[Congressional Record Volume 162, Number 34 (Wednesday, March 2, 2016)]
[Senate]
[Page S1233]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

  SA 3395. Mr. WYDEN (for himself, Mr. Schumer, and Mrs. Murray) 
submitted an amendment intended to be proposed to amendment SA 3378 
proposed by Mr. Grassley (for himself, Mr. Leahy, Mr. Whitehouse, Mr. 
Portman, Ms. Klobuchar, Ms. Ayotte, Mr. Graham, Mr. Coons, Mr. Cornyn, 
and Mr. Durbin) to the bill S. 524, to authorize the Attorney General 
to award grants to address the national epidemics of prescription 
opioid abuse and heroin use; as follows:

       At the appropriate place, insert the following:

     SEC. __. INCREASED ANTI-KICKBACKS PENALTIES.

       Paragraphs (1) and (2) of section 1128B(b) of the Social 
     Security Act (42 U.S.C. 1320a-7b(b)) are each amended by 
     inserting ``(or, beginning January 1, 2017, $50,000)'' after 
     ``$25,000''.

     SEC. __. CENTER FOR MEDICARE AND MEDICAID INNOVATION TESTING 
                   OF OPIOID ABUSE TREATMENT PROGRAM MODEL FOR 
                   PART D PRESCRIPTION DRUG PLAN ENROLLEES.

       Section 1115A of the Social Security Act (42 U.S.C. 1315a) 
     is amended--
       (1) in subsection (b)(2)(A), by adding at the end the 
     following new sentence: ``The models selected under this 
     subparagraph shall include the model described in subsection 
     (h).''; and
       (2) by adding at the end the following new subsection:
       ``(h) Opioid Abuse Treatment Program Model.--
       ``(1) In general.--The Secretary shall test a model 
     requiring prescription drug plans under part D of title XVIII 
     to have in place, directly or through appropriate 
     arrangements, an opioid abuse treatment program for 
     applicable enrollees in lieu of the medication therapy 
     management program under section 1860D-4(c)(2) with respect 
     to such applicable enrollees.
       ``(2) Start date.--The model under this subsection shall 
     start in plan year 2018.
       ``(3) Selection.--The Secretary shall select a limited 
     number of Medicare part D regions in which to the model, 
     giving priority to regions based on the number of total 
     opioid prescriptions in the region.
       ``(4) Requirements for program.--Under an opioid abuse 
     treatment program, the PDP sponsor offering the plan shall--
       ``(A) establish a care team that includes at least--
       ``(i) a pharmacist;
       ``(ii) a physician; and
       ``(iii) an individual licenced in a State with expertise in 
     behavioral health (as determined by the Secretary), which may 
     be the physician described in clause (ii); and
       ``(B) develop, in consultation with the applicable enrollee 
     and with input from the prescriber to the extent necessary 
     and practicable, a care plan for the applicable enrollee that 
     is intended to treat the applicable enrollee's pain and limit 
     any unnecessary opioid prescriptions when possible.
       ``(5) Payment.--
       ``(A) In general.--Under the model under this subsection, 
     the Secretary shall make a monthly payment to the PDP sponsor 
     offering the prescription drug plan for each applicable 
     enrollee who receives services under the opioid abuse 
     treatment program.
       ``(B) Shared savings.--Under the model under this 
     subsection, the Secretary shall (using a methodology 
     determined appropriate by the Secretary) make payments (in 
     addition to the payments under subparagraph (A)) to the PDP 
     sponsor offering the prescription drug plan if the Secretary 
     determines that total spending under parts A, B, and D of 
     title XVIII (and including the payments under subparagraph 
     (A)) for applicable enrollees who receive services under the 
     opioid abuse treatment program is less than a historical 
     benchmark of total spending under such parts A, B, and D for 
     such enrollees or similar enrollees. Such benchmark shall be 
     adjusted at the Secretary's discretion for changes in law or 
     regulation, unforeseen circumstances, or advances in medical 
     practice.
       ``(6) Quality.--Under the model under this subsection, the 
     Secretary shall measure the quality of care furnished by 
     opioid abuse treatment programs, including elements related 
     to access to care, the unnecessary use of opioids, pain 
     management, and the delivery of behavioral health services.
       ``(7) Applicable enrollee.--In this subsection, the term 
     `applicable enrollee' means an individual who is, with 
     respect to a prescription drug plan--
       ``(A) enrolled with the plan; and
       ``(B) an at-risk beneficiary for prescription drug abuse 
     (as defined in section 1860D-4(c)(5)(C)).
       ``(8) Model not applicable to ma-pd plans.--The model under 
     this subsection shall not apply to MA-PD plans or enrollees 
     of such plans.
       ``(9) Clarification of application.--For purposes of the 
     preceding provisions of this section (including paragraphs 
     (3) and (4) of subsection (b) and subsections (d) and (f)), 
     the model under this subsection shall be deemed to be a model 
     under subsection (b).''.
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