[Congressional Record Volume 164, Number 148 (Thursday, September 6, 2018)]
[Senate]
[Pages S6062-S6100]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 4011. Mr. LEE submitted an amendment intended to be proposed by 
him to the bill S. 2554, to ensure that health insurance issuers and 
group health plans do not prohibit pharmacy providers from providing 
certain information to enrollees; which was ordered to lie on the 
table; as follows:

       On page 4, strike line 2 and all that follows through line 
     6 on page 5 and insert the following:
       ``(a) In General.--A self-insured group health plan shall--
       ``(1) not restrict, directly or indirectly, any pharmacy 
     that dispenses a prescription drug to an enrollee in the plan 
     from informing (or penalize such pharmacy for informing) an 
     enrollee of any differential between the enrollee's out-of-
     pocket cost under the plan with respect to acquisition of the 
     drug and the amount an individual would pay for acquisition 
     of the drug without using the plan; and
       ``(2) ensure that any entity that provides pharmacy 
     benefits management services under a contract with any such 
     health plan does not, with respect to such plan, restrict, 
     directly or indirectly, a pharmacy that dispenses a 
     prescription drug from informing (or penalize such pharmacy 
     for informing) an enrollee of any differential between the 
     enrollee's out-of-pocket cost under the plan with respect to 
     acquisition of the drug and the amount an individual would 
     pay for acquisition of the drug without using the plan.
       ``(b) Definition.--For purposes of this section, the term 
     `out-of-pocket cost', with respect to acquisition of a drug, 
     means the amount to be paid by the enrollee under the health 
     plan, including any cost-sharing (including any deductible, 
     copayment, or coinsurance) and, as determined by the 
     Secretary, any other expenditure.''.
                                 ______
                                 
  SA 4012. Mr. McCONNELL (for Mr. Hatch (for himself and Mr. Heinrich)) 
proposed an amendment to the bill S. 1417, to require the Secretary of 
the Interior to develop a categorical exclusion for covered vegetative 
management activities carried out to establish or improve habitat for 
greater sage-grouse and mule deer, and for other purposes; as follows:

                (Purpose: In the nature of a substitute)

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Sage-Grouse and Mule Deer 
     Habitat Conservation and Restoration Act of 2018''.

     SEC. 2. DEFINITIONS.

       In this Act:
       (1) Covered vegetation management activity.--
       (A) In general.--The term ``covered vegetation management 
     activity'' means any activity described in subparagraph (B) 
     that--
       (i) is carried out on public land administered by the 
     Bureau of Land Management;
       (ii) meets the objectives of the order of the Secretary 
     numbered 3336 and dated January 5, 2015;
       (iii) conforms to an applicable land use plan;
       (iv) protects, restores, or improves greater sage-grouse or 
     mule deer habitat in a sagebrush steppe ecosystem as 
     described in--

       (I) Circular 1416 of the United States Geological Survey 
     entitled ``Restoration Handbook for Sagebrush Steppe 
     Ecosystems with Emphasis on Greater Sage-Grouse Habitat--Part 
     1. Concepts for Understanding and Applying Restoration'' 
     (2015); or
       (II) the habitat guidelines for mule deer published by the 
     Mule Deer Working Group of the Western Association of Fish 
     and Wildlife Agencies;

       (v) will not permanently impair--

       (I) the natural state of the treated area;
       (II) outstanding opportunities for solitude;
       (III) outstanding opportunities for primitive, unconfined 
     recreation;
       (IV) economic opportunities consistent with multiple-use 
     management; or
       (V) the identified values of a unit of the National 
     Landscape Conservation System; and

       (vi)(I) restores native vegetation following a natural 
     disturbance;
       (II) prevents the expansion into greater sage-grouse or 
     mule deer habitat of--

       (aa) juniper, pinyon pine, or other associated conifers; or
       (bb) nonnative or invasive vegetation;

       (III) reduces the risk of loss of greater sage-grouse or 
     mule deer habitat from wildfire or any other natural 
     disturbance; or
       (IV) provides emergency stabilization of soil resources 
     after a natural disturbance.
       (B) Description of activities.--An activity referred to in 
     subparagraph (A) is--
       (i) manual cutting and removal of juniper trees, pinyon 
     pine trees, other associated conifers, or other nonnative or 
     invasive vegetation;
       (ii) mechanical mastication, cutting, or mowing, mechanical 
     piling and burning, chaining, broadcast burning, or yarding;
       (iii) removal of cheat grass, medusa head rye, or other 
     nonnative, invasive vegetation;
       (iv) collection and seeding or planting of native 
     vegetation using a manual, mechanical, or aerial method;

[[Page S6063]]

       (v) seeding of nonnative, noninvasive, ruderal vegetation 
     only for the purpose of emergency stabilization;
       (vi) targeted use of an herbicide, subject to the condition 
     that the use shall be in accordance with applicable legal 
     requirements, Federal agency procedures, and land use plans;
       (vii) targeted livestock grazing to mitigate hazardous 
     fuels and control noxious and invasive weeds;
       (viii) temporary removal of wild horses or burros in the 
     area in which the activity is being carried out to ensure 
     treatment objectives are met;
       (ix) in coordination with the affected permit holder, 
     modification or adjustment of permissible usage under an 
     annual plan of use of a grazing permit issued by the 
     Secretary to achieve restoration treatment objectives;
       (x) installation of new, or modification of existing, 
     fencing or water sources intended to control use or improve 
     wildlife habitat; or
       (xi) necessary maintenance of, repairs to, rehabilitation 
     of, or reconstruction of an existing permanent road or 
     construction of temporary roads to accomplish the activities 
     described in this subparagraph.
       (C) Exclusions.--The term ``covered vegetation management 
     activity'' does not include--
       (i) any activity conducted in a wilderness area or 
     wilderness study area; or
       (ii) any activity for the construction of a permanent road 
     or permanent trail.
       (2) Secretary.--The term ``Secretary'' means the Secretary 
     of the Interior.
       (3) Temporary road.--The term ``temporary road'' means a 
     road that is--
       (A) authorized--
       (i) by a contract, permit, lease, other written 
     authorization; or
       (ii) pursuant to an emergency operation;
       (B) not intended to be part of the permanent transportation 
     system of a Federal department or agency;
       (C) not necessary for long-term resource management;
       (D) designed in accordance with standards appropriate for 
     the intended use of the road, taking into consideration--
       (i) safety;
       (ii) the cost of transportation; and
       (iii) impacts to land and resources; and
       (E) managed to minimize--
       (i) erosion; and
       (ii) the introduction or spread of invasive species.

     SEC. 3. IMPROVEMENT OF HABITAT FOR GREATER SAGE-GROUSE AND 
                   MULE DEER.

       (a) Categorical Exclusion.--
       (1) In general.--Not later than 1 year after the date of 
     the enactment of this Act, the Secretary shall develop 1 or 
     more categorical exclusions (as defined in section 1508.4 of 
     title 40, Code of Federal Regulations (or a successor 
     regulation)) for covered vegetation management activities 
     carried out to protect, restore, or improve habitat for 
     greater sage-grouse or mule deer.
       (2) Administration.--In developing and administering a 
     categorical exclusion under paragraph (1), the Secretary 
     shall--
       (A) comply with the National Environmental Policy Act of 
     1969 (42 U.S.C. 4321 et seq.);
       (B) apply the extraordinary circumstances procedures under 
     section 220.6 of title 36, Code of Federal Regulations (or 
     successor regulations), in determining whether to use the 
     categorical exclusion; and
       (C) consider--
       (i) the relative efficacy of landscape-scale habitat 
     projects;
       (ii) the likelihood of continued declines in the 
     populations of greater sage-grouse and mule deer in the 
     absence of landscape-scale vegetation management; and
       (iii) the need for habitat restoration activities after 
     wildfire or other natural disturbances.
       (b) Implementation of Covered Vegetative Management 
     Activities Within the Range of Greater Sage-grouse and Mule 
     Deer.--If a categorical exclusion developed under subsection 
     (a) is used to implement a covered vegetative management 
     activity in an area within the range of both greater sage-
     grouse and mule deer, the covered vegetative management 
     activity shall protect, restore, or improve habitat 
     concurrently for both greater sage-grouse and mule deer.
       (c) Long-term Monitoring and Maintenance.--Before 
     commencing any covered vegetation management activity that is 
     covered by a categorical exclusion under subsection (a), the 
     Secretary shall develop a long-term monitoring and 
     maintenance plan, covering at least the 20 year-period 
     beginning on the date of commencement, to ensure that 
     management of the treated area does not degrade the habitat 
     gains secured by the covered vegetation management activity.
       (d) Disposal of Vegetative Material.--Subject to applicable 
     local restrictions, any vegetative material resulting from a 
     covered vegetation management activity that is covered by a 
     categorical exclusion under subsection (a) may be--
       (1) used for--
       (A) fuel wood; or
       (B) other products; or
       (2) piled or burned, or both.
       (e) Treatment for Temporary Roads.--
       (1) In general.--Notwithstanding section 2(1)(B)(xi), any 
     temporary road constructed in carrying out a covered 
     vegetation management activity that is covered by a 
     categorical exclusion under subsection (a)--
       (A) shall be used by the Secretary for the covered 
     vegetation management activity for not more than 2 years; and
       (B) shall be decommissioned by the Secretary not later than 
     3 years after the earlier of the date on which--
       (i) the temporary road is no longer needed; and
       (ii) the project is completed.
       (2) Requirement.--A treatment under paragraph (1) shall 
     include reestablishing native vegetative cover--
       (A) as soon as practicable; but
       (B) not later than 10 years after the date of completion of 
     the applicable covered vegetation management activity.
                                 ______
                                 
  SA 4013. Mr. ALEXANDER submitted an amendment intended to be proposed 
by him to the bill H.R. 6, to provide for opioid use disorder 
prevention, recovery, and treatment, and for other purposes; which was 
ordered to lie on the table; as follows:

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Opioid 
     Crisis Response Act of 2018''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.

                  TITLE I--OPIOID CRISIS RESPONSE ACT

Sec. 1001. Definitions.

              Subtitle A--Reauthorization of Cures Funding

Sec. 1101. State response to the opioid abuse crisis.

                  Subtitle B--Research and Innovation

Sec. 1201. Advancing cutting-edge research.
Sec. 1202. Pain research.
Sec. 1203. Report on synthetic drug use.

     Subtitle C--Medical Products and Controlled Substances Safety

Sec. 1301. Clarifying FDA regulation of non-addictive pain products.
Sec. 1302. Clarifying FDA packaging authorities.
Sec. 1303. Strengthening FDA and CBP coordination and capacity.
Sec. 1304. Clarifying FDA post-market authorities.
Sec. 1305. Restricting entrance of illicit drugs.
Sec. 1306. First responder training.
Sec. 1307. Disposal of controlled substances of hospice patients.
Sec. 1308. GAO study and report on hospice safe drug management.
Sec. 1309. Delivery of a controlled substance by a pharmacy to be 
              administered by injection or implantation.

                   Subtitle D--Treatment and Recovery

Sec. 1401. Comprehensive opioid recovery centers.
Sec. 1402. Program to support coordination and continuation of care for 
              drug overdose patients.
Sec. 1403. Alternatives to opioids.
Sec. 1404. Building communities of recovery.
Sec. 1405. Peer support technical assistance center.
Sec. 1406. Medication-assisted treatment for recovery from addiction.
Sec. 1407. Grant program.
Sec. 1408. Allowing for more flexibility with respect to medication-
              assisted treatment for opioid use disorders.
Sec. 1409. National recovery housing best practices.
Sec. 1410. Addressing economic and workforce impacts of the opioid 
              crisis.
Sec. 1411. Career Act.
Sec. 1412. Pilot program to help individuals in recovery from a 
              substance use disorder become stably housed.
Sec. 1413. Youth prevention and recovery.
Sec. 1414. Plans of safe care.
Sec. 1415. Regulations relating to special registration for 
              telemedicine.
Sec. 1416. National Health Service Corps behavioral and mental health 
              professionals providing obligated service in schools and 
              other community-based settings.
Sec. 1417. Loan repayment for substance use disorder treatment 
              providers.
Sec. 1418. Protecting moms and infants.
Sec. 1419. Early interventions for pregnant women and infants.
Sec. 1420. Report on investigations regarding parity in mental health 
              and substance use disorder benefits.

                         Subtitle E--Prevention

Sec. 1501. Study on prescribing limits.
Sec. 1502. Programs for health care workforce.
Sec. 1503. Education and awareness campaigns.
Sec. 1504. Enhanced controlled substance overdoses data collection, 
              analysis, and dissemination.
Sec. 1505. Preventing overdoses of controlled substances.
Sec. 1506. CDC surveillance and data collection for child, youth, and 
              adult trauma.
Sec. 1507. Reauthorization of NASPER.
Sec. 1508. Jessie's law.
Sec. 1509. Development and dissemination of model training programs for 
              substance use disorder patient records.
Sec. 1510. Communication with families during emergencies.

[[Page S6064]]

Sec. 1511. Prenatal and postnatal health.
Sec. 1512. Surveillance and education regarding infections associated 
              with illicit drug use and other risk factors.
Sec. 1513. Task force to develop best practices for trauma-informed 
              identification, referral, and support.
Sec. 1514. Grants to improve trauma support services and mental health 
              care for children and youth in educational settings.
Sec. 1515. National Child Traumatic Stress Initiative.
Sec. 1516. National milestones to measure success in curtailing the 
              opioid crisis.

                           TITLE II--FINANCE

Sec. 2001. Short title.

                          Subtitle A--Medicare

Sec. 2101. Medicare opioid safety education.
Sec. 2102. Expanding the use of telehealth services for the treatment 
              of opioid use disorder and other substance use disorders.
Sec. 2103. Comprehensive screenings for seniors.
Sec. 2104. Every prescription conveyed securely.
Sec. 2105. Standardizing electronic prior authorization for safe 
              prescribing.
Sec. 2106. Strengthening partnerships to prevent opioid abuse.
Sec. 2107. Commit to opioid medical prescriber accountability and 
              safety for seniors.
Sec. 2108. Fighting the opioid epidemic with sunshine.
Sec. 2109. Demonstration testing coverage of certain services furnished 
              by opioid treatment programs.
Sec. 2110. Encouraging appropriate prescribing under Medicare for 
              victims of opioid overdose.
Sec. 2111. Automatic escalation to external review under a Medicare 
              part D drug management program for at-risk beneficiaries.
Sec. 2112. Testing of incentive payments for behavioral health 
              providers for adoption and use of certified electronic 
              health record technology.
Sec. 2113. Medicare Improvement Fund.

                          Subtitle B--Medicaid

Sec. 2201. Caring recovery for infants and babies.
Sec. 2202. Peer support enhancement and evaluation review.
Sec. 2203. Medicaid substance use disorder treatment via telehealth.
Sec. 2204. Enhancing patient access to non-opioid treatment options.
Sec. 2205. Assessing barriers to opioid use disorder treatment.
Sec. 2206. Help for moms and babies.
Sec. 2207. Securing flexibility to treat substance use disorders.
Sec. 2208. MACPAC study and report on MAT utilization controls under 
              State Medicaid programs.
Sec. 2209. Opioid addiction treatment programs enhancement.
Sec. 2210. Better data sharing to combat the opioid crisis.
Sec. 2211. Mandatory reporting with respect to adult behavioral health 
              measures.
Sec. 2212. Report on innovative State initiatives and strategies to 
              provide housing-related services and supports to 
              individuals struggling with substance use disorders under 
              Medicaid.
Sec. 2213. Technical assistance and support for innovative State 
              strategies to provide housing-related supports under 
              Medicaid.

                       Subtitle C--Human Services

Sec. 2301. Supporting family-focused residential treatment.
Sec. 2302. Improving recovery and reunifying families.
Sec. 2303. Building capacity for family-focused residential treatment.

       Subtitle D--Synthetics Trafficking and Overdose Prevention

Sec. 2401. Short title.
Sec. 2402. Customs fees.
Sec. 2403. Mandatory advance electronic information for postal 
              shipments.
Sec. 2404. International postal agreements.
Sec. 2405. Cost recoupment.
Sec. 2406. Development of technology to detect illicit narcotics.
Sec. 2407. Civil penalties for postal shipments.
Sec. 2408. Report on violations of arrival, reporting, entry, and 
              clearance requirements and falsity or lack of manifest.
Sec. 2409. Effective date; regulations.

                          TITLE III--JUDICIARY

             Subtitle A--Access to Increased Drug Disposal

Sec. 3101. Short title.
Sec. 3102. Definitions.
Sec. 3103. Authority to make grants.
Sec. 3104. Application.
Sec. 3105. Use of grant funds.
Sec. 3106. Eligibility for grant.
Sec. 3107. Duration of grants.
Sec. 3108. Accountability and oversight.
Sec. 3109. Duration of program.
Sec. 3110. Authorization of appropriations.

           Subtitle B--Using Data To Prevent Opioid Diversion

Sec. 3201. Short title.
Sec. 3202. Purpose.
Sec. 3203. Amendments.
Sec. 3204. Report.

                 Subtitle C--Substance Abuse Prevention

Sec. 3301. Short title.
Sec. 3302. Reauthorization of the Office of National Drug Control 
              Policy.
Sec. 3303. Reauthorization of the Drug-Free Communities Program.
Sec. 3304. Reauthorization of the National Community Anti-Drug 
              Coalition Institute.
Sec. 3305. Reauthorization of the High-Intensity Drug Trafficking Area 
              Program.
Sec. 3306. Reauthorization of drug court program.
Sec. 3307. Drug court training and technical assistance.
Sec. 3308. Drug overdose response strategy.
Sec. 3309. Protecting law enforcement officers from accidental 
              exposure.
Sec. 3310. COPS Anti-Meth Program.
Sec. 3311. COPS anti-heroin task force program.
Sec. 3312. Comprehensive Addiction and Recovery Act education and 
              awareness.
Sec. 3313. Protecting children with addicted parents.
Sec. 3314. Reimbursement of substance use disorder treatment 
              professionals.
Sec. 3315. Sobriety Treatment and Recovery Teams (START).
Sec. 3316. Provider education.
Sec. 3317. Demand reduction.
Sec. 3318. Anti-drug media campaign.
Sec. 3319. Technical corrections to the office of national drug control 
              policy reauthorization act of 1998.

      Subtitle D--Synthetic Abuse and Labeling of Toxic Substances

Sec. 3401. Short title.
Sec. 3402. Controlled substance analogues.

                    Subtitle E--Opioid Quota Reform

Sec. 3501. Short title.
Sec. 3502. Strengthening considerations for DEA opioid quotas.

                 Subtitle F--Preventing Drug Diversion

Sec. 3601. Short title.
Sec. 3602. Improvements to prevent drug diversion.

                     Subtitle G--Sense of Congress

Sec. 3701. Sense of Congress.

                           TITLE IV--COMMERCE

          Subtitle A--Fighting Opioid Abuse in Transportation

Sec. 4101. Short title.
Sec. 4102. Rail mechanical employee controlled substances and alcohol 
              testing.
Sec. 4103. Rail yardmaster controlled substances and alcohol testing.
Sec. 4104. Department of Transportation public drug and alcohol testing 
              database.
Sec. 4105. GAO report on Department of Transportation's collection and 
              use of drug and alcohol testing data.
Sec. 4106. Transportation Workplace Drug and Alcohol Testing Program; 
              addition of fentanyl.
Sec. 4107. Status reports on hair testing guidelines.
Sec. 4108. Mandatory Guidelines for Federal Workplace Drug Testing 
              Programs Using Oral Fluid.
Sec. 4109. Electronic recordkeeping.
Sec. 4110. Status reports on Commercial Driver's License Drug and 
              Alcohol Clearinghouse.

         Subtitle B--Opioid Addiction Recovery Fraud Prevention

Sec. 4201. Short title.
Sec. 4202. Definitions.
Sec. 4203. False or misleading representations with respect to opioid 
              treatment programs and products.

                  TITLE I--OPIOID CRISIS RESPONSE ACT

     SEC. 1001. DEFINITIONS.

       In this title--
       (1) 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); 
     and
       (2) the term ``Secretary'' means the Secretary of Health 
     and Human Services, unless otherwise specified.

              Subtitle A--Reauthorization of Cures Funding

     SEC. 1101. 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 indian 
     tribe'' after ``State'';

[[Page S6065]]

       (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'';
       (B) in paragraph (2)--
       (i) in the matter preceding subparagraph (A), by striking 
     ``to a State'';
       (ii) in subparagraph (A), by striking ``State'';
       (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, 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 the Opioid Crisis Response Act of 2018, 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''.

                  Subtitle B--Research and Innovation

     SEC. 1201. ADVANCING CUTTING-EDGE RESEARCH.

       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. 1202. 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 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 or 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; 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 Director of NIH 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.''.

     SEC. 1203. REPORT ON SYNTHETIC DRUG USE.

       (a) In General.--Not later than 3 years after the date of 
     the enactment of this Act, 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 on the health effects of new 
     psychoactive substances, including synthetic drugs, 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))).

     Subtitle C--Medical Products and Controlled Substances Safety

     SEC. 1301. 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, 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 
     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; 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

[[Page S6066]]

     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 pain, including--
       (A) 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)), 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.

     SEC. 1302. CLARIFYING FDA PACKAGING AUTHORITIES.

       (a) Additional Potential 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 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 non-retrievable (as defined in section 
     1300.05 of title 21, Code of Federal Regulations (or any 
     successor regulation)) if the Secretary has determines that 
     such safe disposal packaging or system may mitigate such 
     serious risk and exists in sufficient quantities.''.
       (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 needs; 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''.

     SEC. 1303. STRENGTHENING FDA AND CBP COORDINATION AND 
                   CAPACITY.

       (a) In General.--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 response to 
     illegal controlled substances and drug imports, including at 
     sites of import (such as international mail facilities). 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) the construction of, or upgrades to, laboratory 
     capacity for purposes of detection and testing of imported 
     goods;
       (iii) upgrades to the security of import facilities; and
       (iv) 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.
       (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 
     relevant committees of Congress on the implementation of this 
     section, including a summary of progress made towards near-
     real-time information sharing and the interoperability of 
     such technologies.
       (d) Authorization of Appropriations.--Out of amounts 
     otherwise available to the Secretary, the Secretary may 
     allocate such sums as may be necessary for purposes of 
     carrying out this section.

     SEC. 1304. CLARIFYING FDA POST-MARKET AUTHORITIES.

       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''.

     SEC. 1305. RESTRICTING ENTRANCE OF ILLICIT DRUGS.

       (a) In General.--The Secretary, acting through the 
     Commissioner of Food and Drugs, upon discovering or 
     receiving, in a package being offered for import, a 
     controlled substance that is offered for import in violation 
     of any requirement of 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, shall transfer such package 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.).
       (b) Debarment, Temporary Denial of Approval, and 
     Suspension.--
       (1) In general.--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.''; and
       (B) in paragraph (3)--
       (i) in the heading, by striking ``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

[[Page S6067]]

     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.''.

       (2) Prohibited act.--Section 301(cc) of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 331(cc)) is amended by 
     inserting ``or a drug'' after ``food''.
       (c) Imports and Exports.--Section 801(a) of the Federal 
     Food, Drug, and Cosmetic Act (21 U.S.C. 381(a)) is amended--
       (1) by striking the second sentence;
       (2) by striking ``If it appears'' and inserting ``Subject 
     to subsection (b), if it appears'';
       (3) by striking ``regarding such article, then such article 
     shall be refused'' and inserting the following: ``regarding 
     such article, 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) may 
     be refused admission. If it appears from the examination of 
     such samples or otherwise that the article is a counterfeit 
     drug, such article shall be refused admission.'';
       (4) by striking ``this Act, then such article shall be 
     refused admission'' and inserting ``this Act, then such 
     article may be refused admission''; and
       (5) 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 
     second 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) is amended by 
     adding at the end the following--
       ``(t) 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, or a dietary supplement; 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 is in effect 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).''.

     SEC. 1306. 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 abuse 
     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''.

     SEC. 1307. DISPOSAL OF CONTROLLED SUBSTANCES OF HOSPICE 
                   PATIENTS.

       (a) In General.--Section 302(g) of the Controlled 
     Substances Act (21 U.S.C. 822(g)) is amended by adding at the 
     end the following:
       ``(5)(A) An employee of a qualified hospice program acting 
     within the scope of employment may handle, in the place of 
     residence of a hospice patient, any controlled substance that 
     was lawfully dispensed to the hospice patient, for the 
     purpose of assisting in the disposal of the controlled 
     substance--
       ``(i) after the hospice patient's death;
       ``(ii) if the controlled substance is expired; or
       ``(iii) if--
       ``(I) the employee is--
       ``(aa) the physician of the hospice patient; 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) In this paragraph:
       ``(i) The term `employee of a qualified hospice program' 
     means a physician, physician assistant, registered nurse, or 
     nurse practitioner who--
       ``(I) is employed by, or is acting pursuant to arrangements 
     made with, a qualified hospice program; and
       ``(II) is licensed or certified to perform such employment, 
     or such activities arranged by the qualified hospice program, 
     in accordance with applicable State law.
       ``(ii) The terms `hospice care' and `hospice program' have 
     the meanings given those terms in section 1861(dd) of the 
     Social Security Act (42 U.S.C. 1395x(dd)).
       ``(iii) The term `hospice patient' means an individual 
     receiving hospice care.
       ``(iv) The term `qualified hospice program' means a hospice 
     program that--
       ``(I) has written policies and procedures for employees of 
     the hospice program to use when assisting in the disposal of 
     the controlled substances of a hospice patient in a 
     circumstance described in clause (i), (ii), or (iii) of 
     subparagraph (A);
       ``(II) at the time when the controlled substances are first 
     ordered--
       ``(aa) provides a copy of the written policies and 
     procedures to the hospice patient or hospice patient 
     representative and the family of the hospice patient;
       ``(bb) discusses the policies and procedures with the 
     hospice patient or hospice patient's representative and the 
     hospice patient's family in a language and manner that such 
     individuals understand to ensure that such individuals are 
     informed regarding the safe disposal of controlled 
     substances; and
       ``(cc) documents in the clinical record of the hospice 
     patient that the written policies and procedures were 
     provided and discussed with the hospice patient or hospice 
     patient's representative; and
       ``(III) at the time when an employee of the hospice program 
     assists in the disposal of controlled substances of a hospice 
     patient, documents in the clinical record of the hospice 
     patient a list of all controlled substances disposed of.
       ``(C) The Attorney General may, by regulation, include 
     additional types of licensed medical professionals in the 
     definition of the term `employee of a qualified hospice 
     program' under subparagraph (B).''.
       (b) No Registration Required.--Section 302(c) of the 
     Controlled Substances Act (21 U.S.C. 822(c)) is amended by 
     adding at the end the following:
       ``(4) An employee of a qualified hospice program for the 
     purpose of assisting in the disposal of a controlled 
     substance in accordance with subsection (g)(5), except as 
     provided in subparagraph (A)(iii) of that subsection.''.
       (c) Guidance.--The Attorney General may issue guidance to 
     qualified hospice programs to assist the programs in 
     satisfying the requirements under paragraph (5) of section 
     302(g) of the Controlled Substances Act (21 U.S.C. 822(g)), 
     as added by subsection (a).
       (d) State and Local Authority.--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. 1308. 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

[[Page S6068]]

     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 challenges encountered by 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.

     SEC. 1309. 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) in the case of administering of the controlled 
     substance for the purpose of maintenance or detoxification 
     treatment under section 303(g)(2)--
       ``(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 subsection (c) 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.''.

                   Subtitle D--Treatment and Recovery

     SEC. 1401. 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 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 Grants.--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 located in 
     a State or Indian Tribe 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.
       (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 and evaluations meet the 
     individualized clinical needs of patients, including by 
     offering assessments for services and care recommendations 
     through independent, evidence-based verification processes 
     for reviewing patient placement in treatment settings;
       (B) provide the full continuum of treatment services, 
     including--
       (i) all drugs approved by the Food and Drug Administration 
     to treat substance use disorders, 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) administer an onsite pharmacy and provide toxicology 
     services, for purposes of carrying out this section; and
       (F) operate a secure, confidential, and interoperable 
     electronic health information system.
       (2) Outreach.--Each Center shall carry out outreach 
     activities to publicize 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

[[Page S6069]]

     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.
       (k) Reports to Congress.--
       (1) Preliminary report.--Not later than 3 years after the 
     date of the enactment of this Act, the Secretary shall submit 
     to Congress a preliminary report that analyzes data submitted 
     under subsection (h).
       (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) an evaluation of the effectiveness of the comprehensive 
     services provided by the Centers established or operated 
     pursuant to this section 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.

     SEC. 1402. PROGRAM TO SUPPORT COORDINATION AND CONTINUATION 
                   OF CARE FOR DRUG OVERDOSE PATIENTS.

       (a) In General.--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 an opioid overdose; and
       (4) the provision 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 an opioid 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 alcohol or drug 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, in consultation with a State alcohol and drug 
     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 approved 
     by the Food and Drug Administration 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 approved by the Food and Drug Administration 
     to treat substance use disorders, 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 program counselor, 
     social worker, therapist, or other 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))), or 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))).
       (B) The eligible entity is located in a State, 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 by the Director of the Centers 
     for Disease Control and Prevention.
       (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) 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.
       (2) 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)).
       (3) State alcohol and drug agency.--The term ``State 
     alcohol and drug agency'' means the principal agency of a 
     State that is responsible for carrying out the block grant 
     for prevention and treatment of substance abuse under subpart 
     II of part B of title XIX of the Public Health Service Act 
     (42 U.S.C. 300x-21 et seq.)
       (d) Reporting Requirements.--
       (1) Reports by grantees.--Each eligible entity awarded a 
     grant under this section

[[Page S6070]]

     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 such sums as may 
     be necessary for each of fiscal years 2019 through 2023.

     SEC. 1403. ALTERNATIVES TO OPIOIDS.

       (a) In General.--The Secretary shall, directly or through 
     grants to, or contracts with, public and private entities, 
     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 acute care providers 
     including emergency departments and other providers that have 
     successfully implemented alternatives to opioids programs, 
     promoting non-addictive protocols and medications while 
     appropriately limiting the use of opioids;
       (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;
       (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; and
       (5) collecting data and reporting on health outcomes 
     associated with the use of alternatives to opioids.
       (b) Pain Management and Funding.--
       (1) In general.--The Secretary shall award grants to 
     hospitals and other acute care settings relating to 
     alternatives to opioids for pain management.
       (2) 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.

     SEC. 1404. 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 the 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. 1405. PEER SUPPORT TECHNICAL ASSISTANCE CENTER.

       (a) Establishment.--The Secretary, acting through the 
     Assistant Secretary for Mental Health and Substance Abuse, 
     shall establish or operate a National Peer-Run Training and 
     Technical Assistance Center for Addiction Recovery Support 
     (referred to in this subsection 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 (as defined in section 547 of the Public Health 
     Service Act).
       (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 of the Public Health Service 
     Act.
       (e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section such sums as may 
     be necessary for each of fiscal years 2019 through 2023.

     SEC. 1406. MEDICATION-ASSISTED TREATMENT FOR RECOVERY FROM 
                   ADDICTION.

       (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 24 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 shall consider 
     ways to ensure that an adequate number of physicians who meet 
     the requirements under the amendment made by subsection (a) 
     and have a specialty in pediatrics, or the treatment of 
     children or of adolescents, are granted a waiver under 
     section 303(g)(2) of the Controlled Substances Act (21

[[Page S6071]]

     U.S.C. 823(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. 1407. GRANT PROGRAM.

       (a) In General.--The Secretary 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 1406(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. 1408. ALLOWING FOR MORE FLEXIBILITY WITH RESPECT TO 
                   MEDICATION-ASSISTED TREATMENT FOR OPIOID USE 
                   DISORDERS.

       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; or
       ``(bb) 275 if the practitioner meets the requirements 
     specified in section 8.610 of title 42, Code of Federal 
     Regulations (or successor regulations).''.

     SEC. 1409. NATIONAL RECOVERY HOUSING BEST PRACTICES.

       (a) Best Practices for Operating Recovery Housing.--
       (1) In general.--The Secretary, in consultation with the 
     individuals and entities described 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--
       (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 Attorney General;
       (C) the Secretary of Housing and Urban Development;
       (D) directors or commissioners, as applicable, of State 
     health departments, tribal health departments, State Medicaid 
     programs, and State insurance agencies;
       (E) representatives of health insurance issuers;
       (F) 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;
       (G) individuals with a history of substance use disorder; 
     and
       (H) other stakeholders identified by the Secretary.
       (3) Requirements.--
       (A) Practices for identification and reporting.--In 
     carrying out the activities described in this subsection, 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 this subsection, the Secretary shall 
     consider identifying or developing indicators regarding--
       (i) unusual billing practices;
       (ii) average lengths of stays;
       (iii) excessive levels of drug testing (in terms of cost or 
     frequency);
       (iv) unusually high levels of recidivism; and
       (v) any other factors identified by the Secretary.
       (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;
       (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 under 
     subsections (a) and (b), the Secretary, in consultation with 
     appropriate stakeholders as described in each such 
     subsection, 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; and
       (2) the term ``tribally designated housing entity'' has the 
     meaning given such term in section 4 of the Native American 
     Housing Assistance and Self-Determination Act of 1996 (25 
     U.S.C. 4103).

     SEC. 1410. 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--

[[Page S6072]]

       (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.--

[[Page S6073]]

       (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

[[Page S6074]]

     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 2018 
     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.

     SEC. 1411. CAREER ACT.

       (a) In General.--The Secretary, in consultation with the 
     Secretary of Labor, shall continue or establish a program to 
     support individuals in recovery from a substance use disorder 
     transition to independent living and 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 recovery from a substance use 
     disorder transition from treatment to independent living and 
     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.--In awarding grants under this section, the 
     Secretary shall give priority to entities located in a State 
     with--
       (1) 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;
       (2) a rate of unemployment, based on data provided by the 
     Bureau of Labor Statistics for calendar years 2013 through 
     2017, that is above the national average; and
       (3) a rate of labor force participation, based on data 
     provided by the Bureau of Labor Statistics for calendar years 
     2013 through 2017, that is below the national average.
       (d) Preference.--In awarding grants under this section, the 
     Secretary shall, as appropriate, give preference to entities 
     located in an area with an age-adjusted rate of drug overdose 
     deaths that is above the national overdose mortality rate.
       (e) 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, and local and State 
     governments, 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 1410, 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.
       (f) 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 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.
       (g) Support for State Strategy.--An eligible entity shall 
     include in its application under subsection (e) 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.
       (h) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary for each of 
     fiscal years 2019 through 2023 for purposes of carrying out 
     this section.

     SEC. 1412. 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.--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. Among such 
     States, priority shall be given to States with the greatest 
     need, as such need is determined by the Secretary based on--
       (A) the highest average rates of unemployment based on data 
     provided by the Bureau of Labor Statistics for calendar years 
     2013 through 2017;
       (B) the lowest average labor force participation rates 
     based on data provided by the Bureau of Labor Statistics for 
     calendar years 2013 through 2017; and
       (C) the highest prevalence of opioid use disorder based on 
     data provided by the Substance Abuse and Mental Health 
     Services Administration for calendar years 2013 through 2017.
       (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 for any 
     provision of any statute or

[[Page S6075]]

     regulation in connection with the obligation by the Secretary 
     or the use of funds except for requirements related to fair 
     housing, nondiscrimination, labor standards, and the 
     environment, upon a finding that such a waiver is necessary 
     to expedite or facilitate the use of such funds.
       (2) Notice.--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 5 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.

     SEC. 1413. 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, acting through the 
     Assistant Secretary for Mental Health and Substance Use and, 
     as appropriate, in consultation with the Secretary of 
     Education and other agencies, 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) Evidence-based.--The term ``evidence-based'' has the 
     meaning given such term in section 8101 of the Elementary and 
     Secondary Education Act (20 U.S.C. 7801).
       (C) 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).
       (D) 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).
       (E) 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);
       (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 the 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 the 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 (8)(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 
     prevention and treatment 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) Priority.--In awarding grants under this subsection, 
     the Secretary shall give priority to eligible entities that 
     propose to use grant funds for activities that meet the 
     criteria described in subclauses (I) and (II) of section 
     8101(21)(A)(i) of the Elementary and Secondary Education Act 
     (20 U.S.C. 7801(21)(A)(i)).
       (8) 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

[[Page S6076]]

       (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 during 
     the grant period; and
       (iii) other indicators, as the Secretary determines 
     appropriate.
       (9) 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 (8).
       (10) Authorization of appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to carry out 
     this subsection for each of fiscal years 2019 through 2023.

     SEC. 1414. PLANS OF SAFE CARE.

       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 shall 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).
       ``(B) Distribution of funds.--
       ``(i) Reservations.--Of the amounts appropriated under 
     subparagraph (H), 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 appropriated under subparagraph (H) 
     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 appropriated under subparagraph (H) 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 appropriated 
     under subparagraph (H) 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;
       ``(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) how the State meets the requirements of section 1927 
     of the Public Health Service Act (42 U.S.C. 300x-27);
       ``(VI) 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
       ``(VII) 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 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--

       ``(I) comply with this Act and parts B and E of title IV of 
     the Social Security Act (42 U.S.C. 621 et seq., 670 et seq.); 
     and
       ``(II) 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; and
       ``(dd) improving access to treatment services, which may be 
     prior to the pregnant woman's delivery date.
       ``(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;
       ``(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 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

[[Page S6077]]

       ``(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 health 
     professionals, health facilities, child welfare 
     professionals, juvenile and family court judges, substance 
     use and mental disorder treatment programs, early childhood 
     education programs, and 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) Reservation of funds.--The Secretary shall use the 
     amount reserved under subparagraph (B)(i)(I) for the purposes 
     of--
       ``(i) providing 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) issuing 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) clarifying key terms; and
       ``(II) 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;

       ``(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) Authorization of appropriations.--To carry out the 
     program under this paragraph, there is authorized to be 
     appropriated $60,000,000 for each of fiscal years 2019 
     through 2023.''.

     SEC. 1415. REGULATIONS RELATING TO SPECIAL REGISTRATION FOR 
                   TELEMEDICINE.

       Section 311(h) of the Controlled Substances Act (21 U.S.C. 
     831(h)) is amended by striking paragraph (2) and inserting 
     the following:
       ``(2) Regulations.--
       ``(A) In general.--Not later than 1 year after the date of 
     enactment of the Opioid Crisis Response Act of 2018, in 
     consultation with the Secretary, and in accordance with the 
     procedure described in subparagraph (B), the Attorney General 
     shall promulgate final regulations specifying--
       ``(i) the limited circumstances in which a special 
     registration under this subsection may be issued; and
       ``(ii) the procedure for obtaining a special registration 
     under this subsection.
       ``(B) Procedure.--In promulgating final regulations under 
     subparagraph (A), the Attorney General shall--
       ``(i) issue a notice of proposed rulemaking that includes a 
     copy of the proposed regulations;
       ``(ii) provide a period of not less than 60 days for 
     comments on the proposed regulations;
       ``(iii) finalize the proposed regulation not later than 6 
     months after the close of the comment period; and
       ``(iv) publish the final regulations not later than 30 days 
     before the effective date of the final regulations.''.

     SEC. 1416. NATIONAL HEALTH SERVICE CORPS BEHAVIORAL AND 
                   MENTAL HEALTH PROFESSIONALS PROVIDING OBLIGATED 
                   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. BEHAVIORAL AND MENTAL HEALTH PROFESSIONALS 
                   PROVIDING OBLIGATED 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. 1417. LOAN REPAYMENT FOR SUBSTANCE USE DISORDER 
                   TREATMENT PROVIDERS.

       (a) Loan Repayment for Substance Use Treatment Providers.--
     The Secretary shall enter into contracts under section 338B 
     of the Public Health Service Act (42 U.S.C. 254l-1) with 
     eligible health professionals providing substance use 
     disorder treatment services in substance use disorder 
     treatment facilities, as defined by the Secretary.
       (b) Provision of Substance Use Disorder Treatment.--In 
     carrying out the activities described in subsection (a)--
       (1) each such facility shall be located in or serving a 
     mental health professional shortage area designated under 
     section 332 of the Public Health Service Act (42 U.S.C. 
     254e), or, as the Secretary determines appropriate, an area 
     with an age-adjusted rate of drug overdose deaths that is 
     above the national overdose mortality rate;
       (2) section 331(a)(3)(D) of such Act (42 U.S.C. 
     254d(a)(3)(D)) shall be applied as if the term ``primary 
     health services'' includes health services regarding 
     substance use disorder treatment and infections associated 
     with illicit drug use;
       (3) section 331(a)(3)(E)(i) of such Act (42 U.S.C. 
     254d(a)(3)(E)(i)) shall be applied as if the term 
     ``behavioral and mental health professionals'' includes 
     master's level, licensed substance use disorder treatment 
     counselors, and other relevant professionals or 
     paraprofessionals, as the Secretary determines appropriate; 
     and
       (4) such professionals and facilities shall provide--
       (A) directly, or through the use of telehealth technology, 
     and pursuant to Federal and State law, counseling 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 progress; and
       (B) medication-assisted treatment, including, to the extent 
     practicable, all drugs approved by the Food and Drug 
     Administration to treat substance use disorders, pursuant to 
     Federal and State law.
       (c) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $25,000,000 for 
     each of fiscal years 2019 through 2023.

     SEC. 1418. PROTECTING MOMS AND INFANTS.

       (a) Report.--

[[Page S6078]]

       (1) In general.--Not later than 60 days after the date of 
     enactment of this Act, the Secretary shall submit to the 
     appropriate committees of Congress 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. 1419. 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 cooperation with relevant stakeholders and the 
     Director of the Centers for Disease Control and Prevention, 
     develop educational materials for clinicians to use with 
     pregnant women for shared decisionmaking regarding pain 
     management 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, support 
     public-private partnerships to assist with education about, 
     and support with respect to, substance use disorder for 
     pregnant women and health care providers who treat pregnant 
     women and babies.''.

     SEC. 1420. 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), by striking ``with findings of any 
     serious violation regarding'' and inserting ``concerning''; 
     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.

                         Subtitle E--Prevention

     SEC. 1501. STUDY ON PRESCRIBING LIMITS.

       Not later than 2 years after the date of enactment of this 
     Act, the Secretary, in consultation with the Attorney 
     General, 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)).

     SEC. 1502. 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(a) of the Public Health Service Act (42 
     U.S.C. 294e-1(a)) is amended--
       (1) in paragraph (1), by inserting ``, trauma,'' after 
     ``focus on child and adolescent mental health''; and
       (2) in paragraphs (2) and (3), by inserting ``trauma-
     informed care and'' before ``substance use disorder 
     prevention and treatment services''.

     SEC. 1503. EDUCATION AND AWARENESS CAMPAIGNS.

       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;
       ``(2) patients, consumers, and other appropriate members of 
     the public, regarding such risks related to unused opioids 
     and the dispensing options under section 309(f) of the 
     Controlled Substances Act, as applicable;
       ``(3) 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

[[Page S6079]]

     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
       ``(4) 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. 1504. ENHANCED CONTROLLED SUBSTANCE OVERDOSES DATA 
                   COLLECTION, ANALYSIS, AND DISSEMINATION.

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

     ``SEC. 392A. ENHANCED CONTROLLED SUBSTANCE OVERDOSES DATA 
                   COLLECTION, ANALYSIS, AND DISSEMINATION.

       ``(a) In General.--The Director of the Centers for Disease 
     Control and Prevention, using the authority provided to the 
     Director under section 392, may--
       ``(1) to the extent practicable, carry out and expand any 
     controlled substance overdose data collection, analysis, and 
     dissemination activity described in subsection (b);
       ``(2) provide training and technical assistance to States, 
     localities, and Indian Tribes for the purpose of carrying out 
     any such activity; and
       ``(3) award grants to States, localities, and Indian Tribes 
     for the purpose of carrying out any such activity.
       ``(b) Controlled Substance Overdose Data Collection and 
     Analysis Activities.--A controlled substance overdose data 
     collection, analysis, and dissemination activity described in 
     this subsection is any of the following activities:
       ``(1) Improving the timeliness of reporting aggregate data 
     to the public, including data on fatal and nonfatal 
     controlled substance overdoses.
       ``(2) 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 department services.
       ``(3) Modernizing the system for coding causes of death 
     related to controlled substance overdoses to use an 
     electronic-based system.
       ``(4) Using data to help identify risk factors associated 
     with controlled substance overdoses, including the delivery 
     of certain health care services.
       ``(5) Supporting entities involved in reporting information 
     on controlled substance overdoses, such as coroners and 
     medical examiners, to improve accurate testing and 
     standardized reporting of causes and contributing factors of 
     such overdoses, and analysis of various opioid analogues to 
     controlled substance overdoses.
       ``(6) Working to enable and encourage the access, exchange, 
     and use of data regarding controlled substances overdoses 
     among data sources and entities.
       ``(c) Definitions.--In this section--
       ``(1) the term `controlled substance' has the meaning given 
     that term in section 102 of the Controlled Substances Act; 
     and
       ``(2) the term `Indian Tribe' has the meaning given the 
     term `Indian tribe' in section 4 of the Indian Self-
     Determination and Education Assistance Act.''.

     SEC. 1505. PREVENTING OVERDOSES OF CONTROLLED SUBSTANCES.

       Part J of title III of the Public Health Service Act (42 
     U.S.C. 280b et seq.), as amended by section 504, is further 
     amended by inserting after section 392A the following:

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

       ``(a) Prevention Activities.--
       ``(1) In general.--The Director of the Centers for Disease 
     Control and Prevention (referred to in this section as the 
     `Director'), using the authority provided to the Director 
     under section 392, may--
       ``(A) to the extent practicable, carry out and expand any 
     prevention activity described in paragraph (2);
       ``(B) provide training and technical assistance to States, 
     localities, and Indian Tribes to carry out any such activity; 
     and
       ``(C) award grants to States, localities, and Indian Tribes 
     for the purpose of carrying out any such activity.
       ``(2) Prevention activities.--A prevention activity 
     described in this paragraph is an activity to improve the 
     efficiency and use of a new or currently operating 
     prescription drug monitoring program, such as--
       ``(A) encouraging all authorized users (as specified by the 
     State or other entity) to register with and use the program;
       ``(B) enabling such users to access any data updates in as 
     close to real-time as practicable;
       ``(C) 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;
       ``(D) 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 alcohol and drug 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;
       ``(E) enhancing interoperability between the program and 
     any health information technology (including certified health 
     information technology), including by integrating program 
     data into such technology;
       ``(F) updating program capabilities to respond to 
     technological innovation for purposes of appropriately 
     addressing the occurrence and evolution of controlled 
     substance overdoses;
       ``(G) developing or enhancing data exchange with other 
     sources such as the Medicaid agency, the Medicare program, 
     pharmacy benefit managers, coroners' reports, and workers' 
     compensation data;
       ``(H) facilitating and encouraging data exchange between 
     the program and the prescription drug monitoring programs of 
     other States;
       ``(I) enhancing data collection and quality, including 
     improving patient matching and proactively monitoring data 
     quality; and
       ``(J) providing prescriber and dispenser practice tools, 
     including prescriber practice insight reports for 
     practitioners to review their prescribing patterns in 
     comparison to such patters of other practitioners in the 
     specialty.
       ``(b) Additional Grants.--The Director may award grants to 
     States, localities, and Indian Tribes--
       ``(1) 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
       ``(2) for any other evidence-based activity for preventing 
     controlled substance misuse, abuse, and overdoses as the 
     Director determines appropriate.
       ``(c) 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.
       ``(d) Public and Prescriber Education.--Pursuant to section 
     102 of the Comprehensive Addiction and Recovery Act of 2016, 
     the Director may advance the education and awareness of 
     prescribers and the public regarding the risk of abuse and 
     misuse of prescription opioids.
       ``(e) Definitions.--In this section--
       ``(1) the term `controlled substance' has the meaning given 
     that term in section 102 of the Controlled Substances Act; 
     and
       ``(2) the term `Indian Tribe' has the meaning given the 
     term `Indian tribe' in section 4 of the Indian Self-
     Determination and Education Assistance Act.
       ``(f) Authorization of Appropriations.--For purposes of 
     carrying out this section, section 392A of this Act, and 
     section 102 of the Comprehensive Addiction and Recovery Act 
     of 2016, there is authorized to be appropriated $486,000,000 
     for each of fiscal years 2019 through 2024.''.

     SEC. 1506. 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 in fiscal year 2019 and every 2 years thereafter.
       (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 tribal 
     and 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 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 such sums as 
     may be necessary for the period of fiscal years 2019 through 
     2021.

     SEC. 1507. REAUTHORIZATION OF NASPER.

       Section 399O of the Public Health Service Act (42 U.S.C. 
     280g-3) is amended--
       (1) in subsection (a)--
       (A) in paragraph (1), in the matter preceding subparagraph 
     (A), by striking ``in consultation with the Administrator of 
     the Substance Abuse and Mental Health Services Administration 
     and Director of the Centers

[[Page S6080]]

     for Disease Control and Prevention'' and inserting ``in 
     coordination with the Director of the Centers for Disease 
     Control and the heads of other departments and agencies as 
     appropriate''; and
       (B) by adding at the end the following:
       ``(4) States and local governments.--
       ``(A) In general.--In the case of a State that does not 
     have a prescription drug monitoring program, a county or 
     other unit of local government within the State that has a 
     prescription drug monitoring program shall be treated as a 
     State for purposes of this section, including for purposes of 
     eligibility for grants under paragraph (1).
       ``(B) Plan for interoperability.--For purposes of meeting 
     the interoperability requirements under subsection (c)(3), a 
     county or other unit of local government shall submit a plan 
     outlining the methods such county or unit of local government 
     will use to ensure the capability of data sharing with other 
     counties and units of local government within the State and 
     with other States, as applicable.'';
       (2) in subsection (c)--
       (A) in paragraph (1)(A)(iii)--
       (i) by inserting ``as such standards become available,'' 
     after ``interoperability standards,''; and
       (ii) by striking ``generated or identified by the Secretary 
     or his or her designee'' and inserting ``recognized by the 
     Office of the National Coordinator for Health Information 
     Technology''; and
       (B) in paragraph (3)(A), by inserting ``including 
     electronic health records,'' after ``technology systems,'';
       (3) in subsection (d)(1), by striking ``not later than 1 
     week after the date of such dispensing'' and inserting ``in 
     as close to real time as practicable'';
       (4) in subsection (f)--
       (A) in paragraph (1)(D), by striking ``medicaid'' and 
     inserting ``Medicaid''; and
       (B) in paragraph (2)--
       (i) in subparagraph (A), by striking ``and'' at the end;
       (ii) in subparagraph (B), by striking the period and 
     inserting a semicolon; and
       (iii) by adding at the end the following:
       ``(C) 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
       ``(D) 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.'';
       (5) in subsection (i), by inserting ``, in collaboration 
     with the National Coordinator for Health Information 
     Technology and the Director of the National Institute of 
     Standards and Technology,'' after ``The Secretary''; and
       (6) in subsection (n), by striking ``2021'' and inserting 
     ``2026''.

     SEC. 1508. JESSIE'S LAW.

       (a) Best Practices.--
       (1) In general.--Not later than 1 year after the date of 
     enactment of this Act, 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. 1509. 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, 
     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, such sums as 
     may be necessary for each of fiscal years 2019 through 2023.

     SEC. 1510. COMMUNICATION WITH FAMILIES DURING EMERGENCIES.

       (a) Promoting Awareness of Authorized Disclosures During 
     Emergencies.--The Secretary shall annually notify health care 
     providers regarding permitted disclosures during emergencies, 
     including overdoses, of certain health information to 
     families and caregivers under Federal health care privacy 
     laws and regulations.
       (b) Use of Material.--For the purposes of carrying out 
     subsection (a), the Secretary may use material produced under 
     section 1509 of this Act or under section 11004 of the 21st 
     Century Cures Act (42 U.S.C. 1320d-2 note).

     SEC. 1511. 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 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) to inform such analysis, additional information or 
     data on family health history, medication exposures during 
     pregnancy, demographic information, such as race, ethnicity, 
     geographic location, and family history, and other relevant 
     information, as appropriate;'';
       (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 
     ``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 ``substance abuse and misuse; and''; and

[[Page S6081]]

       (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. 1512. 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--
       (1) by amending the section heading to read as follows: 
     ``surveillance and education regarding infections associated 
     with illicit drug use and other risk factors'';
       (2) in subsection (a)--
       (A) in the matter preceding paragraph (1), by inserting 
     ``activities'' before the colon;
       (B) in paragraph (1)--
       (i) by inserting ``or maintaining'' after ``implementing'';
       (ii) by striking ``hepatitis C virus infection (in this 
     section referred to as `HCV infection')'' and inserting 
     ``infections commonly associated with illicit drug use, which 
     may include viral hepatitis, human immunodeficiency virus, 
     and infective endocarditis,''; and
       (iii) by striking ``such infection'' and all that follows 
     through the period at the end and inserting ``such 
     infections, which may include the reporting of cases of such 
     infections.'';
       (C) in paragraph (2), by striking ``HCV infection'' and all 
     that follows through the period at the end and inserting 
     ``infections as a result of illicit drug use, receiving blood 
     transfusions prior to July 1992, or other risk factors.'';
       (D) in paragraphs (4) and (5), by striking ``HCV 
     infection'' each place such term appears and inserting 
     ``infections described in paragraph (1)''; and
       (E) in paragraph (5), by striking ``pediatricians and other 
     primary care physicians, and obstetricians and 
     gynecologists'' and inserting ``substance use disorder 
     treatment providers, pediatricians, other primary care 
     providers, and obstetrician-gynecologists'';
       (3) in subsection (b)--
       (A) by striking ``directly and'' and inserting ``directly 
     or''; and
       (B) by striking ``hepatitis C,'' and all that follows 
     through the period at the end and inserting ``infections 
     described in subsection (a)(1).''; and
       (4) in subsection (c), by striking ``such sums as may be 
     necessary for each of the fiscal years 2001 through 2005'' 
     and inserting ``$40,000,000 for each of fiscal years 2019 
     through 2023''.

     SEC. 1513. 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 
     best practices with respect to children and youth, and their 
     families as appropriate, who have experienced or are at risk 
     of experiencing 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.
       (L) The Administration for Children and Families.
       (M) The Office of the Assistant Secretary for Planning and 
     Evaluation.
       (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 6 months 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.
       (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) the identification of infants, children and youth, and 
     their families as appropriate, who have experienced or are at 
     risk of experiencing trauma; and
       (ii) the expeditious referral to and implementation of 
     trauma-informed practices and supports that prevent and 
     mitigate the effects of trauma;
       (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 data 
     sharing and the awarding of grants that support infants, 
     children, and youth, and their families as appropriate, who 
     have experienced or are at risk of experiencing trauma; 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 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;
       (B) providing practices to prevent and mitigate the impact 
     of trauma, including by fostering safe and stable 
     environments and relationships; and

[[Page S6082]]

       (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, including 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 
     health care service providers with expertise in providing 
     support services (including 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 and 
     improve processes for trauma-informed support and outcomes 
     that are culturally sensitive, linguistically appropriate, 
     and specific to age ranges and sex, as applicable; and
       (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.
       (e) Operating Plan.--Not later than 1 year 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; and
       (6) other information that the task force determines 
     appropriate.
       (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, and other 
     relevant cabinet Secretaries, and Congress, a final report 
     containing all of the findings and recommendations required 
     under this section.
       (g) Definition.--In this section, 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).
       (h) Authorization of Appropriations.--To carry out this 
     section, there is authorized to be appropriated such sums as 
     may be necessary for each of fiscal years 2019 through 2022.
       (i) Sunset.--The task force shall on the date that is 60 
     days after the submission of the final report under 
     subsection (f), but not later than September 30, 2022.

     SEC. 1514. 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, Head Start agencies (including 
     Early Head Start agencies), State or local agencies that 
     administer public preschool programs, Indian Tribes or their 
     tribal educational agencies, a school operated by the Bureau 
     of Indian Education, a Regional Corporation (as defined in 
     section 3 of the Alaska Native Claims Settlement Act (43 
     U.S.C. 1602)), or a Native Hawaiian educational organization 
     (as defined in section 6207 of the Elementary and Secondary 
     Education Act of 1965 (20 U.S.C. 7517)), 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 by providing universal trauma screenings to 
     identify students in need of specialized support.
       (2) To implement schoolwide multi-tiered 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 developed by the 
     Interagency Task Force on Trauma-Informed Care established 
     under section 513.
       (4) To create or enhance services at a full-service 
     community school that focuses on trauma-informed supports, 
     which may include establishing a school-site advisory team, 
     managing, coordinating, or delivering pipeline services, 
     hiring 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.
       (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.
       (e) Interagency Agreements.--
       (1) Designation of lead agency.--A recipient of a grant, 
     contract, or cooperative agreement under this section shall 
     designate a lead agency to direct the establishment of an 
     interagency agreement among local educational agencies, 
     agencies responsible for early childhood education programs, 
     juvenile justice authorities, mental health agencies, child 
     welfare agencies, and other relevant entities in the State or 
     Indian Tribe, in collaboration with local entities.
       (2) Contents.--The interagency agreement shall ensure the 
     provision of the services described in subsection (c), 
     specifying with respect to each agency, authority, or 
     entity--
       (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 the 
     agencies, authorities, or entities that are parties to the 
     interagency agreement, including procedures for dispute 
     resolution.
       (f) Evaluation.--The Secretary shall reserve not to exceed 
     3 percent of the funds

[[Page S6083]]

     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, engage, and cooperate with Indian 
     Tribes and their representatives to ensure notice of 
     eligibility.
       (k) Definitions.--In this section:
       (1) Elementary or secondary school.--The term ``elementary 
     or secondary school'' means a public elementary and secondary 
     school as such term is defined 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) Pipeline services.--The term ``pipeline services'' has 
     the meaning given such term in section 4622 of the Elementary 
     and Secondary Education Act of 1965 (20 U.S.C. 7517).
       (5) 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).
       (6) Secretary.--The term ``Secretary'' means the Secretary 
     of Education.
       (7) 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).
       (l) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary for each of fiscal years 2019 through 2023.

     SEC. 1515. 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 ``$53,887,000 for each of fiscal years 
     2019 through 2023''.

     SEC. 1516. 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, in consultation 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 misuse and abuse 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 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.

                           TITLE II--FINANCE

     SEC. 2001. SHORT TITLE.

       This title may be cited as the ``Helping to End Addiction 
     and Lessen Substance Use Disorders Act of 2018'' or the 
     ``HEAL Act of 2018''.

                          Subtitle A--Medicare

     SEC. 2101. 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.

     SEC. 2102. 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 January 1, 2019, 
     to an eligible telehealth individual with a substance use 
     disorder diagnosis for purposes of treatment of such 
     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.--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--
       (1) 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

[[Page S6084]]

       (2) health outcomes related to substance use disorders, 
     such as opioid overdose deaths.

     SEC. 2103. 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 pain management 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) Effective Date.--The amendments made by this section 
     shall apply to examinations and visits furnished on or after 
     January 1, 2019.

     SEC. 2104. 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.

     SEC. 2105. STANDARDIZING ELECTRONIC PRIOR AUTHORIZATION FOR 
                   SAFE PRESCRIBING.

       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 transmittal 
     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. 2106. STRENGTHENING PARTNERSHIPS TO PREVENT OPIOID 
                   ABUSE.

       (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 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 any successor entity to a 
     Medicare drug integrity contractor), in accordance with 
     subsection (j)(3) of such section, for the purpose of 
     enabling through such portal--
       ``(i) the referral by such plans of suspicious activities 
     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 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.

[[Page S6085]]

       ``(iv) In the case of such a plan that makes a referral 
     under subparagraph (A)(i) through the portal with respect to 
     suspicious activities of a provider of services (including a 
     prescriber) or supplier, if such provider (or 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 
     suspicious activities related to fraud, waste, and abuse, 
     using guidance such as what is provided in the Medicare 
     Program Integrity Manual 4.7.1.
       ``(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 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)(4)(C) of the Social Security Act (42 U.S.C. 1395w-
     27(e)(4)(C)) 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 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 of opioids' and a method for determining if a 
     provider of services prescribes such a high volume; and
       ``(ii) establish the process described in subparagraph (B) 
     and the types of information that may 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. 2107. 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 statistical 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 a statistical outlier 
     prescriber of opioids, provide, subject to clause (iv), an 
     annual notification to such prescriber that such prescriber 
     has been so identified that includes resources on proper 
     prescribing methods and other information as specified in 
     accordance with clause (iii).
       ``(ii) Identification of statistical 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 
     statistical 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, as determined 
     appropriate by the Secretary, geographic area, for 
     identifying whether a prescriber in a specialty and 
     geographic area is a statistical 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 statistical 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, if determined 
     appropriate by the Secretary, 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 statistical 
     outlier prescribers.--In the case of a prescriber who the 
     Secretary determines is persistently identified under clause 
     (ii) as a statistical outlier prescriber of opioids, the 
     following shall apply:

       ``(I) The Secretary shall provide an opportunity for such 
     prescriber to receive technical assistance or educational 
     resources on opioid prescribing guidelines (such as the 
     guidelines described in clause (iii)(II)) from an entity that 
     furnishes such assistance or resources, which may include a 
     quality improvement organization under part B of title XI, as 
     available and appropriate.
       ``(II) 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. The Secretary 
     shall determine the length of the period for which such 
     prescriber is required to maintain such enrollment.
       ``(III) Not less frequently than annually (and in a form 
     and manner determined appropriate by the Secretary), the 
     Secretary 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. 2108. FIGHTING THE OPIOID EPIDEMIC WITH SUNSHINE.

       (a) Inclusion of Information Regarding Payments to Advance 
     Practice Nurses.--
       (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.

[[Page S6086]]

       (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.

     SEC. 2109. DEMONSTRATION TESTING COVERAGE OF CERTAIN SERVICES 
                   FURNISHED BY OPIOID TREATMENT PROGRAMS.

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


   ``demonstration testing coverage of certain services furnished by 
                       opioid treatment programs

       ``Sec. 1866F.  (a) Establishment.--
       ``(1) In general.--The Secretary shall conduct a 
     demonstration (in this section referred to as the 
     `demonstration') to test coverage of and payment for opioid 
     use disorder treatment services (as defined in paragraph 
     (2)(B)) furnished by opioid treatment programs (as defined in 
     paragraph (2)(A)) to individuals under part B using a bundled 
     payment as described in paragraph (3).
       ``(2) Definitions.--In this section:
       ``(A) 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--
       ``(i) is selected for participation in the demonstration;
       ``(ii) has in effect a certification by the Substance Abuse 
     and Mental Health Services Administration for such a program;
       ``(iii) is accredited by an accrediting body approved by 
     the Substance Abuse and Mental Health Services 
     Administration;
       ``(iv) submits to the Secretary data and information needed 
     to monitor the quality of services furnished and conduct the 
     evaluation described in subsection (c); and
       ``(v) meets such additional requirements as the Secretary 
     may find necessary.
       ``(B) 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--
       ``(i) 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;
       ``(ii) dispensing and administration of such medications, 
     if applicable;
       ``(iii) substance use counseling by a professional to the 
     extent authorized under State law to furnish such services;
       ``(iv) individual and group therapy with a physician or 
     psychologist (or other mental health professional to the 
     extent authorized under State law);
       ``(v) toxicology testing; and
       ``(vi) other items and services that the Secretary 
     determines are appropriate (but in no case to include meals 
     or transportation).
       ``(3) Bundled payment under part b.--
       ``(A) In general.--The Secretary shall pay, from the 
     Federal Supplementary Medical Insurance Trust Fund under 
     section 1841, to an opioid treatment program participating in 
     the demonstration a bundled payment as determined by the 
     Secretary for opioid use disorder treatment services that are 
     furnished by such treatment program to an individual under 
     part B during an episode of care (as defined by the 
     Secretary).
       ``(B) Considerations.--The Secretary may implement this 
     paragraph 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 furnished, the scope of services furnished, 
     characteristics of the individuals furnished such services, 
     or other factors as the Secretary determines 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.
       ``(b) Implementation.--
       ``(1) Duration.--The demonstration shall be conducted for a 
     period of 5 years, beginning not later than January 1, 2021.
       ``(2) Scope.--In carrying out the demonstration, the 
     Secretary shall limit the number of beneficiaries that may 
     participate at any one time in the demonstration to 2,000.
       ``(3) Waiver.--The Secretary may waive such provisions of 
     this title and title XI as the Secretary determines necessary 
     in order to implement the demonstration.
       ``(4) Administration.--Chapter 35 of title 44, United 
     States Code, shall not apply to this section.
       ``(c) Evaluation and Report.--
       ``(1) Evaluation.--The Secretary shall conduct an 
     evaluation of the demonstration. Such evaluation shall 
     include analyses of--
       ``(A) the impact of the demonstration on--
       ``(i) utilization of health care items and services related 
     to opioid use disorder, including hospitalizations and 
     emergency department visits;
       ``(ii) beneficiary health outcomes related to opioid use 
     disorder, including opioid overdose deaths; and
       ``(iii) overall expenditures under this title; and
       ``(B) the performance of opioid treatment programs 
     participating in the demonstration with respect to applicable 
     quality and cost metrics, including whether any additional 
     quality measures related to opioid use disorder treatment are 
     needed with respect to such programs under this title.
       ``(2) Report.--Not later than 2 years after the completion 
     of the demonstration, the Secretary 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 Secretary 
     determines appropriate.
       ``(d) Funding.--For purposes of administering and carrying 
     out the demonstration, in addition to funds otherwise 
     appropriated, there shall be transferred to the Secretary for 
     the Center for Medicare & Medicaid Services Program 
     Management Account from the Federal Supplementary Medical 
     Insurance Trust Fund under section 1841 $5,000,000, to remain 
     available until expended.''.

     SEC. 2110. 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. 2111. 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. 2112. 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 incentive payments to behavioral health 
     providers for the adoption and use of certified electronic 
     health record 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. 
     Behavioral health providers may include--

       ``(I) psychiatric hospitals (as defined in section 
     1861(f));
       ``(II) community mental health centers (as defined in 
     section 1861(ff)(3)(B));
       ``(III) clinical psychologists (as defined in section 
     1861(ii));
       ``(IV) clinical social workers (as defined in section 
     1861(hh)(1)); and
       ``(V) hospitals, treatment facilities, and mental health or 
     substance use disorder providers that participate in a State 
     plan under title XIX or a waiver of such plan.''.

     SEC. 2113. MEDICARE IMPROVEMENT FUND.

       Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
     1395iii(b)(1)) is amended by striking ``fiscal year 2021, 
     $0'' and inserting ``fiscal year 2024, $65,000,000''.

                          Subtitle B--Medicaid

     SEC. 2201. CARING RECOVERY FOR INFANTS AND BABIES.

       (a) State Plan Amendment.--Section 1902(a) of the Social 
     Security Act (42 U.S.C. 1396a(a)) is amended--
       (1) in paragraph (82), by striking ``and'' after the 
     semicolon;

[[Page S6087]]

       (2) in paragraph (83), by striking the period at the end 
     and inserting ``; and''; and
       (3) by inserting after paragraph (83), the following new 
     paragraph:
       ``(84) 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 (nn)) to infants with neonatal abstinence 
     syndrome.''.
       (b) Residential Pediatric Recovery Center Defined.--Section 
     1902 of such Act (42 U.S.C. 1396a) is amended by adding at 
     the end the following new subsection:
       ``(nn) Residential Pediatric Recovery Center Defined.--
       ``(1) In general.--For purposes of section 1902(a)(84), 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. 2202. 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. 2203. 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) Teleheath services.--The term ``telehealth services'' 
     includes remote patient monitoring and other key modalities 
     such as live video or synchronous telehealth, store-and-
     forward or asynchronous telehealth, mobile health, telephonic 
     consultation, and electronic consult including provider-to-
     provider e-consults.
       (5) 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 Telehealth Services, 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, and medication management, 
     using telehealth services. 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 nonfatal overdose.
       (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 telehealth services.
       (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 telehealth services, 
     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 Telehealth 
     Services 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 Representative identifying best practices and 
     potential solutions for reducing barriers to using telehealth 
     services 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 telehealth services 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 telehealth services 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. 2204. 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. 2205. 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.

[[Page S6088]]

     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. 2206. HELP FOR MOMS AND BABIES.

       (a) Medicaid State Plan.--Section 1905(a) of the Social 
     Security Act (42 U.S.C. 1396d(a)) is 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 (29) 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. 2207. 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. 2208. 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. 2209. 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 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 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 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 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

[[Page S6089]]

     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 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. 2210. 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 2207, is 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 (42 U.S.C. 1396b(m)(8)) 
     (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. 2211. 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.'';
       (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))''.

     SEC. 2212. 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 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. 2213. 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).

                       Subtitle C--Human Services

     SEC. 2301. 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

[[Page S6090]]

     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. 2302. 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

[[Page S6091]]

     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. 2303. 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 D--Synthetics Trafficking and Overdose Prevention

     SEC. 2401. SHORT TITLE.

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

     SEC. 2402. 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. 2403. 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

[[Page S6092]]

     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 
     shipment.
       ``(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 one 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

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     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 2402, 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. 2404. 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 2403(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 2403(a)(1), the Secretary of 
     State should expeditiously conclude such an agreement.

     SEC. 2405. 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. 2406. 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. 2407. 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. 2408. 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 7, 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. 2409. EFFECTIVE DATE; REGULATIONS.

       (a) Effective Date.--This subtitle and the amendments made 
     by this subtitle (other than the amendments made by section 
     2402) shall take effect on the date of the enactment of this 
     Act.
       (b) Regulations.--Not later than one 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.

                          TITLE III--JUDICIARY

             Subtitle A--Access to Increased Drug Disposal

     SEC. 3101. SHORT TITLE.

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

     SEC. 3102. DEFINITIONS.

       In this subtitle--
       (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

[[Page S6094]]

     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. 3103. 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. 3104. 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. 3105. 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. 3106. 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. 3107. DURATION OF GRANTS.

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

     SEC. 3108. 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. 3109. 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. 3110. AUTHORIZATION OF APPROPRIATIONS.

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

           Subtitle B--Using Data To Prevent Opioid Diversion

     SEC. 3201. SHORT TITLE.

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

     SEC. 3202. PURPOSE.

       (a) In General.--The purpose of this subtitle 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 subtitle 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. 3203. 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 15th 
     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--
       (1) 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 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. 3204. 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.

                 Subtitle C--Substance Abuse Prevention

     SEC. 3301. SHORT TITLE.

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

     SEC. 3302. 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:

[[Page S6095]]

       (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.--Section 715(a) of the Office of 
     National Drug Control Policy Reauthorization Act of 1998 (21 
     U.S.C. 1712(a)) is amended by striking ``2010'' and inserting 
     ``2022''.

     SEC. 3303. REAUTHORIZATION OF THE DRUG-FREE COMMUNITIES 
                   PROGRAM.

       Section 1024 of the National Narcotics Leadership Act of 
     1988 (21 U.S.C. 1524(a)) is amended 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 2022.
       ``(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.''.

     SEC. 3304. REAUTHORIZATION OF THE NATIONAL COMMUNITY ANTI-
                   DRUG COALITION INSTITUTE.

       Section 4(c)(4) of Public Law 107-82 (21 U.S.C. 1521 note) 
     is amended by striking ``2008 through 2012'' and inserting 
     ``2018 through 2022''.

     SEC. 3305. REAUTHORIZATION OF THE HIGH-INTENSITY DRUG 
                   TRAFFICKING AREA PROGRAM.

       Section 707(p) of the Office of National Drug Control 
     Policy Reauthorization Act of 1998 (21 U.S.C. 1706(p)) is 
     amended--
       (1) in paragraph (4), by striking ``and'' at the end;
       (2) in paragraph (5), by striking the period at the end and 
     inserting ``; and''; and
       (3) by adding at the end the following:
       ``(6) $280,000,000 for each of fiscal years 2018 through 
     2022.''.

     SEC. 3306. 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 2022.''.

     SEC. 3307. 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.--Using funds appropriated to carry out this title, 
     the Director may make grants to nonprofit organizations for 
     the purpose of providing training and technical assistance to 
     drug courts.''.

     SEC. 3308. 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. 3309. 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 3308, 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. 3310. 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 
     to make competitive grants, in amounts of not less than 
     $1,000,000 for a 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. 3311. 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 3310, as subsection (m); and
       (2) by inserting after subsection (k), as added by section 
     3310, 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, 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. 3312. 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 Attorney General 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 private, nonprofit national organizations 
     that engage in all of the following activities:
       ``(1) Expansion of phone line or call 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.
       ``(c) Authorization of Appropriations.--For each of fiscal 
     years 2018 through 2022, the Attorney General is authorized 
     to award not more than $10,000,000 of amounts otherwise 
     appropriated to the Attorney General for comprehensive opioid 
     abuse reduction activities for purposes of carrying out this 
     section.''.

     SEC. 3313. PROTECTING CHILDREN WITH ADDICTED PARENTS.

       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:

     ``SEC. 550. PROTECTING CHILDREN WITH ADDICTED PARENTS.

       ``(a) Best Practices.--The Secretary, acting through the 
     Assistant Secretary and in cooperation with the Commissioner 
     of the Administration on Children, Youth and Families, shall 
     collect and disseminate best practices for States regarding 
     interventions and strategies to keep families affected by a 
     substance use disorder together, when it can be done safely. 
     Such best practices shall--
       ``(1) utilize comprehensive family-centered approaches;
       ``(2) ensure that families have access to drug screening, 
     substance use disorder treatment, medication-assisted 
     treatment approved by the Food and Drug Administration, and 
     parental support; and
       ``(3) build upon lessons learned from--
       ``(A) programs such as the maternal, infant, and early 
     childhood home visiting program under section 511 of the 
     Social Security Act; and
       ``(B) identifying substance abuse prevention and treatment 
     services that meet the requirements for promising, supported, 
     or

[[Page S6096]]

     well-supported practices specified in section 471(e)(4)(C) of 
     the Social Security Act (as such section shall be in effect 
     beginning on October 1, 2018).
       ``(b) Grant Program.--The Secretary shall award grants to 
     States, units of local government, and tribal governments 
     to--
       ``(1) develop programs and models designed to keep pregnant 
     and post-partum women who have a substance use disorder 
     together with their newborns, including programs and models 
     that provide for screenings of pregnant and post-partum women 
     for substance use disorders, treatment interventions, 
     supportive housing, nonpharmacological interventions for 
     children born with neonatal abstinence syndrome, medication 
     assisted treatment, and other recovery supports; and
       ``(2) support the attendance of children who have a family 
     member living with a substance use disorder at therapeutic 
     camps or other therapeutic programs aimed at addiction 
     prevention education and delaying the onset of first use, 
     providing trusted mentors and education on coping strategies 
     that these children can use in their daily lives, and family 
     support initiatives aimed at keeping these families 
     together.''.

     SEC. 3314. 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. 3315. SOBRIETY TREATMENT AND RECOVERY TEAMS (START).

       Title V of the Public Health Service Act (42 U.S.C. 290dd 
     et seq.), as amended by section 3313, is further amended by 
     adding at the end the following:

     ``SEC. 551. 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.
       ``(e) Authorization of Appropriations.--For each of fiscal 
     years 2018 through 2022, the Secretary is authorized to award 
     not more than $10,000,000 of amounts otherwise appropriated 
     to the Secretary for comprehensive opioid abuse reduction 
     activities for purposes of carrying out this section.''.

     SEC. 3316. 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. 3317. DEMAND REDUCTION.

       Section 702(1) of the Office of National Drug Control 
     Policy Reauthorization Act of 1998 (21 U.S.C. 1701(1)) is 
     amended--
       (1) by redesignating subparagraphs (F) through (J) as 
     subparagraphs (G) through (K), respectively; and
       (2) by inserting after subparagraph (E) the following:
       ``(F) support for long-term recovery from substance use 
     disorders;''.

     SEC. 3318. ANTI-DRUG MEDIA CAMPAIGN.

       Section 709 of the Office of National Drug Control Policy 
     Reauthorization Act of 1998 (21 U.S.C. 1708) is amended--
       (1) in the section heading, by striking ``youth'';
       (2) in subsection (a)--
       (A) in the matter preceding paragraph (1), by striking 
     ``youth'';
       (B) in paragraph (1), by striking ``young'';
       (C) in paragraph (2), by striking ``of adults of the impact 
     of drug abuse on young people'' and inserting ``among the 
     population about the impact of drug abuse''; and
       (D) in paragraph (3), by striking ``parents and other 
     interested adults to discuss with young people'' and 
     inserting ``interested persons to discuss''; and
       (3) in subsection (b)(2)(C)(ii), by striking ``among 
     youth''.

     SEC. 3319. TECHNICAL CORRECTIONS 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) in section 703(b)(3)(E) (21 U.S.C. 1702(b)(3)(E))--
       (A) in clause (i), by adding ``and'' at the end;
       (B) in clause (ii), by striking ``; and'' and inserting a 
     period; and
       (C) by striking clause (iii);
       (2) in section 704 (21 U.S.C. 1703)--
       (A) in subsection (c)(3)(C)--
       (i) in clause (v), by adding ``and'' at the end;
       (ii) in clause (vi), by striking ``; and'' and inserting a 
     period; and
       (iii) by striking clause (vii); and
       (B) in subsection (f)--
       (i) by striking the first paragraph (5); and
       (ii) by striking the second paragraph (4);
       (3) in section 706(a)(2)(A) (21 U.S.C. 1705(a)(2)(A))--
       (A) by striking clause (ix); and
       (B) by redesignating clauses (x) through (xiv) as clauses 
     (ix) through (xiii), respectively; and
       (4) by striking section 708 (21 U.S.C. 1707).

      Subtitle D--Synthetic Abuse and Labeling of Toxic Substances

     SEC. 3401. SHORT TITLE.

       This subtitle may be cited as the ``Synthetic Abuse and 
     Labeling of Toxic Substances Act of 2017'' or the ``SALTS 
     Act''.

     SEC. 3402. 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), evidence related to the following factors may 
     be considered, along with all other relevant evidence:
       ``(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.
       ``(c) Limitation.--For purposes of this section, the 
     existence of evidence that a substance was not marketed, 
     advertised, or labeled for human consumption shall not 
     preclude the Government from establishing, based on all the 
     evidence, that the substance was intended for human 
     consumption.''.

                    Subtitle E--Opioid Quota Reform

     SEC. 3501. SHORT TITLE.

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

     SEC. 3502. 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--

[[Page S6097]]

       ``(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 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 Caucus on International Narcotics 
     Control, 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''.

                 Subtitle F--Preventing Drug Diversion

     SEC. 3601. SHORT TITLE.

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

     SEC. 3602. 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' includes--
       ``(A) an order of a controlled substance of unusual size;
       ``(B) an order of a controlled substance deviating 
     substantially from a normal pattern;
       ``(C) orders of controlled substances of unusual frequency; 
     and
       ``(D) an order having any characteristic that would 
     indicate to a reasonable registrant that it is suspicious or 
     not legitimate.''.
       (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 subtitle.
       (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.

                     Subtitle G--Sense of Congress

     SEC. 3701. SENSE OF CONGRESS.

       It is the sense of Congress that:
       (1) Americans with substance use disorders often seek 
     treatment through recovery homes and clinical treatment 
     facilities that offer detoxification, risk reduction, 
     outpatient treatment, residential treatment, or 
     rehabilitation for substance use. Most of those facilities 
     provide a critical function in addressing substance misuse 
     and abuse, particularly as the incidence and prevalence of 
     substance use disorders, and drug overdose numbers continue 
     to rise.
       (2) Despite the necessity of such treatment facilities and 
     the important services most provide, there are some bad 
     actors in the industry who, through telemarketing and other 
     schemes, actively recruit patients with private insurance so 
     that programs can bill the insurers without providing the 
     necessary treatment services. Often these ``patient brokers'' 
     are paid for each patient successfully recruited. Payments 
     are also made as a percentage of billings, which incentivizes 
     brokers to recommend patients even at low risk levels to the 
     most aggressive and most expensive treatment programs.
       (3) Unless the patient is enrolled in a Federal health care 
     program, a gap in Federal law exists with respect to patient 
     brokers who are improperly recruiting unsuspecting patients 
     to defraud insurance companies.
       (4) It is important that Congress provide a mechanism to 
     penalize these bad actors, while minding legitimate entities 
     who continue to help patients find reputable treatment 
     programs.

[[Page S6098]]

  


                           TITLE IV--COMMERCE

          Subtitle A--Fighting Opioid Abuse in Transportation

     SEC. 4101. SHORT TITLE.

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

     SEC. 4102. RAIL MECHANICAL EMPLOYEE CONTROLLED SUBSTANCES AND 
                   ALCOHOL TESTING.

       (a) Rail Mechanical Employees.--Not later than 2 years 
     after the date of enactment of this Act, the Secretary of 
     Transportation shall publish a final rule in the Federal 
     Register revising the regulations promulgated under section 
     20140 of title 49, United States Code, to designate a rail 
     mechanical employee as a railroad employee responsible for 
     safety-sensitive functions for purposes of that section.
       (b) Definition of Rail Mechanical Employee.--The Secretary 
     shall define the term ``rail mechanical employee'' by 
     regulation under subsection (a).
       (c) Savings Clause.--Nothing in this section may be 
     construed as limiting or otherwise affecting the discretion 
     of the Secretary of Transportation to set different 
     requirements by railroad size or other factors, consistent 
     with applicable law.

     SEC. 4103. RAIL YARDMASTER CONTROLLED SUBSTANCES AND ALCOHOL 
                   TESTING.

       (a) Yardmasters.--Not later than 2 years after the date of 
     enactment of this Act, the Secretary of Transportation shall 
     publish a final rule in the Federal Register revising the 
     regulations promulgated under section 20140 of title 49, 
     United States Code, to designate a yardmaster as a railroad 
     employee responsible for safety-sensitive functions for 
     purposes of that section.
       (b) Definition of Yardmaster.--The Secretary shall define 
     the term ``yardmaster'' by regulation under subsection (a).
       (c) Savings Clause.--Nothing in this section may be 
     construed as limiting or otherwise affecting the discretion 
     of the Secretary of Transportation to set different 
     requirements by railroad size or other factors, consistent 
     with applicable law.

     SEC. 4104. 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 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. 4105. 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 4104, 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 4104.
       (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 4104 could be made more effective; and
       (4) such other recommendations as the Comptroller General 
     considers appropriate.

     SEC. 4106. TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING 
                   PROGRAM; ADDITION OF FENTANYL.

       (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 determine whether a revision of the Mandatory 
     Guidelines for Federal Workplace Drug Testing Programs to 
     expand the opioid category on the list of authorized drug 
     testing to include fentanyl is justified, based on the 
     reliability and cost-effectiveness of available testing.
       (2) Revision of guidelines.--If the expansion of the opioid 
     category 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 opioid category on the list of authorized drug 
     testing to include fentanyl.
       (3) Report.--If the expansion of the opioid category 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 opioid category on 
     the list of authorized drugs to include fentanyl is not 
     justified.
       (b) Department of Transportation Drug-testing Panel.--If 
     the expansion of the opioid category 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 
     fentanyl 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 4107 and 4108 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 drug testing 
     to include an additional substance.

     SEC. 4107. STATUS REPORTS ON HAIR TESTING GUIDELINES.

       (a) In General.--Not later than 30 days after the date of 
     enactment of this Act, and every 180 days 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;
       (3) a schedule, including benchmarks, for the completion of 
     the hair testing guidelines; and
       (4) 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. 4108. 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 (80 Fed. 
     Reg. 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

[[Page S6099]]

     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. 4109. 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. 4110. STATUS REPORTS ON COMMERCIAL DRIVER'S LICENSE DRUG 
                   AND ALCOHOL CLEARINGHOUSE.

       (a) In General.--Not later than 180 days after the date of 
     enactment of this Act, and biannually 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 Fed. Reg. 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 B--Opioid Addiction Recovery Fraud Prevention

     SEC. 4201. SHORT TITLE.

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

     SEC. 4202. DEFINITIONS.

       In this subtitle:
       (1) Opioid treatment product.--The term ``opioid treatment 
     product'' means a product, including any supplement or 
     medication, for use or marketed for use in the treatment, 
     cure, or prevention of an opioid use disorder.
       (2) Opioid treatment program.--The term ``opioid treatment 
     program'' means a program that provides treatment for people 
     diagnosed with, having, or purporting to have an opioid use 
     disorder.
       (3) Opioid use disorder.--The term ``opioid use disorder'' 
     means a cluster of cognitive, behavioral, or physiological 
     symptoms in which the individual continues use of opioids 
     despite significant opioid-induced problems, such as adverse 
     health effects.

     SEC. 4203. FALSE OR MISLEADING REPRESENTATIONS WITH RESPECT 
                   TO OPIOID TREATMENT PROGRAMS AND PRODUCTS.

       (a) Unlawful Activity.--It is unlawful to make any 
     deceptive representation with respect to the cost, price, 
     efficacy, performance, benefit, risk, or safety of any opioid 
     treatment program or opioid 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) Enforcement by States.--
       (1) In general.--Except as provided in paragraph (4), in 
     any case in which the attorney general of a State has reason 
     to believe that an interest of the residents of the State has 
     been or is threatened or adversely affected by any person who 
     violates subsection (a), the attorney general of the State, 
     as parens patriae, may bring a civil action on behalf of the 
     residents of the State in an appropriate district court of 
     the United States to obtain appropriate relief.
       (2) Rights of federal trade commission.--
       (A) Notice to federal trade commission.--
       (i) In general.--Except as provided in clause (iii), the 
     attorney general of a State shall notify the Federal Trade 
     Commission in writing that the attorney general intends to 
     bring a civil action under paragraph (1) before initiating 
     the civil action.
       (ii) Contents.--The notification required by clause (i) 
     with respect to a civil action shall include a copy of the 
     complaint to be filed to initiate the civil action.
       (iii) Exception.--If it is not feasible for the attorney 
     general of a State to provide the notification required by 
     clause (i) before initiating a civil action under paragraph 
     (1), the attorney general shall notify the Federal Trade 
     Commission immediately upon instituting the civil action.
       (B) Intervention by federal trade commission.--The Federal 
     Trade Commission may--
       (i) intervene in any civil action brought by the attorney 
     general of a State under paragraph (1); and
       (ii) upon intervening--

       (I) be heard on all matters arising in the civil action; 
     and
       (II) file petitions for appeal.

       (3) Investigatory powers.--Nothing in this subsection shall 
     be construed to prevent the attorney general of a State from 
     exercising the powers conferred on the attorney general by 
     the laws of the State to conduct investigations, to 
     administer oaths or affirmations, or to compel the attendance 
     of witnesses or the production of documentary or other 
     evidence.
       (4) Preemptive action by federal trade commission.--If the 
     Federal Trade Commission or the Attorney General on behalf of 
     the Commission institutes a civil action, or the Federal 
     Trade Commission institutes an administrative action, with 
     respect to a violation of subsection (a), the attorney 
     general of a State may not, during the pendency of that 
     action, bring a civil action under paragraph (1) against any 
     defendant or respondent named in the complaint of the 
     Commission for the violation with respect to which the 
     Commission instituted such action.
       (5) Venue; service of process.--
       (A) Venue.--Any action brought under paragraph (1) may be 
     brought in any district court of the United States that meets 
     applicable requirements relating to venue under section 1391 
     of title 28, United States Code.
       (B) Service of process.--In an action brought under 
     paragraph (1), process may be served in any district in which 
     the defendant--
       (i) is an inhabitant; or
       (ii) may be found.
       (6) Actions by other state officials.--In addition to civil 
     actions brought by attorneys general under paragraph (1), any 
     other consumer protection officer of a State who is 
     authorized by the State to do so may bring a civil action 
     under paragraph (1), subject to the same requirements and 
     limitations that apply under this subsection to civil actions 
     brought by attorneys general.
       (d) Authority Preserved.--Nothing in this title shall be 
     construed to limit the authority of the Federal Trade 
     Commission or the Food and Drug Administration under any 
     other provision of law.
                                 ______
                                 
  SA 4014. Mr. McCONNELL (for Mr. Alexander) proposed an amendment to 
the bill H.R. 302, to provide protections for certain sports medicine 
professionals who provide certain medical services in a secondary 
State; as follows:

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the Sports Medicine Licensure 
     Clarity Act of 2017.

     SEC. 2. PROTECTIONS FOR COVERED SPORTS MEDICINE 
                   PROFESSIONALS.

       (a) In General.--In the case of a covered sports medicine 
     professional who has in effect medical professional liability 
     insurance coverage and provides in a secondary State covered 
     medical services that are within the scope of practice of 
     such professional in the primary State to an athlete or an 
     athletic team (or a staff member of such an athlete or 
     athletic team) pursuant to an agreement described in 
     subsection (c)(4) with respect to such athlete or athletic 
     team--
       (1) such medical professional liability insurance coverage 
     shall cover (subject to any

[[Page S6100]]

     related premium adjustments) such professional with respect 
     to such covered medical services provided by the professional 
     in the secondary State to such an individual or team as if 
     such services were provided by such professional in the 
     primary State to such an individual or team; and
       (2) to the extent such professional is licensed under the 
     requirements of the primary State to provide such services to 
     such an individual or team, the professional shall be treated 
     as satisfying any licensure requirements of the secondary 
     State to provide such services to such an individual or team 
     to the extent the licensure requirements of the secondary 
     State are substantially similar to the licensure requirements 
     of the primary State.
       (b) Rule of Construction.--Nothing in this section shall be 
     construed--
       (1) to allow a covered sports medicine professional to 
     provide medical services in the secondary State that exceed 
     the scope of that professional's license in the primary 
     State;
       (2) to allow a covered sports medicine professional to 
     provide medical services in the secondary State that exceed 
     the scope of a substantially similar sports medicine 
     professional license in the secondary State;
       (3) to supersede any reciprocity agreement in effect 
     between the two States regarding such services or such 
     professionals;
       (4) to supersede any interstate compact agreement entered 
     into by the two States regarding such services or such 
     professionals; or
       (5) to supersede a licensure exemption the secondary State 
     provides for sports medicine professionals licensed in the 
     primary State.
       (c) Definitions.--In this Act, the following definitions 
     apply:
       (1) Athlete.--The term ``athlete'' means--
       (A) an individual participating in a sporting event or 
     activity for which the individual may be paid;
       (B) an individual participating in a sporting event or 
     activity sponsored or sanctioned by a national governing 
     body; or
       (C) an individual for whom a high school or institution of 
     higher education provides a covered sports medicine 
     professional.
       (2) Athletic team.--The term ``athletic team'' means a 
     sports team--
       (A) composed of individuals who are paid to participate on 
     the team;
       (B) composed of individuals who are participating in a 
     sporting event or activity sponsored or sanctioned by a 
     national governing body; or
       (C) for which a high school or an institution of higher 
     education provides a covered sports medicine professional.
       (3) Covered medical services.--The term ``covered medical 
     services'' means general medical care, emergency medical 
     care, athletic training, or physical therapy services. Such 
     term does not include care provided by a covered sports 
     medicine professional--
       (A) at a health care facility; or
       (B) while a health care provider licensed to practice in 
     the secondary State is transporting the injured individual to 
     a health care facility.
       (4) Covered sports medicine professional.--The term 
     ``covered sports medicine professional'' means a physician, 
     athletic trainer, or other health care professional who--
       (A) is licensed to practice in the primary State;
       (B) provides covered medical services, pursuant to a 
     written agreement with an athlete, an athletic team, a 
     national governing body, a high school, or an institution of 
     higher education; and
       (C) prior to providing the covered medical services 
     described in subparagraph (B), has disclosed the nature and 
     extent of such services to the entity that provides the 
     professional with liability insurance in the primary State.
       (5) Health care facility.--The term ``health care 
     facility'' means a facility in which medical care, diagnosis, 
     or treatment is provided on an inpatient or outpatient basis. 
     Such term does not include facilities at an arena, stadium, 
     or practice facility, or temporary facilities existing for 
     events where athletes or athletic teams may compete.
       (6) 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).
       (7) License.--The term ``license'' or ``licensure'', as 
     applied with respect to a covered sports medicine 
     professional, means a professional that has met the 
     requirements and is approved to provide covered medical 
     services in accordance with State laws and regulations in the 
     primary State. Such term may include the registration or 
     certification, or any other form of special recognition, of 
     an individual as such a professional, as applicable.
       (8) National governing body.--The term ``national governing 
     body'' has the meaning given such term in section 220501 of 
     title 36, United States Code.
       (9) Primary state.--The term ``primary State'' means, with 
     respect to a covered sports medicine professional, the State 
     in which--
       (A) the covered sports medicine professional is licensed to 
     practice; and
       (B) the majority of the covered sports medicine 
     professional's practice is underwritten for medical 
     professional liability insurance coverage.
       (10) Secondary state.--The term ``secondary State'' means, 
     with respect to a covered sports medicine professional, any 
     State that is not the primary State.
       (11) State.--The term ``State'' means each of the several 
     States, the District of Columbia, and each commonwealth, 
     territory, or possession of the United States.
       (12) Substantially similar.--The term ``substantially 
     similar'', with respect to the licensure by primary and 
     secondary States of a sports medicine professional, means 
     that both the primary and secondary States have in place a 
     form of licensure for such professionals that permits such 
     professionals to provide covered medical services.

                          ____________________