[Congressional Record Volume 164, Number 102 (Tuesday, June 19, 2018)]
[House]
[Pages H5245-H5247]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 MEDICAID PROVIDERS ARE REQUIRED TO NOTE EXPERIENCES IN RECORD SYSTEMS 
                      TO HELP IN-NEED PATIENTS ACT

  Mr. GUTHRIE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 5801) to amend title XIX of the Social Security Act to 
provide for requirements under the Medicaid program relating to the use 
of qualified prescription drug monitoring programs and prescribing 
certain controlled substances, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 5801

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

     SECTION 1. SHORT TITLE.

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

     SEC. 2. 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.--Beginning October 1, 2021, a State 
     shall, subject to subsection (d),

[[Page H5246]]

     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.
       ``(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 has a contract to manage the 
     pharmaceutical benefit with respect to individuals enrolled 
     in the State plan (or 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 drug management 
     program before dispensing a controlled substance to such 
     individual.
       ``(2) Report by cms.--Not later than October 1, 2023, the 
     Administrator of the Centers for Medicare & Medicaid Services 
     shall publish on the publicly available website of the 
     Centers for Medicare & Medicaid Services a report including 
     the following information:
       ``(A) Guidance for States on how States can increase the 
     percentage of covered providers who use qualified 
     prescription drug monitoring programs described in subsection 
     (b).
       ``(B) Best practices for how States and covered providers 
     should use such qualified prescription drug monitoring 
     programs to reduce the occurrence of abuse of controlled 
     substances.
       ``(f) Increase to Federal Matching Rate for Certain 
     Expenditures Relating to Qualified Prescription Drug 
     Management Programs.--The Secretary shall increase the 
     Federal medical assistance percentage or Federal matching 
     rate that would otherwise apply to a State under section 
     1903(a) for a calendar quarter occurring during the period 
     beginning October 1, 2018, and ending September 30, 2021, for 
     expenditures by the State for activities under the State plan 
     (or waiver of the State plan) to implement a prescription 
     drug management program that satisfies the criteria described 
     in paragraphs (1) and (2) of subsection (b) if the State (in 
     this subsection referred to as the `administering State') has 
     in place agreements with all States that are contiguous to 
     such administering State that, when combined, enable covered 
     providers in all such contiguous States to access, through 
     the prescription drug management program, the information 
     that is described in subsection (b)(1) of covered individuals 
     of such administering State and that covered providers in 
     such administering State are able to access through such 
     program. In no case shall an increase under this subsection 
     result in a Federal medical assistance percentage or Federal 
     matching rate that exceeds 100 percent.
       ``(g) Rule of Construction.--Nothing in this section 
     prevents a State from requiring pharmacists to check the 
     prescription drug history of covered individuals through a 
     qualified drug management program before dispensing 
     controlled substances to such individuals.
       ``(h) Definitions.--In this section:
       ``(1) Controlled substance.--The term `controlled 
     substance' means a drug that is included in schedule II of 
     section 202(c) of the Controlled Substances Act and, at the 
     option of the State involved, a drug included in schedule III 
     or IV of such section.
       ``(2) Covered individual.--The term `covered individual' 
     means, with respect to a State, an individual who is enrolled 
     in the State plan (or under a waiver of such plan). Such term 
     does not include an individual who--
       ``(A) is receiving--
       ``(i) hospice or palliative care; or
       ``(ii) treatment for cancer;
       ``(B) is a resident of a long-term care facility, of a 
     facility described in section 1905(d), or of another facility 
     for which frequently abused drugs are dispensed for residents 
     through a contract with a single pharmacy; or
       ``(C) the State elects to treat as exempted from such term.
       ``(3) Covered provider.--
       ``(A) In general.--The term `covered provider' means, 
     subject to subparagraph (B), with respect to a State, a 
     health care provider who is participating under the State 
     plan (or waiver of the State plan) and licensed, registered, 
     or otherwise permitted by the State to prescribe a controlled 
     substance (or the designee of such provider).
       ``(B) Exceptions.--
       ``(i) In general.--Beginning October 1, 2021, for purposes 
     of this section, such term does not include a health care 
     provider included in any type of health care provider 
     determined by the Secretary to be exempt from application of 
     this section under clause (ii).
       ``(ii) Exceptions process.--Not later than October 1, 2020, 
     the Secretary, after consultation with the National 
     Association of Medicaid Directors, national health care 
     provider associations, Medicaid beneficiary advocates, and 
     advocates for individuals with rare diseases, shall 
     determine, based on such consultations, the types of health 
     care providers (if any) that should be exempted from the 
     definition of the term `covered provider' for purposes of 
     this section.''.
       (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

[[Page H5247]]

     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 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.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Kentucky (Mr. Guthrie) and the gentleman from Massachusetts (Mr. 
Kennedy) each will control 20 minutes.
  The Chair recognizes the gentleman from Kentucky.


                             General Leave

  Mr. GUTHRIE. Mr. Speaker, I ask unanimous consent that all Members 
have 5 legislative days in which to revise and extend their remarks and 
insert extraneous materials in the Record on the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Kentucky?
  There was no objection.
  Mr. GUTHRIE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, this bill, cosponsored by myself, Representative 
Griffith, Representative Fitzpatrick, and Representative Blackburn, 
requires Medicaid providers to check the prescription drug history of a 
beneficiary through a qualified prescription drug monitoring program, 
or PDMP, before prescribing a schedule II controlled substance. This is 
a crucial step in helping us get a grip on the crisis we are facing.
  Currently, 49 States have a PDMP program, and the final State, 
Missouri, has begun creating a PDMP program. However, only 13 States 
require the prescribers check the patient's prescribing history prior 
to prescribing controlled substances, despite the fact that studies 
show that mandatory PDMP access laws are effective in reducing 
prescription drug abuse and, in particular, opioid abuse.
  For example, evidence from New York suggests that PDMPs are 
associated with a 75 percent decrease in the number of beneficiaries 
who got a prescription drug from more than one prescriber and 
dispenser. Implementation of Florida's PDMP was associated with a 25 
percent decrease in mortality related to oxycodone.
  Both the current and past administrations have noted that PDMPs 
should be leveraged in the opioid crisis and are most effective when 
they are used by all clinicians.
  This bill requires that States have a qualified PDMP by October 1, 
2021, and provides enhanced matching funds from fiscal years 2018 to 
2021 for States to establish data-sharing agreements with bordering 
States.
  Finally, the bill requires CMS to publish best practices for how 
States and covered providers can use PDMPs to reduce the abuse of 
controlled substances.
  Medicaid patients are especially vulnerable to being harmed by the 
opioid epidemic. This bill is an important step and one that I believe 
will help us address the scourge that is the opioid crisis.
  Mr. Speaker, I thank Mr. Griffith for his leadership on this issue, 
which has been invaluable.
  Mr. Speaker, I reserve the balance of my time.
  Mr. KENNEDY. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise to speak on H.R. 5801, the Medicaid PARTNERSHIP 
Act.
  This legislation requires Medicaid providers to have a program that 
requires providers to check a qualified prescription drug monitoring 
program, a PDMP, before prescribing a schedule II controlled substance 
and encourages integration of the PDMP into a provider's clinical work 
flow.
  Today, Mr. Speaker, more than 30 States have some form of mandated 
provider PDMP check. This legislation would require all Medicaid 
programs to have such a policy in place.
  Integrating PDMPs with Medicaid is a critical tool in this crisis for 
our providers to be able to prevent opioid addiction.
  Research has demonstrated that these types of mandates can encourage 
registration and use of a State's PDMP by providers. That is why I 
support investing in our PDMPs so that they are good realtime systems 
that our providers can actually check easily.
  Importantly, this legislation preserves the ability of States to work 
with providers to design a mandate that best meets the needs of all 
involved.
  State flexibility and proper financing of our PDMPs is critical to 
achieving the intent of this legislation, which, if enacted, I will 
closely monitor going forward.
  Mr. Speaker, I yield back the balance of my time.
  Mr. GUTHRIE. Mr. Speaker, I urge my colleagues to vote for this bill, 
and I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Gianforte). The question is on the 
motion offered by the gentleman from Kentucky (Mr. Guthrie) that the 
House suspend the rules and pass the bill, H.R. 5801, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

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