[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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