and employment conditions demonstrate 
        additional federal support needed.--
                    (A) Demonstration.--An eligible entity shall 
                include in the application information that 
                demonstrates that a high rate of a substance use 
                disorder has caused, or is coincident to--
                            (i) an economic or employment downturn in 
                        the service area; or
                            (ii) persistent economically depressed 
                        conditions in such service area.
                    (B) Information.--To meet the requirements of 
                subparagraph (A), an eligible entity may use 
                information including--
                            (i) documentation of any layoff, announced 
                        future layoff, legacy industry decline, 
                        decrease in an employment or labor market 
                        participation rate, or economic impact, whether 
                        or not the result described in this clause is 
                        overtly related to a high rate of a substance 
                        use disorder;
                            (ii) documentation showing decreased 
                        economic activity related to, caused by, or 
                        contributing to a high rate of a substance use 
                        disorder, including a description of how the 
                        service area has been impacted, or will be 
                        impacted, by such a decrease;
                            (iii) information on economic indicators, 
                        labor market analyses, information from public 
                        announcements, and demographic and industry 
                        data;
                            (iv) information on rapid response 
                        activities (as defined in section 3 of the 
                        Workforce Innovation and Opportunity Act (29 
                        U.S.C. 3102)) that have been or will be 
                        conducted, including demographic data gathered 
                        by employer or worker surveys or through other 
                        methods;
                            (v) data or documentation, beyond anecdotal 
                        evidence, showing that employers face 
                        challenges filling job vacancies due to a lack 
                        of skilled workers able to pass a drug test; or
                            (vi) any additional relevant data or 
                        information on the economy, workforce, or 
                        another aspect of the service area to support 
                        the application.
    (d) Subgrant Authorization and Application Process.--
            (1) Subgrants authorized.--
                    (A) In general.--An eligible entity receiving a 
                grant under subsection (b)--
                            (i) may use not more than 5 percent of the 
                        grant funds for the administrative costs of 
                        carrying out the grant;
                            (ii) in the case of an eligible entity 
                        described in subparagraph (A) or (B) of 
                        subsection (a)(3), shall use the remaining 
                        grant funds to make subgrants to local entities 
                        in the service area to carry out the services 
                        and activities described in subsection (e); and
                            (iii) in the case of an eligible entity 
                        described in subsection (a)(3)(C), shall use 
                        the remaining grant funds to carry out the 
                        services and activities described in subsection 
                        (e).
                    (B) Equitable distribution.--In making subgrants 
                under this subsection, an eligible entity shall ensure, 
                to the extent practicable, the equitable distribution 
                of subgrants, based on--
                            (i) geography (such as urban and rural 
                        distribution); and
                            (ii) significantly impacted service areas 
                        as described in subsection (c)(2).
                    (C) Timing of subgrant funds distribution.--An 
                eligible entity making subgrants under this subsection 
                shall disburse subgrant funds to a local board 
                receiving a subgrant from the eligible entity by the 
                later of--
                            (i) the date that is 90 days after the date 
                        on which the Secretary makes the funds 
                        available to the eligible entity; or
                            (ii) the date that is 15 days after the 
                        date that the eligible entity makes the 
                        subgrant under subparagraph (A)(ii).
            (2) Subgrant application.--
                    (A) In general.--A local board desiring to receive 
                a subgrant under this subsection from an eligible 
                entity shall submit an application at such time and in 
                such manner as the eligible entity may reasonably 
                require, including the information described in this 
                paragraph.
                    (B) Contents.--Each application described in 
                subparagraph (A) shall include--
                            (i) an analysis of the estimated 
                        performance of the local board in carrying out 
                        the proposed services and activities under the 
                        subgrant--
                                    (I) based on--
                                            (aa) primary indicators of 
                                        performance described in 
                                        section 116(c)(1)(A)(i) of the 
                                        Workforce Innovation and 
                                        Opportunity Act (29 U.S.C. 
                                        3141(c)(1)(A)(i), to assess 
                                        estimated effectiveness of the 
                                        proposed services and 
                                        activities, including the 
                                        estimated number of individuals 
                                        with a substance use disorder 
                                        who may be served by the 
                                        proposed services and 
                                        activities;
                                            (bb) the record of the 
                                        local board in serving 
                                        individuals with a barrier to 
                                        employment; and
                                            (cc) the ability of the 
                                        local board to establish a 
                                        participating partnership; and
                                    (II) which may include or utilize--
                                            (aa) data from the National 
                                        Center for Health Statistics of 
                                        the Centers for Disease Control 
                                        and Prevention;
                                            (bb) data from the Center 
                                        for Behavioral Health 
                                        Statistics and Quality of the 
                                        Substance Abuse and Mental 
                                        Health Services Administration;
                                            (cc) State vital 
                                        statistics;
                                            (dd) municipal police 
                                        department records;
                                            (ee) reports from local 
                                        coroners; or
                                            (ff) other relevant data; 
                                        and
                            (ii) in the case of a local board proposing 
                        to serve a population described in subsection 
                        (e)(2)(B), a demonstration of the workforce 
                        shortage in the professional area to be 
                        addressed under the subgrant (which may include 
                        substance use disorder treatment and related 
                        services, non-addictive pain therapy and pain 
                        management services, mental health care 
                        treatment services, emergency response 
                        services, or mental health care), which shall 
                        include information that can demonstrate such a 
                        shortage, such as--
                                    (I) the distance between--
                                            (aa) communities affected 
                                        by opioid abuse or another 
                                        substance use disorder; and
                                            (bb) facilities or 
                                        professionals offering services 
                                        in the professional area; or
                                    (II) the maximum capacity of 
                                facilities or professionals to serve 
                                individuals in an affected community, 
                                or increases in arrests related to 
                                opioid or another substance use 
                                disorder, overdose deaths, or nonfatal 
                                overdose emergencies in the community.
    (e) Subgrant Services and Activities.--
            (1) In general.--Each local board that receives a subgrant 
        under subsection (d) shall carry out the services and 
        activities described in this subsection through a participating 
        partnership.
            (2) Selection of population to be served.--A participating 
        partnership shall elect to provide services and activities 
        under the subgrant to one or both of the following populations 
        of workers:
                    (A) Workers, including dislocated workers, 
                individuals with barriers to employment, new entrants 
                in the workforce, or incumbent workers (employed or 
                underemployed), each of whom--
                            (i) is directly or indirectly affected by a 
                        high rate of a substance use disorder; and
                            (ii) voluntarily confirms that the worker, 
                        or a friend or family member of the worker, has 
                        a history of opioid abuse or another substance 
                        use disorder.
                    (B) Workers, including dislocated workers, 
                individuals with barriers to employment, new entrants 
                in the workforce, or incumbent workers (employed or 
                underemployed), who--
                            (i) seek to transition to professions that 
                        support individuals with a substance use 
                        disorder or at risk for developing such 
                        disorder, such as professions that provide--
                                    (I) substance use disorder 
                                treatment and related services;
                                    (II) services offered through 
                                providers of peer recovery support 
                                services;
                                    (III) non-addictive pain therapy 
                                and pain management services;
                                    (IV) emergency response services; 
                                or
                                    (V) mental health care; and
                            (ii) need new or upgraded skills to better 
                        serve such a population of struggling or at-
                        risk individuals.
            (3) Services and activities.--Each participating 
        partnership shall use funds available through a subgrant under 
        this subsection to carry out 1 or more of the following:
                    (A) Engaging employers.--Engaging with employers 
                to--
                            (i) learn about the skill and hiring 
                        requirements of employers;
                            (ii) learn about the support needed by 
                        employers to hire and retain program 
                        participants, and other individuals with a 
                        substance use disorder, and the support needed 
                        by such employers to obtain their commitment to 
                        testing creative solutions to employing program 
                        participants and such individuals;
                            (iii) connect employers and workers to on-
                        the-job or customized training programs before 
                        or after layoff to help facilitate 
                        reemployment;
                            (iv) connect employers with an education 
                        provider to develop classroom instruction to 
                        complement on-the-job learning for program 
                        participants and such individuals;
                            (v) help employers develop the curriculum 
                        design of a work-based learning program for 
                        program participants and such individuals;
                            (vi) help employers employ program 
                        participants or such individuals engaging in a 
                        work-based learning program for a transitional 
                        period before hiring such a program participant 
                        or individual for full-time employment of not 
                        less than 30 hours a week; or
                            (vii) connect employers to program 
                        participants receiving concurrent outpatient 
                        treatment and job training services.
                    (B) Screening services.--Providing screening 
                services, which may include--
                            (i) using an evidence-based screening 
                        method to screen each individual seeking 
                        participation in the pilot program to determine 
                        whether the individual has a substance use 
                        disorder;
                            (ii) conducting an assessment of each such 
                        individual to determine the services needed for 
                        such individual to obtain or retain employment, 
                        including an assessment of strengths and 
                        general work readiness; or
                            (iii) accepting walk-ins or referrals from 
                        employers, labor organizations, or other 
                        entities recommending individuals to 
                        participate in such program.
                    (C) Individual treatment and employment plan.--
                Developing an individual treatment and employment plan 
                for each program participant--
                            (i) in coordination, as appropriate, with 
                        other programs serving the participant such as 
                        the core programs within the workforce 
                        development system under the Workforce 
                        Innovation and Opportunity Act (29 U.S.C. 3101 
                        et seq.); and
                            (ii) which shall include providing a case 
                        manager to work with each participant to 
                        develop the plan, which may include--
                                    (I) identifying employment and 
                                career goals;
                                    (II) exploring career pathways that 
                                lead to in-demand industries and 
                                sectors, as determined by the State 
                                board and the head of the State 
                                workforce agency or, as applicable, the 
                                Tribal entity;
                                    (III) setting appropriate 
                                achievement objectives to attain the 
                                employment and career goals identified 
                                under subclause (I); or
                                    (IV) developing the appropriate 
                                combination of services to enable the 
                                participant to achieve the employment 
                                and career goals identified under 
                                subclause (I).
                    (D) Outpatient treatment and recovery care.--In the 
                case of a participating partnership serving program 
                participants described in paragraph (2)(A) with a 
                substance use disorder, providing individualized and 
                group outpatient treatment and recovery services for 
                such program participants that are offered during the 
                day and evening, and on weekends. Such treatment and 
                recovery services--
                            (i) shall be based on a model that utilizes 
                        combined behavioral interventions and other 
                        evidence-based or evidence-informed 
                        interventions; and
                            (ii) may include additional services such 
                        as--
                                    (I) health, mental health, 
                                addiction, or other forms of outpatient 
                                treatment that may impact a substance 
                                use disorder and co-occurring 
                                conditions;
                                    (II) drug testing for a current 
                                substance use disorder prior to 
                                enrollment in career or training 
                                services or prior to employment;
                                    (III) linkages to community 
                                services, including services offered by 
                                partner organizations designed to 
                                support program participants; or
                                    (IV) referrals to health care, 
                                including referrals to substance use 
                                disorder treatment and mental health 
                                services.
                    (E) Supportive services.--Providing supportive 
                services, which shall include services such as--
                            (i) coordinated wraparound services to 
                        provide maximum support for program 
                        participants to assist the program participants 
                        in maintaining employment and recovery for not 
                        less than 12 months, as appropriate;
                            (ii) assistance in establishing eligibility 
                        for assistance under Federal, State, Tribal, 
                        and local programs providing health services, 
                        mental health services, vocational services, 
                        housing services, transportation services, 
                        social services, or services through early 
                        childhood education programs (as defined in 
                        section 103 of the Higher Education Act of 1965 
                        (20 U.S.C. 1003));
                            (iii) services offered through providers of 
                        peer recovery support services;
                            (iv) networking and mentorship 
                        opportunities; or
                            (v) any supportive services determined 
                        necessary by the local board.
                    (F) Career and job training services.--Offering 
                career services and training services, and related 
                services, concurrently or sequentially with the 
                services provided under subparagraphs (B) through (E). 
                Such services shall include the following:
                            (i) Services provided to program 
                        participants who are in a pre-employment stage 
                        of the program, which may include--
                                    (I) initial education and skills 
                                assessments;
                                    (II) traditional classroom training 
                                funded through individual training 
                                accounts under chapter 3 of subtitle B 
                                of title I of the Workforce Innovation 
                                and Opportunity Act (29 U.S.C. 3171 et 
                                seq.);
                                    (III) services to promote 
                                employability skills such as 
                                punctuality, personal maintenance 
                                skills, and professional conduct;
                                    (IV) in-depth interviewing and 
                                evaluation to identify employment 
                                barriers and to develop individual 
                                employment plans;
                                    (V) career planning that includes--
                                            (aa) career pathways 
                                        leading to in-demand, high-wage 
                                        jobs; and
                                            (bb) job coaching, job 
                                        matching, and job placement 
                                        services;
                                    (VI) provision of payments and fees 
                                for employment and training-related 
                                applications, tests, and 
                                certifications; or
                                    (VII) any other appropriate career 
                                service or training service described 
                                in section 134(c) of the Workforce 
                                Innovation and Opportunity Act (29 
                                U.S.C. 3174(c)).
                            (ii) Services provided to program 
                        participants during their first 6 months of 
                        employment to ensure job retention, which may 
                        include--
                                    (I) case management and support 
                                services, including a continuation of 
                                the services described in clause (i);
                                    (II) a continuation of skills 
                                training, and career and technical 
                                education, described in clause (i) that 
                                is conducted in collaboration with the 
                                employers of such participants;
                                    (III) mentorship services and job 
                                retention support for such 
                                participants; or
                                    (IV) targeted training for managers 
                                and workers working with such 
                                participants (such as mentors), and 
                                human resource representatives in the 
                                business in which such participants are 
                                employed.
                            (iii) Services to assist program 
                        participants in maintaining employment for not 
                        less than 12 months, as appropriate.
                    (G) Proven and promising practices.--Leading 
                efforts in the service area to identify and promote 
                proven and promising strategies and initiatives for 
                meeting the needs of employers and program 
                participants.
            (4) Limitations.--A participating partnership may not use--
                    (A) more than 10 percent of the funds received 
                under a subgrant under subsection (d) for the 
                administrative costs of the partnership;
                    (B) more than 10 percent of the funds received 
                under such subgrant for the provision of treatment and 
                recovery services, as described in paragraph (3)(D); 
                and
                    (C) more than 10 percent of the funds received 
                under such subgrant for the provision of supportive 
                services described in paragraph (3)(E) to program 
                participants.
    (f) Performance Accountability.--
            (1) Reports.--The Secretary shall establish quarterly 
        reporting requirements for recipients of grants and subgrants 
        under this section that, to the extent practicable, are based 
        on the performance accountability system under section 116 of 
        the Workforce Innovation and Opportunity Act (29 U.S.C. 3141) 
        and, in the case of a grant awarded to an eligible entity 
        described in subsection (a)(3)(C), section 166(h) of such Act 
        (29 U.S.C. 3221(h)), including the indicators described in 
        subsection (c)(1)(A)(i) of such section 116 and the 
        requirements for local area performance reports under 
        subsection (d) of such section 116.
            (2) Evaluations.--
                    (A) Authority to enter into agreements.--The 
                Secretary shall ensure that an independent evaluation 
                is conducted on the pilot program carried out under 
                this section to determine the impact of the program on 
                employment of individuals with substance use disorders. 
                The Secretary shall enter into an agreement with 
                eligible entities receiving grants under this section 
                to pay for all or part of such evaluation.
                    (B) Methodologies to be used.--The independent 
                evaluation required under this paragraph shall use 
                experimental designs using random assignment or, when 
                random assignment is not feasible, other reliable, 
                evidence-based research methodologies that allow for 
                the strongest possible causal inferences.
    (g) Funding.--
            (1) Covered fiscal year.--In this subsection, the term 
        ``covered fiscal year'' means any of fiscal years 2019 through 
        2023.
            (2) Using funding for national dislocated worker grants.--
        Subject to paragraph (4) and notwithstanding section 
        132(a)(2)(A) and subtitle D of the Workforce Innovation and 
        Opportunity Act (29 U.S.C. 3172(a)(2)(A), 3221 et seq.), the 
        Secretary may use, to carry out the pilot program under this 
        section for a covered fiscal year--
                    (A) funds made available to carry out section 170 
                of such Act (29 U.S.C. 3225) for that fiscal year;
                    (B) funds made available to carry out section 170 
                of such Act that remain available for that fiscal year; 
                and
                    (C) funds that remain available under section 
                172(f) of such Act (29 U.S.C. 3227(f)).
            (3) Availability of funds.--Funds appropriated under 
        section 136(c) of such Act (29 U.S.C. 3181(c)) and made 
        available to carry out section 170 of such Act for a fiscal 
        year shall remain available for use under paragraph (2) for a 
        subsequent fiscal year until expended.
            (4) Limitation.--The Secretary may not use more than 
        $100,000,000 of the funds described in paragraph (2) for any 
        covered fiscal year under this section.

     Subtitle D--Peer Support Counseling Program for Women Veterans

SEC. 8051. PEER SUPPORT COUNSELING PROGRAM FOR WOMEN VETERANS.

    (a) In General.--Section 1720F(j) of title 38, United States Code, 
is amended by adding at the end the following new paragraph:
    ``(4)(A) 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--
            ``(i) female gender-specific issues and services;
            ``(ii) the provision of information about services and 
        benefits provided under laws administered by the Secretary; or
            ``(iii) employment mentoring.
    ``(B) 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.
    ``(C) The Secretary shall conduct outreach to inform women veterans 
about the program and the assistance available under this paragraph.
    ``(D) 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.
    ``(E) 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 (38 U.S.C. 1712A note).''.
    (b) Funding.--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.
    (c) Report to Congress.--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--
            (1) the number of peer support counselors in the program;
            (2) an assessment of the effectiveness of the program; and
            (3) a description of the oversight of the program.

              Subtitle E--Treating Barriers to Prosperity

SEC. 8061. SHORT TITLE.

    This subtitle may be cited as the ``Treating Barriers to Prosperity 
Act of 2018''.

SEC. 8062. DRUG ABUSE MITIGATION INITIATIVE.

    (a) In General.--Chapter 145 of title 40, United States Code, is 
amended by inserting after section 14509 the following:
``Sec. 14510. Drug abuse mitigation initiative
    ``(a) In General.--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--
            ``(1) to facilitate the sharing of best practices among 
        States, counties, and other experts in the region with respect 
        to reducing such abuse;
            ``(2) 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;
            ``(3) to attract and retain relevant health care services, 
        businesses, and workers; and
            ``(4) to develop relevant infrastructure, including 
        broadband infrastructure that supports the use of telemedicine.
    ``(b) Limitation on Available Amounts.--Of the cost of any activity 
eligible for a grant under this section--
            ``(1) not more than 50 percent may be provided from amounts 
        appropriated to carry out this section; and
            ``(2) notwithstanding paragraph (1)--
                    ``(A) 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
                    ``(B) 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.
    ``(c) Sources of Assistance.--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--
            ``(1) under any other Federal program (subject to the 
        availability of subsequent appropriations); or
            ``(2) from any other source.
    ``(d) Federal Share.--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.''.
    (b) Clerical Amendment.--The analysis for chapter 145 of title 40, 
United States Code, is amended by inserting after the item relating to 
section 14509 the following:

``14510. Drug abuse mitigation initiative.''.

   Subtitle F--Pilot Program to Help Individuals in Recovery From a 
              Substance Use Disorder Become Stably Housed

SEC. 8071. PILOT PROGRAM TO HELP INDIVIDUALS IN RECOVERY FROM A 
              SUBSTANCE USE DISORDER BECOME STABLY HOUSED.

    (a) Authorization of Appropriations.--There is authorized to be 
appropriated under this section such sums as may be necessary for each 
of fiscal years 2019 through 2023 for assistance to States to provide 
individuals in recovery from a substance use disorder stable, temporary 
housing for a period of not more than 2 years or until the individual 
secures permanent housing, whichever is earlier.
    (b) Allocation of Appropriated Amounts.--
            (1) In general.--The amounts appropriated or otherwise made 
        available to States under this section shall be allocated based 
        on a funding formula established by the Secretary of Housing 
        and Urban Development (referred to in this section as the 
        ``Secretary'') not later than 60 days after the date of 
        enactment of this Act.
            (2) Criteria.--
                    (A) In general.--The funding formula required under 
                paragraph (1) shall ensure that any amounts 
                appropriated or otherwise made available under this 
                section are allocated to States with an age-adjusted 
                rate of drug overdose deaths that is above the national 
                overdose mortality rate, according to the Centers for 
                Disease Control and Prevention.
                    (B) Priority.--
                            (i) In general.--Among such States, 
                        priority shall be given to States with the 
                        greatest need, as such need is determined by 
                        the Secretary based on the following factors, 
                        and weighting such factors as described in 
                        clause (ii):
                                    (I) The highest average rates of 
                                unemployment based on data provided by 
                                the Bureau of Labor Statistics for 
                                calendar years 2013 through 2017.
                                    (II) The lowest average labor force 
                                participation rates based on data 
                                provided by the Bureau of Labor 
                                Statistics for calendar years 2013 
                                through 2017.
                                    (III) The highest age-adjusted 
                                rates of drug overdose deaths based on 
                                data from the Centers for Disease 
                                Control and Prevention.
                            (ii) Weighting.--The factors described in 
                        clause (i) shall be weighted as follows:
                                    (I) The rate described in clause 
                                (i)(I) shall be weighted at 15 percent.
                                    (II) The rate described in clause 
                                (i)(II) shall be weighted at 15 
                                percent.
                                    (III) The rate described in clause 
                                (i)(III) shall be weighted at 70 
                                percent.
            (3) Distribution.--Amounts appropriated or otherwise made 
        available under this section shall be distributed according to 
        the funding formula established by the Secretary under 
        paragraph (1) not later than 30 days after the establishment of 
        such formula.
    (c) Use of Funds.--
            (1) In general.--Any State that receives amounts pursuant 
        to this section shall expend at least 30 percent of such funds 
        within one year of the date funds become available to the 
        grantee for obligation.
            (2) Priority.--Any State that receives amounts pursuant to 
        this section shall distribute such amounts giving priority to 
        entities with the greatest need and ability to deliver 
        effective assistance in a timely manner.
            (3) Administrative costs.--Any State that receives amounts 
        pursuant to this section may use up to 5 percent of any grant 
        for administrative costs.
    (d) Rules of Construction.--
            (1) In general.--Except as otherwise provided by this 
        section, amounts appropriated, or amounts otherwise made 
        available to States under this section shall be treated as 
        though such funds were community development block grant funds 
        under title I of the Housing and Community Development Act of 
        1974 (42 U.S.C. 5301 et seq.).
            (2) No match.--No matching funds shall be required in order 
        for a State to receive any amounts under this section.
    (e) Authority to Waive or Specify Alternative Requirements.--
            (1) In general.--In administering any amounts appropriated 
        or otherwise made available under this section, the Secretary 
        may waive or specify alternative requirements to any provision 
        under title I of the Housing and Community Development Act of 
        1974 (42 U.S.C. 5301 et seq.) except for requirements related 
        to fair housing, nondiscrimination, labor standards, the 
        environment, and requirements that activities benefit persons 
        of low- and moderate-income, upon a finding that such a waiver 
        is necessary to expedite or facilitate the use of such funds.
            (2) Notice of intent.--The Secretary shall provide written 
        notice of its intent to exercise the authority to specify 
        alternative requirements under paragraph (1) to the Committee 
        on Banking, Housing, and Urban Affairs of the Senate and the 
        Committee on Financial Services of the House of Representatives 
        not later than 15 business days before such exercise of 
        authority occurs.
            (3) Notice to the public.--The Secretary shall provide 
        written notice of its intent to exercise the authority to 
        specify alternative requirements under paragraph (1) to the 
        public via notice, on the internet website of the Department of 
        Housing and Urban Development, and by other appropriate means, 
        not later than 15 business days before such exercise of 
        authority occurs.
    (f) Technical Assistance.--For the 2-year period following the date 
of enactment of this Act, the Secretary may use not more than 2 percent 
of the funds made available under this section for technical assistance 
to grantees.
    (g) State.--For purposes of this section the term ``State'' 
includes any State as defined in section 102 of the Housing and 
Community Development Act of 1974 (42 U.S.C. 5302) and the District of 
Columbia.

                       Subtitle G--Human Services

SEC. 8081. SUPPORTING FAMILY-FOCUSED RESIDENTIAL TREATMENT.

    (a) Definitions.--In this section:
            (1) Family-focused residential treatment program.--The term 
        ``family-focused residential treatment program'' means a 
        trauma-informed residential program primarily for substance use 
        disorder treatment for pregnant and postpartum women and 
        parents and guardians that allows children to reside with such 
        women or their parents or guardians during treatment to the 
        extent appropriate and applicable.
            (2) Medicaid program.--The term ``Medicaid program'' means 
        the program established under title XIX of the Social Security 
        Act (42 U.S.C. 1396 et seq.).
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (4) Title iv-e program.--The term ``title IV-E program'' 
        means the program for foster care, prevention, and permanency 
        established under part E of title IV of the Social Security Act 
        (42 U.S.C. 670 et seq.).
    (b) Guidance on Family-focused Residential Treatment Programs.--
            (1) In general.--Not later than 180 days after the date of 
        enactment of this Act, the Secretary, in consultation with 
        divisions of the Department of Health and Human Services 
        administering substance use disorder or child welfare programs, 
        shall develop and issue guidance to States identifying 
        opportunities to support family-focused residential treatment 
        programs for the provision of substance use disorder treatment. 
        Before issuing such guidance, the Secretary shall solicit input 
        from representatives of States, health care providers with 
        expertise in addiction medicine, obstetrics and gynecology, 
        neonatology, child trauma, and child development, health plans, 
        recipients of family-focused treatment services, and other 
        relevant stakeholders.
            (2) Additional requirements.--The guidance required under 
        paragraph (1) shall include descriptions of the following:
                    (A) Existing opportunities and flexibilities under 
                the Medicaid program, including under waivers 
                authorized under section 1115 or 1915 of the Social 
                Security Act (42 U.S.C. 1315, 1396n), for States to 
                receive Federal Medicaid funding for the provision of 
                substance use disorder treatment for pregnant and 
                postpartum women and parents and guardians and, to the 
                extent applicable, their children, in family-focused 
                residential treatment programs.
                    (B) How States can employ and coordinate funding 
                provided under the Medicaid program, the title IV-E 
                program, and other programs administered by the 
                Secretary to support the provision of treatment and 
                services provided by a family-focused residential 
                treatment facility such as substance use disorder 
                treatment and services, including medication-assisted 
                treatment, family, group, and individual counseling, 
                case management, parenting education and skills 
                development, the provision, assessment, or coordination 
                of care and services for children, including necessary 
                assessments and appropriate interventions, non-
                emergency transportation for necessary care provided at 
                or away from a program site, transitional services and 
                supports for families leaving treatment, and other 
                services.
                    (C) How States can employ and coordinate funding 
                provided under the Medicaid program and the title IV-E 
                program (including as amended by the Family First 
                Prevention Services Act enacted under title VII of 
                division E of Public Law 115-123, and particularly with 
                respect to the authority under subsections (a)(2)(C) 
                and (j) of section 472 and section 474(a)(1) of the 
                Social Security Act (42 U.S.C. 672, 674(a)(1)) (as 
                amended by section 50712 of Public Law 115-123) to 
                provide foster care maintenance payments for a child 
                placed with a parent who is receiving treatment in a 
                licensed residential family-based treatment facility 
                for a substance use disorder) to support placing 
                children with their parents in family-focused 
                residential treatment programs.

SEC. 8082. IMPROVING RECOVERY AND REUNIFYING FAMILIES.

    (a) Family Recovery and Reunification Program Replication 
Project.--Section 435 of the Social Security Act (42 U.S.C. 629e) is 
amended by adding at the end the following:
    ``(e) Family Recovery and Reunification Program Replication 
Project.--
            ``(1) Purpose.--The purpose of this subsection is to 
        provide resources to the Secretary to support the conduct and 
        evaluation of a family recovery and reunification program 
        replication project (referred to in this subsection as the 
        `project') and to determine the extent to which such programs 
        may be appropriate for use at different intervention points 
        (such as when a child is at risk of entering foster care or 
        when a child is living with a guardian while a parent is in 
        treatment). The family recovery and reunification program 
        conducted under the project shall use a recovery coach model 
        that is designed to help reunify families and protect children 
        by working with parents or guardians with a substance use 
        disorder who have temporarily lost custody of their children.
            ``(2) Program components.--The family recovery and 
        reunification program conducted under the project shall adhere 
        closely to the elements and protocol determined to be most 
        effective in other recovery coaching programs that have been 
        rigorously evaluated and shown to increase family reunification 
        and protect children and, consistent with such elements and 
        protocol, shall provide such items and services as--
                    ``(A) assessments to evaluate the needs of the 
                parent or guardian;
                    ``(B) assistance in receiving the appropriate 
                benefits to aid the parent or guardian in recovery;
                    ``(C) services to assist the parent or guardian in 
                prioritizing issues identified in assessments, 
                establishing goals for resolving such issues that are 
                consistent with the goals of the treatment provider, 
                child welfare agency, courts, and other agencies 
                involved with the parent or guardian or their children, 
                and making a coordinated plan for achieving such goals;
                    ``(D) home visiting services coordinated with the 
                child welfare agency and treatment provider involved 
                with the parent or guardian or their children;
                    ``(E) case management services to remove barriers 
                for the parent or guardian to participate and continue 
                in treatment, as well as to re-engage a parent or 
                guardian who is not participating or progressing in 
                treatment;
                    ``(F) access to services needed to monitor the 
                parent's or guardian's compliance with program 
                requirements;
                    ``(G) frequent reporting between the treatment 
                provider, child welfare agency, courts, and other 
                agencies involved with the parent or guardian or their 
                children to ensure appropriate information on the 
                parent's or guardian's status is available to inform 
                decision-making; and
                    ``(H) assessments and recommendations provided by a 
                recovery coach to the child welfare caseworker 
                responsible for documenting the parent's or guardian's 
                progress in treatment and recovery as well as the 
                status of other areas identified in the treatment plan 
                for the parent or guardian, including a recommendation 
                regarding the expected safety of the child if the child 
                is returned to the custody of the parent or guardian 
                that can be used by the caseworker and a court to make 
                permanency decisions regarding the child.
            ``(3) Responsibilities of the secretary.--
                    ``(A) In general.--The Secretary shall, through a 
                grant or contract with 1 or more entities, conduct and 
                evaluate the family recovery and reunification program 
                under the project.
                    ``(B) Requirements.--In identifying 1 or more 
                entities to conduct the evaluation of the family 
                recovery and reunification program, the Secretary 
                shall--
                            ``(i) determine that the area or areas in 
                        which the program will be conducted have 
                        sufficient substance use disorder treatment 
                        providers and other resources (other than those 
                        provided with funds made available to carry out 
                        the project) to successfully conduct the 
                        program;
                            ``(ii) determine that the area or areas in 
                        which the program will be conducted have enough 
                        potential program participants, and will serve 
                        a sufficient number of parents or guardians and 
                        their children, so as to allow for the 
                        formation of a control group, evaluation 
                        results to be adequately powered, and 
                        preliminary results of the evaluation to be 
                        available within 4 years of the program's 
                        implementation;
                            ``(iii) provide the entity or entities with 
                        technical assistance for the program design, 
                        including by working with 1 or more entities 
                        that are or have been involved in recovery 
                        coaching programs that have been rigorously 
                        evaluated and shown to increase family 
                        reunification and protect children so as to 
                        make sure the program conducted under the 
                        project adheres closely to the elements and 
                        protocol determined to be most effective in 
                        such other recovery coaching programs;
                            ``(iv) assist the entity or entities in 
                        securing adequate coaching, treatment, child 
                        welfare, court, and other resources needed to 
                        successfully conduct the family recovery and 
                        reunification program under the project; and
                            ``(v) ensure the entity or entities will be 
                        able to monitor the impacts of the program in 
                        the area or areas in which it is conducted for 
                        at least 5 years after parents or guardians and 
                        their children are randomly assigned to 
                        participate in the program or to be part of the 
                        program's control group.
            ``(4) Evaluation requirements.--
                    ``(A) In general.--The Secretary, in consultation 
                with the entity or entities conducting the family 
                recovery and reunification program under the project, 
                shall conduct an evaluation to determine whether the 
                program has been implemented effectively and resulted 
                in improvements for children and families. The 
                evaluation shall have 3 components: a pilot phase, an 
                impact study, and an implementation study.
                    ``(B) Pilot phase.--The pilot phase component of 
                the evaluation shall consist of the Secretary providing 
                technical assistance to the entity or entities 
                conducting the family recovery and reunification 
                program under the project to ensure--
                            ``(i) the program's implementation adheres 
                        closely to the elements and protocol determined 
                        to be most effective in other recovery coaching 
                        programs that have been rigorously evaluated 
                        and shown to increase family reunification and 
                        protect children; and
                            ``(ii) random assignment of parents or 
                        guardians and their children to be participants 
                        in the program or to be part of the program's 
                        control group is being carried out.
                    ``(C) Impact study.--The impact study component of 
                the evaluation shall determine the impacts of the 
                family recovery and reunification program conducted 
                under the project on the parents and guardians and 
                their children participating in the program. The impact 
                study component shall--
                            ``(i) be conducted using an experimental 
                        design that uses a random assignment research 
                        methodology;
                            ``(ii) consistent with previous studies of 
                        other recovery coaching programs that have been 
                        rigorously evaluated and shown to increase 
                        family reunification and protect children, 
                        measure outcomes for parents and guardians and 
                        their children over multiple time periods, 
                        including for a period of 5 years; and
                            ``(iii) include measurements of family 
                        stability and parent, guardian, and child 
                        safety for program participants and the program 
                        control group that are consistent with 
                        measurements of such factors for participants 
                        and control groups from previous studies of 
                        other recovery coaching programs so as to allow 
                        results of the impact study to be compared with 
                        the results of such prior studies, including 
                        with respect to comparisons between program 
                        participants and the program control group 
                        regarding--
                                    ``(I) safe family reunification;
                                    ``(II) time to reunification;
                                    ``(III) permanency (such as through 
                                measures of reunification, adoption, or 
                                placement with guardians);
                                    ``(IV) safety (such as through 
                                measures of subsequent maltreatment);
                                    ``(V) parental or guardian 
                                treatment persistence and engagement;
                                    ``(VI) parental or guardian 
                                substance use;
                                    ``(VII) juvenile delinquency;
                                    ``(VIII) cost; and
                                    ``(IX) other measurements agreed 
                                upon by the Secretary and the entity or 
                                entities operating the family recovery 
                                and reunification program under the 
                                project.
                    ``(D) Implementation study.--The implementation 
                study component of the evaluation shall be conducted 
                concurrently with the conduct of the impact study 
                component and shall include, in addition to such other 
                information as the Secretary may determine, 
                descriptions and analyses of--
                            ``(i) the adherence of the family recovery 
                        and reunification program conducted under the 
                        project to other recovery coaching programs 
                        that have been rigorously evaluated and shown 
                        to increase family reunification and protect 
                        children; and
                            ``(ii) the difference in services received 
                        or proposed to be received by the program 
                        participants and the program control group.
                    ``(E) Report.--The Secretary shall publish on an 
                internet website maintained by the Secretary the 
                following information:
                            ``(i) A report on the pilot phase component 
                        of the evaluation.
                            ``(ii) A report on the impact study 
                        component of the evaluation.
                            ``(iii) A report on the implementation 
                        study component of the evaluation.
                            ``(iv) A report that includes--
                                    ``(I) analyses of the extent to 
                                which the program has resulted in 
                                increased reunifications, increased 
                                permanency, case closures, net savings 
                                to the State or States involved (taking 
                                into account both costs borne by States 
                                and the Federal government), or other 
                                outcomes, or if the program did not 
                                produce such outcomes, an analysis of 
                                why the replication of the program did 
                                not yield such results;
                                    ``(II) if, based on such analyses, 
                                the Secretary determines the program 
                                should be replicated, a replication 
                                plan; and
                                    ``(III) such recommendations for 
                                legislation and administrative action 
                                as the Secretary determines 
                                appropriate.
            ``(5) Appropriation.--In addition to any amounts otherwise 
        made available to carry out this subpart, out of any money in 
        the Treasury of the United States not otherwise appropriated, 
        there are appropriated $15,000,000 for fiscal year 2019 to 
        carry out the project, which shall remain available through 
        fiscal year 2026.''.
    (b) Clarification of Payer of Last Resort Application to Child 
Welfare Prevention and Family Services.--Section 471(e)(10) of the 
Social Security Act (42 U.S.C. 671(e)(10)), as added by section 
50711(a)(2) of division E of Public Law 115-123, is amended--
            (1) in subparagraph (A), by inserting ``, nor shall the 
        provision of such services or programs be construed to permit 
        the State to reduce medical or other assistance available to a 
        recipient of such services or programs'' after ``under this 
        Act''; and
            (2) by adding at the end the following:
                    ``(C) Payer of last resort.--In carrying out its 
                responsibilities to ensure access to services or 
                programs under this subsection, the State agency shall 
                not be considered to be a legally liable third party 
                for purposes of satisfying a financial commitment for 
                the cost of providing such services or programs with 
                respect to any individual for whom such cost would have 
                been paid for from another public or private source but 
                for the enactment of this subsection (except that 
                whenever considered necessary to prevent a delay in the 
                receipt of appropriate early intervention services by a 
                child or family in a timely fashion, funds provided 
                under section 474(a)(6) may be used to pay the provider 
                of services or programs pending reimbursement from the 
                public or private source that has ultimate 
                responsibility for the payment).''.
    (c) Effective Date.--The amendments made by subsection (b) shall 
take effect as if included in section 50711 of division E of Public Law 
115-123.

SEC. 8083. BUILDING CAPACITY FOR FAMILY-FOCUSED RESIDENTIAL TREATMENT.

    (a) Definitions.--In this section:
            (1) Eligible entity.--The term ``eligible entity'' means a 
        State, county, local, or tribal health or child welfare agency, 
        a private nonprofit organization, a research organization, a 
        treatment service provider, an institution of higher education 
        (as defined under section 101 of the Higher Education Act of 
        1965 (20 U.S.C. 1001)), or another entity specified by the 
        Secretary.
            (2) Family-focused residential treatment program.--The term 
        ``family-focused residential treatment program'' means a 
        trauma-informed residential program primarily for substance use 
        disorder treatment for pregnant and postpartum women and 
        parents and guardians that allows children to reside with such 
        women or their parents or guardians during treatment to the 
        extent appropriate and applicable.
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (b) Support for the Development of Evidence-based Family-focused 
Residential Treatment Programs.--
            (1) Authority to award grants.--The Secretary shall award 
        grants to eligible entities for purposes of developing, 
        enhancing, or evaluating family-focused residential treatment 
        programs to increase the availability of such programs that 
        meet the requirements for promising, supported, or well-
        supported practices specified in section 471(e)(4)(C) of the 
        Social Security Act (42 U.S.C. 671(e)(4)(C))) (as added by the 
        Family First Prevention Services Act enacted under title VII of 
        division E of Public Law 115-123).
            (2) Evaluation requirement.--The Secretary shall require 
        any evaluation of a family-focused residential treatment 
        program by an eligible entity that uses funds awarded under 
        this section for all or part of the costs of the evaluation be 
        designed to assist in the determination of whether the program 
        may qualify as a promising, supported, or well-supported 
        practice in accordance with the requirements of such section 
        471(e)(4)(C).
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary to carry out this section, $20,000,000 
for fiscal year 2019, which shall remain available through fiscal year 
2023.

Subtitle H--Reauthorizing and Extending Grants for Recovery From Opioid 
                              Use Programs

SEC. 8091. SHORT TITLE.

    This subtitle may be cited as the ``Reauthorizing and Extending 
Grants for Recovery from Opioid Use Programs Act of 2018'' or the 
``REGROUP Act of 2018''.

SEC. 8092. REAUTHORIZATION OF THE COMPREHENSIVE OPIOID ABUSE GRANT 
              PROGRAM.

    Section 1001(a)(27) of the Omnibus Crime Control and Safe Streets 
Act of 1968 (34 U.S.C. 10261(a)(27)) is amended by striking ``through 
2021'' and inserting ``and 2018, and $330,000,000 for each of fiscal 
years 2019 through 2023''.

          Subtitle I--Fighting Opioid Abuse in Transportation

SEC. 8101. SHORT TITLE.

    This subtitle may be cited as the ``Fighting Opioid Abuse in 
Transportation Act''.

SEC. 8102. ALCOHOL AND CONTROLLED SUBSTANCE TESTING OF MECHANICAL 
              EMPLOYEES.

    (a) In General.--Not later than 2 years after the date of enactment 
of this Act, the Secretary of Transportation shall publish a rule in 
the Federal Register revising the regulations promulgated under section 
20140 of title 49, United States Code, to cover all employees of 
railroad carriers who perform mechanical activities.
    (b) Definition of Mechanical Activities.--For the purposes of the 
rule under subsection (a), the Secretary shall define the term 
``mechanical activities'' by regulation.

SEC. 8103. DEPARTMENT OF TRANSPORTATION PUBLIC DRUG AND ALCOHOL TESTING 
              DATABASE.

    (a) In General.--Subject to subsection (c), the Secretary of 
Transportation shall--
            (1) not later than March 31, 2019, establish and make 
        publicly available on its website a database of the drug and 
        alcohol testing data reported by employers for each mode of 
        transportation; and
            (2) update the database annually.
    (b) Contents.--The database under subsection (a) shall include, for 
each mode of transportation--
            (1) the total number of drug and alcohol tests by type of 
        substance tested;
            (2) the drug and alcohol test results by type of substance 
        tested;
            (3) the reason for the drug or alcohol test, such as pre-
        employment, random, post-accident, reasonable suspicion or 
        cause, return-to-duty, or follow-up, by type of substance 
        tested; and
            (4) the number of individuals who refused testing.
    (c) Commercially Sensitive Data.--The Department of Transportation 
shall not release any commercially sensitive data or personally 
identifiable data furnished by an employer under this section unless 
the data is aggregated or otherwise in a form that does not identify 
the employer providing the data.
    (d) Savings Clause.--Nothing in this section may be construed as 
limiting or otherwise affecting the requirements of the Secretary of 
Transportation to adhere to requirements applicable to confidential 
business information and sensitive security information, consistent 
with applicable law.

SEC. 8104. GAO REPORT ON DEPARTMENT OF TRANSPORTATION'S COLLECTION AND 
              USE OF DRUG AND ALCOHOL TESTING DATA.

    (a) In General.--Not later than 2 years after the date the 
Department of Transportation public drug and alcohol testing database 
is established under section 8103, the Comptroller General of the 
United States shall--
            (1) review the Department of Transportation Drug and 
        Alcohol Testing Management Information System; and
            (2) submit to the Committee on Commerce, Science, and 
        Transportation of the Senate and the Committee on 
        Transportation and Infrastructure of the House of 
        Representatives a report on the review, including 
        recommendations under subsection (c).
    (b) Contents.--The report under subsection (a) shall include--
            (1) a description of the process the Department of 
        Transportation uses to collect and record drug and alcohol 
        testing data submitted by employers for each mode of 
        transportation;
            (2) an assessment of whether and, if so, how the Department 
        of Transportation uses the data described in paragraph (1) in 
        carrying out its responsibilities; and
            (3) an assessment of the Department of Transportation 
        public drug and alcohol testing database under section 8103.
    (c) Recommendations.--The report under subsection (a) may include 
recommendations regarding--
            (1) how the Department of Transportation can best use the 
        data described in subsection (b)(1);
            (2) any improvements that could be made to the process 
        described in subsection (b)(1);
            (3) whether and, if so, how the Department of 
        Transportation public drug and alcohol testing database under 
        section 8103 could be made more effective; and
            (4) such other recommendations as the Comptroller General 
        considers appropriate.

SEC. 8105. TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAM; 
              ADDITION OF FENTANYL AND OTHER SUBSTANCES.

    (a) Mandatory Guidelines for Federal Workplace Drug Testing 
Programs.--
            (1) In general.--Not later than 180 days after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services shall--
                    (A) determine whether a revision of the Mandatory 
                Guidelines for Federal Workplace Drug Testing Programs 
                to expand the opiate category on the list of authorized 
                substance testing to include fentanyl is justified, 
                based on the reliability and cost-effectiveness of 
                available testing; and
                    (B) consider whether to include with the 
                determination under subparagraph (A) a separate 
                determination on whether a revision of the Mandatory 
                Guidelines for Federal Workplace Drug Testing Programs 
                to expand the list of substances authorized for testing 
                to include any other drugs or other substances listed 
                in schedule I and II of section 202 of the Controlled 
                Substances Act (21 U.S.C. 812) is justified based on 
                the criteria described in subparagraph (A).
            (2) Revision of guidelines.--If an expansion of the 
        substance list is determined to be justified under paragraph 
        (1), the Secretary of Health and Human Services shall--
                    (A) notify the Committee on Commerce, Science, and 
                Transportation of the Senate and the Committee on 
                Transportation and Infrastructure of the House of 
                Representatives of the determination; and
                    (B) publish in the Federal Register, not later than 
                18 months after the date of the determination under 
                that paragraph, a final notice of the revision of the 
                Mandatory Guidelines for Federal Workplace Drug Testing 
                Programs to expand the list of substances authorized to 
                be tested to include the substance or substances 
                determined to be justified for inclusion.
            (3) Report.--If an expansion of the substance list is 
        determined not to be justified under paragraph (1), the 
        Secretary of Health and Human Services shall submit to the 
        Committee on Commerce, Science, and Transportation of the 
        Senate and the Committee on Transportation and Infrastructure 
        of the House of Representatives a report explaining, in detail, 
        the reasons the expansion of the list of authorized substances 
        is not justified.
    (b) Department of Transportation Drug-testing Panel.--If an 
expansion is determined to be justified under subsection (a)(1), the 
Secretary of Transportation shall publish in the Federal Register, not 
later than 18 months after the date the final notice is published under 
subsection (a)(2), a final rule revising part 40 of title 49, Code of 
Federal Regulations, to include such substances in the Department of 
Transportation's drug-testing panel, consistent with the Mandatory 
Guidelines for Federal Workplace Drug Testing Programs as revised by 
the Secretary of Health and Human Services under subsection (a).
    (c) Savings Provision.--Nothing in this section may be construed 
as--
            (1) delaying the publication of the notices described in 
        sections 8106 and 8107 of this Act until the Secretary of 
        Health and Human Services makes a determination or publishes a 
        notice under this section; or
            (2) limiting or otherwise affecting any authority of the 
        Secretary of Health and Human Services or the Secretary of 
        Transportation to expand the list of authorized substance 
        testing to include an additional substance.

SEC. 8106. STATUS REPORTS ON HAIR TESTING GUIDELINES.

    (a) In General.--Not later than 60 days after the date of enactment 
of this Act, and annually thereafter until the date that the Secretary 
of Health and Human Services publishes in the Federal Register a final 
notice of scientific and technical guidelines for hair testing in 
accordance with section 5402(b) of the Fixing America's Surface 
Transportation Act (Public Law 114-94; 129 Stat. 1312), the Secretary 
of Health and Human Services shall submit to the Committee on Commerce, 
Science, and Transportation of the Senate and the Committee on 
Transportation and Infrastructure of the House of Representatives a 
report on--
            (1) the status of the hair testing guidelines;
            (2) an explanation for why the hair testing guidelines have 
        not been issued; and
            (3) an estimated date of completion of the hair testing 
        guidelines.
    (b) Requirement.--To the extent practicable and consistent with the 
objective of the hair testing described in subsection (a) to detect 
illegal or unauthorized use of substances by the individual being 
tested, the final notice of scientific and technical guidelines under 
that subsection, as determined by the Secretary of Health and Human 
Services, shall eliminate the risk of positive test results, of the 
individual being tested, caused solely by the drug use of others and 
not caused by the drug use of the individual being tested.

SEC. 8107. MANDATORY GUIDELINES FOR FEDERAL WORKPLACE DRUG TESTING 
              PROGRAMS USING ORAL FLUID.

    (a) Deadline.--Not later than December 31, 2018, the Secretary of 
Health and Human Services shall publish in the Federal Register a final 
notice of the Mandatory Guidelines for Federal Workplace Drug Testing 
Programs using Oral Fluid, based on the notice of proposed mandatory 
guidelines published in the Federal Register on May 15, 2015 (94 FR 
28054).
    (b) Requirement.--To the extent practicable and consistent with the 
objective of the testing described in subsection (a) to detect illegal 
or unauthorized use of substances by the individual being tested, the 
final notice of scientific and technical guidelines under that 
subsection, as determined by the Secretary of Health and Human 
Services, shall eliminate the risk of positive test results, of the 
individual being tested, caused solely by the drug use of others and 
not caused by the drug use of the individual being tested.
    (c) Rule of Construction.--Nothing in this section may be construed 
as requiring the Secretary of Health and Human Services to reissue a 
notice of proposed mandatory guidelines to carry out subsection (a).

SEC. 8108. ELECTRONIC RECORDKEEPING.

    (a) Deadline.--Not later than 1 year after the date of enactment of 
this Act, the Secretary of Health and Human Services shall--
            (1) ensure that each certified laboratory that requests 
        approval for the use of completely paperless electronic Federal 
        Drug Testing Custody and Control Forms from the National 
        Laboratory Certification Program's Electronic Custody and 
        Control Form systems receives approval for those completely 
        paperless electronic forms instead of forms that include any 
        combination of electronic traditional handwritten signatures 
        executed on paper forms; and
            (2) establish a deadline for a certified laboratory to 
        request approval under paragraph (1).
    (b) Savings Clause.--Nothing in this section may be construed as 
limiting or otherwise affecting any authority of the Secretary of 
Health and Human Services to grant approval to a certified laboratory 
for use of completely paperless electronic Federal Drug Testing Custody 
and Control Forms, including to grant approval outside of the process 
under subsection (a).
    (c) Electronic Signatures.--Not later than 18 months after the date 
of the deadline under subsection (a)(2), the Secretary of 
Transportation shall issue a final rule revising part 40 of title 49, 
Code of Federal Regulations, to authorize, to the extent practicable, 
the use of electronic signatures or digital signatures executed to 
electronic forms instead of traditional handwritten signatures executed 
on paper forms.

SEC. 8109. STATUS REPORTS ON COMMERCIAL DRIVER'S LICENSE DRUG AND 
              ALCOHOL CLEARINGHOUSE.

    (a) In General.--Not later than 60 days after the date of enactment 
of this Act, and annually thereafter until the compliance date, the 
Administrator of the Federal Motor Carrier Safety Administration shall 
submit to the Committee on Commerce, Science, and Transportation of the 
Senate and the Committee on Transportation and Infrastructure of the 
House of Representatives a status report on implementation of the final 
rule for the Commercial Driver's License Drug and Alcohol Clearinghouse 
(81 FR 87686), including--
            (1) an updated schedule, including benchmarks, for 
        implementing the final rule as soon as practicable, but not 
        later than the compliance date; and
            (2) a description of each action the Federal Motor Carrier 
        Safety Administration is taking to implement the final rule 
        before the compliance date.
    (b) Definition of Compliance Date.--In this section, the term 
``compliance date'' means the earlier of--
            (1) January 6, 2020; or
            (2) the date that the national clearinghouse required under 
        section 31306a of title 49, United States Code, is operational.

             Subtitle J--Eliminating Kickbacks in Recovery

SEC. 8121. SHORT TITLE.

    This subtitle may be cited as the ``Eliminating Kickbacks in 
Recovery Act of 2018''.

SEC. 8122. CRIMINAL PENALTIES.

    (a) In General.--Chapter 11 of title 18, United States Code, is 
amended by inserting after section 219 the following:
``Sec. 220. Illegal remunerations for referrals to recovery homes, 
              clinical treatment facilities, and laboratories
    ``(a) Offense.--Except as provided in subsection (b), whoever, with 
respect to services covered by a health care benefit program, in or 
affecting interstate or foreign commerce, knowingly and willfully--
            ``(1) solicits or receives any remuneration (including any 
        kickback, bribe, or rebate) directly or indirectly, overtly or 
        covertly, in cash or in kind, in return for referring a patient 
        or patronage to a recovery home, clinical treatment facility, 
        or laboratory; or
            ``(2) pays or offers any remuneration (including any 
        kickback, bribe, or rebate) directly or indirectly, overtly or 
        covertly, in cash or in kind--
                    ``(A) to induce a referral of an individual to a 
                recovery home, clinical treatment facility, or 
                laboratory; or
                    ``(B) in exchange for an individual using the 
                services of that recovery home, clinical treatment 
                facility, or laboratory,
shall be fined not more than $200,000, imprisoned not more than 10 
years, or both, for each occurrence.
    ``(b) Applicability.--Subsection (a) shall not apply to--
            ``(1) a discount or other reduction in price obtained by a 
        provider of services or other entity under a health care 
        benefit program if the reduction in price is properly disclosed 
        and appropriately reflected in the costs claimed or charges 
        made by the provider or entity;
            ``(2) a payment made by an employer to an employee or 
        independent contractor (who has a bona fide employment or 
        contractual relationship with such employer) for employment, if 
        the employee's payment is not determined by or does not vary 
        by--
                    ``(A) the number of individuals referred to a 
                particular recovery home, clinical treatment facility, 
                or laboratory;
                    ``(B) the number of tests or procedures performed; 
                or
                    ``(C) the amount billed to or received from, in 
                part or in whole, the health care benefit program from 
                the individuals referred to a particular recovery home, 
                clinical treatment facility, or laboratory;
            ``(3) a discount in the price of an applicable drug of a 
        manufacturer that is furnished to an applicable beneficiary 
        under the Medicare coverage gap discount program under section 
        1860D-14A(g) of the Social Security Act (42 U.S.C. 1395w-
        114a(g));
            ``(4) a payment made by a principal to an agent as 
        compensation for the services of the agent under a personal 
        services and management contract that meets the requirements of 
        section 1001.952(d) of title 42, Code of Federal Regulations, 
        as in effect on the date of enactment of this section;
            ``(5) a waiver or discount (as defined in section 
        1001.952(h)(5) of title 42, Code of Federal Regulations, or any 
        successor regulation) of any coinsurance or copayment by a 
        health care benefit program if--
                    ``(A) the waiver or discount is not routinely 
                provided; and
                    ``(B) the waiver or discount is provided in good 
                faith;
            ``(6) a remuneration described in section 1128B(b)(3)(I) of 
        the Social Security Act (42 U.S.C. 1320a-7b(b)(3)(I));
            ``(7) a remuneration made pursuant to an alternative 
        payment model (as defined in section 1833(z)(3)(C) of the 
        Social Security Act) or pursuant to a payment arrangement used 
        by a State, health insurance issuer, or group health plan if 
        the Secretary of Health and Human Services has determined that 
        such arrangement is necessary for care coordination or value-
        based care; or
            ``(8) any other payment, remuneration, discount, or 
        reduction as determined by the Attorney General, in 
        consultation with the Secretary of Health and Human Services, 
        by regulation.
    ``(c) Regulations.--The Attorney General, in consultation with the 
Secretary of Health and Human Services, may promulgate regulations to 
clarify the exceptions described in subsection (b).
    ``(d) Preemption.--
            ``(1) Federal law.--This section shall not apply to conduct 
        that is prohibited under section 1128B of the Social Security 
        Act (42 U.S.C. 1320a-7b).
            ``(2) State law.--Nothing in this section shall be 
        construed to occupy the field in which any provisions of this 
        section operate to the exclusion of State laws on the same 
        subject matter.
    ``(e) Definitions.--In this section--
            ``(1) the terms `applicable beneficiary' and `applicable 
        drug' have the meanings given those terms in section 1860D-
        14A(g) of the Social Security Act (42 U.S.C. 1395w-114a(g));
            ``(2) the term `clinical treatment facility' means a 
        medical setting , other than a hospital, that provides 
        detoxification, risk reduction, outpatient treatment and care, 
        residential treatment, or rehabilitation for substance use, 
        pursuant to licensure or certification under State law;
            ``(3) the term `health care benefit program' has the 
        meaning given the term in section 24(b);
            ``(4) the term `laboratory' has the meaning given the term 
        in section 353 of the Public Health Service Act (42 U.S.C. 
        263a); and
            ``(5) the term `recovery home' means a shared living 
        environment that is, or purports to be, free from alcohol and 
        illicit drug use and centered on peer support and connection to 
        services that promote sustained recovery from substance use 
        disorders.''.
    (b) Clerical Amendment.--The table of sections for chapter 11 of 
title 18, United States Code, is amended by inserting after the item 
related to section 219 the following:

``220. Illegal remunerations for referrals to recovery homes, clinical 
                            treatment facilities, and laboratories.''.

                 Subtitle K--Substance Abuse Prevention

SEC. 8201. SHORT TITLE.

    This subtitle may be cited as the ``Substance Abuse Prevention Act 
of 2018''.

SEC. 8202. REAUTHORIZATION OF THE OFFICE OF NATIONAL DRUG CONTROL 
              POLICY.

    (a) Office of National Drug Control Policy Reauthorization Act of 
1998.--
            (1) In general.--The Office of National Drug Control Policy 
        Reauthorization Act of 1998 (21 U.S.C. 1701 et seq.), as in 
        effect on September 29, 2003, and as amended by the laws 
        described in paragraph (2), is revived and restored.
            (2) Laws described.--The laws described in this paragraph 
        are:
                    (A) The Office of National Drug Control Policy 
                Reauthorization Act of 2006 (Public Law 109-469; 120 
                Stat. 3502).
                    (B) The Presidential Appointment Efficiency and 
                Streamlining Act of 2011 (Public Law 112-166; 126 Stat. 
                1283).
    (b) Reauthorization.--
            (1) In general.--Section 714 of the Office of National Drug 
        Control Policy Reauthorization Act of 1998 (21 U.S.C. 1711) is 
        amended by striking ``such sums as may be necessary for each of 
        fiscal years 2006 through 2010'' and inserting ``$18,400,000 
        for each of fiscal years 2018 through 2023''.
            (2) Repeal of termination.--The Office of National Drug 
        Control Policy Reauthorization Act of 1998 (21 U.S.C. 1701 et 
        seq.) is amended by striking section 715 (21 U.S.C. 1712).

SEC. 8203. REAUTHORIZATION OF THE DRUG-FREE COMMUNITIES PROGRAM.

    (a) Revival of National Narcotics Leadership Act of 1988.--
            (1) In general.--Chapter 2 of the National Narcotics 
        Leadership Act of 1988 (21 U.S.C. 1521 et seq.), except for 
        subchapter II (21 U.S.C. 1541 et seq.), as in effect on 
        September 29, 1997, and as amended by the laws described in 
        paragraph (2), is revived and restored.
            (2) Laws described.--The laws described in this paragraph 
        are:
                    (A) Public Law 107-82 (115 Stat. 814).
                    (B) The Office of National Drug Control Policy 
                Reauthorization Act of 2006 (Public Law 109-469: 120 
                Stat. 3502), as amended by paragraph (4).
            (3) Amendment to termination provision.--Section 1009 of 
        the National Narcotics Leadership Act of 1988 (21 U.S.C. 1056) 
        is amended by inserting ``and sections 1021 through 1035'' 
        after ``section 1007''.
            (4) Technical correction.--
                    (A) In general.--Title VIII of the Office of 
                National Drug Control Policy Reauthorization Act of 
                2006 (Public Law 109-469; 120 Stat. 3535) is amended by 
                striking ``Drug-Free Communities Act of 1997'' each 
                place it appears and inserting ``National Narcotics 
                Leadership Act of 1988''.
                    (B) Effective date.--The amendments made by 
                subparagraph (A) shall take effect as though enacted as 
                part of the Office of National Drug Control Policy 
                Reauthorization Act of 2006 (Public Law 109-469; 120 
                Stat. 3502).
    (b) Amendment to National Narcotics Leadership Act of 1988.--
Chapter 2 of subtitle A of title I of the National Narcotics Leadership 
Act of 1988 (21 U.S.C. 1521 et seq.) is amended--
            (1) in section 1022 (21 U.S.C. 1522), by striking 
        ``substance abuse'' each place it appears and inserting 
        ``substance use and misuse'';
            (2) in section 1023 (21 U.S.C. 1523), by striking paragraph 
        (9) and inserting the following:
            ``(9) Substance use and misuse.--The term `substance use 
        and misuse' means--
                    ``(A) the illegal use or misuse of drugs, including 
                substances for which a listing is effect under any of 
                schedules I through V under section 202 of the 
                Controlled Substances Act (21 U.S.C. 812);
                    ``(B) the misuse of inhalants or over-the-counter 
                drugs; or
                    ``(C) the use of alcohol, tobacco, or other related 
                product as such use is prohibited by State or local 
                law.'';
            (3) in section 1024 (21 U.S.C. 1524), by striking 
        subsections (a) and (b) and inserting the following:
    ``(a) In General.--There is authorized to be appropriated to the 
Office of National Drug Control Policy to carry out this chapter 
$99,000,000 for each of fiscal years 2018 through 2023.
    ``(b) Administrative Costs.--Not more than 8 percent of the funds 
appropriated to carry out this chapter may be used by the Office of 
National Drug Control Policy to pay administrative costs associated 
with the responsibilities of the Office under this chapter.'';
            (4) in subchapter I (21 U.S.C. 1531 et seq.)--
                    (A) by striking ``substance abuse'' each place it 
                appears and inserting ``substance use and misuse''; and
                    (B) in section 1032(b)(1)(A) (21 U.S.C. 
                1532(b)(1)(A)), by striking clause (iii) and inserting 
                the following:
                            ``(iii) Renewal grants.--Subject to clause 
                        (iv), the Administrator may award a renewal 
                        grant to a grant recipient under this 
                        subparagraph for each fiscal year of the 4-
                        fiscal-year period following the first fiscal 
                        year for which the initial additional grant is 
                        awarded in an amount not to exceed the 
                        following:
                                    ``(I) For the first and second 
                                fiscal years of the 4-fiscal-year 
                                period, the amount of the non-Federal 
                                funds, including in-kind contributions, 
                                raised by the coalition for the 
                                applicable fiscal year is not less than 
                                125 percent of the amount awarded.
                                    ``(II) For the third and fourth 
                                fiscal tears of the 4-fiscal-year 
                                period, the amount of the non-Federal 
                                funds, including in-kind contributions, 
                                raised by the coalition for the 
                                applicable fiscal year is not less than 
                                150 percent of the amount awarded.''; 
                                and
            (5) by striking subchapter II (21 U.S.C. 1541 et seq.).

SEC. 8204. REAUTHORIZATION OF THE NATIONAL COMMUNITY ANTI-DRUG 
              COALITION INSTITUTE.

    Section 4 of Public Law 107-82 (21 U.S.C. 1521 note) is amended to 
read as follows:

``SEC. 4. AUTHORIZATION FOR NATIONAL COMMUNITY ANTIDRUG COALITION 
              INSTITUTE.

    ``(a) In General.--The Director shall, using amounts authorized to 
be appropriated by subsection (d), make a competitive grant to provide 
for the continuation of the National Community Anti-drug Coalition 
Institute.
    ``(b) Eligible Organizations.--An organization eligible for the 
grant under subsection (a) is any national nonprofit organization that 
represents, provides technical assistance and training to, and has 
special expertise and broad, national-level experience in community 
antidrug coalitions under this subchapter.
    ``(c) Use of Grant Amount.--The organization that receives the 
grant under subsection (a) shall continue a National Community Anti-
Drug Coalition Institute to--
            ``(1) provide education, training, and technical assistance 
        for coalition leaders and community teams, with emphasis on the 
        development of coalitions serving economically disadvantaged 
        areas;
            ``(2) develop and disseminate evaluation tools, mechanisms, 
        and measures to better assess and document coalition 
        performance measures and outcomes; and
            ``(3) bridge the gap between research and practice by 
        translating knowledge from research into practical information.
    ``(d) Authorization of Appropriations.--The Director shall, using 
amounts authorized to be appropriated by section 1032 of the National 
Narcotics Leadership Act of 1988 (15 U.S.C. 1532), make a grant of $2 
million under subsection (a), for each of the fiscal years 2018 through 
2023.''.

SEC. 8205. REAUTHORIZATION OF THE HIGH-INTENSITY DRUG TRAFFICKING AREA 
              PROGRAM.

    Section 707 of the Office of National Drug Control Policy 
Reauthorization Act of 1998 (21 U.S.C. 1706) is amended--
            (1) in subsection (f), by striking ``no Federal'' and all 
        that follows through ``programs.'' and inserting the following: 
        ``not more than a total of 5 percent of Federal funds 
        appropriated for the Program are expended for substance use 
        disorder treatment programs and drug prevention programs.'';
            (2) in subsection (p)--
                    (A) in paragraph (4), by striking ``and'' at the 
                end;
                    (B) in paragraph (5), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following:
            ``(6) $280,000,000 for each of fiscal years 2018 through 
        2023.''; and
            (3) in subsection (q)--
                    (A) by striking paragraph (2) and inserting the 
                following:
            ``(2) Required uses.--The funds used under paragraph (1) 
        shall be used to ensure the safety of neighborhoods and the 
        protection of communities, including the prevention of the 
        intimidation of witnesses of illegal drug distribution and 
        related activities and the establishment of, or support for, 
        programs that provide protection or assistance to witnesses in 
        court proceedings.''; and
                    (B) by adding at the end the following:
            ``(3) Best practice models.--The Director shall work with 
        HIDTAs to develop and maintain best practice models to assist 
        State, local, and Tribal governments in addressing witness 
        safety, relocation, financial and housing assistance, or any 
        other services related to witness protection or assistance in 
        cases of illegal drug distribution and related activities. The 
        Director shall ensure dissemination of the best practice models 
        to each HIDTA.''.

SEC. 8206. REAUTHORIZATION OF DRUG COURT PROGRAM.

    Section 1001(a)(25)(A) of title I of the Omnibus Crime Control and 
Safe Streets Act of 1968 (34 U.S.C. 10261(a)(25)(A)) is amended by 
striking ``Except as provided'' and all that follows and inserting the 
following: ``Except as provided in subparagraph (C), there is 
authorized to be appropriated to carry out part EE $75,000,000 for each 
of fiscal years 2018 through 2023.''.

SEC. 8207. DRUG COURT TRAINING AND TECHNICAL ASSISTANCE.

    Section 705 of the Office of National Drug Control Policy 
Reauthorization Act of 1998 (21 U.S.C. 1704) is amended by adding at 
the end the following:
    ``(e) Drug Court Training and Technical Assistance Program.--
            ``(1) Grants authorized.--The Director may make a grant to 
        a nonprofit organization for the purpose of providing training 
        and technical assistance to drug courts.
            ``(2) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $2,000,000 for 
        each of fiscal years 2018 through 2023.''.

SEC. 8208. DRUG OVERDOSE RESPONSE STRATEGY.

    Section 707 of the Office of National Drug Control Policy 
Reauthorization Act of 1998 (21 U.S.C. 1706) is amended by adding at 
the end the following:
    ``(r) Drug Overdose Response Strategy Implementation.--The Director 
may use funds appropriated to carry out this section to implement a 
drug overdose response strategy in high intensity drug trafficking 
areas on a nationwide basis by--
            ``(1) coordinating multi-disciplinary efforts to prevent, 
        reduce, and respond to drug overdoses, including the uniform 
        reporting of fatal and non-fatal overdoses to public health and 
        safety officials;
            ``(2) increasing data sharing among public safety and 
        public health officials concerning drug-related abuse trends, 
        including new psychoactive substances, and related crime; and
            ``(3) enabling collaborative deployment of prevention, 
        intervention, and enforcement resources to address substance 
        use addiction and narcotics trafficking.''.

SEC. 8209. PROTECTING LAW ENFORCEMENT OFFICERS FROM ACCIDENTAL 
              EXPOSURE.

    Section 707 of the Office of National Drug Control Policy 
Reauthorization Act of 1998 (21 U.S.C. 1706), as amended by section 
8208, is amended by adding at the end the following:
    ``(s) Supplemental Grants.--The Director is authorized to use not 
more than $10,000,000 of the amounts otherwise appropriated to carry 
out this section to provide supplemental competitive grants to high 
intensity drug trafficking areas that have experienced high seizures of 
fentanyl and new psychoactive substances for the purposes of--
            ``(1) purchasing portable equipment to test for fentanyl 
        and other substances;
            ``(2) training law enforcement officers and other first 
        responders on best practices for handling fentanyl and other 
        substances; and
            ``(3) purchasing protective equipment, including overdose 
        reversal drugs.''.

SEC. 8210. COPS ANTI-METH PROGRAM.

    Section 1701 of title I of the Omnibus Crime Control and Safe 
Streets Act of 1968 (34 U.S.C. 10381) is amended--
            (1) by redesignating subsection (k) as subsection (l); and
            (2) by inserting after subsection (j) the following:
    ``(k) COPS Anti-Meth Program.--The Attorney General shall use 
amounts otherwise appropriated to carry out this section for a fiscal 
year (beginning with fiscal year 2019) to make competitive grants, in 
amounts of not less than $1,000,000 for such fiscal year, to State law 
enforcement agencies with high seizures of precursor chemicals, 
finished methamphetamine, laboratories, and laboratory dump seizures 
for the purpose of locating or investigating illicit activities, such 
as precursor diversion, laboratories, or methamphetamine 
traffickers.''.

SEC. 8211. COPS ANTI-HEROIN TASK FORCE PROGRAM.

    Section 1701 of title I of the Omnibus Crime Control and Safe 
Streets Act of 1968 (34 U.S.C. 10381) is amended--
            (1) by redesignating subsection (l), as so redesignated by 
        section 8210, as subsection (m); and
            (2) by inserting after subsection (k), as added by section 
        8210, the following:
    ``(l) Cops Anti-heroin Task Force Program.--The Attorney General 
shall use amounts otherwise appropriated to carry out this section, or 
other amounts as appropriated, for a fiscal year (beginning with fiscal 
year 2019) to make competitive grants to State law enforcement agencies 
in States with high per capita rates of primary treatment admissions, 
for the purpose of locating or investigating illicit activities, 
through Statewide collaboration, relating to the distribution of 
heroin, fentanyl, or carfentanil or relating to the unlawful 
distribution of prescription opioids.''.

SEC. 8212. COMPREHENSIVE ADDICTION AND RECOVERY ACT EDUCATION AND 
              AWARENESS.

    Title VII of the Comprehensive Addiction and Recovery Act of 2016 
(Public Law 114-198; 130 Stat. 735) is amended by adding at the end the 
following:

``SEC. 709. SERVICES FOR FAMILIES AND PATIENTS IN CRISIS.

    ``(a) In General.--The Secretary of Health and Human Services may 
make grants to entities that focus on addiction and substance use 
disorders and specialize in family and patient services, advocacy for 
patients and families, and educational information.
    ``(b) Allowable Uses.--A grant awarded under this section may be 
used for nonprofit national, State, or local organizations that engage 
in the following activities:
            ``(1) Expansion of resource center services with 
        professional, clinical staff that provide, for families and 
        individuals impacted by a substance use disorder, support, 
        access to treatment resources, brief assessments, medication 
        and overdose prevention education, compassionate listening 
        services, recovery support or peer specialists, bereavement and 
        grief support, and case management.
            ``(2) Continued development of health information 
        technology systems that leverage new and upcoming technology 
        and techniques for prevention, intervention, and filling 
        resource gaps in communities that are underserved.
            ``(3) Enhancement and operation of treatment and recovery 
        resources, easy-to-read scientific and evidence-based education 
        on addiction and substance use disorders, and other 
        informational tools for families and individuals impacted by a 
        substance use disorder and community stakeholders, such as law 
        enforcement agencies.
            ``(4) Provision of training and technical assistance to 
        State and local governments, law enforcement agencies, health 
        care systems, research institutions, and other stakeholders.
            ``(5) Expanding upon and implementing educational 
        information using evidence-based information on substance use 
        disorders.
            ``(6) Expansion of training of community stakeholders, law 
        enforcement officers, and families across a broad-range of 
        addiction, health, and related topics on substance use 
        disorders, local issues and community-specific issues related 
        to the drug epidemic.
            ``(7) Program evaluation.''.

SEC. 8213. REIMBURSEMENT OF SUBSTANCE USE DISORDER TREATMENT 
              PROFESSIONALS.

    Not later than January 1, 2020, the Comptroller General of the 
United States shall submit to Congress a report examining how substance 
use disorder services are reimbursed.

SEC. 8214. SOBRIETY TREATMENT AND RECOVERY TEAMS (START).

    Title V of the Public Health Service Act (42 U.S.C. 290dd et seq.) 
is amended by adding at the end the following:

``SEC. 550. SOBRIETY TREATMENT AND RECOVERY TEAMS.

    ``(a) In General.--The Secretary may make grants to States, units 
of local government, or tribal governments to establish or expand 
Sobriety Treatment And Recovery Team (referred to in this section as 
`START') or other similar programs to determine the effectiveness of 
pairing social workers or mentors with families that are struggling 
with a substance use disorder and child abuse or neglect in order to 
help provide peer support, intensive treatment, and child welfare 
services to such families.
    ``(b) Allowable Uses.--A grant awarded under this section may be 
used for one or more of the following activities:
            ``(1) Training eligible staff, including social workers, 
        social services coordinators, child welfare specialists, 
        substance use disorder treatment professionals, and mentors.
            ``(2) Expanding access to substance use disorder treatment 
        services and drug testing.
            ``(3) Enhancing data sharing with law enforcement agencies, 
        child welfare agencies, substance use disorder treatment 
        providers, judges, and court personnel.
            ``(4) Program evaluation and technical assistance.
    ``(c) Program Requirements.--A State, unit of local government, or 
tribal government receiving a grant under this section shall--
            ``(1) serve only families for which--
                    ``(A) there is an open record with the child 
                welfare agency; and
                    ``(B) substance use disorder was a reason for the 
                record or finding described in paragraph (1); and
            ``(2) coordinate any grants awarded under this section with 
        any grant awarded under section 437(f) of the Social Security 
        Act focused on improving outcomes for children affected by 
        substance abuse.
    ``(d) Technical Assistance.--The Secretary may reserve not more 
than 5 percent of funds provided under this section to provide 
technical assistance on the establishment or expansion of programs 
funded under this section from the National Center on Substance Abuse 
and Child Welfare.''.

SEC. 8215. PROVIDER EDUCATION.

    Not later than 60 days after the date of enactment of this Act, the 
Attorney General, in consultation with the Secretary of Health and 
Human Services, shall complete the plan related to medical registration 
coordination required by Senate Report 114-239, which accompanied the 
Veterans Care Financial Protection Act of 2017 (Public Law 115-131; 132 
Stat. 334).

SEC. 8216. DEFINITIONS.

    Section 702 of the Office of National Drug Control Policy 
Reauthorization Act of 1998 (21 U.S.C. 1701) is amended--
            (1) by striking paragraphs (5), (12), and (13);
            (2) by redesignating paragraph (11) as paragraph (17);
            (3) by redesignating paragraphs (9) and (10) as paragraphs 
        (14) and (15), respectively;
            (4) by redesignating paragraphs (6), (7), and (8) as 
        paragraphs (10), (11), and (12), respectively;
            (5) by redesignating paragraphs (1), (2), (3), and (4) as 
        paragraphs (3), (4), (5), and (6), respectively;
            (6) by inserting before paragraph (3), as so redesignated, 
        the following:
            ``(1) Agency.--The term `agency' has the meaning given the 
        term `executive agency' in section 102 of title 31, United 
        States Code.
            ``(2) Appropriate congressional committees.--
                    ``(A) In general.--The term `appropriate 
                congressional committees' means--
                            ``(i) the Committee on the Judiciary, the 
                        Committee on Appropriations, and the Committee 
                        on Health, Education, Labor, and Pensions of 
                        the Senate; and
                            ``(ii) the Committee on Oversight and 
                        Government Reform, the Committee on the 
                        Judiciary, the Committee on Energy and 
                        Commerce, and the Committee on Appropriations 
                        of the House of Representatives.
                    ``(B) Submission to congress.--Any submission to 
                Congress shall mean submission to the appropriate 
                congressional committees.'';
            (7) by amending paragraph (3), as so redesignated, to read 
        as follows:
            ``(3) Demand reduction.--The term `demand reduction' means 
        any activity conducted by a National Drug Control Program 
        Agency, other than an enforcement activity, that is intended to 
        reduce or prevent the use of drugs or support, expand, or 
        provide treatment and recovery efforts, including--
                    ``(A) education about the dangers of illicit drug 
                use;
                    ``(B) services, programs, or strategies to prevent 
                substance use disorder, including evidence-based 
                education campaigns, community-based prevention 
                programs, collection and disposal of unused 
                prescription drugs, and services to at-risk populations 
                to prevent or delay initial use of an illicit drug;
                    ``(C) substance use disorder treatment;
                    ``(D) support for long-term recovery from substance 
                use disorders;
                    ``(E) drug-free workplace programs;
                    ``(F) drug testing, including the testing of 
                employees;
                    ``(G) interventions for illicit drug use and 
                dependence;
                    ``(H) expanding availability of access to health 
                care services for the treatment of substance use 
                disorders;
                    ``(I) international drug control coordination and 
                cooperation with respect to activities described in 
                this paragraph;
                    ``(J) pre- and post-arrest criminal justice 
                interventions such as diversion programs, drug courts, 
                and the provision of evidence-based treatment to 
                individuals with substance use disorders who are 
                arrested or under some form of criminal justice 
                supervision, including medication assisted treatment;
                    ``(K) other coordinated and joint initiatives among 
                Federal, State, local, and Tribal agencies to promote 
                comprehensive drug control strategies designed to 
                reduce the demand for, and the availability of, illegal 
                drugs;
                    ``(L) international illicit drug use education, 
                prevention, treatment, recovery, research, 
                rehabilitation activities, and interventions for 
                illicit drug use and dependence; and
                    ``(M) research related to illicit drug use and any 
                of the activities described in this paragraph.'';
            (8) by inserting after paragraph (6), as so redesignated, 
        the following:
            ``(7) Emerging drug threat.--The term `emerging drug 
        threat' means the occurrence of a new and growing trend in the 
        use of an illicit drug or class of drugs, including rapid 
        expansion in the supply of or demand for such drug.
            ``(8) Illicit drug use; illicit drugs; illegal drugs.--The 
        terms `illicit drug use', `illicit drugs', and `illegal drugs' 
        include the illegal or illicit use of prescription drugs.
            ``(9) Law enforcement.--The term `law enforcement' or `drug 
        law enforcement' means all efforts by a Federal, State, local, 
        or Tribal government agency to enforce the drug laws of the 
        United States or any State, including investigation, arrest, 
        prosecution, and incarceration or other punishments or 
        penalties.'';
            (9) by amending paragraph (11), as so redesignated, to read 
        as follows:
            ``(11) National drug control program agency.--The term 
        `National Drug Control Program Agency' means any agency (or 
        bureau, office, independent agency, board, division, 
        commission, subdivision, unit, or other component thereof) that 
        is responsible for implementing any aspect of the National Drug 
        Control Strategy, including any agency that receives Federal 
        funds to implement any aspect of the National Drug Control 
        Strategy, but does not include any agency that receives funds 
        for drug control activity solely under the National 
        Intelligence Program or the Joint Military Intelligence 
        Program.'';
            (10) in paragraph (12), as so redesignated--
                    (A) by inserting ``or `Strategy''' before 
                ``means''; and
                    (B) by inserting ``, including any report, plan, or 
                strategy required to be incorporated into or issued 
                concurrently with such strategy'' before the period at 
                the end;
            (11) by inserting after paragraph (12), as so redesignated, 
        the following:
            ``(13) Nonprofit organization.--The term `nonprofit 
        organization' means an organization that is described in 
        section 501(c)(3) of the Internal Revenue Code of 1986 and 
        exempt from tax under section 501(a) of such Code.'';
            (12) in paragraph (14), as so redesignated, by striking 
        ``Unless the context clearly indicates otherwise, the'' and 
        inserting ``The'';
            (13) by inserting after paragraph (15), as so redesignated, 
        the following:
            ``(16) Substance use disorder treatment.--The term 
        `substance use disorder treatment' means an evidence-based, 
        professionally directed, deliberate, and planned regimen 
        including evaluation, observation, medical monitoring, and 
        rehabilitative services and interventions such as 
        pharmacotherapy, behavioral therapy, and individual and group 
        counseling, on an inpatient or outpatient basis, to help 
        patients with substance use disorder reach recovery.''; and
            (14) in paragraph (17), as so redesignated--
                    (A) by redesignating subparagraphs (B), (C), (D), 
                and (E), as subparagraphs (C), (D), (E), and (F), 
                respectively;
                    (B) by inserting after subparagraph (A) the 
                following:
                    ``(B) domestic law enforcement;'';
                    (C) in subparagraph (E), as so redesignated, by 
                striking ``and'' at the end;
                    (D) in subparagraph (F), as so redesignated, by 
                striking the period at the end and inserting a 
                semicolon; and
                    (E) by adding at the end the following:
                    ``(G) activities to prevent the diversion of drugs 
                for their illicit use; and
                    ``(H) research related to any of the activities 
                described in this paragraph.''.

SEC. 8217. AMENDMENTS TO ADMINISTRATION OF THE OFFICE.

    (a) Responsibilities of Office.--Section 703(a) of the Office of 
National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 
1702(a)) is amended--
            (1) by striking paragraph (1) and inserting the following:
            ``(1) lead the national drug control effort, including 
        coordinating with the National Drug Control Program 
        Agencies;'';
            (2) in paragraph (2), by inserting before the semicolon the 
        following: ``, including the National Drug Control Strategy'';
            (3) in paragraph (3), by striking ``and'' at the end; and
            (4) by striking paragraph (4) and all that follows through 
        ``the National Academy of Sciences.'' and inserting the 
        following:
            ``(4) evaluate the effectiveness of national drug control 
        policy efforts, including the National Drug Control Program 
        Agencies' program, by developing and applying specific goals 
        and performance measurements and monitoring the agencies' 
        program-level spending;
            ``(5) identify and respond to emerging drug threats related 
        to illicit drug use;
            ``(6) administer the Drug-Free Communities Program, the 
        High-Intensity Drug Trafficking Areas Program, and other grant 
        programs directly authorized to be administered by the Office 
        in furtherance of the National Drug Control Strategy; and
            ``(7) facilitate broad-scale information sharing and data 
        standardization among Federal, State, and local entities to 
        support the national drug control efforts.''.
    (b) Ethics Guidelines.--Section 703(d) of the Office of National 
Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 1702(d)) is 
amended by adding at the end the following:
            ``(4) Ethics guidelines.--The Director shall establish 
        written guidelines setting forth the criteria to be used in 
        determining whether a gift or donation should be declined under 
        this subsection because the acceptance of the gift or donation 
        would--
                    ``(A) reflect unfavorably upon the ability of the 
                Director or the Office, or any employee of the Office, 
                to carry out responsibilities or official duties under 
                this chapter in a fair and objective manner; or
                    ``(B) compromise the integrity or the appearance of 
                integrity of programs or services provided under this 
                chapter or of any official involved in those programs 
                or services.
            ``(5) Registry of gifts.--The Director shall maintain a 
        list of--
                    ``(A) the source and amount of each gift or 
                donation accepted by the Office; and
                    ``(B) the source and amount of each gift or 
                donation accepted by a contractor to be used in its 
                performance of a contract for the Office.
            ``(6) Report to congress.--The Director shall include in 
        the annual assessment under section 706(g) a copy of the 
        registry maintained under paragraph (5).''.
    (c) Appointment of Director and Deputy Director.--Section 704(a) of 
the Office of National Drug Control Policy Reauthorization Act of 1998 
(21 U.S.C. 1703(a)) is amended--
            (1) in paragraph (1), by striking subparagraphs (A), (B), 
        and (C), and inserting the following:
                    ``(A) Director.--
                            ``(i) In general.--There shall be at the 
                        head of the Office a Director who shall hold 
                        the same rank and status as the head of an 
                        executive department listed in section 101 of 
                        title 5, United States Code.
                            ``(ii) Appointment.--The Director shall be 
                        appointed by the President, by and with the 
                        advice and consent of the Senate, and shall 
                        serve at the pleasure of the President.
                    ``(B) Deputy director.--There shall be a Deputy 
                Director who shall report directly to the Director, and 
                who shall be appointed by the President, and shall 
                serve at the pleasure of the President.
                    ``(C) Coordinators.--The following coordinators 
                shall be appointed by the Director:
                            ``(i) Performance Budget Coordinator, as 
                        described in section 704(c)(4).
                            ``(ii) Interdiction Coordinator, as 
                        described in section 711.
                            ``(iii) Emerging and Continuing Threats 
                        Coordinator, as described in section 709.
                            ``(iv) State, Local, and Tribal Affairs 
                        Coordinator, to carry out the activities 
                        described in section 704(j).
                            ``(v) Demand Reduction Coordinator, as 
                        described in subparagraph (D).
                    ``(D) Demand reduction coordinator.--The Director 
                shall designate or appoint a United States Demand 
                Reduction Coordinator to be responsible for the 
                activities described in section 702(3). The Director 
                shall determine whether the coordinator position is a 
                noncareer appointee in the Senior Executive Service or 
                a career appointee in a position at level 15 of the 
                General Schedule (or equivalent).'';
            (2) in paragraph (5), by striking ``such official'' and 
        inserting ``such officer or employee''; and
            (3) by adding at the end the following:
            ``(6) Prohibition on the use of funds for ballot 
        initiatives.--No funds authorized under this title may be 
        obligated for the purpose of expressly advocating the passage 
        or defeat of a State or local ballot initiative.''.
    (d) Consultation.--Section 704(b) of the Office of National Drug 
Control Policy Reauthorization Act of 1998 (21 U.S.C. 1703(b)) is 
amended--
            (1) in paragraph (19), by striking ``; and'' and inserting 
        a semicolon;
            (2) in paragraph (20), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(21) in order to formulate the national drug control 
        policies, goals, objectives, and priorities--
                    ``(A) shall consult with and assist--
                            ``(i) State and local governments;
                            ``(ii) National Drug Control Program 
                        Agencies;
                            ``(iii) each committee, working group, 
                        council, or other entity established under this 
                        chapter, as appropriate;
                            ``(iv) the public;
                            ``(v) appropriate congressional committees; 
                        and
                            ``(vi) any other person in the discretion 
                        of the Director; and
                    ``(B) may--
                            ``(i) establish advisory councils;
                            ``(ii) acquire data from agencies; and
                            ``(iii) request data from any other 
                        entity.''.
    (e) National Drug Control Program Budget.--Section 704(c) of the 
Office of National Drug Control Policy Reauthorization Act of 1998 (21 
U.S.C. 1703(c)) is amended--
            (1) in paragraph (2)--
                    (A) in subparagraph (A), by striking ``paragraph 
                (1)(C);'' and inserting the following: ``paragraph 
                (1)(C) and include--
                            ``(i) the funding level for each National 
                        Drug Control Program agency; and
                            ``(ii) alternative funding structures that 
                        could improve progress on achieving the goals 
                        fo the National Drug Control Strategy; and'';
                    (B) in subparagraph (B), strike ``the President; 
                and'' and inserting ``the President and Congress.''; 
                and
                    (C) by striking subparagraph (C);
            (2) in paragraph (3)(E), by striking clause (ii) and 
        inserting the following:
                            ``(ii) Certification.--The Director shall--
                                    ``(I) review each budget submission 
                                submitted under subparagraph (A);
                                    ``(II) based on the review under 
                                clause (i), make a determination as to 
                                whether the budget submission of a 
                                National Drug Control Program agency 
                                includes the funding levels and 
                                initiatives described in subparagraph 
                                (B); and
                                    ``(III) submit to the appropriate 
                                congressional committees--
                                            ``(aa) a written statement 
                                        that either--

                                                    ``(AA) certifies 
                                                that the budget 
                                                submission includes 
                                                sufficient funding; or

                                                    ``(BB) decertifies 
                                                the budget submission 
                                                as not including 
                                                sufficient funding;

                                            ``(bb) a copy of the 
                                        description made under 
                                        subparagraph (B); and
                                            ``(cc) the budget 
                                        recommendations made under 
                                        subsection (b)(8).''; and
            (3) by adding at the end the following:
            ``(5) Performance-budget coordinator.--
                    ``(A) Designation.--The Director shall designate or 
                appoint a United States Performance-Budget Coordinator 
                to--
                            ``(i) ensure the Director has sufficient 
                        information necessary to analyze the 
                        performance of each National Drug Control 
                        Program Agency, the impact Federal funding has 
                        had on the goals in the Strategy, and the 
                        likely contributions to the goals of the 
                        Strategy based on funding levels of each 
                        National Drug Control Program Agency, to make 
                        an independent assessment of the budget request 
                        of each agency under this subsection;
                            ``(ii) advise the Director on agency 
                        budgets, performance measures and targets, and 
                        additional data and research needed to make 
                        informed policy decisions under this section 
                        and section 706; and
                            ``(iii) other duties as may be determined 
                        by the Director with respect to measuring or 
                        assessing performance or agency budgets.
                    ``(B) Determination of position.--The Director 
                shall determine whether the coordinator position is a 
                noncareer appointee in the Senior Executive Service or 
                a career appointee in a position at level 15 of the 
                General Schedule (or equivalent).
            ``(6) Budget estimate or request submission to congress.--
        Whenever the Director submits any budget estimate or request to 
        the President or the Office of Management and Budget, the 
        Director shall concurrently transmit to the appropriate 
        congressional committees a detailed statement of the budgetary 
        needs of the Office to execute its mission based on the good-
        faith assessment of the Director.''.
    (f) Powers and Responsibilities of the Director.--Section 704 of 
the Office of National Drug Control Policy Reauthorization Act of 1998 
(21 U.S.C. 1703) is amended--
            (1) in subsection (d)(8)--
                    (A) in subparagraph (D), by striking ``and'' at the 
                end;
                    (B) in subparagraph (E)--
                            (i) in clause (i)--
                                    (I) by striking ``Congress, 
                                including to the Committees on 
                                Appropriations of the Senate and the 
                                House of Representatives, the 
                                authorizing committees for the 
                                Office,'' and inserting ``the 
                                appropriate congressional committees''; 
                                and
                                    (II) by striking ``or agencies'';
                            (ii) in clause (ii)--
                                    (I) by striking ``Congress'' and 
                                inserting ``the appropriate 
                                congressional committees''; and
                                    (II) by adding ``and'' at the end; 
                                and
                            (iii) by adding at the end the following:
                            ``(iii) funds may only be used for--
                                    ``(I) expansion of demand reduction 
                                activities;
                                    ``(II) interdiction of illicit 
                                drugs on the high seas, in United 
                                States territorial waters, and at 
                                United States ports of entry by 
                                officers and employees of National Drug 
                                Control Program Agencies and domestic 
                                and foreign law enforcement officers;
                                    ``(III) accurate assessment and 
                                monitoring of international drug 
                                production and interdiction programs 
                                and policies;
                                    ``(IV) activities to facilitate and 
                                enhance the sharing of domestic and 
                                foreign intelligence information among 
                                National Drug Control Program Agencies 
                                related to the production and 
                                trafficking of drugs in the United 
                                States and foreign countries; and
                                    ``(V) research related to any of 
                                these activities.'';
            (2) in subsection (e)(2)(A), by striking ``Notwithstanding 
        any other provision of law'' and inserting ``Subject to the 
        availability of appropriations''; and
            (3) by adding at the end the following:
    ``(i) Model Acts Program.--
            ``(1) In general.--The Director shall provide for or shall 
        enter into an agreement with a nonprofit organization to--
                    ``(A) advise States on establishing laws and 
                policies to address illicit drug use issues; and
                    ``(B) revise such model State drug laws and draft 
                supplementary model State laws to take into 
                consideration changes in illicit drug use issues in the 
                State involved.
            ``(2) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $1,250,000 for 
        each of fiscal years 2018 through 2023.
    ``(j) State, Local, and Tribal Affairs Coordinator.--The Director 
shall designate or appoint a United States State, Local, and Tribal 
Affairs Coordinator to perform the duties of the Office outlined in 
this section and 706 and such other duties as may be determined by the 
Director with respect to coordination of drug control efforts between 
agencies and State, local, and Tribal governments. The Director shall 
determine whether the coordinator position is a noncareer appointee in 
the Senior Executive Service or a career appointee in a position at 
level 15 of the General Schedule (or equivalent).
    ``(k) Harm Reduction Programs .--When developing the national drug 
control policy, any policy of the Director, including policies relating 
to syringe exchange programs for intravenous drug users, shall be based 
on the best available medical and scientific evidence regarding the 
effectiveness of such policy in promoting individual health and 
preventing the spread of infectious disease and the impact of such 
policy on drug addiction and use. In making any policy relating to harm 
reduction programs, the Director shall consult with the National 
Institutes of Health and the National Academy of Sciences.''.
    (g) Accounting of Funds Expended.--Section 705 of the Office of 
National Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 
1704(d)), as amended by section 8207 is further amended--
            (1) by amending subsection (d) to read as follows:
    ``(d) Accounting of Funds Expended.--
            ``(1) In general.--Not later than February 1 of each year, 
        in accordance with guidance issued by the Director, the head of 
        each National Drug Control Program Agency shall submit to the 
        Director a detailed accounting of all funds expended by the 
        agency for National Drug Control Program activities during the 
        previous fiscal year and shall ensure such detailed accounting 
        is authenticated for the previous fiscal year by the Inspector 
        General for such agency prior to the submission to the Director 
        as frequently as determined by the Inspector General but not 
        less frequently that every 3 years.
            ``(2) Submission to congress.--The Director shall submit to 
        Congress not later than April 1 of each year the information 
        submitted to the Director under paragraph (1).''; and
            (2) by adding at the end the following:
    ``(f) Tracking System for Federally Funded Grant Programs.--
            ``(1) Establishment.--The Director, or the head of an 
        agency designated by the Director, in coordination with the 
        Secretary of Health and Human Services, shall track federally-
        funded grant programs to--
                    ``(A) ensure the public has electronic access to 
                information identifying:
                            ``(i) all drug control grants and pertinent 
                        identifying information for each grant;
                            ``(ii) any available performance metrics, 
                        evaluations, or other information indicating 
                        the effectiveness of such programs;
                    ``(B) facilitate efforts to identify duplication, 
                overlap, or gaps in funding to provide increased 
                accountability of Federally-funded grants for substance 
                use disorder treatment, prevention, and enforcement; 
                and
                    ``(C) identify barriers in the grant application 
                process impediments that applicants currently have in 
                the grant application process with applicable agencies.
            ``(2) National drug control agencies.--The head of each 
        National Drug Control Program Agency shall provide to the 
        Director a complete list of all drug control program grant 
        programs and any other relevant information for inclusion in 
        the system developed under paragraph (1) and annually update 
        such list.
            ``(3) Updating existing systems.--The Director may meet the 
        requirements of this subsection by utilizing, updating, or 
        improving existing Federal information systems to ensure they 
        meet the requirements of this subsection.
            ``(4) Report.--Not later than 3 years after the date of 
        enactment of this subsection, the Comptroller General of the 
        United States shall submit to Congress a report examining 
        implementation of this subsection.''.
    (h) Technical and Conforming Amendment.--Section 1105 of the Office 
of National Drug Control Policy Reauthorization Act of 2006 (21 U.S.C. 
1701 note) is repealed.

SEC. 8218. EMERGING THREATS COMMITTEE, PLAN, AND MEDIA CAMPAIGN.

    (a) In General.--Section 709 of the Office of National Drug Control 
Policy Reauthorization Act of 1998 (21 U.S.C. 1708) is amended to read 
as follows:

``SEC. 709. EMERGING THREATS COMMITTEE, PLAN, AND MEDIA CAMPAIGN.

    ``(a) Emerging Threats Coordinator.--The Director shall designate 
or appoint a United States Emerging and Continuing Threats Coordinator 
to perform the duties of that position described in this section and 
such other duties as may be determined by the Director. The Director 
shall determine whether the coordinator position is a noncareer 
appointee in the Senior Executive Service or a career appointee in a 
position at level 15 of the General Schedule (or equivalent).
    ``(b) Emerging Threats Committee.--
            ``(1) In general.--The Emerging Threats Committee shall--
                    ``(A) monitor evolving and emerging drug threats in 
                the United States;
                    ``(B) identify and discuss evolving and emerging 
                drug trends in the United States using the criteria 
                required to be established under paragraph (6);
                    ``(C) assist in the formulation of and oversee 
                implementation of any plan described in subsection (d);
                    ``(D) provide such other advice to the Coordinator 
                and Director concerning strategy and policies for 
                emerging drug threats and trends as the Committee 
                determines to be appropriate; and
                    ``(E) disseminate and facilitate the sharing with 
                Federal, State, local, and Tribal officials and other 
                entities as determined by the Director of pertinent 
                information and data relating to--
                            ``(i) recent trends in drug supply and 
                        demand;
                            ``(ii) fatal and nonfatal overdoses;
                            ``(iii) demand for and availability of 
                        evidence-based substance use disorder 
                        treatment, including the extent of the unmet 
                        treatment need, and treatment admission trends;
                            ``(iv) recent trends in drug interdiction, 
                        supply, and demand from State, local, and 
                        Tribal law enforcement agencies; and
                            ``(v) other subject matter as determined 
                        necessary by the Director.
            ``(2) Chairperson.--The Director shall designate one of the 
        members of the Emerging Threats Committee to serve as 
        Chairperson.
            ``(3) Members.--The Director shall appoint other members of 
        the Committee, which shall include--
                    ``(A) representatives from National Drug Control 
                Program Agencies or other agencies;
                    ``(B) representatives from State, local, and Tribal 
                governments; and
                    ``(C) representatives from other entities as 
                designated by the Director.
            ``(4) Meetings.--The members of the Emerging Threats 
        Committee shall meet, in person and not through any delegate or 
        representative, not less frequently than once per calendar 
        year, before June 1. At the call of the Director or the 
        Chairperson, the Emerging Threats Committee may hold additional 
        meetings as the members may choose.
            ``(5) Contract, agreement, and other authority.--The 
        Director may award contracts, enter into interagency 
        agreements, manage individual projects, and conduct other 
        activities in support of the identification of emerging drug 
        threats and in support of the development, implementation, and 
        assessment of any Emerging Threat Response Plan.
            ``(6) Criteria to identify emerging drug threats.--Not 
        later than 180 days after the date on which the Committee first 
        meets, the Committee shall develop and recommend to the 
        Director criteria to be used to identify an emerging drug 
        threat or the termination of an emerging drug threat 
        designation based on information gathered by the Committee, 
        statistical data, and other evidence.
    ``(c) Designation.--
            ``(1) In general.--The Director, in consultation with the 
        Coordinator, the Committee, and the head of each National Drug 
        Control Program Agency, may designate an emerging drug threat 
        in the United States.
            ``(2) Standards for designation.--The Director, in 
        consultation with the Coordinator, shall promulgate and make 
        publicly available standards by which a designation under 
        paragraph (1) and the termination of such designation may be 
        made. In developing such standards, the Director shall consider 
        the recommendations of the committee and other criteria the 
        Director considers to be appropriate.
            ``(3) Public statement required.--The Director shall 
        publish a public written statement on the portal of the Office 
        explaining the designation of an emerging drug threat or the 
        termination of such designation and shall notify the 
        appropriate congressional committees of the availability of 
        such statement when a designation or termination of such 
        designation has been made.
    ``(d) Plan.--
            ``(1) Public availability of plan.--Not later than 90 days 
        after making a designation under subsection (c), the Director 
        shall publish and make publicly available an Emerging Threat 
        Response Plan and notify the President and the appropriate 
        congressional committees of such plan's availability.
            ``(2) Timing.--Concurrently with the annual submissions 
        under section 706(g), the Director shall update the plan and 
        report on implementation of the plan, until the Director issues 
        the public statement required under subsection (c)(3) to 
        terminate the emerging drug threat designation.
            ``(3) Contents of an emerging threat response plan.--The 
        Director shall include in the plan required under this 
        subsection--
                    ``(A) a comprehensive strategic assessment of the 
                emerging drug threat, including the current 
                availability of, demand for, and effectiveness of 
                evidence-based prevention, treatment, and enforcement 
                programs and efforts to respond to the emerging drug 
                threat;
                    ``(B) comprehensive, research-based, short- and 
                long-term, quantifiable goals for addressing the 
                emerging drug threat, including for reducing the supply 
                of the drug designated as the emerging drug threat and 
                for expanding the availability and effectiveness of 
                evidence-based substance use disorder treatment and 
                prevention programs to reduce the demand for the 
                emerging drug threat;
                    ``(C) performance measures pertaining to the plan's 
                goals, including quantifiable and measurable objectives 
                and specific targets;
                    ``(D) the level of funding needed to implement the 
                plan, including whether funding is available to be 
                reprogrammed or transferred to support implementation 
                of the plan or whether additional appropriations are 
                necessary to implement the plan;
                    ``(E) an implementation strategy for the media 
                campaign under subsection (f), including goals as 
                described under subparagraph (B) of this paragraph and 
                performance measures, objectives, and targets, as 
                described under subparagraph (C) of this paragraph; and
                    ``(F) any other information necessary to inform the 
                public of the status, progress, or response of an 
                emerging drug threat.
            ``(4) Implementation.--
                    ``(A) In general.--Not later than 120 days after 
                the date on which a designation is made under 
                subsection (c), the Director, in consultation with the 
                President, the appropriate congressional committees, 
                and the head of each National Drug Control Program 
                Agency, shall issue guidance on implementation of the 
                plan described in this subsection to the National Drug 
                Control Program Agencies and any other relevant agency 
                determined to be necessary by the Director.
                    ``(B) Coordinator's responsibilities.--The 
                Coordinator shall--
                            ``(i) direct the implementation of the plan 
                        among the agencies identified in the plan, 
                        State, local, and Tribal governments, and other 
                        relevant entities;
                            ``(ii) facilitate information-sharing 
                        between agencies identified in the plan, State, 
                        local, and Tribal governments, and other 
                        relevant entities; and
                            ``(iii) monitor implementation of the plan 
                        by coordinating the development and 
                        implementation of collection and reporting 
                        systems to support performance measurement and 
                        adherence to the plan by agencies identified in 
                        plan, where appropriate.
                    ``(C) Reporting.--Not later than 180 days after the 
                date on which a designation is made under subsection 
                (c) and in accordance with subparagraph (A), the head 
                of each agency identified in the plan shall submit to 
                the Coordinator a report on implementation of the plan.
    ``(e) Evaluation of Media Campaign.--Upon designation of an 
emerging drug threat, the Director shall evaluate whether a media 
campaign would be appropriate to address that threat.
    ``(f) National Anti-drug Media Campaign.--
            ``(1) In general.--The Director shall, to the extent 
        feasible and appropriate, conduct a national anti-drug media 
        campaign (referred to in this subtitle as the `national media 
        campaign') in accordance with this subsection for the purposes 
        of--
                    ``(A) preventing substance abuse among people in 
                the United States;
                    ``(B) educating the public about the dangers and 
                negative consequences of substance use and abuse, 
                including patient and family education about the 
                characteristics and hazards of substance abuse and 
                methods to safeguard against substance use, to include 
                the safe disposal of prescription medications;
                    ``(C) supporting evidence-based prevention programs 
                targeting the attitudes, perception, and beliefs of 
                persons concerning substance use and intentions to 
                initiate or continue such use;
                    ``(D) encouraging individuals affected by substance 
                use disorders to seek treatment and providing such 
                individuals with information on--
                            ``(i) how to recognize addiction issues;
                            ``(ii) what forms of evidence-based 
                        treatment options are available; and
                            ``(iii) how to access such treatment;
                    ``(E) combating the stigma of addiction and 
                substance use disorders, including the stigma of 
                treating such disorders with medication-assisted 
                treatment therapies; and
                    ``(F) informing the public about the dangers of any 
                drug identified by the Director as an emerging drug 
                threat as appropriate.
            ``(2) Use of funds.--
                    ``(A) In general.--Amounts made available to carry 
                out this subsection for the national media campaign may 
                only be used for the following:
                            ``(i) The purchase of media time and space, 
                        including the strategic planning for, tracking, 
                        and accounting of, such purchases.
                            ``(ii) Creative and talent costs, 
                        consistent with subparagraph (B)(i).
                            ``(iii) Advertising production costs, which 
                        may include television, radio, internet, social 
                        media, and other commercial marketing venues.
                            ``(iv) Testing and evaluation of 
                        advertising.
                            ``(v) Evaluation of the effectiveness of 
                        the national media campaign.
                            ``(vi) Costs of contracts to carry out 
                        activities authorized by this subsection.
                            ``(vii) Partnerships with professional and 
                        civic groups, community-based organizations, 
                        including faith-based organizations, and 
                        government organizations related to the 
                        national media campaign.
                            ``(viii) Entertainment industry outreach, 
                        interactive outreach, media projects and 
                        activities, public information, news media 
                        outreach, and corporate sponsorship and 
                        participation.
                            ``(ix) Operational and management expenses.
                    ``(B) Specific requirements.--
                            ``(i) Creative services.--In using amounts 
                        for creative and talent costs under 
                        subparagraph (A)(ii), the Director shall use 
                        creative services donated at no cost to the 
                        Government wherever feasible and may only 
                        procure creative services for advertising--
                                    ``(I) responding to high-priority 
                                or emergent campaign needs that cannot 
                                timely be obtained at no cost; or
                                    ``(II) intended to reach a 
                                minority, ethnic, or other special 
                                audience that cannot reasonably be 
                                obtained at no cost.
                            ``(ii) Testing and evaluation of 
                        advertising.--In using amounts for testing and 
                        evaluation of advertising under subparagraph 
                        (A)(iv), the Director shall test all 
                        advertisements prior to use in the national 
                        media campaign to ensure that the 
                        advertisements are effective with the target 
                        audience and meet industry-accepted standards. 
                        The Director may waive this requirement for 
                        advertisements using no more than 10 percent of 
                        the purchase of advertising time purchased 
                        under this subsection in a fiscal year and no 
                        more than 10 percent of the advertising space 
                        purchased under this subsection in a fiscal 
                        year, if the advertisements respond to emergent 
                        and time-sensitive campaign needs or the 
                        advertisements will not be widely utilized in 
                        the national media campaign.
                            ``(iii) Consultation.--For the planning of 
                        the campaign under paragraph (1), the Director 
                        may consult with--
                                    ``(I) the head of any appropriate 
                                National Drug Control Program Agency;
                                    ``(II) experts on the designated 
                                drug;
                                    ``(III) State, local, and Tribal 
                                government officials and relevant 
                                agencies;
                                    ``(IV) communications 
                                professionals;
                                    ``(V) the public; and
                                    ``(VI) appropriate congressional 
                                committees.
                            ``(iv) Evaluation of effectiveness of 
                        national media campaign.--In using amounts for 
                        the evaluation of the effectiveness of the 
                        national media campaign under subparagraph 
                        (A)(v), the Director shall--
                                    ``(I) designate an independent 
                                entity to evaluate by April 20 of each 
                                year the effectiveness of the national 
                                media campaign based on data from--
                                            ``(aa) the Monitoring the 
                                        Future Study published by the 
                                        Department of Health and Human 
                                        Services;
                                            ``(bb) the National Survey 
                                        on Drug Use and Health; and
                                            ``(cc) other relevant 
                                        studies or publications, as 
                                        determined by the Director, 
                                        including tracking and 
                                        evaluation data collected 
                                        according to marketing and 
                                        advertising industry standards; 
                                        and
                                    ``(II) ensure that the 
                                effectiveness of the national media 
                                campaign is evaluated in a manner that 
                                enables consideration of whether the 
                                national media campaign has contributed 
                                to changes in attitude or behaviors 
                                among the target audience with respect 
                                to substance use and such other 
                                measures of evaluation as the Director 
                                determines are appropriate.
            ``(3) Advertising.--In carrying out this subsection, the 
        Director shall ensure that sufficient funds are allocated to 
        meet the stated goals of the national media campaign.
            ``(4) Responsibilities and functions under the program.--
                    ``(A) In general.--The Director shall determine the 
                overall purposes and strategy of the national media 
                campaign.
                    ``(B) Director.--
                            ``(i) In general.--The Director shall 
                        approve--
                                    ``(I) the strategy of the national 
                                media campaign;
                                    ``(II) all advertising and 
                                promotional material used in the 
                                national media campaign; and
                                    ``(III) the plan for the purchase 
                                of advertising time and space for the 
                                national media campaign.
                            ``(ii) Implementation.--The Director shall 
                        be responsible for implementing a focused 
                        national media campaign to meet the purposes 
                        set forth in paragraph (1) and shall ensure--
                                    ``(I) information disseminated 
                                through the campaign is accurate and 
                                scientifically valid; and
                                    ``(II) the campaign is designed 
                                using strategies demonstrated to be the 
                                most effective at achieving the goals 
                                and requirements of paragraph (1), 
                                which may include--
                                            ``(aa) a media campaign, as 
                                        described in paragraph (2);
                                            ``(bb) local, regional, or 
                                        population specific messaging;
                                            ``(cc) the development of 
                                        websites to publicize and 
                                        disseminate information;
                                            ``(dd) conducting outreach 
                                        and providing educational 
                                        resources for parents;
                                            ``(ee) collaborating with 
                                        law enforcement agencies; and
                                            ``(ff) providing support 
                                        for school-based public health 
                                        education classes to improve 
                                        teen knowledge about the 
                                        effects of substance use.
            ``(5) Prohibitions.--None of the amounts made available 
        under paragraph (2) may be obligated or expended for any of the 
        following:
                    ``(A) To supplant current anti-drug community-based 
                coalitions.
                    ``(B) To supplant pro bono public service time 
                donated by national and local broadcasting networks for 
                other public service campaigns.
                    ``(C) For partisan political purposes, or to 
                express advocacy in support of or to defeat any clearly 
                identified candidate, clearly identified ballot 
                initiative, or clearly identified legislative or 
                regulatory proposal.
                    ``(D) To fund advertising that features any elected 
                officials, persons seeking elected office, cabinet 
                level officials, or other Federal officials employed 
                pursuant to section 213 of Schedule C of title 5, Code 
                of Federal Regulations.
                    ``(E) To fund advertising that does not contain a 
                primary message intended to reduce or prevent substance 
                use.
                    ``(F) To fund advertising containing a primary 
                message intended to promote support for the national 
                media campaign or private sector contributions to the 
                national media campaign.
            ``(6) Matching requirement.--
                    ``(A) In general.--Amounts made available under 
                paragraph (2) for media time and space shall be matched 
                by an equal amount of non-Federal funds for the 
                national media campaign, or be matched with in-kind 
                contributions of the same value.
                    ``(B) No-cost match advertising direct relationship 
                requirement.--The Director shall ensure that not less 
                than 85 percent of no-cost match advertising directly 
                relates to substance abuse prevention consistent with 
                the specific purposes of the national media campaign.
                    ``(C) No-cost match advertising not directly 
                related.--The Director shall ensure that no-cost match 
                advertising that does not directly relate to substance 
                abuse prevention consistent with the purposes of the 
                national media campaign includes a clear anti-drug 
                message. Such message is not required to be the primary 
                message of the match advertising.
            ``(7) Financial and performance accountability.--The 
        Director shall cause to be performed--
                    ``(A) audits and reviews of costs of the national 
                media campaign pursuant to section 4706 of title 41, 
                United States Code; and
                    ``(B) an audit to determine whether the costs of 
                the national media campaign are allowable under chapter 
                43 of title 41, United States Code.
            ``(8) Report to congress.--The Director shall submit on an 
        annual basis a report to Congress that describes--
                    ``(A) the strategy of the national media campaign 
                and whether specific objectives of the national media 
                campaign were accomplished;
                    ``(B) steps taken to ensure that the national media 
                campaign operates in an effective and efficient manner 
                consistent with the overall strategy and focus of the 
                national media campaign;
                    ``(C) plans to purchase advertising time and space;
                    ``(D) policies and practices implemented to ensure 
                that Federal funds are used responsibly to purchase 
                advertising time and space and eliminate the potential 
                for waste, fraud, and abuse;
                    ``(E) all contracts entered into with a 
                corporation, partnership, or individual working on 
                behalf of the national media campaign;
                    ``(F) the results of any financial audit of the 
                national media campaign;
                    ``(G) a description of any evidence used to develop 
                the national media campaign;
                    ``(H) specific policies and steps implemented to 
                ensure compliance with this section;
                    ``(I) a detailed accounting of the amount of funds 
                obligated during the previous fiscal year for carrying 
                out the national media campaign, including each 
                recipient of funds, the purpose of each expenditure, 
                the amount of each expenditure, any available outcome 
                information, and any other information necessary to 
                provide a complete accounting of the funds expended; 
                and
                    ``(J) a review and evaluation of the effectiveness 
                of the national media campaign strategy for the past 
                year.
            ``(9) Required notice for communication from the office.--
        Any communication, including an advertisement, paid for or 
        otherwise disseminated by the Office directly or through a 
        contract awarded by the Office shall include a prominent notice 
        informing the audience that the communication was paid for by 
        the Office.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to the Office to carry out this section, $25,000,000 for 
each of fiscal years 2018 through 2023.''.
    (b) Technical and Conforming Amendment.--Subsection (a) of section 
203 of the Office of National Drug Control Policy Reauthorization Act 
of 2006 (21 U.S.C. 1708a) is repealed.

SEC. 8219. DRUG INTERDICTION.

    (a) Repeal.--This first section 711 of the Office of National Drug 
Control Policy Reauthorization Act of 1998 (21 U.S.C. 1710) is 
repealed.
    (b) Amendments.--Section 711 of the Office of National Drug Control 
Policy Reauthorization Act of 1998 (21 U.S.C. 1710), as added by Public 
Law 109-469 (120 Stat. 3507), is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1)--
                            (i) by striking ``The United'' and 
                        inserting ``The Director shall designate or 
                        appoint an appointee in the Senior Executive 
                        Service or an appointee in a position at level 
                        15 of the General Schedule (or equivalent) as 
                        the United''; and
                            (ii) by striking ``shall'' and inserting 
                        ``to'';
                    (B) in paragraph (2)(B)--
                            (i) by striking ``March 1'' and inserting 
                        ``September 1''; and
                            (ii) by striking ``paragraph (3)'' and 
                        inserting ``paragraph (4)'';
                    (C) in paragraph (3)--
                            (i) by striking ``also, at his 
                        discretion,''; and
                            (ii) by striking ``the Office of Supply 
                        Reduction for that purpose'' and inserting 
                        ``assist in carrying out such 
                        responsibilities''; and
                    (D) in paragraph (4)--
                            (i) in subparagraph (B), by striking ``The 
                        United'' and inserting ``Before submission of 
                        the National Drug Control Strategy or annual 
                        assessment required under section 706, as 
                        applicable, the United'';
                            (ii) by striking subparagraphs (C) and (E);
                            (iii) by redesignating subparagraph (D) as 
                        subparagraph (C);
                            (iv) in subparagraph (C), as so 
                        redesignated--
                                    (I) in the matter preceding clause 
                                (i)--
                                            (aa) by striking ``March 
                                        1'' and inserting ``September 
                                        1'';
                                            (bb) by inserting ``the 
                                        Director, acting through'' 
                                        before ``the United States'';
                                            (cc) by inserting a comma 
                                        after ``Coordinator'';
                                            (dd) by striking ``a report 
                                        on behalf of the Director''; 
                                        and
                                            (ee) by striking ``, which 
                                        shall include'' and inserting 
                                        ``a report that'';
                                    (II) by redesignating clauses (i), 
                                (ii), and (iii) as subclauses (I), 
                                (II), and (III), and adjusting the 
                                margins accordingly;
                                    (III) by inserting before subclause 
                                (I), as so redesignated, the following:
                            ``(i) includes--'';
                                    (IV) in clause (i), as so 
                                redesignated--
                                            (aa) in subclause (I), as 
                                        so redesignated, by inserting 
                                        ``, including information about 
                                        how each National Drug Control 
                                        Program agency conducting drug 
                                        interdiction activities is 
                                        engaging with relevant 
                                        international partners'' after 
                                        ``Plan'';
                                            (bb) in subclause (II), as 
                                        so redesignated, by striking 
                                        ``, as well as'' and inserting 
                                        ``and'';
                                            (cc) in subclause III, as 
                                        so redesignated--

                                                    (AA) by striking 
                                                ``, as well as'' and 
                                                inserting ``and''; and

                                                    (BB) by striking 
                                                the period at the end 
                                                and inserting ``; 
                                                and''; and

                                    (V) by adding at the end the 
                                following:
                            ``(ii) may include recommendations for 
                        changes to existing agency authorities or laws 
                        governing interagency relationships.''; and
                            (v) by adding at the end the following:
                    ``(D) Classified annex.--Each report required to be 
                submitted under subparagraph (C) shall be in 
                unclassified form, but may include a classified 
                annex.'';
            (2) in subsection (b)--
                    (A) in paragraph (1)(B), by inserting ``and how to 
                strengthen international partnerships to better achieve 
                the goals of that plan'' after ``that plan'';
                    (B) in paragraph (2)--
                            (i) in the paragraph heading, by striking 
                        ``Chairman'' and inserting ``Chairperson''; and
                            (ii) by striking ``chairman'' and inserting 
                        ``Chairperson'';
                    (C) in paragraph (3)--
                            (i) by striking ``prior to March 1'' and 
                        inserting ``before June 1'';
                            (ii) by striking ``either'' each place it 
                        appears;
                            (iii) by striking ``current chairman'' and 
                        inserting ``Chairperson''; and
                            (iv) by striking ``they'' and inserting 
                        ``the members''; and
                    (D) in paragraph (4)--
                            (i) by striking ``chairman'' each place it 
                        appears and inserting ``Chairperson'';
                            (ii) in the first sentence, by striking ``a 
                        report'';
                            (iii) by inserting ``a report'' after 
                        ``committees''; and
                            (iv) by striking the second sentence and 
                        inserting the following: ``The report required 
                        under this paragraph shall be in unclassified 
                        form, but may include a classified annex.''; 
                        and
            (3) by adding at the end the following:
    ``(c) International Coordination.--The Director may facilitate 
international drug control coordination efforts.''.

SEC. 8220. GAO AUDIT.

    Not later than 4 years after the date of enactment of this Act, and 
every 4 years thereafter, the Comptroller General of the United States 
shall--
            (1) conduct an audit relating to the programs and 
        operations of--
                    (A) the Office; and
                    (B) certain programs within the Office, including--
                            (i) the High Intensity Drug Trafficking 
                        Areas Program;
                            (ii) the Drug-Free Communities Program; and
                            (iii) the campaign under section 709(f) of 
                        the Office of National Drug Control Policy 
                        Reauthorization Act of 1998 (21 U.S.C. 
                        1708(f)); and
            (2) submit to the Director and the appropriate 
        congressional committees a report containing an evaluation of 
        and recommendations on the--
                    (A) policies and activities of the programs and 
                operations subject to the audit;
                    (B) economy, efficiency, and effectiveness in the 
                administration of the reviewed programs and operations; 
                and
                    (C) policy or management changes needed to prevent 
                and detect fraud and abuse in such programs and 
                operations.

SEC. 8221. NATIONAL DRUG CONTROL STRATEGY.

    (a) In General.--Section 706 of the Office of National Drug Control 
Policy Reauthorization Act of 1998 (21 U.S.C. 1705) is amended to read 
as follows:

``SEC. 706. NATIONAL DRUG CONTROL STRATEGY.

    ``(a) In General.--
            ``(1) Statement of drug policy priorities.--The Director 
        shall release a statement of drug control policy priorities in 
        the calendar year of a Presidential inauguration following the 
        inauguration, but not later than April 1.
            ``(2) National drug control strategy submitted by the 
        president.--Not later than the first Monday in February 
        following the year in which the term of the President 
        commences, and every 2 years thereafter, the President shall 
        submit to Congress a National Drug Control Strategy.
    ``(b) Development of the National Drug Control Strategy.--
            ``(1) Promulgation.--The Director shall promulgate the 
        National Drug Control Strategy, which shall set forth a 
        comprehensive plan to reduce illicit drug use and the 
        consequences of such illicit drug use in the United States by 
        limiting the availability of and reducing the demand for 
        illegal drugs and promoting prevention, early intervention, 
        treatment, and recovery support for individuals with substance 
        use disorders.
            ``(2) State and local commitment.--The Director shall seek 
        the support and commitment of State, local, and Tribal 
        officials in the formulation and implementation of the National 
        Drug Control Strategy.
            ``(3) Strategy based on evidence.--The Director shall 
        ensure the National Drug Control Strategy is based on the best 
        available evidence regarding the policies that are most 
        effective in reducing the demand for and supply of illegal 
        drugs.
            ``(4) Process for development and submission of national 
        drug control strategy.--In developing and effectively 
        implementing the National Drug Control Strategy, the Director--
                    ``(A) shall consult with--
                            ``(i) the heads of the National Drug 
                        Control Program Agencies;
                            ``(ii) each Coordinator listed in section 
                        704;
                            ``(iii) the Interdiction Committee and the 
                        Emerging Threats Committee;
                            ``(iv) the appropriate congressional 
                        committees and any other committee of 
                        jurisdiction;
                            ``(v) State, local, and Tribal officials;
                            ``(vi) private citizens and organizations, 
                        including community and faith-based 
                        organizations, with experience and expertise in 
                        demand reduction;
                            ``(vii) private citizens and organizations 
                        with experience and expertise in supply 
                        reduction; and
                            ``(viii) appropriate representatives of 
                        foreign governments; and
                    ``(B) in satisfying the requirements of 
                subparagraph (A), shall ensure, to the maximum extent 
                possible, that State, local, and Tribal officials and 
                relevant private organizations commit to support and 
                take steps to achieve the goals and objectives of the 
                National Drug Control Strategy.
    ``(c) Contents of the National Drug Control Strategy.--
            ``(1) In general.--The National Drug Control Strategy 
        submitted under subsection (a)(2) shall include the following:
                    ``(A) A mission statement detailing the major 
                functions of the National Drug Control Program.
                    ``(B) Comprehensive, research-based, long-range, 
                quantifiable goals for reducing illicit drug use, and 
                the consequences of illicit drug use in the United 
                States.
                    ``(C) Annual quantifiable and measurable objectives 
                and specific targets to accomplish long-term 
                quantifiable goals that the Director determines may be 
                achieved during each year beginning on the date on 
                which the National Drug Control Strategy is submitted.
                    ``(D) A 5-year projection for the National Drug 
                Control Program and budget priorities.
                    ``(E) A review of international, State, local, and 
                private sector drug control activities to ensure that 
                the United States pursues coordinated and effective 
                drug control at all levels of government.
                    ``(F) A description of how each goal established 
                under subparagraph (B) will be achieved, including for 
                each goal--
                            ``(i) a list of each relevant National Drug 
                        Control Program Agency and each such agency's 
                        related programs, activities, and available 
                        assets and the role of each such program, 
                        activity, and asset in achieving such goal;
                            ``(ii) a list of relevant stakeholders and 
                        each such stakeholder's role in achieving such 
                        goal;
                            ``(iii) an estimate of Federal funding and 
                        other resources needed to achieve such goal;
                            ``(iv) a list of each existing or new 
                        coordinating mechanism needed to achieve such 
                        goal; and
                            ``(v) a description of the Office's role in 
                        facilitating the achievement of such goal.
                    ``(G) For each year covered by the Strategy, a 
                performance evaluation plan for each goal established 
                under subparagraph (B) for each National Drug Control 
                Program Agency, including--
                            ``(i) specific performance measures for 
                        each National Drug Control Program Agency;
                            ``(ii) annual and, to the extent 
                        practicable, quarterly objectives and targets 
                        for each performance measure; and
                            ``(iii) an estimate of Federal funding and 
                        other resources needed to achieve each 
                        performance objective and target.
                    ``(H) A list identifying existing data sources or a 
                description of data collection needed to evaluate 
                performance, including a description of how the 
                Director will obtain such data.
                    ``(I) A list of any anticipated challenges to 
                achieving the National Drug Control Strategy goals and 
                planned actions to address such challenges.
                    ``(J) A description of how each goal established 
                under subparagraph (B) was determined, including--
                            ``(i) a description of each required 
                        consultation and a description of how such 
                        consultation was incorporated; and
                            ``(ii) data, research, or other information 
                        used to inform the determination to establish 
                        the goal.
                    ``(K) A description of the current prevalence of 
                illicit drug use in the United States, including both 
                the availability of illicit drugs and the prevalence of 
                substance use disorders.
                    ``(L) Such other statistical data and information 
                as the Director considers appropriate to demonstrate 
                and assess trends relating to illicit drug use, the 
                effects and consequences of illicit drug use (including 
                the effects on children), supply reduction, demand 
                reduction, drug-related law enforcement, and the 
                implementation of the National Drug Control Strategy.
                    ``(M) A systematic plan for increasing data 
                collection to enable real time surveillance of drug 
                control threats, developing analysis and monitoring 
                capabilities, and identifying and addressing policy 
                questions related to the National Drug Control Strategy 
                and Program, which shall include--
                            ``(i) a list of policy-relevant questions 
                        for which the Director and each National Drug 
                        Control Program Agency intends to develop 
                        evidence to support the National Drug Control 
                        Program and Strategy;
                            ``(ii) a list of data the Director and each 
                        National Drug Control Program Agency intends to 
                        collect, use, or acquire to facilitate the use 
                        of evidence in drug control policymaking and 
                        monitoring;
                            ``(iii) a list of methods and analytical 
                        approaches that may be used to develop evidence 
                        to support the National Drug Control Program 
                        and Strategy and related policy;
                            ``(iv) a list of any challenges to 
                        developing evidence to support policymaking, 
                        including any barriers to accessing, 
                        collecting, or using relevant data;
                            ``(v) a description of the steps the 
                        Director and the head of each National Drug 
                        Control Program Agency will take to effectuate 
                        the plan; and
                            ``(vi) any other relevant information as 
                        determined by the Director.
                    ``(N) A plan to expand treatment of substance use 
                disorders, which shall--
                            ``(i) identify unmet needs for treatment 
                        for substance use disorders and a strategy for 
                        closing the gap between available and needed 
                        treatment;
                            ``(ii) describe the specific roles and 
                        responsibilities of the relevant National Drug 
                        Control Programs for implementing the plan;
                            ``(iii) identify the specific resources 
                        required to enable the relevant National Drug 
                        Control Agencies to implement that strategy; 
                        and
                            ``(iv) identify the resources, including 
                        private sources, required to eliminate the 
                        unmet need for evidence-based substance use 
                        disorder treatment.
            ``(2) Consultation.--In developing the plan required under 
        paragraph (1), the Director shall consult with the following:
                    ``(A) The public.
                    ``(B) Any evaluation or analysis units and 
                personnel of the Office.
                    ``(C) Office officials responsible for implementing 
                privacy policy.
                    ``(D) Office officials responsible for data 
                governance.
                    ``(E) The appropriate congressional committees.
                    ``(F) Any other individual or entity as determined 
                by the Director.
            ``(3) Additional strategies.--
                    ``(A) In general.--The Director shall include in 
                the National Drug Control Strategy the additional 
                strategies described under this paragraph and shall 
                comply with the following:
                            ``(i) Provide a copy of the additional 
                        strategies to the appropriate congressional 
                        committees and to the Committee on Armed 
                        Services and the Committee on Homeland Security 
                        of the House of Representatives, and the 
                        Committee on Homeland Security and Governmental 
                        Affairs and the Committee on Armed Services of 
                        the Senate.
                            ``(ii) Issue the additional strategies in 
                        consultation with the head of each relevant 
                        National Drug Control Program Agency, any 
                        relevant official of a State, local, or Tribal 
                        government, and the government of other 
                        relevant countries.
                            ``(iii) Not change any existing agency 
                        authority or construe any strategy described 
                        under this paragraph to amend or modify any law 
                        governing interagency relationship but may 
                        include recommendations about changes to such 
                        authority or law.
                            ``(iv) Present separately from the rest of 
                        any strategy described under this paragraph any 
                        information classified under criteria 
                        established by an Executive order, or whose 
                        public disclosure, as determined by the 
                        Director or the head of any relevant National 
                        Drug Control Program Agency, would be 
                        detrimental to the law enforcement or national 
                        security activities of any Federal, State, 
                        local, or Tribal agency.
                    ``(B) Requirement for southwest border 
                counternarcotics strategy.--
                            ``(i) Purposes.--The Southwest Border 
                        Counternarcotics Strategy shall--
                                    ``(I) set forth the Government's 
                                strategy for preventing the illegal 
                                trafficking of drugs across the 
                                international border between the United 
                                States and Mexico, including through 
                                ports of entry and between ports of 
                                entry on that border;
                                    ``(II) state the specific roles and 
                                responsibilities of the relevant 
                                National Drug Control Program Agencies 
                                for implementing that strategy; and
                                    ``(III) identify the specific 
                                resources required to enable the 
                                relevant National Drug Control Program 
                                Agencies to implement that strategy.
                            ``(ii) Specific content related to drug 
                        tunnels between the united states and mexico.--
                        The Southwest Border Counternarcotics Strategy 
                        shall include--
                                    ``(I) a strategy to end the 
                                construction and use of tunnels and 
                                subterranean passages that cross the 
                                international border between the United 
                                States and Mexico for the purpose of 
                                illegal trafficking of drugs across 
                                such border; and
                                    ``(II) recommendations for criminal 
                                penalties for persons who construct or 
                                use such a tunnel or subterranean 
                                passage for such a purpose.
                    ``(C) Requirement for northern border 
                counternarcotics strategy.--
                            ``(i) Purposes.--The Northern Border 
                        Counternarcotics Strategy shall--
                                    ``(I) set forth the strategy of the 
                                Federal Government for preventing the 
                                illegal trafficking of drugs across the 
                                international border between the United 
                                States and Canada, including through 
                                ports of entry and between ports of 
                                entry on the border;
                                    ``(II) state the specific roles and 
                                responsibilities of each relevant 
                                National Drug Control Program Agency 
                                for implementing the strategy;
                                    ``(III) identify the specific 
                                resources required to enable the 
                                relevant National Drug Control Program 
                                Agencies to implement the strategy;
                                    ``(IV) be designed to promote, and 
                                not hinder, legitimate trade and 
                                travel; and
                                    ``(V) reflect the unique nature of 
                                small communities along the 
                                international border between the United 
                                States and Canada, ongoing cooperation 
                                and coordination with Canadian law, 
                                enforcement authorities, and variations 
                                in the volumes of vehicles and 
                                pedestrians crossing through ports of 
                                entry along the international border 
                                between the United States and Canada.
                            ``(ii) Specific content related to cross-
                        border indian reservations.--The Northern 
                        Border Counternarcotics Strategy shall 
                        include--
                                    ``(I) a strategy to end the illegal 
                                trafficking of drugs to or through 
                                Indian reservations on or near the 
                                international border between the United 
                                States and Canada; and
                                    ``(II) recommendations for 
                                additional assistance, if any, needed 
                                by Tribal law enforcement agencies 
                                relating to the strategy, including an 
                                evaluation of Federal technical and 
                                financial assistance, infrastructure 
                                capacity building, and interoperability 
                                deficiencies.
            ``(4) Classified information.--Any contents of the National 
        Drug Control Strategy that involve information properly 
        classified under criteria established by an Executive order 
        shall be presented to Congress separately from the rest of the 
        National Drug Control Strategy.
            ``(5) Selection of data and information.--In selecting data 
        and information for inclusion in the Strategy, the Director 
        shall ensure--
                    ``(A) the inclusion of data and information that 
                will permit analysis of current trends against 
                previously compiled data and information where the 
                Director believes such analysis enhances long-term 
                assessment of the National Drug Control Strategy; and
                    ``(B) the inclusion of data and information to 
                permit a standardized and uniform assessment of the 
                effectiveness of drug treatment programs in the United 
                States.
    ``(d) Submission of Revised Strategy.--The President may submit to 
Congress a revised National Drug Control Strategy that meets the 
requirements of this section--
            ``(1) at any time, upon a determination of the President, 
        in consultation with the Director, that the National Drug 
        Control Strategy in effect is not sufficiently effective; or
            ``(2) if a new President or Director takes office.
    ``(e) Failure of Director to Submit National Drug Control 
Strategy.--If the Director does not submit a National Drug Control 
Strategy to Congress in accordance with subsection (a)(2), not later 
than five days after the first Monday in February following the year in 
which the term of the President commences, the Director shall send a 
notification to the appropriate congressional committees--
            ``(1) explaining why the Strategy was not submitted; and
            ``(2) specifying the date by which the Strategy will be 
        submitted.
    ``(f) Drug Control Data Dashboard.--
            ``(1) In general.--The Director shall collect and 
        disseminate, as appropriate, such information as the Director 
        determines is appropriate, but not less than the information 
        described in this subsection. The data shall be publicly 
        available in a machine-readable format on the online portal of 
        the Office, and to the extent practicable on the Drug Control 
        Data Dashboard.
            ``(2) Establishment.--The Director shall publish to the 
        online portal of the office in a machine-readable, sortable, 
        and searchable format, or to the extent practicable, establish 
        and maintain a data dashboard on the online portal of the 
        Office to be known as the `Drug Control Data Dashboard'. To the 
        extent practicable, when establishing the Drug Control 
        Dashboard, the Director shall ensure the user interface of the 
        dashboard is constructed with modern design standards. To the 
        extent practicable, the data made available on the dashboard 
        shall be publicly available in a machine-readable format and 
        searchable by year, agency, drug, and location.
            ``(3) Data.--The data included in the Drug Control Data 
        Dashboard shall be updated quarterly to the extent practicable, 
        but not less frequently than annually and shall include, at a 
        minimum, the following:
                    ``(A) For each substance identified by the Director 
                as having a significant impact on the prevalence of 
                illicit drug use--
                            ``(i) data sufficient to show the 
                        quantities of such substance available in the 
                        United States, including--
                                    ``(I) the total amount seized and 
                                disrupted in the calendar year and each 
                                of the previous 3 calendar years, 
                                including to the extent practicable the 
                                amount seized by State, local, and 
                                Tribal governments;
                                    ``(II) the known and estimated 
                                flows into the United States from all 
                                sources in the calendar year and each 
                                of the previous 3 calendar years;
                                    ``(III) the total amount of known 
                                flows that could not be interdicted or 
                                disrupted in the calendar year and each 
                                of the previous 3 calendar years;
                                    ``(IV) the known and estimated 
                                levels of domestic production in the 
                                calendar year and each of the previous 
                                three calendar years, including the 
                                levels of domestic production if the 
                                drug is a prescription drug, as 
                                determined under the Federal Food, 
                                Drug, and Cosmetic Act, for which a 
                                listing is in effect under section 202 
                                of the Controlled Substances Act (21 
                                U.S.C. 812);
                                    ``(V) the average street price for 
                                the calendar year and the highest known 
                                street price during the preceding 10-
                                year period; and
                                    ``(VI) to the extent practicable, 
                                related prosecutions by State, local, 
                                and Tribal governments;
                            ``(ii) data sufficient to show the 
                        frequency of use of such substance, including--
                                    ``(I) use of such substance in the 
                                workplace and productivity lost by such 
                                use;
                                    ``(II) use of such substance by 
                                arrestees, probationers, and parolees;
                                    ``(III) crime and criminal activity 
                                related to such substance;
                                    ``(IV) to the extent practicable, 
                                related prosecutions by State, local, 
                                and Tribal governments;
                    ``(B) For the calendar year and each of the 
                previous three years data sufficient to show, 
                disaggregated by State and, to the extent feasible, by 
                region within a State, county, or city, the following:
                            ``(i) The number of fatal and non-fatal 
                        overdoses caused by each drug identified under 
                        subparagraph (A)(i).
                            ``(ii) The prevalence of substance use 
                        disorders.
                            ``(iii) The number of individuals who have 
                        received substance use disorder treatment, 
                        including medication assisted treatment, for a 
                        substance use disorder, including treatment 
                        provided through publicly-financed health care 
                        programs.
                            ``(iv) The extent of the unmet need for 
                        substance use disorder treatment, including the 
                        unmet need for medication-assisted treatment.
                    ``(C) Data sufficient to show the extent of 
                prescription drug diversion, trafficking, and misuse in 
                the calendar year and each of the previous 3 calendar 
                years.
                    ``(D) Any quantifiable measures the Director 
                determines to be appropriate to detail progress toward 
                the achievement of the goals of the National Drug 
                Control Strategy.
    ``(g) Development of an Annual National Drug Control Assessment.--
            ``(1) Timing.--Not later than the first Monday in February 
        of each year, the Director shall submit to the President, 
        Congress, and the appropriate congressional committees, a 
        report assessing the progress of each National Drug Control 
        Program Agency toward achieving each goal, objective, and 
        target contained in the National Drug Control Strategy 
        applicable to the prior fiscal year.
            ``(2) Process for development of the annual assessment.--
        Not later than November 1 of each year, the head of each 
        National Drug Control Program Agency shall submit, in 
        accordance with guidance issued by the Director, to the 
        Director an evaluation of progress by the agency with respect 
        to the National Drug Control Strategy goals using the 
        performance measures for the agency developed under this title, 
        including progress with respect to--
                    ``(A) success in achieving the goals of the 
                National Drug Control Strategy;
                    ``(B) success in reducing domestic and foreign 
                sources of illegal drugs;
                    ``(C) success in expanding access to and increasing 
                the effectiveness of substance use disorder treatment;
                    ``(D) success in protecting the borders of the 
                United States (and in particular the Southwestern 
                border of the United States) from penetration by 
                illegal narcotics;
                    ``(E) success in reducing crime associated with 
                drug use in the United States;
                    ``(F) success in reducing the negative health and 
                social consequences of drug use in the United States;
                    ``(G) implementation of evidence-based substance 
                use disorder treatment and prevention programs in the 
                United States and improvements in the adequacy and 
                effectiveness of such programs; and
                    ``(H) success in increasing the prevention of 
                illicit drug use.
            ``(3) Contents of the annual assessment.--The Director 
        shall include in the annual assessment required under paragraph 
        (1)--
                    ``(A) a summary of each evaluation received by the 
                Director under paragraph (2);
                    ``(B) a summary of the progress of each National 
                Drug Control Program Agency toward the National Drug 
                Control Strategy goals of the agency using the 
                performance measures for the agency developed under 
                this chapter;
                    ``(C) an assessment of the effectiveness of each 
                National Drug Control Program Agency and program in 
                achieving the National Drug Control Strategy for the 
                previous year, including a specific evaluation of 
                whether the applicable goals, measures, objectives, and 
                targets for the previous year were met; and
                    ``(D) the assessments required under this 
                subsection shall be based on the Performance 
                Measurement System.''.
    (b) Technical and Conforming Amendments.--
            (1) Section 704(b) of the Office of National Drug Control 
        Policy Reauthorization Act of 1998 (21 U.S.C. 1703(b)) is 
        amended--
                    (A) by striking paragraphs (13) and (17); and
                    (B) in paragraph (14)(A), by striking ``paragraph 
                (13)'' and inserting ``section 706(g)(2)''.
            (2) The Office of National Drug Control Policy 
        Reauthorization Act of 2006 (Public Law 109-469; 120 Stat. 
        3502) is amended by striking sections 1110 and 1110A.

SEC. 8222. TECHNICAL AND CONFORMING AMENDMENTS TO THE OFFICE OF 
              NATIONAL DRUG CONTROL POLICY REAUTHORIZATION ACT OF 1998.

    The Office of National Drug Control Policy Reauthorization Act of 
1998 (21 U.S.C. 1701 et seq.) is amended--
            (1) by striking section 703(b) (21 U.S.C. 1702(b));
            (2) in section 704 (21 U.S.C. 1703)--
                    (A) in subsection (c)--
                            (i) in paragraph (3)(C)--
                                    (I) in the matter before clause 
                                (i), by inserting ``requests a level of 
                                funding that will not enable 
                                achievement of the goals of the 
                                National Drug Control Strategy, 
                                including'' after ``request that'';
                                    (II) in clause (iii)--
                                            (aa) by striking ``drug 
                                        treatment'' and inserting 
                                        ``substance use disorder 
                                        prevention and treatment''; and
                                            (bb) by striking the 
                                        semicolon at the end and 
                                        inserting ``; and'';
                                    (III) by striking clauses (iv), 
                                (vi), and (vii);
                                    (IV) by redesignating clause (v) as 
                                clause (iv); and
                                    (V) in clause (iv), as so 
                                redesignated, by striking the semicolon 
                                and inserting a period;
                            (ii) in paragraph (4)(A), by striking 
                        ``$1,000,000'' and inserting ``$5,000,000 or 10 
                        percent of a specific program or account''; and
                    (B) in subsection (f)--
                            (i) by striking the first paragraph (5); 
                        and
                            (ii) by striking the second paragraph (4); 
                        and
            (3) by striking section 708 (21 U.S.C. 1707).

                     Subtitle L--Budgetary Effects

SEC. 8231. BUDGETARY EFFECT.

    (a) In General.--The budgetary effects of this Act shall not be 
entered on either PAYGO scorecard maintained pursuant to section 4(d) 
of the Statutory Pay-As-You-Go Act of 2010 (2 U.S.C. 933(d)).
    (b) Senate PAYGO Scorecards.--The budgetary effects of this Act 
shall not be entered on any PAYGO scorecard maintained for purposes of 
section 4106 of H. Con. Res. 71 (115th Congress).

            Attest:

                                                                 Clerk.
115th CONGRESS

  2d Session

                                 H.R. 6

_______________________________________________________________________

                  HOUSE AMENDMENT TO SENATE AMENDMENT