    [Congressional Bills 115th Congress]
    [From the U.S. Government Publishing Office]
    [H.R. 6 Enrolled Bill (ENR)]

            H.R.6

                         One Hundred Fifteenth Congress

                                     of the

                            United States of America

                              AT THE SECOND SESSION

             Begun and held at the City of Washington on Wednesday,
               the third day of January, two thousand and eighteen

                                     An Act

    To provide for opioid use disorder prevention, recovery, and treatment,
                             and for other purposes.

        Be it enacted by the Senate and House of Representatives of the
    United States of America in Congress assembled,
    SECTION 1. SHORT TITLE; 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).

                                   Speaker of the House of Representatives.

                                Vice President of the United States and
                                                   President of the Senate.