[Congressional Record Volume 164, Number 161 (Friday, September 28, 2018)]
[House]
[Pages H9174-H9255]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  SUBSTANCE USE-DISORDER PREVENTION THAT PROMOTES OPIOID RECOVERY AND 
               TREATMENT FOR PATIENTS AND COMMUNITIES ACT

  Mr. WALDEN. Mr. Speaker, I move to suspend the rules and agree to the 
resolution (H. Res. 1099) providing for the concurrence by the House in 
the Senate amendment to H.R. 6, with an amendment.
  The Clerk read the title of the resolution.
  The text of the resolution is as follows:

                              H. Res. 1099

       Resolved, That upon the adoption of this resolution the 
     House shall be considered to have taken from the Speaker's 
     table the bill, H.R. 6, with the Senate amendment thereto, 
     and to have concurred in the Senate amendment with the 
     following amendment:
       In lieu of the matter proposed to be inserted by the 
     amendment of the Senate to the text of the bill, insert the 
     following:

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Substance 
     Use-Disorder Prevention that Promotes Opioid Recovery and 
     Treatment for Patients and Communities Act'' or the ``SUPPORT 
     for Patients and Communities Act''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.

       TITLE I--MEDICAID PROVISIONS TO ADDRESS THE OPIOID CRISIS

Sec. 1001. At-risk youth Medicaid protection.
Sec. 1002. Health insurance for former foster youth.
Sec. 1003. Demonstration project to increase substance use provider 
              capacity under the Medicaid program.
Sec. 1004. Medicaid drug review and utilization.
Sec. 1005. Guidance to improve care for infants with neonatal 
              abstinence syndrome and their mothers; GAO study on gaps 
              in Medicaid coverage for pregnant and postpartum women 
              with substance use disorder.
Sec. 1006. Medicaid health homes for substance-use-disorder Medicaid 
              enrollees.
Sec. 1007. Caring recovery for infants and babies.
Sec. 1008. Peer support enhancement and evaluation review.
Sec. 1009. Medicaid substance use disorder treatment via telehealth.
Sec. 1010. Enhancing patient access to non-opioid treatment options.
Sec. 1011. Assessing barriers to opioid use disorder treatment.
Sec. 1012. Help for moms and babies.
Sec. 1013. Securing flexibility to treat substance use disorders.
Sec. 1014. MACPAC study and report on MAT utilization controls under 
              State Medicaid programs.
Sec. 1015. Opioid addiction treatment programs enhancement.
Sec. 1016. Better data sharing to combat the opioid crisis.
Sec. 1017. Report on innovative State initiatives and strategies to 
              provide housing-related services and supports to 
              individuals struggling with substance use disorders under 
              Medicaid.
Sec. 1018. Technical assistance and support for innovative State 
              strategies to provide housing-related supports under 
              Medicaid.

       TITLE II--MEDICARE PROVISIONS TO ADDRESS THE OPIOID CRISIS

Sec. 2001. Expanding the use of telehealth services for the treatment 
              of opioid use disorder and other substance use disorders.
Sec. 2002. Comprehensive screenings for seniors.
Sec. 2003. Every prescription conveyed securely.
Sec. 2004. Requiring prescription drug plan sponsors under Medicare to 
              establish drug management programs for at-risk 
              beneficiaries.
Sec. 2005. Medicare coverage of certain services furnished by opioid 
              treatment programs.
Sec. 2006. Encouraging appropriate prescribing under Medicare for 
              victims of opioid overdose.
Sec. 2007. Automatic escalation to external review under a Medicare 
              part D drug management program for at-risk beneficiaries.
Sec. 2008. Suspension of payments by Medicare prescription drug plans 
              and MA-PD plans pending investigations of credible 
              allegations of fraud by pharmacies.

           TITLE III--FDA AND CONTROLLED SUBSTANCE PROVISIONS

                       Subtitle A--FDA Provisions

                         Chapter 1--In General

Sec. 3001. Clarifying FDA regulation of non-addictive pain products.
Sec. 3002. Evidence-based opioid analgesic prescribing guidelines and 
              report.

     Chapter 2--Stop Counterfeit Drugs by Regulating and Enhancing 
                            Enforcement Now

Sec. 3011. Short title.
Sec. 3012. Notification, nondistribution, and recall of controlled 
              substances.
Sec. 3013. Single source pattern of imported illegal drugs.
Sec. 3014. Strengthening FDA and CBP coordination and capacity.

                Chapter 3--Stop Illicit Drug Importation

Sec. 3021. Short title.
Sec. 3022. Restricting entrance of illicit drugs.

[[Page H9175]]

   Chapter 4--Securing Opioids and Unused Narcotics With Deliberate 
                         Disposal and Packaging

Sec. 3031. Short title.
Sec. 3032. Safety-enhancing packaging and disposal features.

               Chapter 5--Postapproval Study Requirements

Sec. 3041. Clarifying FDA postmarket authorities.

              Subtitle B--Controlled Substance Provisions

    Chapter 1--More Flexibility With Respect to Medication-Assisted 
                   Treatment for Opioid Use Disorders

Sec. 3201. Allowing for more flexibility with respect to medication-
              assisted treatment for opioid use disorders.
Sec. 3202. Medication-assisted treatment for recovery from substance 
              use disorder.
Sec. 3203. Grants to enhance access to substance use disorder 
              treatment.
Sec. 3204. Delivery of a controlled substance by a pharmacy to be 
              administered by injection or implantation.

  Chapter 2--Empowering Pharmacists in the Fight Against Opioid Abuse

Sec. 3211. Short title.
Sec. 3212. Programs and materials for training on certain circumstances 
              under which a pharmacist may decline to fill a 
              prescription.

             Chapter 3--Safe Disposal of Unused Medication

Sec. 3221. Short title.
Sec. 3222. Disposal of controlled substances of a hospice patient by 
              employees of a qualified hospice program.
Sec. 3223. GAO study and report on hospice safe drug management.

     Chapter 4--Special Registration for Telemedicine Clarification

Sec. 3231. Short title.
Sec. 3232. Regulations relating to a special registration for 
              telemedicine.

      Chapter 5--Synthetic Abuse and Labeling of Toxic Substances

Sec. 3241. Controlled substance analogues.

              Chapter 6--Access to Increased Drug Disposal

Sec. 3251. Short title.
Sec. 3252. Definitions.
Sec. 3253. Authority to make grants.
Sec. 3254. Application.
Sec. 3255. Use of grant funds.
Sec. 3256. Eligibility for grant.
Sec. 3257. Duration of grants.
Sec. 3258. Accountability and oversight.
Sec. 3259. Duration of program.
Sec. 3260. Authorization of appropriations.

           Chapter 7--Using Data To Prevent Opioid Diversion

Sec. 3271. Short title.
Sec. 3272. Purpose.
Sec. 3273. Amendments.
Sec. 3274. Report.

                     Chapter 8--Opioid Quota Reform

Sec. 3281. Short title.
Sec. 3282. Strengthening considerations for DEA opioid quotas.

                  Chapter 9--Preventing Drug Diversion

Sec. 3291. Short title.
Sec. 3292. Improvements to prevent drug diversion.

                           TITLE IV--OFFSETS

Sec. 4001. Promoting value in Medicaid managed care.
Sec. 4002. Requiring reporting by group health plans of prescription 
              drug coverage information for purposes of identifying 
              primary payer situations under the Medicare program.
Sec. 4003. Additional religious exemption from health coverage 
              responsibility requirement.
Sec. 4004. Modernizing the reporting of biological and biosimilar 
              products.

                   TITLE V--OTHER MEDICAID PROVISIONS

Subtitle A--Mandatory Reporting With Respect to Adult Behavioral Health 
                                Measures

Sec. 5001. Mandatory reporting with respect to adult behavioral health 
              measures.

                Subtitle B--Medicaid IMD Additional Info

Sec. 5011. Short title.
Sec. 5012. MACPAC exploratory study and report on institutions for 
              mental diseases requirements and practices under 
              Medicaid.

    Subtitle C--CHIP Mental Health and Substance Use Disorder Parity

Sec. 5021. Short title.
Sec. 5022. Ensuring access to mental health and substance use disorder 
              services for children and pregnant women under the 
              Children's Health Insurance Program.

                      Subtitle D--Medicaid Reentry

Sec. 5031. Short title.
Sec. 5032. Promoting State innovations to ease transitions integration 
              to the community for certain individuals.

                    Subtitle E--Medicaid Partnership

Sec. 5041. Short title.
Sec. 5042. Medicaid providers are required to note experiences in 
              record systems to help in-need patients.

                        Subtitle F--IMD CARE Act

Sec. 5051. Short title.
Sec. 5052. State option to provide Medicaid coverage for certain 
              individuals with substance use disorders who are patients 
              in certain institutions for mental diseases.

                 Subtitle G--Medicaid Improvement Fund

Sec. 5061. Medicaid Improvement Fund.

                  TITLE VI--OTHER MEDICARE PROVISIONS

    Subtitle A--Testing of Incentive Payments for Behavioral Health 
 Providers for Adoption and Use of Certified Electronic Health Record 
                               Technology

Sec. 6001. Testing of incentive payments for behavioral health 
              providers for adoption and use of certified electronic 
              health record technology.

                   Subtitle B--Abuse Deterrent Access

Sec. 6011. Short title.
Sec. 6012. Study on abuse-deterrent opioid formulations access barriers 
              under Medicare.

              Subtitle C--Medicare Opioid Safety Education

Sec. 6021. Medicare opioid safety education.

                Subtitle D--Opioid Addiction Action Plan

Sec. 6031. Short title.
Sec. 6032. Action plan on recommendations for changes under Medicare 
              and Medicaid to prevent opioids addictions and enhance 
              access to medication-assisted treatment.

 Subtitle E--Advancing High Quality Treatment for Opioid Use Disorders 
                              in Medicare

Sec. 6041. Short title.
Sec. 6042. Opioid use disorder treatment demonstration program.

 Subtitle F--Responsible Education Achieves Care and Healthy Outcomes 
                          for Users' Treatment

Sec. 6051. Short title.
Sec. 6052. Grants to provide technical assistance to outlier 
              prescribers of opioids.

        Subtitle G--Preventing Addiction for Susceptible Seniors

Sec. 6061. Short title.
Sec. 6062. Electronic prior authorization for covered part D drugs.
Sec. 6063. Program integrity transparency measures under Medicare parts 
              C and D.
Sec. 6064. Expanding eligibility for medication therapy management 
              programs under part D.
Sec. 6065. Commit to opioid medical prescriber accountability and 
              safety for seniors.
Sec. 6066. No additional funds authorized.

   Subtitle H--Expanding Oversight of Opioid Prescribing and Payment

Sec. 6071. Short title.
Sec. 6072. Medicare Payment Advisory Commission report on opioid 
              payment, adverse incentives, and data under the Medicare 
              program.
Sec. 6073. No additional funds authorized.

  Subtitle I--Dr. Todd Graham Pain Management, Treatment, and Recovery

Sec. 6081. Short title.
Sec. 6082. Review and adjustment of payments under the Medicare 
              outpatient prospective payment system to avoid financial 
              incentives to use opioids instead of non-opioid 
              alternative treatments.
Sec. 6083. Expanding access under the Medicare program to addiction 
              treatment in Federally qualified health centers and rural 
              health clinics.
Sec. 6084. Studying the availability of supplemental benefits designed 
              to treat or prevent substance use disorders under 
              Medicare Advantage plans.
Sec. 6085. Clinical psychologist services models under the Center for 
              Medicare and Medicaid Innovation; GAO study and report.
Sec. 6086. Dr. Todd Graham pain management study.

        Subtitle J--Combating Opioid Abuse for Care in Hospitals

Sec. 6091. Short title.
Sec. 6092. Developing guidance on pain management and opioid use 
              disorder prevention for hospitals receiving payment under 
              part A of the Medicare program.
Sec. 6093. Requiring the review of quality measures relating to opioids 
              and opioid use disorder treatments furnished under the 
              medicare program and other federal health care programs.
Sec. 6094. Technical expert panel on reducing surgical setting opioid 
              use; Data collection on perioperative opioid use.
Sec. 6095. Requiring the posting and periodic update of opioid 
              prescribing guidance for Medicare beneficiaries.

  Subtitle K--Providing Reliable Options for Patients and Educational 
                               Resources

Sec. 6101. Short title.
Sec. 6102. Requiring Medicare Advantage plans and part D prescription 
              drug plans to include information on risks associated 
              with opioids and coverage of nonpharmacological therapies 
              and nonopioid medications or devices used to treat pain.

[[Page H9176]]

Sec. 6103. Requiring Medicare Advantage plans and prescription drug 
              plans to provide information on the safe disposal of 
              prescription drugs.
Sec. 6104. Revising measures used under the Hospital Consumer 
              Assessment of Healthcare Providers and Systems survey 
              relating to pain management.

         Subtitle L--Fighting the Opioid Epidemic With Sunshine

Sec. 6111. Fighting the opioid epidemic with sunshine.

                  TITLE VII--PUBLIC HEALTH PROVISIONS

                   Subtitle A--Awareness and Training

Sec. 7001. Report on effects on public health of synthetic drug use.
Sec. 7002. First responder training.

  Subtitle B--Pilot Program for Public Health Laboratories To Detect 
                  Fentanyl and Other Synthetic Opioids

Sec. 7011. Pilot program for public health laboratories to detect 
              fentanyl and other synthetic opioids.

         Subtitle C--Indexing Narcotics, Fentanyl, and Opioids

Sec. 7021. Establishment of substance use disorder information 
              dashboard.
Sec. 7022. Interdepartmental Substance Use Disorders Coordinating 
              Committee.
Sec. 7023. National milestones to measure success in curtailing the 
              opioid crisis.
Sec. 7024. Study on prescribing limits.

          Subtitle D--Ensuring Access to Quality Sober Living

Sec. 7031. National recovery housing best practices.

              Subtitle E--Advancing Cutting Edge Research

Sec. 7041. Unique research initiatives.
Sec. 7042. Pain research.

                        Subtitle F--Jessie's Law

Sec. 7051. Inclusion of opioid addiction history in patient records.
Sec. 7052. Communication with families during emergencies.
Sec. 7053. Development and dissemination of model training programs for 
              substance use disorder patient records.

           Subtitle G--Protecting Pregnant Women and Infants

Sec. 7061. Report on addressing maternal and infant health in the 
              opioid crisis.
Sec. 7062. Protecting moms and infants.
Sec. 7063. Early interventions for pregnant women and infants.
Sec. 7064. Prenatal and postnatal health.
Sec. 7065. Plans of safe care.

         Subtitle H--Substance Use Disorder Treatment Workforce

Sec. 7071. Loan repayment program for substance use disorder treatment 
              workforce.
Sec. 7072. Clarification regarding service in schools and other 
              community-based settings.
Sec. 7073. Programs for health care workforce.

       Subtitle I--Preventing Overdoses While in Emergency Rooms

Sec. 7081. Program to support coordination and continuation of care for 
              drug overdose patients.

    Subtitle J--Alternatives to Opioids in the Emergency Department

Sec. 7091. Emergency department alternatives to opioids demonstration 
              program.

    Subtitle K--Treatment, Education, and Community Help To Combat 
                               Addiction

Sec. 7101. Establishment of regional centers of excellence in substance 
              use disorder education.
Sec. 7102. Youth prevention and recovery.

 Subtitle L--Information From National Mental Health and Substance Use 
                           Policy Laboratory

Sec. 7111. Information from National Mental Health and Substance Use 
              Policy Laboratory.

           Subtitle M--Comprehensive Opioid Recovery Centers

Sec. 7121. Comprehensive opioid recovery centers.

                    Subtitle N--Trauma-Informed Care

Sec. 7131. CDC surveillance and data collection for child, youth, and 
              adult trauma.
Sec. 7132. Task force to develop best practices for trauma-informed 
              identification, referral, and support.
Sec. 7133. National Child Traumatic Stress Initiative.
Sec. 7134. Grants to improve trauma support services and mental health 
              care for children and youth in educational settings.
Sec. 7135. Recognizing early childhood trauma related to substance 
              abuse.

       Subtitle O--Eliminating Opioid Related Infectious Diseases

Sec. 7141. Reauthorization and expansion of program of surveillance and 
              education regarding infections associated with illicit 
              drug use and other risk factors.

            Subtitle P--Peer Support Communities of Recovery

Sec. 7151. Building communities of recovery.
Sec. 7152. Peer support technical assistance center.

 Subtitle Q--Creating Opportunities That Necessitate New and Enhanced 
         Connections That Improve Opioid Navigation Strategies

Sec. 7161. Preventing overdoses of controlled substances.
Sec. 7162. Prescription drug monitoring program.

   Subtitle R--Review of Substance Use Disorder Treatment Providers 
                       Receiving Federal Funding

Sec. 7171. Review of substance use disorder treatment providers 
              receiving Federal funding.

                  Subtitle S--Other Health Provisions

Sec. 7181. State response to the opioid abuse crisis.
Sec. 7182. Report on investigations regarding parity in mental health 
              and substance use disorder benefits.
Sec. 7183. CAREER Act.

                       TITLE VIII--MISCELLANEOUS

       Subtitle A--Synthetics Trafficking and Overdose Prevention

Sec. 8001. Short title.
Sec. 8002. Customs fees.
Sec. 8003. Mandatory advance electronic information for postal 
              shipments.
Sec. 8004. International postal agreements.
Sec. 8005. Cost recoupment.
Sec. 8006. Development of technology to detect illicit narcotics.
Sec. 8007. Civil penalties for postal shipments.
Sec. 8008. Report on violations of arrival, reporting, entry, and 
              clearance requirements and falsity or lack of manifest.
Sec. 8009. Effective date; regulations.

         Subtitle B--Opioid Addiction Recovery Fraud Prevention

Sec. 8021. Short title.
Sec. 8022. Definitions.
Sec. 8023. Unfair or deceptive acts or practices with respect to 
              substance use disorder treatment service and products.

  Subtitle C--Addressing Economic and Workforce Impacts of the Opioid 
                                 Crisis

Sec. 8041. Addressing economic and workforce impacts of the opioid 
              crisis.

     Subtitle D--Peer Support Counseling Program for Women Veterans

Sec. 8051. Peer support counseling program for women veterans.

              Subtitle E--Treating Barriers to Prosperity

Sec. 8061. Short title.
Sec. 8062. Drug abuse mitigation initiative.

   Subtitle F--Pilot Program to Help Individuals in Recovery From a 
              Substance Use Disorder Become Stably Housed

Sec. 8071. Pilot program to help individuals in recovery from a 
              substance use disorder become stably housed.

                       Subtitle G--Human Services

Sec. 8081. Supporting family-focused residential treatment.
Sec. 8082. Improving recovery and reunifying families.
Sec. 8083. Building capacity for family-focused residential treatment.

Subtitle H--Reauthorizing and Extending Grants for Recovery From Opioid 
                              Use Programs

Sec. 8091. Short title.
Sec. 8092. Reauthorization of the comprehensive opioid abuse grant 
              program.

          Subtitle I--Fighting Opioid Abuse in Transportation

Sec. 8101. Short title.
Sec. 8102. Alcohol and controlled substance testing of mechanical 
              employees.
Sec. 8103. Department of Transportation public drug and alcohol testing 
              database.
Sec. 8104. GAO report on Department of Transportation's collection and 
              use of drug and alcohol testing data.
Sec. 8105. Transportation Workplace Drug and Alcohol Testing Program; 
              addition of fentanyl and other substances.
Sec. 8106. Status reports on hair testing guidelines.
Sec. 8107. Mandatory Guidelines for Federal Workplace Drug Testing 
              Programs using Oral Fluid.
Sec. 8108. Electronic recordkeeping.
Sec. 8109. Status reports on Commercial Driver's License Drug and 
              Alcohol Clearinghouse.

             Subtitle J--Eliminating Kickbacks in Recovery

Sec. 8121. Short title.
Sec. 8122. Criminal penalties.

                 Subtitle K--Substance Abuse Prevention

Sec. 8201. Short title.
Sec. 8202. Reauthorization of the Office of National Drug Control 
              Policy.
Sec. 8203. Reauthorization of the Drug-Free Communities Program.
Sec. 8204. Reauthorization of the National Community Anti-Drug 
              Coalition Institute.
Sec. 8205. Reauthorization of the High-Intensity Drug Trafficking Area 
              Program.
Sec. 8206. Reauthorization of drug court program.
Sec. 8207. Drug court training and technical assistance.

[[Page H9177]]

Sec. 8208. Drug overdose response strategy.
Sec. 8209. Protecting law enforcement officers from accidental 
              exposure.
Sec. 8210. COPS Anti-Meth Program.
Sec. 8211. COPS anti-heroin task force program.
Sec. 8212. Comprehensive Addiction and Recovery Act education and 
              awareness.
Sec. 8213. Reimbursement of substance use disorder treatment 
              professionals.
Sec. 8214. Sobriety Treatment and Recovery Teams (START).
Sec. 8215. Provider education.
Sec. 8216. Definitions.
Sec. 8217. Amendments to administration of the Office.
Sec. 8218. Emerging threats committee, plan, and media campaign.
Sec. 8219. Drug interdiction.
Sec. 8220. GAO Audit.
Sec. 8221. National Drug Control Strategy.
Sec. 8222. Technical and conforming amendments to the Office of 
              National Drug Control Policy Reauthorization Act of 1998.

                     Subtitle L--Budgetary Effects

Sec. 8231. Budgetary effect.

       TITLE I--MEDICAID PROVISIONS TO ADDRESS THE OPIOID CRISIS

     SEC. 1001. AT-RISK YOUTH MEDICAID PROTECTION.

       (a) In General.--Section 1902 of the Social Security Act 
     (42 U.S.C. 1396a) is amended--
       (1) in subsection (a)--
       (A) by striking ``and'' at the end of paragraph (82);
       (B) by striking the period at the end of paragraph (83) and 
     inserting ``; and''; and
       (C) by inserting after paragraph (83) the following new 
     paragraph:
       ``(84) provide that--
       ``(A) the State shall not terminate eligibility for medical 
     assistance under the State plan for an individual who is an 
     eligible juvenile (as defined in subsection (nn)(2)) because 
     the juvenile is an inmate of a public institution (as defined 
     in subsection (nn)(3)), but may suspend coverage during the 
     period the juvenile is such an inmate;
       ``(B) in the case of an individual who is an eligible 
     juvenile described in paragraph (2)(A) of subsection (nn), 
     the State shall, prior to the individual's release from such 
     a public institution, conduct a redetermination of 
     eligibility for such individual with respect to such medical 
     assistance (without requiring a new application from the 
     individual) and, if the State determines pursuant to such 
     redetermination that the individual continues to meet the 
     eligibility requirements for such medical assistance, the 
     State shall restore coverage for such medical assistance to 
     such an individual upon the individual's release from such 
     public institution; and
       ``(C) in the case of an individual who is an eligible 
     juvenile described in paragraph (2)(B) of subsection (nn), 
     the State shall process any application for medical 
     assistance submitted by, or on behalf of, such individual 
     such that the State makes a determination of eligibility for 
     such individual with respect to such medical assistance upon 
     release of such individual from such public institution.''; 
     and
       (2) by adding at the end the following new subsection:
       ``(nn) Juvenile; Eligible Juvenile; Public Institution.--
     For purposes of subsection (a)(84) and this subsection:
       ``(1) Juvenile.--The term `juvenile' means an individual 
     who is--
       ``(A) under 21 years of age; or
       ``(B) described in subsection (a)(10)(A)(i)(IX).
       ``(2) Eligible juvenile.--The term `eligible juvenile' 
     means a juvenile who is an inmate of a public institution and 
     who--
       ``(A) was determined eligible for medical assistance under 
     the State plan immediately before becoming an inmate of such 
     a public institution; or
       ``(B) is determined eligible for such medical assistance 
     while an inmate of a public institution.
       ``(3) Inmate of a public institution.--The term `inmate of 
     a public institution' has the meaning given such term for 
     purposes of applying the subdivision (A) following paragraph 
     (30) of section 1905(a), taking into account the exception in 
     such subdivision for a patient of a medical institution.''.
       (b) No Change in Exclusion From Medical Assistance for 
     Inmates of Public Institutions.--Nothing in this section 
     shall be construed as changing the exclusion from medical 
     assistance under the subdivision (A) following paragraph (30) 
     of section 1905(a) of the Social Security Act (42 U.S.C. 
     1396d(a)), as redesignated by section 1006(b)(2)(B) of this 
     Act, including any applicable restrictions on a State 
     submitting claims for Federal financial participation under 
     title XIX of such Act for such assistance.
       (c) No Change in Continuity of Eligibility Before 
     Adjudication or Sentencing.--Nothing in this section shall be 
     construed to mandate, encourage, or suggest that a State 
     suspend or terminate coverage for individuals before they 
     have been adjudicated or sentenced.
       (d) Effective Date.--
       (1) In general.--Except as provided in paragraph (2), the 
     amendments made by subsection (a) shall apply to eligibility 
     of juveniles who become inmates of public institutions on or 
     after the date that is 1 year after the date of the enactment 
     of this Act.
       (2) Rule for changes requiring state legislation.--In the 
     case of a State plan for medical assistance under title XIX 
     of the Social Security Act which the Secretary of Health and 
     Human Services determines requires State legislation (other 
     than legislation appropriating funds) in order for the plan 
     to meet the additional requirements imposed by the amendments 
     made by subsection (a), the State plan shall not be regarded 
     as failing to comply with the requirements of such title 
     solely on the basis of its failure to meet these additional 
     requirements before the first day of the first calendar 
     quarter beginning after the close of the first regular 
     session of the State legislature that begins after the date 
     of the enactment of this Act. For purposes of the previous 
     sentence, in the case of a State that has a 2-year 
     legislative session, each year of such session shall be 
     deemed to be a separate regular session of the State 
     legislature.

     SEC. 1002. HEALTH INSURANCE FOR FORMER FOSTER YOUTH.

       (a) Coverage Continuity for Former Foster Care Children up 
     to Age 26.--
       (1) In general.--Section 1902(a)(10)(A)(i)(IX) of the 
     Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)(IX)) is 
     amended--
       (A) in item (bb), by striking ``are not described in or 
     enrolled under'' and inserting ``are not described in and are 
     not enrolled under'';
       (B) in item (cc), by striking ``responsibility of the 
     State'' and inserting ``responsibility of a State''; and
       (C) in item (dd), by striking ``the State plan under this 
     title or under a waiver of the'' and inserting ``a State plan 
     under this title or under a waiver of such a''.
       (2) Effective date.--The amendments made by this subsection 
     shall take effect with respect to foster youth who attain 18 
     years of age on or after January 1, 2023.
       (b) Guidance.--Not later than 1 year after the date of the 
     enactment of this Act, the Secretary of Health and Human 
     Services shall issue guidance to States, with respect to the 
     State Medicaid programs of such States--
       (1) on best practices for--
       (A) removing barriers and ensuring streamlined, timely 
     access to Medicaid coverage for former foster youth up to age 
     26; and
       (B) conducting outreach and raising awareness among such 
     youth regarding Medicaid coverage options for such youth; and
       (2) which shall include examples of States that have 
     successfully extended Medicaid coverage to former foster 
     youth up to age 26.

     SEC. 1003. DEMONSTRATION PROJECT TO INCREASE SUBSTANCE USE 
                   PROVIDER CAPACITY UNDER THE MEDICAID PROGRAM.

       Section 1903 of the Social Security Act (42 U.S.C. 1396b) 
     is amended by adding at the end the following new subsection:
       ``(aa) Demonstration Project To Increase Substance Use 
     Provider Capacity.--
       ``(1) In general.--Not later than the date that is 180 days 
     after the date of the enactment of this subsection, the 
     Secretary shall, in consultation, as appropriate, with the 
     Director of the Agency for Healthcare Research and Quality 
     and the Assistant Secretary for Mental Health and Substance 
     Use, conduct a 54-month demonstration project for the purpose 
     described in paragraph (2) under which the Secretary shall--
       ``(A) for the first 18-month period of such project, award 
     planning grants described in paragraph (3); and
       ``(B) for the remaining 36-month period of such project, 
     provide to each State selected under paragraph (4) payments 
     in accordance with paragraph (5).
       ``(2) Purpose.--The purpose described in this paragraph is 
     for each State selected under paragraph (4) to increase the 
     treatment capacity of providers participating under the State 
     plan (or a waiver of such plan) to provide substance use 
     disorder treatment or recovery services under such plan (or 
     waiver) through the following activities:
       ``(A) For the purpose described in paragraph (3)(C)(i), 
     activities that support an ongoing assessment of the 
     behavioral health treatment needs of the State, taking into 
     account the matters described in subclauses (I) through (IV) 
     of such paragraph.
       ``(B) Activities that, taking into account the results of 
     the assessment described in subparagraph (A), support the 
     recruitment, training, and provision of technical assistance 
     for providers participating under the State plan (or a waiver 
     of such plan) that offer substance use disorder treatment or 
     recovery services.
       ``(C) Improved reimbursement for and expansion of, through 
     the provision of education, training, and technical 
     assistance, the number or treatment capacity of providers 
     participating under the State plan (or waiver) that--
       ``(i) are authorized to dispense drugs approved by the Food 
     and Drug Administration for individuals with a substance use 
     disorder who need withdrawal management or maintenance 
     treatment for such disorder;
       ``(ii) have in effect a registration or waiver under 
     section 303(g) of the Controlled Substances Act for purposes 
     of dispensing narcotic drugs to individuals for maintenance 
     treatment or detoxification treatment and are in compliance 
     with any regulation promulgated by the Assistant Secretary 
     for Mental Health and Substance Use for purposes of carrying 
     out the requirements of such section 303(g); and

[[Page H9178]]

       ``(iii) are qualified under applicable State law to provide 
     substance use disorder treatment or recovery services.
       ``(D) Improved reimbursement for and expansion of, through 
     the provision of education, training, and technical 
     assistance, the number or treatment capacity of providers 
     participating under the State plan (or waiver) that have the 
     qualifications to address the treatment or recovery needs 
     of--
       ``(i) individuals enrolled under the State plan (or a 
     waiver of such plan) who have neonatal abstinence syndrome, 
     in accordance with guidelines issued by the American Academy 
     of Pediatrics and American College of Obstetricians and 
     Gynecologists relating to maternal care and infant care with 
     respect to neonatal abstinence syndrome;
       ``(ii) pregnant women, postpartum women, and infants, 
     particularly the concurrent treatment, as appropriate, and 
     comprehensive case management of pregnant women, postpartum 
     women and infants, enrolled under the State plan (or a waiver 
     of such plan);
       ``(iii) adolescents and young adults between the ages of 12 
     and 21 enrolled under the State plan (or a waiver of such 
     plan); or
       ``(iv) American Indian and Alaska Native individuals 
     enrolled under the State plan (or a waiver of such plan).
       ``(3) Planning grants.--
       ``(A) In general.--The Secretary shall, with respect to the 
     first 18-month period of the demonstration project conducted 
     under paragraph (1), award planning grants to at least 10 
     States selected in accordance with subparagraph (B) for 
     purposes of preparing an application described in paragraph 
     (4)(C) and carrying out the activities described in 
     subparagraph (C).
       ``(B) Selection.--In selecting States for purposes of this 
     paragraph, the Secretary shall--
       ``(i) select States that have a State plan (or waiver of 
     the State plan) approved under this title;
       ``(ii) select States in a manner that ensures geographic 
     diversity; and
       ``(iii) give preference to States with a prevalence of 
     substance use disorders (in particular opioid use disorders) 
     that is comparable to or higher than the national average 
     prevalence, as measured by aggregate per capita drug 
     overdoses, or any other measure that the Secretary deems 
     appropriate.
       ``(C) Activities described.--Activities described in this 
     subparagraph are, with respect to a State, each of the 
     following:
       ``(i) Activities that support the development of an initial 
     assessment of the behavioral health treatment needs of the 
     State to determine the extent to which providers are needed 
     (including the types of such providers and geographic area of 
     need) to improve the network of providers that treat 
     substance use disorders under the State plan (or waiver), 
     including the following:

       ``(I) An estimate of the number of individuals enrolled 
     under the State plan (or a waiver of such plan) who have a 
     substance use disorder.
       ``(II) Information on the capacity of providers to provide 
     substance use disorder treatment or recovery services to 
     individuals enrolled under the State plan (or waiver), 
     including information on providers who provide such services 
     and their participation under the State plan (or waiver).
       ``(III) Information on the gap in substance use disorder 
     treatment or recovery services under the State plan (or 
     waiver) based on the information described in subclauses (I) 
     and (II).
       ``(IV) Projections regarding the extent to which the State 
     participating under the demonstration project would increase 
     the number of providers offering substance use disorder 
     treatment or recovery services under the State plan (or 
     waiver) during the period of the demonstration project.

       ``(ii) Activities that, taking into account the results of 
     the assessment described in clause (i), support the 
     development of State infrastructure to, with respect to the 
     provision of substance use disorder treatment or recovery 
     services under the State plan (or a waiver of such plan), 
     recruit prospective providers and provide training and 
     technical assistance to such providers.
       ``(D) Funding.--For purposes of subparagraph (A), there is 
     appropriated, out of any funds in the Treasury not otherwise 
     appropriated, $50,000,000, to remain available until 
     expended.
       ``(4) Post-planning states.--
       ``(A) In general.--The Secretary shall, with respect to the 
     remaining 36-month period of the demonstration project 
     conducted under paragraph (1), select not more than 5 States 
     in accordance with subparagraph (B) for purposes of carrying 
     out the activities described in paragraph (2) and receiving 
     payments in accordance with paragraph (5).
       ``(B) Selection.--In selecting States for purposes of this 
     paragraph, the Secretary shall--
       ``(i) select States that received a planning grant under 
     paragraph (3);
       ``(ii) select States that submit to the Secretary an 
     application in accordance with the requirements in 
     subparagraph (C), taking into consideration the quality of 
     each such application;
       ``(iii) select States in a manner that ensures geographic 
     diversity; and
       ``(iv) give preference to States with a prevalence of 
     substance use disorders (in particular opioid use disorders) 
     that is comparable to or higher than the national average 
     prevalence, as measured by aggregate per capita drug 
     overdoses, or any other measure that the Secretary deems 
     appropriate.
       ``(C) Applications.--
       ``(i) In general.--A State seeking to be selected for 
     purposes of this paragraph shall submit to the Secretary, at 
     such time and in such form and manner as the Secretary 
     requires, an application that includes such information, 
     provisions, and assurances, as the Secretary may require, in 
     addition to the following:

       ``(I) A proposed process for carrying out the ongoing 
     assessment described in paragraph (2)(A), taking into account 
     the results of the initial assessment described in paragraph 
     (3)(C)(i).
       ``(II) A review of reimbursement methodologies and other 
     policies related to substance use disorder treatment or 
     recovery services under the State plan (or waiver) that may 
     create barriers to increasing the number of providers 
     delivering such services.
       ``(III) The development of a plan, taking into account 
     activities carried out under paragraph (3)(C)(ii), that will 
     result in long-term and sustainable provider networks under 
     the State plan (or waiver) that will offer a continuum of 
     care for substance use disorders. Such plan shall include the 
     following:

       ``(aa) Specific activities to increase the number of 
     providers (including providers that specialize in providing 
     substance use disorder treatment or recovery services, 
     hospitals, health care systems, Federally qualified health 
     centers, and, as applicable, certified community behavioral 
     health clinics) that offer substance use disorder treatment, 
     recovery, or support services, including short-term 
     detoxification services, outpatient substance use disorder 
     services, and evidence-based peer recovery services.
       ``(bb) Strategies that will incentivize providers described 
     in subparagraphs (C) and (D) of paragraph (2) to obtain the 
     necessary training, education, and support to deliver 
     substance use disorder treatment or recovery services in the 
     State.
       ``(cc) Milestones and timeliness for implementing 
     activities set forth in the plan.
       ``(dd) Specific measurable targets for increasing the 
     substance use disorder treatment and recovery provider 
     network under the State plan (or a waiver of such plan).

       ``(IV) A proposed process for reporting the information 
     required under paragraph (6)(A), including information to 
     assess the effectiveness of the efforts of the State to 
     expand the capacity of providers to deliver substance use 
     disorder treatment or recovery services during the period of 
     the demonstration project under this subsection.
       ``(V) The expected financial impact of the demonstration 
     project under this subsection on the State.
       ``(VI) A description of all funding sources available to 
     the State to provide substance use disorder treatment or 
     recovery services in the State.
       ``(VII) A preliminary plan for how the State will sustain 
     any increase in the capacity of providers to deliver 
     substance use disorder treatment or recovery services 
     resulting from the demonstration project under this 
     subsection after the termination of such demonstration 
     project.
       ``(VIII) A description of how the State will coordinate the 
     goals of the demonstration project with any waiver granted 
     (or submitted by the State and pending) pursuant to section 
     1115 for the delivery of substance use services under the 
     State plan, as applicable.

       ``(ii) Consultation.--In completing an application under 
     clause (i), a State shall consult with relevant stakeholders, 
     including Medicaid managed care plans, health care providers, 
     and Medicaid beneficiary advocates, and include in such 
     application a description of such consultation.
       ``(5) Payment.--
       ``(A) In general.--For each quarter occurring during the 
     period for which the demonstration project is conducted 
     (after the first 18 months of such period), the Secretary 
     shall pay under this subsection, subject to subparagraph (C), 
     to each State selected under paragraph (4) an amount equal to 
     80 percent of so much of the qualified sums expended during 
     such quarter.
       ``(B) Qualified sums defined.--For purposes of subparagraph 
     (A), the term `qualified sums' means, with respect to a State 
     and a quarter, the amount equal to the amount (if any) by 
     which the sums expended by the State during such quarter 
     attributable to substance use disorder treatment or recovery 
     services furnished by providers participating under the State 
     plan (or a waiver of such plan) exceeds 1/4 of such sums 
     expended by the State during fiscal year 2018 attributable to 
     substance use disorder treatment or recovery services.
       ``(C) Non-duplication of payment.--In the case that payment 
     is made under subparagraph (A) with respect to expenditures 
     for substance use disorder treatment or recovery services 
     furnished by providers participating under the State plan (or 
     a waiver of such plan), payment may not also be made under 
     subsection (a) with respect to expenditures for the same 
     services so furnished.
       ``(6) Reports.--
       ``(A) State reports.--A State receiving payments under 
     paragraph (5) shall, for the period of the demonstration 
     project under this subsection, submit to the Secretary a 
     quarterly report, with respect to expenditures for substance 
     use disorder treatment or recovery services for which payment 
     is made

[[Page H9179]]

     to the State under this subsection, on the following:
       ``(i) The specific activities with respect to which payment 
     under this subsection was provided.
       ``(ii) The number of providers that delivered substance use 
     disorder treatment or recovery services in the State under 
     the demonstration project compared to the estimated number of 
     providers that would have otherwise delivered such services 
     in the absence of such demonstration project.
       ``(iii) The number of individuals enrolled under the State 
     plan (or a waiver of such plan) who received substance use 
     disorder treatment or recovery services under the 
     demonstration project compared to the estimated number of 
     such individuals who would have otherwise received such 
     services in the absence of such demonstration project.
       ``(iv) Other matters as determined by the Secretary.
       ``(B) CMS reports.--
       ``(i) Initial report.--Not later than October 1, 2020, the 
     Administrator of the Centers for Medicare & Medicaid Services 
     shall, in consultation with the Director of the Agency for 
     Healthcare Research and Quality and the Assistant Secretary 
     for Mental Health and Substance Use, submit to Congress an 
     initial report on--

       ``(I) the States awarded planning grants under paragraph 
     (3);
       ``(II) the criteria used in such selection; and
       ``(III) the activities carried out by such States under 
     such planning grants.

       ``(ii) Interim report.--Not later than October 1, 2022, the 
     Administrator of the Centers for Medicare & Medicaid Services 
     shall, in consultation with the Director of the Agency for 
     Healthcare Research and Quality and the Assistant Secretary 
     for Mental Health and Substance Use, submit to Congress an 
     interim report--

       ``(I) on activities carried out under the demonstration 
     project under this subsection;
       ``(II) on the extent to which States selected under 
     paragraph (4) have achieved the stated goals submitted in 
     their applications under subparagraph (C) of such paragraph;
       ``(III) with a description of the strengths and limitations 
     of such demonstration project; and
       ``(IV) with a plan for the sustainability of such project.

       ``(iii) Final report.--Not later than October 1, 2024, the 
     Administrator of the Centers for Medicare & Medicaid Services 
     shall, in consultation with the Director of the Agency for 
     Healthcare Research and Quality and the Assistant Secretary 
     for Mental Health and Substance Use, submit to Congress a 
     final report--

       ``(I) providing updates on the matters reported in the 
     interim report under clause (ii);
       ``(II) including a description of any changes made with 
     respect to the demonstration project under this subsection 
     after the submission of such interim report; and
       ``(III) evaluating such demonstration project.

       ``(C) AHRQ report.--Not later than 3 years after the date 
     of the enactment of this subsection, the Director of the 
     Agency for Healthcare Research and Quality, in consultation 
     with the Administrator of the Centers for Medicare & Medicaid 
     Services, shall submit to Congress a summary on the 
     experiences of States awarded planning grants under paragraph 
     (3) and States selected under paragraph (4).
       ``(7) Data sharing and best practices.--During the period 
     of the demonstration project under this subsection, the 
     Secretary shall, in collaboration with States selected under 
     paragraph (4), facilitate data sharing and the development of 
     best practices between such States and States that were not 
     so selected.
       ``(8) CMS funding.--There is appropriated, out of any funds 
     in the Treasury not otherwise appropriated, $5,000,000 to the 
     Centers for Medicare & Medicaid Services for purposes of 
     implementing this subsection. Such amount shall remain 
     available until expended.''.

     SEC. 1004. MEDICAID DRUG REVIEW AND UTILIZATION.

       (a) Medicaid Drug Utilization Review.--
       (1) State plan requirement.--Section 1902(a) of the Social 
     Security Act (42 U.S.C. 1396a(a)), as amended by section 
     1001, is further amended--
       (A) in paragraph (83), at the end, by striking ``and'';
       (B) in paragraph (84), at the end, by striking the period 
     and inserting ``; and''; and
       (C) by inserting after paragraph (84) the following new 
     paragraph:
       ``(85) provide that the State is in compliance with the 
     drug review and utilization requirements under subsection 
     (oo)(1).''.
       (2) Drug review and utilization requirements.--Section 1902 
     of the Social Security Act (42 U.S.C. 1396a), as amended by 
     section 1001, is further amended by adding at the end the 
     following new subsection:
       ``(oo) Drug Review and Utilization Requirements.--
       ``(1) In general.--For purposes of subsection (a)(85), the 
     drug review and utilization requirements under this 
     subsection are, subject to paragraph (3) and beginning 
     October 1, 2019, the following:
       ``(A) Claims review limitations.--
       ``(i) In general.--The State has in place--

       ``(I) safety edits (as specified by the State) for 
     subsequent fills for opioids and a claims review automated 
     process (as designed and implemented by the State) that 
     indicates when an individual enrolled under the State plan 
     (or under a waiver of the State plan) is prescribed a 
     subsequent fill of opioids in excess of any limitation that 
     may be identified by the State;
       ``(II) safety edits (as specified by the State) on the 
     maximum daily morphine equivalent that can be prescribed to 
     an individual enrolled under the State plan (or under a 
     waiver of the State plan) for treatment of chronic pain and a 
     claims review automated process (as designed and implemented 
     by the State) that indicates when an individual enrolled 
     under the plan (or waiver) is prescribed the morphine 
     equivalent for such treatment in excess of any limitation 
     that may be identified by the State; and
       ``(III) a claims review automated process (as designed and 
     implemented by the State) that monitors when an individual 
     enrolled under the State plan (or under a waiver of the State 
     plan) is concurrently prescribed opioids and--

       ``(aa) benzodiazepines; or
       ``(bb) antipsychotics.
       ``(ii) Managed care entities.--The State requires each 
     managed care entity (as defined in section 1932(a)(1)(B)) 
     with respect to which the State has a contract under section 
     1903(m) or under section 1905(t)(3) to have in place, subject 
     to paragraph (3), with respect to individuals who are 
     eligible for medical assistance under the State plan (or 
     under a waiver of the State plan) and who are enrolled with 
     the entity, the limitations described in subclauses (I) and 
     (II) of clause (i) and a claims review automated process 
     described in subclause (III) of such clause.
       ``(iii) Rules of construction.--Nothing in this 
     subparagraph may be construed as prohibiting a State or 
     managed care entity from designing and implementing a claims 
     review automated process under this subparagraph that 
     provides for prospective or retrospective reviews of claims. 
     Nothing in this subparagraph shall be understood as 
     prohibiting the exercise of clinical judgment from a provider 
     enrolled as a participating provider in a State plan (or 
     waiver of the State plan) or contracting with a managed care 
     entity regarding the best items and services for an 
     individual enrolled under such State plan (or waiver).
       ``(B) Program to monitor antipsychotic medications by 
     children.--The State has in place a program (as designed and 
     implemented by the State) to monitor and manage the 
     appropriate use of antipsychotic medications by children 
     enrolled under the State plan (or under a waiver of the State 
     plan) and submits annually to the Secretary such information 
     as the Secretary may require on activities carried out under 
     such program for individuals not more than the age of 18 
     years generally and children in foster care specifically.
       ``(C) Fraud and abuse identification.--The State has in 
     place a process (as designed and implemented by the State) 
     that identifies potential fraud or abuse of controlled 
     substances by individuals enrolled under the State plan (or 
     under a waiver of the State plan), health care providers 
     prescribing drugs to individuals so enrolled, and pharmacies 
     dispensing drugs to individuals so enrolled.
       ``(D) Reports.--The State shall include in the annual 
     report submitted to the Secretary under section 1927(g)(3)(D) 
     information on the limitations, requirement, program, and 
     processes applied by the State under subparagraphs (A) 
     through (C) in accordance with such manner and time as 
     specified by the Secretary.
       ``(E) Clarification.--Nothing shall prevent a State from 
     satisfying the requirement--
       ``(i) described in subparagraph (A) by having safety edits 
     or a claims review automated process described in such 
     subparagraph that was in place before October 1, 2019;
       ``(ii) described in subparagraph (B) by having a program 
     described in such subparagraph that was in place before such 
     date; or
       ``(iii) described in subparagraph (C) by having a process 
     described in such subparagraph that was in place before such 
     date.
       ``(2) Annual report by secretary.--For each fiscal year 
     beginning with fiscal year 2020, the Secretary shall submit 
     to Congress a report on the most recent information submitted 
     by States under paragraph (1)(D).
       ``(3) Exceptions.--
       ``(A) Certain individuals exempted.--The drug review and 
     utilization requirements under this subsection shall not 
     apply with respect to an individual who--
       ``(i) is receiving--

       ``(I) hospice or palliative care; or
       ``(II) treatment for cancer;

       ``(ii) is a resident of a long-term care facility, of a 
     facility described in section 1905(d), or of another facility 
     for which frequently abused drugs are dispensed for residents 
     through a contract with a single pharmacy; or
       ``(iii) the State elects to treat as exempted from such 
     requirements.
       ``(B)  Exception relating to ensuring access.--In order to 
     ensure reasonable access to health care, the Secretary shall 
     waive the drug review and utilization requirements under this 
     subsection, with respect to a State, in the case of natural 
     disasters and similar situations, and in the case of the 
     provision of emergency services (as defined for purposes of 
     section 1860D-4(c)(5)(D)(ii)(II)).''.
       (3) Managed care entities.--Section 1932 of the Social 
     Security Act (42 U.S.C. 1396u-2) is amended by adding at the 
     end the following new subsection:

[[Page H9180]]

       ``(i) Drug Utilization Review Activities and 
     Requirements.--Beginning not later than October 1, 2019, each 
     contract under a State plan with a managed care entity (other 
     than a primary care case manager) under section 1903(m) shall 
     provide that the entity is in compliance with the applicable 
     provisions of section 438.3(s)(2) of title 42, Code of 
     Federal Regulations, section 483.3(s)(4)) of such title, and 
     section 483.3(s)(5) of such title, as such provisions were in 
     effect on March 31, 2018.''.
       (b) Identifying and Addressing Inappropriate Prescribing 
     and Billing Practices Under Medicaid.--
       (1) In general.--Section 1927(g) of the Social Security Act 
     (42 U.S.C. 1396r-8(g)) is amended--
       (A) in paragraph (1)(A)--
       (i) by striking ``of section 1903(i)(10)(B)'' and inserting 
     ``of section 1902(a)(54)'';
       (ii) by striking ``, by not later than January 1, 1993,'';
       (iii) by inserting after ``gross overuse,'' the following: 
     ``excessive utilization,''; and
       (iv) by striking ``or inappropriate or medically 
     unnecessary care'' and inserting ``inappropriate or medically 
     unnecessary care, or prescribing or billing practices that 
     indicate abuse or excessive utilization''; and
       (B) in paragraph (2)(B)--
       (i) by inserting after ``gross overuse,'' the following: 
     ``excessive utilization,''; and
       (ii) by striking ``or inappropriate or medically 
     unnecessary care'' and inserting ``inappropriate or medically 
     unnecessary care, or prescribing or billing practices that 
     indicate abuse or excessive utilization''.
       (2) Effective date.--The amendments made by paragraph (1) 
     shall take effect with respect to retrospective drug use 
     reviews conducted on or after October 1, 2020.

     SEC. 1005. GUIDANCE TO IMPROVE CARE FOR INFANTS WITH NEONATAL 
                   ABSTINENCE SYNDROME AND THEIR MOTHERS; GAO 
                   STUDY ON GAPS IN MEDICAID COVERAGE FOR PREGNANT 
                   AND POSTPARTUM WOMEN WITH SUBSTANCE USE 
                   DISORDER.

       (a) Guidance.--Not later than 1 year after the date of the 
     enactment of this Act, the Secretary of Health and Human 
     Services shall issue guidance to improve care for infants 
     with neonatal abstinence syndrome and their families. Such 
     guidance shall include--
       (1) best practices from States with respect to innovative 
     or evidenced-based payment models that focus on prevention, 
     screening, treatment, plans of safe care, and postdischarge 
     services for mothers and fathers with substance use disorders 
     and babies with neonatal abstinence syndrome that improve 
     care and clinical outcomes;
       (2) recommendations for States on available financing 
     options under the Medicaid program under title XIX of such 
     Act and under the Children's Health Insurance Program under 
     title XXI of such Act for Children's Health Insurance Program 
     Health Services Initiative funds for parents with substance 
     use disorders, infants with neonatal abstinence syndrome, and 
     home-visiting services;
       (3) guidance and technical assistance to State Medicaid 
     agencies regarding additional flexibilities and incentives 
     related to screening, prevention, and postdischarge services, 
     including parenting supports, and infant-caregiver bonding, 
     including breastfeeding when it is appropriate; and
       (4) guidance regarding suggested terminology and ICD codes 
     to identify infants with neonatal abstinence syndrome and 
     neonatal opioid withdrawal syndrome, which could include 
     opioid-exposure, opioid withdrawal not requiring 
     pharmacotherapy, and opioid withdrawal requiring 
     pharmacotherapy.
       (b) GAO Study.--Not later than 1 year after the date of the 
     enactment of this Act, the Comptroller General of the United 
     States shall conduct a study, and submit to Congress a 
     report, addressing gaps in coverage for pregnant women with 
     substance use disorder under the Medicaid program under title 
     XIX of the Social Security Act, and gaps in coverage for 
     postpartum women with substance use disorder who had coverage 
     during their pregnancy under the Medicaid program under such 
     title.

     SEC. 1006. MEDICAID HEALTH HOMES FOR SUBSTANCE-USE-DISORDER 
                   MEDICAID ENROLLEES.

       (a) Extension of Enhanced FMAP for Certain Health Homes for 
     Individuals With Substance Use Disorders.--Section 1945(c) of 
     the Social Security Act (42 U.S.C. 1396w-4(c)) is amended--
       (1) in paragraph (1), by inserting ``subject to paragraph 
     (4),'' after ``except that,''; and
       (2) by adding at the end the following new paragraph:
       ``(4) Special rule relating to substance use disorder 
     health homes.--
       ``(A) In general.--In the case of a State with an SUD-
     focused State plan amendment approved by the Secretary on or 
     after October 1, 2018, the Secretary may, at the request of 
     the State, extend the application of the Federal medical 
     assistance percentage described in paragraph (1) to payments 
     for the provision of health home services to SUD-eligible 
     individuals under such State plan amendment, in addition to 
     the first 8 fiscal year quarters the State plan amendment is 
     in effect, for the subsequent 2 fiscal year quarters that the 
     State plan amendment is in effect. Nothing in this section 
     shall be construed as prohibiting a State with a State plan 
     amendment that is approved under this section and that is not 
     an SUD-focused State plan amendment from additionally having 
     approved on or after such date an SUD-focused State plan 
     amendment under this section, including for purposes of 
     application of this paragraph.
       ``(B) Report requirements.--In the case of a State with an 
     SUD-focused State plan amendment for which the application of 
     the Federal medical assistance percentage has been extended 
     under subparagraph (A), such State shall, at the end of the 
     period of such State plan amendment, submit to the Secretary 
     a report on the following, with respect to SUD-eligible 
     individuals provided health home services under such State 
     plan amendment:
       ``(i) The quality of health care provided to such 
     individuals, with a focus on outcomes relevant to the 
     recovery of each such individual.
       ``(ii) The access of such individuals to health care.
       ``(iii) The total expenditures of such individuals for 
     health care.
     For purposes of this subparagraph, the Secretary shall 
     specify all applicable measures for determining quality, 
     access, and expenditures.
       ``(C) Best practices.--Not later than October 1, 2020, the 
     Secretary shall make publicly available on the internet 
     website of the Centers for Medicare & Medicaid Services best 
     practices for designing and implementing an SUD-focused State 
     plan amendment, based on the experiences of States that have 
     State plan amendments approved under this section that 
     include SUD-eligible individuals.
       ``(D) Definitions.--For purposes of this paragraph:
       ``(i) SUD-eligible individuals.--The term `SUD-eligible 
     individual' means, with respect to a State, an individual who 
     satisfies all of the following:

       ``(I) The individual is an eligible individual with chronic 
     conditions.
       ``(II) The individual is an individual with a substance use 
     disorder.
       ``(III) The individual has not previously received health 
     home services under any other State plan amendment approved 
     for the State under this section by the Secretary.

       ``(ii) SUD-focused state plan amendment.--The term `SUD-
     focused State plan amendment' means a State plan amendment 
     under this section that is designed to provide health home 
     services primarily to SUD-eligible individuals.''.
       (b) Requirement for State Medicaid Plans To Provide 
     Coverage for Medication-Assisted Treatment.--
       (1) Requirement for state medicaid plans to provide 
     coverage for medication-assisted treatment.--Section 
     1902(a)(10)(A) of the Social Security Act (42 U.S.C. 
     1396a(a)(10)(A)) is amended, in the matter preceding clause 
     (i), by striking ``and (28)'' and inserting ``(28), and 
     (29)''.
       (2) Inclusion of medication-assisted treatment as medical 
     assistance.--Section 1905(a) of the Social Security Act (42 
     U.S.C. 1396d(a)) is amended--
       (A) in paragraph (28), by striking ``and'' at the end;
       (B) by redesignating paragraph (29) as paragraph (30); and
       (C) by inserting after paragraph (28) the following new 
     paragraph:
       ``(29) subject to paragraph (2) of subsection (ee), for the 
     period beginning October 1, 2020, and ending September 30, 
     2025, medication-assisted treatment (as defined in paragraph 
     (1) of such subsection); and''.
       (3) Medication-assisted treatment defined; waivers.--
     Section 1905 of the Social Security Act (42 U.S.C. 1396d) is 
     amended by adding at the end the following new subsection:
       ``(ee) Medication-Assisted Treatment.--
       ``(1) Definition.--For purposes of subsection (a)(29), the 
     term `medication-assisted treatment'--
       ``(A) means all drugs approved under section 505 of the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355), 
     including methadone, and all biological products licensed 
     under section 351 of the Public Health Service Act (42 U.S.C. 
     262) to treat opioid use disorders; and
       ``(B) includes, with respect to the provision of such drugs 
     and biological products, counseling services and behavioral 
     therapy.
       ``(2) Exception.--The provisions of paragraph (29) of 
     subsection (a) shall not apply with respect to a State for 
     the period specified in such paragraph, if before the 
     beginning of such period the State certifies to the 
     satisfaction of the Secretary that implementing such 
     provisions statewide for all individuals eligible to enroll 
     in the State plan (or waiver of the State plan) would not be 
     feasible by reason of a shortage of qualified providers of 
     medication-assisted treatment, or facilities providing such 
     treatment, that will contract with the State or a managed 
     care entity with which the State has a contract under section 
     1903(m) or under section 1905(t)(3).''.
       (4) Effective date.--
       (A) In general.--Subject to subparagraph (B), the 
     amendments made by this subsection shall apply with respect 
     to medical assistance provided on or after October 1, 2020, 
     and before October 1, 2025.
       (B) Exception for state legislation.--In the case of a 
     State plan under title XIX of the Social Security Act (42 
     U.S.C. 1396 et seq.) that the Secretary of Health and Human 
     Services determines requires State legislation in order for 
     the respective plan to meet any requirement imposed by the 
     amendments made by this subsection, the respective plan shall 
     not be regarded as failing to comply with the requirements of 
     such

[[Page H9181]]

     title solely on the basis of its failure to meet such an 
     additional requirement before the first day of the first 
     calendar quarter beginning after the close of the first 
     regular session of the State legislature that begins after 
     the date of the enactment of this Act. For purposes of the 
     previous sentence, in the case of a State that has a 2-year 
     legislative session, each year of the session shall be 
     considered to be a separate regular session of the State 
     legislature.

     SEC. 1007. CARING RECOVERY FOR INFANTS AND BABIES.

       (a) State Plan Amendment.--Section 1902(a) of the Social 
     Security Act (42 U.S.C. 1396a(a)), as amended by sections 
     1001 and 1004, is further amended--
       (1) in paragraph (84)(C), by striking ``and'' after the 
     semicolon;
       (2) in paragraph (85), by striking the period at the end 
     and inserting ``; and''; and
       (3) by inserting after paragraph (85), the following new 
     paragraph:
       ``(86) provide, at the option of the State, for making 
     medical assistance available on an inpatient or outpatient 
     basis at a residential pediatric recovery center (as defined 
     in subsection (pp)) to infants with neonatal abstinence 
     syndrome.''.
       (b) Residential Pediatric Recovery Center Defined.--Section 
     1902 of such Act (42 U.S.C. 1396a), as amended by sections 
     1001 and 1004, is further amended by adding at the end the 
     following new subsection:
       ``(pp) Residential Pediatric Recovery Center Defined.--
       ``(1) In general.--For purposes of section 1902(a)(86), the 
     term `residential pediatric recovery center' means a center 
     or facility that furnishes items and services for which 
     medical assistance is available under the State plan to 
     infants with the diagnosis of neonatal abstinence syndrome 
     without any other significant medical risk factors.
       ``(2) Counseling and services.--A residential pediatric 
     recovery center may offer counseling and other services to 
     mothers (and other appropriate family members and caretakers) 
     of infants receiving treatment at such centers if such 
     services are otherwise covered under the State plan under 
     this title or under a waiver of such plan. Such other 
     services may include the following:
       ``(A) Counseling or referrals for services.
       ``(B) Activities to encourage caregiver-infant bonding.
       ``(C) Training on caring for such infants.''.
       (c) Effective Date.--The amendments made by this section 
     take effect on the date of enactment of this Act and shall 
     apply to medical assistance furnished on or after that date, 
     without regard to final regulations to carry out such 
     amendments being promulgated as of such date.

     SEC. 1008. PEER SUPPORT ENHANCEMENT AND EVALUATION REVIEW.

       (a) In General.--Not later than 2 years after the date of 
     the enactment of this Act, the Comptroller General of the 
     United States shall submit to the Committee on Energy and 
     Commerce of the House of Representatives, the Committee on 
     Finance of the Senate, and the Committee on Health, 
     Education, Labor and Pensions of the Senate a report on the 
     provision of peer support services under the Medicaid 
     program.
       (b) Content of Report.--
       (1) In general.--The report required under subsection (a) 
     shall include the following information:
       (A) Information on State coverage of peer support services 
     under Medicaid, including--
       (i) the mechanisms through which States may provide such 
     coverage, including through existing statutory authority or 
     through waivers;
       (ii) the populations to which States have provided such 
     coverage;
       (iii) the payment models, including any alternative payment 
     models, used by States to pay providers of such services; and
       (iv) where available, information on Federal and State 
     spending under Medicaid for peer support services.
       (B) Information on selected State experiences in providing 
     medical assistance for peer support services under State 
     Medicaid plans and whether States measure the effects of 
     providing such assistance with respect to--
       (i) improving access to behavioral health services;
       (ii) improving early detection, and preventing worsening, 
     of behavioral health disorders;
       (iii) reducing chronic and comorbid conditions; and
       (iv) reducing overall health costs.
       (2) Recommendations.--The report required under subsection 
     (a) shall include recommendations, including recommendations 
     for such legislative and administrative actions related to 
     improving services, including peer support services, and 
     access to peer support services under Medicaid as the 
     Comptroller General of the United States determines 
     appropriate.

     SEC. 1009. MEDICAID SUBSTANCE USE DISORDER TREATMENT VIA 
                   TELEHEALTH.

       (a) Definitions.--In this section:
       (1) Comptroller general.--The term ``Comptroller General'' 
     means the Comptroller General of the United States.
       (2) School-based health center.--The term ``school-based 
     health center'' has the meaning given that term in section 
     2110(c)(9) of the Social Security Act (42 U.S.C. 
     1397jj(c)(9)).
       (3) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (4) Underserved area.--The term ``underserved area'' means 
     a health professional shortage area (as defined in section 
     332(a)(1)(A) of the Public Health Service Act (42 U.S.C. 
     254e(a)(1)(A))) and a medically underserved area (according 
     to a designation under section 330(b)(3)(A) of the Public 
     Health Service Act (42 U.S.C. 254b(b)(3)(A))).
       (b) Guidance to States Regarding Federal Reimbursement for 
     Furnishing Services and Treatment for Substance Use Disorders 
     Under Medicaid Using Services Delivered Via Telehealth, 
     Including in School-Based Health Centers.--Not later than 1 
     year after the date of enactment of this Act, the Secretary, 
     acting through the Administrator of the Centers for Medicare 
     & Medicaid Services, shall issue guidance to States on the 
     following:
       (1) State options for Federal reimbursement of expenditures 
     under Medicaid for furnishing services and treatment for 
     substance use disorders, including assessment, medication-
     assisted treatment, counseling, medication management, and 
     medication adherence with prescribed medication regimes, 
     using services delivered via telehealth. Such guidance shall 
     also include guidance on furnishing services and treatments 
     that address the needs of high-risk individuals, including at 
     least the following groups:
       (A) American Indians and Alaska Natives.
       (B) Adults under the age of 40.
       (C) Individuals with a history of non-fatal overdose.
       (D) Individuals with a co-occurring serious mental illness 
     and substance use disorder.
       (2) State options for Federal reimbursement of expenditures 
     under Medicaid for education directed to providers serving 
     Medicaid beneficiaries with substance use disorders using the 
     hub and spoke model, through contracts with managed care 
     entities, through administrative claiming for disease 
     management activities, and under Delivery System Reform 
     Incentive Payment (``DSRIP'') programs.
       (3) State options for Federal reimbursement of expenditures 
     under Medicaid for furnishing services and treatment for 
     substance use disorders for individuals enrolled in Medicaid 
     in a school-based health center using services delivered via 
     telehealth.
       (c) GAO Evaluation of Children's Access to Services and 
     Treatment for Substance Use Disorders Under Medicaid.--
       (1) Study.--The Comptroller General shall evaluate 
     children's access to services and treatment for substance use 
     disorders under Medicaid. The evaluation shall include an 
     analysis of State options for improving children's access to 
     such services and treatment and for improving outcomes, 
     including by increasing the number of Medicaid providers who 
     offer services or treatment for substance use disorders in a 
     school-based health center using services delivered via 
     telehealth, particularly in rural and underserved areas. The 
     evaluation shall include an analysis of Medicaid provider 
     reimbursement rates for services and treatment for substance 
     use disorders.
       (2) Report.--Not later than 1 year after the date of 
     enactment of this Act, the Comptroller General shall submit 
     to Congress a report containing the results of the evaluation 
     conducted under paragraph (1), together with recommendations 
     for such legislation and administrative action as the 
     Comptroller General determines appropriate.
       (d) Report on Reducing Barriers to Using Services Delivered 
     Via Telehealth and Remote Patient Monitoring for Pediatric 
     Populations Under Medicaid.--
       (1) In general.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary, acting through the 
     Administrator of the Centers for Medicare & Medicaid 
     Services, shall issue a report to the Committee on Finance of 
     the Senate and the Committee on Energy and Commerce of the 
     House of Representatives identifying best practices and 
     potential solutions for reducing barriers to using services 
     delivered via telehealth to furnish services and treatment 
     for substance use disorders among pediatric populations under 
     Medicaid. The report shall include--
       (A) analyses of the best practices, barriers, and potential 
     solutions for using services delivered via telehealth to 
     diagnose and provide services and treatment for children with 
     substance use disorders, including opioid use disorder; and
       (B) identification and analysis of the differences, if any, 
     in furnishing services and treatment for children with 
     substance use disorders using services delivered via 
     telehealth and using services delivered in person, such as, 
     and to the extent feasible, with respect to--
       (i) utilization rates;
       (ii) costs;
       (iii) avoidable inpatient admissions and readmissions;
       (iv) quality of care; and
       (v) patient, family, and provider satisfaction.
       (2) Publication.--The Secretary shall publish the report 
     required under paragraph (1) on a public internet website of 
     the Department of Health and Human Services.

     SEC. 1010. ENHANCING PATIENT ACCESS TO NON-OPIOID TREATMENT 
                   OPTIONS.

       Not later than January 1, 2019, the Secretary of Health and 
     Human Services, acting through the Administrator of the 
     Centers for Medicare & Medicaid Services, shall issue 1 or 
     more final guidance documents, or update existing guidance 
     documents, to States regarding mandatory and optional items 
     and services that may be provided under a State plan under 
     title XIX of the Social Security Act (42 U.S.C. 1396 et 
     seq.), or under a waiver

[[Page H9182]]

     of such a plan, for non-opioid treatment and management of 
     pain, including, but not limited to, evidence-based, non-
     opioid pharmacological therapies and non-pharmacological 
     therapies.

     SEC. 1011. ASSESSING BARRIERS TO OPIOID USE DISORDER 
                   TREATMENT.

       (a) Study.--
       (1) In general.--The Comptroller General of the United 
     States (in this section referred to as the ``Comptroller 
     General'') shall conduct a study regarding the barriers to 
     providing medication used in the treatment of substance use 
     disorders under Medicaid distribution models such as the 
     ``buy-and-bill'' model, and options for State Medicaid 
     programs to remove or reduce such barriers. The study shall 
     include analyses of each of the following models of 
     distribution of substance use disorder treatment medications, 
     particularly buprenorphine, naltrexone, and buprenorphine-
     naloxone combinations:
       (A) The purchasing, storage, and administration of 
     substance use disorder treatment medications by providers.
       (B) The dispensing of substance use disorder treatment 
     medications by pharmacists.
       (C) The ordering, prescribing, and obtaining substance use 
     disorder treatment medications on demand from specialty 
     pharmacies by providers.
       (2) Requirements.--For each model of distribution specified 
     in paragraph (1), the Comptroller General shall evaluate how 
     each model presents barriers or could be used by selected 
     State Medicaid programs to reduce the barriers related to the 
     provision of substance use disorder treatment by examining 
     what is known about the effects of the model of distribution 
     on--
       (A) Medicaid beneficiaries' access to substance use 
     disorder treatment medications;
       (B) the differential cost to the program between each 
     distribution model for medication-assisted treatment; and
       (C) provider willingness to provide or prescribe substance 
     use disorder treatment medications.
       (b) Report.--Not later than 15 months after the date of the 
     enactment of this Act, the Comptroller General shall submit 
     to Congress a report containing the results of the study 
     conducted under subsection (a), together with recommendations 
     for such legislation and administrative action as the 
     Comptroller General determines appropriate.

     SEC. 1012. HELP FOR MOMS AND BABIES.

       (a) Medicaid State Plan.--Section 1905(a) of the Social 
     Security Act (42 U.S.C. 1396d(a)), as amended by section 
     1006, is further amended by adding at the end the following 
     new sentence: ``In the case of a woman who is eligible for 
     medical assistance on the basis of being pregnant (including 
     through the end of the month in which the 60-day period 
     beginning on the last day of her pregnancy ends), who is a 
     patient in an institution for mental diseases for purposes of 
     receiving treatment for a substance use disorder, and who was 
     enrolled for medical assistance under the State plan 
     immediately before becoming a patient in an institution for 
     mental diseases or who becomes eligible to enroll for such 
     medical assistance while such a patient, the exclusion from 
     the definition of `medical assistance' set forth in the 
     subdivision (B) following paragraph (30) of the first 
     sentence of this subsection shall not be construed as 
     prohibiting Federal financial participation for medical 
     assistance for items or services that are provided to the 
     woman outside of the institution.''.
       (b) Effective Date.--
       (1) In general.--Except as provided in paragraph (2), the 
     amendment made by subsection (a) shall take effect on the 
     date of enactment of this Act.
       (2) Rule for changes requiring state legislation.--In the 
     case of a State plan under title XIX of the Social Security 
     Act which the Secretary of Health and Human Services 
     determines requires State legislation (other than legislation 
     appropriating funds) in order for the plan to meet the 
     additional requirements imposed by the amendment made by 
     subsection (a), the State plan shall not be regarded as 
     failing to comply with the requirements of such title solely 
     on the basis of its failure to meet these additional 
     requirements before the first day of the first calendar 
     quarter beginning after the close of the first regular 
     session of the State legislature that begins after the date 
     of the enactment of this Act. For purposes of the previous 
     sentence, in the case of a State that has a 2-year 
     legislative session, each year of such session shall be 
     deemed to be a separate regular session of the State 
     legislature.

     SEC. 1013. SECURING FLEXIBILITY TO TREAT SUBSTANCE USE 
                   DISORDERS.

       Section 1903(m) of the Social Security Act (42 U.S.C. 
     1396b(m)) is amended by adding at the end the following new 
     paragraph:
       ``(7) Payment shall be made under this title to a State for 
     expenditures for capitation payments described in section 
     438.6(e) of title 42, Code of Federal Regulations (or any 
     successor regulation).''.

     SEC. 1014. MACPAC STUDY AND REPORT ON MAT UTILIZATION 
                   CONTROLS UNDER STATE MEDICAID PROGRAMS.

       (a) Study.--The Medicaid and CHIP Payment and Access 
     Commission shall conduct a study and analysis of utilization 
     control policies applied to medication-assisted treatment for 
     substance use disorders under State Medicaid programs, 
     including policies and procedures applied both in fee-for-
     service Medicaid and in risk-based managed care Medicaid, 
     which shall--
       (1) include an inventory of such utilization control 
     policies and related protocols for ensuring access to 
     medically necessary treatment;
       (2) determine whether managed care utilization control 
     policies and procedures for medication-assisted treatment for 
     substance use disorders are consistent with section 
     438.210(a)(4)(ii) of title 42, Code of Federal Regulations; 
     and
       (3) identify policies that--
       (A) limit an individual's access to medication-assisted 
     treatment for a substance use disorder by limiting the 
     quantity of medication-assisted treatment prescriptions, or 
     the number of refills for such prescriptions, available to 
     the individual as part of a prior authorization process or 
     similar utilization protocols; and
       (B) apply without evaluating individual instances of fraud, 
     waste, or abuse.
       (b) Report.--Not later than 1 year after the date of the 
     enactment of this Act, the Medicaid and CHIP Payment and 
     Access Commission shall make publicly available a report 
     containing the results of the study conducted under 
     subsection (a).

     SEC. 1015. OPIOID ADDICTION TREATMENT PROGRAMS ENHANCEMENT.

       (a) T-MSIS Substance Use Disorder Data Book.--
       (1) In general.--Not later than the date that is 12 months 
     after the date of enactment of this Act, the Secretary of 
     Health and Human Services (in this section referred to as the 
     ``Secretary'') shall publish on the public website of the 
     Centers for Medicare & Medicaid Services a report with 
     comprehensive data on the prevalence of substance use 
     disorders in the Medicaid beneficiary population and services 
     provided for the treatment of substance use disorders under 
     Medicaid.
       (2) Content of report.--The report required under paragraph 
     (1) shall include, at a minimum, the following data for each 
     State (including, to the extent available, for the District 
     of Columbia, Puerto Rico, the United States Virgin Islands, 
     Guam, the Northern Mariana Islands, and American Samoa):
       (A) The number and percentage of individuals enrolled in 
     the State Medicaid plan or waiver of such plan in each of the 
     major enrollment categories (as defined in a public letter 
     from the Medicaid and CHIP Payment and Access Commission to 
     the Secretary) who have been diagnosed with a substance use 
     disorder and whether such individuals are enrolled under the 
     State Medicaid plan or a waiver of such plan, including the 
     specific waiver authority under which they are enrolled, to 
     the extent available.
       (B) A list of the substance use disorder treatment services 
     by each major type of service, such as counseling, 
     medication-assisted treatment, peer support, residential 
     treatment, and inpatient care, for which beneficiaries in 
     each State received at least 1 service under the State 
     Medicaid plan or a waiver of such plan.
       (C) The number and percentage of individuals with a 
     substance use disorder diagnosis enrolled in the State 
     Medicaid plan or waiver of such plan who received substance 
     use disorder treatment services under such plan or waiver by 
     each major type of service under subparagraph (B) within each 
     major setting type, such as outpatient, inpatient, 
     residential, and other home-based and community-based 
     settings.
       (D) The number of services provided under the State 
     Medicaid plan or waiver of such plan per individual with a 
     substance use disorder diagnosis enrolled in such plan or 
     waiver for each major type of service under subparagraph (B).
       (E) The number and percentage of individuals enrolled in 
     the State Medicaid plan or waiver, by major enrollment 
     category, who received substance use disorder treatment 
     through--
       (i) a medicaid managed care entity (as defined in section 
     1932(a)(1)(B) of the Social Security Act (42 U.S.C. 1396u-
     2(a)(1)(B))), including the number of such individuals who 
     received such assistance through a prepaid inpatient health 
     plan or a prepaid ambulatory health plan;
       (ii) a fee-for-service payment model; or
       (iii) an alternative payment model, to the extent 
     available.
       (F) The number and percentage of individuals with a 
     substance use disorder who receive substance use disorder 
     treatment services in an outpatient or home-based and 
     community-based setting after receiving treatment in an 
     inpatient or residential setting, and the number of services 
     received by such individuals in the outpatient or home-based 
     and community-based setting.
       (3) Annual updates.--The Secretary shall issue an updated 
     version of the report required under paragraph (1) not later 
     than January 1 of each calendar year through 2024.
       (4) Use of t-msis data.--The report required under 
     paragraph (1) and updates required under paragraph (3) 
     shall--
       (A) use data and definitions from the Transformed Medicaid 
     Statistical Information System (``T-MSIS'') data set that is 
     no more than 12 months old on the date that the report or 
     update is published; and
       (B) as appropriate, include a description with respect to 
     each State of the quality and completeness of the data and 
     caveats describing the limitations of the data reported to 
     the Secretary by the State that is sufficient to communicate 
     the appropriate uses for the information.

[[Page H9183]]

       (b) Making T-MSIS Data on Substance Use Disorders Available 
     to Researchers.--
       (1) In general.--The Secretary shall publish in the Federal 
     Register a system of records notice for the data specified in 
     paragraph (2) for the Transformed Medicaid Statistical 
     Information System, in accordance with section 552a(e)(4) of 
     title 5, United States Code. The notice shall outline 
     policies that protect the security and privacy of the data 
     that, at a minimum, meet the security and privacy policies of 
     SORN 09-70-0541 for the Medicaid Statistical Information 
     System.
       (2) Required data.--The data covered by the systems of 
     records notice required under paragraph (1) shall be 
     sufficient for researchers and States to analyze the 
     prevalence of substance use disorders in the Medicaid 
     beneficiary population and the treatment of substance use 
     disorders under Medicaid across all States (including the 
     District of Columbia, Puerto Rico, the United States Virgin 
     Islands, Guam, the Northern Mariana Islands, and American 
     Samoa), forms of treatment, and treatment settings.
       (3) Initiation of data-sharing activities.--Not later than 
     January 1, 2019, the Secretary shall initiate the data-
     sharing activities outlined in the notice required under 
     paragraph (1).

     SEC. 1016. BETTER DATA SHARING TO COMBAT THE OPIOID CRISIS.

       (a) In General.--Section 1903(m) of the Social Security Act 
     (42 U.S.C. 1396b(m)), as amended by section 1013, is further 
     amended by adding at the end the following new paragraph:
       ``(8)(A) The State agency administering the State plan 
     under this title may have reasonable access, as determined by 
     the State, to 1 or more prescription drug monitoring program 
     databases administered or accessed by the State to the extent 
     the State agency is permitted to access such databases under 
     State law.
       ``(B) Such State agency may facilitate reasonable access, 
     as determined by the State, to 1 or more prescription drug 
     monitoring program databases administered or accessed by the 
     State, to same extent that the State agency is permitted 
     under State law to access such databases, for--
       ``(i) any provider enrolled under the State plan to provide 
     services to Medicaid beneficiaries; and
       ``(ii) any managed care entity (as defined under section 
     1932(a)(1)(B)) that has a contract with the State under this 
     subsection or under section 1905(t)(3).
       ``(C) Such State agency may share information in such 
     databases, to the same extent that the State agency is 
     permitted under State law to share information in such 
     databases, with--
       ``(i) any provider enrolled under the State plan to provide 
     services to Medicaid beneficiaries; and
       ``(ii) any managed care entity (as defined under section 
     1932(a)(1)(B)) that has a contract with the State under this 
     subsection or under section 1905(t)(3).''.
       (b) Security and Privacy.--All applicable State and Federal 
     security and privacy protections and laws shall apply to any 
     State agency, individual, or entity accessing 1 or more 
     prescription drug monitoring program databases or obtaining 
     information in such databases in accordance with section 
     1903(m)(8) of the Social Security Act (as added by subsection 
     (a)).
       (c) Effective Date.--The amendment made by subsection (a) 
     shall take effect on the date of enactment of this Act.

     SEC. 1017. REPORT ON INNOVATIVE STATE INITIATIVES AND 
                   STRATEGIES TO PROVIDE HOUSING-RELATED SERVICES 
                   AND SUPPORTS TO INDIVIDUALS STRUGGLING WITH 
                   SUBSTANCE USE DISORDERS UNDER MEDICAID.

       (a) In General.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall issue a report to Congress describing 
     innovative State initiatives and strategies for providing 
     housing-related services and supports under a State Medicaid 
     program to individuals with substance use disorders who are 
     experiencing or at risk of experiencing homelessness.
       (b) Content of Report.--The report required under 
     subsection (a) shall describe the following:
       (1) Existing methods and innovative strategies developed 
     and adopted by State Medicaid programs that have achieved 
     positive outcomes in increasing housing stability among 
     Medicaid beneficiaries with substance use disorders who are 
     experiencing or at risk of experiencing homelessness, 
     including Medicaid beneficiaries with substance use disorders 
     who are--
       (A) receiving treatment for substance use disorders in 
     inpatient, residential, outpatient, or home-based and 
     community-based settings;
       (B) transitioning between substance use disorder treatment 
     settings; or
       (C) living in supportive housing or another model of 
     affordable housing.
       (2) Strategies employed by Medicaid managed care 
     organizations, primary care case managers, hospitals, 
     accountable care organizations, and other care coordination 
     providers to deliver housing-related services and supports 
     and to coordinate services provided under State Medicaid 
     programs across different treatment settings.
       (3) Innovative strategies and lessons learned by States 
     with Medicaid waivers approved under section 1115 or 1915 of 
     the Social Security Act (42 U.S.C. 1315, 1396n), including--
       (A) challenges experienced by States in designing, 
     securing, and implementing such waivers or plan amendments;
       (B) how States developed partnerships with other 
     organizations such as behavioral health agencies, State 
     housing agencies, housing providers, health care services 
     agencies and providers, community-based organizations, and 
     health insurance plans to implement waivers or State plan 
     amendments; and
       (C) how and whether States plan to provide Medicaid 
     coverage for housing-related services and supports in the 
     future, including by covering such services and supports 
     under State Medicaid plans or waivers.
       (4) Existing opportunities for States to provide housing-
     related services and supports through a Medicaid waiver under 
     sections 1115 or 1915 of the Social Security Act (42 U.S.C. 
     1315, 1396n) or through a State Medicaid plan amendment, such 
     as the Assistance in Community Integration Service pilot 
     program, which promotes supportive housing and other housing-
     related supports under Medicaid for individuals with 
     substance use disorders and for which Maryland has a waiver 
     approved under such section 1115 to conduct the program.
       (5) Innovative strategies and partnerships developed and 
     implemented by State Medicaid programs or other entities to 
     identify and enroll eligible individuals with substance use 
     disorders who are experiencing or at risk of experiencing 
     homelessness in State Medicaid programs.

     SEC. 1018. TECHNICAL ASSISTANCE AND SUPPORT FOR INNOVATIVE 
                   STATE STRATEGIES TO PROVIDE HOUSING-RELATED 
                   SUPPORTS UNDER MEDICAID.

       (a) In General.--The Secretary of Health and Human Services 
     shall provide technical assistance and support to States 
     regarding the development and expansion of innovative State 
     strategies (including through State Medicaid demonstration 
     projects) to provide housing-related supports and services 
     and care coordination services under Medicaid to individuals 
     with substance use disorders.
       (b) Report.--Not later than 180 days after the date of 
     enactment of this Act, the Secretary shall issue a report to 
     Congress detailing a plan of action to carry out the 
     requirements of subsection (a).

       TITLE II--MEDICARE PROVISIONS TO ADDRESS THE OPIOID CRISIS

     SEC. 2001. EXPANDING THE USE OF TELEHEALTH SERVICES FOR THE 
                   TREATMENT OF OPIOID USE DISORDER AND OTHER 
                   SUBSTANCE USE DISORDERS.

       (a) In General.--Section 1834(m) of the Social Security Act 
     (42 U.S.C. 1395m(m)) is amended--
       (1) in paragraph (2)(B)--
       (A) in clause (i), in the matter preceding subclause (I), 
     by striking ``clause (ii)'' and inserting ``clause (ii) and 
     paragraph (6)(C)''; and
       (B) in clause (ii), in the heading, by striking ``for home 
     dialysis therapy'';
       (2) in paragraph (4)(C)--
       (A) in clause (i), by striking ``paragraph (6)'' and 
     inserting ``paragraphs (5), (6), and (7)''; and
       (B) in clause (ii)(X), by inserting ``or telehealth 
     services described in paragraph (7)'' before the period at 
     the end; and
       (3) by adding at the end the following new paragraph:
       ``(7) Treatment of substance use disorder services 
     furnished through telehealth.--The geographic requirements 
     described in paragraph (4)(C)(i) shall not apply with respect 
     to telehealth services furnished on or after July 1, 2019, to 
     an eligible telehealth individual with a substance use 
     disorder diagnosis for purposes of treatment of such disorder 
     or co-occurring mental health disorder, as determined by the 
     Secretary, at an originating site described in paragraph 
     (4)(C)(ii) (other than an originating site described in 
     subclause (IX) of such paragraph).''.
       (b) Implementation.--The Secretary of Health and Human 
     Services (in this section referred to as the ``Secretary'') 
     may implement the amendments made by this section by interim 
     final rule.
       (c) Report.--
       (1) In general.--Not later than 5 years after the date of 
     the enactment of this Act, the Secretary shall submit to 
     Congress a report on the impact of the implementation of the 
     amendments made by this section with respect to telehealth 
     services under section 1834(m) of the Social Security Act (42 
     U.S.C. 1395m(m)) on--
       (A) the utilization of health care items and services under 
     title XVIII of such Act (42 U.S.C. 1395 et seq.) related to 
     substance use disorders, including emergency department 
     visits; and
       (B) health outcomes related to substance use disorders, 
     such as opioid overdose deaths.
       (2) Funding.--For purposes of carrying out paragraph (1), 
     in addition to funds otherwise available, the Secretary shall 
     provide for the transfer, from the Federal Supplementary 
     Medical Insurance Trust Fund under section 1841, of 
     $3,000,000 to the Centers for Medicare & Medicaid Services 
     Program Management Account to remain available until 
     expended.

[[Page H9184]]

  


     SEC. 2002. COMPREHENSIVE SCREENINGS FOR SENIORS.

       (a) Initial Preventive Physical Examination.--Section 
     1861(ww) of the Social Security Act (42 U.S.C. 1395x(ww)) is 
     amended--
       (1) in paragraph (1)--
       (A) by striking ``paragraph (2) and'' and inserting 
     ``paragraph (2),''; and
       (B) by inserting ``and the furnishing of a review of any 
     current opioid prescriptions (as defined in paragraph (4)),'' 
     after ``upon the agreement with the individual,''; and
       (2) in paragraph (2)--
       (A) by redesignating subparagraph (N) as subparagraph (O); 
     and
       (B) by inserting after subparagraph (M) the following new 
     subparagraph:
       ``(N) Screening for potential substance use disorders.''; 
     and
       (3) by adding at the end the following new paragraph:
       ``(4) For purposes of paragraph (1), the term `a review of 
     any current opioid prescriptions' means, with respect to an 
     individual determined to have a current prescription for 
     opioids--
       ``(A) a review of the potential risk factors to the 
     individual for opioid use disorder;
       ``(B) an evaluation of the individual's severity of pain 
     and current treatment plan;
       ``(C) the provision of information on non-opioid treatment 
     options; and
       ``(D) a referral to a specialist, as appropriate.''.
       (b) Annual Wellness Visit.--Section 1861(hhh)(2) of the 
     Social Security Act (42 U.S.C. 1395x(hhh)(2)) is amended--
       (1) by redesignating subparagraph (G) as subparagraph (I); 
     and
       (2) by inserting after subparagraph (F) the following new 
     subparagraphs:
       ``(G) Screening for potential substance use disorders and 
     referral for treatment as appropriate.
       ``(H) The furnishing of a review of any current opioid 
     prescriptions (as defined in subsection (ww)(4)).''.
       (c) Rule of Construction.--Nothing in the amendments made 
     by subsection (a) or (b) shall be construed to prohibit 
     separate payment for structured assessment and intervention 
     services for substance abuse furnished to an individual on 
     the same day as an initial preventive physical examination or 
     an annual wellness visit.
       (d) Effective Date.--The amendments made by this section 
     shall apply to examinations and visits furnished on or after 
     January 1, 2020.

     SEC. 2003. EVERY PRESCRIPTION CONVEYED SECURELY.

       (a) In General.--Section 1860D-4(e) of the Social Security 
     Act (42 U.S.C. 1395w-104(e)) is amended by adding at the end 
     the following:
       ``(7) Requirement of e-prescribing for controlled 
     substances.--
       ``(A) In general.--Subject to subparagraph (B), a 
     prescription for a covered part D drug under a prescription 
     drug plan (or under an MA-PD plan) for a schedule II, III, 
     IV, or V controlled substance shall be transmitted by a 
     health care practitioner electronically in accordance with an 
     electronic prescription drug program that meets the 
     requirements of paragraph (2).
       ``(B) Exception for certain circumstances.--The Secretary 
     shall, through rulemaking, specify circumstances and 
     processes by which the Secretary may waive the requirement 
     under subparagraph (A), with respect to a covered part D 
     drug, including in the case of--
       ``(i) a prescription issued when the practitioner and 
     dispensing pharmacy are the same entity;
       ``(ii) a prescription issued that cannot be transmitted 
     electronically under the most recently implemented version of 
     the National Council for Prescription Drug Programs SCRIPT 
     Standard;
       ``(iii) a prescription issued by a practitioner who 
     received a waiver or a renewal thereof for a period of time 
     as determined by the Secretary, not to exceed one year, from 
     the requirement to use electronic prescribing due to 
     demonstrated economic hardship, technological limitations 
     that are not reasonably within the control of the 
     practitioner, or other exceptional circumstance demonstrated 
     by the practitioner;
       ``(iv) a prescription issued by a practitioner under 
     circumstances in which, notwithstanding the practitioner's 
     ability to submit a prescription electronically as required 
     by this subsection, such practitioner reasonably determines 
     that it would be impractical for the individual involved to 
     obtain substances prescribed by electronic prescription in a 
     timely manner, and such delay would adversely impact the 
     individual's medical condition involved;
       ``(v) a prescription issued by a practitioner prescribing a 
     drug under a research protocol;
       ``(vi) a prescription issued by a practitioner for a drug 
     for which the Food and Drug Administration requires a 
     prescription to contain elements that are not able to be 
     included in electronic prescribing, such as a drug with risk 
     evaluation and mitigation strategies that include elements to 
     assure safe use;
       ``(vii) a prescription issued by a practitioner--

       ``(I) for an individual who receives hospice care under 
     this title; and
       ``(II) that is not covered under the hospice benefit under 
     this title; and

       ``(viii) a prescription issued by a practitioner for an 
     individual who is--

       ``(I) a resident of a nursing facility (as defined in 
     section 1919(a)); and
       ``(II) dually eligible for benefits under this title and 
     title XIX.

       ``(C) Dispensing.--(i) Nothing in this paragraph shall be 
     construed as requiring a sponsor of a prescription drug plan 
     under this part, MA organization offering an MA-PD plan under 
     part C, or a pharmacist to verify that a practitioner, with 
     respect to a prescription for a covered part D drug, has a 
     waiver (or is otherwise exempt) under subparagraph (B) from 
     the requirement under subparagraph (A).
       ``(ii) Nothing in this paragraph shall be construed as 
     affecting the ability of the plan to cover or the 
     pharmacists' ability to continue to dispense covered part D 
     drugs from otherwise valid written, oral, or fax 
     prescriptions that are consistent with laws and regulations.
       ``(iii) Nothing in this paragraph shall be construed as 
     affecting the ability of an individual who is being 
     prescribed a covered part D drug to designate a particular 
     pharmacy to dispense the covered part D drug to the extent 
     consistent with the requirements under subsection (b)(1) and 
     under this paragraph.
       ``(D) Enforcement.--The Secretary shall, through 
     rulemaking, have authority to enforce and specify appropriate 
     penalties for non-compliance with the requirement under 
     subparagraph (A).''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to coverage of drugs prescribed on or after 
     January 1, 2021.
       (c) Update of Biometric Component of Multifactor 
     Authentication.--Not later than 1 year after the date of 
     enactment of this Act, the Attorney General shall update the 
     requirements for the biometric component of multifactor 
     authentication with respect to electronic prescriptions of 
     controlled substances.

     SEC. 2004. REQUIRING PRESCRIPTION DRUG PLAN SPONSORS UNDER 
                   MEDICARE TO ESTABLISH DRUG MANAGEMENT PROGRAMS 
                   FOR AT-RISK BENEFICIARIES.

       Section 1860D-4(c) of the Social Security Act (42 U.S.C. 
     1395w-104(c)) is amended--
       (1) in paragraph (1), by inserting after subparagraph (E) 
     the following new subparagraph:
       ``(F) With respect to plan years beginning on or after 
     January 1, 2022, a drug management program for at-risk 
     beneficiaries described in paragraph (5).''; and
       (2) in paragraph (5)(A), by inserting ``(and for plan years 
     beginning on or after January 1, 2022, a PDP sponsor shall)'' 
     after ``A PDP sponsor may''.

     SEC. 2005. MEDICARE COVERAGE OF CERTAIN SERVICES FURNISHED BY 
                   OPIOID TREATMENT PROGRAMS.

       (a) Coverage.--Section 1861(s)(2) of the Social Security 
     Act (42 U.S.C. 1395x(s)(2)) is amended--
       (1) in subparagraph (FF), by striking at the end ``and'';
       (2) in subparagraph (GG), by inserting at the end ``and''; 
     and
       (3) by adding at the end the following new subparagraph:
       ``(HH) opioid use disorder treatment services (as defined 
     in subsection (jjj)).''.
       (b) Opioid Use Disorder Treatment Services and Opioid 
     Treatment Program Defined.--Section 1861 of the Social 
     Security Act (42 U.S.C. 1395x) is amended by adding at the 
     end the following new subsection:
       ``(jjj) Opioid Use Disorder Treatment Services; Opioid 
     Treatment Program.--
       ``(1) Opioid use disorder treatment services.--The term 
     `opioid use disorder treatment services' means items and 
     services that are furnished by an opioid treatment program 
     for the treatment of opioid use disorder, including--
       ``(A) opioid agonist and antagonist treatment medications 
     (including oral, injected, or implanted versions) that are 
     approved by the Food and Drug Administration under section 
     505 of the Federal Food, Drug, and Cosmetic Act for use in 
     the treatment of opioid use disorder;
       ``(B) dispensing and administration of such medications, if 
     applicable;
       ``(C) substance use counseling by a professional to the 
     extent authorized under State law to furnish such services;
       ``(D) individual and group therapy with a physician or 
     psychologist (or other mental health professional to the 
     extent authorized under State law);
       ``(E) toxicology testing, and
       ``(F) other items and services that the Secretary 
     determines are appropriate (but in no event to include meals 
     or transportation).
       ``(2) Opioid treatment program.--The term `opioid treatment 
     program' means an entity that is an opioid treatment program 
     (as defined in section 8.2 of title 42 of the Code of Federal 
     Regulations, or any successor regulation) that--
       ``(A) is enrolled under section 1866(j);
       ``(B) has in effect a certification by the Substance Abuse 
     and Mental Health Services Administration for such a program;
       ``(C) is accredited by an accrediting body approved by the 
     Substance Abuse and Mental Health Services Administration; 
     and
       ``(D) meets such additional conditions as the Secretary may 
     find necessary to ensure--
       ``(i) the health and safety of individuals being furnished 
     services under such program; and
       ``(ii) the effective and efficient furnishing of such 
     services.''.
       (c) Payment.--
       (1) In general.--Section 1833(a)(1) of the Social Security 
     Act (42 U.S.C. 1395l(a)(1)) is amended--

[[Page H9185]]

       (A) by striking ``and (bb)'' and inserting ``(bb)''; and
       (B) by inserting before the semicolon at the end the 
     following ``, and (cc) with respect to opioid use disorder 
     treatment services furnished during an episode of care, the 
     amount paid shall be equal to the amount payable under 
     section 1834(w) less any copayment required as specified by 
     the Secretary''.
       (2) Payment determination.--Section 1834 of the Social 
     Security Act (42 U.S.C. 1395m) is amended by adding at the 
     end the following new subsection:
       ``(w) Opioid Use Disorder Treatment Services.--
       ``(1) In general.--The Secretary shall pay to an opioid 
     treatment program (as defined in paragraph (2) of section 
     1861(jjj)) an amount that is equal to 100 percent of a 
     bundled payment under this part for opioid use disorder 
     treatment services (as defined in paragraph (1) of such 
     section) that are furnished by such program to an individual 
     during an episode of care (as defined by the Secretary) 
     beginning on or after January 1, 2020. The Secretary shall 
     ensure, as determined appropriate by the Secretary, that no 
     duplicative payments are made under this part or part D for 
     items and services furnished by an opioid treatment program.
       ``(2) Considerations.--The Secretary may implement this 
     subsection through one or more bundles based on the type of 
     medication provided (such as buprenorphine, methadone, 
     naltrexone, or a new innovative drug), the frequency of 
     services, the scope of services furnished, characteristics of 
     the individuals furnished such services, or other factors as 
     the Secretary determine appropriate. In developing such 
     bundles, the Secretary may consider payment rates paid to 
     opioid treatment programs for comparable services under State 
     plans under title XIX or under the TRICARE program under 
     chapter 55 of title 10 of the United States Code.
       ``(3) Annual updates.--The Secretary shall provide an 
     update each year to the bundled payment amounts under this 
     subsection.''.
       (d) Including Opioid Treatment Programs as Medicare 
     Providers.--Section 1866(e) of the Social Security Act (42 
     U.S.C. 1395cc(e)) is amended--
       (1) in paragraph (1), by striking at the end ``and'';
       (2) in paragraph (2), by striking the period at the end and 
     inserting ``; and''; and
       (3) by adding at the end the following new paragraph:
       ``(3) opioid treatment programs (as defined in paragraph 
     (2) of section 1861(jjj)), but only with respect to the 
     furnishing of opioid use disorder treatment services (as 
     defined in paragraph (1) of such section).''.

     SEC. 2006. ENCOURAGING APPROPRIATE PRESCRIBING UNDER MEDICARE 
                   FOR VICTIMS OF OPIOID OVERDOSE.

       Section 1860D-4(c)(5)(C) of the Social Security Act (42 
     U.S.C. 1395w-104(c)(5)(C)) is amended--
       (1) in clause (i), in the matter preceding subclause (I), 
     by striking ``For purposes'' and inserting ``Except as 
     provided in clause (v), for purposes''; and
       (2) by adding at the end the following new clause:
       ``(v) Treatment of enrollees with a history of opioid-
     related overdose.--

       ``(I) In general.--For plan years beginning not later than 
     January 1, 2021, a part D eligible individual who is not an 
     exempted individual described in clause (ii) and who is 
     identified under this clause as a part D eligible individual 
     with a history of opioid-related overdose (as defined by the 
     Secretary) shall be included as a potentially at-risk 
     beneficiary for prescription drug abuse under the drug 
     management program under this paragraph.
       ``(II) Identification and notice.--For purposes of this 
     clause, the Secretary shall--

       ``(aa) identify part D eligible individuals with a history 
     of opioid-related overdose (as so defined); and
       ``(bb) notify the PDP sponsor of the prescription drug plan 
     in which such an individual is enrolled of such 
     identification.''.

     SEC. 2007. AUTOMATIC ESCALATION TO EXTERNAL REVIEW UNDER A 
                   MEDICARE PART D DRUG MANAGEMENT PROGRAM FOR AT-
                   RISK BENEFICIARIES.

       (a) In General.--Section 1860D-4(c)(5) of the Social 
     Security Act (42 U.S.C. 1395ww-10(c)(5)) is amended--
       (1) in subparagraph (B), in each of clauses (ii)(III) and 
     (iii)(IV), by striking ``and the option of an automatic 
     escalation to external review'' and inserting ``, including 
     notice that if on reconsideration a PDP sponsor affirms its 
     denial, in whole or in part, the case shall be automatically 
     forwarded to the independent, outside entity contracted with 
     the Secretary for review and resolution''; and
       (2) in subparagraph (E), by striking ``and the option'' and 
     all that follows and inserting the following: ``and if on 
     reconsideration a PDP sponsor affirms its denial, in whole or 
     in part, the case shall be automatically forwarded to the 
     independent, outside entity contracted with the Secretary for 
     review and resolution.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply beginning not later January 1, 2021.

     SEC. 2008. SUSPENSION OF PAYMENTS BY MEDICARE PRESCRIPTION 
                   DRUG PLANS AND MA-PD PLANS PENDING 
                   INVESTIGATIONS OF CREDIBLE ALLEGATIONS OF FRAUD 
                   BY PHARMACIES.

       (a) In General.--Section 1860D-12(b) of the Social Security 
     Act (42 U.S.C. 1395w-112(b)) is amended by adding at the end 
     the following new paragraph:
       ``(7) Suspension of payments pending investigation of 
     credible allegations of fraud by pharmacies.--
       ``(A) In general.--Section 1862(o)(1) shall apply with 
     respect to a PDP sponsor with a contract under this part, a 
     pharmacy, and payments to such pharmacy under this part in 
     the same manner as such section applies with respect to the 
     Secretary, a provider of services or supplier, and payments 
     to such provider of services or supplier under this title. A 
     PDP sponsor shall notify the Secretary regarding the 
     imposition of any payment suspension pursuant to the previous 
     sentence, such as through the secure internet website portal 
     (or other successor technology) established under section 
     1859(i).
       ``(B) Rule of construction.--Nothing in this paragraph 
     shall be construed as limiting the authority of a PDP sponsor 
     to conduct postpayment review.''.
       (b) Application to MA-PD Plans.--Section 1857(f)(3) of the 
     Social Security Act (42 U.S.C. 1395w-27(f)(3)) is amended by 
     adding at the end the following new subparagraph:
       ``(D) Suspension of payments pending investigation of 
     credible allegations of fraud by pharmacies.--Section 1860D-
     12(b)(7).''.
       (c) Conforming Amendment.--Section 1862(o)(3) of the Social 
     Security Act (42 U.S.C. 1395y(o)(3)) is amended by inserting 
     ``, section 1860D-12(b)(7) (including as applied pursuant to 
     section 1857(f)(3)(D)),'' after ``this subsection''.
       (d) Clarification Relating to Credible Allegation of 
     Fraud.--Section 1862(o) of the Social Security Act (42 U.S.C. 
     1395y(o)) is amended by adding at the end the following new 
     paragraph:
       ``(4) Credible allegation of fraud.--In carrying out this 
     subsection, section 1860D-12(b)(7) (including as applied 
     pursuant to section 1857(f)(3)(D)), and section 
     1903(i)(2)(C), a fraud hotline tip (as defined by the 
     Secretary) without further evidence shall not be treated as 
     sufficient evidence for a credible allegation of fraud.''.
       (e) Effective Date.--The amendments made by this section 
     shall apply with respect to plan years beginning on or after 
     January 1, 2020.

           TITLE III--FDA AND CONTROLLED SUBSTANCE PROVISIONS

                       Subtitle A--FDA Provisions

                         CHAPTER 1--IN GENERAL

     SEC. 3001. CLARIFYING FDA REGULATION OF NON-ADDICTIVE PAIN 
                   PRODUCTS.

       (a) Public Meetings.--Not later than one year after the 
     date of enactment of this Act, the Secretary of Health and 
     Human Services (referred to in this section as the 
     ``Secretary''), acting through the Commissioner of Food and 
     Drugs, shall hold not less than one public meeting to address 
     the challenges and barriers of developing non-addictive 
     medical products intended to treat acute or chronic pain or 
     addiction, which may include--
       (1) the manner by which the Secretary may incorporate the 
     risks of misuse and abuse of a controlled substance (as 
     defined in section 102 of the Controlled Substances Act (21 
     U.S.C. 802)) into the risk benefit assessments under 
     subsections (d) and (e) of section 505 of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 355), section 510(k) of 
     such Act (21 U.S.C. 360(k)), or section 515(c) of such Act 
     (21 U.S.C. 360e(c)), as applicable;
       (2) the application of novel clinical trial designs 
     (consistent with section 3021 of the 21st Century Cures Act 
     (Public Law 114-255)), use of real world evidence (consistent 
     with section 505F of the Federal Food, Drug, and Cosmetic Act 
     (21 U.S.C. 355g)), and use of patient experience data 
     (consistent with section 569C of the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C. 360bbb-8c)) for the development of 
     non-addictive medical products intended to treat pain or 
     addiction;
       (3) the evidentiary standards and the development of 
     opioid-sparing data for inclusion in the labeling of medical 
     products intended to treat acute or chronic pain; and
       (4) the application of eligibility criteria under sections 
     506 and 515B of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 356, 360e-3) for non-addictive medical products 
     intended to treat pain or addiction.
       (b) Guidance.--Not less than one year after the public 
     meetings are conducted under subsection (a) the Secretary 
     shall issue one or more final guidance documents, or update 
     existing guidance documents, to help address challenges to 
     developing non-addictive medical products to treat pain or 
     addiction. Such guidance documents shall include information 
     regarding--
       (1) how the Food and Drug Administration may apply sections 
     506 and 515B of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 356, 360e-3) to non-addictive medical products 
     intended to treat pain or addiction, including the 
     circumstances under which the Secretary--
       (A) may apply the eligibility criteria under such sections 
     506 and 515B to non-addictive medical products intended to 
     treat pain or addiction;
       (B) considers the risk of addiction of controlled 
     substances approved to treat pain when establishing unmet 
     medical need; and
       (C) considers pain, pain control, or pain management in 
     assessing whether a disease or condition is a serious or 
     life-threatening disease or condition;
       (2) the methods by which sponsors may evaluate acute and 
     chronic pain, endpoints for non-addictive medical products 
     intended to treat pain, the manner in which endpoints

[[Page H9186]]

     and evaluations of efficacy will be applied across and within 
     review divisions, taking into consideration the etiology of 
     the underlying disease, and the manner in which sponsors may 
     use surrogate endpoints, intermediate endpoints, and real 
     world evidence;
       (3) the manner in which the Food and Drug Administration 
     will assess evidence to support the inclusion of opioid-
     sparing data in the labeling of non-addictive medical 
     products intended to treat acute or chronic pain, including--
       (A) alternative data collection methodologies, including 
     the use of novel clinical trial designs (consistent with 
     section 3021 of the 21st Century Cures Act (Public Law 114-
     255)) and real world evidence (consistent with section 505F 
     of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
     355g)), including patient registries and patient reported 
     outcomes, as appropriate, to support product labeling;
       (B) ethical considerations of exposing subjects to 
     controlled substances in clinical trials to develop opioid-
     sparing data and considerations on data collection methods 
     that reduce harm, which may include the reduction of opioid 
     use as a clinical benefit;
       (C) endpoints, including primary, secondary, and surrogate 
     endpoints, to evaluate the reduction of opioid use;
       (D) best practices for communication between sponsors and 
     the agency on the development of data collection methods, 
     including the initiation of data collection; and
       (E) the appropriate format in which to submit such data 
     results to the Secretary; and
       (4) the circumstances under which the Food and Drug 
     Administration considers misuse and abuse of a controlled 
     substance (as defined in section 102 of the Controlled 
     Substances Act (21 U.S.C. 802)) in making the risk benefit 
     assessment under paragraphs (2) and (4) of subsection (d) of 
     section 505 of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 355) and in finding that a drug is unsafe under 
     paragraph (1) or (2) of subsection (e) of such section.
       (c) Definitions.--In this section--
       (1) the term ``medical product'' means a drug (as defined 
     in section 201(g)(1) of the Federal Food, Drug, and Cosmetic 
     Act (21 U.S.C. 321(g)(1))), biological product (as defined in 
     section 351(i) of the Public Health Service Act (42 U.S.C. 
     262(i))), or device (as defined in section 201(h) of the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(h))); and
       (2) the term ``opioid-sparing'' means reducing, replacing, 
     or avoiding the use of opioids or other controlled substances 
     intended to treat acute or chronic pain.

     SEC. 3002. EVIDENCE-BASED OPIOID ANALGESIC PRESCRIBING 
                   GUIDELINES AND REPORT.

       (a) Guidelines.--The Commissioner of Food and Drugs shall 
     develop evidence-based opioid analgesic prescribing 
     guidelines for the indication-specific treatment of acute 
     pain only for the relevant therapeutic areas where such 
     guidelines do not exist.
       (b) Public Input.--In developing the guidelines under 
     subsection (a), the Commissioner of Food and Drugs shall--
       (1) consult with stakeholders, which may include conducting 
     a public meeting of medical professional societies (including 
     any State-based societies), health care providers, State 
     medical boards, medical specialties including pain medicine 
     specialty societies, patient groups, pharmacists, academic or 
     medical research entities, and other entities with experience 
     in health care, as appropriate;
       (2) collaborate with the Director of the Centers for 
     Disease Control and Prevention, as applicable and 
     appropriate, and other Federal agencies with relevant 
     expertise as appropriate; and
       (3) provide for a notice and comment period consistent with 
     section 701(h) of the Federal Food, Drug, and Cosmetic Act 
     (21 U.S.C. 371(h)) for the submission of comments by the 
     public.
       (c) Report.--Not later than 1 year after the date of 
     enactment of this Act, or, if earlier, at the time the 
     guidelines under subsection (a) are finalized, the 
     Commissioner of Food and Drugs shall submit to the Committee 
     on Energy and Commerce of the House of Representatives and 
     the Committee on Health, Education, Labor, and Pensions of 
     the Senate, and post on the public website of the Food and 
     Drug Administration, a report on how the Food and Drug 
     Administration will utilize the guidelines under subsection 
     (a) to protect the public health and a description of the 
     public health need with respect to each such indication-
     specific treatment guideline.
       (d) Updates.--The Commissioner of Food and Drugs shall 
     periodically--
       (1) update the guidelines under subsection (a), informed by 
     public input described in subsection (b); and
       (2) submit to the committees specified in subsection (c) 
     and post on the public website of the Food and Drug 
     Administration an updated report under such subsection.
       (e) Statement To Accompany Guidelines and 
     Recommendations.--The Commissioner of Food and Drugs shall 
     ensure that opioid analgesic prescribing guidelines and other 
     recommendations developed under this section are accompanied 
     by a clear statement that such guidelines or recommendations, 
     as applicable--
       (1) are intended to help inform clinical decisionmaking by 
     prescribers and patients; and
       (2) are not intended to be used for the purposes of 
     restricting, limiting, delaying, or denying coverage for, or 
     access to, a prescription issued for a legitimate medical 
     purpose by an individual practitioner acting in the usual 
     course of professional practice.

     CHAPTER 2--STOP COUNTERFEIT DRUGS BY REGULATING AND ENHANCING 
                            ENFORCEMENT NOW

     SEC. 3011. SHORT TITLE.

       This chapter may be cited as the ``Stop Counterfeit Drugs 
     by Regulating and Enhancing Enforcement Now Act'' or the 
     ``SCREEN Act''.

     SEC. 3012. NOTIFICATION, NONDISTRIBUTION, AND RECALL OF 
                   CONTROLLED SUBSTANCES.

       (a) Prohibited Acts.--Section 301 of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 331) is amended by adding 
     at the end the following:
       ``(eee) The failure to comply with any order issued under 
     section 569D.''.
       (b) Notification, Nondistribution, and Recall of Controlled 
     Substances.--Subchapter E of chapter V of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 360bbb et seq.) is amended 
     by adding at the end the following:

     ``SEC. 569D. NOTIFICATION, NONDISTRIBUTION, AND RECALL OF 
                   CONTROLLED SUBSTANCES.

       ``(a) Order To Cease Distribution and Recall.--
       ``(1) In general.--If the Secretary determines there is a 
     reasonable probability that a controlled substance would 
     cause serious adverse health consequences or death, the 
     Secretary may, after providing the appropriate person with an 
     opportunity to consult with the agency, issue an order 
     requiring manufacturers, importers, distributors, or 
     pharmacists, who distribute such controlled substance to 
     immediately cease distribution of such controlled substance.
       ``(2) Hearing.--An order under paragraph (1) shall provide 
     the person subject to the order with an opportunity for an 
     informal hearing, to be held not later than 10 days after the 
     date of issuance of the order, on whether adequate evidence 
     exists to justify an amendment to the order, and what actions 
     are required by such amended order pursuant to subparagraph 
     (3).
       ``(3) Order resolution.--After an order is issued according 
     to the process under paragraphs (1) and (2), the Secretary 
     shall, except as provided in paragraph (4)--
       ``(A) vacate the order, if the Secretary determines that 
     inadequate grounds exist to support the actions required by 
     the order;
       ``(B) continue the order ceasing distribution of the 
     controlled substance until a date specified in such order; or
       ``(C) amend the order to require a recall of the controlled 
     substance, including any requirements to notify appropriate 
     persons, a timetable for the recall to occur, and a schedule 
     for updates to be provided to the Secretary regarding such 
     recall.
       ``(4) Risk assessment.--If the Secretary determines that 
     the risk of recalling a controlled substance presents a 
     greater health risk than the health risk of not recalling 
     such controlled substance from use, an amended order under 
     subparagraph (B) or (C) of paragraph (3) shall not include 
     either a recall order for, or an order to cease distribution 
     of, such controlled substance, as applicable.
       ``(5) Action following order.--Any person who is subject to 
     an order pursuant to subparagraph (B) or (C) of paragraph (3) 
     shall immediately cease distribution of or recall, as 
     applicable, the controlled substance and provide notification 
     as required by such order.
       ``(b) Notice to Persons Affected.--If the Secretary 
     determines necessary, the Secretary may require the person 
     subject to an order pursuant to paragraph (1) or an amended 
     order pursuant to subparagraph (B) or (C) of paragraph (3) to 
     provide either a notice of a recall order for, or an order to 
     cease distribution of, such controlled substance, as 
     applicable, under this section to appropriate persons, 
     including persons who manufacture, distribute, import, or 
     offer for sale such product that is the subject of an order 
     and to the public. In providing such notice, the Secretary 
     may use the assistance of health professionals who prescribed 
     or dispensed such controlled substances.
       ``(c) Nondelegation.--An order described in subsection 
     (a)(3) shall be ordered by the Secretary or an official 
     designated by the Secretary. An official may not be so 
     designated under this section unless the official is the 
     Director of the Center for Drug Evaluation and Research or an 
     official senior to such Director.
       ``(d) Savings Clause.--Nothing contained in this section 
     shall be construed as limiting--
       ``(1) the authority of the Secretary to issue an order to 
     cease distribution of, or to recall, any drug under any other 
     provision of this Act or the Public Health Service Act; or
       ``(2) the ability of the Secretary to request any person to 
     perform a voluntary activity related to any drug subject to 
     this Act or the Public Health Service Act.''.
       (c) Controlled Substances Subject to Refusal.--The third 
     sentence of section 801(a) of the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C. 381(a)) is amended by inserting ``, 
     or is a controlled substance subject to an order under 
     section 569D'' before ``, or (4)''.
       (d) Effective Date.--Sections 301(eee) and 569D of the 
     Federal Food, Drug, and Cosmetic Act, as added by subsections 
     (a) and (b), shall be effective beginning on the date of 
     enactment of this Act.

[[Page H9187]]

  


     SEC. 3013. SINGLE SOURCE PATTERN OF IMPORTED ILLEGAL DRUGS.

       Section 801 of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 381), as amended by section 3012, is further amended 
     by adding at the end the following:
       ``(t) Single Source Pattern of Imported Illegal Drugs.--If 
     the Secretary determines that a person subject to debarment 
     as a result of engaging in a pattern of importing or offering 
     for import controlled substances or drugs as described in 
     section 306(b)(3)(D), and such pattern is identified by the 
     Secretary as being offered for import from the same 
     manufacturer, distributor, or importer, the Secretary may by 
     order determine all drugs being offered for import from such 
     person as adulterated or misbranded, unless such person can 
     provide evidence otherwise.''.

     SEC. 3014. STRENGTHENING FDA AND CBP COORDINATION AND 
                   CAPACITY.

       (a) In General.--The Secretary of Health and Human Services 
     (referred to in this section as the ``Secretary''), acting 
     through the Commissioner of Food and Drugs, shall coordinate 
     with the Secretary of Homeland Security to carry out 
     activities related to customs and border protection and in 
     response to illegal controlled substances and drug imports, 
     including at sites of import (such as international mail 
     facilities), that will provide improvements to such 
     facilities, technologies, and inspection capacity. Such 
     Secretaries may carry out such activities through a 
     memorandum of understanding between the Food and Drug 
     Administration and the U.S. Customs and Border Protection.
       (b) FDA Import Facilities and Inspection Capacity.--
       (1) In general.--In carrying out this section, the 
     Secretary shall, in collaboration with the Secretary of 
     Homeland Security and the Postmaster General of the United 
     States Postal Service, provide that import facilities in 
     which the Food and Drug Administration operates or carries 
     out activities related to drug imports within the 
     international mail facilities include--
       (A) facility upgrades and improved capacity in order to 
     increase and improve inspection and detection capabilities, 
     which may include, as the Secretary determines appropriate--
       (i) improvements to facilities, such as upgrades or 
     renovations, and support for the maintenance of existing 
     import facilities and sites to improve coordination between 
     Federal agencies;
       (ii) improvements in equipment and information technology 
     enhancement to identify unapproved, counterfeit, or other 
     unlawful controlled substances for destruction;
       (iii) the construction of, or upgrades to, laboratory 
     capacity for purposes of detection and testing of imported 
     goods;
       (iv) upgrades to the security of import facilities; and
       (v) innovative technology and equipment to facilitate 
     improved and near-real-time information sharing between the 
     Food and Drug Administration, the Department of Homeland 
     Security, and the United States Postal Service; and
       (B) innovative technology, including controlled substance 
     detection and testing equipment and other applicable 
     technology, in order to collaborate with the U.S. Customs and 
     Border Protection to share near-real-time information, 
     including information about test results, as appropriate.
       (2) Innovative technology.--Any technology used in 
     accordance with paragraph (1)(B) shall be interoperable with 
     technology used by other relevant Federal agencies, including 
     the U.S. Customs and Border Protection, as the Secretary 
     determines appropriate and practicable.
       (c) Report.--Not later than 6 months after the date of 
     enactment of this Act, the Secretary, in consultation with 
     the Secretary of Homeland Security and the Postmaster General 
     of the United States Postal Service, shall report to the 
     Committee on Energy and Commerce and the Committee on 
     Homeland Security of the House of Representatives and the 
     Committee on Health, Education, Labor, and Pensions and the 
     Committee on Homeland Security and Governmental Affairs of 
     the Senate on the implementation of this section, including a 
     summary of progress made toward near-real-time information 
     sharing and the interoperability of such technologies.

                CHAPTER 3--STOP ILLICIT DRUG IMPORTATION

     SEC. 3021. SHORT TITLE.

       This chapter may be cited as the ``Stop Illicit Drug 
     Importation Act of 2018''.

     SEC. 3022. RESTRICTING ENTRANCE OF ILLICIT DRUGS.

       (a) Food and Drug Administration and U.S. Customs and 
     Border Protection Cooperation.--
       (1) In general.--The Secretary of Health and Human Services 
     (referred to in this section as the ``Secretary''), acting 
     through the Commissioner of Food and Drugs and in 
     consultation with the U.S. Customs and Border Protection, 
     shall develop and periodically update a mutually agreed upon 
     list of the controlled substances that the Secretary will 
     refer to U.S. Customs and Border Protection, unless the 
     Secretary and U.S. Customs and Border Protection agree 
     otherwise, when such substances are offered for import via 
     international mail and appear to violate the Controlled 
     Substances Act (21 U.S.C. 801 et seq.), the Controlled 
     Substances Import and Export Act (21 U.S.C. 951 et seq.), the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.), 
     or any other applicable law. The Secretary shall transfer 
     controlled substances on such list to the U.S. Customs and 
     Border Protection. If the Secretary identifies additional 
     packages that appear to be the same as such package 
     containing a controlled substance, such additional packages 
     may also be transferred to U.S. Customs and Border 
     Protection. The U.S. Customs and Border Protection shall 
     receive such packages consistent with the requirements of the 
     Controlled Substances Act (21 U.S.C. 801 et seq.).
       (2) Report.--Not later than 9 months after the date of 
     enactment of this Act, the Secretary, acting through the 
     Commissioner of Food and Drugs and in consultation with the 
     Secretary of Homeland Security, shall report to the Committee 
     on Energy and Commerce of the House of Representatives and 
     the Committee on Health, Education, Labor, and Pensions of 
     the Senate on the implementation of this section.
       (b) Debarment, Temporary Denial of Approval, and 
     Suspension.--
       (1) Prohibited act.--Section 301(cc) of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 331(cc)) is amended--
       (A) by inserting ``or a drug'' after ``food''; and
       (B) by inserting ``from such activity'' after ``person 
     debarred''.
       (2) Debarment.--Section 306(b) of the Federal Food, Drug, 
     and Cosmetic Act (21 U.S.C. 335a(b)) is amended--
       (A) in paragraph (1)--
       (i) in the matter preceding subparagraph (A), by inserting 
     ``or (3)'' after ``paragraph (2)'';
       (ii) in subparagraph (A), by striking the comma at the end 
     and inserting a semicolon;
       (iii) in subparagraph (B), by striking ``, or'' and 
     inserting a semicolon;
       (iv) in subparagraph (C), by striking the period and 
     inserting ``; or''; and
       (v) by adding at the end the following:
       ``(D) a person from importing or offering for import into 
     the United States a drug.'';
       (B) in paragraph (3)--
       (i) in the heading, by inserting ``or drug'' after 
     ``Food'';
       (ii) in subparagraph (A), by striking ``; or'' and 
     inserting a semicolon;
       (iii) in subparagraph (B), by striking the period and 
     inserting a semicolon; and
       (iv) by adding at the end the following:
       ``(C) the person has been convicted of a felony for conduct 
     relating to the importation into the United States of any 
     drug or controlled substance (as defined in section 102 of 
     the Controlled Substances Act);
       ``(D) the person has engaged in a pattern of importing or 
     offering for import--
       ``(i) controlled substances that are prohibited from 
     importation under section 401(m) of the Tariff Act of 1930 
     (19 U.S.C. 1401(m)); or
       ``(ii) adulterated or misbranded drugs that are--

       ``(I) not designated in an authorized electronic data 
     interchange system as a product that is regulated by the 
     Secretary; or
       ``(II) knowingly or intentionally falsely designated in an 
     authorized electronic data interchange system as a product 
     that is regulated by the Secretary.''; and

       (C) by adding at the end the following:
       ``(5) Definition.--For purposes of paragraph (3)(D), the 
     term `pattern of importing or offering for import' means 
     importing or offering for import a drug described in clause 
     (i) or (ii) of paragraph (3)(D) in an amount, frequency, or 
     dosage that is inconsistent with personal or household use by 
     the importer.''.
       (c) Imports and Exports.--Section 801(a) of the Federal 
     Food, Drug, and Cosmetic Act (21 U.S.C. 381(a)), as amended, 
     is further amended--
       (1) by striking ``, then such article shall be refused 
     admission'' inserting ``or (5) such article is being imported 
     or offered for import in violation of section 301(cc), then 
     any such article described in any of clauses (1) through (5) 
     shall be refused admission'';
       (2) by inserting ``If it appears from the examination of 
     such samples or otherwise that the article is a counterfeit 
     drug, such article shall be refused admission.'' before 
     ``With respect to an article of food, if importation''; and
       (3) by striking ``Clause (2) of the third sentence'' and 
     all that follows through the period at the end and inserting 
     the following: ``Neither clause (2) nor clause (5) of the 
     third sentence of this subsection shall be construed to 
     prohibit the admission of narcotic drugs, the importation of 
     which is permitted under the Controlled Substances Import and 
     Export Act.''.
       (d) Certain Illicit Articles.--Section 801 of the Federal 
     Food, Drug, and Cosmetic Act (21 U.S.C. 381), as amended, is 
     amended by adding at the end the following--
       ``(u) Illicit Articles Containing Active Pharmaceutical 
     Ingredients.--
       ``(1) In general.--For purposes of this section, an article 
     that is being imported or offered for import into the United 
     States may be treated by the Secretary as a drug if the 
     article--
       ``(A) is not--
       ``(i) accompanied by an electronic import entry for such 
     article submitted using an authorized electronic data 
     interchange system; and
       ``(ii) designated in such a system as an article regulated 
     by the Secretary (which may include regulation as a drug, a 
     device, a dietary supplement, or other product that is 
     regulated under this Act); and
       ``(B) is an ingredient that presents significant public 
     health concern and is, or contains--

[[Page H9188]]

       ``(i) an active ingredient in a drug--

       ``(I) that is approved under section 505 or licensed under 
     section 351 of the Public Health Service Act; or
       ``(II) for which--

       ``(aa) an investigational use exemption has been authorized 
     under section 505(i) of this Act or section 351(a) of the 
     Public Health Service Act; and
       ``(bb) a substantial clinical investigation has been 
     instituted, and such investigation has been made public; or
       ``(ii) a substance that has a chemical structure that is 
     substantially similar to the chemical structure of an active 
     ingredient in a drug or biological product described in 
     subclause (I) or (II) of clause (i).
       ``(2) Effect.--This subsection shall not be construed to 
     bear upon any determination of whether an article is a drug 
     within the meaning of section 201(g), other than for the 
     purposes described in paragraph (1).''.

   CHAPTER 4--SECURING OPIOIDS AND UNUSED NARCOTICS WITH DELIBERATE 
                         DISPOSAL AND PACKAGING

     SEC. 3031. SHORT TITLE.

       This chapter may be cited as the ``Securing Opioids and 
     Unused Narcotics with Deliberate Disposal and Packaging Act 
     of 2018'' or the ``SOUND Disposal and Packaging Act''.

     SEC. 3032. SAFETY-ENHANCING PACKAGING AND DISPOSAL FEATURES.

        (a) Deliberate Disposal and Packaging Elements of 
     Strategy.--Section 505-1(e) of the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C. 355-1(e)) is amended by adding at the 
     end the following:
       ``(4) Packaging and disposal.--The Secretary may require a 
     risk evaluation mitigation strategy for a drug for which 
     there is a serious risk of an adverse drug experience 
     described in subparagraph (B) or (C) of subsection (b)(1), 
     taking into consideration the factors described in 
     subparagraphs (C) and (D) of subsection (f)(2) and in 
     consultation with other relevant Federal agencies with 
     authorities over drug disposal packaging, which may include 
     requiring that--
       ``(A) the drug be made available for dispensing to certain 
     patients in unit dose packaging, packaging that provides a 
     set duration, or another packaging system that the Secretary 
     determines may mitigate such serious risk; or
       ``(B) the drug be dispensed to certain patients with a safe 
     disposal packaging or safe disposal system for purposes of 
     rendering drugs nonretrievable (as defined in section 1300.05 
     of title 21, Code of Federal Regulations (or any successor 
     regulation)) if the Secretary determines that such safe 
     disposal packaging or system may mitigate such serious risk 
     and is sufficiently available.''.
       (b) Assuring Access and Minimizing Burden.--Section 505-
     1(f)(2)(C) of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 355-1(f)(2)(C)) is amended--
       (1) in clause (i) by striking ``and'' at the end; and
       (2) by adding at the end the following:
       ``(iii) patients with functional limitations; and''.
       (c) Application to Abbreviated New Drug Applications.--
     Section 505-1(i) of the Federal Food, Drug, and Cosmetic Act 
     (21 U.S.C. 355-1(i)) is amended--
       (1) in paragraph (1)--
       (A) by redesignating subparagraph (B) as subparagraph (C); 
     and
       (B) inserting after subparagraph (A) the following:
       ``(B) A packaging or disposal requirement, if required 
     under subsection (e)(4) for the applicable listed drug.''; 
     and
       (2) in paragraph (2)--
       (A) in subparagraph (A), by striking ``and'' at the end;
       (B) by redesignating subparagraph (B) as subparagraph (C); 
     and
       (C) by inserting after subparagraph (A) the following:
       ``(B) shall permit packaging systems and safe disposal 
     packaging or safe disposal systems that are different from 
     those required for the applicable listed drug under 
     subsection (e)(4); and''.
       (d) GAO Report.--Not later than 12 months after the date of 
     enactment of this Act, the Comptroller General of the United 
     States shall prepare and submit to Congress a report 
     containing--
       (1) a description of available evidence, if any, on the 
     effectiveness of site-of-use, in-home controlled substance 
     disposal products and packaging technologies;
       (2) an evaluation of existing reference standards with 
     respect to controlled substance disposal products and 
     packaging technologies, including any such standards 
     established by a standards development organization, and how 
     such standards should be considered in ensuring effectiveness 
     of such products and technologies;
       (3) identification of ways in which such disposal products 
     intended for use by patients, consumers, and other end users 
     that are not registrants under the Controlled Substances Act 
     (21 U.S.C. 801 et seq.), are made available to the public and 
     any barriers to the use of such disposal products;
       (4) identification of ways in which packaging technologies 
     are made available to the public and any barriers to the use 
     of such technologies;
       (5) a description of current Federal oversight, if any, of 
     site-of-use, in-home controlled substance disposal products, 
     including--
       (A) identification of the Federal agencies that oversee 
     such products;
       (B) identification of the methods of disposal of controlled 
     substances recommended by such agencies for site-of-use, in-
     home disposal; and
       (C) a description of the effectiveness of such 
     recommendations at preventing the diversion of legally 
     prescribed controlled substances;
       (6) a description of current Federal oversight, if any, of 
     controlled substance packaging technologies, including--
       (A) identification of the Federal agencies that oversee 
     such technologies;
       (B) identification of the technologies recommended by such 
     agencies, including unit dose packaging, packaging that 
     provides a set duration, and other packaging systems that may 
     mitigate abuse or misuse; and
       (C) a description of the effectiveness of such 
     recommendations at preventing the diversion of legally 
     prescribed controlled substances; and
       (7) recommendations, as appropriate, on--
       (A) whether site-of-use, in-home controlled substance 
     disposal products and packaging technologies require Federal 
     oversight and, if so, which agency or agencies should be 
     responsible for such oversight and, as applicable, review of 
     such products or technologies; and
       (B) whether there are applicable standards that should be 
     considered to ensure the effectiveness of such products.

               CHAPTER 5--POSTAPPROVAL STUDY REQUIREMENTS

     SEC. 3041. CLARIFYING FDA POSTMARKET AUTHORITIES.

       (a) Definition of Adverse Drug Experience.--Section 505-
     1(b)(1)(E) of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 355-1(b)(1)(E)) is amended by striking ``of the drug'' 
     and inserting ``of the drug, which may include reduced 
     effectiveness under the conditions of use prescribed in the 
     labeling of such drug, but which may not include reduced 
     effectiveness that is in accordance with such labeling''.
       (b) Safety Labeling Changes.--Section 505(o)(4) of the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355(o)(4)) is 
     amended--
       (1) in subparagraph (A) by--
       (A) striking ``Safety information'' and inserting ``Safety 
     or new effectiveness information''; and
       (B) by striking ``If the Secretary becomes'' and all that 
     follows through ``in the labeling of the drug'' and inserting 
     ``If the Secretary becomes aware of new information, 
     including any new safety information or information related 
     to reduced effectiveness, that the Secretary determines 
     should be included in the labeling of the drug'';
       (2) in clause (i) of subparagraph (B), by inserting before 
     the semicolon ``, or new effectiveness information'';
       (3) in subparagraph (C) by striking ``safety information'' 
     and inserting ``safety or new effectiveness information''; 
     and
       (4) in subparagraph (E) by striking ``safety information'' 
     and inserting ``safety or new effectiveness information''.
       (c) Guidance.--Not less than one year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall issue guidance regarding the circumstances 
     under which the Food and Drug Administration may require 
     postmarket studies or clinical trials to assess the potential 
     reduction in effectiveness of a drug and how such reduction 
     in effectiveness could result in a change to the benefits of 
     the drug and the risks to the patient. Such guidance shall 
     also address how the Food and Drug Administration may apply 
     this section and the amendments made thereby with respect to 
     circumstances under which the Food and Drug Administration 
     may require postmarket studies or clinical trials and safety 
     labeling changes related to the use of controlled substances 
     for acute or chronic pain.

              Subtitle B--Controlled Substance Provisions

    CHAPTER 1--MORE FLEXIBILITY WITH RESPECT TO MEDICATION-ASSISTED 
                   TREATMENT FOR OPIOID USE DISORDERS

     SEC. 3201. ALLOWING FOR MORE FLEXIBILITY WITH RESPECT TO 
                   MEDICATION-ASSISTED TREATMENT FOR OPIOID USE 
                   DISORDERS.

       (a) Conforming Applicable Number.--Subclause (II) of 
     section 303(g)(2)(B)(iii) of the Controlled Substances Act 
     (21 U.S.C. 823(g)(2)(B)(iii)) is amended to read as follows:
       ``(II) The applicable number is--
       ``(aa) 100 if, not sooner than 1 year after the date on 
     which the practitioner submitted the initial notification, 
     the practitioner submits a second notification to the 
     Secretary of the need and intent of the practitioner to treat 
     up to 100 patients;
       ``(bb) 100 if the practitioner holds additional 
     credentialing, as defined in section 8.2 of title 42, Code of 
     Federal Regulations (or successor regulations);
       ``(cc) 100 if the practitioner provides medication-assisted 
     treatment (MAT) using covered medications (as such terms are 
     defined in section 8.2 of title 42, Code of Federal 
     Regulations (or successor regulations)) in a qualified 
     practice setting (as described in section 8.615 of title 42, 
     Code of Federal Regulations (or successor regulations)); or
       ``(dd) 275 if the practitioner meets the requirements 
     specified in sections 8.610 through 8.655 of title 42, Code 
     of Federal Regulations (or successor regulations).''.
       (b) Eliminating Any Time Limitation for Nurse Practitioners 
     and Physician Assistants To Become Qualifying 
     Practitioners.--Clause (iii) of section 303(g)(2)(G)

[[Page H9189]]

     of the Controlled Substances Act (21 U.S.C. 823(g)(2)(G)) is 
     amended--
       (1) in subclause (I), by striking ``or'' at the end; and
       (2) by amending subclause (II) to read as follows:
       ``(II) a qualifying other practitioner, as defined in 
     clause (iv), who is a nurse practitioner or physician 
     assistant; or''.
       (c) Imposing a Time Limitation for Clinical Nurse 
     Specialists, Certified Registered Nurse Anesthetists, and 
     Certified Nurse Midwifes To Become Qualifying 
     Practitioners.--Clause (iii) of section 303(g)(2)(G) of the 
     Controlled Substances Act (21 U.S.C. 823(g)(2)(G)), as 
     amended by subsection (b), is further amended by adding at 
     the end the following:
       ``(III) for the period beginning on October 1, 2018, and 
     ending on October 1, 2023, a qualifying other practitioner, 
     as defined in clause (iv), who is a clinical nurse 
     specialist, certified registered nurse anesthetist, or 
     certified nurse midwife.''.
       (d) Definition of Qualifying Other Practitioner.--Section 
     303(g)(2)(G)(iv) of the Controlled Substances Act (21 U.S.C. 
     823(g)(2)(G)(iv)) is amended by striking ``nurse practitioner 
     or physician assistant'' each place it appears and inserting 
     ``nurse practitioner, clinical nurse specialist, certified 
     registered nurse anesthetist, certified nurse midwife, or 
     physician assistant''.
       (e) Report by Secretary.--Not later than 2 years after the 
     date of the enactment of this Act, the Secretary of Health 
     and Human Services, in consultation with the Drug Enforcement 
     Administration, shall submit to Congress a report that 
     assesses the care provided by qualifying practitioners (as 
     defined in section 303(g)(2)(G)(iii) of the Controlled 
     Substances Act (21 U.S.C. 823(g)(2)(G)(iii))) who are 
     treating, in the case of physicians, more than 100 patients, 
     and in the case of qualifying practitioners who are not 
     physicians, more than 30 patients. Such report shall include 
     recommendations on future applicable patient number levels 
     and limits. In preparing such report, the Secretary shall 
     study, with respect to opioid use disorder treatment--
       (1) the average frequency with which qualifying 
     practitioners see their patients;
       (2) the average frequency with which patients receive 
     counseling, including the rates by which such counseling is 
     provided by such a qualifying practitioner directly, or by 
     referral;
       (3) the frequency of toxicology testing, including the 
     average frequency with which random toxicology testing is 
     administered;
       (4) the average monthly patient caseload for each type of 
     qualifying practitioner;
       (5) the treatment retention rates for patients;
       (6) overdose and mortality rates; and
       (7) any available information regarding the diversion of 
     drugs by patients receiving such treatment from such a 
     qualifying practitioner.

     SEC. 3202. MEDICATION-ASSISTED TREATMENT FOR RECOVERY FROM 
                   SUBSTANCE USE DISORDER.

       (a) Waivers for Maintenance Treatment or Detoxification.--
     Section 303(g)(2)(G)(ii) of the Controlled Substances Act (21 
     U.S.C. 823(g)(2)(G)(ii)) is amended by adding at the end the 
     following:
       ``(VIII) The physician graduated in good standing from an 
     accredited school of allopathic medicine or osteopathic 
     medicine in the United States during the 5-year period 
     immediately preceding the date on which the physician submits 
     to the Secretary a written notification under subparagraph 
     (B) and successfully completed a comprehensive allopathic or 
     osteopathic medicine curriculum or accredited medical 
     residency that--
       ``(aa) included not less than 8 hours of training on 
     treating and managing opioid-dependent patients; and
       ``(bb) included, at a minimum--
       ``(AA) the training described in items (aa) through (gg) of 
     subclause (IV); and
       ``(BB) training with respect to any other best practice the 
     Secretary determines should be included in the curriculum, 
     which may include training on pain management, including 
     assessment and appropriate use of opioid and non-opioid 
     alternatives.''.
       (b) Treatment for Children.--The Secretary of Health and 
     Human Services shall consider ways to ensure that an adequate 
     number of qualified practitioners, as defined in subparagraph 
     (G)(ii) of section 303(g)(2) of the Controlled Substances Act 
     (21 U.S.C. 823(g)(2)), who have a specialty in pediatrics or 
     the treatment of children or adolescents, are granted a 
     waiver under such section 303(g)(2) to treat children and 
     adolescents with substance use disorders.
       (c) Technical Amendment.--Section 102(24) of the Controlled 
     Substances Act (21 U.S.C. 802(24)) is amended by striking 
     ``Health, Education, and Welfare'' and inserting ``Health and 
     Human Services''.

     SEC. 3203. GRANTS TO ENHANCE ACCESS TO SUBSTANCE USE DISORDER 
                   TREATMENT.

       (a) In General.--The Secretary of Health and Human Services 
     shall establish a grant program under which the Secretary may 
     make grants to accredited schools of allopathic medicine or 
     osteopathic medicine and teaching hospitals located in the 
     United States to support the development of curricula that 
     meet the requirements under subclause (VIII) of section 
     303(g)(2)(G)(ii) of the Controlled Substances Act, as added 
     by section 3202(a) of this Act.
       (b) Authorization of Appropriations.--There is authorized 
     to be appropriated, for grants under subsection (a), 
     $4,000,000 for each of fiscal years 2019 through 2023.

     SEC. 3204. DELIVERY OF A CONTROLLED SUBSTANCE BY A PHARMACY 
                   TO BE ADMINISTERED BY INJECTION OR 
                   IMPLANTATION.

       (a) In General.--The Controlled Substances Act is amended 
     by inserting after section 309 (21 U.S.C. 829) the following:


``delivery of a controlled substance by a pharmacy to an administering 
                              practitioner

       ``Sec. 309A.  (a) In General.--Notwithstanding section 
     102(10), a pharmacy may deliver a controlled substance to a 
     practitioner in accordance with a prescription that meets the 
     requirements of this title and the regulations issued by the 
     Attorney General under this title, for the purpose of 
     administering the controlled substance by the practitioner 
     if--
       ``(1) the controlled substance is delivered by the pharmacy 
     to the prescribing practitioner or the practitioner 
     administering the controlled substance, as applicable, at the 
     location listed on the practitioner's certificate of 
     registration issued under this title;
       ``(2) the controlled substance is to be administered for 
     the purpose of maintenance or detoxification treatment under 
     section 303(g)(2) and--
       ``(A) the practitioner who issued the prescription is a 
     qualifying practitioner authorized under, and acting within 
     the scope of that section; and
       ``(B) the controlled substance is to be administered by 
     injection or implantation;
       ``(3) the pharmacy and the practitioner are authorized to 
     conduct the activities specified in this section under the 
     law of the State in which such activities take place;
       ``(4) the prescription is not issued to supply any 
     practitioner with a stock of controlled substances for the 
     purpose of general dispensing to patients;
       ``(5) except as provided in subsection (b), the controlled 
     substance is to be administered only to the patient named on 
     the prescription not later than 14 days after the date of 
     receipt of the controlled substance by the practitioner; and
       ``(6) notwithstanding any exceptions under section 307, the 
     prescribing practitioner, and the practitioner administering 
     the controlled substance, as applicable, maintain complete 
     and accurate records of all controlled substances delivered, 
     received, administered, or otherwise disposed of under this 
     section, including the persons to whom controlled substances 
     were delivered and such other information as may be required 
     by regulations of the Attorney General.
       ``(b) Modification of Number of Days Before Which 
     Controlled Substance Shall Be Administered.--
       ``(1) Initial 2-year period.--During the 2-year period 
     beginning on the date of enactment of this section, the 
     Attorney General, in coordination with the Secretary, may 
     reduce the number of days described in subsection (a)(5) if 
     the Attorney General determines that such reduction will--
       ``(A) reduce the risk of diversion; or
       ``(B) protect the public health.
       ``(2) Modifications after submission of report.--After the 
     date on which the report described in section 3204(b) of the 
     SUPPORT for Patients and Communities Act is submitted, the 
     Attorney General, in coordination with the Secretary, may 
     modify the number of days described in subsection (a)(5).
       ``(3) Minimum number of days.--Any modification under this 
     subsection shall be for a period of not less than 7 days.''.
       (b) Study and Report.--Not later than 2 years after the 
     date of enactment of this section, the Comptroller General of 
     the United States shall conduct a study and submit to 
     Congress a report on access to and potential diversion of 
     controlled substances administered by injection or 
     implantation.
       (c) Technical and Conforming Amendment.--The table of 
     contents for the Comprehensive Drug Abuse Prevention and 
     Control Act of 1970 is amended by inserting after the item 
     relating to section 309 the following:

``Sec. 309A. Delivery of a controlled substance by a pharmacy to an 
              administering practitioner.''.

  CHAPTER 2--EMPOWERING PHARMACISTS IN THE FIGHT AGAINST OPIOID ABUSE

     SEC. 3211. SHORT TITLE.

       This chapter may be cited as the ``Empowering Pharmacists 
     in the Fight Against Opioid Abuse Act''.

     SEC. 3212. PROGRAMS AND MATERIALS FOR TRAINING ON CERTAIN 
                   CIRCUMSTANCES UNDER WHICH A PHARMACIST MAY 
                   DECLINE TO FILL A PRESCRIPTION.

       (a) In General.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services, in consultation with the Administrator of the Drug 
     Enforcement Administration, Commissioner of Food and Drugs, 
     Director of the Centers for Disease Control and Prevention, 
     and Assistant Secretary for Mental Health and Substance Use, 
     shall develop and disseminate, as appropriate, materials for 
     pharmacists, health care providers, and patients on--
       (1) circumstances under which a pharmacist may, consistent 
     with section 309 of the Controlled Substances Act (21 U.S.C. 
     829) and regulations thereunder, including section 1306.04 of 
     title 21, Code of Federal Regulations, decline to fill a 
     prescription for a

[[Page H9190]]

     controlled substance because the pharmacist suspects the 
     prescription is fraudulent, forged, or of doubtful, 
     questionable, or suspicious origin; and
       (2) other Federal requirements pertaining to declining to 
     fill a prescription under such circumstances, including the 
     partial fill of prescriptions for certain controlled 
     substances.
       (b) Materials Included.--In developing materials under 
     subsection (a), the Secretary of Health and Human Services 
     shall include information for--
       (1) pharmacists on how to decline to fill a prescription 
     and actions to take after declining to fill a prescription; 
     and
       (2) other health care practitioners and the public on a 
     pharmacist's ability to decline to fill prescriptions in 
     certain circumstances and a description of those 
     circumstances (as described in the materials developed under 
     subsection (a)(1)).
       (c) Stakeholder Input.--In developing the programs and 
     materials required under subsection (a), the Secretary of 
     Health and Human Services shall seek input from relevant 
     national, State, and local associations, boards of pharmacy, 
     medical societies, licensing boards, health care 
     practitioners, and patients, including individuals with 
     chronic pain.

             CHAPTER 3--SAFE DISPOSAL OF UNUSED MEDICATION

     SEC. 3221. SHORT TITLE.

       This chapter may be cited as the ``Safe Disposal of Unused 
     Medication Act''.

     SEC. 3222. DISPOSAL OF CONTROLLED SUBSTANCES OF A HOSPICE 
                   PATIENT BY EMPLOYEES OF A QUALIFIED HOSPICE 
                   PROGRAM.

       (a) In General.--Subsection (g) of section 302 of the 
     Controlled Substances Act (21 U.S.C. 822) is amended by 
     adding at the end the following:
       ``(5)(A) In the case of a person receiving hospice care, an 
     employee of a qualified hospice program, acting within the 
     scope of employment, may handle, without being registered 
     under this section, any controlled substance that was 
     lawfully dispensed to the person receiving hospice care, for 
     the purpose of disposal of the controlled substance so long 
     as such disposal occurs onsite in accordance with all 
     applicable Federal, State, Tribal, and local law and--
       ``(i) the disposal occurs after the death of a person 
     receiving hospice care;
       ``(ii) the controlled substance is expired; or
       ``(iii)(I) the employee is--
       ``(aa) the physician of the person receiving hospice care; 
     and
       ``(bb) registered under section 303(f); and
       ``(II) the hospice patient no longer requires the 
     controlled substance because the plan of care of the hospice 
     patient has been modified.
       ``(B) For the purposes of this paragraph:
       ``(i) The terms `hospice care' and `hospice program' have 
     the meanings given to those terms in section 1861(dd) of the 
     Social Security Act.
       ``(ii) The term `employee of a qualified hospice program' 
     means a physician, physician assistant, nurse, or other 
     person who--
       ``(I) is employed by, or pursuant to arrangements made by, 
     a qualified hospice program;
       ``(II)(aa) is licensed to perform medical or nursing 
     services by the jurisdiction in which the person receiving 
     hospice care was located; and
       ``(bb) is acting within the scope of such employment in 
     accordance with applicable State law; and
       ``(III) has completed training through the qualified 
     hospice program regarding the disposal of controlled 
     substances in a secure and responsible manner so as to 
     discourage abuse, misuse, or diversion.
       ``(iii) The term `qualified hospice program' means a 
     hospice program that--
       ``(I) has written policies and procedures for assisting in 
     the disposal of the controlled substances of a person 
     receiving hospice care after the person's death;
       ``(II) at the time when the controlled substances are first 
     ordered--
       ``(aa) provides a copy of the written policies and 
     procedures to the patient or patient representative and 
     family;
       ``(bb) discusses the policies and procedures with the 
     patient or representative and the family in a language and 
     manner that they understand to ensure that these parties are 
     educated regarding the safe disposal of controlled 
     substances; and
       ``(cc) documents in the patient's clinical record that the 
     written policies and procedures were provided and discussed; 
     and
       ``(III) at the time following the disposal of the 
     controlled substances--
       ``(aa) documents in the patient's clinical record the type 
     of controlled substance, dosage, route of administration, and 
     quantity so disposed; and
       ``(bb) the time, date, and manner in which that disposal 
     occurred.''.
       (b) Guidance.--The Attorney General may issue guidance to 
     hospice programs (as defined in paragraph (5) of section 
     302(g) of the Controlled Substances Act (21 U.S.C. 822(g)), 
     as added by subsection (a)) to assist the programs in 
     satisfying the requirements under such paragraph (5).
       (c) Rule of Construction Relating to State and Local Law.--
     Nothing in this section or the amendments made by this 
     section shall be construed to prevent a State or local 
     government from imposing additional controls or restrictions 
     relating to the regulation of the disposal of controlled 
     substances in hospice care or hospice programs.

     SEC. 3223. GAO STUDY AND REPORT ON HOSPICE SAFE DRUG 
                   MANAGEMENT.

       (a) Study.--
       (1) In general.--The Comptroller General of the United 
     States (in this section referred to as the ``Comptroller 
     General'') shall conduct a study on the requirements 
     applicable to, and challenges of, hospice programs with 
     regard to the management and disposal of controlled 
     substances in the home of an individual.
       (2) Contents.--In conducting the study under paragraph (1), 
     the Comptroller General shall include--
       (A) an overview of any challenges encountered by selected 
     hospice programs regarding the disposal of controlled 
     substances, such as opioids, in a home setting, including any 
     key changes in policies, procedures, or best practices for 
     the disposal of controlled substances over time; and
       (B) a description of Federal requirements, including 
     requirements under the Medicare program, for hospice programs 
     regarding the disposal of controlled substances in a home 
     setting, and oversight of compliance with those requirements.
       (b) Report.--Not later than 18 months after the date of 
     enactment of this Act, the Comptroller General shall submit 
     to Congress a report containing the results of the study 
     conducted under subsection (a), together with 
     recommendations, if any, for such legislation and 
     administrative action as the Comptroller General determines 
     appropriate.

     CHAPTER 4--SPECIAL REGISTRATION FOR TELEMEDICINE CLARIFICATION

     SEC. 3231. SHORT TITLE.

       This chapter may be cited as the ``Special Registration for 
     Telemedicine Clarification Act of 2018''.

     SEC. 3232. REGULATIONS RELATING TO A SPECIAL REGISTRATION FOR 
                   TELEMEDICINE.

       Section 311(h)(2) of the Controlled Substances Act (21 
     U.S.C. 831(h)(2)) is amended to read as follows:
       ``(2) Regulations.--Not later than 1 year after the date of 
     enactment of the SUPPORT for Patients and Communities Act, in 
     consultation with the Secretary, the Attorney General shall 
     promulgate final regulations specifying--
       ``(A) the limited circumstances in which a special 
     registration under this subsection may be issued; and
       ``(B) the procedure for obtaining a special registration 
     under this subsection.''.

      CHAPTER 5--SYNTHETIC ABUSE AND LABELING OF TOXIC SUBSTANCES

     SEC. 3241. CONTROLLED SUBSTANCE ANALOGUES.

       Section 203 of the Controlled Substances Act (21 U.S.C. 
     813) is amended--
       (1) by striking ``A controlled'' and inserting ``(a) In 
     General.--A controlled''; and
       (2) by adding at the end the following:
       ``(b) Determination.--In determining whether a controlled 
     substance analogue was intended for human consumption under 
     subsection (a), the following factors may be considered, 
     along with any other relevant factors:
       ``(1) The marketing, advertising, and labeling of the 
     substance.
       ``(2) The known efficacy or usefulness of the substance for 
     the marketed, advertised, or labeled purpose.
       ``(3) The difference between the price at which the 
     substance is sold and the price at which the substance it is 
     purported to be or advertised as is normally sold.
       ``(4) The diversion of the substance from legitimate 
     channels and the clandestine importation, manufacture, or 
     distribution of the substance.
       ``(5) Whether the defendant knew or should have known the 
     substance was intended to be consumed by injection, 
     inhalation, ingestion, or any other immediate means.
       ``(6) Any controlled substance analogue that is 
     manufactured, formulated, sold, distributed, or marketed with 
     the intent to avoid the provisions of existing drug laws.
       ``(c) Limitation.--For purposes of this section, evidence 
     that a substance was not marketed, advertised, or labeled for 
     human consumption, by itself, shall not be sufficient to 
     establish that the substance was not intended for human 
     consumption.''.

              CHAPTER 6--ACCESS TO INCREASED DRUG DISPOSAL

     SEC. 3251. SHORT TITLE.

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

     SEC. 3252. DEFINITIONS.

       In this chapter--
       (1) the term ``Attorney General'' means the Attorney 
     General, acting through the Assistant Attorney General for 
     the Office of Justice Programs;
       (2) the term ``authorized collector'' means a narcotic 
     treatment program, a hospital or clinic with an on-site 
     pharmacy, a retail pharmacy, or a reverse distributor, that 
     is authorized as a collector under section 1317.40 of title 
     21, Code of Federal Regulations (or any successor 
     regulation);
       (3) the term ``covered grant'' means a grant awarded under 
     section 3003; and
       (4) the term ``eligible collector'' means a person who is 
     eligible to be an authorized collector.

     SEC. 3253. AUTHORITY TO MAKE GRANTS.

       The Attorney General shall award grants to States to enable 
     the States to increase the participation of eligible 
     collectors as authorized collectors.

[[Page H9191]]

  


     SEC. 3254. APPLICATION.

       A State desiring a covered grant shall submit to the 
     Attorney General an application that, at a minimum--
       (1) identifies the single State agency that oversees 
     pharmaceutical care and will be responsible for complying 
     with the requirements of the grant;
       (2) details a plan to increase participation rates of 
     eligible collectors as authorized collectors; and
       (3) describes how the State will select eligible collectors 
     to be served under the grant.

     SEC. 3255. USE OF GRANT FUNDS.

       A State that receives a covered grant, and any subrecipient 
     of the grant, may use the grant amounts only for the costs of 
     installation, maintenance, training, purchasing, and disposal 
     of controlled substances associated with the participation of 
     eligible collectors as authorized collectors.

     SEC. 3256. ELIGIBILITY FOR GRANT.

       The Attorney General shall award a covered grant to 5 
     States, not less than 3 of which shall be States in the 
     lowest quartile of States based on the participation rate of 
     eligible collectors as authorized collectors, as determined 
     by the Attorney General.

     SEC. 3257. DURATION OF GRANTS.

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

     SEC. 3258. ACCOUNTABILITY AND OVERSIGHT.

       A State that receives a covered grant shall submit to the 
     Attorney General a report, at such time and in such manner as 
     the Attorney General may reasonably require, that--
       (1) lists the ultimate recipients of the grant amounts;
       (2) describes the activities undertaken by the State using 
     the grant amounts; and
       (3) contains performance measures relating to the 
     effectiveness of the grant, including changes in the 
     participation rate of eligible collectors as authorized 
     collectors.

     SEC. 3259. DURATION OF PROGRAM.

       The Attorney General may award covered grants for each of 
     the first 5 fiscal years beginning after the date of 
     enactment of this Act.

     SEC. 3260. AUTHORIZATION OF APPROPRIATIONS.

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

           CHAPTER 7--USING DATA TO PREVENT OPIOID DIVERSION

     SEC. 3271. SHORT TITLE.

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

     SEC. 3272. PURPOSE.

       (a) In General.--The purpose of this chapter is to provide 
     drug manufacturers and distributors with access to anonymized 
     information through the Automated Reports and Consolidated 
     Orders System to help drug manufacturers and distributors 
     identify, report, and stop suspicious orders of opioids and 
     reduce diversion rates.
       (b) Rule of Construction.--Nothing in this chapter should 
     be construed to absolve a drug manufacturer, drug 
     distributor, or other Drug Enforcement Administration 
     registrant from the responsibility of the manufacturer, 
     distributor, or other registrant to--
       (1) identify, stop, and report suspicious orders; or
       (2) maintain effective controls against diversion in 
     accordance with section 303 of the Controlled Substances Act 
     (21 U.S.C. 823) or any successor law or associated 
     regulation.

     SEC. 3273. AMENDMENTS.

       (a) Records and Reports of Registrants.--Section 307 of the 
     Controlled Substances Act (21 U.S.C. 827) is amended--
       (1) by redesignating subsections (f), (g), and (h) as 
     subsections (g), (h), and (i), respectively;
       (2) by inserting after subsection (e) the following:
       ``(f)(1) The Attorney General shall, not less frequently 
     than quarterly, make the following information available to 
     manufacturer and distributor registrants through the 
     Automated Reports and Consolidated Orders System, or any 
     subsequent automated system developed by the Drug Enforcement 
     Administration to monitor selected controlled substances:
       ``(A) The total number of distributor registrants that 
     distribute controlled substances to a pharmacy or 
     practitioner registrant, aggregated by the name and address 
     of each pharmacy and practitioner registrant.
       ``(B) The total quantity and type of opioids distributed, 
     listed by Administration Controlled Substances Code Number, 
     to each pharmacy and practitioner registrant described in 
     subparagraph (A).
       ``(2) The information required to be made available under 
     paragraph (1) shall be made available not later than the 30th 
     day of the first month following the quarter to which the 
     information relates.
       ``(3)(A) All registered manufacturers and distributors 
     shall be responsible for reviewing the information made 
     available by the Attorney General under this subsection.
       ``(B) In determining whether to initiate proceedings under 
     this title against a registered manufacturer or distributor 
     based on the failure of the registrant to maintain effective 
     controls against diversion or otherwise comply with the 
     requirements of this title or the regulations issued 
     thereunder, the Attorney General may take into account that 
     the information made available under this subsection was 
     available to the registrant.''; and
       (3) by inserting after subsection (i), as so redesignated, 
     the following:
       ``(j) All of the reports required under this section shall 
     be provided in an electronic format.''.
       (b) Cooperative Arrangements.--Section 503 of the 
     Controlled Substances Act (21 U.S.C. 873) is amended by 
     striking subsection (c) and inserting the following:
       ``(c)(1) The Attorney General shall, once every 6 months, 
     prepare and make available to regulatory, licensing, 
     attorneys general, and law enforcement agencies of States a 
     standardized report containing descriptive and analytic 
     information on the actual distribution patterns, as gathered 
     through the Automated Reports and Consolidated Orders System, 
     or any subsequent automated system, pursuant to section 307 
     and which includes detailed amounts, outliers, and trends of 
     distributor and pharmacy registrants, in such States for the 
     controlled substances contained in schedule II, which, in the 
     discretion of the Attorney General, are determined to have 
     the highest abuse.
       ``(2) If the Attorney General publishes the report 
     described in paragraph (1) once every 6 months as required 
     under paragraph (1), nothing in this subsection shall be 
     construed to bring an action in any court to challenge the 
     sufficiency of the information or to compel the Attorney 
     General to produce any documents or reports referred to in 
     this subsection.''.
       (c) Civil and Criminal Penalties.--Section 402 of the 
     Controlled Substances Act (21 U.S.C. 842) is amended--
       (1) in subsection (a)--
       (A) in paragraph (15), by striking ``or'' at the end;
       (B) in paragraph (16), by striking the period at the end 
     and inserting ``; or''; and
       (C) by inserting after paragraph (16) the following:
       ``(17) in the case of a registered manufacturer or 
     distributor of opioids, to fail to review the most recent 
     information, directly related to the customers of the 
     manufacturer or distributor, made available by the Attorney 
     General in accordance with section 307(f).''; and
       (2) in subsection (c)--
       (A) in paragraph (1), by striking subparagraph (B) and 
     inserting the following:
       ``(B)(i) Except as provided in clause (ii), in the case of 
     a violation of paragraph (5), (10), or (17) of subsection 
     (a), the civil penalty shall not exceed $10,000.
       ``(ii) In the case of a violation described in clause (i) 
     committed by a registered manufacturer or distributor of 
     opioids and related to the reporting of suspicious orders for 
     opioids, failing to maintain effective controls against 
     diversion of opioids, or failing to review the most recent 
     information made available by the Attorney General in 
     accordance with section 307(f), the penalty shall not exceed 
     $100,000.''; and
       (B) in paragraph (2)--
       (i) in subparagraph (A), by inserting ``or (D)'' after 
     ``subparagraph (B)''; and
       (ii) by adding at the end the following:
       ``(D) In the case of a violation described in subparagraph 
     (A) that was a violation of paragraph (5), (10), or (17) of 
     subsection (a) committed by a registered manufacturer or 
     distributor of opioids that relates to the reporting of 
     suspicious orders for opioids, failing to maintain effective 
     controls against diversion of opioids, or failing to review 
     the most recent information made available by the Attorney 
     General in accordance with section 307(f), the criminal fine 
     under title 18, United States Code, shall not exceed 
     $500,000.''.

     SEC. 3274. REPORT.

       Not later than 1 year after the date of enactment of this 
     Act, the Attorney General shall submit to Congress a report 
     that provides information about how the Attorney General is 
     using data in the Automation of Reports and Consolidated 
     Orders System to identify and stop suspicious activity, 
     including whether the Attorney General is looking at 
     aggregate orders from individual pharmacies to multiple 
     distributors that in total are suspicious, even if no 
     individual order rises to the level of a suspicious order to 
     a given distributor.

                     CHAPTER 8--OPIOID QUOTA REFORM

     SEC. 3281. SHORT TITLE.

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

     SEC. 3282. STRENGTHENING CONSIDERATIONS FOR DEA OPIOID 
                   QUOTAS.

       (a) In General.--Section 306 of the Controlled Substances 
     Act (21 U.S.C. 826) is amended--
       (1) in subsection (a)--
       (A) by inserting ``(1)'' after ``(a)'';
       (B) in the second sentence, by striking ``Production'' and 
     inserting ``Except as provided in paragraph (2), 
     production''; and
       (C) by adding at the end the following:
       ``(2) The Attorney General may, if the Attorney General 
     determines it will assist in avoiding the overproduction, 
     shortages, or diversion of a controlled substance, establish 
     an aggregate or individual production quota under this 
     subsection, or a procurement quota established by the 
     Attorney General by regulation, in terms of pharmaceutical 
     dosage forms prepared from or containing the controlled 
     substance.'';
       (2) in subsection (b), in the first sentence, by striking 
     ``production'' and inserting ``manufacturing'';
       (3) in subsection (c), by striking ``October'' and 
     inserting ``December''; and
       (4) by adding at the end the following:

[[Page H9192]]

       ``(i)(1)(A) In establishing any quota under this section, 
     or any procurement quota established by the Attorney General 
     by regulation, for fentanyl, oxycodone, hydrocodone, 
     oxymorphone, or hydromorphone (in this subsection referred to 
     as a `covered controlled substance'), the Attorney General 
     shall estimate the amount of diversion of the covered 
     controlled substance that occurs in the United States.
       ``(B) In estimating diversion under this paragraph, the 
     Attorney General--
       ``(i) shall consider information the Attorney General, in 
     consultation with the Secretary of Health and Human Services, 
     determines reliable on rates of overdose deaths and abuse and 
     overall public health impact related to the covered 
     controlled substance in the United States; and
       ``(ii) may take into consideration whatever other sources 
     of information the Attorney General determines reliable.
       ``(C) After estimating the amount of diversion of a covered 
     controlled substance, the Attorney General shall make 
     appropriate quota reductions, as determined by the Attorney 
     General, from the quota the Attorney General would have 
     otherwise established had such diversion not been considered.
       ``(2)(A) For any year for which the approved aggregate 
     production quota for a covered controlled substance is higher 
     than the approved aggregate production quota for the covered 
     controlled substance for the previous year, the Attorney 
     General, in consultation with the Secretary of Health and 
     Human Services, shall include in the final order an 
     explanation of why the public health benefits of increasing 
     the quota clearly outweigh the consequences of having an 
     increased volume of the covered controlled substance 
     available for sale, and potential diversion, in the United 
     States.
       ``(B) Not later than 1 year after the date of enactment of 
     this subsection, and every year thereafter, the Attorney 
     General shall submit to the Committee on the Judiciary, the 
     Committee on Health, Education, Labor, and Pensions, and the 
     Committee on Appropriations of the Senate and the Committee 
     on the Judiciary, the Committee on Energy and Commerce, and 
     the Committee on Appropriations of the House of 
     Representatives the following information with regard to each 
     covered controlled substance:
       ``(i) An anonymized count of the total number of 
     manufacturers issued individual manufacturing quotas that 
     year for the covered controlled substance.
       ``(ii) An anonymized count of how many such manufacturers 
     were issued an approved manufacturing quota that was higher 
     than the quota issued to that manufacturer for the covered 
     controlled substance in the previous year.
       ``(3) Not later than 1 year after the date of enactment of 
     this subsection, the Attorney General shall submit to 
     Congress a report on how the Attorney General, when fixing 
     and adjusting production and manufacturing quotas under this 
     section for covered controlled substances, will--
       ``(A) take into consideration changes in the accepted 
     medical use of the covered controlled substances; and
       ``(B) work with the Secretary of Health and Human Services 
     on methods to appropriately and anonymously estimate the type 
     and amount of covered controlled substances that are 
     submitted for collection from approved drug collection 
     receptacles, mail-back programs, and take-back events.''.
       (b) Conforming Change.--The Law Revision Counsel is 
     directed to amend the heading for subsection (b) of section 
     826 of title 21, United States Code, by striking 
     ``Production'' and inserting ``Manufacturing''.

                  CHAPTER 9--PREVENTING DRUG DIVERSION

     SEC. 3291. SHORT TITLE.

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

     SEC. 3292. IMPROVEMENTS TO PREVENT DRUG DIVERSION.

       (a) Definition.--Section 102 of the Controlled Substances 
     Act (21 U.S.C. 802) is amended by adding at the end the 
     following:
       ``(57) The term `suspicious order' may include, but is not 
     limited to--
       ``(A) an order of a controlled substance of unusual size;
       ``(B) an order of a controlled substance deviating 
     substantially from a normal pattern; and
       ``(C) orders of controlled substances of unusual 
     frequency.''.
       (b) Suspicious Orders.--Part C of the Controlled Substances 
     Act (21 U.S.C. 821 et seq.) is amended by adding at the end 
     the following:

     ``SEC. 312. SUSPICIOUS ORDERS.

       ``(a) Reporting.--Each registrant shall--
       ``(1) design and operate a system to identify suspicious 
     orders for the registrant;
       ``(2) ensure that the system designed and operated under 
     paragraph (1) by the registrant complies with applicable 
     Federal and State privacy laws; and
       ``(3) upon discovering a suspicious order or series of 
     orders, notify the Administrator of the Drug Enforcement 
     Administration and the Special Agent in Charge of the 
     Division Office of the Drug Enforcement Administration for 
     the area in which the registrant is located or conducts 
     business.
       ``(b) Suspicious Order Database.--
       ``(1) In general.--Not later than 1 year after the date of 
     enactment of this section, the Attorney General shall 
     establish a centralized database for collecting reports of 
     suspicious orders.
       ``(2) Satisfaction of reporting requirements.--If a 
     registrant reports a suspicious order to the centralized 
     database established under paragraph (1), the registrant 
     shall be considered to have complied with the requirement 
     under subsection (a)(3) to notify the Administrator of the 
     Drug Enforcement Administration and the Special Agent in 
     Charge of the Division Office of the Drug Enforcement 
     Administration for the area in which the registrant is 
     located or conducts business.
       ``(c) Sharing Information With the States.--
       ``(1) In general.--The Attorney General shall prepare and 
     make available information regarding suspicious orders in a 
     State, including information in the database established 
     under subsection (b)(1), to the point of contact for purposes 
     of administrative, civil, and criminal oversight relating to 
     the diversion of controlled substances for the State, as 
     designated by the Governor or chief executive officer of the 
     State.
       ``(2) Timing.--The Attorney General shall provide 
     information in accordance with paragraph (1) within a 
     reasonable period of time after obtaining the information.
       ``(3) Coordination.--In establishing the process for the 
     provision of information under this subsection, the Attorney 
     General shall coordinate with States to ensure that the 
     Attorney General has access to information, as permitted 
     under State law, possessed by the States relating to 
     prescriptions for controlled substances that will assist in 
     enforcing Federal law.''.
       (c) Reports to Congress.--
       (1) Definition.--In this subsection, the term ``suspicious 
     order'' has the meaning given that term in section 102 of the 
     Controlled Substances Act, as amended by this chapter.
       (2) One-time report.--Not later than 1 year after the date 
     of enactment of this Act, the Attorney General shall submit 
     to Congress a report on the reporting of suspicious orders, 
     which shall include--
       (A) a description of the centralized database established 
     under section 312 of the Controlled Substances Act, as added 
     by this section, to collect reports of suspicious orders;
       (B) a description of the system and reports established 
     under section 312 of the Controlled Substances Act, as added 
     by this section, to share information with States;
       (C) information regarding how the Attorney General used 
     reports of suspicious orders before the date of enactment of 
     this Act and after the date of enactment of this Act, 
     including how the Attorney General received the reports and 
     what actions were taken in response to the reports; and
       (D) descriptions of the data analyses conducted on reports 
     of suspicious orders to identify, analyze, and stop 
     suspicious activity.
       (3) Additional reports.--Not later than 1 year after the 
     date of enactment of this Act, and annually thereafter until 
     the date that is 5 years after the date of enactment of this 
     Act, the Attorney General shall submit to Congress a report 
     providing, for the previous year--
       (A) the number of reports of suspicious orders;
       (B) a summary of actions taken in response to reports, in 
     the aggregate, of suspicious orders; and
       (C) a description of the information shared with States 
     based on reports of suspicious orders.
       (4) One-time gao report.--Not later than 1 year after the 
     date of enactment of this Act, the Comptroller General of the 
     United States, in consultation with the Administrator of the 
     Drug Enforcement Administration, shall submit to Congress a 
     report on the reporting of suspicious orders, which shall 
     include an evaluation of the utility of real-time reporting 
     of potential suspicious orders of opioids on a national level 
     using computerized algorithms, including the extent to which 
     such algorithms--
       (A) would help ensure that potentially suspicious orders 
     are more accurately captured, identified, and reported in 
     real time to suppliers before orders are filled;
       (B) may produce false positives of suspicious order reports 
     that could result in market disruptions for legitimate orders 
     of opioids; and
       (C) would reduce the overall length of an investigation 
     that prevents the diversion of suspicious orders of opioids.

                           TITLE IV--OFFSETS

     SEC. 4001. PROMOTING VALUE IN MEDICAID MANAGED CARE.

       Section 1903(m) of the Social Security Act (42 U.S.C. 
     1396b(m)), as amended by sections 1013 and 1016, is further 
     amended by adding at the end the following new paragraph:
       ``(9)(A) With respect to expenditures described in 
     subparagraph (B) that are incurred by a State for any fiscal 
     year after fiscal year 2020 (and before fiscal year 2024), in 
     determining the pro rata share to which the United States is 
     equitably entitled under subsection (d)(3), the Secretary 
     shall substitute the Federal medical assistance percentage 
     that applies for such fiscal year to the State under section 
     1905(b) (without regard to any adjustments to such percentage 
     applicable under such section or any other provision of law) 
     for the percentage that applies to such expenditures under 
     section 1905(y).
       ``(B) Expenditures described in this subparagraph, with 
     respect to a fiscal year to which subparagraph (A) applies, 
     are expenditures incurred by a State for payment for

[[Page H9193]]

     medical assistance provided to individuals described in 
     subclause (VIII) of section 1902(a)(10)(A)(i) by a managed 
     care entity, or other specified entity (as defined in 
     subparagraph (D)(iii)), that are treated as remittances 
     because the State--
       ``(i) has satisfied the requirement of section 438.8 of 
     title 42, Code of Federal Regulations (or any successor 
     regulation), by electing--
       ``(I) in the case of a State described in subparagraph (C), 
     to apply a minimum medical loss ratio (as defined in 
     subparagraph (D)(ii)) that is at least 85 percent but not 
     greater than the minimum medical loss ratio (as so defined) 
     that such State applied as of May 31, 2018; or
       ``(II) in the case of a State not described in subparagraph 
     (C), to apply a minimum medical loss ratio that is equal to 
     85 percent; and
       ``(ii) recovered all or a portion of the expenditures as a 
     result of the entity's failure to meet such ratio.
       ``(C) For purposes of subparagraph (B), a State described 
     in this subparagraph is a State that as of May 31, 2018, 
     applied a minimum medical loss ratio (as calculated under 
     subsection (d) of section 438.8 of title 42, Code of Federal 
     Regulations (as in effect on June 1, 2018)) for payment for 
     services provided by entities described in such subparagraph 
     under the State plan under this title (or a waiver of the 
     plan) that is equal to or greater than 85 percent.
       ``(D) For purposes of this paragraph:
       ``(i) The term `managed care entity' means a medicaid 
     managed care organization described in section 
     1932(a)(1)(B)(i).
       ``(ii) The term `minimum medical loss ratio' means, with 
     respect to a State, a minimum medical loss ratio (as 
     calculated under subsection (d) of section 438.8 of title 42, 
     Code of Federal Regulations (as in effect on June 1, 2018)) 
     for payment for services provided by entities described in 
     subparagraph (B) under the State plan under this title (or a 
     waiver of the plan).
       ``(iii) The term `other specified entity' means--
       ``(I) a prepaid inpatient health plan, as defined in 
     section 438.2 of title 42, Code of Federal Regulations (or 
     any successor regulation); and
       ``(II) a prepaid ambulatory health plan, as defined in such 
     section (or any successor regulation).''.

     SEC. 4002. REQUIRING REPORTING BY GROUP HEALTH PLANS OF 
                   PRESCRIPTION DRUG COVERAGE INFORMATION FOR 
                   PURPOSES OF IDENTIFYING PRIMARY PAYER 
                   SITUATIONS UNDER THE MEDICARE PROGRAM.

       Clause (i) of section 1862(b)(7)(A) of the Social Security 
     Act (42 U.S.C. 1395y(b)(7)(A)) is amended to read as follows:
       ``(i) secure from the plan sponsor and plan participants 
     such information as the Secretary shall specify for the 
     purpose of identifying situations where the group health plan 
     is or has been--

       ``(I) a primary plan to the program under this title; or
       ``(II) for calendar quarters beginning on or after January 
     1, 2020, a primary payer with respect to benefits relating to 
     prescription drug coverage under part D; and''.

     SEC. 4003. ADDITIONAL RELIGIOUS EXEMPTION FROM HEALTH 
                   COVERAGE RESPONSIBILITY REQUIREMENT.

       (a) In General.--Section 5000A(d)(2)(A) of the Internal 
     Revenue Code of 1986 is amended to read as follows:
       ``(A) Religious conscience exemptions.--
       ``(i) In general.--Such term shall not include any 
     individual for any month if such individual has in effect an 
     exemption under section 1311(d)(4)(H) of the Patient 
     Protection and Affordable Care Act which certifies that--

       ``(I) such individual is a member of a recognized religious 
     sect or division thereof which is described in section 
     1402(g)(1), and is adherent of established tenets or 
     teachings of such sect or division as described in such 
     section; or
       ``(II) such individual is a member of a religious sect or 
     division thereof which is not described in section 
     1402(g)(1), who relies solely on a religious method of 
     healing, and for whom the acceptance of medical health 
     services would be inconsistent with the religious beliefs of 
     the individual.

       ``(ii) Special rules.--

       ``(I) Medical health services defined.--For purposes of 
     this subparagraph, the term `medical health services' does 
     not include routine dental, vision and hearing services, 
     midwifery services, vaccinations, necessary medical services 
     provided to children, services required by law or by a third 
     party, and such other services as the Secretary of Health and 
     Human Services may provide in implementing section 
     1311(d)(4)(H) of the Patient Protection and Affordable Care 
     Act.
       ``(II) Attestation required.--Clause (i)(II) shall apply to 
     an individual for months in a taxable year only if the 
     information provided by the individual under section 
     1411(b)(5)(A) of such Act includes an attestation that the 
     individual has not received medical health services during 
     the preceding taxable year.''.

       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to taxable years beginning after December 31, 
     2018.
       (c) Construction.--Nothing in the amendment made by 
     subsection (a) shall preempt any State law requiring the 
     provision of medical treatment for children, especially those 
     who are seriously ill.

     SEC. 4004. MODERNIZING THE REPORTING OF BIOLOGICAL AND 
                   BIOSIMILAR PRODUCTS.

       Subtitle B of title XI of the Medicare Prescription Drug, 
     Improvement, and Modernization Act of 2003 (Public Law 108-
     173) is amended--
       (1) in section 1111, as amended by section 3(1) of the 
     Patient Right to Know Drug Prices Act--
       (A) in the paragraph (3) inserted by such section 3(1), by 
     striking ``an application'' and inserting ``a biosimilar 
     biological product application'';
       (B) in the paragraph (4) inserted by such section 3(1), by 
     inserting ``application'' before ``under section 351(k) of 
     the Public Health Service Act'';
       (C) in the paragraph (5) inserted by such section 3(1), by 
     striking ``for licensure of a biological product under 
     section 351(k) of the Public Health Service Act'' and 
     inserting ``under section 351(k) of the Public Health Service 
     Act for licensure of a biological product as biosimilar to, 
     or interchangeable with, a reference product'';
       (D) in paragraph (7), as redesignated and amended by such 
     section 3(1), by striking ``or under section 351(a) of the 
     Public Health Service Act'' and inserting ``or the owner, or 
     exclusive licensee, of a patent included in a list provided 
     under section 351(l)(3) of the Public Health Service Act''; 
     and
       (E) in the paragraph (12) added by such section 3(1), by 
     striking ``means a brand name drug for which a license is in 
     effect under section 351(a)'' and inserting ``has the meaning 
     given such term in section 351(i)''; and
       (2) in section 1112, as amended by section 3(2) of the 
     Patient Right to Know Drug Prices Act--
       (A) in subsection (a)--
       (i) in paragraph (1), by striking ``for which a statement 
     under section 351(l)(3)(B)(ii)(I) of the Public Health 
     Service Act has been provided'';
       (ii) in paragraph (2)--

       (I) in subparagraph (C)(i), by striking ``brand name'' and 
     inserting ``listed''; and
       (II) by amending clause (ii) of subparagraph (C) to read as 
     follows:

       ``(ii) any of the time periods referred to in section 
     351(k)(6) of the Public Health Service Act as such period 
     applies to such biosimilar biological product application or 
     to any other biosimilar biological product application based 
     on the same reference product.'';
       (B) in subsection (b)--
       (i) in the subsection heading, by inserting ``or Biosimilar 
     Biological Product Applicant'' after ``Applicant'';
       (ii) in paragraph (1)(B), by striking the first sentence 
     and inserting the following: ``A biosimilar biological 
     product applicant that has submitted a biosimilar biological 
     product application that references a reference product and 
     another biosimilar biological product applicant that has 
     submitted a biosimilar biological product application that 
     references the same reference product shall each file the 
     agreement in accordance with subsection (c).''; and
       (iii) in paragraph (2)--

       (I) by striking ``2 generic drug applicants'' and inserting 
     ``2 or more generic drug applicants''; and
       (II) by striking ``or an agreement between 2 biosimilar 
     biological product applicants regarding the 1-year period 
     referred to in section 351(k)(6)(A) of the Public Health 
     Service Act as it applies to the biosimilar biological 
     product applications with which the agreement is concerned'' 
     and inserting ``, an agreement between 2 or more biosimilar 
     biological product applicants regarding a time period 
     referred to in section 351(k)(6) of the Public Health Service 
     Act as it applies to the biosimilar biological product, or an 
     agreement between 2 or more biosimilar biological product 
     applicants regarding the manufacture, marketing, or sale of a 
     biosimilar biological product''; and

       (C) in subsection (c)(2), by inserting ``were entered into 
     within 30 days of,'' after ``condition for,''.

                   TITLE V--OTHER MEDICAID PROVISIONS

Subtitle A--Mandatory Reporting With Respect to Adult Behavioral Health 
                                Measures

     SEC. 5001. MANDATORY REPORTING WITH RESPECT TO ADULT 
                   BEHAVIORAL HEALTH MEASURES.

       Section 1139B of the Social Security Act (42 U.S.C. 1320b-
     9b) is amended--
       (1) in subsection (b)--
       (A) in paragraph (3)--
       (i) by striking ``Not later than January 1, 2013'' and 
     inserting the following:
       ``(A) Voluntary reporting.--Not later than January 1, 
     2013''; and
       (ii) by adding at the end the following:
       ``(B) Mandatory reporting with respect to behavioral health 
     measures.--Beginning with the State report required under 
     subsection (d)(1) for 2024, the Secretary shall require 
     States to use all behavioral health measures included in the 
     core set of adult health quality measures and any updates or 
     changes to such measures to report information, using the 
     standardized format for reporting information and procedures 
     developed under subparagraph (A), regarding the quality of 
     behavioral health care for Medicaid eligible adults.''; and
       (B) in paragraph (5), by adding at the end the following 
     new subparagraph:
       ``(C) Behavioral health measures.--Beginning with respect 
     to State reports required under subsection (d)(1) for 2024, 
     the core set of adult health quality measures maintained 
     under this paragraph (and any updates or changes to such 
     measures) shall include behavioral health measures.''; and
       (2) in subsection (d)(1)(A)--
       (A) by striking ``the such plan'' and inserting ``such 
     plan''; and

[[Page H9194]]

       (B) by striking ``subsection (a)(5)'' and inserting 
     ``subsection (b)(5) and, beginning with the report for 2024, 
     all behavioral health measures included in the core set of 
     adult health quality measures maintained under such 
     subsection (b)(5) and any updates or changes to such measures 
     (as required under subsection (b)(3))''.

                Subtitle B--Medicaid IMD Additional Info

     SEC. 5011. SHORT TITLE.

       This subtitle may be cited as the ``Medicaid Institutes for 
     Mental Disease Are Decisive in Delivering Inpatient Treatment 
     for Individuals but Opportunities for Needed Access are 
     Limited without Information Needed about Facility Obligations 
     Act'' or the ``Medicaid IMD ADDITIONAL INFO Act''.

     SEC. 5012. MACPAC EXPLORATORY STUDY AND REPORT ON 
                   INSTITUTIONS FOR MENTAL DISEASES REQUIREMENTS 
                   AND PRACTICES UNDER MEDICAID.

       (a) In General.--Not later than January 1, 2020, the 
     Medicaid and CHIP Payment and Access Commission established 
     under section 1900 of the Social Security Act (42 U.S.C. 
     1396) shall conduct an exploratory study, using data from a 
     representative sample of States, and submit to Congress a 
     report on at least the following information, with respect to 
     services furnished to individuals enrolled under State plans 
     under the Medicaid program under title XIX of such Act (42 
     U.S.C. 1396 et seq.) (or waivers of such plans) who are 
     patients in institutions for mental diseases and for which 
     payment is made through fee-for-service or managed care 
     arrangements under such State plans (or waivers):
       (1) A description of such institutions for mental diseases 
     in each such State, including at a minimum--
       (A) the number of such institutions in the State;
       (B) the facility type of such institutions in the State; 
     and
       (C) any coverage limitations under each such State plan (or 
     waiver) on scope, duration, or frequency of such services.
       (2) With respect to each such institution for mental 
     diseases in each such State, a description of--
       (A) such services provided at such institution;
       (B) the process, including any timeframe, used by such 
     institution to clinically assess and reassess such 
     individuals; and
       (C) the discharge process used by such institution, 
     including any care continuum of relevant services or 
     facilities provided or used in such process.
       (3) A description of--
       (A) any Federal waiver that each such State has for such 
     institutions and the Federal statutory authority for such 
     waiver; and
       (B) any other Medicaid funding sources used by each such 
     State for funding such institutions, such as supplemental 
     payments.
       (4) A summary of State requirements (such as certification, 
     licensure, and accreditation) applied by each such State to 
     such institutions in order for such institutions to receive 
     payment under the State plan (or waiver) and how each such 
     State determines if such requirements have been met.
       (5) A summary of State standards (such as quality 
     standards, clinical standards, and facility standards) that 
     such institutions must meet to receive payment under such 
     State plans (or waivers) and how each such State determines 
     if such standards have been met.
       (6) If determined appropriate by the Commission, 
     recommendations for policies and actions by Congress and the 
     Centers for Medicare & Medicaid Services, such as on how 
     State Medicaid programs may improve care and improve 
     standards and including a recommendation for how the Centers 
     for Medicare & Medicaid Services can improve data collection 
     from such programs to address any gaps in information.
       (b) Stakeholder Input.--In carrying out subsection (a), the 
     Medicaid and CHIP Payment and Access Commission shall seek 
     input from State Medicaid directors and stakeholders, 
     including at a minimum the Substance Abuse and Mental Health 
     Services Administration, Centers for Medicare & Medicaid 
     Services, State Medicaid officials, State mental health 
     authorities, Medicaid beneficiary advocates, health care 
     providers, and Medicaid managed care organizations.
       (c) Definitions.--In this section:
       (1) Representative sample of states.--The term 
     ``representative sample of States'' means a non-probability 
     sample in which at least two States are selected based on the 
     knowledge and professional judgment of the selector.
       (2) State.--The term ``State'' means each of the 50 States, 
     the District of Columbia, and any commonwealth or territory 
     of the United States.
       (3) Institution for mental diseases.--The term 
     ``institution for mental diseases'' has the meaning given 
     such term in section 435.1010 of title 42, Code of Federal 
     Regulations, or any successor regulation.

    Subtitle C--CHIP Mental Health and Substance Use Disorder Parity

     SEC. 5021. SHORT TITLE.

       This subtitle may be cited as the ``CHIP Mental Health and 
     Substance Use Disorder Parity Act''.

     SEC. 5022. ENSURING ACCESS TO MENTAL HEALTH AND SUBSTANCE USE 
                   DISORDER SERVICES FOR CHILDREN AND PREGNANT 
                   WOMEN UNDER THE CHILDREN'S HEALTH INSURANCE 
                   PROGRAM.

       (a) In General.--Section 2103(c)(1) of the Social Security 
     Act (42 U.S.C. 1397cc(c)(1)) is amended by adding at the end 
     the following new subparagraph:
       ``(E) Mental health and substance use disorder services (as 
     defined in paragraph (5)).''.
       (b) Mental Health and Substance Use Disorder Services.--
       (1) In general.--Section 2103(c) of the Social Security Act 
     (42 U.S.C. 1397cc(c)) is amended--
       (A) by redesignating paragraphs (5), (6), (7), and (8) as 
     paragraphs (6), (7), (8), and (9), respectively; and
       (B) by inserting after paragraph (4) the following new 
     paragraph:
       ``(5) Mental health and substance use disorder services.--
     Regardless of the type of coverage elected by a State under 
     subsection (a), child health assistance provided under such 
     coverage for targeted low-income children and, in the case 
     that the State elects to provide pregnancy-related assistance 
     under such coverage pursuant to section 2112, such pregnancy-
     related assistance for targeted low-income pregnant women (as 
     defined in section 2112(d)) shall--
       ``(A) include coverage of mental health services (including 
     behavioral health treatment) necessary to prevent, diagnose, 
     and treat a broad range of mental health symptoms and 
     disorders, including substance use disorders; and
       ``(B) be delivered in a culturally and linguistically 
     appropriate manner.''.
       (2) Conforming amendments.--
       (A) Section 2103(a) of the Social Security Act (42 U.S.C. 
     1397cc(a)) is amended, in the matter before paragraph (1), by 
     striking ``paragraphs (5), (6), and (7)'' and inserting 
     ``paragraphs (5), (6), (7), and (8)''.
       (B) Section 2110(a) of the Social Security Act (42 U.S.C. 
     1397jj(a)) is amended--
       (i) in paragraph (18), by striking ``substance abuse'' each 
     place it appears and inserting ``substance use''; and
       (ii) in paragraph (19), by striking ``substance abuse'' and 
     inserting ``substance use''.
       (C) Section 2110(b)(5)(A)(i) of the Social Security Act (42 
     U.S.C. 1397jj(b)(5)(A)(i)) is amended by striking 
     ``subsection (c)(5)'' and inserting ``subsection (c)(6)''.
       (c) Assuring Access to Care.--Section 2102(a)(7)(B) of the 
     Social Security Act (42 U.S.C. 1397bb(c)(2)) is amended by 
     striking ``section 2103(c)(5)'' and inserting ``paragraphs 
     (5) and (6) of section 2103(c)''.
       (d) Mental Health Services Parity.--Subparagraph (A) of 
     paragraph (7) of section 2103(c) of the Social Security Act 
     (42 U.S.C. 1397cc(c)) (as redesignated by subsection (b)(1)) 
     is amended to read as follows:
       ``(A) In general.--A State child health plan shall ensure 
     that the financial requirements and treatment limitations 
     applicable to mental health and substance use disorder 
     services (as described in paragraph (5)) provided under such 
     plan comply with the requirements of section 2726(a) of the 
     Public Health Service Act in the same manner as such 
     requirements or limitations apply to a group health plan 
     under such section.''.
       (e) Effective Date.--
       (1) In general.--Subject to paragraph (2), the amendments 
     made by this section shall take effect with respect to child 
     health assistance provided on or after the date that is 1 
     year after the date of the enactment of this Act.
       (2) Exception for state legislation.--In the case of a 
     State child health plan under title XXI of the Social 
     Security Act (or a waiver of such plan), which the Secretary 
     of Health and Human Services determines requires State 
     legislation in order for the respective plan (or waiver) to 
     meet any requirement imposed by the amendments made by this 
     section, the respective plan (or waiver) shall not be 
     regarded as failing to comply with the requirements of such 
     title solely on the basis of its failure to meet such an 
     additional requirement before the first day of the first 
     calendar quarter beginning after the close of the first 
     regular session of the State legislature that begins after 
     the date of enactment of this section. For purposes of the 
     previous sentence, in the case of a State that has a 2-year 
     legislative session, each year of the session shall be 
     considered to be a separate regular session of the State 
     legislature.

                      Subtitle D--Medicaid Reentry

     SEC. 5031. SHORT TITLE.

       This subtitle may be cited as the ``Medicaid Reentry Act''.

     SEC. 5032. PROMOTING STATE INNOVATIONS TO EASE TRANSITIONS 
                   INTEGRATION TO THE COMMUNITY FOR CERTAIN 
                   INDIVIDUALS.

       (a) Stakeholder Group Development of Best Practices; State 
     Medicaid Program Innovation.--
       (1) Stakeholder group best practices.--Not later than 6 
     months after the date of the enactment of this Act, the 
     Secretary of Health and Human Services shall convene a 
     stakeholder group of representatives of managed care 
     organizations, Medicaid beneficiaries, health care providers, 
     the National Association of Medicaid Directors, and other 
     relevant representatives from local, State, and Federal jail 
     and prison systems to develop best practices (and submit to 
     the Secretary and Congress a report on such best practices) 
     for States--
       (A) to ease the health care-related transition of an 
     individual who is an inmate of a public institution from the 
     public institution to the community, including best practices 
     for ensuring continuity of health insurance coverage or 
     coverage under the State Medicaid plan under title XIX of the 
     Social Security Act, as applicable, and relevant social 
     services; and

[[Page H9195]]

       (B) to carry out, with respect to such an individual, such 
     health care-related transition not later than 30 days after 
     such individual is released from the public institution.
       (2) State medicaid program innovation.--The Secretary of 
     Health and Human Services shall work with States on 
     innovative strategies to help individuals who are inmates of 
     public institutions and otherwise eligible for medical 
     assistance under the Medicaid program under title XIX of the 
     Social Security Act transition, with respect to enrollment 
     for medical assistance under such program, seamlessly to the 
     community.
       (b) Guidance on Innovative Service Delivery Systems 
     Demonstration Project Opportunities.--Not later than 1 year 
     after the date of the enactment of this Act, the Secretary of 
     Health and Human Services, through the Administrator of the 
     Centers for Medicare & Medicaid Services, shall issue a State 
     Medicaid Director letter, based on best practices developed 
     under subsection (a)(1), regarding opportunities to design 
     demonstration projects under section 1115 of the Social 
     Security Act (42 U.S.C. 1315) to improve care transitions for 
     certain individuals who are soon-to-be former inmates of a 
     public institution and who are otherwise eligible to receive 
     medical assistance under title XIX of such Act, including 
     systems for, with respect to a period (not to exceed 30 days) 
     immediately prior to the day on which such individuals are 
     expected to be released from such institution--
       (1) providing assistance and education for enrollment under 
     a State plan under the Medicaid program under title XIX of 
     such Act for such individuals during such period; and
       (2) providing health care services for such individuals 
     during such period.
       (c) Rule of Construction.--Nothing under title XIX of the 
     Social Security Act or any other provision of law precludes a 
     State from reclassifying or suspending (rather than 
     terminating) eligibility of an individual for medical 
     assistance under title XIX of the Social Security Act while 
     such individual is an inmate of a public institution.

                    Subtitle E--Medicaid Partnership

     SEC. 5041. SHORT TITLE.

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

     SEC. 5042. MEDICAID PROVIDERS ARE REQUIRED TO NOTE 
                   EXPERIENCES IN RECORD SYSTEMS TO HELP IN-NEED 
                   PATIENTS.

       (a) Requirements Under the Medicaid Program Relating to 
     Qualified Prescription Drug Monitoring Programs and 
     Prescribing Certain Controlled Substances.--Title XIX of the 
     Social Security Act (42 U.S.C. 1396 et seq.) is amended by 
     inserting after section 1943 the following new section:

     ``SEC. 1944. REQUIREMENTS RELATING TO QUALIFIED PRESCRIPTION 
                   DRUG MONITORING PROGRAMS AND PRESCRIBING 
                   CERTAIN CONTROLLED SUBSTANCES.

       ``(a) In General.--Subject to subsection (d), beginning 
     October 1, 2021, a State--
       ``(1) shall require each covered provider to check, in 
     accordance with such timing, manner, and form as specified by 
     the State, the prescription drug history of a covered 
     individual being treated by the covered provider through a 
     qualified prescription drug monitoring program described in 
     subsection (b) before prescribing to such individual a 
     controlled substance; and
       ``(2) in the case that such a provider is not able to 
     conduct such a check despite a good faith effort by such 
     provider--
       ``(A) shall require the provider to document such good 
     faith effort, including the reasons why the provider was not 
     able to conduct the check; and
       ``(B) may require the provider to submit, upon request, 
     such documentation to the State.
       ``(b) Qualified Prescription Drug Monitoring Program 
     Described.--A qualified prescription drug monitoring program 
     described in this subsection is, with respect to a State, a 
     prescription drug monitoring program administered by the 
     State that, at a minimum, satisfies each of the following 
     criteria:
       ``(1) The program facilitates access by a covered provider 
     to, at a minimum, the following information with respect to a 
     covered individual, in as close to real-time as possible:
       ``(A) Information regarding the prescription drug history 
     of a covered individual with respect to controlled 
     substances.
       ``(B) The number and type of controlled substances 
     prescribed to and filled for the covered individual during at 
     least the most recent 12-month period.
       ``(C) The name, location, and contact information (or other 
     identifying number selected by the State, such as a national 
     provider identifier issued by the National Plan and Provider 
     Enumeration System of the Centers for Medicare & Medicaid 
     Services) of each covered provider who prescribed a 
     controlled substance to the covered individual during at 
     least the most recent 12-month period.
       ``(2) The program facilitates the integration of 
     information described in paragraph (1) into the workflow of a 
     covered provider, which may include the electronic system the 
     covered provider uses to prescribe controlled substances.

     A qualified prescription drug monitoring program described in 
     this subsection, with respect to a State, may have in place, 
     in accordance with applicable State and Federal law, a data-
     sharing agreement with the State Medicaid program that allows 
     the medical director and pharmacy director of such program 
     (and any designee of such a director who reports directly to 
     such director) to access the information described in 
     paragraph (1) in an electronic format. The State Medicaid 
     program under this title may facilitate reasonable and 
     limited access, as determined by the State and ensuring 
     documented beneficiary protections regarding the use of such 
     data, to such qualified prescription drug monitoring program 
     for the medical director or pharmacy director of any managed 
     care entity (as defined under section 1932(a)(1)(B)) that has 
     a contract with the State under section 1903(m) or under 
     section 1905(t)(3), or the medical director or pharmacy 
     director of any entity that has a contract to manage the 
     pharmaceutical benefit with respect to individuals enrolled 
     in the State plan (or under a waiver of the State plan). All 
     applicable State and Federal security and privacy laws shall 
     apply to the directors or designees of such directors of any 
     State Medicaid program or entity accessing a qualified 
     prescription drug monitoring program under this section.
       ``(c) Application of Privacy Rules Clarification.--The 
     Secretary shall clarify privacy requirements, including 
     requirements under the regulations promulgated pursuant to 
     section 264(c) of the Health Insurance Portability and 
     Accountability Act of 1996 (42 U.S.C. 1320d-2 note), related 
     to the sharing of data under subsection (b) in the same 
     manner as the Secretary is required under subparagraph (J) of 
     section 1860D-4(c)(5) to clarify privacy requirements related 
     to the sharing of data described in such subparagraph.
       ``(d) Ensuring Access.--In order to ensure reasonable 
     access to health care, the Secretary shall waive the 
     application of the requirement under subsection (a), with 
     respect to a State, in the case of natural disasters and 
     similar situations, and in the case of the provision of 
     emergency services (as defined for purposes of section 1860D-
     4(c)(5)(D)(ii)(II)).
       ``(e) Reports.--
       ``(1) State reports.--Each State shall include in the 
     annual report submitted to the Secretary under section 
     1927(g)(3)(D), beginning with such reports submitted for 
     2023, information including, at a minimum, the following 
     information for the most recent 12-month period:
       ``(A) The percentage of covered providers (as determined 
     pursuant to a process established by the State) who checked 
     the prescription drug history of a covered individual through 
     a qualified prescription drug monitoring program described in 
     subsection (b) before prescribing to such individual a 
     controlled substance.
       ``(B) Aggregate trends with respect to prescribing 
     controlled substances such as--
       ``(i) the quantity of daily morphine milligram equivalents 
     prescribed for controlled substances;
       ``(ii) the number and quantity of daily morphine milligram 
     equivalents prescribed for controlled substances per covered 
     individual; and
       ``(iii) the types of controlled substances prescribed, 
     including the dates of such prescriptions, the supplies 
     authorized (including the duration of such supplies), and the 
     period of validity of such prescriptions, in different 
     populations (such as individuals who are elderly, individuals 
     with disabilities, and individuals who are enrolled under 
     both this title and title XVIII).
       ``(C) Whether or not the State requires (and a detailed 
     explanation as to why the State does or does not require) 
     pharmacists to check the prescription drug history of a 
     covered individual through a qualified prescription drug 
     monitoring program described in subsection (b) before 
     dispensing a controlled substance to such individual.
       ``(D) An accounting of any data or privacy breach of a 
     qualified prescription drug monitoring program described in 
     subsection (b), the number of covered individuals impacted by 
     each such breach, and a description of the steps the State 
     has taken to address each such breach, including, to the 
     extent required by State or Federal law or otherwise 
     determined appropriate by the State, alerting any such 
     impacted individual and law enforcement of the breach.
       ``(2) Report by cms.--Not later than October 1, 2023, the 
     Administrator of the Centers for Medicare & Medicaid Services 
     shall publish on the publicly available website of the 
     Centers for Medicare & Medicaid Services a report including 
     the following information:
       ``(A) Guidance for States on how States can increase the 
     percentage of covered providers who use qualified 
     prescription drug monitoring programs described in subsection 
     (b).
       ``(B) Best practices for how States and covered providers 
     should use such qualified prescription drug monitoring 
     programs to reduce the occurrence of abuse of controlled 
     substances.
       ``(f) Increase to FMAP and Federal Matching Rates for 
     Certain Expenditures Relating to Qualified Prescription Drug 
     Monitoring Programs.--
       ``(1) In general.--With respect to a State that meets the 
     condition described in paragraph (2) and any quarter 
     occurring during fiscal year 2019 or fiscal year 2020, the 
     Federal medical assistance percentage or Federal matching 
     rate that would otherwise

[[Page H9196]]

     apply to such State under section 1903(a) for such quarter, 
     with respect to expenditures by the State for activities 
     under the State plan (or a waiver of such plan) to design, 
     develop, or implement a prescription drug monitoring program 
     (and to make connections to such program) that satisfies the 
     criteria described in paragraphs (1) and (2) of subsection 
     (b), shall be equal to 100 percent.
       ``(2) Condition.--The condition described in this 
     paragraph, with respect to a State, is that the State (in 
     this paragraph referred to as the `administering State') has 
     in place agreements with all States that are contiguous to 
     such administering State that, when combined, enable covered 
     providers in all such contiguous States to access, through 
     the prescription drug monitoring program, the information 
     that is described in subsection (b)(1) of covered individuals 
     of such administering State and that covered providers in 
     such administering State are able to access through such 
     program.
       ``(g) Rule of Construction.--Nothing in this section 
     prevents a State from requiring pharmacists to check the 
     prescription drug history of covered individuals through a 
     qualified prescription drug monitoring program before 
     dispensing controlled substances to such individuals.
       ``(h) Definitions.--In this section:
       ``(1) Controlled substance.--The term `controlled 
     substance' means a drug that is included in schedule II of 
     section 202(c) of the Controlled Substances Act and, at the 
     option of the State involved, a drug included in schedule III 
     or IV of such section.
       ``(2) Covered individual.--The term `covered individual' 
     means, with respect to a State, an individual who is enrolled 
     in the State plan (or under a waiver of such plan). Such term 
     does not include an individual who--
       ``(A) is receiving--
       ``(i) hospice or palliative care; or
       ``(ii) treatment for cancer;
       ``(B) is a resident of a long-term care facility, of a 
     facility described in section 1905(d), or of another facility 
     for which frequently abused drugs are dispensed for residents 
     through a contract with a single pharmacy; or
       ``(C) the State elects to treat as exempted from such term.
       ``(3) Covered provider.--
       ``(A) In general.--The term `covered provider' means, 
     subject to subparagraph (B), with respect to a State, a 
     health care provider who is participating under the State 
     plan (or waiver of the State plan) and licensed, registered, 
     or otherwise permitted by the State to prescribe a controlled 
     substance (or the designee of such provider).
       ``(B) Exceptions.--
       ``(i) In general.--Beginning October 1, 2021, for purposes 
     of this section, such term does not include a health care 
     provider included in any type of health care provider 
     determined by the Secretary to be exempt from application of 
     this section under clause (ii).
       ``(ii) Exceptions process.--Not later than October 1, 2020, 
     the Secretary, after consultation with the National 
     Association of Medicaid Directors, national health care 
     provider associations, Medicaid beneficiary advocates, and 
     advocates for individuals with rare diseases, shall 
     determine, based on such consultations, the types of health 
     care providers (if any) that should be exempted from the 
     definition of the term `covered provider' for purposes of 
     this section.''.
       (b) Guidance.--Not later than October 1, 2019, the 
     Administrator of the Centers for Medicare & Medicaid 
     Services, in consultation with the Director of the Centers 
     for Disease Control and Prevention, shall issue guidance on 
     best practices on the uses of prescription drug monitoring 
     programs required of prescribers and on protecting the 
     privacy of Medicaid beneficiary information maintained in and 
     accessed through prescription drug monitoring programs.
       (c) Development of Model State Practices.--
       (1) In general.--Not later than October 1, 2020, the 
     Secretary of Health and Human Services shall develop and 
     publish model practices to assist State Medicaid program 
     operations in identifying and implementing strategies to 
     utilize data-sharing agreements described in the matter 
     following paragraph (2) of section 1944(b) of the Social 
     Security Act, as added by subsection (a), for the following 
     purposes:
       (A) Monitoring and preventing fraud, waste, and abuse.
       (B) Improving health care for individuals enrolled in a 
     State plan under title XIX of such Act (or under a waiver of 
     such plan) who--
       (i) transition in and out of coverage under such title;
       (ii) may have sources of health care coverage in addition 
     to coverage under such title; or
       (iii) pay for prescription drugs with cash.
       (C) Any other purposes specified by the Secretary.
       (2) Elements of model practices.--The model practices 
     described in paragraph (1)--
       (A) shall include strategies for assisting States in 
     allowing the medical director or pharmacy director (or 
     designees of such a director) of managed care organizations 
     or pharmaceutical benefit managers to access information with 
     respect to all covered individuals served by such managed 
     care organizations or pharmaceutical benefit managers to 
     access as a single data set, in an electronic format; and
       (B) shall include any appropriate beneficiary protections 
     and privacy guidelines.
       (3) Consultation.--In developing model practices under this 
     subsection, the Secretary shall consult with the National 
     Association of Medicaid Directors, managed care entities (as 
     defined in section 1932(a)(1)(B) of the Social Security Act) 
     with contracts with States pursuant to section 1903(m) of 
     such Act, pharmaceutical benefit managers, physicians and 
     other health care providers, beneficiary advocates, and 
     individuals with expertise in health care technology related 
     to prescription drug monitoring programs and electronic 
     health records.
       (d) Report by Comptroller General.--Not later than October 
     1, 2020, the Comptroller General of the United States shall 
     issue a report examining the operation of prescription drug 
     monitoring programs administered by States, including data 
     security and access standards used by such programs.

                        Subtitle F--IMD CARE Act

     SEC. 5051. SHORT TITLE.

       This title may be cited as the ``Individuals in Medicaid 
     Deserve Care that is Appropriate and Responsible in its 
     Execution Act'' or the ``IMD CARE Act''.

     SEC. 5052. STATE OPTION TO PROVIDE MEDICAID COVERAGE FOR 
                   CERTAIN INDIVIDUALS WITH SUBSTANCE USE 
                   DISORDERS WHO ARE PATIENTS IN CERTAIN 
                   INSTITUTIONS FOR MENTAL DISEASES.

       (a) In General.--Title XIX of the Social Security Act (42 
     U.S.C. 1396 et seq.), as amended by preceding sections of 
     this Act, is further amended--
       (1) in section 1905(a), in the subdivision (B) that follows 
     paragraph (30), by inserting ``(except in the case of 
     services provided under a State plan amendment described in 
     section 1915(l))'' before the period; and
       (2) in section 1915, by adding at the end the following new 
     subsection:
       ``(l) State Plan Amendment Option to Provide Medical 
     Assistance for Certain Individuals Who Are Patients in 
     Certain Institutions for Mental Diseases.--
       ``(1) In general.--With respect to calendar quarters 
     beginning during the period beginning October 1, 2019, and 
     ending September 30, 2023, a State may elect, through a State 
     plan amendment, to provide medical assistance for items and 
     services furnished to an eligible individual who is a patient 
     in an eligible institution for mental diseases in accordance 
     with the requirements of this subsection.
       ``(2) Payments.--Subject to paragraphs (3) and (4), amounts 
     expended under a State plan amendment under paragraph (1) for 
     services described in such paragraph furnished, with respect 
     to a 12-month period, to an eligible individual who is a 
     patient in an eligible institution for mental diseases shall 
     be treated as medical assistance for which payment is made 
     under section 1903(a) but only to the extent that such 
     services are furnished for not more than a period of 30 days 
     (whether or not consecutive) during such 12-month period.
       ``(3) Maintenance of effort.--
       ``(A) In general.--As a condition for a State receiving 
     payments under section 1903(a) for medical assistance 
     provided in accordance with this subsection, the State shall 
     (during the period in which it so furnished such medical 
     assistance through a State plan amendment under this 
     subsection) maintain on an annual basis a level of funding 
     expended by the State (and political subdivisions thereof) 
     other than under this title from non-Federal funds for--
       ``(i) items and services furnished to eligible individuals 
     who are patients in eligible institutions for mental diseases 
     that is not less than the level of such funding for such 
     items and services for the most recently ended fiscal year as 
     of the date of enactment of this subsection or, if higher, 
     for the most recently ended fiscal year as of the date the 
     State submits a State plan amendment to the Secretary to 
     provide such medical assistance in accordance with this 
     subsection; and
       ``(ii) items and services (including services described in 
     subparagraph (B)) furnished to eligible individuals in 
     outpatient and community-based settings that is not less than 
     the level of such funding for such items and services for the 
     most recently ended fiscal year as of the date of enactment 
     of this subsection or, if higher, for the most recently ended 
     fiscal year as of the date the State submits a State plan 
     amendment to the Secretary to provide such medical assistance 
     in accordance with this subsection.
       ``(B) Services described.--For purposes of subparagraph 
     (A)(ii), services described in this subparagraph are the 
     following:
       ``(i) Outpatient and community-based substance use disorder 
     treatment.
       ``(ii) Evidence-based recovery and support services.
       ``(iii) Clinically-directed therapeutic treatment to 
     facilitate recovery skills, relapse prevention, and emotional 
     coping strategies.
       ``(iv) Outpatient medication-assisted treatment, related 
     therapies, and pharmacology.
       ``(v) Counseling and clinical monitoring.
       ``(vi) Outpatient withdrawal management and related 
     treatment designed to alleviate acute emotional, behavioral, 
     cognitive, or biomedical distress resulting from, or 
     occurring with, an individual's use of alcohol and other 
     drugs.
       ``(vii) Routine monitoring of medication adherence.
       ``(viii) Other outpatient and community-based services for 
     the treatment of substance

[[Page H9197]]

     use disorders, as designated by the Secretary.
       ``(C) State reporting requirement.--
       ``(i) In general.--Prior to approval of a State plan 
     amendment under this subsection, as a condition for a State 
     receiving payments under section 1903(a) for medical 
     assistance provided in accordance with this subsection, the 
     State shall report to the Secretary, in accordance with the 
     process established by the Secretary under clause (ii), the 
     information deemed necessary by the Secretary under such 
     clause.
       ``(ii) Process.--Not later than the date that is 8 months 
     after the date of enactment of this subsection, the Secretary 
     shall establish a process for States to report to the 
     Secretary, at such time and in such manner as the Secretary 
     deems appropriate, such information as the Secretary deems 
     necessary to verify a State's compliance with subparagraph 
     (A).
       ``(4) Ensuring a continuum of services.--
       ``(A) In general.--As a condition for a State receiving 
     payments under section 1903(a) for medical assistance 
     provided in accordance with this subsection, the State shall 
     carry out each of the requirements described in subparagraphs 
     (B) through (D).
       ``(B) Notification.--Prior to approval of a State plan 
     amendment under this subsection, the State shall notify the 
     Secretary of how the State will ensure that eligible 
     individuals receive appropriate evidence-based clinical 
     screening prior to being furnished with items and services in 
     an eligible institution for mental diseases, including 
     initial and periodic assessments to determine the appropriate 
     level of care, length of stay, and setting for such care for 
     each individual.
       ``(C) Outpatient services; inpatient and residential 
     services.--
       ``(i) Outpatient services.--The State shall, at a minimum, 
     provide medical assistance for services that could otherwise 
     be covered under the State plan, consistent with each of the 
     following outpatient levels of care:

       ``(I) Early intervention for individuals who, for a known 
     reason, are at risk of developing substance-related problems 
     and for individuals for whom there is not yet sufficient 
     information to document a diagnosable substance use disorder.
       ``(II) Outpatient services for less than 9 hours per week 
     for adults, and for less than 6 hours per week for 
     adolescents, for recovery or motivational enhancement 
     therapies and strategies.
       ``(III) Intensive outpatient services for 9 hours or more 
     per week for adults, and for 6 hours or more per week for 
     adolescents, to treat multidimensional instability.
       ``(IV) Partial hospitalization services for 20 hours or 
     more per week for adults and adolescents to treat 
     multidimensional instability that does not require 24-hour 
     care.

       ``(ii) Inpatient and residential services.--The State shall 
     provide medical assistance for services that could otherwise 
     be covered under the State plan, consistent with at least 2 
     of the following inpatient and residential levels of care:

       ``(I) Clinically managed, low-intensity residential 
     services that provide adults and adolescents with 24-hour 
     living support and structure with trained personnel and at 
     least 5 hours of clinical service per week per individual.
       ``(II) Clinically managed, population-specific, high-
     intensity residential services that provide adults with 24-
     hour care with trained counselors to stabilize 
     multidimensional imminent danger along with less intense 
     milieu and group treatment for those with cognitive or other 
     impairments unable to use full active milieu or therapeutic 
     community.
       ``(III) Clinically managed, medium-intensity residential 
     services for adolescents, and clinically managed, high-
     intensity residential services for adults, that provide 24-
     hour care with trained counselors to stabilize 
     multidimensional imminent danger and preparation for 
     outpatient treatment.
       ``(IV) Medically monitored, high-intensity inpatient 
     services for adolescents, and medically monitored, intensive 
     inpatient services withdrawal management for adults, that 
     provide 24-hour nursing care, make physicians available for 
     significant problems in Dimensions 1, 2, or 3, and provide 
     counseling services 16 hours per day.
       ``(V) Medically managed, intensive inpatient services for 
     adolescents and adults that provide 24-hour nursing care and 
     daily physician care for severe, unstable problems in 
     Dimensions 1, 2 or 3.

       ``(D) Transition of care.--In order to ensure an 
     appropriate transition for an eligible individual from 
     receiving care in an eligible institution for mental diseases 
     to receiving care at a lower level of clinical intensity 
     within the continuum of care (including outpatient services), 
     the State shall ensure that--
       ``(i) a placement in such eligible institution for mental 
     diseases would allow for an eligible individual's successful 
     transition to the community, considering such factors as 
     proximity to an individual's support network (such as family 
     members, employment, and counseling and other services near 
     an individual's residence); and
       ``(ii) all eligible institutions for mental diseases that 
     furnish items and services to individuals for which medical 
     assistance is provided under the State plan--

       ``(I) are able to provide care at such lower level of 
     clinical intensity; or
       ``(II) have an established relationship with another 
     facility or provider that is able to provide care at such 
     lower level of clinical intensity and accepts patients 
     receiving medical assistance under this title under which the 
     eligible institution for mental diseases may arrange for 
     individuals to receive such care from such other facility or 
     provider.

       ``(5) Application to managed care.--Payments for, and 
     limitations to, medical assistance furnished in accordance 
     with this subsection shall be in addition to and shall not be 
     construed to limit or supersede the ability of States to make 
     monthly capitation payments to managed care organizations for 
     individuals receiving treatment in institutions for mental 
     diseases in accordance with section 438.6(e) of title 42, 
     Code of Federal Regulations (or any successor regulation).
       ``(6) Other medical assistance.--The provision of medical 
     assistance for items and services furnished to an eligible 
     individual who is a patient in an eligible institution for 
     mental diseases in accordance with the requirements of this 
     subsection shall not prohibit Federal financial participation 
     for medical assistance for items or services that are 
     provided to such eligible individual in or away from the 
     eligible institution for mental disease during any period in 
     which the eligible individual is receiving items or services 
     in accordance with this subsection.
       ``(7) Definitions.--In this subsection:
       ``(A) Dimensions 1, 2, or 3.--The term `Dimensions 1, 2, or 
     3' has the meaning given that term for purposes of the 
     publication of the American Society of Addiction Medicine 
     entitled `The ASAM Criteria: Treatment Criteria for Addictive 
     Substance-Related, and Co-Occurring Conditions, 2013'.
       ``(B) Eligible individual.--The term `eligible individual' 
     means an individual who--
       ``(i) with respect to a State, is enrolled for medical 
     assistance under the State plan or a waiver of such plan;
       ``(ii) is at least 21 years of age;
       ``(iii) has not attained 65 years of age; and
       ``(iv) has at least 1 substance use disorder.
       ``(C) Eligible institution for mental diseases.--The term 
     `eligible institution for mental diseases' means an 
     institution for mental diseases that--
       ``(i) follows reliable, evidence-based practices; and
       ``(ii) offers at least 2 forms of medication-assisted 
     treatment for substance use disorders on site, including, in 
     the case of medication-assisted treatment for opioid use 
     disorder, at least 1 antagonist and 1 partial agonist.
       ``(D) Institution for mental diseases.--The term 
     `institution for mental diseases' has the meaning given that 
     term in section 1905(i).''.
       (b) Rule of Construction.--Nothing in the amendments made 
     by subsection (a) shall be construed as encouraging a State 
     to place an individual in an inpatient or a residential care 
     setting where a home or community-based care setting would be 
     more appropriate for the individual, or as preventing a State 
     from conducting or pursuing a demonstration project under 
     section 1115 of the Social Security Act to improve access to, 
     and the quality of, substance use disorder treatment for 
     eligible populations.

                 Subtitle G--Medicaid Improvement Fund

     SEC. 5061. MEDICAID IMPROVEMENT FUND.

       Section 1941(b)(1) of the Social Security Act (42 U.S.C. 
     1396w-1(b)(1)) is amended by striking ``$0'' and inserting 
     ``$31,000,000''.

                  TITLE VI--OTHER MEDICARE PROVISIONS

    Subtitle A--Testing of Incentive Payments for Behavioral Health 
 Providers for Adoption and Use of Certified Electronic Health Record 
                               Technology

     SEC. 6001. TESTING OF INCENTIVE PAYMENTS FOR BEHAVIORAL 
                   HEALTH PROVIDERS FOR ADOPTION AND USE OF 
                   CERTIFIED ELECTRONIC HEALTH RECORD TECHNOLOGY.

       Section 1115A(b)(2)(B) of the Social Security Act (42 
     U.S.C. 1315a(b)(2)(B)) is amended by adding at the end the 
     following new clause:
       ``(xxv) Providing, for the adoption and use of certified 
     EHR technology (as defined in section 1848(o)(4)) to improve 
     the quality and coordination of care through the electronic 
     documentation and exchange of health information, incentive 
     payments to behavioral health providers (such as psychiatric 
     hospitals (as defined in section 1861(f)), community mental 
     health centers (as defined in section 1861(ff)(3)(B)), 
     hospitals that participate in a State plan under title XIX or 
     a waiver of such plan, treatment facilities that participate 
     in such a State plan or such a waiver, mental health or 
     substance use disorder providers that participate in such a 
     State plan or such a waiver, clinical psychologists (as 
     defined in section 1861(ii)), nurse practitioners (as defined 
     in section 1861(aa)(5)) with respect to the provision of 
     psychiatric services, and clinical social workers (as defined 
     in section 1861(hh)(1))).''.

                   Subtitle B--Abuse Deterrent Access

     SEC. 6011. SHORT TITLE.

       This subtitle may be cited at the ``Abuse Deterrent Access 
     Act of 2018''.

     SEC. 6012. STUDY ON ABUSE-DETERRENT OPIOID FORMULATIONS 
                   ACCESS BARRIERS UNDER MEDICARE.

       (a) In General.--Not later than 1 year after the date of 
     the enactment of this Act, the Secretary of Health and Human 
     Services shall conduct a study and submit to Congress a 
     report on--
       (1) the adequacy of access to abuse-deterrent opioid 
     formulations for individuals with chronic pain enrolled in an 
     MA-PD plan

[[Page H9198]]

     under part C of title XVIII of the Social Security Act or a 
     prescription drug plan under part D of such title of such 
     Act, taking into account any barriers preventing such 
     individuals from accessing such formulations under such MA-PD 
     or part D plans, such as cost-sharing tiers, fail-first 
     requirements, the price of such formulations, and prior 
     authorization requirements; and
       (2) the effectiveness of abuse-deterrent opioid 
     formulations in preventing opioid abuse or misuse; the impact 
     of the use of abuse-deterrent opioid formulations on the use 
     or abuse of other prescription or illicit opioids (including 
     changes in deaths from such opioids); and other public health 
     consequences of the use of abuse-deterrent opioid 
     formulations, such as an increase in rates of human 
     immunodeficiency virus.
       (b) Definition of Abuse-Deterrent Opioid Formulation.--In 
     this section, the term ``abuse-deterrent opioid formulation'' 
     means an opioid that is a prodrug or that has certain abuse-
     deterrent properties, such as physical or chemical barriers, 
     agonist or antagonist combinations, aversion properties, 
     delivery system mechanisms, or other features designed to 
     prevent abuse of such opioid.

              Subtitle C--Medicare Opioid Safety Education

     SEC. 6021. MEDICARE OPIOID SAFETY EDUCATION.

       (a) In General.--Section 1804 of the Social Security Act 
     (42 U.S.C. 1395b-2) is amended by adding at the end the 
     following new subsection:
       ``(d) The notice provided under subsection (a) shall 
     include--
       ``(1) references to educational resources regarding opioid 
     use and pain management;
       ``(2) a description of categories of alternative, non-
     opioid pain management treatments covered under this title; 
     and
       ``(3) a suggestion for the beneficiary to talk to a 
     physician regarding opioid use and pain management.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to notices distributed prior to each Medicare 
     open enrollment period beginning after January 1, 2019.

                Subtitle D--Opioid Addiction Action Plan

     SEC. 6031. SHORT TITLE.

       This subtitle may be cited as the ``Opioid Addiction Action 
     Plan Act''.

     SEC. 6032. ACTION PLAN ON RECOMMENDATIONS FOR CHANGES UNDER 
                   MEDICARE AND MEDICAID TO PREVENT OPIOIDS 
                   ADDICTIONS AND ENHANCE ACCESS TO MEDICATION-
                   ASSISTED TREATMENT.

       (a) In General.--Not later than January 1, 2020, the 
     Secretary of Health and Human Services (in this section 
     referred to as the ``Secretary''), in collaboration with the 
     Pain Management Best Practices Inter-Agency Task Force 
     convened under section 101(b) of the Comprehensive Addiction 
     and Recovery Act of 2016 (Public Law 114-198), shall develop 
     an action plan as described in subsection (b).
       (b) Action Plan Components.--The action plan shall include 
     a review by the Secretary of Medicare and Medicaid payment 
     and coverage policies that may be viewed as potential 
     obstacles to an effective response to the opioid crisis, and 
     recommendations, as determined appropriate by the Secretary, 
     on the following:
       (1) A review of payment and coverage policies under the 
     Medicare program under title XVIII of the Social Security Act 
     and the Medicaid program under title XIX of such Act, 
     including a review of coverage and payment under such 
     programs of all medication-assisted treatment approved by the 
     Food and Drug Administration related to the treatment of 
     opioid use disorder and other therapies that manage chronic 
     and acute pain and treat and minimize risk of opioid misuse 
     and abuse, including in such review, payment under the 
     Medicare prospective payment system for inpatient hospital 
     services under section 1886(d) of such Act (42 U.S.C. 
     1395ww(d)) and the Medicare prospective payment system for 
     hospital outpatient department services under section 1833(t) 
     of such Act (42 U.S.C. 1395I(t)), to determine whether those 
     payment policies resulted in incentives or disincentives that 
     have contributed to the opioid crisis.
       (2) Recommendations for payment and service delivery models 
     to be tested as appropriate by the Center for Medicare and 
     Medicaid Innovation and other federally authorized 
     demonstration projects, including value-based models, that 
     may encourage the use of appropriate medication-assisted 
     treatment approved by the Food and Drug Administration for 
     the treatment of opioid use disorder and other therapies that 
     manage chronic and acute pain and treat and minimize risk of 
     opioid misuse and abuse.
       (3) Recommendations for data collection that could 
     facilitate research and policy-making regarding prevention of 
     opioid use disorder as well as data that would aid the 
     Secretary in making coverage and payment decisions under the 
     Medicare and Medicaid programs related to the access to 
     appropriate opioid dependence treatments.
       (4) A review of Medicare and Medicaid beneficiaries' access 
     to the full range of medication-assisted treatment approved 
     by the Food and Drug Administration for the treatment of 
     opioid use disorder and other therapies that manage chronic 
     and acute pain and treat and minimize risk of opioid misuse 
     and abuse, including access of beneficiaries residing in 
     rural or medically underserved communities.
       (5) A review of payment and coverage policies under the 
     Medicare program and the Medicaid program related to medical 
     devices that are non-opioid based treatments approved by the 
     Food and Drug Administration for the management of acute pain 
     and chronic pain, for monitoring substance use withdrawal and 
     preventing overdoses of controlled substances, and for 
     treating substance use disorder, including barriers to 
     patient access.
       (c) Stakeholder Meetings.--
       (1) In general.--Beginning not later than 3 months after 
     the date of the enactment of this section, the Secretary 
     shall convene a public stakeholder meeting to solicit public 
     comment on the components of the action plan described in 
     subsection (b).
       (2) Participants.--Participants of meetings described in 
     paragraph (1) shall include representatives from the Food and 
     Drug Administration and National Institutes of Health, 
     biopharmaceutical industry members, medical researchers, 
     health care providers, the medical device industry, the 
     Medicare program, the Medicaid program, and patient 
     advocates.
       (d) Request for Information.--Not later than 3 months after 
     the date of the enactment of this section, the Secretary 
     shall issue a request for information seeking public feedback 
     regarding ways in which the Centers for Medicare & Medicaid 
     Services can help address the opioid crisis through the 
     development of and application of the action plan.
       (e) Report to Congress.--Not later than June 1, 2020, the 
     Secretary shall submit to Congress, and make public, a report 
     that includes--
       (1) a summary of the results of the Secretary's review and 
     any recommendations under the action plan;
       (2) the Secretary's planned next steps with respect to the 
     action plan; and
       (3) an evaluation of price trends for drugs used to reverse 
     opioid overdoses (such as naloxone), including 
     recommendations on ways to lower such prices for consumers.
       (f) Definition of Medication-Assisted Treatment.--In this 
     section, the term ``medication-assisted treatment'' includes 
     opioid treatment programs, behavioral therapy, and 
     medications to treat substance abuse disorder.

 Subtitle E--Advancing High Quality Treatment for Opioid Use Disorders 
                              in Medicare

     SEC. 6041. SHORT TITLE.

       This subtitle may be cited as the ``Advancing High Quality 
     Treatment for Opioid Use Disorders in Medicare Act''.

     SEC. 6042. OPIOID USE DISORDER TREATMENT DEMONSTRATION 
                   PROGRAM.

       Title XVIII of the Social Security Act (42 U.S.C. 1395 et 
     seq.) is amended by inserting after section 1866E (42 U.S.C. 
     1395cc-5) the following new section:

     ``SEC. 1866F. OPIOID USE DISORDER TREATMENT DEMONSTRATION 
                   PROGRAM.

       ``(a) Implementation of 4-Year Demonstration Program.--
       ``(1) In general.--Not later than January 1, 2021, the 
     Secretary shall implement a 4-year demonstration program 
     under this title (in this section referred to as the 
     `Program') to increase access of applicable beneficiaries to 
     opioid use disorder treatment services, improve physical and 
     mental health outcomes for such beneficiaries, and to the 
     extent possible, reduce expenditures under this title. Under 
     the Program, the Secretary shall make payments under 
     subsection (e) to participants (as defined in subsection 
     (c)(1)(A)) for furnishing opioid use disorder treatment 
     services delivered through opioid use disorder care teams, or 
     arranging for such services to be furnished, to applicable 
     beneficiaries participating in the Program.
       ``(2) Opioid use disorder treatment services.--For purposes 
     of this section, the term `opioid use disorder treatment 
     services'--
       ``(A) means, with respect to an applicable beneficiary, 
     services that are furnished for the treatment of opioid use 
     disorders and that utilize drugs approved under section 505 
     of the Federal Food, Drug, and Cosmetic Act for the treatment 
     of opioid use disorders in an outpatient setting; and
       ``(B) includes--
       ``(i) medication-assisted treatment;
       ``(ii) treatment planning;
       ``(iii) psychiatric, psychological, or counseling services 
     (or any combination of such services), as appropriate;
       ``(iv) social support services, as appropriate; and
       ``(v) care management and care coordination services, 
     including coordination with other providers of services and 
     suppliers not on an opioid use disorder care team.
       ``(b) Program Design.--
       ``(1) In general.--The Secretary shall design the Program 
     in such a manner to allow for the evaluation of the extent to 
     which the Program accomplishes the following purposes:
       ``(A) Reduces hospitalizations and emergency department 
     visits.
       ``(B) Increases use of medication-assisted treatment for 
     opioid use disorders.
       ``(C) Improves health outcomes of individuals with opioid 
     use disorders, including by reducing the incidence of 
     infectious diseases (such as hepatitis C and HIV).
       ``(D) Does not increase the total spending on items and 
     services under this title.
       ``(E) Reduces deaths from opioid overdose.
       ``(F) Reduces the utilization of inpatient residential 
     treatment.

[[Page H9199]]

       ``(2) Consultation.--In designing the Program, including 
     the criteria under subsection (e)(2)(A), the Secretary shall, 
     not later than 3 months after the date of the enactment of 
     this section, consult with specialists in the field of 
     addiction, clinicians in the primary care community, and 
     beneficiary groups.
       ``(c) Participants; Opioid Use Disorder Care Teams.--
       ``(1) Participants.--
       ``(A) Definition.--In this section, the term `participant' 
     means an entity or individual--
       ``(i) that is otherwise enrolled under this title and that 
     is--

       ``(I) a physician (as defined in section 1861(r)(1));
       ``(II) a group practice comprised of at least one physician 
     described in subclause (I);
       ``(III) a hospital outpatient department;
       ``(IV) a federally qualified health center (as defined in 
     section 1861(aa)(4));
       ``(V) a rural health clinic (as defined in section 
     1861(aa)(2));
       ``(VI) a community mental health center (as defined in 
     section 1861(ff)(3)(B));
       ``(VII) a clinic certified as a certified community 
     behavioral health clinic pursuant to section 223 of the 
     Protecting Access to Medicare Act of 2014; or
       ``(VIII) any other individual or entity specified by the 
     Secretary;

       ``(ii) that applied for and was selected to participate in 
     the Program pursuant to an application and selection process 
     established by the Secretary; and
       ``(iii) that establishes an opioid use disorder care team 
     (as defined in paragraph (2)) through employing or 
     contracting with health care practitioners described in 
     paragraph (2)(A), and uses such team to furnish or arrange 
     for opioid use disorder treatment services in the outpatient 
     setting under the Program.
       ``(B) Preference.--In selecting participants for the 
     Program, the Secretary shall give preference to individuals 
     and entities that are located in areas with a prevalence of 
     opioid use disorders that is higher than the national average 
     prevalence.
       ``(2) Opioid use disorder care teams.--
       ``(A) In general.--For purposes of this section, the term 
     `opioid use disorder care team' means a team of health care 
     practitioners established by a participant described in 
     paragraph (1)(A) that--
       ``(i) shall include--

       ``(I) at least one physician (as defined in section 
     1861(r)(1)) furnishing primary care services or addiction 
     treatment services to an applicable beneficiary; and
       ``(II) at least one eligible practitioner (as defined in 
     paragraph (3)), who may be a physician who meets the 
     criterion in subclause (I); and

       ``(ii) may include other practitioners licensed under State 
     law to furnish psychiatric, psychological, counseling, and 
     social services to applicable beneficiaries.
       ``(B) Requirements for receipt of payment under program.--
     In order to receive payments under subsection (e), each 
     participant in the Program shall--
       ``(i) furnish opioid use disorder treatment services 
     through opioid use disorder care teams to applicable 
     beneficiaries who agree to receive the services;
       ``(ii) meet minimum criteria, as established by the 
     Secretary; and
       ``(iii) submit to the Secretary, in such form, manner, and 
     frequency as specified by the Secretary, with respect to each 
     applicable beneficiary for whom opioid use disorder treatment 
     services are furnished by the opioid use disorder care team, 
     data and such other information as the Secretary determines 
     appropriate to--

       ``(I) monitor and evaluate the Program;
       ``(II) determine if minimum criteria are met under clause 
     (ii); and
       ``(III) determine the incentive payment under subsection 
     (e).

       ``(3) Eligible practitioner defined.--For purposes of this 
     section, the term `eligible practitioner' means a physician 
     or other health care practitioner, such as a nurse 
     practitioner, that--
       ``(A) is enrolled under section 1866(j)(1);
       ``(B) is authorized to prescribe or dispense narcotic drugs 
     to individuals for maintenance treatment or detoxification 
     treatment; and
       ``(C) has in effect a waiver in accordance with section 
     303(g) of the Controlled Substances Act for such purpose and 
     is otherwise in compliance with regulations promulgated by 
     the Substance Abuse and Mental Health Services Administration 
     to carry out such section.
       ``(d) Participation of Applicable Beneficiaries.--
       ``(1) Applicable beneficiary defined.--In this section, the 
     term `applicable beneficiary' means an individual who--
       ``(A) is entitled to, or enrolled for, benefits under part 
     A and enrolled for benefits under part B;
       ``(B) is not enrolled in a Medicare Advantage plan under 
     part C;
       ``(C) has a current diagnosis for an opioid use disorder; 
     and
       ``(D) meets such other criteria as the Secretary determines 
     appropriate.

     Such term shall include an individual who is dually eligible 
     for benefits under this title and title XIX if such 
     individual satisfies the criteria described in subparagraphs 
     (A) through (D).
       ``(2) Voluntary beneficiary participation; limitation on 
     number of beneficiaries.--An applicable beneficiary may 
     participate in the Program on a voluntary basis and may 
     terminate participation in the Program at any time. Not more 
     than 20,000 applicable beneficiaries may participate in the 
     Program at any time.
       ``(3) Services.--In order to participate in the Program, an 
     applicable beneficiary shall agree to receive opioid use 
     disorder treatment services from a participant. Participation 
     under the Program shall not affect coverage of or payment for 
     any other item or service under this title for the applicable 
     beneficiary.
       ``(4) Beneficiary access to services.--Nothing in this 
     section shall be construed as encouraging providers to limit 
     applicable beneficiary access to services covered under this 
     title, and applicable beneficiaries shall not be required to 
     relinquish access to any benefit under this title as a 
     condition of receiving services from a participant in the 
     Program.
       ``(e) Payments.--
       ``(1) Per applicable beneficiary per month care management 
     fee.--
       ``(A) In general.--The Secretary shall establish a schedule 
     of per applicable beneficiary per month care management fees. 
     Such a per applicable beneficiary per month care management 
     fee shall be paid to a participant in addition to any other 
     amount otherwise payable under this title to the health care 
     practitioners in the participant's opioid use disorder care 
     team or, if applicable, to the participant. A participant may 
     use such per applicable beneficiary per month care management 
     fee to deliver additional services to applicable 
     beneficiaries, including services not otherwise eligible for 
     payment under this title.
       ``(B) Payment amounts.--In carrying out subparagraph (A), 
     the Secretary may--
       ``(i) consider payments otherwise payable under this title 
     for opioid use disorder treatment services and the needs of 
     applicable beneficiaries;
       ``(ii) pay a higher per applicable beneficiary per month 
     care management fee for an applicable beneficiary who 
     receives more intensive treatment services from a participant 
     and for whom those services are appropriate based on clinical 
     guidelines for opioid use disorder care;
       ``(iii) pay a higher per applicable beneficiary per month 
     care management fee for the month in which the applicable 
     beneficiary begins treatment with a participant than in 
     subsequent months, to reflect the greater time and costs 
     required for the planning and initiation of treatment, as 
     compared to maintenance of treatment; and
       ``(iv) take into account whether a participant's opioid use 
     disorder care team refers applicable beneficiaries to other 
     suppliers or providers for any opioid use disorder treatment 
     services.
       ``(C) No duplicate payment.--The Secretary shall make 
     payments under this paragraph to only one participant for 
     services furnished to an applicable beneficiary during a 
     calendar month.
       ``(2) Incentive payments.--
       ``(A) In general.--Under the Program, the Secretary shall 
     establish a performance-based incentive payment, which shall 
     be paid (using a methodology established and at a time 
     determined appropriate by the Secretary) to participants 
     based on the performance of participants with respect to 
     criteria, as determined appropriate by the Secretary, in 
     accordance with subparagraph (B).
       ``(B) Criteria.--
       ``(i) In general.--Criteria described in subparagraph (A) 
     may include consideration of the following:

       ``(I) Patient engagement and retention in treatment.
       ``(II) Evidence-based medication-assisted treatment.
       ``(III) Other criteria established by the Secretary.

       ``(ii) Required consultation and consideration.--In 
     determining criteria described in subparagraph (A), the 
     Secretary shall--

       ``(I) consult with stakeholders, including clinicians in 
     the primary care community and in the field of addiction 
     medicine; and
       ``(II) consider existing clinical guidelines for the 
     treatment of opioid use disorders.

       ``(C) No duplicate payment.--The Secretary shall ensure 
     that no duplicate payments under this paragraph are made with 
     respect to an applicable beneficiary.
       ``(f) Multipayer Strategy.--In carrying out the Program, 
     the Secretary shall encourage other payers to provide similar 
     payments and to use similar criteria as applied under the 
     Program under subsection (e)(2)(C). The Secretary may enter 
     into a memorandum of understanding with other payers to align 
     the methodology for payment provided by such a payer related 
     to opioid use disorder treatment services with such 
     methodology for payment under the Program.
       ``(g) Evaluation.--
       ``(1) In general.--The Secretary shall conduct an 
     intermediate and final evaluation of the program. Each such 
     evaluation shall determine the extent to which each of the 
     purposes described in subsection (b) have been accomplished 
     under the Program.
       ``(2) Reports.--The Secretary shall submit to Congress--
       ``(A) a report with respect to the intermediate evaluation 
     under paragraph (1) not later than 3 years after the date of 
     the implementation of the Program; and
       ``(B) a report with respect to the final evaluation under 
     paragraph (1) not later than 6 years after such date.
       ``(h) Funding.--

[[Page H9200]]

       ``(1) Administrative funding.--For the purposes of 
     implementing, administering, and carrying out the Program 
     (other than for purposes described in paragraph (2)), 
     $5,000,000 shall be available from the Federal Supplementary 
     Medical Insurance Trust Fund under section 1841.
       ``(2) Care management fees and incentives.--For the 
     purposes of making payments under subsection (e), $10,000,000 
     shall be available from the Federal Supplementary Medical 
     Insurance Trust Fund under section 1841 for each of fiscal 
     years 2021 through 2024.
       ``(3) Availability.--Amounts transferred under this 
     subsection for a fiscal year shall be available until 
     expended.
       ``(i) Waivers.--The Secretary may waive any provision of 
     this title as may be necessary to carry out the Program under 
     this section.''.

 Subtitle F--Responsible Education Achieves Care and Healthy Outcomes 
                          for Users' Treatment

     SEC. 6051. SHORT TITLE.

       This subtitle may be cited as the ``Responsible Education 
     Achieves Care and Healthy Outcomes for Users' Treatment Act 
     of 2018'' or the ``REACH OUT Act of 2018''.

     SEC. 6052. GRANTS TO PROVIDE TECHNICAL ASSISTANCE TO OUTLIER 
                   PRESCRIBERS OF OPIOIDS.

       (a) Grants Authorized.--The Secretary of Health and Human 
     Services (in this section referred to as the ``Secretary'') 
     shall, through the Centers for Medicare & Medicaid Services, 
     award grants, contracts, or cooperative agreements to 
     eligible entities for the purposes described in subsection 
     (b).
       (b) Use of Funds.--Grants, contracts, and cooperative 
     agreements awarded under subsection (a) shall be used to 
     support eligible entities through technical assistance--
       (1) to educate and provide outreach to outlier prescribers 
     of opioids about best practices for prescribing opioids;
       (2) to educate and provide outreach to outlier prescribers 
     of opioids about non-opioid pain management therapies; and
       (3) to reduce the amount of opioid prescriptions prescribed 
     by outlier prescribers of opioids.
       (c) Application.--Each eligible entity seeking to receive a 
     grant, contract, or cooperative agreement under subsection 
     (a) shall submit to the Secretary an application, at such 
     time, in such manner, and containing such information as the 
     Secretary may require.
       (d) Geographic Distribution.--In awarding grants, 
     contracts, and cooperative agreements under this section, the 
     Secretary shall prioritize establishing technical assistance 
     resources in each State.
       (e) Definitions.--In this section:
       (1) Eligible entity.--The term ``eligible entity'' means--
       (A) an organization--
       (i) that has demonstrated experience providing technical 
     assistance to health care professionals on a State or 
     regional basis; and
       (ii) that has at least--

       (I) one individual who is a representative of consumers on 
     its governing body; and
       (II) one individual who is a representative of health care 
     providers on its governing body; or

       (B) an entity that is a quality improvement entity with a 
     contract under part B of title XI of the Social Security Act 
     (42 U.S.C. 1320c et seq.).
       (2) Outlier prescriber of opioids.--The term ``outlier 
     prescriber of opioids'' means, with respect to a period, a 
     prescriber identified by the Secretary under subparagraph 
     (D)(ii) of section 1860D-4(c)(4) of the Social Security Act 
     (42 U.S.C. 1395w-104(c)(4)), as added by section 6065 of this 
     Act, to be an outlier prescriber of opioids for such period.
       (3) Prescribers.--The term ``prescriber'' means any health 
     care professional, including a nurse practitioner or 
     physician assistant, who is licensed to prescribe opioids by 
     the State or territory in which such professional practices.
       (f) Funding.--For purposes of implementing this section, 
     $75,000,000 shall be available from the Federal Supplementary 
     Medical Insurance Trust Fund under section 1841 of the Social 
     Security Act (42 U.S.C. 1395t), to remain available until 
     expended.

        Subtitle G--Preventing Addiction for Susceptible Seniors

     SEC. 6061. SHORT TITLE.

       This subtitle may be cited as the ``Preventing Addiction 
     for Susceptible Seniors Act of 2018'' or the ``PASS Act of 
     2018''.

     SEC. 6062. ELECTRONIC PRIOR AUTHORIZATION FOR COVERED PART D 
                   DRUGS.

       Section 1860D-4(e)(2) of the Social Security Act (42 U.S.C. 
     1395w-104(e)(2)) is amended by adding at the end the 
     following new subparagraph:
       ``(E) Electronic prior authorization.--
       ``(i) In general.--Not later than January 1, 2021, the 
     program shall provide for the secure electronic transmission 
     of--

       ``(I) a prior authorization request from the prescribing 
     health care professional for coverage of a covered part D 
     drug for a part D eligible individual enrolled in a part D 
     plan (as defined in section 1860D-23(a)(5)) to the PDP 
     sponsor or Medicare Advantage organization offering such 
     plan; and
       ``(II) a response, in accordance with this subparagraph, 
     from such PDP sponsor or Medicare Advantage organization, 
     respectively, to such professional.

       ``(ii) Electronic transmission.--

       ``(I) Exclusions.--For purposes of this subparagraph, a 
     facsimile, a proprietary payer portal that does not meet 
     standards specified by the Secretary, or an electronic form 
     shall not be treated as an electronic transmission described 
     in clause (i).
       ``(II) Standards.--In order to be treated, for purposes of 
     this subparagraph, as an electronic transmission described in 
     clause (i), such transmission shall comply with technical 
     standards adopted by the Secretary in consultation with the 
     National Council for Prescription Drug Programs, other 
     standard setting organizations determined appropriate by the 
     Secretary, and stakeholders including PDP sponsors, Medicare 
     Advantage organizations, health care professionals, and 
     health information technology software vendors.
       ``(III) Application.--Notwithstanding any other provision 
     of law, for purposes of this subparagraph, the Secretary may 
     require the use of such standards adopted under subclause 
     (II) in lieu of any other applicable standards for an 
     electronic transmission described in clause (i) for a covered 
     part D drug for a part D eligible individual.''.

     SEC. 6063. PROGRAM INTEGRITY TRANSPARENCY MEASURES UNDER 
                   MEDICARE PARTS C AND D.

       (a) In General.--Section 1859 of the Social Security Act 
     (42 U.S.C. 1395w-28) is amended by adding at the end the 
     following new subsection:
       ``(i) Program Integrity Transparency Measures.--
       ``(1) Program integrity portal.--
       ``(A) In general.--Not later than 2 years after the date of 
     the enactment of this subsection, the Secretary shall, after 
     consultation with stakeholders, establish a secure internet 
     website portal (or other successor technology) that would 
     allow a secure path for communication between the Secretary, 
     MA plans under this part, prescription drug plans under part 
     D, and an eligible entity with a contract under section 1893 
     (such as a Medicare drug integrity contractor or an entity 
     responsible for carrying out program integrity activities 
     under this part and part D) for the purpose of enabling 
     through such portal (or other successor technology)--
       ``(i) the referral by such plans of substantiated or 
     suspicious activities, as defined by the Secretary, of a 
     provider of services (including a prescriber) or supplier 
     related to fraud, waste, and abuse for initiating or 
     assisting investigations conducted by the eligible entity; 
     and
       ``(ii) data sharing among such MA plans, prescription drug 
     plans, and the Secretary.
       ``(B) Required uses of portal.--The Secretary shall 
     disseminate the following information to MA plans under this 
     part and prescription drug plans under part D through the 
     secure internet website portal (or other successor 
     technology) established under subparagraph (A):
       ``(i) Providers of services and suppliers that have been 
     referred pursuant to subparagraph (A)(i) during the previous 
     12-month period.
       ``(ii) Providers of services and suppliers who are the 
     subject of an active exclusion under section 1128 or who are 
     subject to a suspension of payment under this title pursuant 
     to section 1862(o) or otherwise.
       ``(iii) Providers of services and suppliers who are the 
     subject of an active revocation of participation under this 
     title, including for not satisfying conditions of 
     participation.
       ``(iv) In the case of such a plan that makes a referral 
     under subparagraph (A)(i) through the portal (or other 
     successor technology) with respect to activities of 
     substantiated or suspicious activities of fraud, waste, or 
     abuse of a provider of services (including a prescriber) or 
     supplier, if such provider (including a prescriber) or 
     supplier has been the subject of an administrative action 
     under this title or title XI with respect to similar 
     activities, a notification to such plan of such action so 
     taken.
       ``(C) Rulemaking.--For purposes of this paragraph, the 
     Secretary shall, through rulemaking, specify what constitutes 
     substantiated or suspicious activities of fraud, waste, and 
     abuse, using guidance such as what is provided in the 
     Medicare Program Integrity Manual 4.8. In carrying out this 
     subsection, a fraud hotline tip (as defined by the Secretary) 
     without further evidence shall not be treated as sufficient 
     evidence for substantiated fraud, waste, or abuse.
       ``(D) HIPAA compliant information only.--For purposes of 
     this subsection, communications may only occur if the 
     communications are permitted under the Federal regulations 
     (concerning the privacy of individually identifiable health 
     information) promulgated under section 264(c) of the Health 
     Insurance Portability and Accountability Act of 1996.
       ``(2) Quarterly reports.--Beginning not later than 2 years 
     after the date of the enactment of this subsection, the 
     Secretary shall make available to MA plans under this part 
     and prescription drug plans under part D in a timely manner 
     (but no less frequently than quarterly) and using information 
     submitted to an entity described in paragraph (1) through the 
     portal (or other successor technology) described in such 
     paragraph or pursuant to section 1893, information on fraud, 
     waste, and abuse schemes and trends in identifying suspicious 
     activity. Information included in each such report shall--

[[Page H9201]]

       ``(A) include administrative actions, pertinent information 
     related to opioid overprescribing, and other data determined 
     appropriate by the Secretary in consultation with 
     stakeholders; and
       ``(B) be anonymized information submitted by plans without 
     identifying the source of such information.
       ``(3) Clarification.--Nothing in this subsection shall 
     preclude or otherwise affect referrals to the Inspector 
     General of the Department of Health and Human Services or 
     other law enforcement entities.''.
       (b) Contract Requirement to Communicate Plan Corrective 
     Actions Against Opioids Over-prescribers.--Section 1857(e) of 
     the Social Security Act (42 U.S.C. 1395w-27(e)) is amended by 
     adding at the end the following new paragraph:
       ``(5) Communicating plan corrective actions against opioids 
     over-prescribers.--
       ``(A) In general.--Beginning with plan years beginning on 
     or after January 1, 2021, a contract under this section with 
     an MA organization shall require the organization to submit 
     to the Secretary, through the process established under 
     subparagraph (B), information on the investigations, credible 
     evidence of suspicious activities of a provider of services 
     (including a prescriber) or supplier related to fraud, and 
     other actions taken by such plans related to inappropriate 
     prescribing of opioids.
       ``(B) Process.--Not later than January 1, 2021, the 
     Secretary shall, in consultation with stakeholders, establish 
     a process under which MA plans and prescription drug plans 
     shall submit to the Secretary information described in 
     subparagraph (A).
       ``(C) Regulations.--For purposes of this paragraph, 
     including as applied under section 1860D-12(b)(3)(D), the 
     Secretary shall, pursuant to rulemaking--
       ``(i) specify a definition for the term `inappropriate 
     prescribing' and a method for determining if a provider of 
     services prescribes inappropriate prescribing; and
       ``(ii) establish the process described in subparagraph (B) 
     and the types of information that shall be submitted through 
     such process.''.
       (c) Reference Under Part D to Program Integrity 
     Transparency Measures.--Section 1860D-4 of the Social 
     Security Act (42 U.S.C. 1395w-104) is amended by adding at 
     the end the following new subsection:
       ``(m) Program Integrity Transparency Measures.--For program 
     integrity transparency measures applied with respect to 
     prescription drug plan and MA plans, see section 1859(i).''.

     SEC. 6064. EXPANDING ELIGIBILITY FOR MEDICATION THERAPY 
                   MANAGEMENT PROGRAMS UNDER PART D.

       Section 1860D-4(c)(2)(A)(ii) of the Social Security Act (42 
     U.S.C. 1395w-104(c)(2)(A)(ii)) is amended--
       (1) by redesignating subclauses (I) through (III) as items 
     (aa) through (cc), respectively, and adjusting the margins 
     accordingly;
       (2) by striking ``are part D eligible individuals who--'' 
     and inserting ``are the following:

       ``(I) Part D eligible individuals who--''; and

       (3) by adding at the end the following new subclause:

       ``(II) Beginning January 1, 2021, at-risk beneficiaries for 
     prescription drug abuse (as defined in paragraph (5)(C)).''.

     SEC. 6065. COMMIT TO OPIOID MEDICAL PRESCRIBER ACCOUNTABILITY 
                   AND SAFETY FOR SENIORS.

       Section 1860D-4(c)(4) of the Social Security Act (42 U.S.C. 
     1395w-104(c)(4)) is amended by adding at the end the 
     following new subparagraph:
       ``(D) Notification and additional requirements with respect 
     to outlier prescribers of opioids.--
       ``(i) Notification.--Not later than January 1, 2021, the 
     Secretary shall, in the case of a prescriber identified by 
     the Secretary under clause (ii) to be an outlier prescriber 
     of opioids, provide, subject to clause (iv), an annual 
     notification to such prescriber that such prescriber has been 
     so identified and that includes resources on proper 
     prescribing methods and other information as specified in 
     accordance with clause (iii).
       ``(ii) Identification of outlier prescribers of opioids.--

       ``(I) In general.--The Secretary shall, subject to 
     subclause (III), using the valid prescriber National Provider 
     Identifiers included pursuant to subparagraph (A) on claims 
     for covered part D drugs for part D eligible individuals 
     enrolled in prescription drug plans under this part or MA-PD 
     plans under part C and based on the thresholds established 
     under subclause (II), identify prescribers that are outlier 
     opioids prescribers for a period of time specified by the 
     Secretary.
       ``(II) Establishment of thresholds.--For purposes of 
     subclause (I) and subject to subclause (III), the Secretary 
     shall, after consultation with stakeholders, establish 
     thresholds, based on prescriber specialty and geographic 
     area, for identifying whether a prescriber in a specialty and 
     geographic area is an outlier prescriber of opioids as 
     compared to other prescribers of opioids within such 
     specialty and area.
       ``(III) Exclusions.--The following shall not be included in 
     the analysis for identifying outlier prescribers of opioids 
     under this clause:

       ``(aa) Claims for covered part D drugs for part D eligible 
     individuals who are receiving hospice care under this title.
       ``(bb) Claims for covered part D drugs for part D eligible 
     individuals who are receiving oncology services under this 
     title.
       ``(cc) Prescribers who are the subject of an investigation 
     by the Centers for Medicare & Medicaid Services or the 
     Inspector General of the Department of Health and Human 
     Services.
       ``(iii) Contents of notification.--The Secretary shall 
     include the following information in the notifications 
     provided under clause (i):

       ``(I) Information on how such prescriber compares to other 
     prescribers within the same specialty and geographic area.
       ``(II) Information on opioid prescribing guidelines, based 
     on input from stakeholders, that may include the Centers for 
     Disease Control and Prevention guidelines for prescribing 
     opioids for chronic pain and guidelines developed by 
     physician organizations.
       ``(III) Other information determined appropriate by the 
     Secretary.

       ``(iv) Modifications and expansions.--

       ``(I) Frequency.--Beginning 5 years after the date of the 
     enactment of this subparagraph, the Secretary may change the 
     frequency of the notifications described in clause (i) based 
     on stakeholder input and changes in opioid prescribing 
     utilization and trends.
       ``(II) Expansion to other prescriptions.--The Secretary may 
     expand notifications under this subparagraph to include 
     identifications and notifications with respect to concurrent 
     prescriptions of covered Part D drugs used in combination 
     with opioids that are considered to have adverse side effects 
     when so used in such combination, as determined by the 
     Secretary.

       ``(v) Additional requirements for persistent outlier 
     prescribers.--In the case of a prescriber who the Secretary 
     determines is persistently identified under clause (ii) as an 
     outlier prescriber of opioids, the following shall apply:

       ``(I) Such prescriber may be required to enroll in the 
     program under this title under section 1866(j) if such 
     prescriber is not otherwise required to enroll, but only 
     after other appropriate remedies have been provided, such as 
     the provision of education funded through section 6052 of the 
     SUPPORT for Patients and Communities Act, for a period 
     determined by the Secretary as sufficient to correct the 
     prescribing patterns that lead to identification of such 
     prescriber as a persistent outlier prescriber of opioids. The 
     Secretary shall determine the length of the period for which 
     such prescriber is required to maintain such enrollment, 
     which shall be the minimum period necessary to correct such 
     prescribing patterns.
       ``(II) Not less frequently than annually (and in a form and 
     manner determined appropriate by the Secretary), the 
     Secretary, consistent with clause(iv)(I), shall communicate 
     information on such prescribers to sponsors of a prescription 
     drug plan and Medicare Advantage organizations offering an 
     MA-PD plan.

       ``(vi) Public availability of information.--The Secretary 
     shall make aggregate information under this subparagraph 
     available on the internet website of the Centers for Medicare 
     & Medicaid Services. Such information shall be in a form and 
     manner determined appropriate by the Secretary and shall not 
     identify any specific prescriber. In carrying out this 
     clause, the Secretary shall consult with interested 
     stakeholders.
       ``(vii) Opioids defined.--For purposes of this 
     subparagraph, the term `opioids' has such meaning as 
     specified by the Secretary.
       ``(viii) Other activities.--Nothing in this subparagraph 
     shall preclude the Secretary from conducting activities that 
     provide prescribers with information as to how they compare 
     to other prescribers that are in addition to the activities 
     under this subparagraph, including activities that were being 
     conducted as of the date of the enactment of this 
     subparagraph.''.

     SEC. 6066. NO ADDITIONAL FUNDS AUTHORIZED.

       No additional funds are authorized to be appropriated to 
     carry out the requirements of this subtitle and the 
     amendments made by this subtitle. Such requirements shall be 
     carried out using amounts otherwise authorized to be 
     appropriated.

   Subtitle H--Expanding Oversight of Opioid Prescribing and Payment

     SEC. 6071. SHORT TITLE.

       This subtitle may be cited as the ``Expanding Oversight of 
     Opioid Prescribing and Payment Act of 2018''.

     SEC. 6072. MEDICARE PAYMENT ADVISORY COMMISSION REPORT ON 
                   OPIOID PAYMENT, ADVERSE INCENTIVES, AND DATA 
                   UNDER THE MEDICARE PROGRAM.

       Not later than March 15, 2019, the Medicare Payment 
     Advisory Commission shall submit to Congress a report on, 
     with respect to the Medicare program under title XVIII of the 
     Social Security Act, the following:
       (1) A description of how the Medicare program pays for pain 
     management treatments (both opioid and non-opioid pain 
     management alternatives) in both inpatient and outpatient 
     hospital settings.
       (2) The identification of incentives under the hospital 
     inpatient prospective payment system under section 1886 of 
     the Social Security Act (42 U.S.C. 1395ww) and incentives 
     under the hospital outpatient prospective payment system 
     under section 1833(t) of such Act (42 U.S.C. 1395l(t)) for 
     prescribing opioids and incentives under each such system for 
     prescribing non-opioid treatments, and recommendations as the 
     Commission deems appropriate for addressing any of such 
     incentives that are adverse incentives.

[[Page H9202]]

       (3) A description of how opioid use is tracked and 
     monitored through Medicare claims data and other mechanisms 
     and the identification of any areas in which further data and 
     methods are needed for improving data and understanding of 
     opioid use.

     SEC. 6073. NO ADDITIONAL FUNDS AUTHORIZED.

       No additional funds are authorized to be appropriated to 
     carry out the requirements of this subtitle. Such 
     requirements shall be carried out using amounts otherwise 
     authorized to be appropriated.

  Subtitle I--Dr. Todd Graham Pain Management, Treatment, and Recovery

     SEC. 6081. SHORT TITLE.

       This subtitle may be cited as the ``Dr. Todd Graham Pain 
     Management, Treatment, and Recovery Act of 2018''.

     SEC. 6082. REVIEW AND ADJUSTMENT OF PAYMENTS UNDER THE 
                   MEDICARE OUTPATIENT PROSPECTIVE PAYMENT SYSTEM 
                   TO AVOID FINANCIAL INCENTIVES TO USE OPIOIDS 
                   INSTEAD OF NON-OPIOID ALTERNATIVE TREATMENTS.

       (a) Outpatient Prospective Payment System.--Section 1833(t) 
     of the Social Security Act (42 U.S.C. 1395l(t)) is amended by 
     adding at the end the following new paragraph:
       ``(22) Review and revisions of payments for non-opioid 
     alternative treatments.--
       ``(A) In general.--With respect to payments made under this 
     subsection for covered OPD services (or groups of services), 
     including covered OPD services assigned to a comprehensive 
     ambulatory payment classification, the Secretary--
       ``(i) shall, as soon as practicable, conduct a review (part 
     of which may include a request for information) of payments 
     for opioids and evidence-based non-opioid alternatives for 
     pain management (including drugs and devices, nerve blocks, 
     surgical injections, and neuromodulation) with a goal of 
     ensuring that there are not financial incentives to use 
     opioids instead of non-opioid alternatives;
       ``(ii) may, as the Secretary determines appropriate, 
     conduct subsequent reviews of such payments; and
       ``(iii) shall consider the extent to which revisions under 
     this subsection to such payments (such as the creation of 
     additional groups of covered OPD services to classify 
     separately those procedures that utilize opioids and non-
     opioid alternatives for pain management) would reduce payment 
     incentives to use opioids instead of non-opioid alternatives 
     for pain management.
       ``(B) Priority.--In conducting the review under clause (i) 
     of subparagraph (A) and considering revisions under clause 
     (iii) of such subparagraph, the Secretary shall focus on 
     covered OPD services (or groups of services) assigned to a 
     comprehensive ambulatory payment classification, ambulatory 
     payment classifications that primarily include surgical 
     services, and other services determined by the Secretary 
     which generally involve treatment for pain management.
       ``(C) Revisions.--If the Secretary identifies revisions to 
     payments pursuant to subparagraph (A)(iii), the Secretary 
     shall, as determined appropriate, begin making such revisions 
     for services furnished on or after January 1, 2020. Revisions 
     under the previous sentence shall be treated as adjustments 
     for purposes of application of paragraph (9)(B).
       ``(D) Rules of construction.--Nothing in this paragraph 
     shall be construed to preclude the Secretary--
       ``(i) from conducting a demonstration before making the 
     revisions described in subparagraph (C); or
       ``(ii) prior to implementation of this paragraph, from 
     changing payments under this subsection for covered OPD 
     services (or groups of services) which include opioids or 
     non-opioid alternatives for pain management.''.
       (b) Ambulatory Surgical Centers.--Section 1833(i) of the 
     Social Security Act (42 U.S.C. 1395l(i)) is amended by adding 
     at the end the following new paragraph:
       ``(8) The Secretary shall conduct a similar type of review 
     as required under paragraph (22) of section 1833(t)), 
     including the second sentence of subparagraph (C) of such 
     paragraph, to payment for services under this subsection, and 
     make such revisions under this paragraph, in an appropriate 
     manner (as determined by the Secretary).''.

     SEC. 6083. EXPANDING ACCESS UNDER THE MEDICARE PROGRAM TO 
                   ADDICTION TREATMENT IN FEDERALLY QUALIFIED 
                   HEALTH CENTERS AND RURAL HEALTH CLINICS.

       (a) Federally Qualified Health Centers.--Section 1834(o) of 
     the Social Security Act (42 U.S.C. 1395m(o)) is amended by 
     adding at the end the following new paragraph:
       ``(3) Additional payments for certain fqhcs with physicians 
     or other practitioners receiving data 2000 waivers.--
       ``(A) In general.--In the case of a Federally qualified 
     health center with respect to which, beginning on or after 
     January 1, 2019, Federally qualified health center services 
     (as defined in section 1861(aa)(3)) are furnished for the 
     treatment of opioid use disorder by a physician or 
     practitioner who meets the requirements described in 
     subparagraph (C), the Secretary shall, subject to 
     availability of funds under subparagraph (D), make a payment 
     (at such time and in such manner as specified by the 
     Secretary) to such Federally qualified health center after 
     receiving and approving an application submitted by such 
     Federally qualified health center under subparagraph (B). 
     Such a payment shall be in an amount determined by the 
     Secretary, based on an estimate of the average costs of 
     training for purposes of receiving a waiver described in 
     subparagraph (C)(ii). Such a payment may be made only one 
     time with respect to each such physician or practitioner.
       ``(B) Application.--In order to receive a payment described 
     in subparagraph (A), a Federally qualified health center 
     shall submit to the Secretary an application for such a 
     payment at such time, in such manner, and containing such 
     information as specified by the Secretary. A Federally 
     qualified health center may apply for such a payment for each 
     physician or practitioner described in subparagraph (A) 
     furnishing services described in such subparagraph at such 
     center.
       ``(C) Requirements.--For purposes of subparagraph (A), the 
     requirements described in this subparagraph, with respect to 
     a physician or practitioner, are the following:
       ``(i) The physician or practitioner is employed by or 
     working under contract with a Federally qualified health 
     center described in subparagraph (A) that submits an 
     application under subparagraph (B).
       ``(ii) The physician or practitioner first receives a 
     waiver under section 303(g) of the Controlled Substances Act 
     on or after January 1, 2019.
       ``(D) Funding.--For purposes of making payments under this 
     paragraph, there are appropriated, out of amounts in the 
     Treasury not otherwise appropriated, $6,000,000, which shall 
     remain available until expended.''.
       (b) Rural Health Clinic.--Section 1833 of the Social 
     Security Act (42 U.S.C. 1395l) is amended--
       (1) by redesignating the subsection (z) relating to medical 
     review of spinal subluxation services as subsection (aa); and
       (2) by adding at the end the following new subsection:
       ``(bb) Additional Payments for Certain Rural Health Clinics 
     With Physicians or Practitioners Receiving DATA 2000 
     Waivers.--
       ``(1) In general.--In the case of a rural health clinic 
     with respect to which, beginning on or after January 1, 2019, 
     rural health clinic services (as defined in section 
     1861(aa)(1)) are furnished for the treatment of opioid use 
     disorder by a physician or practitioner who meets the 
     requirements described in paragraph (3), the Secretary shall, 
     subject to availability of funds under paragraph (4), make a 
     payment (at such time and in such manner as specified by the 
     Secretary) to such rural health clinic after receiving and 
     approving an application described in paragraph (2). Such 
     payment shall be in an amount determined by the Secretary, 
     based on an estimate of the average costs of training for 
     purposes of receiving a waiver described in paragraph (3)(B). 
     Such payment may be made only one time with respect to each 
     such physician or practitioner.
       ``(2) Application.--In order to receive a payment described 
     in paragraph (1), a rural health clinic shall submit to the 
     Secretary an application for such a payment at such time, in 
     such manner, and containing such information as specified by 
     the Secretary. A rural health clinic may apply for such a 
     payment for each physician or practitioner described in 
     paragraph (1) furnishing services described in such paragraph 
     at such clinic.
       ``(3) Requirements.--For purposes of paragraph (1), the 
     requirements described in this paragraph, with respect to a 
     physician or practitioner, are the following:
       ``(A) The physician or practitioner is employed by or 
     working under contract with a rural health clinic described 
     in paragraph (1) that submits an application under paragraph 
     (2).
       ``(B) The physician or practitioner first receives a waiver 
     under section 303(g) of the Controlled Substances Act on or 
     after January 1, 2019.
       ``(4) Funding.--For purposes of making payments under this 
     subsection, there are appropriated, out of amounts in the 
     Treasury not otherwise appropriated, $2,000,000, which shall 
     remain available until expended.''.

     SEC. 6084. STUDYING THE AVAILABILITY OF SUPPLEMENTAL BENEFITS 
                   DESIGNED TO TREAT OR PREVENT SUBSTANCE USE 
                   DISORDERS UNDER MEDICARE ADVANTAGE PLANS.

       (a) In General.--Not later than 2 years after the date of 
     the enactment of this Act, the Secretary of Health and Human 
     Services (in this section referred to as the ``Secretary'') 
     shall submit to Congress a report on the availability of 
     supplemental health care benefits (as described in section 
     1852(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w-
     22(a)(3)(A))) designed to treat or prevent substance use 
     disorders under Medicare Advantage plans offered under part C 
     of title XVIII of such Act. Such report shall include the 
     analysis described in subsection (c) and any differences in 
     the availability of such benefits under specialized MA plans 
     for special needs individuals (as defined in section 
     1859(b)(6) of such Act (42 U.S.C. 1395w-28(b)(6))) offered to 
     individuals entitled to medical assistance under title XIX of 
     such Act and other such Medicare Advantage plans.
       (b) Consultation.--The Secretary shall develop the report 
     described in subsection (a) in consultation with relevant 
     stakeholders, including--
       (1) individuals entitled to benefits under part A or 
     enrolled under part B of title XVIII of the Social Security 
     Act;
       (2) entities who advocate on behalf of such individuals;
       (3) Medicare Advantage organizations;
       (4) pharmacy benefit managers; and
       (5) providers of services and suppliers (as such terms are 
     defined in section 1861 of such Act (42 U.S.C. 1395x)).

[[Page H9203]]

       (c) Contents.--The report described in subsection (a) shall 
     include an analysis on the following:
       (1) The extent to which plans described in such subsection 
     offer supplemental health care benefits relating to coverage 
     of--
       (A) medication-assisted treatments for opioid use, 
     substance use disorder counseling, peer recovery support 
     services, or other forms of substance use disorder treatments 
     (whether furnished in an inpatient or outpatient setting); 
     and
       (B) non-opioid alternatives for the treatment of pain.
       (2) Challenges associated with such plans offering 
     supplemental health care benefits relating to coverage of 
     items and services described in subparagraph (A) or (B) of 
     paragraph (1).
       (3) The impact, if any, of increasing the applicable rebate 
     percentage determined under section 1854(b)(1)(C) of the 
     Social Security Act (42 U.S.C. 1395w-24(b)(1)(C)) for plans 
     offering such benefits relating to such coverage would have 
     on the availability of such benefits relating to such 
     coverage offered under Medicare Advantage plans.
       (4) Potential ways to improve upon such coverage or to 
     incentivize such plans to offer additional supplemental 
     health care benefits relating to such coverage.

     SEC. 6085. CLINICAL PSYCHOLOGIST SERVICES MODELS UNDER THE 
                   CENTER FOR MEDICARE AND MEDICAID INNOVATION; 
                   GAO STUDY AND REPORT.

       (a) CMI Models.--Section 1115A(b)(2)(B) of the Social 
     Security Act (42 U.S.C. 1315a(b)(2)(B)), as amended by 
     section 6001, is further amended by adding at the end the 
     following new clauses:
       ``(xxvi) Supporting ways to familiarize individuals with 
     the availability of coverage under part B of title XVIII for 
     qualified psychologist services (as defined in section 
     1861(ii)).
       ``(xxvii) Exploring ways to avoid unnecessary 
     hospitalizations or emergency department visits for mental 
     and behavioral health services (such as for treating 
     depression) through use of a 24-hour, 7-day a week help line 
     that may inform individuals about the availability of 
     treatment options, including the availability of qualified 
     psychologist services (as defined in section 1861(ii)).''.
       (b) GAO Study and Report.--Not later than 18 months after 
     the date of the enactment of this Act, the Comptroller 
     General of the United States shall conduct a study, and 
     submit to Congress a report, on mental and behavioral health 
     services under the Medicare program under title XVIII of the 
     Social Security Act, including an examination of the 
     following:
       (1) Information about services furnished by psychiatrists, 
     clinical psychologists, and other professionals.
       (2) Information about ways that Medicare beneficiaries 
     familiarize themselves about the availability of Medicare 
     payment for qualified psychologist services (as defined in 
     section 1861(ii) of the Social Security Act (42 U.S.C. 
     1395x(ii)) and ways that the provision of such information 
     could be improved.

     SEC. 6086. DR. TODD GRAHAM PAIN MANAGEMENT STUDY.

       (a) In General.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services (referred to in this section as the ``Secretary'') 
     shall conduct a study analyzing best practices as well as 
     payment and coverage for pain management services under title 
     XVIII of the Social Security Act and submit to the Committee 
     on Ways and Means and the Committee on Energy and Commerce of 
     the House of Representatives and the Committee on Finance of 
     the Senate a report containing options for revising payment 
     to providers and suppliers of services and coverage related 
     to the use of multi-disciplinary, evidence-based, non-opioid 
     treatments for acute and chronic pain management for 
     individuals entitled to benefits under part A or enrolled 
     under part B of title XVIII of the Social Security Act. The 
     Secretary shall make such report available on the public 
     website of the Centers for Medicare & Medicaid Services.
       (b) Consultation.--In developing the report described in 
     subsection (a), the Secretary shall consult with--
       (1) relevant agencies within the Department of Health and 
     Human Services;
       (2) licensed and practicing osteopathic and allopathic 
     physicians, behavioral health practitioners, physician 
     assistants, nurse practitioners, dentists, pharmacists, and 
     other providers of health services;
       (3) providers and suppliers of services (as such terms are 
     defined in section 1861 of the Social Security Act (42 U.S.C. 
     1395x));
       (4) substance abuse and mental health professional 
     organizations;
       (5) pain management professional organizations and advocacy 
     entities, including individuals who personally suffer chronic 
     pain;
       (6) medical professional organizations and medical 
     specialty organizations;
       (7) licensed health care providers who furnish alternative 
     pain management services;
       (8) organizations with expertise in the development of 
     innovative medical technologies for pain management;
       (9) beneficiary advocacy organizations; and
       (10) other organizations with expertise in the assessment, 
     diagnosis, treatment, and management of pain, as determined 
     appropriate by the Secretary.
       (c) Contents.--The report described in subsection (a) shall 
     include the following:
       (1) An analysis of payment and coverage under title XVIII 
     of the Social Security Act with respect to the following:
       (A) Evidence-based treatments and technologies for chronic 
     or acute pain, including such treatments that are covered, 
     not covered, or have limited coverage under such title.
       (B) Evidence-based treatments and technologies that monitor 
     substance use withdrawal and prevent overdoses of opioids.
       (C) Evidence-based treatments and technologies that treat 
     substance use disorders.
       (D) Items and services furnished by practitioners through a 
     multi-disciplinary treatment model for pain management, 
     including the patient-centered medical home.
       (E) Items and services furnished to beneficiaries with 
     psychiatric disorders, substance use disorders, or who are at 
     risk of suicide, or have comorbidities and require 
     consultation or management of pain with one or more 
     specialists in pain management, mental health, or addiction 
     treatment.
       (2) An evaluation of the following:
       (A) Barriers inhibiting individuals entitled to benefits 
     under part A or enrolled under part B of such title from 
     accessing treatments and technologies described in 
     subparagraphs (A) through (E) of paragraph (1).
       (B) Costs and benefits associated with potential expansion 
     of coverage under such title to include items and services 
     not covered under such title that may be used for the 
     treatment of pain, such as acupuncture, therapeutic massage, 
     and items and services furnished by integrated pain 
     management programs.
       (C) Pain management guidance published by the Federal 
     Government that may be relevant to coverage determinations or 
     other coverage requirements under title XVIII of the Social 
     Security Act.
       (3) An assessment of all guidance published by the 
     Department of Health and Human Services on or after January 
     1, 2016, relating to the prescribing of opioids. Such 
     assessment shall consider incorporating into such guidance 
     relevant elements of the ``Va/DoD Clinical Practice Guideline 
     for Opioid Therapy for Chronic Pain'' published in February 
     2017 by the Department of Veterans Affairs and Department of 
     Defense, including adoption of elements of the Department of 
     Defense and Department of Veterans Affairs pain rating scale.
       (4) The options described in subsection (d).
       (5) The impact analysis described in subsection (e).
       (d) Options.--The options described in this subsection are, 
     with respect to individuals entitled to benefits under part A 
     or enrolled under part B of title XVIII of the Social 
     Security Act, legislative and administrative options for 
     accomplishing the following:
       (1) Improving coverage of and payment for pain management 
     therapies without the use of opioids, including 
     interventional pain therapies, and options to augment opioid 
     therapy with other clinical and complementary, integrative 
     health services to minimize the risk of substance use 
     disorder, including in a hospital setting.
       (2) Improving coverage of and payment for medical devices 
     and non-opioid based pharmacological and non-pharmacological 
     therapies approved or cleared by the Food and Drug 
     Administration for the treatment of pain as an alternative or 
     augment to opioid therapy.
       (3) Improving and disseminating treatment strategies for 
     beneficiaries with psychiatric disorders, substance use 
     disorders, or who are at risk of suicide, and treatment 
     strategies to address health disparities related to opioid 
     use and opioid abuse treatment.
       (4) Improving and disseminating treatment strategies for 
     beneficiaries with comorbidities who require a consultation 
     or comanagement of pain with one or more specialists in pain 
     management, mental health, or addiction treatment, including 
     in a hospital setting.
       (5) Educating providers on risks of coadministration of 
     opioids and other drugs, particularly benzodiazepines.
       (6) Ensuring appropriate case management for beneficiaries 
     who transition between inpatient and outpatient hospital 
     settings, or between opioid therapy to non-opioid therapy, 
     which may include the use of care transition plans.
       (7) Expanding outreach activities designed to educate 
     providers of services and suppliers under the Medicare 
     program and individuals entitled to benefits under part A or 
     under part B of such title on alternative, non-opioid 
     therapies to manage and treat acute and chronic pain.
       (8) Creating a beneficiary education tool on alternatives 
     to opioids for chronic pain management.
       (e) Impact Analysis.--The impact analysis described in this 
     subsection consists of an analysis of any potential effects 
     implementing the options described in subsection (d) would 
     have--
       (1) on expenditures under the Medicare program; and
       (2) on preventing or reducing opioid addiction for 
     individuals receiving benefits under the Medicare program.

        Subtitle J--Combating Opioid Abuse for Care in Hospitals

     SEC. 6091. SHORT TITLE.

       This subtitle may be cited as the ``Combating Opioid Abuse 
     for Care in Hospitals Act of 2018'' or the ``COACH Act of 
     2018''.

[[Page H9204]]

  


     SEC. 6092. DEVELOPING GUIDANCE ON PAIN MANAGEMENT AND OPIOID 
                   USE DISORDER PREVENTION FOR HOSPITALS RECEIVING 
                   PAYMENT UNDER PART A OF THE MEDICARE PROGRAM.

       (a) In General.--Not later than July 1, 2019, the Secretary 
     of Health and Human Services (in this section referred to as 
     the ``Secretary'') shall develop and publish on the public 
     website of the Centers for Medicare & Medicaid Services 
     guidance for hospitals receiving payment under part A of 
     title XVIII of the Social Security Act (42 U.S.C. 1395c et 
     seq.) on pain management strategies and opioid use disorder 
     prevention strategies with respect to individuals entitled to 
     benefits under such part.
       (b) Consultation.--In developing the guidance described in 
     subsection (a), the Secretary shall consult with relevant 
     stakeholders, including--
       (1) medical professional organizations;
       (2) providers and suppliers of services (as such terms are 
     defined in section 1861 of the Social Security Act (42 U.S.C. 
     1395x));
       (3) health care consumers or groups representing such 
     consumers; and
       (4) other entities determined appropriate by the Secretary.
       (c) Contents.--The guidance described in subsection (a) 
     shall include, with respect to hospitals and individuals 
     described in such subsection, the following:
       (1) Best practices regarding evidence-based screening and 
     practitioner education initiatives relating to screening and 
     treatment protocols for opioid use disorder, including--
       (A) methods to identify such individuals at-risk of opioid 
     use disorder, including risk stratification;
       (B) ways to prevent, recognize, and treat opioid overdoses; 
     and
       (C) resources available to such individuals, such as opioid 
     treatment programs, peer support groups, and other recovery 
     programs.
       (2) Best practices for such hospitals to educate 
     practitioners furnishing items and services at such hospital 
     with respect to pain management and substance use disorders, 
     including education on--
       (A) the adverse effects of prolonged opioid use;
       (B) non-opioid, evidence-based, non-pharmacological pain 
     management treatments;
       (C) monitoring programs for individuals who have been 
     prescribed opioids; and
       (D) the prescribing of naloxone along with an initial 
     opioid prescription.
       (3) Best practices for such hospitals to make such 
     individuals aware of the risks associated with opioid use 
     (which may include use of the notification template described 
     in paragraph (4)).
       (4) A notification template developed by the Secretary, for 
     use as appropriate, for such individuals who are prescribed 
     an opioid that--
       (A) explains the risks and side effects associated with 
     opioid use (including the risks of addiction and overdose) 
     and the importance of adhering to the prescribed treatment 
     regimen, avoiding medications that may have an adverse 
     interaction with such opioid, and storing such opioid safely 
     and securely;
       (B) highlights multimodal and evidence-based non-opioid 
     alternatives for pain management;
       (C) encourages such individuals to talk to their health 
     care providers about such alternatives;
       (D) provides for a method (through signature or otherwise) 
     for such an individual, or person acting on such individual's 
     behalf, to acknowledge receipt of such notification template;
       (E) is worded in an easily understandable manner and made 
     available in multiple languages determined appropriate by the 
     Secretary; and
       (F) includes any other information determined appropriate 
     by the Secretary.
       (5) Best practices for such hospital to track opioid 
     prescribing trends by practitioners furnishing items and 
     services at such hospital, including--
       (A) ways for such hospital to establish target levels, 
     taking into account the specialties of such practitioners and 
     the geographic area in which such hospital is located, with 
     respect to opioids prescribed by such practitioners;
       (B) guidance on checking the medical records of such 
     individuals against information included in prescription drug 
     monitoring programs;
       (C) strategies to reduce long-term opioid prescriptions; 
     and
       (D) methods to identify such practitioners who may be over-
     prescribing opioids.
       (6) Other information the Secretary determines appropriate, 
     including any such information from the Opioid Safety 
     Initiative established by the Department of Veterans Affairs 
     or the Opioid Overdose Prevention Toolkit published by the 
     Substance Abuse and Mental Health Services Administration.

     SEC. 6093. REQUIRING THE REVIEW OF QUALITY MEASURES RELATING 
                   TO OPIOIDS AND OPIOID USE DISORDER TREATMENTS 
                   FURNISHED UNDER THE MEDICARE PROGRAM AND OTHER 
                   FEDERAL HEALTH CARE PROGRAMS.

       Section 1890A of the Social Security Act (42 U.S.C. 
     1395aaa-1) is amended by adding at the end the following new 
     subsection:
       ``(g) Technical Expert Panel Review of Opioid and Opioid 
     Use Disorder Quality Measures.--
       ``(1) In general.--Not later than 180 days after the date 
     of the enactment of this subsection, the Secretary shall 
     establish a technical expert panel for purposes of reviewing 
     quality measures relating to opioids and opioid use 
     disorders, including care, prevention, diagnosis, health 
     outcomes, and treatment furnished to individuals with opioid 
     use disorders. The Secretary may use the entity with a 
     contract under section 1890(a) and amend such contract as 
     necessary to provide for the establishment of such technical 
     expert panel.
       ``(2) Review and assessment.--Not later than 1 year after 
     the date the technical expert panel described in paragraph 
     (1) is established (and periodically thereafter as the 
     Secretary determines appropriate), the technical expert panel 
     shall--
       ``(A) review quality measures that relate to opioids and 
     opioid use disorders, including existing measures and those 
     under development;
       ``(B) identify gaps in areas of quality measurement that 
     relate to opioids and opioid use disorders, and identify 
     measure development priorities for such measure gaps; and
       ``(C) make recommendations to the Secretary on quality 
     measures with respect to opioids and opioid use disorders for 
     purposes of improving care, prevention, diagnosis, health 
     outcomes, and treatment, including recommendations for 
     revisions of such measures, need for development of new 
     measures, and recommendations for including such measures in 
     the Merit-Based Incentive Payment System under section 
     1848(q), the alternative payment models under section 
     1833(z)(3)(C), the shared savings program under section 1899, 
     the quality reporting requirements for inpatient hospitals 
     under section 1886(b)(3)(B)(viii), and the hospital value-
     based purchasing program under section 1886(o).
       ``(3) Consideration of measures by secretary.--The 
     Secretary shall consider--
       ``(A) using opioid and opioid use disorder measures 
     (including measures used under the Merit-Based Incentive 
     Payment System under section 1848(q), measures recommended 
     under paragraph (2)(C), and other such measures identified by 
     the Secretary) in alternative payment models under section 
     1833(z)(3)(C) and in the shared savings program under section 
     1899; and
       ``(B) using opioid measures described in subparagraph (A), 
     as applicable, in the quality reporting requirements for 
     inpatient hospitals under section 1886(b)(3)(B)(viii), and in 
     the hospital value-based purchasing program under section 
     1886(o).
       ``(4) Prioritization of measure development.--The Secretary 
     shall prioritize for measure development the gaps in quality 
     measures identified under paragraph (2)(B).
       ``(5) Prioritization of measure endorsement.--The 
     Secretary--
       ``(A) during the period beginning on the date of the 
     enactment of this subsection and ending on December 31, 2023, 
     shall prioritize the endorsement of measures relating to 
     opioids and opioid use disorders by the entity with a 
     contract under subsection (a) of section 1890 in connection 
     with endorsement of measures described in subsection (b)(2) 
     of such section; and
       ``(B) on and after January 1, 2024, may prioritize the 
     endorsement of such measures by such entity.''.

     SEC. 6094. TECHNICAL EXPERT PANEL ON REDUCING SURGICAL 
                   SETTING OPIOID USE; DATA COLLECTION ON 
                   PERIOPERATIVE OPIOID USE.

       (a) Technical Expert Panel on Reducing Surgical Setting 
     Opioid Use.--
       (1) In general.--Not later than 6 months after the date of 
     the enactment of this Act, the Secretary of Health and Human 
     Services shall convene a technical expert panel, including 
     medical and surgical specialty societies and hospital 
     organizations, to provide recommendations on reducing opioid 
     use in the inpatient and outpatient surgical settings and on 
     best practices for pain management, including with respect to 
     the following:
       (A) Approaches that limit patient exposure to opioids 
     during the perioperative period, including pre-surgical and 
     post-surgical injections, and that identify such patients at 
     risk of opioid use disorder pre-operation.
       (B) Shared decision making with patients and families on 
     pain management, including a review of payment to ensure 
     payment under the Medicare program under title XVIII of the 
     Social Security Act accounts for time spent on shared 
     decision making.
       (C) Education on the safe use, storage, and disposal of 
     opioids.
       (D) Prevention of opioid misuse and abuse after discharge.
       (E) Development of a clinical algorithm to identify and 
     treat at-risk, opiate-tolerant patients and reduce reliance 
     on opioids for acute pain during the perioperative period.
       (2) Report.--Not later than 1 year after the date of the 
     enactment of this Act, the Secretary shall submit to Congress 
     and make public a report containing the recommendations 
     developed under paragraph (1) and an action plan for broader 
     implementation of pain management protocols that limit the 
     use of opioids in the perioperative setting and upon 
     discharge from such setting.
       (b) Data Collection on Perioperative Opioid Use.--Not later 
     than 1 year after the date of the enactment of this Act, the 
     Secretary of Health and Human Services shall submit to 
     Congress a report that contains the following:
       (1) The diagnosis-related group codes identified by the 
     Secretary as having the highest volume of surgeries.

[[Page H9205]]

       (2) With respect to each of such diagnosis-related group 
     codes so identified, a determination by the Secretary of the 
     data that is both available and reported on opioid use 
     following such surgeries, such as with respect to--
       (A) surgical volumes, practices, and opioid prescribing 
     patterns;
       (B) opioid consumption, including--
       (i) perioperative days of therapy;
       (ii) average daily dose at the hospital, including dosage 
     greater than 90 milligram morphine equivalent;
       (iii) post-discharge prescriptions and other combination 
     drugs that are used before intervention and after 
     intervention;
       (iv) quantity and duration of opioid prescription at 
     discharge; and
       (v) quantity consumed and number of refills;
       (C) regional anesthesia and analgesia practices, including 
     pre-surgical and post-surgical injections;
       (D) naloxone reversal;
       (E) post-operative respiratory failure;
       (F) information about storage and disposal; and
       (G) such other information as the Secretary may specify.
       (3) Recommendations for improving data collection on 
     perioperative opioid use, including an analysis to identify 
     and reduce barriers to collecting, reporting, and analyzing 
     the data described in paragraph (2), including barriers 
     related to technological availability.

     SEC. 6095. REQUIRING THE POSTING AND PERIODIC UPDATE OF 
                   OPIOID PRESCRIBING GUIDANCE FOR MEDICARE 
                   BENEFICIARIES.

       (a) In General.--Not later than 180 days after the date of 
     the enactment of this Act, the Secretary of Health and Human 
     Services (in this section referred to as the ``Secretary'') 
     shall post on the public website of the Centers for Medicare 
     & Medicaid Services all guidance published by the Department 
     of Health and Human Services on or after January 1, 2016, 
     relating to the prescribing of opioids and applicable to 
     opioid prescriptions for individuals entitled to benefits 
     under part A of title XVIII of the Social Security Act (42 
     U.S.C. 1395c et seq.) or enrolled under part B of such title 
     of such Act (42 U.S.C. 1395j et seq.).
       (b) Update of Guidance.--
       (1) Periodic update.--The Secretary shall, in consultation 
     with the entities specified in paragraph (2), periodically 
     (as determined appropriate by the Secretary) update guidance 
     described in subsection (a) and revise the posting of such 
     guidance on the website described in such subsection.
       (2) Consultation.--The entities specified in this paragraph 
     are the following:
       (A) Medical professional organizations.
       (B) Providers and suppliers of services (as such terms are 
     defined in section 1861 of the Social Security Act (42 U.S.C. 
     1395x)).
       (C) Health care consumers or groups representing such 
     consumers.
       (D) Other entities determined appropriate by the Secretary.

  Subtitle K--Providing Reliable Options for Patients and Educational 
                               Resources

     SEC. 6101. SHORT TITLE.

       This subtitle may be cited as the ``Providing Reliable 
     Options for Patients and Educational Resources Act of 2018'' 
     or the ``PROPER Act of 2018''.

     SEC. 6102. REQUIRING MEDICARE ADVANTAGE PLANS AND PART D 
                   PRESCRIPTION DRUG PLANS TO INCLUDE INFORMATION 
                   ON RISKS ASSOCIATED WITH OPIOIDS AND COVERAGE 
                   OF NONPHARMACOLOGICAL THERAPIES AND NONOPIOID 
                   MEDICATIONS OR DEVICES USED TO TREAT PAIN.

       Section 1860D-4(a)(1) of the Social Security Act (42 U.S.C. 
     1395w-104(a)(1)) is amended--
       (1) in subparagraph (A), by inserting ``, subject to 
     subparagraph (C),'' before ``including'';
       (2) in subparagraph (B), by adding at the end the following 
     new clause:
       ``(vi) For plan year 2021 and each subsequent plan year, 
     subject to subparagraph (C), with respect to the treatment of 
     pain--

       ``(I) the risks associated with prolonged opioid use; and
       ``(II) coverage of nonpharmacological therapies, devices, 
     and nonopioid medications--

       ``(aa) in the case of an MA-PD plan under part C, under 
     such plan; and
       ``(bb) in the case of a prescription drug plan, under such 
     plan and under parts A and B.''; and
       (3) by adding at the end the following new subparagraph:
       ``(C) Targeted provision of information.--A PDP sponsor of 
     a prescription drug plan may, in lieu of disclosing the 
     information described in subparagraph (B)(vi) to each 
     enrollee under the plan, disclose such information through 
     mail or electronic communications to a subset of enrollees 
     under the plan, such as enrollees who have been prescribed an 
     opioid in the previous 2-year period.''.

     SEC. 6103. REQUIRING MEDICARE ADVANTAGE PLANS AND 
                   PRESCRIPTION DRUG PLANS TO PROVIDE INFORMATION 
                   ON THE SAFE DISPOSAL OF PRESCRIPTION DRUGS.

       (a) Medicare Advantage.--Section 1852 of the Social 
     Security Act (42 U.S.C. 1395w-22) is amended by adding at the 
     end the following new subsection:
       ``(n) Provision of Information Relating to the Safe 
     Disposal of Certain Prescription Drugs.--
       ``(1) In general.--In the case of an individual enrolled 
     under an MA or MA-PD plan who is furnished an in-home health 
     risk assessment on or after January 1, 2021, such plan shall 
     ensure that such assessment includes information on the safe 
     disposal of prescription drugs that are controlled substances 
     that meets the criteria established under paragraph (2). Such 
     information shall include information on drug takeback 
     programs that meet such requirements determined appropriate 
     by the Secretary and information on in-home disposal.
       ``(2) Criteria.--The Secretary shall, through rulemaking, 
     establish criteria the Secretary determines appropriate with 
     respect to information provided to an individual to ensure 
     that such information sufficiently educates such individual 
     on the safe disposal of prescription drugs that are 
     controlled substances.''.
       (b) Prescription Drug Plans.--Section 1860D-4(c)(2)(B) of 
     the Social Security Act (42 U.S.C. 1395w-104(c)(2)(B)) is 
     amended--
       (1) by striking ``may include elements that promote'';
       (2) by redesignating clauses (i) through (iii) as 
     subclauses (I) through (III) and adjusting the margins 
     accordingly;
       (3) by inserting before subclause (I), as so redesignated, 
     the following new clause:
       ``(i) may include elements that promote--'';
       (4) in subclause (III), as so redesignated, by striking the 
     period at the end and inserting ``; and''; and
       (5) by adding at the end the following new clause:
       ``(ii) with respect to plan years beginning on or after 
     January 1, 2021, shall provide for--

       ``(I) the provision of information to the enrollee on the 
     safe disposal of prescription drugs that are controlled 
     substances that meets the criteria established under section 
     1852(n)(2), including information on drug takeback programs 
     that meet such requirements determined appropriate by the 
     Secretary and information on in-home disposal; and
       ``(II) cost-effective means by which an enrollee may so 
     safely dispose of such drugs.''.

     SEC. 6104. REVISING MEASURES USED UNDER THE HOSPITAL CONSUMER 
                   ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS 
                   SURVEY RELATING TO PAIN MANAGEMENT.

       (a) Restriction on the Use of Pain Questions in HCAHPS.--
     Section 1886(b)(3)(B)(viii) of the Social Security Act (42 
     U.S.C. 1395ww(b)(3)(B)(viii)) is amended by adding at the end 
     the following new subclause:
       ``(XII)(aa) With respect to a Hospital Consumer Assessment 
     of Healthcare Providers and Systems survey (or a successor 
     survey) conducted on or after January 1, 2020, such survey 
     may not include questions about communication by hospital 
     staff with an individual about such individual's pain unless 
     such questions take into account, as applicable, whether an 
     individual experiencing pain was informed about risks 
     associated with the use of opioids and about non-opioid 
     alternatives for the treatment of pain.
       ``(bb) The Secretary shall not include on the Hospital 
     Compare internet website any measures based on the questions 
     appearing on the Hospital Consumer Assessment of Healthcare 
     Providers and Systems survey in 2018 or 2019 about 
     communication by hospital staff with an individual about such 
     individual's pain.''.
       (b) Restriction on Use of 2018 and 2019 Pain Questions in 
     the Hospital Value-based Purchasing Program.--Section 
     1886(o)(2)(B) of the Social Security Act (42 U.S.C. 
     1395ww(o)(2)(B)) is amended by adding at the end the 
     following new clause:
       ``(iii) HCAHPS pain questions.--The Secretary may not 
     include under subparagraph (A) a measure that is based on the 
     questions appearing on the Hospital Consumer Assessment of 
     Healthcare Providers and Systems survey in 2018 or 2019 about 
     communication by hospital staff with an individual about the 
     individual's pain.''.

         Subtitle L--Fighting the Opioid Epidemic With Sunshine

     SEC. 6111. FIGHTING THE OPIOID EPIDEMIC WITH SUNSHINE.

       (a) Inclusion of Information Regarding Payments to 
     Additional Practitioners.--
       (1) In general.--Section 1128G(e)(6) of the Social Security 
     Act (42 U.S.C. 1320a-7h(e)(6)) is amended--
       (A) in subparagraph (A), by adding at the end the following 
     new clauses:
       ``(iii) A physician assistant, nurse practitioner, or 
     clinical nurse specialist (as such terms are defined in 
     section 1861(aa)(5)).
       ``(iv) A certified registered nurse anesthetist (as defined 
     in section 1861(bb)(2)).
       ``(v) A certified nurse-midwife (as defined in section 
     1861(gg)(2)).''; and
       (B) in subparagraph (B), by inserting ``, physician 
     assistant, nurse practitioner, clinical nurse specialist, 
     certified nurse anesthetist, or certified nurse-midwife'' 
     after ``physician''.
       (2) Effective date.--The amendments made by this subsection 
     shall apply with respect to information required to be 
     submitted under section 1128G of the Social Security Act (42 
     U.S.C. 1320a-7h) on or after January 1, 2022.

[[Page H9206]]

       (b) Sunset of Exclusion of National Provider Identifier of 
     Covered Recipient in Information Made Publicly Available.--
     Section 1128G(c)(1)(C)(viii) of the Social Security Act (42 
     U.S.C. 1320a-7h(c)(1)(C)(viii)) is amended by striking ``does 
     not contain'' and inserting ``in the case of information made 
     available under this subparagraph prior to January 1, 2022, 
     does not contain''.
       (c) Administration.--Chapter 35 of title 44, United States 
     Code, shall not apply to this section or the amendments made 
     by this section.

                  TITLE VII--PUBLIC HEALTH PROVISIONS

                   Subtitle A--Awareness and Training

     SEC. 7001. REPORT ON EFFECTS ON PUBLIC HEALTH OF SYNTHETIC 
                   DRUG USE.

       (a) In General.--Not later than 3 years after the date of 
     the enactment of this Act, the Secretary of Health and Human 
     Services, in coordination with the Surgeon General of the 
     Public Health Service, shall submit to the Committee on 
     Energy and Commerce of the House of Representatives and the 
     Committee on Health, Education, Labor, and Pensions of the 
     Senate a report on the health effects of new psychoactive 
     substances, including synthetic drugs, used by adolescents 
     and young adults.
       (b) New Psychoactive Substance Defined.--For purposes of 
     subsection (a), the term ``new psychoactive substance'' means 
     a controlled substance analogue (as defined in section 
     102(32) of the Controlled Substances Act (21 U.S.C. 802(32)).

     SEC. 7002. FIRST RESPONDER TRAINING.

       Section 546 of the Public Health Service Act (42 U.S.C. 
     290ee-1) is amended--
       (1) in subsection (c)--
       (A) in paragraph (2), by striking ``and'' at the end;
       (B) in paragraph (3), by striking the period and inserting 
     ``; and''; and
       (C) by adding at the end the following:
       ``(4) train and provide resources for first responders and 
     members of other key community sectors on safety around 
     fentanyl, carfentanil, and other dangerous licit and illicit 
     drugs to protect themselves from exposure to such drugs and 
     respond appropriately when exposure occurs.'';
       (2) in subsection (d), by striking ``and mechanisms for 
     referral to appropriate treatment for an entity receiving a 
     grant under this section'' and inserting ``mechanisms for 
     referral to appropriate treatment, and safety around 
     fentanyl, carfentanil, and other dangerous licit and illicit 
     drugs'';
       (3) in subsection (f)--
       (A) in paragraph (3), by striking ``and'' at the end;
       (B) in paragraph (4), by striking the period and inserting 
     ``; and''; and
       (C) by adding at the end the following:
       ``(5) the number of first responders and members of other 
     key community sectors trained on safety around fentanyl, 
     carfentanil, and other dangerous licit and illicit drugs.'';
       (4) by redesignating subsection (g) as subsection (h);
       (5) by inserting after subsection (f) the following:
       ``(g) Other Key Community Sectors.--In this section, the 
     term `other key community sectors' includes substance use 
     disorder treatment providers, emergency medical services 
     agencies, agencies and organizations working with prison and 
     jail populations and offender reentry programs, health care 
     providers, harm reduction groups, pharmacies, community 
     health centers, tribal health facilities, and mental health 
     providers.''; and
       (6) in subsection (h), as so redesignated, by striking 
     ``$12,000,000 for each of fiscal years 2017 through 2021'' 
     and inserting ``$36,000,000 for each of fiscal years 2019 
     through 2023''.

  Subtitle B--Pilot Program for Public Health Laboratories To Detect 
                  Fentanyl and Other Synthetic Opioids

     SEC. 7011. PILOT PROGRAM FOR PUBLIC HEALTH LABORATORIES TO 
                   DETECT FENTANYL AND OTHER SYNTHETIC OPIOIDS.

       (a) Grants.--The Secretary of Health and Human Services 
     (referred to in this section as the ``Secretary'') shall 
     award grants to, or enter into cooperative agreements with, 
     Federal, State, and local agencies to improve coordination 
     between public health laboratories and laboratories operated 
     by law enforcement agencies, such as Customs and Border 
     Protection and the Drug Enforcement Administration, to 
     improve detection of synthetic opioids, including fentanyl 
     and its analogues, as described in subsection (b).
       (b) Detection Activities.--The Secretary, in consultation 
     with the Director of the National Institute of Standards and 
     Technology, the Director of the Centers for Disease Control 
     and Prevention, the Attorney General of the United States, 
     and the Administrator of the Drug Enforcement Administration, 
     shall, for purposes of this section, develop or identify--
       (1) best practices for safely handling and testing 
     synthetic opioids, including fentanyl and its analogues, 
     including with respect to reference materials, instrument 
     calibration, and quality control protocols;
       (2) reference materials and quality control standards 
     related to synthetic opioids, including fentanyl and its 
     analogues, to enhance--
       (A) clinical diagnostics;
       (B) postmortem data collection; and
       (C) portable testing equipment utilized by law enforcement 
     and public health officials; and
       (3) procedures for the identification of new and emerging 
     synthetic opioid formulations and procedures for reporting 
     those findings to appropriate law enforcement agencies and 
     Federal, State, and local public health laboratories and 
     health departments, as appropriate.
       (c) Laboratories.--The Secretary shall require recipients 
     of grants or cooperative agreements under subsection (a) to--
       (1) follow the best practices established under subsection 
     (b) and have the appropriate capabilities to provide 
     laboratory testing of controlled substances, such as 
     synthetic fentanyl, and biospecimens for the purposes of 
     aggregating and reporting public health information to 
     Federal, State, and local public health officials, 
     laboratories, and other entities the Secretary deems 
     appropriate;
       (2) work with law enforcement agencies and public health 
     authorities, as practicable;
       (3) provide early warning information to Federal, State, 
     and local law enforcement agencies and public health 
     authorities regarding trends or other data related to the 
     supply of synthetic opioids, including fentanyl and its 
     analogues;
       (4) provide biosurveillance capabilities with respect to 
     identifying trends in adverse health outcomes associated with 
     non-fatal exposures; and
       (5) provide diagnostic testing, as appropriate and 
     practicable, for non-fatal exposures of emergency personnel, 
     first responders, and other individuals.
       (d) Authorization of Appropriations.--To carry out this 
     section, there is authorized to be appropriated $15,000,000 
     for each of fiscal years 2019 through 2023.

         Subtitle C--Indexing Narcotics, Fentanyl, and Opioids

     SEC. 7021. ESTABLISHMENT OF SUBSTANCE USE DISORDER 
                   INFORMATION DASHBOARD.

       Title XVII of the Public Health Service Act (42 U.S.C. 300u 
     et seq.) is amended by adding at the end the following new 
     section:

     ``SEC. 1711. ESTABLISHMENT OF SUBSTANCE USE DISORDER 
                   INFORMATION DASHBOARD.

       ``(a) In General.--Not later than 6 months after the date 
     of the enactment of this section, the Secretary of Health and 
     Human Services shall, in consultation with the Director of 
     National Drug Control Policy, establish and periodically 
     update, on the Internet website of the Department of Health 
     and Human Services, a public information dashboard that--
       ``(1) provides links to information on programs within the 
     Department of Health and Human Services related to the 
     reduction of opioid and other substance use disorders;
       ``(2) provides access, to the extent practicable and 
     appropriate, to publicly available data, which may include 
     data from agencies within the Department of Health and Human 
     Services and--
       ``(A) other Federal agencies;
       ``(B) State, local, and Tribal governments;
       ``(C) nonprofit organizations;
       ``(D) law enforcement;
       ``(E) medical experts;
       ``(F) public health educators; and
       ``(G) research institutions regarding prevention, 
     treatment, recovery, and other services for opioid and other 
     substance use disorders;
       ``(3) provides data on substance use disorder prevention 
     and treatment strategies in different regions of and 
     populations in the United States;
       ``(4) identifies information on alternatives to controlled 
     substances for pain management, such as approaches studied by 
     the National Institutes of Health Pain Consortium, the 
     National Center for Complimentary and Integrative Health, and 
     other institutes and centers at the National Institutes of 
     Health, as appropriate; and
       ``(5) identifies guidelines and best practices for health 
     care providers regarding treatment of substance use 
     disorders.
       ``(b) Controlled Substance Defined.--In this section, the 
     term `controlled substance' has the meaning given that term 
     in section 102 of the Controlled Substances Act (21 U.S.C. 
     802).''.

     SEC. 7022. INTERDEPARTMENTAL SUBSTANCE USE DISORDERS 
                   COORDINATING COMMITTEE.

       (a) Establishment.--Not later than 3 months after the date 
     of the enactment of this Act, the Secretary of Health and 
     Human Services (in this section referred to as the 
     ``Secretary'') shall, in coordination with the Director of 
     National Drug Control Policy, establish a committee, to be 
     known as the Interdepartmental Substance Use Disorders 
     Coordinating Committee (in this section referred to as the 
     ``Committee''), to coordinate Federal activities related to 
     substance use disorders.
       (b) Membership.--
       (1) Federal members.--The Committee shall be composed of 
     the following Federal representatives, or the designees of 
     such representatives:
       (A) The Secretary, who shall serve as the Chair of the 
     Committee.
       (B) The Attorney General of the United States.
       (C) The Secretary of Labor.
       (D) The Secretary of Housing and Urban Development.
       (E) The Secretary of Education.
       (F) The Secretary of Veterans Affairs.

[[Page H9207]]

       (G) The Commissioner of Social Security.
       (H) The Assistant Secretary for Mental Health and Substance 
     Use.
       (I) The Director of National Drug Control Policy.
       (J) Representatives of other Federal agencies that support 
     or conduct activities or programs related to substance use 
     disorders, as determined appropriate by the Secretary.
       (2) Non-federal members.--The Committee shall include a 
     minimum of 15 non-Federal members appointed by the Secretary, 
     of which--
       (A) at least two such members shall be an individual who 
     has received treatment for a diagnosis of a substance use 
     disorder;
       (B) at least two such members shall be a director of a 
     State substance abuse agency;
       (C) at least two such members shall be a representative of 
     a leading research, advocacy, or service organization for 
     adults with substance use disorder;
       (D) at least two such members shall--
       (i) be a physician, licensed mental health professional, 
     advance practice registered nurse, or physician assistant; 
     and
       (ii) have experience in treating individuals with substance 
     use disorders;
       (E) at least one such member shall be a substance use 
     disorder treatment professional who provides treatment 
     services at a certified opioid treatment program;
       (F) at least one such member shall be a substance use 
     disorder treatment professional who has research or clinical 
     experience in working with racial and ethnic minority 
     populations;
       (G) at least one such member shall be a substance use 
     disorder treatment professional who has research or clinical 
     mental health experience in working with medically 
     underserved populations;
       (H) at least one such member shall be a State-certified 
     substance use disorder peer support specialist;
       (I) at least one such member shall be a drug court judge or 
     a judge with experience in adjudicating cases related to 
     substance use disorder;
       (J) at least one such member shall be a public safety 
     officer with extensive experience in interacting with adults 
     with a substance use disorder; and
       (K) at least one such member shall be an individual with 
     experience providing services for homeless individuals with a 
     substance use disorder.
       (c) Terms.--
       (1) In general.--A member of the Committee appointed under 
     subsection (b)(2) shall be appointed for a term of 3 years 
     and may be reappointed for one or more 3-year terms.
       (2) Vacancies.--A vacancy on the Committee shall be filled 
     in the same manner in which the original appointment was 
     made. Any individual appointed to fill a vacancy for an 
     unexpired term shall be appointed for the remainder of such 
     term and may serve after the expiration of such term until a 
     successor has been appointed.
       (d) Meetings.--The Committee shall meet not fewer than two 
     times each year.
       (e) Duties.--The Committee shall--
       (1) identify areas for improved coordination of activities, 
     if any, related to substance use disorders, including 
     research, services, supports, and prevention activities 
     across all relevant Federal agencies;
       (2) identify and provide to the Secretary recommendations 
     for improving Federal programs for the prevention and 
     treatment of, and recovery from, substance use disorders, 
     including by expanding access to prevention, treatment, and 
     recovery services;
       (3) analyze substance use disorder prevention and treatment 
     strategies in different regions of and populations in the 
     United States and evaluate the extent to which Federal 
     substance use disorder prevention and treatment strategies 
     are aligned with State and local substance use disorder 
     prevention and treatment strategies;
       (4) make recommendations to the Secretary regarding any 
     appropriate changes with respect to the activities and 
     strategies described in paragraphs (1) through (3);
       (5) make recommendations to the Secretary regarding public 
     participation in decisions relating to substance use 
     disorders and the process by which public feedback can be 
     better integrated into such decisions; and
       (6) make recommendations to ensure that substance use 
     disorder research, services, supports, and prevention 
     activities of the Department of Health and Human Services and 
     other Federal agencies are not unnecessarily duplicative.
       (f) Annual Report.--Not later than 1 year after the date of 
     the enactment of this Act, and annually thereafter for the 
     life of the Committee, the Committee shall publish on the 
     Internet website of the Department of Health and Human 
     Services, which may include the public information dashboard 
     established under section 1711 of the Public Health Service 
     Act, as added by section 7021, a report summarizing the 
     activities carried out by the Committee pursuant to 
     subsection (e), including any findings resulting from such 
     activities.
       (g) Working Groups.--The Committee may establish working 
     groups for purposes of carrying out the duties described in 
     subsection (e). Any such working group shall be composed of 
     members of the Committee (or the designees of such members) 
     and may hold such meetings as are necessary to enable the 
     working group to carry out the duties delegated to the 
     working group.
       (h) Federal Advisory Committee Act.--The Federal Advisory 
     Committee Act (5 U.S.C. App.) shall apply to the Committee 
     only to the extent that the provisions of such Act do not 
     conflict with the requirements of this section.
       (i) Sunset.--The Committee shall terminate on the date that 
     is 6 years after the date on which the Committee is 
     established under subsection (a).

     SEC. 7023. NATIONAL MILESTONES TO MEASURE SUCCESS IN 
                   CURTAILING THE OPIOID CRISIS.

       (a) In General.--Not later than 180 days after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services (referred to in this section as the ``Secretary''), 
     in coordination with the Administrator of the Drug 
     Enforcement Administration and the Director of the Office of 
     National Drug Control Policy, shall develop or identify 
     existing national indicators (referred to in this section as 
     the ``national milestones'') to measure success in curtailing 
     the opioid crisis, with the goal of significantly reversing 
     the incidence and prevalence of opioid misuse and abuse, and 
     opioid-related morbidity and mortality in the United States 
     within 5 years of such date of enactment.
       (b) National Milestones to End the Opioid Crisis.--The 
     national milestones under subsection (a) shall include the 
     following:
       (1) Not fewer than 10 indicators or metrics to accurately 
     and expediently measure progress in meeting the goal 
     described in subsection (a), which shall, as appropriate, 
     include, indicators or metrics related to--
       (A) the number of fatal and non-fatal opioid overdoses;
       (B) the number of emergency room visits related to opioid 
     misuse and abuse;
       (C) the number of individuals in sustained recovery from 
     opioid use disorder;
       (D) the number of infections associated with illicit drug 
     use, such as HIV, viral hepatitis, and infective 
     endocarditis, and available capacity for treating such 
     infections;
       (E) the number of providers prescribing medication-assisted 
     treatment for opioid use disorders, including in primary care 
     settings, community health centers, jails, and prisons;
       (F) the number of individuals receiving treatment for 
     opioid use disorder; and
       (G) additional indicators or metrics, as appropriate, such 
     as metrics pertaining to specific populations, including 
     women and children, American Indians and Alaskan Natives, 
     individuals living in rural and non-urban areas, and justice-
     involved populations, that would further clarify the progress 
     made in addressing the opioid crisis.
       (2) A reasonable goal, such as a percentage decrease or 
     other specified metric, that signifies progress in meeting 
     the goal described in subsection (a), and annual targets to 
     help achieve that goal.
       (c) Consideration of Other Substance Use Disorders.--In 
     developing the national milestones under subsection (b), the 
     Secretary shall, as appropriate, consider other substance use 
     disorders in addition to opioid use disorder.
       (d) Extension of Period.--If the Secretary determines that 
     the goal described in subsection (a) will not be achieved 
     with respect to any indicator or metric established under 
     subsection (b)(2) within 5 years of the date of enactment of 
     this Act, the Secretary may extend the timeline for meeting 
     such goal with respect to that indicator or metric. The 
     Secretary shall include with any such extension a rationale 
     for why additional time is needed and information on whether 
     significant changes are needed in order to achieve such goal 
     with respect to the indicator or metric.
       (e) Annual Status Update.--Not later than one year after 
     the date of enactment of this Act, the Secretary shall make 
     available on the Internet website of the Department of Health 
     and Human Services, and submit to the Committee on Health, 
     Education, Labor, and Pensions of the Senate and the 
     Committee on Energy and Commerce of the House of 
     Representatives, an update on the progress, including 
     expected progress in the subsequent year, in achieving the 
     goals detailed in the national milestones. Each such update 
     shall include the progress made in the first year or since 
     the previous report, as applicable, in meeting each indicator 
     or metric in the national milestones.

     SEC. 7024. STUDY ON PRESCRIBING LIMITS.

       Not later than 2 years after the date of enactment of this 
     Act, the Secretary of Health and Human Services, in 
     consultation with the Attorney General of the United States, 
     shall submit to the Committee on Health, Education, Labor, 
     and Pensions of the Senate and the Committee on Energy and 
     Commerce of the House of Representatives a report on the 
     impact of Federal and State laws and regulations that limit 
     the length, quantity, or dosage of opioid prescriptions. Such 
     report shall address--
       (1) the impact of such limits on--
       (A) the incidence and prevalence of overdose related to 
     prescription opioids;
       (B) the incidence and prevalence of overdose related to 
     illicit opioids;
       (C) the prevalence of opioid use disorders;
       (D) medically appropriate use of, and access to, opioids, 
     including any impact on travel expenses and pain management 
     outcomes for patients, whether such limits are associated 
     with significantly higher rates of negative health outcomes, 
     including suicide, and whether the impact of such limits 
     differs based on the clinical indication for which opioids 
     are prescribed;
       (2) whether such limits lead to a significant increase in 
     burden for prescribers of

[[Page H9208]]

     opioids or prescribers of treatments for opioid use disorder, 
     including any impact on patient access to treatment, and 
     whether any such burden is mitigated by any factors such as 
     electronic prescribing or telemedicine; and
       (3) the impact of such limits on diversion or misuse of any 
     controlled substance in schedule II, III, or IV of section 
     202(c) of the Controlled Substances Act (21 U.S.C. 812(c)).

          Subtitle D--Ensuring Access to Quality Sober Living

     SEC. 7031. NATIONAL RECOVERY HOUSING BEST PRACTICES.

       Part D of title V of the Public Health Service Act (42 
     U.S.C. 290dd et seq.) is amended by adding at the end the 
     following new section:

     ``SEC. 550. NATIONAL RECOVERY HOUSING BEST PRACTICES.

       ``(a) Best Practices for Operating Recovery Housing.--
       ``(1) In general.--The Secretary, in consultation with the 
     individuals and entities specified in paragraph (2), shall 
     identify or facilitate the development of best practices, 
     which may include model laws for implementing suggested 
     minimum standards, for operating recovery housing.
       ``(2) Consultation.--In carrying out the activities 
     described in paragraph (1), the Secretary shall consult with, 
     as appropriate--
       ``(A) relevant divisions of the Department of Health and 
     Human Services, including the Substance Abuse and Mental 
     Health Services Administration, the Office of Inspector 
     General, the Indian Health Service, and the Centers for 
     Medicare & Medicaid Services;
       ``(B) the Secretary of Housing and Urban Development;
       ``(C) directors or commissioners, as applicable, of State 
     health departments, tribal health departments, State Medicaid 
     programs, and State insurance agencies;
       ``(D) representatives of health insurance issuers;
       ``(E) national accrediting entities and reputable providers 
     of, and analysts of, recovery housing services, including 
     Indian tribes, tribal organizations, and tribally designated 
     housing entities that provide recovery housing services, as 
     applicable;
       ``(F) individuals with a history of substance use disorder; 
     and
       ``(G) other stakeholders identified by the Secretary.
       ``(b) Identification of Fraudulent Recovery Housing 
     Operators.--
       ``(1) In general.--The Secretary, in consultation with the 
     individuals and entities described in paragraph (2), shall 
     identify or facilitate the development of common indicators 
     that could be used to identify potentially fraudulent 
     recovery housing operators.
       ``(2) Consultation.--In carrying out the activities 
     described in paragraph (1), the Secretary shall consult with, 
     as appropriate, the individuals and entities specified in 
     subsection (a)(2) and the Attorney General of the United 
     States.
       ``(3) Requirements.--
       ``(A) Practices for identification and reporting.--In 
     carrying out the activities described in paragraph (1), the 
     Secretary shall consider how law enforcement, public and 
     private payers, and the public can best identify and report 
     fraudulent recovery housing operators.
       ``(B) Factors to be considered.--In carrying out the 
     activities described in paragraph (1), the Secretary shall 
     identify or develop indicators, which may include indicators 
     related to--
       ``(i) unusual billing practices;
       ``(ii) average lengths of stays;
       ``(iii) excessive levels of drug testing (in terms of cost 
     or frequency); and
       ``(iv) unusually high levels of recidivism.
       ``(c) Dissemination.--The Secretary shall, as appropriate, 
     disseminate the best practices identified or developed under 
     subsection (a) and the common indicators identified or 
     developed under subsection (b) to--
       ``(1) State agencies, which may include the provision of 
     technical assistance to State agencies seeking to adopt or 
     implement such best practices;
       ``(2) Indian tribes, tribal organizations, and tribally 
     designated housing entities;
       ``(3) the Attorney General of the United States;
       ``(4) the Secretary of Labor;
       ``(5) the Secretary of Housing and Urban Development;
       ``(6) State and local law enforcement agencies;
       ``(7) health insurance issuers;
       ``(8) recovery housing entities; and
       ``(9) the public.
       ``(d) Requirements.--In carrying out the activities 
     described in subsections (a) and (b), the Secretary, in 
     consultation with appropriate individuals and entities 
     described in subsections (a)(2) and (b)(2), shall consider 
     how recovery housing is able to support recovery and prevent 
     relapse, recidivism, or overdose (including overdose death), 
     including by improving access and adherence to treatment, 
     including medication-assisted treatment.
       ``(e) Rule of Construction.--Nothing in this section shall 
     be construed to provide the Secretary with the authority to 
     require States to adhere to minimum standards in the State 
     oversight of recovery housing.
       ``(f) Definitions.--In this section:
       ``(1) The term `recovery housing' means a shared living 
     environment free from alcohol and illicit drug use and 
     centered on peer support and connection to services that 
     promote sustained recovery from substance use disorders.
       ``(2) The terms `Indian tribe' and `tribal organization' 
     have the meanings given those terms in section 4 of the 
     Indian Self-Determination and Education Assistance Act (25 
     U.S.C. 5304).
       ``(3) The term `tribally designated housing entity' has the 
     meaning given that term in section 4 of the Native American 
     Housing Assistance and Self-Determination Act of 1996 (25 
     U.S.C. 4103).
       ``(g) Authorization of Appropriations.--To carry out this 
     section, there is authorized to be appropriated $3,000,000 
     for the period of fiscal years 2019 through 2021.''.

              Subtitle E--Advancing Cutting Edge Research

     SEC. 7041. UNIQUE RESEARCH INITIATIVES.

       Section 402(n)(1) of the Public Health Service Act (42 
     U.S.C. 282(n)(1)) is amended--
       (1) in subparagraph (A), by striking ``or'';
       (2) in subparagraph (B), by striking the period and 
     inserting ``; or''; and
       (3) by adding at the end the following:
       ``(C) high impact cutting-edge research that fosters 
     scientific creativity and increases fundamental biological 
     understanding leading to the prevention, diagnosis, or 
     treatment of diseases and disorders, or research urgently 
     required to respond to a public health threat.''.

     SEC. 7042. PAIN RESEARCH.

       Section 409J(b) of the Public Health Service Act (42 U.S.C. 
     284q(b)) is amended--
       (1) in paragraph (5)--
       (A) in subparagraph (A), by striking ``and treatment of 
     pain and diseases and disorders associated with pain'' and 
     inserting ``treatment, and management of pain and diseases 
     and disorders associated with pain, including information on 
     best practices for the utilization of non-pharmacologic 
     treatments, non-addictive medical products, and other drugs 
     or devices approved or cleared by the Food and Drug 
     Administration'';
       (B) in subparagraph (B), by striking ``on the symptoms and 
     causes of pain;'' and inserting the following: ``on--
       ``(i) the symptoms and causes of pain, including the 
     identification of relevant biomarkers and screening models 
     and the epidemiology of acute and chronic pain;
       ``(ii) the diagnosis, prevention, treatment, and management 
     of acute and chronic pain, including with respect to non-
     pharmacologic treatments, non-addictive medical products, and 
     other drugs or devices approved or cleared by the Food and 
     Drug Administration; and
       ``(iii) risk factors for, and early warning signs of, 
     substance use disorders in populations with acute and chronic 
     pain; and''; and
       (C) by striking subparagraphs (C) through (E) and inserting 
     the following:
       ``(C) make recommendations to the Director of NIH--
       ``(i) to ensure that the activities of the National 
     Institutes of Health and other Federal agencies are free of 
     unnecessary duplication of effort;
       ``(ii) on how best to disseminate information on pain care 
     and epidemiological data related to acute and chronic pain; 
     and
       ``(iii) on how to expand partnerships between public 
     entities and private entities to expand collaborative, cross-
     cutting research.'';
       (2) by redesignating paragraph (6) as paragraph (7); and
       (3) by inserting after paragraph (5) the following:
       ``(6) Report.--The Secretary shall ensure that 
     recommendations and actions taken by the Director with 
     respect to the topics discussed at the meetings described in 
     paragraph (4) are included in appropriate reports to 
     Congress.''.

                        Subtitle F--Jessie's Law

     SEC. 7051. INCLUSION OF OPIOID ADDICTION HISTORY IN PATIENT 
                   RECORDS.

       (a) Best Practices.--
       (1) In general.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services (in this section referred to as the ``Secretary''), 
     in consultation with appropriate stakeholders, including a 
     patient with a history of opioid use disorder, an expert in 
     electronic health records, an expert in the confidentiality 
     of patient health information and records, and a health care 
     provider, shall identify or facilitate the development of 
     best practices regarding--
       (A) the circumstances under which information that a 
     patient has provided to a health care provider regarding such 
     patient's history of opioid use disorder should, only at the 
     patient's request, be prominently displayed in the medical 
     records (including electronic health records) of such 
     patient;
       (B) what constitutes the patient's request for the purpose 
     described in subparagraph (A); and
       (C) the process and methods by which the information should 
     be so displayed.
       (2) Dissemination.--The Secretary shall disseminate the 
     best practices developed under paragraph (1) to health care 
     providers and State agencies.
       (b) Requirements.--In identifying or facilitating the 
     development of best practices under subsection (a), as 
     applicable, the Secretary, in consultation with appropriate 
     stakeholders, shall consider the following:
       (1) The potential for addiction relapse or overdose, 
     including overdose death, when opioid medications are 
     prescribed to a patient recovering from opioid use disorder.
       (2) The benefits of displaying information about a 
     patient's opioid use disorder history

[[Page H9209]]

     in a manner similar to other potentially lethal medical 
     concerns, including drug allergies and contraindications.
       (3) The importance of prominently displaying information 
     about a patient's opioid use disorder when a physician or 
     medical professional is prescribing medication, including 
     methods for avoiding alert fatigue in providers.
       (4) The importance of a variety of appropriate medical 
     professionals, including physicians, nurses, and pharmacists, 
     having access to information described in this section when 
     prescribing or dispensing opioid medication, consistent with 
     Federal and State laws and regulations.
       (5) The importance of protecting patient privacy, including 
     the requirements related to consent for disclosure of 
     substance use disorder information under all applicable laws 
     and regulations.
       (6) All applicable Federal and State laws and regulations.

     SEC. 7052. COMMUNICATION WITH FAMILIES DURING EMERGENCIES.

       (a)  Promoting Awareness of Authorized Disclosures During 
     Emergencies.--The Secretary of Health and Human Services 
     shall annually notify health care providers regarding 
     permitted disclosures under Federal health care privacy law 
     during emergencies, including overdoses, of certain health 
     information to families, caregivers, and health care 
     providers.
       (b) Use of Material.--For the purposes of carrying out 
     subsection (a), the Secretary of Health and Human Services 
     may use material produced under section 7053 of this Act or 
     section 11004 of the 21st Century Cures Act (42 U.S.C. 1320d-
     2 note).

     SEC. 7053. DEVELOPMENT AND DISSEMINATION OF MODEL TRAINING 
                   PROGRAMS FOR SUBSTANCE USE DISORDER PATIENT 
                   RECORDS.

       (a) Initial Programs and Materials.--Not later than 1 year 
     after the date of the enactment of this Act, the Secretary of 
     Health and Human Services (in this section referred to as the 
     ``Secretary''), in consultation with appropriate experts, 
     shall identify the following model programs and materials (or 
     if no such programs or materials exist, recognize private or 
     public entities to develop and disseminate such programs and 
     materials):
       (1) Model programs and materials for training health care 
     providers (including physicians, emergency medical personnel, 
     psychiatrists, psychologists, counselors, therapists, nurse 
     practitioners, physician assistants, behavioral health 
     facilities and clinics, care managers, and hospitals, 
     including individuals such as general counsels or regulatory 
     compliance staff who are responsible for establishing 
     provider privacy policies) concerning the permitted uses and 
     disclosures, consistent with the standards and regulations 
     governing the privacy and security of substance use disorder 
     patient records promulgated by the Secretary under section 
     543 of the Public Health Service Act (42 U.S.C. 290dd-2) for 
     the confidentiality of patient records.
       (2) Model programs and materials for training patients and 
     their families regarding their rights to protect and obtain 
     information under the standards and regulations described in 
     paragraph (1).
       (b) Requirements.--The model programs and materials 
     described in paragraphs (1) and (2) of subsection (a) shall 
     address circumstances under which disclosure of substance use 
     disorder patient records is needed to--
       (1) facilitate communication between substance use disorder 
     treatment providers and other health care providers to 
     promote and provide the best possible integrated care;
       (2) avoid inappropriate prescribing that can lead to 
     dangerous drug interactions, overdose, or relapse; and
       (3) notify and involve families and caregivers when 
     individuals experience an overdose.
       (c) Periodic Updates.--The Secretary shall--
       (1) periodically review and update the model program and 
     materials identified or developed under subsection (a); and
       (2) disseminate such updated programs and materials to the 
     individuals described in subsection (a)(1).
       (d) Input of Certain Entities.--In identifying, reviewing, 
     or updating the model programs and materials under this 
     section, the Secretary shall solicit the input of relevant 
     stakeholders.
       (e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section--
       (1) $4,000,000 for fiscal year 2019;
       (2) $2,000,000 for each of fiscal years 2020 and 2021; and
       (3) $1,000,000 for each of fiscal years 2022 and 2023.

           Subtitle G--Protecting Pregnant Women and Infants

     SEC. 7061. REPORT ON ADDRESSING MATERNAL AND INFANT HEALTH IN 
                   THE OPIOID CRISIS.

       (a) In General.--Not later than 18 months after the date of 
     the enactment of this Act, the Secretary of Health and Human 
     Services, in coordination with the Centers for Disease 
     Control and Prevention, the National Institutes of Health, 
     the Indian Health Service, and the Substance Abuse and Mental 
     Health Services Administration, shall develop and submit to 
     the Committee on Health, Education, Labor, and Pensions of 
     the Senate and the Committee on Energy and Commerce of the 
     House of Representatives a report that includes--
       (1) information on opioid, non-opioid, and non-
     pharmacologic pain management practices during pregnancy and 
     after pregnancy;
       (2) recommendations for increasing public awareness and 
     education about substance use disorders, including opioid use 
     disorders, during and after pregnancy, including available 
     treatment resources in urban and rural areas;
       (3) recommendations to prevent, identify, and reduce 
     substance use disorders, including opioid use disorders, 
     during pregnancy to improve care for pregnant women with 
     substance use disorders and their infants; and
       (4) an identification of areas in need of further research 
     with respect to acute and chronic pain management during and 
     after pregnancy.
       (b) No Additional Funds.--No additional funds are 
     authorized to be appropriated for purposes of carrying out 
     subsection (a).

     SEC. 7062. PROTECTING MOMS AND INFANTS.

       (a) Report.--
       (1) In general.--Not later than 60 days after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services (referred to in this section as the ``Secretary'') 
     shall submit to the Committee on Health, Education, Labor, 
     and Pensions of the Senate and the Committee on Energy and 
     Commerce of the House of Representatives, and make available 
     to the public on the Internet website of the Department of 
     Health and Human Services, a report regarding the 
     implementation of the recommendations in the strategy 
     relating to prenatal opioid use, including neonatal 
     abstinence syndrome, developed pursuant to section 2 of the 
     Protecting Our Infants Act of 2015 (Public Law 114-91). Such 
     report shall include--
       (A) an update on the implementation of the recommendations 
     in the strategy, including information regarding the agencies 
     involved in the implementation; and
       (B) information on additional funding or authority the 
     Secretary requires, if any, to implement the strategy, which 
     may include authorities needed to coordinate implementation 
     of such strategy across the Department of Health and Human 
     Services.
       (2) Periodic updates.--The Secretary shall periodically 
     update the report under paragraph (1).
       (b) Residential Treatment Programs for Pregnant and 
     Postpartum Women.--Section 508(s) of the Public Health 
     Service Act (42 U.S.C. 290bb-1(s)) is amended by striking 
     ``$16,900,000 for each of fiscal years 2017 through 2021'' 
     and inserting ``$29,931,000 for each of fiscal years 2019 
     through 2023''.

     SEC. 7063. EARLY INTERVENTIONS FOR PREGNANT WOMEN AND 
                   INFANTS.

       (a) Development of Educational Materials by Center for 
     Substance Abuse Prevention.--Section 515(b) of the Public 
     Health Service Act (42 U.S.C. 290bb-21(b)) is amended--
       (1) in paragraph (13), by striking ``and'' at the end;
       (2) in paragraph (14), by striking the period at the end 
     and inserting ``; and''; and
       (3) by adding at the end the following:
       ``(15) in consultation with relevant stakeholders and in 
     collaboration with the Director of the Centers for Disease 
     Control and Prevention, develop educational materials for 
     clinicians to use with pregnant women for shared decision 
     making regarding pain management and the prevention of 
     substance use disorders during pregnancy.''.
       (b) Guidelines and Recommendations by Center for Substance 
     Abuse Treatment.--Section 507(b) of the Public Health Service 
     Act (42 U.S.C. 290bb(b)) is amended--
       (1) in paragraph (13), by striking ``and'' at the end;
       (2) in paragraph (14), by striking the period at the end 
     and inserting a semicolon; and
       (3) by adding at the end the following:
       ``(15) in cooperation with the Secretary, implement and 
     disseminate, as appropriate, the recommendations in the 
     report entitled `Protecting Our Infants Act: Final Strategy' 
     issued by the Department of Health and Human Services in 
     2017; and''.
       (c) Support of Partnerships by Center for Substance Abuse 
     Treatment.--Section 507(b) of the Public Health Service Act 
     (42 U.S.C. 290bb(b)), as amended by subsection (b), is 
     further amended by adding at the end the following:
       ``(16) in cooperation with relevant stakeholders, and 
     through public-private partnerships, encourage education 
     about substance use disorders for pregnant women and health 
     care providers who treat pregnant women and babies.''.

     SEC. 7064. PRENATAL AND POSTNATAL HEALTH.

       Section 317L of the Public Health Service Act (42 U.S.C. 
     247b-13) is amended--
       (1) in subsection (a)--
       (A) by amending paragraph (1) to read as follows:
       ``(1) to collect, analyze, and make available data on 
     prenatal smoking and alcohol and other substance abuse and 
     misuse, including--
       ``(A) data on--
       ``(i) the incidence, prevalence, and implications of such 
     activities; and
       ``(ii) the incidence and prevalence of implications and 
     outcomes, including neonatal abstinence syndrome and other 
     maternal and child health outcomes associated with such 
     activities; and
       ``(B) additional information or data, as appropriate, on 
     family health history, medication exposures during pregnancy, 
     demographic information, such as race, ethnicity,

[[Page H9210]]

     geographic location, and family history, and other relevant 
     information, to inform such analysis;'';
       (B) in paragraph (2)--
       (i) by striking ``prevention of'' and inserting 
     ``prevention and long-term outcomes associated with''; and
       (ii) by striking ``illegal drug use'' and inserting ``other 
     substance abuse and misuse'';
       (C) in paragraph (3), by striking ``and cessation programs; 
     and'' and inserting ``, treatment, and cessation programs;'';
       (D) in paragraph (4), by striking ``illegal drug use.'' and 
     inserting ``other substance abuse and misuse; and''; and
       (E) by adding at the end the following:
       ``(5) to issue public reports on the analysis of data 
     described in paragraph (1), including analysis of--
       ``(A) long-term outcomes of children affected by neonatal 
     abstinence syndrome;
       ``(B) health outcomes associated with prenatal smoking, 
     alcohol, and substance abuse and misuse; and
       ``(C) relevant studies, evaluations, or information the 
     Secretary determines to be appropriate.'';
       (2) in subsection (b), by inserting ``tribal entities,'' 
     after ``local governments,'';
       (3) by redesignating subsection (c) as subsection (d);
       (4) by inserting after subsection (b) the following:
       ``(c) Coordinating Activities.--To carry out this section, 
     the Secretary may--
       ``(1) provide technical and consultative assistance to 
     entities receiving grants under subsection (b);
       ``(2) ensure a pathway for data sharing between States, 
     tribal entities, and the Centers for Disease Control and 
     Prevention;
       ``(3) ensure data collection under this section is 
     consistent with applicable State, Federal, and Tribal privacy 
     laws; and
       ``(4) coordinate with the National Coordinator for Health 
     Information Technology, as appropriate, to assist States and 
     Tribes in implementing systems that use standards recognized 
     by such National Coordinator, as such recognized standards 
     are available, in order to facilitate interoperability 
     between such systems and health information technology 
     systems, including certified health information 
     technology.''; and
       (5) in subsection (d), as so redesignated, by striking 
     ``2001 through 2005'' and inserting ``2019 through 2023''.

     SEC. 7065. PLANS OF SAFE CARE.

       (a) In General.--Section 105(a) of the Child Abuse 
     Prevention and Treatment Act (42 U.S.C. 5106(a)) is amended 
     by adding at the end the following:
       ``(7) Grants to states to improve and coordinate their 
     response to ensure the safety, permanency, and well-being of 
     infants affected by substance use.--
       ``(A) Program authorized.--The Secretary is authorized to 
     make grants to States for the purpose of assisting child 
     welfare agencies, social services agencies, substance use 
     disorder treatment agencies, hospitals with labor and 
     delivery units, medical staff, public health and mental 
     health agencies, and maternal and child health agencies to 
     facilitate collaboration in developing, updating, 
     implementing, and monitoring plans of safe care described in 
     section 106(b)(2)(B)(iii). Section 112(a)(2) shall not apply 
     to the program authorized under this paragraph.
       ``(B) Distribution of funds.--
       ``(i) Reservations.--Of the amounts made available to carry 
     out subparagraph (A), the Secretary shall reserve--

       ``(I) no more than 3 percent for the purposes described in 
     subparagraph (G); and
       ``(II) up to 3 percent for grants to Indian Tribes and 
     tribal organizations to address the needs of infants born 
     with, and identified as being affected by, substance abuse or 
     withdrawal symptoms resulting from prenatal drug exposure or 
     a fetal alcohol spectrum disorder and their families or 
     caregivers, which to the extent practicable, shall be 
     consistent with the uses of funds described under 
     subparagraph (D).

       ``(ii) Allotments to states and territories.--The Secretary 
     shall allot the amount made available to carry out 
     subparagraph (A) that remains after application of clause (i) 
     to each State that applies for such a grant, in an amount 
     equal to the sum of--

       ``(I) $500,000; and
       ``(II) an amount that bears the same relationship to any 
     funds made available to carry out subparagraph (A) and 
     remaining after application of clause (i), as the number of 
     live births in the State in the previous calendar year bears 
     to the number of live births in all States in such year.

       ``(iii) Ratable reduction.--If the amount made available to 
     carry out subparagraph (A) is insufficient to satisfy the 
     requirements of clause (ii), the Secretary shall ratably 
     reduce each allotment to a State.
       ``(C) Application.--A State desiring a grant under this 
     paragraph shall submit an application to the Secretary at 
     such time and in such manner as the Secretary may require. 
     Such application shall include--
       ``(i) a description of--

       ``(I) the impact of substance use disorder in such State, 
     including with respect to the substance or class of 
     substances with the highest incidence of abuse in the 
     previous year in such State, including--

       ``(aa) the prevalence of substance use disorder in such 
     State;
       ``(bb) the aggregate rate of births in the State of infants 
     affected by substance abuse or withdrawal symptoms or a fetal 
     alcohol spectrum disorder (as determined by hospitals, 
     insurance claims, claims submitted to the State Medicaid 
     program, or other records), if available and to the extent 
     practicable; and
       ``(cc) the number of infants identified, for whom a plan of 
     safe care was developed, and for whom a referral was made for 
     appropriate services, as reported under section 106(d)(18);

       ``(II) the challenges the State faces in developing, 
     implementing, and monitoring plans of safe care in accordance 
     with section 106(b)(2)(B)(iii);
       ``(III) the State's lead agency for the grant program and 
     how that agency will coordinate with relevant State entities 
     and programs, including the child welfare agency, the 
     substance use disorder treatment agency, hospitals with labor 
     and delivery units, health care providers, the public health 
     and mental health agencies, programs funded by the Substance 
     Abuse and Mental Health Services Administration that provide 
     substance use disorder treatment for women, the State 
     Medicaid program, the State agency administering the block 
     grant program under title V of the Social Security Act (42 
     U.S.C. 701 et seq.), the State agency administering the 
     programs funded under part C of the Individuals with 
     Disabilities Education Act (20 U.S.C. 1431 et seq.), the 
     maternal, infant, and early childhood home visiting program 
     under section 511 of the Social Security Act (42 U.S.C. 711), 
     the State judicial system, and other agencies, as determined 
     by the Secretary, and Indian Tribes and tribal organizations, 
     as appropriate, to implement the activities under this 
     paragraph;
       ``(IV) how the State will monitor local development and 
     implementation of plans of safe care, in accordance with 
     section 106(b)(2)(B)(iii)(II), including how the State will 
     monitor to ensure plans of safe care address differences 
     between substance use disorder and medically supervised 
     substance use, including for the treatment of a substance use 
     disorder;
       ``(V) if applicable, how the State plans to utilize funding 
     authorized under part E of title IV of the Social Security 
     Act (42 U.S.C. 670 et seq.) to assist in carrying out any 
     plan of safe care, including such funding authorized under 
     section 471(e) of such Act (as in effect on October 1, 2018) 
     for mental health and substance abuse prevention and 
     treatment services and in-home parent skill-based programs 
     and funding authorized under such section 472(j) (as in 
     effect on October 1, 2018) for children with a parent in a 
     licensed residential family-based treatment facility for 
     substance abuse; and
       ``(VI) an assessment of the treatment and other services 
     and programs available in the State to effectively carry out 
     any plan of safe care developed, including identification of 
     needed treatment, and other services and programs to ensure 
     the well-being of young children and their families affected 
     by substance use disorder, such as programs carried out under 
     part C of the Individuals with Disabilities Education Act (20 
     U.S.C. 1431 et seq.) and comprehensive early childhood 
     development services and programs such as Head Start 
     programs;

       ``(ii) a description of how the State plans to use funds 
     for activities described in subparagraph (D) for the purposes 
     of ensuring State compliance with requirements under clauses 
     (ii) and (iii) of section 106(b)(2)(B); and
       ``(iii) an assurance that the State will comply with 
     requirements to refer a child identified as substance-exposed 
     to early intervention services as required pursuant to a 
     grant under part C of the Individuals with Disabilities 
     Education Act (20 U.S.C. 1431 et seq.).
       ``(D) Uses of funds.--Funds awarded to a State under this 
     paragraph may be used for the following activities, which may 
     be carried out by the State directly, or through grants or 
     subgrants, contracts, or cooperative agreements:
       ``(i) Improving State and local systems with respect to the 
     development and implementation of plans of safe care, which--

       ``(I) shall include parent and caregiver engagement, as 
     required under section 106(b)(2)(B)(iii)(I), regarding 
     available treatment and service options, which may include 
     resources available for pregnant, perinatal, and postnatal 
     women; and
       ``(II) may include activities such as--

       ``(aa) developing policies, procedures, or protocols for 
     the administration or development of evidence-based and 
     validated screening tools for infants who may be affected by 
     substance use withdrawal symptoms or a fetal alcohol spectrum 
     disorder and pregnant, perinatal, and postnatal women whose 
     infants may be affected by substance use withdrawal symptoms 
     or a fetal alcohol spectrum disorder;
       ``(bb) improving assessments used to determine the needs of 
     the infant and family;
       ``(cc) improving ongoing case management services;
       ``(dd) improving access to treatment services, which may be 
     prior to the pregnant woman's delivery date; and
       ``(ee) keeping families safely together when it is in the 
     best interest of the child.
       ``(ii) Developing policies, procedures, or protocols in 
     consultation and coordination with health professionals, 
     public and private health facilities, and substance use 
     disorder treatment agencies to ensure that--

       ``(I) appropriate notification to child protective services 
     is made in a timely manner, as required under section 
     106(b)(2)(B)(ii);
       ``(II) a plan of safe care is in place, in accordance with 
     section 106(b)(2)(B)(iii), before the infant is discharged 
     from the birth or health care facility; and

[[Page H9211]]

       ``(III) such health and related agency professionals are 
     trained on how to follow such protocols and are aware of the 
     supports that may be provided under a plan of safe care.

       ``(iii) Training health professionals and health system 
     leaders, child welfare workers, substance use disorder 
     treatment agencies, and other related professionals such as 
     home visiting agency staff and law enforcement in relevant 
     topics including--

       ``(I) State mandatory reporting laws established under 
     section 106(b)(2)(B)(i) and the referral and process 
     requirements for notification to child protective services 
     when child abuse or neglect reporting is not mandated;
       ``(II) the co-occurrence of pregnancy and substance use 
     disorder, and implications of prenatal exposure;
       ``(III) the clinical guidance about treating substance use 
     disorder in pregnant and postpartum women;
       ``(IV) appropriate screening and interventions for infants 
     affected by substance use disorder, withdrawal symptoms, or a 
     fetal alcohol spectrum disorder and the requirements under 
     section 106(b)(2)(B)(iii); and
       ``(V) appropriate multigenerational strategies to address 
     the mental health needs of the parent and child together.

       ``(iv) Establishing partnerships, agreements, or memoranda 
     of understanding between the lead agency and other entities 
     (including health professionals, health facilities, child 
     welfare professionals, juvenile and family court judges, 
     substance use and mental disorder treatment programs, early 
     childhood education programs, maternal and child health and 
     early intervention professionals (including home visiting 
     providers), peer-to-peer recovery programs such as parent 
     mentoring programs, and housing agencies) to facilitate the 
     implementation of, and compliance with, section 106(b)(2) and 
     clause (ii) of this subparagraph, in areas which may 
     include--

       ``(I) developing a comprehensive, multi-disciplinary 
     assessment and intervention process for infants, pregnant 
     women, and their families who are affected by substance use 
     disorder, withdrawal symptoms, or a fetal alcohol spectrum 
     disorder, that includes meaningful engagement with and takes 
     into account the unique needs of each family and addresses 
     differences between medically supervised substance use, 
     including for the treatment of substance use disorder, and 
     substance use disorder;
       ``(II) ensuring that treatment approaches for serving 
     infants, pregnant women, and perinatal and postnatal women 
     whose infants may be affected by substance use, withdrawal 
     symptoms, or a fetal alcohol spectrum disorder, are designed 
     to, where appropriate, keep infants with their mothers during 
     both inpatient and outpatient treatment; and
       ``(III) increasing access to all evidence-based medication-
     assisted treatment approved by the Food and Drug 
     Administration, behavioral therapy, and counseling services 
     for the treatment of substance use disorders, as appropriate.

       ``(v) Developing and updating systems of technology for 
     improved data collection and monitoring under section 
     106(b)(2)(B)(iii), including existing electronic medical 
     records, to measure the outcomes achieved through the plans 
     of safe care, including monitoring systems to meet the 
     requirements of this Act and submission of performance 
     measures.
       ``(E) Reporting.--Each State that receives funds under this 
     paragraph, for each year such funds are received, shall 
     submit a report to the Secretary, disaggregated by geographic 
     location, economic status, and major racial and ethnic 
     groups, except that such disaggregation shall not be required 
     if the results would reveal personally identifiable 
     information on, with respect to infants identified under 
     section 106(b)(2)(B)(ii)--
       ``(i) the number who experienced removal associated with 
     parental substance use;
       ``(ii) the number who experienced removal and subsequently 
     are reunified with parents, and the length of time between 
     such removal and reunification;
       ``(iii) the number who are referred to community providers 
     without a child protection case;
       ``(iv) the number who receive services while in the care of 
     their birth parents;
       ``(v) the number who receive post-reunification services 
     within 1 year after a reunification has occurred; and
       ``(vi) the number who experienced a return to out-of-home 
     care within 1 year after reunification.
       ``(F) Secretary's report to congress.--The Secretary shall 
     submit an annual report to the Committee on Health, 
     Education, Labor, and Pensions and the Committee on 
     Appropriations of the Senate and the Committee on Education 
     and the Workforce and the Committee on Appropriations of the 
     House of Representatives that includes the information 
     described in subparagraph (E) and recommendations or 
     observations on the challenges, successes, and lessons 
     derived from implementation of the grant program.
       ``(G) Assisting states' implementation.--The Secretary 
     shall use the amount reserved under subparagraph (B)(i)(I) to 
     provide written guidance and technical assistance to support 
     States in complying with and implementing this paragraph, 
     which shall include--
       ``(i) technical assistance, including programs of in-depth 
     technical assistance, to additional States, territories, and 
     Indian Tribes and tribal organizations in accordance with the 
     substance-exposed infant initiative developed by the National 
     Center on Substance Abuse and Child Welfare;
       ``(ii) guidance on the requirements of this Act with 
     respect to infants born with and identified as being affected 
     by substance use or withdrawal symptoms or fetal alcohol 
     spectrum disorder, as described in clauses (ii) and (iii) of 
     section 106(b)(2)(B), including by--

       ``(I) enhancing States' understanding of requirements and 
     flexibilities under the law, including by clarifying key 
     terms;
       ``(II) addressing state-identified challenges with 
     developing, implementing, and monitoring plans of safe care, 
     including those reported under subparagraph (C)(i)(II);
       ``(III) disseminating best practices on implementation of 
     plans of safe care, on such topics as differential response, 
     collaboration and coordination, and identification and 
     delivery of services for different populations, while 
     recognizing needs of different populations and varying 
     community approaches across States; and
       ``(IV) helping States improve the long-term safety and 
     well-being of young children and their families;

       ``(iii) supporting State efforts to develop information 
     technology systems to manage plans of safe care; and
       ``(iv) preparing the Secretary's report to Congress 
     described in subparagraph (F).
       ``(H) Sunset.--The authority under this paragraph shall 
     sunset on September 30, 2023.''.
       (b) Repeal.--The Abandoned Infants Assistance Act of 1988 
     (42 U.S.C. 5117aa et seq.) is repealed.

         Subtitle H--Substance Use Disorder Treatment Workforce

     SEC. 7071. LOAN REPAYMENT PROGRAM FOR SUBSTANCE USE DISORDER 
                   TREATMENT WORKFORCE.

       Title VII of the Public Health Service Act is amended--
       (1) by redesignating part F as part G; and
       (2) by inserting after part E (42 U.S.C. 294n et seq.) the 
     following:

          ``PART F--SUBSTANCE USE DISORDER TREATMENT WORKFORCE

     ``SEC. 781. LOAN REPAYMENT PROGRAM FOR SUBSTANCE USE DISORDER 
                   TREATMENT WORKFORCE.

       ``(a) In General.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, shall carry out a program under which--
       ``(1) the Secretary enters into agreements with individuals 
     to make payments in accordance with subsection (b) on the 
     principal of and interest on any eligible loan; and
       ``(2) the individuals each agree to the requirements of 
     service in substance use disorder treatment employment, as 
     described in subsection (d).
       ``(b) Payments.--For each year of obligated service by an 
     individual pursuant to an agreement under subsection (a), the 
     Secretary shall make a payment to such individual as follows:
       ``(1) Service in a shortage area.--The Secretary shall 
     pay--
       ``(A) for each year of obligated service by an individual 
     pursuant to an agreement under subsection (a), \1/6\ of the 
     principal of and interest on each eligible loan of the 
     individual which is outstanding on the date the individual 
     began service pursuant to the agreement; and
       ``(B) for completion of the sixth and final year of such 
     service, the remainder of such principal and interest.
       ``(2) Maximum amount.--The total amount of payments under 
     this section to any individual shall not exceed $250,000.
       ``(c) Eligible Loans.--The loans eligible for repayment 
     under this section are each of the following:
       ``(1) Any loan for education or training for a substance 
     use disorder treatment employment.
       ``(2) Any loan under part E of title VIII (relating to 
     nursing student loans).
       ``(3) Any Federal Direct Stafford Loan, Federal Direct PLUS 
     Loan, Federal Direct Unsubsidized Stafford Loan, or Federal 
     Direct Consolidation Loan (as such terms are used in section 
     455 of the Higher Education Act of 1965).
       ``(4) Any Federal Perkins Loan under part E of title I of 
     the Higher Education Act of 1965.
       ``(5) Any other Federal loan as determined appropriate by 
     the Secretary.
       ``(d) Requirements of Service.--Any individual receiving 
     payments under this program as required by an agreement under 
     subsection (a) shall agree to an annual commitment to full-
     time employment, with no more than 1 year passing between any 
     2 years of covered employment, in substance use disorder 
     treatment employment in the United States in--
       ``(1) a Mental Health Professional Shortage Area, as 
     designated under section 332; or
       ``(2) a county (or a municipality, if not contained within 
     any county) where the mean drug overdose death rate per 
     100,000 people over the past 3 years for which official data 
     is available from the State, is higher than the most recent 
     available national average overdose death rate per 100,000 
     people, as reported by the Centers for Disease Control and 
     Prevention.

[[Page H9212]]

       ``(e) Ineligibility for Double Benefits.--No borrower may, 
     for the same service, receive a reduction of loan obligations 
     or a loan repayment under both--
       ``(1) this section; and
       ``(2) any Federally supported loan forgiveness program, 
     including under section 338B, 338I, or 846 of this Act, or 
     section 428J, 428L, 455(m), or 460 of the Higher Education 
     Act of 1965.
       ``(f) Breach.--
       ``(1) Liquidated damages formula.--The Secretary may 
     establish a liquidated damages formula to be used in the 
     event of a breach of an agreement entered into under 
     subsection (a).
       ``(2) Limitation.--The failure by an individual to complete 
     the full period of service obligated pursuant to such an 
     agreement, taken alone, shall not constitute a breach of the 
     agreement, so long as the individual completed in good faith 
     the years of service for which payments were made to the 
     individual under this section.
       ``(g) Additional Criteria.--The Secretary--
       ``(1) may establish such criteria and rules to carry out 
     this section as the Secretary determines are needed and in 
     addition to the criteria and rules specified in this section; 
     and
       ``(2) shall give notice to the committees specified in 
     subsection (h) of any criteria and rules so established.
       ``(h) Report to Congress.--Not later than 5 years after the 
     date of enactment of this section, and every other year 
     thereafter, the Secretary shall prepare and submit to the 
     Committee on Energy and Commerce of the House of 
     Representatives and the Committee on Health, Education, 
     Labor, and Pensions of the Senate a report on--
       ``(1) the number and location of borrowers who have 
     qualified for loan repayments under this section; and
       ``(2) the impact of this section on the availability of 
     substance use disorder treatment employees nationally and in 
     shortage areas and counties described in subsection (d).
       ``(i) Definition.--In this section:
       ``(1) The terms `Indian tribe' and `tribal organization' 
     have the meanings given those terms in section 4 of the 
     Indian Self-Determination and Education Assistance Act.
       ``(2) The term `municipality' means a city, town, or other 
     public body created by or pursuant to State law, or an Indian 
     tribe.
       ``(3) The term `substance use disorder treatment 
     employment' means full-time employment (including a 
     fellowship)--
       ``(A) where the primary intent and function of the position 
     is the direct treatment or recovery support of patients with 
     or in recovery from a substance use disorder, including 
     master's level social workers, psychologists, counselors, 
     marriage and family therapists, psychiatric mental health 
     practitioners, occupational therapists, psychology doctoral 
     interns, and behavioral health paraprofessionals and 
     physicians, physician assistants, and nurses, who are 
     licensed or certified in accordance with applicable State and 
     Federal laws; and
       ``(B) which is located at a substance use disorder 
     treatment program, private physician practice, hospital or 
     health system-affiliated inpatient treatment center or 
     outpatient clinic (including an academic medical center-
     affiliated treatment program), correctional facility or 
     program, youth detention center or program, inpatient 
     psychiatric facility, crisis stabilization unit, community 
     health center, community mental health or other specialty 
     community behavioral health center, recovery center, school, 
     community-based organization, telehealth platform, migrant 
     health center, health program or facility operated by an 
     Indian tribe or tribal organization, Federal medical 
     facility, or any other facility as determined appropriate for 
     purposes of this section by the Secretary.
       ``(j) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $25,000,000 for each of fiscal years 2019 through 2023.''.

     SEC. 7072. CLARIFICATION REGARDING SERVICE IN SCHOOLS AND 
                   OTHER COMMUNITY-BASED SETTINGS.

       Subpart III of part D of title III of the Public Health 
     Service Act (42 U.S.C. 254l et seq.) is amended by adding at 
     the end the following:

     ``SEC. 338N. CLARIFICATION REGARDING SERVICE IN SCHOOLS AND 
                   OTHER COMMUNITY-BASED SETTINGS.

       ``(a) Schools and Community-based Settings.--An entity to 
     which a participant in the Scholarship Program or the Loan 
     Repayment Program (referred to in this section as a 
     `participant') is assigned under section 333 may direct such 
     participant to provide service as a behavioral or mental 
     health professional at a school or other community-based 
     setting located in a health professional shortage area.
       ``(b) Obligated Service.--
       ``(1) In general.--Any service described in subsection (a) 
     that a participant provides may count towards such 
     participant's completion of any obligated service 
     requirements under the Scholarship Program or the Loan 
     Repayment Program, subject to any limitation imposed under 
     paragraph (2).
       ``(2) Limitation.--The Secretary may impose a limitation on 
     the number of hours of service described in subsection (a) 
     that a participant may credit towards completing obligated 
     service requirements, provided that the limitation allows a 
     member to credit service described in subsection (a) for not 
     less than 50 percent of the total hours required to complete 
     such obligated service requirements.
       ``(c) Rule of Construction.--The authorization under 
     subsection (a) shall be notwithstanding any other provision 
     of this subpart or subpart II.''.

     SEC. 7073. PROGRAMS FOR HEALTH CARE WORKFORCE.

       (a) Program for Education and Training in Pain Care.--
     Section 759 of the Public Health Service Act (42 U.S.C. 294i) 
     is amended--
       (1) in subsection (a), by striking ``hospices, and other 
     public and private entities'' and inserting ``hospices, 
     tribal health programs (as defined in section 4 of the Indian 
     Health Care Improvement Act), and other public and nonprofit 
     private entities'';
       (2) in subsection (b)--
       (A) in the matter preceding paragraph (1), by striking 
     ``award may be made under subsection (a) only if the 
     applicant for the award agrees that the program carried out 
     with the award will include'' and inserting ``entity 
     receiving an award under this section shall develop a 
     comprehensive education and training plan that includes'';
       (B) in paragraph (1)--
       (i) by inserting ``preventing,'' after ``diagnosing,''; and
       (ii) by inserting ``non-addictive medical products and non-
     pharmacologic treatments and'' after ``including'';
       (C) in paragraph (2)--
       (i) by inserting ``Federal, State, and local'' after 
     ``applicable''; and
       (ii) by striking ``the degree to which'' and all that 
     follows through ``effective pain care'' and inserting 
     ``opioids'';
       (D) in paragraph (3), by inserting ``, integrated, 
     evidence-based pain management, and, as appropriate, non-
     pharmacotherapy'' before the semicolon;
       (E) in paragraph (4), by striking ``; and'' and inserting 
     ``;''; and
       (F) by striking paragraph (5) and inserting the following:
       ``(5) recent findings, developments, and advancements in 
     pain care research and the provision of pain care, which may 
     include non-addictive medical products and non-pharmacologic 
     treatments intended to treat pain; and
       ``(6) the dangers of opioid abuse and misuse, detection of 
     early warning signs of opioid use disorders (which may 
     include best practices related to screening for opioid use 
     disorders, training on screening, brief intervention, and 
     referral to treatment), and safe disposal options for 
     prescription medications (including such options provided by 
     law enforcement or other innovative deactivation 
     mechanisms).'';
       (3) in subsection (d), by inserting ``prevention,'' after 
     ``diagnosis,''; and
       (4) in subsection (e), by striking ``2010 through 2012'' 
     and inserting ``2019 through 2023''.
       (b) Mental and Behavioral Health Education and Training 
     Program.--Section 756 of the Public Health Service Act (42 
     U.S.C. 294e-1) is amended--
       (1) in subsection (a)--
       (A) in paragraph (1), by inserting ``, trauma,'' after 
     ``focus on child and adolescent mental health''; and
       (B) in paragraphs (2) and (3), by inserting ``trauma-
     informed care and'' before ``substance use disorder 
     prevention and treatment services''; and
       (2) in subsection (f), by striking ``2018 through 2022'' 
     and inserting ``2019 through 2023''.

       Subtitle I--Preventing Overdoses While in Emergency Rooms

     SEC. 7081. PROGRAM TO SUPPORT COORDINATION AND CONTINUATION 
                   OF CARE FOR DRUG OVERDOSE PATIENTS.

       (a) In General.--The Secretary of Health and Human Services 
     (referred to in this section as the ``Secretary'') shall 
     identify or facilitate the development of best practices 
     for--
       (1) emergency treatment of known or suspected drug 
     overdose;
       (2) the use of recovery coaches, as appropriate, to 
     encourage individuals who experience a non-fatal overdose to 
     seek treatment for substance use disorder and to support 
     coordination and continuation of care;
       (3) coordination and continuation of care and treatment, 
     including, as appropriate, through referrals, of individuals 
     after a drug overdose; and
       (4) the provision or prescribing of overdose reversal 
     medication, as appropriate.
       (b) Grant Establishment and Participation.--
       (1) In general.--The Secretary shall award grants on a 
     competitive basis to eligible entities to support 
     implementation of voluntary programs for care and treatment 
     of individuals after a drug overdose, as appropriate, which 
     may include implementation of the best practices described in 
     subsection (a).
       (2) Eligible entity.--In this section, the term ``eligible 
     entity'' means--
       (A) a State substance abuse agency;
       (B) an Indian Tribe or tribal organization; or
       (C) an entity that offers treatment or other services for 
     individuals in response to, or following, drug overdoses or a 
     drug overdose, such as an emergency department, in 
     consultation with a State substance abuse agency.
       (3) Application.--An eligible entity desiring a grant under 
     this section shall submit an application to the Secretary, at 
     such time and in such manner as the Secretary may require, 
     that includes--

[[Page H9213]]

       (A) evidence that such eligible entity carries out, or is 
     capable of contracting and coordinating with other community 
     entities to carry out, the activities described in paragraph 
     (4);
       (B) evidence that such eligible entity will work with a 
     recovery community organization to recruit, train, hire, 
     mentor, and supervise recovery coaches and fulfill the 
     requirements described in paragraph (4)(A); and
       (C) such additional information as the Secretary may 
     require.
       (4) Use of grant funds.--An eligible entity awarded a grant 
     under this section shall use such grant funds to--
       (A) hire or utilize recovery coaches to help support 
     recovery, including by--
       (i) connecting patients to a continuum of care services, 
     such as--

       (I) treatment and recovery support programs;
       (II) programs that provide non-clinical recovery support 
     services;
       (III) peer support networks;
       (IV) recovery community organizations;
       (V) health care providers, including physicians and other 
     providers of behavioral health and primary care;
       (VI) education and training providers;
       (VII) employers;
       (VIII) housing services; and
       (IX) child welfare agencies;

       (ii) providing education on overdose prevention and 
     overdose reversal to patients and families, as appropriate;
       (iii) providing follow-up services for patients after an 
     overdose to ensure continued recovery and connection to 
     support services;
       (iv) collecting and evaluating outcome data for patients 
     receiving recovery coaching services; and
       (v) providing other services the Secretary determines 
     necessary to help ensure continued connection with recovery 
     support services, including culturally appropriate services, 
     as applicable;
       (B) establish policies and procedures, pursuant to Federal 
     and State law, that address the provision of overdose 
     reversal medication, the administration of all drugs or 
     devices approved or cleared under the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C. 301 et seq.) and all biological 
     products licensed under section 351 of the Public Health 
     Service Act (42 U.S.C. 262) to treat substance use disorder, 
     and subsequent continuation of, or referral to, evidence-
     based treatment for patients with a substance use disorder 
     who have experienced a non-fatal drug overdose, in order to 
     support long-term treatment, prevent relapse, and reduce 
     recidivism and future overdose; and
       (C) establish integrated models of care for individuals who 
     have experienced a non-fatal drug overdose which may include 
     patient assessment, follow up, and transportation to and from 
     treatment facilities.
       (5) Additional permissible uses.--In addition to the uses 
     described in paragraph (4), a grant awarded under this 
     section may be used, directly or through contractual 
     arrangements, to provide--
       (A) all drugs or devices approved or cleared under the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) 
     and all biological products licensed under section 351 of the 
     Public Health Service Act (42 U.S.C. 262) to treat substance 
     use disorders or reverse overdose, pursuant to Federal and 
     State law;
       (B) withdrawal and detoxification services that include 
     patient evaluation, stabilization, and preparation for 
     treatment of substance use disorder, including treatment 
     described in subparagraph (A), as appropriate; or
       (C) mental health services provided by a certified 
     professional who is licensed and qualified by education, 
     training, or experience to assess the psychosocial background 
     of patients, to contribute to the appropriate treatment plan 
     for patients with substance use disorder, and to monitor 
     patient progress.
       (6) Preference.--In awarding grants under this section, the 
     Secretary shall give preference to eligible entities that 
     meet any or all of the following criteria:
       (A) The eligible entity is a critical access hospital (as 
     defined in section 1861(mm)(1) of the Social Security Act (42 
     U.S.C. 1395x(mm)(1))), a low volume hospital (as defined in 
     section 1886(d)(12)(C)(i) of such Act (42 U.S.C. 
     1395ww(d)(12)(C)(i))), a sole community hospital (as defined 
     in section 1886(d)(5)(D)(iii) of such Act (42 U.S.C. 
     1395ww(d)(5)(D)(iii))), or a hospital that receives 
     disproportionate share hospital payments under section 
     1886(d)(5)(F) of the Social Security Act (42 U.S.C. 
     1395ww(d)(5)(F)).
       (B) The eligible entity is located in a State with an age-
     adjusted rate of drug overdose deaths that is above the 
     national overdose mortality rate, as determined by the 
     Director of the Centers for Disease Control and Prevention, 
     or under the jurisdiction of an Indian Tribe with an age-
     adjusted rate of drug overdose deaths that is above the 
     national overdose mortality rate, as determined through 
     appropriate mechanisms as determined by the Secretary in 
     consultation with Indian Tribes.
       (C) The eligible entity demonstrates that recovery coaches 
     will be placed in both health care settings and community 
     settings.
       (7) Period of grant.--A grant awarded to an eligible entity 
     under this section shall be for a period of not more than 5 
     years.
       (c) Definitions.--In this section:
       (1) Indian tribe; tribal organization.--The terms ``Indian 
     Tribe'' and ``tribal organization'' have the meanings given 
     the terms ``Indian tribe'' and ``tribal organization'' in 
     section 4 of the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 5304).
       (2) Recovery coach.--the term ``recovery coach'' means an 
     individual--
       (A) with knowledge of, or experience with, recovery from a 
     substance use disorder; and
       (B) who has completed training from, and is determined to 
     be in good standing by, a recovery services organization 
     capable of conducting such training and making such 
     determination.
       (3) Recovery community organization.--The term ``recovery 
     community organization'' has the meaning given such term in 
     section 547(a) of the Public Health Service Act (42 U.S.C. 
     290ee-2(a)).
       (d) Reporting Requirements.--
       (1) Reports by grantees.--Each eligible entity awarded a 
     grant under this section shall submit to the Secretary an 
     annual report for each year for which the entity has received 
     such grant that includes information on--
       (A) the number of individuals treated by the entity for 
     non-fatal overdoses, including the number of non-fatal 
     overdoses where overdose reversal medication was 
     administered;
       (B) the number of individuals administered medication-
     assisted treatment by the entity;
       (C) the number of individuals referred by the entity to 
     other treatment facilities after a non-fatal overdose, the 
     types of such other facilities, and the number of such 
     individuals admitted to such other facilities pursuant to 
     such referrals; and
       (D) the frequency and number of patients with 
     reoccurrences, including readmissions for non-fatal overdoses 
     and evidence of relapse related to substance use disorder.
       (2) Report by secretary.--Not later than 5 years after the 
     date of enactment of this Act, the Secretary shall submit to 
     Congress a report that includes an evaluation of the 
     effectiveness of the grant program carried out under this 
     section with respect to long term health outcomes of the 
     population of individuals who have experienced a drug 
     overdose, the percentage of patients treated or referred to 
     treatment by grantees, and the frequency and number of 
     patients who experienced relapse, were readmitted for 
     treatment, or experienced another overdose.
       (e) Privacy.--The requirements of this section, including 
     with respect to data reporting and program oversight, shall 
     be subject to all applicable Federal and State privacy laws.
       (f) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $10,000,000 for 
     each of fiscal years 2019 through 2023.

    Subtitle J--Alternatives to Opioids in the Emergency Department

     SEC. 7091. EMERGENCY DEPARTMENT ALTERNATIVES TO OPIOIDS 
                   DEMONSTRATION PROGRAM.

       (a) Demonstration Program Grants.--
       (1) In general.--The Secretary of Health and Human Services 
     (in this section referred to as the ``Secretary'') shall 
     carry out a demonstration program for purposes of awarding 
     grants to hospitals and emergency departments, including 
     freestanding emergency departments, to develop, implement, 
     enhance, or study alternatives to opioids for pain management 
     in such settings.
       (2) Eligibility.--To be eligible to receive a grant under 
     paragraph (1), a hospital or emergency department shall 
     submit an application to the Secretary at such time, in such 
     manner, and containing such information as the Secretary may 
     require.
       (3) Geographic distribution.--In awarding grants under this 
     section, the Secretary shall seek to ensure geographical 
     distribution among grant recipients.
       (4) Use of funds.--Grants under paragraph (1) shall be used 
     to--
       (A) target treatment approaches for painful conditions 
     frequently treated in such settings;
       (B) train providers and other hospital personnel on 
     protocols or best practices related to the use and 
     prescription of opioids and alternatives to opioids for pain 
     management in the emergency department; and
       (C) develop or continue strategies to provide alternatives 
     to opioids, as appropriate.
       (b) Additional Demonstration Program.--The Secretary may 
     carry out a demonstration program similar to the program 
     under subsection (a) for other acute care settings.
       (c) Consultation.--The Secretary shall implement a process 
     for recipients of grants under subsection (a) or (b) to share 
     evidence-based and best practices and promote consultation 
     with persons having robust knowledge, including emergency 
     departments and physicians that have successfully implemented 
     programs that use alternatives to opioids for pain 
     management, as appropriate, such as approaches studied 
     through the National Center for Complimentary and Integrative 
     Health or other institutes and centers at the National 
     Institutes of Health, as appropriate. The Secretary shall 
     offer to each recipient of a grant under subsection (a) or 
     (b) technical assistance as necessary.
       (d) Technical Assistance.--The Secretary shall identify or 
     facilitate the development of best practices on alternatives 
     to opioids for pain management and provide technical 
     assistance to hospitals and other acute care settings on 
     alternatives to opioids for pain management. The technical 
     assistance provided shall be for the purpose of--

[[Page H9214]]

       (1) utilizing information from recipients of a grant under 
     subsection (a) or (b) that have successfully implemented 
     alternatives to opioids programs;
       (2) identifying or facilitating the development of best 
     practices on the use of alternatives to opioids, which may 
     include pain-management strategies that involve non-addictive 
     medical products, non-pharmacologic treatments, and 
     technologies or techniques to identify patients at risk for 
     opioid use disorder;
       (3) identifying or facilitating the development of best 
     practices on the use of alternatives to opioids that target 
     common painful conditions and include certain patient 
     populations, such as geriatric patients, pregnant women, and 
     children; and
       (4) disseminating information on the use of alternatives to 
     opioids to providers in acute care settings, which may 
     include emergency departments, outpatient clinics, critical 
     access hospitals, Federally qualified health centers, Indian 
     Health Service health facilities, and tribal hospitals.
       (e) Report to the Secretary.--Each recipient of a grant 
     under this section shall submit to the Secretary (during the 
     period of such grant) annual reports on the progress of the 
     program funded through the grant. These reports shall 
     include, in accordance with all applicable State and Federal 
     privacy laws--
       (1) a description of and specific information about the 
     opioid alternative pain management programs, including the 
     demographic characteristics of patients who were treated with 
     an alternative pain management protocol, implemented in 
     hospitals, emergency departments, and other acute care 
     settings;
       (2) data on the opioid alternative pain management 
     strategies used, including the number of opioid prescriptions 
     written--
       (A) during a baseline period before the program began; or
       (B) at various stages of the program; and
       (3) data on patients who were eventually prescribed opioids 
     after alternative pain management protocols and treatments 
     were utilized; and
       (4) any other information the Secretary determines 
     appropriate.
       (f) Report to Congress.--Not later than 1 year after 
     completion of the demonstration program under this section, 
     the Secretary shall submit a report to the Congress on the 
     results of the demonstration program and include in the 
     report--
       (1) the number of applications received and the number 
     funded;
       (2) a summary of the reports described in subsection (e), 
     including data that allows for comparison of programs; and
       (3) recommendations for broader implementation of pain 
     management strategies that encourage the use of alternatives 
     to opioids in hospitals, emergency departments, or other 
     acute care settings.
       (g) Authorization of Appropriations.--To carry out this 
     section, there is authorized to be appropriated $10,000,000 
     for each of fiscal years 2019 through 2021.

    Subtitle K--Treatment, Education, and Community Help To Combat 
                               Addiction

     SEC. 7101. ESTABLISHMENT OF REGIONAL CENTERS OF EXCELLENCE IN 
                   SUBSTANCE USE DISORDER EDUCATION.

       Part D of title V of the Public Health Service Act, as 
     amended by section 7031, is further amended by adding at the 
     end the following new section:

     ``SEC. 551. REGIONAL CENTERS OF EXCELLENCE IN SUBSTANCE USE 
                   DISORDER EDUCATION.

       ``(a) In General.--The Secretary, in consultation with 
     appropriate agencies, shall award cooperative agreements to 
     eligible entities for the designation of such entities as 
     Regional Centers of Excellence in Substance Use Disorder 
     Education for purposes of improving health professional 
     training resources with respect to substance use disorder 
     prevention, treatment, and recovery.
       ``(b) Eligibility.--To be eligible to receive a cooperative 
     agreement under subsection (a), an entity shall--
       ``(1) be an accredited entity that offers education to 
     students in various health professions, which may include--
       ``(A) a teaching hospital;
       ``(B) a medical school;
       ``(C) a certified behavioral health clinic; or
       ``(D) any other health professions school, school of public 
     health, or Cooperative Extension Program at institutions of 
     higher education, as defined in section 101 of the Higher 
     Education Act of 1965, engaged in the prevention, treatment, 
     or recovery of substance use disorders;
       ``(2) demonstrate community engagement and partnerships 
     with community stakeholders, including entities that train 
     health professionals, mental health counselors, social 
     workers, peer recovery specialists, substance use treatment 
     programs, community health centers, physician offices, 
     certified behavioral health clinics, research institutions, 
     and law enforcement; and
       ``(3) submit to the Secretary an application containing 
     such information, at such time, and in such manner, as the 
     Secretary may require.
       ``(c) Activities.--An entity receiving an award under this 
     section shall develop, evaluate, and distribute evidence-
     based resources regarding the prevention and treatment of, 
     and recovery from, substance use disorders. Such resources 
     may include information on--
       ``(1) the neurology and pathology of substance use 
     disorders;
       ``(2) advancements in the treatment of substance use 
     disorders;
       ``(3) techniques and best practices to support recovery 
     from substance use disorders;
       ``(4) strategies for the prevention and treatment of, and 
     recovery from substance use disorders across patient 
     populations; and
       ``(5) other topic areas that are relevant to the objectives 
     described in subsection (a).
       ``(d) Geographic Distribution.--In awarding cooperative 
     agreements under subsection (a), the Secretary shall take 
     into account regional differences among eligible entities and 
     shall make an effort to ensure geographic distribution.
       ``(e) Evaluation.--The Secretary shall evaluate each 
     project carried out by an entity receiving an award under 
     this section and shall disseminate the findings with respect 
     to each such evaluation to appropriate public and private 
     entities.
       ``(f) Funding.--There is authorized to be appropriated to 
     carry out this section, $4,000,000 for each of fiscal years 
     2019 through 2023.''.

     SEC. 7102. YOUTH PREVENTION AND RECOVERY.

       (a)  Substance Abuse Treatment Services for Children, 
     Adolescents, and Young Adults.--Section 514 of the Public 
     Health Service Act (42 U.S.C. 290bb-7) is amended--
       (1) in the section heading, by striking ``children and 
     adolescents'' and inserting ``children, adolescents, and 
     young adults'';
       (2) in subsection (a)(2), by striking ``children, 
     including'' and inserting ``children, adolescents, and young 
     adults, including''; and
       (3) by striking ``children and adolescents'' each place it 
     appears and inserting ``children, adolescents, and young 
     adults''.
       (b) Resource Center.--The Secretary of Health and Human 
     Services (referred to in this section as the ``Secretary'', 
     except as otherwise provided), in consultation with the 
     Secretary of Education and other heads of agencies, including 
     the Assistant Secretary for Mental Health and Substance Use 
     and the Administrator of the Health Resources and Services 
     Administration, as appropriate, shall establish a resource 
     center to provide technical support to recipients of grants 
     under subsection (c).
       (c) Youth Prevention and Recovery Initiative.--
       (1) In general.--The Secretary, in consultation with the 
     Secretary of Education, shall administer a program to provide 
     support for communities to support the prevention of, 
     treatment of, and recovery from, substance use disorders for 
     children, adolescents, and young adults.
       (2) Definitions.--In this subsection:
       (A) Eligible entity.--The term ``eligible entity'' means--
       (i) a local educational agency that is seeking to establish 
     or expand substance use prevention or recovery support 
     services at one or more high schools;
       (ii) a State educational agency;
       (iii) an institution of higher education (or consortia of 
     such institutions), which may include a recovery program at 
     an institution of higher education;
       (iv) a local board or one-stop operator;
       (v) a nonprofit organization with appropriate expertise in 
     providing services or programs for children, adolescents, or 
     young adults, excluding a school;
       (vi) a State, political subdivision of a State, Indian 
     tribe, or tribal organization; or
       (vii) a high school or dormitory serving high school 
     students that receives funding from the Bureau of Indian 
     Education.
       (B) Foster care.--The term ``foster care'' has the meaning 
     given such term in section 1355.20(a) of title 45, Code of 
     Federal Regulations (or any successor regulations).
       (C) High school.--The term ``high school'' has the meaning 
     given such term in section 8101 of the Elementary and 
     Secondary Education Act of 1965 (20 U.S.C. 7801).
       (D) Homeless youth.--The term ``homeless youth'' has the 
     meaning given the term ``homeless children or youths'' in 
     section 725 of the McKinney-Vento Homeless Assistance Act (42 
     U.S.C. 11434a).
       (E) Indian tribe; tribal organization.--The terms ``Indian 
     tribe'' and ``tribal organization'' have the meanings given 
     such terms in section 4 of the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 5304).
       (F) Institution of higher education.--The term 
     ``institution of higher education'' has the meaning given 
     such term in section 101 of the Higher Education Act of 1965 
     (20 U.S.C. 1001) and includes a ``postsecondary vocational 
     institution'' as defined in section 102(c) of such Act (20 
     U.S.C. 1002(c)).
       (G) Local educational agency.--The term ``local educational 
     agency'' has the meaning given such term in section 8101 of 
     the Elementary and Secondary Education Act of 1965 (20 U.S.C. 
     7801).
       (H) Local board; one-stop operator.--The terms ``local 
     board'' and ``one-stop operator'' have the meanings given 
     such terms in section 3 of the Workforce Innovation and 
     Opportunity Act (29 U.S.C. 3102).
       (I) Out-of-school youth.--The term ``out-of-school youth'' 
     has the meaning given such term in section 129(a)(1)(B) of 
     the Workforce Innovation and Opportunity Act (29 U.S.C. 
     3164(a)(1)(B)).
       (J) Recovery program.--The term ``recovery program'' means 
     a program--
       (i) to help children, adolescents, or young adults who are 
     recovering from substance use disorders to initiate, 
     stabilize, and maintain healthy and productive lives in the 
     community; and

[[Page H9215]]

       (ii) that includes peer-to-peer support delivered by 
     individuals with lived experience in recovery, and communal 
     activities to build recovery skills and supportive social 
     networks.
       (K) State educational agency.--The term ``State educational 
     agency'' has the meaning given such term in section 8101 of 
     the Elementary and Secondary Education Act (20 U.S.C. 7801).
       (3) Best practices.--The Secretary, in consultation with 
     the Secretary of Education, shall--
       (A) identify or facilitate the development of evidence-
     based best practices for prevention of substance misuse and 
     abuse by children, adolescents, and young adults, including 
     for specific populations such as youth in foster care, 
     homeless youth, out-of-school youth, and youth who are at 
     risk of or have experienced trafficking that address--
       (i) primary prevention;
       (ii) appropriate recovery support services;
       (iii) appropriate use of medication-assisted treatment for 
     such individuals, if applicable, and ways of overcoming 
     barriers to the use of medication-assisted treatment in such 
     population; and
       (iv) efficient and effective communication, which may 
     include the use of social media, to maximize outreach 
     efforts;
       (B) disseminate such best practices to State educational 
     agencies, local educational agencies, schools and dormitories 
     funded by the Bureau of Indian Education, institutions of 
     higher education, recovery programs at institutions of higher 
     education, local boards, one-stop operators, family and youth 
     homeless providers, and nonprofit organizations, as 
     appropriate;
       (C) conduct a rigorous evaluation of each grant funded 
     under this subsection, particularly its impact on the 
     indicators described in paragraph (7)(B); and
       (D) provide technical assistance for grantees under this 
     subsection.
       (4) Grants authorized.--The Secretary, in consultation with 
     the Secretary of Education, shall award 3-year grants, on a 
     competitive basis, to eligible entities to enable such 
     entities, in coordination with Indian tribes, if applicable, 
     and State agencies responsible for carrying out substance use 
     disorder prevention and treatment programs, to carry out 
     evidence-based programs for--
       (A) prevention of substance misuse and abuse by children, 
     adolescents, and young adults, which may include primary 
     prevention;
       (B) recovery support services for children, adolescents, 
     and young adults, which may include counseling, job training, 
     linkages to community-based services, family support groups, 
     peer mentoring, and recovery coaching; or
       (C) treatment or referrals for treatment of substance use 
     disorders, which may include the use of medication-assisted 
     treatment, as appropriate.
       (5) Special consideration.--In awarding grants under this 
     subsection, the Secretary shall give special consideration to 
     the unique needs of tribal, urban, suburban, and rural 
     populations.
       (6) Application.--To be eligible for a grant under this 
     subsection, an entity shall submit to the Secretary an 
     application at such time, in such manner, and containing such 
     information as the Secretary may require. Such application 
     shall include--
       (A) a description of--
       (i) the impact of substance use disorders in the population 
     that will be served by the grant program;
       (ii) how the eligible entity has solicited input from 
     relevant stakeholders, which may include faculty, teachers, 
     staff, families, students, and experts in substance use 
     disorder prevention, treatment, and recovery in developing 
     such application;
       (iii) the goals of the proposed project, including the 
     intended outcomes;
       (iv) how the eligible entity plans to use grant funds for 
     evidence-based activities, in accordance with this subsection 
     to prevent, provide recovery support for, or treat substance 
     use disorders amongst such individuals, or a combination of 
     such activities; and
       (v) how the eligible entity will collaborate with relevant 
     partners, which may include State educational agencies, local 
     educational agencies, institutions of higher education, 
     juvenile justice agencies, prevention and recovery support 
     providers, local service providers, including substance use 
     disorder treatment programs, providers of mental health 
     services, youth serving organizations, family and youth 
     homeless providers, child welfare agencies, and primary care 
     providers, in carrying out the grant program; and
       (B) an assurance that the eligible entity will participate 
     in the evaluation described in paragraph (3)(C).
       (7) Reports to the secretary.--Each eligible entity awarded 
     a grant under this subsection shall submit to the Secretary a 
     report at such time and in such manner as the Secretary may 
     require. Such report shall include--
       (A) a description of how the eligible entity used grant 
     funds, in accordance with this subsection, including the 
     number of children, adolescents, and young adults reached 
     through programming; and
       (B) a description, including relevant data, of how the 
     grant program has made an impact on the intended outcomes 
     described in paragraph (6)(A)(iii), including--
       (i) indicators of student success, which, if the eligible 
     entity is an educational institution, shall include student 
     well-being and academic achievement;
       (ii) substance use disorders amongst children, adolescents, 
     and young adults, including the number of overdoses and 
     deaths amongst children, adolescents, and young adults served 
     by the grant during the grant period; and
       (iii) other indicators, as the Secretary determines 
     appropriate.
       (8) Report to congress.--The Secretary shall, not later 
     than October 1, 2022, submit a report to the Committee on 
     Health, Education, Labor, and Pensions of the Senate and the 
     Committee on Energy and Commerce and the Committee on 
     Education and the Workforce of the House of Representatives a 
     report summarizing the effectiveness of the grant program 
     under this subsection, based on the information submitted in 
     reports required under paragraph (7).
       (9) Authorization of appropriations.--There is authorized 
     to be appropriated $10,000,000 to carry out this subsection 
     for each of fiscal years 2019 through 2023.

 Subtitle L--Information From National Mental Health and Substance Use 
                           Policy Laboratory

     SEC. 7111. INFORMATION FROM NATIONAL MENTAL HEALTH AND 
                   SUBSTANCE USE POLICY LABORATORY.

       Section 501A(b) of the Public Health Service Act (42 U.S.C. 
     290aa-0(b)) is amended--
       (1) in paragraph (5)(C), by striking ``; and'' at the end 
     and inserting a semicolon;
       (2) by redesignating paragraph (6) as paragraph (7); and
       (3) by inserting after paragraph (5) the following:
       ``(6) issue and periodically update information for 
     entities applying for grants or cooperative agreements from 
     the Substance Abuse and Mental Health Services Administration 
     in order to--
       ``(A) encourage the implementation and replication of 
     evidence-based practices; and
       ``(B) provide technical assistance to applicants for 
     funding, including with respect to justifications for such 
     programs and activities; and''.

           Subtitle M--Comprehensive Opioid Recovery Centers

     SEC. 7121. COMPREHENSIVE OPIOID RECOVERY CENTERS.

       (a) In General.--Part D of title V of the Public Health 
     Service Act (42 U.S.C. 290dd et seq.), as amended by sections 
     7031 and 7101, is further amended by adding at the end the 
     following new section:

     ``SEC. 552. COMPREHENSIVE OPIOID RECOVERY CENTERS.

       ``(a) In General.--The Secretary shall award grants on a 
     competitive basis to eligible entities to establish or 
     operate a comprehensive opioid recovery center (referred to 
     in this section as a `Center'). A Center may be a single 
     entity or an integrated delivery network.
       ``(b) Grant Period.--
       ``(1) In general.--A grant awarded under subsection (a) 
     shall be for a period of not less than 3 years and not more 
     than 5 years.
       ``(2) Renewal.--A grant awarded under subsection (a) may be 
     renewed, on a competitive basis, for additional periods of 
     time, as determined by the Secretary. In determining whether 
     to renew a grant under this paragraph, the Secretary shall 
     consider the data submitted under subsection (h).
       ``(c) Minimum Number of Centers.--The Secretary shall 
     allocate the amounts made available under subsection (j) such 
     that not fewer than 10 grants may be awarded. Not more than 
     one grant shall be made to entities in a single State for any 
     one period.
       ``(d) Application.--
       ``(1) Eligible entity.--An entity is eligible for a grant 
     under this section if the entity offers treatment and other 
     services for individuals with a substance use disorder.
       ``(2) Submission of application.--In order to be eligible 
     for a grant under subsection (a), an entity shall submit an 
     application to the Secretary at such time and in such manner 
     as the Secretary may require. Such application shall 
     include--
       ``(A) evidence that such entity carries out, or is capable 
     of coordinating with other entities to carry out, the 
     activities described in subsection (g); and
       ``(B) such other information as the Secretary may require.
       ``(e) Priority.--In awarding grants under subsection (a), 
     the Secretary shall give priority to eligible entities--
       ``(1) located in a State with an age-adjusted rate of drug 
     overdose deaths that is above the national overdose mortality 
     rate, as determined by the Director of the Centers for 
     Disease Control and Prevention; or
       ``(2) serving an Indian Tribe (as defined in section 4 of 
     the Indian Self-Determination and Education Assistance Act) 
     with an age-adjusted rate of drug overdose deaths that is 
     above the national overdose mortality rate, as determined 
     through appropriate mechanisms determined by the Secretary in 
     consultation with Indian Tribes.
       ``(f) Preference.--In awarding grants under subsection (a), 
     the Secretary may give preference to eligible entities 
     utilizing technology-enabled collaborative learning and 
     capacity building models, including such models as defined in 
     section 2 of the Expanding Capacity for Health Outcomes Act 
     (Public Law 114-270; 130 Stat. 1395), to conduct the 
     activities described in this section.
       ``(g) Center Activities.--Each Center shall, at a minimum, 
     carry out the following activities directly, through 
     referral, or through contractual arrangements, which

[[Page H9216]]

     may include carrying out such activities through technology-
     enabled collaborative learning and capacity building models 
     described in subsection (f):
       ``(1) Treatment and recovery services.--Each Center shall--
       ``(A) Ensure that intake, evaluations, and periodic patient 
     assessments meet the individualized clinical needs of 
     patients, including by reviewing patient placement in 
     treatment settings to support meaningful recovery.
       ``(B) Provide the full continuum of treatment services, 
     including--
       ``(i) all drugs and devices approved or cleared under the 
     Federal Food, Drug, and Cosmetic Act and all biological 
     products licensed under section 351 of this Act to treat 
     substance use disorders or reverse overdoses, pursuant to 
     Federal and State law;
       ``(ii) medically supervised withdrawal management, that 
     includes patient evaluation, stabilization, and readiness for 
     and entry into treatment;
       ``(iii) counseling provided by a program counselor or other 
     certified professional who is licensed and qualified by 
     education, training, or experience to assess the 
     psychological and sociological background of patients, to 
     contribute to the appropriate treatment plan for the patient, 
     and to monitor patient progress;
       ``(iv) treatment, as appropriate, for patients with co-
     occurring substance use and mental disorders;
       ``(v) testing, as appropriate, for infections commonly 
     associated with illicit drug use;
       ``(vi) residential rehabilitation, and outpatient and 
     intensive outpatient programs;
       ``(vii) recovery housing;
       ``(viii) community-based and peer recovery support 
     services;
       ``(ix) job training, job placement assistance, and 
     continuing education assistance to support reintegration into 
     the workforce; and
       ``(x) other best practices to provide the full continuum of 
     treatment and services, as determined by the Secretary.
       ``(C) Ensure that all programs covered by the Center 
     include medication-assisted treatment, as appropriate, and do 
     not exclude individuals receiving medication-assisted 
     treatment from any service.
       ``(D) Periodically conduct patient assessments to support 
     sustained and clinically significant recovery, as defined by 
     the Assistant Secretary for Mental Health and Substance Use.
       ``(E) Provide onsite access to medication, as appropriate, 
     and toxicology services; for purposes of carrying out this 
     section.
       ``(F) Operate a secure, confidential, and interoperable 
     electronic health information system.
       ``(G) Offer family support services such as child care, 
     family counseling, and parenting interventions to help 
     stabilize families impacted by substance use disorder, as 
     appropriate.
       ``(2) Outreach.--Each Center shall carry out outreach 
     activities regarding the services offered through the 
     Centers, which may include--
       ``(A) training and supervising outreach staff, as 
     appropriate, to work with State and local health departments, 
     health care providers, the Indian Health Service, State and 
     local educational agencies, schools funded by the Indian 
     Bureau of Education, institutions of higher education, State 
     and local workforce development boards, State and local 
     community action agencies, public safety officials, first 
     responders, Indian Tribes, child welfare agencies, as 
     appropriate, and other community partners and the public, 
     including patients, to identify and respond to community 
     needs;
       ``(B) ensuring that the entities described in subparagraph 
     (A) are aware of the services of the Center; and
       ``(C) disseminating and making publicly available, 
     including through the internet, evidence-based resources that 
     educate professionals and the public on opioid use disorder 
     and other substance use disorders, including co-occurring 
     substance use and mental disorders.
       ``(h) Data Reporting and Program Oversight.--With respect 
     to a grant awarded under subsection (a), not later than 90 
     days after the end of the first year of the grant period, and 
     annually thereafter for the duration of the grant period 
     (including the duration of any renewal period for such 
     grant), the entity shall submit data, as appropriate, to the 
     Secretary regarding--
       ``(1) the programs and activities funded by the grant;
       ``(2) health outcomes of the population of individuals with 
     a substance use disorder who received services from the 
     Center, evaluated by an independent program evaluator through 
     the use of outcomes measures, as determined by the Secretary;
       ``(3) the retention rate of program participants; and
       ``(4) any other information that the Secretary may require 
     for the purpose of--ensuring that the Center is complying 
     with all the requirements of the grant, including providing 
     the full continuum of services described in subsection 
     (g)(1)(B).
       ``(i) Privacy.--The provisions of this section, including 
     with respect to data reporting and program oversight, shall 
     be subject to all applicable Federal and State privacy laws.
       ``(j) Authorization of Appropriations.--There is authorized 
     to be appropriated $10,000,000 for each of fiscal years 2019 
     through 2023 for purposes of carrying out this section.''.
       (b) Reports to Congress.--
       (1) Preliminary report.--Not later than 3 years after the 
     date of the enactment of this Act, the Secretary of Health 
     and Human Services shall submit to Congress a preliminary 
     report that analyzes data submitted under section 552(h) of 
     the Public Health Service Act, as added by subsection (a).
       (2) Final report.--Not later than 2 years after submitting 
     the preliminary report required under paragraph (1), the 
     Secretary of Health and Human Services shall submit to 
     Congress a final report that includes--
       (A) an evaluation of the effectiveness of the comprehensive 
     services provided by the Centers established or operated 
     pursuant to section 552 of the Public Health Service Act, as 
     added by subsection (a), with respect to health outcomes of 
     the population of individuals with substance use disorder who 
     receive services from the Center, which shall include an 
     evaluation of the effectiveness of services for treatment and 
     recovery support and to reduce relapse, recidivism, and 
     overdose; and
       (B) recommendations, as appropriate, regarding ways to 
     improve Federal programs related to substance use disorders, 
     which may include dissemination of best practices for the 
     treatment of substance use disorders to health care 
     professionals.

                    Subtitle N--Trauma-Informed Care

     SEC. 7131. CDC SURVEILLANCE AND DATA COLLECTION FOR CHILD, 
                   YOUTH, AND ADULT TRAUMA.

       (a) Data Collection.--The Director of the Centers for 
     Disease Control and Prevention (referred to in this section 
     as the ``Director'') may, in cooperation with the States, 
     collect and report data on adverse childhood experiences 
     through the Behavioral Risk Factor Surveillance System, the 
     Youth Risk Behavior Surveillance System, and other relevant 
     public health surveys or questionnaires.
       (b) Timing.--The collection of data under subsection (a) 
     may occur biennially.
       (c) Data From Rural Areas.--The Director shall encourage 
     each State that participates in collecting and reporting data 
     under subsection (a) to collect and report data from rural 
     areas within such State, in order to generate a statistically 
     reliable representation of such areas.
       (d) Data From Tribal Areas.--The Director may, in 
     cooperation with Indian Tribes (as defined in section 4 of 
     the Indian Self-Determination and Education Assistance Act) 
     and pursuant to a written request from an Indian Tribe, 
     provide technical assistance to such Indian Tribe to collect 
     and report data on adverse childhood experiences through the 
     Behavioral Risk Factor Surveillance System, the Youth Risk 
     Behavior Surveillance System, or another relevant public 
     health survey or questionnaire.
       (e) Authorization of Appropriations.--To carry out this 
     section, there is authorized to be appropriated $2,000,000 
     for each of fiscal years 2019 through 2023.

     SEC. 7132. TASK FORCE TO DEVELOP BEST PRACTICES FOR TRAUMA-
                   INFORMED IDENTIFICATION, REFERRAL, AND SUPPORT.

       (a) Establishment.--There is established a task force, to 
     be known as the Interagency Task Force on Trauma-Informed 
     Care (in this section referred to as the ``task force'') that 
     shall identify, evaluate, and make recommendations 
     regarding--
       (1) best practices with respect to children and youth, and 
     their families as appropriate, who have experienced or are at 
     risk of experiencing trauma; and
       (2) ways in which Federal agencies can better coordinate to 
     improve the Federal response to families impacted by 
     substance use disorders and other forms of trauma.
       (b) Membership.--
       (1) Composition.--The task force shall be composed of the 
     heads of the following Federal departments and agencies, or 
     their designees:
       (A) The Centers for Medicare & Medicaid Services.
       (B) The Substance Abuse and Mental Health Services 
     Administration.
       (C) The Agency for Healthcare Research and Quality.
       (D) The Centers for Disease Control and Prevention.
       (E) The Indian Health Service.
       (F) The Department of Veterans Affairs.
       (G) The National Institutes of Health.
       (H) The Food and Drug Administration.
       (I) The Health Resources and Services Administration.
       (J) The Department of Defense.
       (K) The Office of Minority Health of the Department of 
     Health and Human Services.
       (L) The Administration for Children and Families.
       (M) The Office of the Assistant Secretary for Planning and 
     Evaluation of the Department of Health and Human Services.
       (N) The Office for Civil Rights of the Department of Health 
     and Human Services.
       (O) The Office of Juvenile Justice and Delinquency 
     Prevention of the Department of Justice.
       (P) The Office of Community Oriented Policing Services of 
     the Department of Justice.
       (Q) The Office on Violence Against Women of the Department 
     of Justice.
       (R) The National Center for Education Evaluation and 
     Regional Assistance of the Department of Education.
       (S) The National Center for Special Education Research of 
     the Institute of Education Science.
       (T) The Office of Elementary and Secondary Education of the 
     Department of Education.

[[Page H9217]]

       (U) The Office for Civil Rights of the Department of 
     Education.
       (V) The Office of Special Education and Rehabilitative 
     Services of the Department of Education.
       (W) The Bureau of Indian Affairs of the Department of the 
     Interior.
       (X) The Veterans Health Administration of the Department of 
     Veterans Affairs.
       (Y) The Office of Special Needs Assistance Programs of the 
     Department of Housing and Urban Development.
       (Z) The Office of Head Start of the Administration for 
     Children and Families.
       (AA) The Children's Bureau of the Administration for 
     Children and Families.
       (BB) The Bureau of Indian Education of the Department of 
     the Interior.
       (CC) Such other Federal agencies as the Secretaries 
     determine to be appropriate.
       (2) Date of appointments.--The heads of Federal departments 
     and agencies shall appoint the corresponding members of the 
     task force not later than 60 days after the date of enactment 
     of this Act.
       (3) Chairperson.--The task force shall be chaired by the 
     Assistant Secretary for Mental Health and Substance Use, or 
     the Assistant Secretary's designee.
       (c) Task Force Duties.--The task force shall--
       (1) solicit input from stakeholders, including frontline 
     service providers, educators, mental health professionals, 
     researchers, experts in infant, child, and youth trauma, 
     child welfare professionals, and the public, in order to 
     inform the activities under paragraph (2); and
       (2) identify, evaluate, make recommendations, and update 
     such recommendations not less than annually, to the general 
     public, the Secretary of Education, the Secretary of Health 
     and Human Services, the Secretary of Labor, the Secretary of 
     the Interior, the Attorney General, and other relevant 
     cabinet Secretaries, and Congress regarding--
       (A) a set of evidence-based, evidence-informed, and 
     promising best practices with respect to--
       (i) prevention strategies for individuals at risk of 
     experiencing or being exposed to trauma, including trauma as 
     a result of exposure to substance use;
       (ii) the identification of infants, children and youth, and 
     their families as appropriate, who have experienced or are at 
     risk of experiencing trauma;
       (iii) the expeditious referral to and implementation of 
     trauma-informed practices and supports that prevent and 
     mitigate the effects of trauma, which may include whole-
     family and multi-generational approaches; and
       (iv) community based or multi-generational practices that 
     support children and their families;
       (B) a national strategy on how the task force and member 
     agencies will collaborate, prioritize options for, and 
     implement a coordinated approach, which may include--
       (i) data sharing;
       (ii) providing support to infants, children, and youth, and 
     their families as appropriate, who have experienced or are at 
     risk of experiencing trauma;
       (iii) identifying options for coordinating existing grants 
     that support infants, children, and youth, and their families 
     as appropriate, who have experienced, or are at risk of 
     experiencing, exposure to substance use or other trauma, 
     including trauma related to substance use; and
       (iv) other ways to improve coordination, planning, and 
     communication within and across Federal agencies, offices, 
     and programs, to better serve children and families impacted 
     by substance use disorders; and
       (C) existing Federal authorities at the Department of 
     Education, Department of Health and Human Services, 
     Department of Justice, Department of Labor, Department of the 
     Interior, and other relevant agencies, and specific Federal 
     grant programs to disseminate best practices on, provide 
     training in, or deliver services through, trauma-informed 
     practices, and disseminate such information--
       (i) in writing to relevant program offices at such agencies 
     to encourage grant applicants in writing to use such funds, 
     where appropriate, for trauma-informed practices; and
       (ii) to the general public through the internet website of 
     the task force.
       (d) Best Practices.--In identifying, evaluating, and 
     recommending the set of best practices under subsection (c), 
     the task force shall--
       (1) include guidelines for providing professional 
     development and education for front-line services providers, 
     including school personnel, early childhood education program 
     providers, providers from child- or youth-serving 
     organizations, housing and homeless providers, primary and 
     behavioral health care providers, child welfare and social 
     services providers, juvenile and family court personnel, 
     health care providers, individuals who are mandatory 
     reporters of child abuse or neglect, trained nonclinical 
     providers (including peer mentors and clergy), and first 
     responders, in--
       (A) understanding and identifying early signs and risk 
     factors of trauma in infants, children, and youth, and their 
     families as appropriate, including through screening 
     processes and services;
       (B) providing practices to prevent and mitigate the impact 
     of trauma, including by fostering safe and stable 
     environments and relationships; and
       (C) developing and implementing policies, procedures, or 
     systems that--
       (i) are designed to quickly refer infants, children, youth, 
     and their families as appropriate, who have experienced or 
     are at risk of experiencing trauma to the appropriate trauma-
     informed screening and support and age-appropriate treatment, 
     and to ensure such infants, children, youth, and family 
     members receive such support;
       (ii) utilize and develop partnerships with early childhood 
     education programs, local social services organizations, such 
     as organizations serving youth, and clinical mental health or 
     other health care providers with expertise in providing 
     support services and age-appropriate trauma-informed and 
     evidence-based treatment aimed at preventing or mitigating 
     the effects of trauma;
       (iii) educate children and youth to--

       (I) understand and identify the signs, effects, or symptoms 
     of trauma; and
       (II) build the resilience and coping skills to mitigate the 
     effects of experiencing trauma;

       (iv) promote and support multi-generational practices that 
     assist parents, foster parents, and kinship and other 
     caregivers in accessing resources related to, and developing 
     environments conducive to, the prevention and mitigation of 
     trauma; and
       (v) collect and utilize data from screenings, referrals, or 
     the provision of services and supports to evaluate outcomes 
     and improve processes for trauma-informed services and 
     supports that are culturally sensitive, linguistically 
     appropriate, and specific to age ranges and sex, as 
     applicable;
       (2) recommend best practices that are designed to avoid 
     unwarranted custody loss or criminal penalties for parents or 
     guardians in connection with infants, children, and youth who 
     have experienced or are at risk of experiencing trauma; and
       (3) recommend opportunities for local- and State-level 
     partnerships that--
       (A) are designed to quickly identify and refer children and 
     families, as appropriate, who have experienced or are at risk 
     of experiencing exposure to trauma, including related to 
     substance use;
       (B) utilize and develop partnerships with early childhood 
     education programs, local social services organizations, and 
     health care services aimed at preventing or mitigating the 
     effects of exposure to trauma, including related to substance 
     use;
       (C) offer community-based prevention activities, including 
     educating families and children on the effects of exposure to 
     trauma, such as trauma related to substance use, and how to 
     build resilience and coping skills to mitigate those effects;
       (D) in accordance with Federal privacy protections, utilize 
     non-personally-identifiable data from screenings, referrals, 
     or the provision of services and supports to evaluate and 
     improve processes addressing exposure to trauma, including 
     related to substance use; and
       (E) are designed to prevent separation and support 
     reunification of families if in the best interest of the 
     child.
       (e) Operating Plan.--Not later than 120 days after the date 
     of enactment of this Act, the task force shall hold the first 
     meeting. Not later than 2 years after such date of enactment, 
     the task force shall submit to the Secretary of Education, 
     Secretary of Health and Human Services, Secretary of Labor, 
     Secretary of the Interior, the Attorney General, and Congress 
     an operating plan for carrying out the activities of the task 
     force described in subsection (c)(2). Such operating plan 
     shall include--
       (1) a list of specific activities that the task force plans 
     to carry out for purposes of carrying out duties described in 
     subsection (c)(2), which may include public engagement;
       (2) a plan for carrying out the activities under subsection 
     (c)(2);
       (3) a list of members of the task force and other 
     individuals who are not members of the task force that may be 
     consulted to carry out such activities;
       (4) an explanation of Federal agency involvement and 
     coordination needed to carry out such activities, including 
     any statutory or regulatory barriers to such coordination;
       (5) a budget for carrying out such activities;
       (6) a proposed timeline for implementing recommendations 
     and efforts identified under subsection (c); and
       (7) other information that the task force determines 
     appropriate as related to its duties.
       (f) Final Report.--Not later than 3 years after the date of 
     the first meeting of the task force, the task force shall 
     submit to the general public, Secretary of Education, 
     Secretary of Health and Human Services, Secretary of Labor, 
     Secretary of the Interior, the Attorney General, other 
     relevant cabinet Secretaries, the Committee on Energy and 
     Commerce and the Committee on Education and the Workforce of 
     the House of Representatives and the Committee on Health, 
     Education, Labor, and Pensions of the Senate, and Congress, a 
     final report containing all of the findings and 
     recommendations required under this section, and shall make 
     such report available online in an accessible format.
       (g) Additional Reports.--In addition to the final report 
     under subsection (f). the task force shall submit--
       (1) a report to Congress identifying any recommendations 
     identified under subsection (c) that require additional 
     legislative authority to implement; and
       (2) a report to the Governors describing the opportunities 
     for local- and State-level partnerships, professional 
     development, or best

[[Page H9218]]

     practices recommended under subsection (d)(3).
       (h) Definitions.--In this section--
       (1) the term ``early childhood education program'' has the 
     meaning given such term in section 103 of the Higher 
     Education Act of 1965 (20 U.S.C. 1003);
       (2) The term ``Governor'' means the chief executive officer 
     of a State; and
       (3) the term ``State'' means each of the several States, 
     the District of Columbia, the Commonwealth of Puerto Rico, 
     the Virgin Islands, Guam, American Samoa, and the 
     Commonwealth of the Northern Mariana Islands.
       (i) Sunset.--The task force shall sunset on the date that 
     is 60 days after the submission of the final report under 
     subsection (f), but not later than September 30, 2023.

     SEC. 7133. NATIONAL CHILD TRAUMATIC STRESS INITIATIVE.

       Section 582(j) of the Public Health Service Act (42 U.S.C. 
     290hh-1(j)) (relating to grants to address the problems of 
     persons who experience violence-related stress) is amended by 
     striking ``$46,887,000 for each of fiscal years 2018 through 
     2022'' and inserting ``$63,887,000 for each of fiscal years 
     2019 through 2023''.

     SEC. 7134. GRANTS TO IMPROVE TRAUMA SUPPORT SERVICES AND 
                   MENTAL HEALTH CARE FOR CHILDREN AND YOUTH IN 
                   EDUCATIONAL SETTINGS.

       (a) Grants, Contracts, and Cooperative Agreements 
     Authorized.--The Secretary, in coordination with the 
     Assistant Secretary for Mental Health and Substance Use, is 
     authorized to award grants to, or enter into contracts or 
     cooperative agreements with, State educational agencies, 
     local educational agencies, Indian Tribes (as defined in 
     section 4 of the Indian Self-Determination and Education 
     Assistance Act) or their tribal educational agencies, a 
     school operated by the Bureau of Indian Education, a Regional 
     Corporation, or a Native Hawaiian educational organization, 
     for the purpose of increasing student access to evidence-
     based trauma support services and mental health care by 
     developing innovative initiatives, activities, or programs to 
     link local school systems with local trauma-informed support 
     and mental health systems, including those under the Indian 
     Health Service.
       (b) Duration.--With respect to a grant, contract, or 
     cooperative agreement awarded or entered into under this 
     section, the period during which payments under such grant, 
     contract or agreement are made to the recipient may not 
     exceed 4 years.
       (c) Use of Funds.--An entity that receives a grant, 
     contract, or cooperative agreement under this section shall 
     use amounts made available through such grant, contract, or 
     cooperative agreement for evidence-based activities, which 
     shall include any of the following:
       (1) Collaborative efforts between school-based service 
     systems and trauma-informed support and mental health service 
     systems to provide, develop, or improve prevention, 
     screening, referral, and treatment and support services to 
     students, such as providing trauma screenings to identify 
     students in need of specialized support.
       (2) To implement schoolwide positive behavioral 
     interventions and supports, or other trauma-informed models 
     of support.
       (3) To provide professional development to teachers, 
     teacher assistants, school leaders, specialized instructional 
     support personnel, and mental health professionals that--
       (A) fosters safe and stable learning environments that 
     prevent and mitigate the effects of trauma, including through 
     social and emotional learning;
       (B) improves school capacity to identify, refer, and 
     provide services to students in need of trauma support or 
     behavioral health services; or
       (C) reflects the best practices for trauma-informed 
     identification, referral, and support developed by the Task 
     Force under section 7132.
       (4) Services at a full-service community school that 
     focuses on trauma-informed supports, which may include a 
     full-time site coordinator, or other activities consistent 
     with section 4625 of the Elementary and Secondary Education 
     Act of 1965 (20 U.S.C. 7275).
       (5) Engaging families and communities in efforts to 
     increase awareness of child and youth trauma, which may 
     include sharing best practices with law enforcement regarding 
     trauma-informed care and working with mental health 
     professionals to provide interventions, as well as longer 
     term coordinated care within the community for children and 
     youth who have experienced trauma and their families.
       (6) To provide technical assistance to school systems and 
     mental health agencies.
       (7) To evaluate the effectiveness of the program carried 
     out under this section in increasing student access to 
     evidence-based trauma support services and mental health 
     care.
       (8) To establish partnerships with or provide subgrants to 
     Head Start agencies (including Early Head Start agencies), 
     public and private preschool programs, child care programs 
     (including home-based providers), or other entities described 
     in subsection (a), to include such entities described in this 
     paragraph in the evidence-based trauma initiatives, 
     activities, support services, and mental health systems 
     established under this section in order to provide, develop, 
     or improve prevention, screening, referral, and treatment and 
     support services to young children and their families.
       (d) Applications.--To be eligible to receive a grant, 
     contract, or cooperative agreement under this section, an 
     entity described in subsection (a) shall submit an 
     application to the Secretary at such time, in such manner, 
     and containing such information as the Secretary may 
     reasonably require, which shall include the following:
       (1) A description of the innovative initiatives, 
     activities, or programs to be funded under the grant, 
     contract, or cooperative agreement, including how such 
     program will increase access to evidence-based trauma support 
     services and mental health care for students, and, as 
     applicable, the families of such students.
       (2) A description of how the program will provide 
     linguistically appropriate and culturally competent services.
       (3) A description of how the program will support students 
     and the school in improving the school climate in order to 
     support an environment conducive to learning.
       (4) An assurance that--
       (A) persons providing services under the grant, contract, 
     or cooperative agreement are adequately trained to provide 
     such services; and
       (B) teachers, school leaders, administrators, specialized 
     instructional support personnel, representatives of local 
     Indian Tribes or tribal organizations as appropriate, other 
     school personnel, and parents or guardians of students 
     participating in services under this section will be engaged 
     and involved in the design and implementation of the 
     services.
       (5) A description of how the applicant will support and 
     integrate existing school-based services with the program in 
     order to provide mental health services for students, as 
     appropriate.
       (6) A description of the entities in the community with 
     which the applicant will partner or to which the applicant 
     will provide subgrants in accordance with subsection (c)(8).
       (e) Interagency Agreements.--
       (1) Local interagency agreements.--To ensure the provision 
     of the services described in subsection (c), a recipient of a 
     grant, contract, or cooperative agreement under this section, 
     or their designee, shall establish a local interagency 
     agreement among local educational agencies, agencies 
     responsible for early childhood education programs, Head 
     Start agencies (including Early Head Start agencies), 
     juvenile justice authorities, mental health agencies, child 
     welfare agencies, and other relevant agencies, authorities, 
     or entities in the community that will be involved in the 
     provision of such services.
       (2) Contents.--In ensuring the provision of the services 
     described in subsection (c), the local interagency agreement 
     shall specify with respect to each agency, authority, or 
     entity that is a party to such agreement--
       (A) the financial responsibility for the services;
       (B) the conditions and terms of responsibility for the 
     services, including quality, accountability, and coordination 
     of the services; and
       (C) the conditions and terms of reimbursement among such 
     agencies, authorities, or entities, including procedures for 
     dispute resolution.
       (f) Evaluation.--The Secretary shall reserve not more than 
     3 percent of the funds made available under subsection (l) 
     for each fiscal year to--
       (1) conduct a rigorous, independent evaluation of the 
     activities funded under this section; and
       (2) disseminate and promote the utilization of evidence-
     based practices regarding trauma support services and mental 
     health care.
       (g) Distribution of Awards.--The Secretary shall ensure 
     that grants, contracts, and cooperative agreements awarded or 
     entered into under this section are equitably distributed 
     among the geographical regions of the United States and among 
     tribal, urban, suburban, and rural populations.
       (h) Rule of Construction.--Nothing in this section shall be 
     construed--
       (1) to prohibit an entity involved with a program carried 
     out under this section from reporting a crime that is 
     committed by a student to appropriate authorities; or
       (2) to prevent Federal, State, and tribal law enforcement 
     and judicial authorities from exercising their 
     responsibilities with regard to the application of Federal, 
     tribal, and State law to crimes committed by a student.
       (i) Supplement, Not Supplant.--Any services provided 
     through programs carried out under this section shall 
     supplement, and not supplant, existing mental health 
     services, including any special education and related 
     services provided under the Individuals with Disabilities 
     Education Act (20 U.S.C. 1400 et seq.).
       (j) Consultation With Indian Tribes.--In carrying out 
     subsection (a), the Secretary shall, in a timely manner, 
     meaningfully consult with Indian Tribes and their 
     representatives to ensure notice of eligibility.
       (k) Definitions.--In this section:
       (1) Elementary school.--The term ``elementary school'' has 
     the meaning given such term in section 8101 of the Elementary 
     and Secondary Education Act of 1965 (20 U.S.C. 7801).
       (2) Evidence-based.--The term ``evidence-based'' has the 
     meaning given such term in section 8101(21)(A)(i) of the 
     Elementary and Secondary Education Act of 1965 (20 U.S.C. 
     7801(21)(A)(i)).
       (3) Native hawaiian educational organization.--The term 
     ``Native Hawaiian educational organization'' has the meaning 
     given such term in section 6207 of the Elementary and 
     Secondary Education Act of 1965 (20 U.S.C. 7517).

[[Page H9219]]

       (4) Local educational agency.--The term ``local educational 
     agency'' has the meaning given such term in section 8101 of 
     the Elementary and Secondary Education Act of 1965 (20 U.S.C. 
     7801).
       (5) Regional corporation.--The term ``Regional 
     Corporation'' has the meaning given the term in section 3 of 
     the Alaska Native Claims Settlement Act (43 U.S.C. 1602)).
       (6) School.--The term ``school'' means a public elementary 
     school or public secondary school.
       (7) School leader.--The term ``school leader'' has the 
     meaning given such term in section 8101 of the Elementary and 
     Secondary Education Act of 1965 (20 U.S.C. 7801).
       (8) Secondary school.--The term ``secondary school'' has 
     the meaning given such term in section 8101 of the Elementary 
     and Secondary Education Act of 1965 (20 U.S.C. 7801).
       (9) Secretary.--The term ``Secretary'' means the Secretary 
     of Education.
       (10) Specialized instructional support personnel.--The term 
     ``specialized instructional support personnel'' has the 
     meaning given such term in section 8101 of the Elementary and 
     Secondary Education Act of 1965 (20 U.S.C. 7801).
       (11) State educational agency.--The term ``State 
     educational agency'' has the meaning given such term in 
     section 8101 of the Elementary and Secondary Education Act of 
     1965 (20 U.S.C. 7801).
       (l) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $50,000,000 for 
     each of fiscal years 2019 through 2023.

     SEC. 7135. RECOGNIZING EARLY CHILDHOOD TRAUMA RELATED TO 
                   SUBSTANCE ABUSE.

       (a) Dissemination of Information.--The Secretary of Health 
     and Human Services shall disseminate information, resources, 
     and, if requested, technical assistance to early childhood 
     care and education providers and professionals working with 
     young children on--
       (1) ways to properly recognize children who may be impacted 
     by trauma, including trauma related to substance use by a 
     family member or other adult; and
       (2) how to respond appropriately in order to provide for 
     the safety and well-being of young children and their 
     families.
       (b) Goals.--The information, resources, and technical 
     assistance provided under subsection (a) shall--
       (1) educate early childhood care and education providers 
     and professionals working with young children on 
     understanding and identifying the early signs and risk 
     factors of children who might be impacted by trauma, 
     including trauma due to exposure to substance use;
       (2) suggest age-appropriate communication tools, 
     procedures, and practices for trauma-informed care, including 
     ways to prevent or mitigate the effects of trauma;
       (3) provide options for responding to children impacted by 
     trauma, including due to exposure to substance use, that 
     consider the needs of the child and family, including 
     recommending resources and referrals for evidence-based 
     services to support such family; and
       (4) promote whole-family and multi-generational approaches 
     to keep families safely together when it is in the best 
     interest of the child.
       (c) Coordination.--The Secretary of Health and Human 
     Services shall coordinate with the task force to develop best 
     practices for trauma-informed identification, referral, and 
     support authorized under section 7132 in disseminating the 
     information, resources, and technical assistance described 
     under subsection (b).
       (d) Rule of Construction.--Such information, resources, and 
     if applicable, technical assistance, shall not be construed 
     to amend the requirements under--
       (1) the Child Care and Development Block Grant Act of 1990 
     (42 U.S.C. 9858 et seq.);
       (2) the Head Start Act (42 U.S.C. 9831 et seq.); or
       (3) the Individuals with Disabilities Education Act (20 
     U.S.C. 1400 et seq.).

       Subtitle O--Eliminating Opioid Related Infectious Diseases

     SEC. 7141. REAUTHORIZATION AND EXPANSION OF PROGRAM OF 
                   SURVEILLANCE AND EDUCATION REGARDING INFECTIONS 
                   ASSOCIATED WITH ILLICIT DRUG USE AND OTHER RISK 
                   FACTORS.

       Section 317N of the Public Health Service Act (42 U.S.C. 
     247b-15) is amended to read as follows:

     ``SEC. 317N. SURVEILLANCE AND EDUCATION REGARDING INFECTIONS 
                   ASSOCIATED WITH ILLICIT DRUG USE AND OTHER RISK 
                   FACTORS.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     may (directly or through grants to public and nonprofit 
     private entities) provide for programs for the following:
       ``(1) To cooperate with States and Indian tribes in 
     implementing or maintaining a national system to determine 
     the incidence of infections commonly associated with illicit 
     drug use, such as viral hepatitis, human immunodeficiency 
     virus, and infective endocarditis, and to assist the States 
     in determining the prevalence of such infections, which may 
     include the reporting of cases of such infections.
       ``(2) To identify, counsel, and offer testing to 
     individuals who are at risk of infections described in 
     paragraph (1) resulting from illicit drug use, receiving 
     blood transfusions prior to July 1992, or other risk factors.
       ``(3) To provide appropriate referrals for counseling, 
     testing, and medical treatment of individuals identified 
     under paragraph (2) and to ensure, to the extent practicable, 
     the provision of appropriate follow-up services.
       ``(4) To develop and disseminate public information and 
     education programs for the detection and control of 
     infections described in paragraph (1), with priority given to 
     high-risk populations as determined by the Secretary.
       ``(5) To improve the education, training, and skills of 
     health professionals in the detection and control of 
     infections described in paragraph (1), including to improve 
     coordination of treatment of substance use disorders and 
     infectious diseases, with priority given to substance use 
     disorder treatment providers, pediatricians and other primary 
     care providers, obstetrician-gynecologists, and infectious 
     disease clinicians, including HIV clinicians.
       ``(b) Laboratory Procedures.--The Secretary may (directly 
     or through grants to public and nonprofit private entities) 
     carry out programs to provide for improvements in the quality 
     of clinical-laboratory procedures regarding infections 
     described in subsection (a)(1).
       ``(c) Definition.--In this section, the term `Indian tribe' 
     has the meaning given that term in section 4 of the Indian 
     Self-Determination and Education Assistance Act.
       ``(d) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated $40,000,000 for each of the fiscal years 2019 
     through 2023.''.

            Subtitle P--Peer Support Communities of Recovery

     SEC. 7151. BUILDING COMMUNITIES OF RECOVERY.

       Section 547 of the Public Health Service Act (42 U.S.C. 
     290ee-2) is amended to read as follows:

     ``SEC. 547. BUILDING COMMUNITIES OF RECOVERY.

       ``(a) Definition.--In this section, the term `recovery 
     community organization' means an independent nonprofit 
     organization that--
       ``(1) mobilizes resources within and outside of the 
     recovery community, which may include through a peer support 
     network, to increase the prevalence and quality of long-term 
     recovery from substance use disorders; and
       ``(2) is wholly or principally governed by people in 
     recovery for substance use disorders who reflect the 
     community served.
       ``(b) Grants Authorized.--The Secretary shall award grants 
     to recovery community organizations to enable such 
     organizations to develop, expand, and enhance recovery 
     services.
       ``(c) Federal Share.--The Federal share of the costs of a 
     program funded by a grant under this section may not exceed 
     85 percent.
       ``(d) Use of Funds.--Grants awarded under subsection (b)--
       ``(1) shall be used to develop, expand, and enhance 
     community and statewide recovery support services; and
       ``(2) may be used to--
       ``(A) build connections between recovery networks, 
     including between recovery community organizations and peer 
     support networks, and with other recovery support services, 
     including--
       ``(i) behavioral health providers;
       ``(ii) primary care providers and physicians;
       ``(iii) educational and vocational schools;
       ``(iv) employers;
       ``(v) housing services;
       ``(vi) child welfare agencies; and
       ``(vii) other recovery support services that facilitate 
     recovery from substance use disorders, including non-clinical 
     community services;
       ``(B) reduce stigma associated with substance use 
     disorders; and
       ``(C) conduct outreach on issues relating to substance use 
     disorders and recovery, including--
       ``(i) identifying the signs of substance use disorder;
       ``(ii) the resources available to individuals with 
     substance use disorder and to families of an individual with 
     a substance use disorder, including programs that mentor and 
     provide support services to children;
       ``(iii) the resources available to help support individuals 
     in recovery; and
       ``(iv) related medical outcomes of substance use disorders, 
     the potential of acquiring an infection commonly associated 
     with illicit drug use, and neonatal abstinence syndrome among 
     infants exposed to opioids during pregnancy.
       ``(e) Special Consideration.--In carrying out this section, 
     the Secretary shall give special consideration to the unique 
     needs of rural areas, including areas with an age-adjusted 
     rate of drug overdose deaths that is above the national 
     average and areas with a shortage of prevention and treatment 
     services.
       ``(f) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $5,000,000 for 
     each of fiscal years 2019 through 2023.''.

     SEC. 7152. PEER SUPPORT TECHNICAL ASSISTANCE CENTER.

       Title V of the Public Health Service Act (42 U.S.C. 290dd 
     et seq.) is amended by inserting after section 547 the 
     following:

[[Page H9220]]

  


     ``SEC. 547A. PEER SUPPORT TECHNICAL ASSISTANCE CENTER.

       ``(a) Establishment.--The Secretary, acting through the 
     Assistant Secretary, shall establish or operate a National 
     Peer-Run Training and Technical Assistance Center for 
     Addiction Recovery Support (referred to in this section as 
     the `Center').
       ``(b) Functions.--The Center established under subsection 
     (a) shall provide technical assistance and support to 
     recovery community organizations and peer support networks, 
     including such assistance and support related to--
       ``(1) training on identifying--
       ``(A) signs of substance use disorder;
       ``(B) resources to assist individuals with a substance use 
     disorder, or resources for families of an individual with a 
     substance use disorder; and
       ``(C) best practices for the delivery of recovery support 
     services;
       ``(2) the provision of translation services, 
     interpretation, or other such services for clients with 
     limited English speaking proficiency;
       ``(3) data collection to support research, including for 
     translational research;
       ``(4) capacity building; and
       ``(5) evaluation and improvement, as necessary, of the 
     effectiveness of such services provided by recovery community 
     organizations.
       ``(c) Best Practices.--The Center established under 
     subsection (a) shall periodically issue best practices for 
     use by recovery community organizations and peer support 
     networks.
       ``(d) Recovery Community Organization.--In this section, 
     the term `recovery community organization' has the meaning 
     given such term in section 547.
       ``(e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $1,000,000 for 
     each of fiscal years 2019 through 2023.''.

 Subtitle Q--Creating Opportunities That Necessitate New and Enhanced 
         Connections That Improve Opioid Navigation Strategies

     SEC. 7161. PREVENTING OVERDOSES OF CONTROLLED SUBSTANCES.

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

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

       ``(a) Evidence-Based Prevention Grants.--
       ``(1) In general.--The Director of the Centers for Disease 
     Control and Prevention may--
       ``(A) to the extent practicable, carry out and expand any 
     evidence-based prevention activities described in paragraph 
     (2);
       ``(B) provide training and technical assistance to States, 
     localities, and Indian tribes for purposes of carrying out 
     such activity; and
       ``(C) award grants to States, localities, and Indian tribes 
     for purposes of carrying out such activity.
       ``(2) Evidence-based prevention activities.--An evidence-
     based prevention activity described in this paragraph is any 
     of the following activities:
       ``(A) Improving the efficiency and use of a new or 
     currently operating prescription drug monitoring program, 
     including by--
       ``(i) encouraging all authorized users (as specified by the 
     State or other entity) to register with and use the program;
       ``(ii) enabling such users to access any updates to 
     information collected by the program in as close to real-time 
     as possible;
       ``(iii) improving the ease of use of such program;
       ``(iv) providing for a mechanism for the program to notify 
     authorized users of any potential misuse or abuse of 
     controlled substances and any detection of inappropriate 
     prescribing or dispensing practices relating to such 
     substances;
       ``(v) encouraging the analysis of prescription drug 
     monitoring data for purposes of providing de-identified, 
     aggregate reports based on such analysis to State public 
     health agencies, State substance abuse agencies, State 
     licensing boards, and other appropriate State agencies, as 
     permitted under applicable Federal and State law and the 
     policies of the prescription drug monitoring program and not 
     containing any protected health information, to prevent 
     inappropriate prescribing, drug diversion, or abuse and 
     misuse of controlled substances, and to facilitate better 
     coordination among agencies;
       ``(vi) enhancing interoperability between the program and 
     any health information technology (including certified health 
     information technology), including by integrating program 
     data into such technology;
       ``(vii) updating program capabilities to respond to 
     technological innovation for purposes of appropriately 
     addressing the occurrence and evolution of controlled 
     substance overdoses;
       ``(viii) facilitating and encouraging data exchange between 
     the program and the prescription drug monitoring programs of 
     other States;
       ``(ix) enhancing data collection and quality, including 
     improving patient matching and proactively monitoring data 
     quality;
       ``(x) providing prescriber and dispenser practice tools, 
     including prescriber practice insight reports for 
     practitioners to review their prescribing patterns in 
     comparison to such patterns of other practitioners in the 
     specialty; and
       ``(xi) meeting the purpose of the program established under 
     section 399O, as described in section 399O(a).
       ``(B) Promoting community or health system interventions.
       ``(C) Evaluating interventions to prevent controlled 
     substance overdoses.
       ``(D) Implementing projects to advance an innovative 
     prevention approach with respect to new and emerging public 
     health crises and opportunities to address such crises, such 
     as enhancing public education and awareness on the risks 
     associated with opioids.
       ``(3) Additional grants.--The Director may award grants to 
     States, localities, and Indian Tribes--
       ``(A) to carry out innovative projects for grantees to 
     rapidly respond to controlled substance misuse, abuse, and 
     overdoses, including changes in patterns of controlled 
     substance use; and
       ``(B) for any other evidence-based activity for preventing 
     controlled substance misuse, abuse, and overdoses as the 
     Director determines appropriate.
       ``(4) Research.--The Director, in coordination with the 
     Assistant Secretary for Mental Health and Substance Use and 
     the National Mental Health and Substance Use Policy 
     Laboratory established under section 501A, as appropriate and 
     applicable, may conduct studies and evaluations to address 
     substance use disorders, including preventing substance use 
     disorders or other related topics the Director determines 
     appropriate.
       ``(b) Enhanced Controlled Substance Overdose Data 
     Collection, Analysis, and Dissemination Grants.--
       ``(1) In general.--The Director of the Centers for Disease 
     Control and Prevention may--
       ``(A) to the extent practicable, carry out any controlled 
     substance overdose data collection activities described in 
     paragraph (2);
       ``(B) provide training and technical assistance to States, 
     localities, and Indian tribes for purposes of carrying out 
     such activity;
       ``(C) award grants to States, localities, and Indian tribes 
     for purposes of carrying out such activity; and
       ``(D) coordinate with the Assistant Secretary for Mental 
     Health and Substance Use to collect data pursuant to section 
     505(d)(1)(A) (relating to the number of individuals admitted 
     to emergency departments as a result of the abuse of alcohol 
     or other drugs).
       ``(2) Controlled substance overdose data collection and 
     analysis activities.--A controlled substance overdose data 
     collection, analysis, and dissemination activity described in 
     this paragraph is any of the following activities:
       ``(A) Improving the timeliness of reporting data to the 
     public, including data on fatal and nonfatal overdoses of 
     controlled substances.
       ``(B) Enhancing the comprehensiveness of controlled 
     substance overdose data by collecting information on such 
     overdoses from appropriate sources such as toxicology 
     reports, autopsy reports, death scene investigations, and 
     emergency departments.
       ``(C) Modernizing the system for coding causes of death 
     related to controlled substance overdoses to use an 
     electronic-based system.
       ``(D) Using data to help identify risk factors associated 
     with controlled substance overdoses.
       ``(E) Supporting entities involved in providing information 
     on controlled substance overdoses, such as coroners, medical 
     examiners, and public health laboratories to improve accurate 
     testing and standardized reporting of causes and contributing 
     factors to controlled substances overdoses and analysis of 
     various opioid analogues to controlled substance overdoses.
       ``(F) Working to enable and encourage the access, exchange, 
     and use of information regarding controlled substance 
     overdoses among data sources and entities.
       ``(c) Definitions.--In this section:
       ``(1) Controlled substance.--The term `controlled 
     substance' has the meaning given that term in section 102 of 
     the Controlled Substances Act.
       ``(2) Indian tribe.--The term `Indian tribe' has the 
     meaning given that term in section 4 of the Indian Self-
     Determination and Education Assistance Act.
       ``(d) Authorization of Appropriations.--For purposes of 
     carrying out this section, section 399O of this Act, and 
     section 102 of the Comprehensive Addiction and Recovery Act 
     of 2016 (Public Law 114-198), there is authorized to be 
     appropriated $496,000,000 for each of fiscal years 2019 
     through 2023.''.
       (b) Education and Awareness.--Section 102 of the 
     Comprehensive Addiction and Recovery Act of 2016 (Public Law 
     114-198) is amended--
       (1) by amending subsection (a) to read as follows:
       ``(a) In General.--The Secretary of Health and Human 
     Services, acting through the Director of the Centers for 
     Disease Control and Prevention and in coordination with the 
     heads of other departments and agencies, shall advance 
     education and awareness regarding the risks related to misuse 
     and abuse of opioids, as appropriate, which may include 
     developing or improving existing programs, conducting 
     activities, and awarding grants that advance the education 
     and awareness of--
       ``(1) the public, including patients and consumers--
       ``(A) generally; and

[[Page H9221]]

       ``(B) regarding such risks related to unused opioids and 
     the dispensing options under section 309(f) of the Controlled 
     Substances Act, as applicable; and
       ``(2) providers, which may include--
       ``(A) providing for continuing education on appropriate 
     prescribing practices;
       ``(B) education related to applicable State or local 
     prescriber limit laws, information on the use of non-
     addictive alternatives for pain management, and the use of 
     overdose reversal drugs, as appropriate;
       ``(C) disseminating and improving the use of evidence-based 
     opioid prescribing guidelines across relevant health care 
     settings, as appropriate, and updating guidelines as 
     necessary;
       ``(D) implementing strategies, such as best practices, to 
     encourage and facilitate the use of prescriber guidelines, in 
     accordance with State and local law;
       ``(E) disseminating information to providers about 
     prescribing options for controlled substances, including such 
     options under section 309(f) of the Controlled Substances 
     Act, as applicable; and
       ``(F) disseminating information, as appropriate, on the 
     National Pain Strategy developed by or in consultation with 
     the Assistant Secretary for Health; and
       ``(3) other appropriate entities.''; and
       (2) in subsection (b)--
       (A) by striking ``opioid abuse'' each place such term 
     appears and inserting ``opioid misuse and abuse''; and
       (B) in paragraph (2), by striking ``safe disposal of 
     prescription medications and other'' and inserting ``non-
     addictive treatment options, safe disposal options for 
     prescription medications, and other applicable''.

     SEC. 7162. PRESCRIPTION DRUG MONITORING PROGRAM.

       Section 399O of the Public Health Service Act (42 U.S.C. 
     280g-3) is amended to read as follows:

     ``SEC. 399O. PRESCRIPTION DRUG MONITORING PROGRAM.

       ``(a) Program.--
       ``(1) In general.--Each fiscal year, the Secretary, acting 
     through the Director of the Centers for Disease Control and 
     Prevention, in coordination with the heads of other 
     departments and agencies as appropriate, shall support States 
     or localities for the purpose of improving the efficiency and 
     use of PDMPs, including--
       ``(A) establishment and implementation of a PDMP;
       ``(B) maintenance of a PDMP;
       ``(C) improvements to a PDMP by--
       ``(i) enhancing functional components to work toward--

       ``(I) universal use of PDMPs among providers and their 
     delegates, to the extent that State laws allow;
       ``(II) more timely inclusion of data within a PDMP;
       ``(III) active management of the PDMP, in part by sending 
     proactive or unsolicited reports to providers to inform 
     prescribing; and
       ``(IV) ensuring the highest level of ease in use of and 
     access to PDMPs by providers and their delegates, to the 
     extent that State laws allow;

       ``(ii) in consultation with the Office of the National 
     Coordinator for Health Information Technology, improving the 
     intrastate interoperability of PDMPs by--

       ``(I) making PDMPs more actionable by integrating PDMPs 
     within electronic health records and health information 
     technology infrastructure; and
       ``(II) linking PDMP data to other data systems within the 
     State, including--

       ``(aa) the data of pharmacy benefit managers, medical 
     examiners and coroners, and the State's Medicaid program;
       ``(bb) worker's compensation data; and
       ``(cc) prescribing data of providers of the Department of 
     Veterans Affairs and the Indian Health Service within the 
     State;
       ``(iii) in consultation with the Office of the National 
     Coordinator for Health Information Technology, improving the 
     interstate interoperability of PDMPs through--

       ``(I) sharing of dispensing data in near-real time across 
     State lines; and
       ``(II) integration of automated queries for multistate PDMP 
     data and analytics into clinical workflow to improve the use 
     of such data and analytics by practitioners and dispensers; 
     or

       ``(iv) improving the ability to include treatment 
     availability resources and referral capabilities within the 
     PDMP.
       ``(2) Legislation.--As a condition on the receipt of 
     support under this section, the Secretary shall require a 
     State or locality to demonstrate that it has enacted 
     legislation or regulations--
       ``(A) to provide for the implementation of the PDMP; and
       ``(B) to permit the imposition of appropriate penalties for 
     the unauthorized use and disclosure of information maintained 
     by the PDMP.
       ``(b) PDMP Strategies.--The Secretary shall encourage a 
     State or locality, in establishing, improving, or maintaining 
     a PDMP, to implement strategies that improve--
       ``(1) the reporting of dispensing in the State or locality 
     of a controlled substance to an ultimate user so the 
     reporting occurs not later than 24 hours after the dispensing 
     event;
       ``(2) the consultation of the PDMP by each prescribing 
     practitioner, or their designee, in the State or locality 
     before initiating treatment with a controlled substance, or 
     any substance as required by the State to be reported to the 
     PDMP, and over the course of ongoing treatment for each 
     prescribing event;
       ``(3) the consultation of the PDMP before dispensing a 
     controlled substance, or any substance as required by the 
     State to be reported to the PDMP;
       ``(4) the proactive notification to a practitioner when 
     patterns indicative of controlled substance misuse by a 
     patient, including opioid misuse, are detected;
       ``(5) the availability of data in the PDMP to other States, 
     as allowable under State law; and
       ``(6) the availability of nonidentifiable information to 
     the Centers for Disease Control and Prevention for 
     surveillance, epidemiology, statistical research, or 
     educational purposes.
       ``(c) Drug Misuse and Abuse.--In consultation with 
     practitioners, dispensers, and other relevant and interested 
     stakeholders, a State receiving support under this section--
       ``(1) shall establish a program to notify practitioners and 
     dispensers of information that will help to identify and 
     prevent the unlawful diversion or misuse of controlled 
     substances;
       ``(2) may, to the extent permitted under State law, notify 
     the appropriate authorities responsible for carrying out drug 
     diversion investigations if the State determines that 
     information in the PDMP maintained by the State indicates an 
     unlawful diversion or abuse of a controlled substance;
       ``(3) may conduct analyses of controlled substance program 
     data for purposes of providing appropriate State agencies 
     with aggregate reports based on such analyses in as close to 
     real-time as practicable, regarding prescription patterns 
     flagged as potentially presenting a risk of misuse, abuse, 
     addiction, overdose, and other aggregate information, as 
     appropriate and in compliance with applicable Federal and 
     State laws and provided that such reports shall not include 
     protected health information; and
       ``(4) may access information about prescriptions, such as 
     claims data, to ensure that such prescribing and dispensing 
     history is updated in as close to real-time as practicable, 
     in compliance with applicable Federal and State laws and 
     provided that such information shall not include protected 
     health information.
       ``(d) Evaluation and Reporting.--As a condition on receipt 
     of support under this section, the State shall report on 
     interoperability with PDMPs of other States and Federal 
     agencies, where appropriate, intrastate interoperability with 
     health information technology systems such as electronic 
     health records, health information exchanges, and e-
     prescribing, where appropriate, and whether or not the State 
     provides automatic, up-to-date, or daily information about a 
     patient when a practitioner (or the designee of a 
     practitioner, where permitted) requests information about 
     such patient.
       ``(e) Evaluation and Reporting.--A State receiving support 
     under this section shall provide the Secretary with aggregate 
     nonidentifiable information, as permitted by State law, to 
     enable the Secretary--
       ``(1) to evaluate the success of the State's program in 
     achieving the purpose described in subsection (a); or
       ``(2) to prepare and submit to the Congress the report 
     required by subsection (i)(2).
       ``(f) Education and Access to the Monitoring System.--A 
     State receiving support under this section shall take steps 
     to--
       ``(1) facilitate prescribers and dispensers, and their 
     delegates, as permitted by State law, to use the PDMP, to the 
     extent practicable; and
       ``(2) educate prescribers and dispensers, and their 
     delegates on the benefits of the use of PDMPs.
       ``(g) Electronic Format.--The Secretary may issue 
     guidelines specifying a uniform electronic format for the 
     reporting, sharing, and disclosure of information pursuant to 
     PDMPs. To the extent possible, such guidelines shall be 
     consistent with standards recognized by the Office of the 
     National Coordinator for Health Information Technology.
       ``(h) Rules of Construction.--
       ``(1) Functions otherwise authorized by law.--Nothing in 
     this section shall be construed to restrict the ability of 
     any authority, including any local, State, or Federal law 
     enforcement, narcotics control, licensure, disciplinary, or 
     program authority, to perform functions otherwise authorized 
     by law.
       ``(2) Additional privacy protections.--Nothing in this 
     section shall be construed as preempting any State from 
     imposing any additional privacy protections.
       ``(3) Federal privacy requirements.--Nothing in this 
     section shall be construed to supersede any Federal privacy 
     or confidentiality requirement, including the regulations 
     promulgated under section 264(c) of the Health Insurance 
     Portability and Accountability Act of 1996 (Public Law 104-
     191; 110 Stat. 2033) and section 543 of this Act.
       ``(4) No federal private cause of action.--Nothing in this 
     section shall be construed to create a Federal private cause 
     of action.
       ``(i) Progress Report.--Not later than 3 years after the 
     date of enactment of this section, the Secretary shall--
       ``(1) complete a study that--
       ``(A) determines the progress of grantees in establishing 
     and implementing PDMPs consistent with this section;
       ``(B) provides an analysis of the extent to which the 
     operation of PDMPs has--
       ``(i) reduced inappropriate use, abuse, diversion of, and 
     overdose with, controlled substances;

[[Page H9222]]

       ``(ii) established or strengthened initiatives to ensure 
     linkages to substance use disorder treatment services; or
       ``(iii) affected patient access to appropriate care in 
     States operating PDMPs;
       ``(C) determine the progress of grantees in achieving 
     interstate interoperability and intrastate interoperability 
     of PDMPs, including an assessment of technical, legal, and 
     financial barriers to such progress and recommendations for 
     addressing these barriers;
       ``(D) determines the progress of grantees in implementing 
     near real-time electronic PDMPs;
       ``(E) provides an analysis of the privacy protections in 
     place for the information reported to the PDMP in each State 
     or locality receiving support under this section and any 
     recommendations of the Secretary for additional Federal or 
     State requirements for protection of this information;
       ``(F) determines the progress of States or localities in 
     implementing technological alternatives to centralized data 
     storage, such as peer-to-peer file sharing or data pointer 
     systems, in PDMPs and the potential for such alternatives to 
     enhance the privacy and security of individually identifiable 
     data; and
       ``(G) evaluates the penalties that States or localities 
     have enacted for the unauthorized use and disclosure of 
     information maintained in PDMPs, and the criteria used by the 
     Secretary to determine whether such penalties qualify as 
     appropriate for purposes of subsection (a)(2); and
       ``(2) submit a report to the Congress on the results of the 
     study.
       ``(j) Advisory Council.--
       ``(1) Establishment.--A State or locality may establish an 
     advisory council to assist in the establishment, improvement, 
     or maintenance of a PDMP consistent with this section.
       ``(2) Limitation.--A State or locality may not use Federal 
     funds for the operations of an advisory council to assist in 
     the establishment, improvement, or maintenance of a PDMP.
       ``(3) Sense of congress.--It is the sense of the Congress 
     that, in establishing an advisory council to assist in the 
     establishment, improvement, or maintenance of a PDMP, a State 
     or locality should consult with appropriate professional 
     boards and other interested parties.
       ``(k) Definitions.--For purposes of this section:
       ``(1) The term `controlled substance' means a controlled 
     substance (as defined in section 102 of the Controlled 
     Substances Act) in schedule II, III, or IV of section 202 of 
     such Act.
       ``(2) The term `dispense' means to deliver a controlled 
     substance to an ultimate user by, or pursuant to the lawful 
     order of, a practitioner, irrespective of whether the 
     dispenser uses the Internet or other means to effect such 
     delivery.
       ``(3) The term `dispenser' means a physician, pharmacist, 
     or other person that dispenses a controlled substance to an 
     ultimate user.
       ``(4) The term `interstate interoperability' with respect 
     to a PDMP means the ability of the PDMP to electronically 
     share reported information with another State if the 
     information concerns either the dispensing of a controlled 
     substance to an ultimate user who resides in such other 
     State, or the dispensing of a controlled substance prescribed 
     by a practitioner whose principal place of business is 
     located in such other State.
       ``(5) The term `intrastate interoperability' with respect 
     to a PDMP means the integration of PDMP data within 
     electronic health records and health information technology 
     infrastructure or linking of a PDMP to other data systems 
     within the State, including the State's Medicaid program, 
     workers' compensation programs, and medical examiners or 
     coroners.
       ``(6) The term `nonidentifiable information' means 
     information that does not identify a practitioner, dispenser, 
     or an ultimate user and with respect to which there is no 
     reasonable basis to believe that the information can be used 
     to identify a practitioner, dispenser, or an ultimate user.
       ``(7) The term `PDMP' means a prescription drug monitoring 
     program that is State-controlled.
       ``(8) The term `practitioner' means a physician, dentist, 
     veterinarian, scientific investigator, pharmacy, hospital, or 
     other person licensed, registered, or otherwise permitted, by 
     the United States or the jurisdiction in which the individual 
     practices or does research, to distribute, dispense, conduct 
     research with respect to, administer, or use in teaching or 
     chemical analysis, a controlled substance in the course of 
     professional practice or research.
       ``(9) The term `State' means each of the 50 States, the 
     District of Columbia, and any commonwealth or territory of 
     the United States.
       ``(10) The term `ultimate user' means a person who has 
     obtained from a dispenser, and who possesses, a controlled 
     substance for the person's own use, for the use of a member 
     of the person's household, or for the use of an animal owned 
     by the person or by a member of the person's household.
       ``(11) The term `clinical workflow' means the integration 
     of automated queries for prescription drug monitoring 
     programs data and analytics into health information 
     technologies such as electronic health record systems, health 
     information exchanges, and/or pharmacy dispensing software 
     systems, thus streamlining provider access through automated 
     queries.''.

   Subtitle R--Review of Substance Use Disorder Treatment Providers 
                       Receiving Federal Funding

     SEC. 7171. REVIEW OF SUBSTANCE USE DISORDER TREATMENT 
                   PROVIDERS RECEIVING FEDERAL FUNDING.

       (a) In General.--The Secretary of Health and Human Services 
     (in this section referred to as the ``Secretary'') shall 
     conduct a review of entities that receive Federal funding for 
     the provision of substance use disorder treatment services. 
     The review shall include:
       (1) The length of time the entity has provided substance 
     use disorder treatment services and the geographic area 
     served by the entity.
       (2) A detailed analysis of the patient population served by 
     the entity, including but not limited to the number of 
     patients, types of diagnosed substance use disorders and the 
     demographic information of such patients, including sex, 
     race, ethnicity, and socioeconomic status.
       (3) Detailed information on the types of substance use 
     disorders for which the entity has the experience, 
     capability, and capacity to provide such services.
       (4) An analysis of how the entity handles patients 
     requiring treatment for a substance use disorder that the 
     organization is not able to treat.
       (5) An analysis of what is needed in order to improve the 
     entity's ability to meet the addiction treatment needs of the 
     communities served by that entity.
       (6) Based on the identified needs of the communities 
     served, a description of unmet needs and inadequate services 
     and how such needs and services could be better addressed to 
     treat individuals with methamphetamine, cocaine, including 
     crack cocaine, heroin, opioid, and other substance use 
     disorders.
       (b) Report.--Not later than 2 years after the date of the 
     enactment of this Act, the Secretary shall develop and submit 
     to Congress a plan to direct appropriate resources to 
     entities that provide substance use disorder treatment 
     services in order to address inadequacies in services or 
     funding identified through the survey described in subsection 
     (a).

                  Subtitle S--Other Health Provisions

     SEC. 7181. STATE RESPONSE TO THE OPIOID ABUSE CRISIS.

       (a) In General.--Section 1003 of the 21st Century Cures Act 
     (Public Law 114-255) is amended--
       (1) in subsection (a)--
       (A) by striking ``the authorization of appropriations under 
     subsection (b) to carry out the grant program described in 
     subsection (c)'' and inserting ``subsection (h) to carry out 
     the grant program described in subsection (b)''; and
       (B) by inserting ``and Indian Tribes'' after ``States'';
       (2) by striking subsection (b);
       (3) by redesignating subsections (c) through (e) as 
     subsections (b) through (d), respectively;
       (4) by redesignating subsection (f) as subsection (j);
       (5) in subsection (b), as so redesignated--
       (A) in paragraph (1)--
       (i) in the paragraph heading, by inserting ``and tribal'' 
     after ``State'';
       (ii) by striking ``States for the purpose of addressing the 
     opioid abuse crisis within such States'' and inserting 
     ``States and Indian Tribes for the purpose of addressing the 
     opioid abuse crisis within such States and Indian Tribes'';
       (iii) by inserting ``or Indian Tribes'' after ``preference 
     to States''; and
       (iv) by inserting before the period of the second sentence 
     ``or other Indian Tribes, as applicable''; and
       (B) in paragraph (2)--
       (i) in the matter preceding subparagraph (A), by striking 
     ``to a State'';
       (ii) in subparagraph (A), by striking ``Improving State'' 
     and inserting ``Establishing or improving'';
       (iii) in subparagraph (C), by inserting ``preventing 
     diversion of controlled substances,'' after ``treatment 
     programs,''; and
       (iv) in subparagraph (E), by striking ``as the State 
     determines appropriate, related to addressing the opioid 
     abuse crisis within the State'' and inserting ``as the State 
     or Indian Tribe determines appropriate, related to addressing 
     the opioid abuse crisis within the State or Indian Tribe, 
     including directing resources in accordance with local needs 
     related to substance use disorders'';
       (6) in subsection (c), as so redesignated, by striking 
     ``subsection (c)'' and inserting ``subsection (b)'';
       (7) in subsection (d), as so redesignated--
       (A) in the matter preceding paragraph (1), by striking 
     ``the authorization of appropriations under subsection (b)'' 
     and inserting ``subsection (h)''; and
       (B) in paragraph (1), by striking ``subsection (c)'' and 
     inserting ``subsection (b)''; and
       (8) by inserting after subsection (d), as so redesignated, 
     the following:
       ``(e) Indian Tribes.--
       ``(1) Definition.--For purposes of this section, the term 
     `Indian Tribe' has the meaning given the term `Indian tribe' 
     in section 4 of the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 5304).
       ``(2) Appropriate mechanisms.--The Secretary, in 
     consultation with Indian Tribes, shall identify and establish 
     appropriate mechanisms for Tribes to demonstrate or report 
     the information as required under subsections (b), (c), and 
     (d).

[[Page H9223]]

       ``(f) Report to Congress.--Not later than 1 year after the 
     date on which amounts are first awarded after the date of 
     enactment of this subsection, pursuant to subsection (b), and 
     annually thereafter, the Secretary shall submit to the 
     Committee on Health, Education, Labor, and Pensions of the 
     Senate and the Committee on Energy and Commerce of the House 
     of Representatives a report summarizing the information 
     provided to the Secretary in reports made pursuant to 
     subsection (c), including the purposes for which grant funds 
     are awarded under this section and the activities of such 
     grant recipients.
       ``(g) Technical Assistance.--The Secretary, including 
     through the Tribal Training and Technical Assistance Center 
     of the Substance Abuse and Mental Health Services 
     Administration, shall provide State agencies and Indian 
     Tribes, as applicable, with technical assistance concerning 
     grant application and submission procedures under this 
     section, award management activities, and enhancing outreach 
     and direct support to rural and underserved communities and 
     providers in addressing the opioid crisis.
       ``(h) Authorization of Appropriations.--For purposes of 
     carrying out the grant program under subsection (b), there is 
     authorized to be appropriated $500,000,000 for each of fiscal 
     years 2019 through 2021, to remain available until expended.
       ``(i) Set Aside.--Of the amounts made available for each 
     fiscal year to award grants under subsection (b) for a fiscal 
     year, 5 percent of such amount for such fiscal year shall be 
     made available to Indian Tribes, and up to 15 percent of such 
     amount for such fiscal year may be set aside for States with 
     the highest age-adjusted rate of drug overdose death based on 
     the ordinal ranking of States according to the Director of 
     the Centers for Disease Control and Prevention.''.
       (b) Conforming Amendment.--Section 1004(c) of the 21st 
     Century Cures Act (Public Law 114-255) is amended by striking 
     ``, the FDA Innovation Account, or the Account For the State 
     Response to the Opioid Abuse Crisis'' and inserting ``or the 
     FDA Innovation Account''.

     SEC. 7182. REPORT ON INVESTIGATIONS REGARDING PARITY IN 
                   MENTAL HEALTH AND SUBSTANCE USE DISORDER 
                   BENEFITS.

       (a) In General.--Section 13003 of the 21st Century Cures 
     Act (Public Law 114-255) is amended--
       (1) in subsection (a)--
       (A) by striking ``with findings of any serious violation 
     regarding'' and inserting ``concerning''; and
       (B) by inserting ``and the Committee on Education and the 
     Workforce'' after ``Energy and Commerce''; and
       (2) in subsection (b)(1)--
       (A) by inserting ``complaints received and number of'' 
     before ``closed''; and
       (B) by inserting before the period ``, and, for each such 
     investigation closed, which agency conducted the 
     investigation, whether the health plan that is the subject of 
     the investigation is fully insured or not fully insured and a 
     summary of any coordination between the applicable State 
     regulators and the Department of Labor, the Department of 
     Health and Human Services, or the Department of the Treasury, 
     and references to any guidance provided by the agencies 
     addressing the category of violation committed''.
       (b) Applicability.--The amendments made by subsection (a) 
     shall apply with respect to the second annual report required 
     under such section 13003 and each such annual report 
     thereafter.

     SEC. 7183. CAREER ACT.

       (a) In General.--The Secretary of Health and Human Services 
     (referred to in this section as the ``Secretary''), in 
     consultation with the Secretary of Labor, shall continue or 
     establish a program to support individuals in substance use 
     disorder treatment and recovery to live independently and 
     participate in the workforce.
       (b) Grants Authorized.--In carrying out the activities 
     under this section, the Secretary shall, on a competitive 
     basis, award grants for a period of not more than 5 years to 
     entities to enable such entities to carry out evidence-based 
     programs to help individuals in substance use disorder 
     treatment and recovery to live independently and participate 
     in the workforce. Such entities shall coordinate, as 
     applicable, with Indian tribes or tribal organizations (as 
     applicable), State boards and local boards (as defined in 
     section 3 of the Workforce Innovation and Opportunity Act (29 
     U.S.C. 3102), lead State agencies with responsibility for a 
     workforce investment activity (as defined in such section 3), 
     and State agencies responsible for carrying out substance use 
     disorder prevention and treatment programs.
       (c) Priority.--
       (1) In general.--In awarding grants under this section, the 
     Secretary shall give priority based on the State in which the 
     entity is located. Priority shall be given among States 
     according to a formula based on the rates described in 
     paragraph (2) and weighted as described in paragraph (3).
       (2) Rates.--The rates described in this paragraph are the 
     following:
       (A) The amount by which the rate of drug overdose deaths in 
     the State, adjusted for age, is above the national overdose 
     mortality rate, as determined by the Director of the Centers 
     for Disease Control and Prevention.
       (B) The amount by which the rate of unemployment for the 
     State, based on data provided by the Bureau of Labor 
     Statistics for the preceding 5 calendar years for which there 
     is available data, is above the national average.
       (C) The amount by which rate of labor force participation 
     in the State, based on data provided by the Bureau of Labor 
     Statistics for the preceding 5 calendar years for which there 
     is available data, is below the national average.
       (3) Weighting.--The rates described in paragraph (2) shall 
     be weighted as follows:
       (A) The rate described in paragraph (2)(A) shall be 
     weighted 70 percent.
       (B) The rate described in paragraph (2)(B) shall be 
     weighted 15 percent.
       (C) The rate described in paragraph (2)(C) shall be 
     weighted 15 percent.
       (d) Preference.--In awarding grants under this section, the 
     Secretary shall give preference to entities located in areas 
     within States with the greatest need, with such need based on 
     the highest mortality rate related to substance use disorder.
       (e) Definitions.--In this section:
       (1) Eligible entity.--The term ``eligible entity'' means an 
     entity that offers treatment or recovery services for 
     individuals with substance use disorders, and partners with 
     one or more local or State stakeholders, which may include 
     local employers, community organizations, the local workforce 
     development board, local and State governments, and Indian 
     Tribes or tribal organizations, to support recovery, 
     independent living, and participation in the workforce.
       (2) Indian tribes; tribal organization.--The terms ``Indian 
     Tribe'' and ``tribal organization'' have the meanings given 
     the terms ``Indian tribe'' and ``tribal organization'' in 
     section 4 of the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 5304).
       (3) State.--The term ``State'' includes only the several 
     States and the District of Columbia.
       (f) Applications.--An eligible entity shall submit an 
     application at such time and in such manner as the Secretary 
     may require. In submitting an application, the entity shall 
     demonstrate the ability to partner with local stakeholders, 
     which may include local employers, community stakeholders, 
     the local workforce development board, local and State 
     governments, and Indian Tribes or tribal organizations, as 
     applicable, to--
       (1) identify gaps in the workforce due to the prevalence of 
     substance use disorders;
       (2) in coordination with statewide employment and training 
     activities, including coordination and alignment of 
     activities carried out by entities provided grant funds under 
     section 8041, help individuals in recovery from a substance 
     use disorder transition into the workforce, including by 
     providing career services, training services as described in 
     paragraph (2) of section 134(c) of the Workforce Innovation 
     and Opportunity Act (29 U.S.C. 3174(c)), and related services 
     described in section 134(a)(3) of such Act (42 U.S.C. 
     3174(a)); and
       (3) assist employers with informing their employees of the 
     resources, such as resources related to substance use 
     disorders that are available to their employees.
       (g) Use of Funds.--An entity receiving a grant under this 
     section shall use the funds to conduct one or more of the 
     following activities:
       (1) Hire case managers, care coordinators, providers of 
     peer recovery support services, as described in section 
     547(a) of the Public Health Service Act (42 U.S.C. 290ee-
     2(a)), or other professionals, as appropriate, to provide 
     services that support treatment, recovery, and 
     rehabilitation, and prevent relapse, recidivism, and 
     overdose, including by encouraging--
       (A) the development and strengthening of daily living 
     skills; and
       (B) the use of counseling, care coordination, and other 
     services, as appropriate, to support recovery from substance 
     use disorders.
       (2) Implement or utilize innovative technologies, which may 
     include the use of telemedicine.
       (3) In coordination with the lead State agency with 
     responsibility for a workforce investment activity or local 
     board described in subsection (b), provide--
       (A) short-term prevocational training services; and
       (B) training services that are directly linked to the 
     employment opportunities in the local area or the planning 
     region.
       (h) Support for State Strategy.--An eligible entity shall 
     include in its application under subsection (f) information 
     describing how the services and activities proposed in such 
     application are aligned with the State, outlying area, or 
     Tribal strategy, as applicable, for addressing issues 
     described in such application and how such entity will 
     coordinate with existing systems to deliver services as 
     described in such application.
       (i) Data Reporting and Program Oversight.--Each eligible 
     entity awarded a grant under this section shall submit to the 
     Secretary a report at such time and in such manner as the 
     Secretary may require. Such report shall include a 
     description of--
       (1) the programs and activities funded by the grant;
       (2) outcomes of the population of individuals with a 
     substance use disorder the grantee served through activities 
     described in subsection (g); and
       (3) any other information that the Secretary may require 
     for the purpose of ensuring that the grantee is complying 
     with all of the requirements of the grant.
       (j) Reports to Congress.--
       (1) Preliminary report.--Not later than 2 years after the 
     end of the first year of the

[[Page H9224]]

     grant period under this section, the Secretary shall submit 
     to Congress a preliminary report that analyzes reports 
     submitted under subsection (i).
       (2) Final report.--Not later than 2 years after submitting 
     the preliminary report required under paragraph (1), the 
     Secretary shall submit to Congress a final report that 
     includes--
       (A) a description of how the grant funding was used, 
     including the number of individuals who received services 
     under subsection (g)(3) and an evaluation of the 
     effectiveness of the activities conducted by the grantee with 
     respect to outcomes of the population of individuals with 
     substance use disorder who receive services from the grantee; 
     and
       (B) recommendations related to best practices for health 
     care professionals to support individuals in substance use 
     disorder treatment or recovery to live independently and 
     participate in the workforce.
       (k) Authorization of Appropriations.--There is authorized 
     to be appropriated $5,000,000 for each of fiscal years 2019 
     through 2023 for purposes of carrying out this section.

                       TITLE VIII--MISCELLANEOUS

       Subtitle A--Synthetics Trafficking and Overdose Prevention

     SEC. 8001. SHORT TITLE.

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

     SEC. 8002. CUSTOMS FEES.

       (a) In General.--Section 13031(b)(9) of the Consolidated 
     Omnibus Budget Reconciliation Act of 1985 (19 U.S.C. 
     58c(b)(9)) is amended by adding at the end the following:
       ``(D)(i) With respect to the processing of items that are 
     sent to the United States through the international postal 
     network by `Inbound Express Mail service' or `Inbound EMS' 
     (as that service is described in the mail classification 
     schedule referred to in section 3631 of title 39, United 
     States Code), the following payments are required:
       ``(I) $1 per Inbound EMS item.
       ``(II) If an Inbound EMS item is formally entered, the fee 
     provided for under subsection (a)(9), if applicable.
       ``(ii) Notwithstanding section 451 of the Tariff Act of 
     1930 (19 U.S.C. 1451), the payments required by clause (i), 
     as allocated pursuant to clause (iii)(I), shall be the only 
     payments required for reimbursement of U.S. Customs and 
     Border Protection for customs services provided in connection 
     with the processing of an Inbound EMS item.
       ``(iii)(I) The payments required by clause (i)(I) shall be 
     allocated as follows:
       ``(aa) 50 percent of the amount of the payments shall be 
     paid on a quarterly basis by the United States Postal Service 
     to the Commissioner of U.S. Customs and Border Protection in 
     accordance with regulations prescribed by the Secretary of 
     the Treasury to reimburse U.S. Customs and Border Protection 
     for customs services provided in connection with the 
     processing of Inbound EMS items.
       ``(bb) 50 percent of the amount of the payments shall be 
     retained by the Postal Service to reimburse the Postal 
     Service for services provided in connection with the customs 
     processing of Inbound EMS items.
       ``(II) Payments received by U.S. Customs and Border 
     Protection under subclause (I)(aa) shall, in accordance with 
     section 524 of the Tariff Act of 1930 (19 U.S.C. 1524), be 
     deposited in the Customs User Fee Account and used to 
     directly reimburse each appropriation for the amount paid out 
     of that appropriation for the costs incurred in providing 
     services to international mail facilities. Amounts deposited 
     in accordance with the preceding sentence shall be available 
     until expended for the provision of such services.
       ``(III) Payments retained by the Postal Service under 
     subclause (I)(bb) shall be used to directly reimburse the 
     Postal Service for the costs incurred in providing services 
     in connection with the customs processing of Inbound EMS 
     items.
       ``(iv) Beginning in fiscal year 2021, the Secretary, in 
     consultation with the Postmaster General, may adjust, not 
     more frequently than once each fiscal year, the amount 
     described in clause (i)(I) to an amount commensurate with the 
     costs of services provided in connection with the customs 
     processing of Inbound EMS items, consistent with the 
     obligations of the United States under international 
     agreements.''.
       (b) Conforming Amendments.--Section 13031(a) of the 
     Consolidated Omnibus Budget Reconciliation Act of 1985 (19 
     U.S.C. 58c(a)) is amended--
       (1) in paragraph (6), by inserting ``(other than an item 
     subject to a fee under subsection (b)(9)(D))'' after 
     ``customs officer''; and
       (2) in paragraph (10)--
       (A) in subparagraph (C), in the matter preceding clause 
     (i), by inserting ``(other than Inbound EMS items described 
     in subsection (b)(9)(D))'' after ``release''; and
       (B) in the flush at the end, by inserting ``or of Inbound 
     EMS items described in subsection (b)(9)(D),'' after 
     ``(C),''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect on January 1, 2020.

     SEC. 8003. MANDATORY ADVANCE ELECTRONIC INFORMATION FOR 
                   POSTAL SHIPMENTS.

       (a) Mandatory Advance Electronic Information.--
       (1) In general.--Section 343(a)(3)(K) of the Trade Act of 
     2002 (Public Law 107-210; 19 U.S.C. 2071 note) is amended to 
     read as follows:
       ``(K)(i) The Secretary shall prescribe regulations 
     requiring the United States Postal Service to transmit the 
     information described in paragraphs (1) and (2) to the 
     Commissioner of U.S. Customs and Border Protection for 
     international mail shipments by the Postal Service (including 
     shipments to the Postal Service from foreign postal operators 
     that are transported by private carrier) consistent with the 
     requirements of this subparagraph.
       ``(ii) In prescribing regulations under clause (i), the 
     Secretary shall impose requirements for the transmission to 
     the Commissioner of information described in paragraphs (1) 
     and (2) for mail shipments described in clause (i) that are 
     comparable to the requirements for the transmission of such 
     information imposed on similar non-mail shipments of cargo, 
     taking into account the parameters set forth in subparagraphs 
     (A) through (J).
       ``(iii) The regulations prescribed under clause (i) shall 
     require the transmission of the information described in 
     paragraphs (1) and (2) with respect to a shipment as soon as 
     practicable in relation to the transportation of the 
     shipment, consistent with subparagraph (H).
       ``(iv) Regulations prescribed under clause (i) shall allow 
     for the requirements for the transmission to the Commissioner 
     of information described in paragraphs (1) and (2) for mail 
     shipments described in clause (i) to be implemented in 
     phases, as appropriate, by--
       ``(I) setting incremental targets for increasing the 
     percentage of such shipments for which information is 
     required to be transmitted to the Commissioner; and
       ``(II) taking into consideration--

       ``(aa) the risk posed by such shipments;
       ``(bb) the volume of mail shipped to the United States by 
     or through a particular country; and
       ``(cc) the capacities of foreign postal operators to 
     provide that information to the Postal Service.

       ``(v)(I) Notwithstanding clause (iv), the Postal Service 
     shall, not later than December 31, 2018, arrange for the 
     transmission to the Commissioner of the information described 
     in paragraphs (1) and (2) for not less than 70 percent of the 
     aggregate number of mail shipments, including 100 percent of 
     mail shipments from the People's Republic of China, described 
     in clause (i).
       ``(II) If the requirements of subclause (I) are not met, 
     the Comptroller General of the United States shall submit to 
     the appropriate congressional committees, not later than June 
     30, 2019, a report--
       ``(aa) assessing the reasons for the failure to meet those 
     requirements; and
       ``(bb) identifying recommendations to improve the 
     collection by the Postal Service of the information described 
     in paragraphs (1) and (2).
       ``(vi)(I) Notwithstanding clause (iv), the Postal Service 
     shall, not later than December 31, 2020, arrange for the 
     transmission to the Commissioner of the information described 
     in paragraphs (1) and (2) for 100 percent of the aggregate 
     number of mail shipments described in clause (i).
       ``(II) The Commissioner, in consultation with the 
     Postmaster General, may determine to exclude a country from 
     the requirement described in subclause (I) to transmit 
     information for mail shipments described in clause (i) from 
     the country if the Commissioner determines that the country--
       ``(aa) does not have the capacity to collect and transmit 
     such information;
       ``(bb) represents a low risk for mail shipments that 
     violate relevant United States laws and regulations; and
       ``(cc) accounts for low volumes of mail shipments that can 
     be effectively screened for compliance with relevant United 
     States laws and regulations through an alternate means.
       ``(III) The Commissioner shall, at a minimum on an annual 
     basis, re-evaluate any determination made under subclause 
     (II) to exclude a country from the requirement described in 
     subclause (I). If, at any time, the Commissioner determines 
     that a country no longer meets the requirements under 
     subclause (II), the Commissioner may not further exclude the 
     country from the requirement described in subclause (I).
       ``(IV) The Commissioner shall, on an annual basis, submit 
     to the appropriate congressional committees--
       ``(aa) a list of countries with respect to which the 
     Commissioner has made a determination under subclause (II) to 
     exclude the countries from the requirement described in 
     subclause (I); and
       ``(bb) information used to support such determination with 
     respect to such countries.
       ``(vii)(I) The Postmaster General shall, in consultation 
     with the Commissioner, refuse any shipments received after 
     December 31, 2020, for which the information described in 
     paragraphs (1) and (2) is not transmitted as required under 
     this subparagraph, except as provided in subclause (II).
       ``(II) If remedial action is warranted in lieu of refusal 
     of shipments pursuant to subclause (I), the Postmaster 
     General and the Commissioner shall take remedial action with 
     respect to the shipments, including destruction, seizure, 
     controlled delivery or other law enforcement initiatives, or 
     correction of the failure to provide the information 
     described in paragraphs (1) and (2) with respect to the 
     shipments.

[[Page H9225]]

       ``(viii) Nothing in this subparagraph shall be construed to 
     limit the authority of the Secretary to obtain information 
     relating to international mail shipments from private 
     carriers or other appropriate parties.
       ``(ix) In this subparagraph, the term `appropriate 
     congressional committees' means--
       ``(I) the Committee on Finance and the Committee on 
     Homeland Security and Governmental Affairs of the Senate; and
       ``(II) the Committee on Ways and Means, the Committee on 
     Oversight and Government Reform, and the Committee on 
     Homeland Security of the House of Representatives.''.
       (2) Joint strategic plan on mandatory advance 
     information.--Not later than 60 days after the date of the 
     enactment of this Act, the Secretary of Homeland Security and 
     the Postmaster General shall develop and submit to the 
     appropriate congressional committees a joint strategic plan 
     detailing specific performance measures for achieving--
       (A) the transmission of information as required by section 
     343(a)(3)(K) of the Trade Act of 2002, as amended by 
     paragraph (1); and
       (B) the presentation by the Postal Service to U.S. Customs 
     and Border Protection of all mail targeted by U.S. Customs 
     and Border Protection for inspection.
       (b) Capacity Building.--
       (1) In general.--Section 343(a) of the Trade Act of 2002 
     (Public Law 107-210; 19 U.S.C. 2071 note) is amended by 
     adding at the end the following:
       ``(5) Capacity building.--
       ``(A) In general.--The Secretary, with the concurrence of 
     the Secretary of State, and in coordination with the 
     Postmaster General and the heads of other Federal agencies, 
     as appropriate, may provide technical assistance, equipment, 
     technology, and training to enhance the capacity of foreign 
     postal operators--
       ``(i) to gather and provide the information required by 
     paragraph (3)(K); and
       ``(ii) to otherwise gather and provide postal shipment 
     information related to--

       ``(I) terrorism;
       ``(II) items the importation or introduction of which into 
     the United States is prohibited or restricted, including 
     controlled substances; and
       ``(III) such other concerns as the Secretary determines 
     appropriate.

       ``(B) Provision of equipment and technology.--With respect 
     to the provision of equipment and technology under 
     subparagraph (A), the Secretary may lease, loan, provide, or 
     otherwise assist in the deployment of such equipment and 
     technology under such terms and conditions as the Secretary 
     may prescribe, including nonreimbursable loans or the 
     transfer of ownership of equipment and technology.''.
       (2) Joint strategic plan on capacity building.--Not later 
     than 1 year after the date of the enactment of this Act, the 
     Secretary of Homeland Security and the Postmaster General 
     shall, in consultation with the Secretary of State, jointly 
     develop and submit to the appropriate congressional 
     committees a joint strategic plan--
       (A) detailing the extent to which U.S. Customs and Border 
     Protection and the United States Postal Service are engaged 
     in capacity building efforts under section 343(a)(5) of the 
     Trade Act of 2002, as added by paragraph (1);
       (B) describing plans for future capacity building efforts; 
     and
       (C) assessing how capacity building has increased the 
     ability of U.S. Customs and Border Protection and the Postal 
     Service to advance the goals of this subtitle and the 
     amendments made by this subtitle.
       (c) Report and Consultations by Secretary of Homeland 
     Security and Postmaster General.--
       (1) Report.--Not later than 180 days after the date of the 
     enactment of this Act, and annually thereafter until 3 years 
     after the Postmaster General has met the requirement under 
     clause (vi) of subparagraph (K) of section 343(a)(3) of the 
     Trade Act of 2002, as amended by subsection (a)(1), the 
     Secretary of Homeland Security and the Postmaster General 
     shall, in consultation with the Secretary of State, jointly 
     submit to the appropriate congressional committees a report 
     on compliance with that subparagraph that includes the 
     following:
       (A) An assessment of the status of the regulations required 
     to be promulgated under that subparagraph.
       (B) An update regarding new and existing agreements reached 
     with foreign postal operators for the transmission of the 
     information required by that subparagraph.
       (C) A summary of deliberations between the United States 
     Postal Service and foreign postal operators with respect to 
     issues relating to the transmission of that information.
       (D) A summary of the progress made in achieving the 
     transmission of that information for the percentage of 
     shipments required by that subparagraph.
       (E) An assessment of the quality of that information being 
     received by foreign postal operators, as determined by the 
     Secretary of Homeland Security, and actions taken to improve 
     the quality of that information.
       (F) A summary of policies established by the Universal 
     Postal Union that may affect the ability of the Postmaster 
     General to obtain the transmission of that information.
       (G) A summary of the use of technology to detect illicit 
     synthetic opioids and other illegal substances in 
     international mail parcels and planned acquisitions and 
     advancements in such technology.
       (H) Such other information as the Secretary of Homeland 
     Security and the Postmaster General consider appropriate with 
     respect to obtaining the transmission of information required 
     by that subparagraph.
       (2) Consultations.--Not later than 180 days after the date 
     of the enactment of this Act, and every 180 days thereafter 
     until the Postmaster General has met the requirement under 
     clause (vi) of section 343(a)(3)(K) of the Trade Act of 2002, 
     as amended by subsection (a)(1), to arrange for the 
     transmission of information with respect to 100 percent of 
     the aggregate number of mail shipments described in clause 
     (i) of that section, the Secretary of Homeland Security and 
     the Postmaster General shall provide briefings to the 
     appropriate congressional committees on the progress made in 
     achieving the transmission of that information for that 
     percentage of shipments.
       (d) Government Accountability Office Report.--Not later 
     than June 30, 2019, the Comptroller General of the United 
     States shall submit to the appropriate congressional 
     committees a report--
       (1) assessing the progress of the United States Postal 
     Service in achieving the transmission of the information 
     required by subparagraph (K) of section 343(a)(3) of the 
     Trade Act of 2002, as amended by subsection (a)(1), for the 
     percentage of shipments required by that subparagraph;
       (2) assessing the quality of the information received from 
     foreign postal operators for targeting purposes;
       (3) assessing the specific percentage of targeted mail 
     presented by the Postal Service to U.S. Customs and Border 
     Protection for inspection;
       (4) describing the costs of collecting the information 
     required by such subparagraph (K) from foreign postal 
     operators and the costs of implementing the use of that 
     information;
       (5) assessing the benefits of receiving that information 
     with respect to international mail shipments;
       (6) assessing the feasibility of assessing a customs fee 
     under section 13031(b)(9) of the Consolidated Omnibus Budget 
     Reconciliation Act of 1985, as amended by section 8002, on 
     international mail shipments other than Inbound Express Mail 
     service in a manner consistent with the obligations of the 
     United States under international agreements; and
       (7) identifying recommendations, including recommendations 
     for legislation, to improve the compliance of the Postal 
     Service with such subparagraph (K), including an assessment 
     of whether the detection of illicit synthetic opioids in the 
     international mail would be improved by--
       (A) requiring the Postal Service to serve as the consignee 
     for international mail shipments containing goods; or
       (B) designating a customs broker to act as an importer of 
     record for international mail shipments containing goods.
       (e) Technical Correction.--Section 343 of the Trade Act of 
     2002 (Public Law 107-210; 19 U.S.C. 2071 note) is amended in 
     the section heading by striking ``advanced'' and inserting 
     ``advance''.
       (f) Appropriate Congressional Committees Defined.--In this 
     section, the term ``appropriate congressional committees'' 
     means--
       (1) the Committee on Finance and the Committee on Homeland 
     Security and Governmental Affairs of the Senate; and
       (2) the Committee on Ways and Means, the Committee on 
     Oversight and Government Reform, and the Committee on 
     Homeland Security of the House of Representatives.

     SEC. 8004. INTERNATIONAL POSTAL AGREEMENTS.

       (a) Existing Agreements.--
       (1) In general.--In the event that any provision of this 
     subtitle, or any amendment made by this subtitle, is 
     determined to be in violation of obligations of the United 
     States under any postal treaty, convention, or other 
     international agreement related to international postal 
     services, or any amendment to such an agreement, the 
     Secretary of State should negotiate to amend the relevant 
     provisions of the agreement so that the United States is no 
     longer in violation of the agreement.
       (2) Rule of construction.--Nothing in this subsection shall 
     be construed to permit delay in the implementation of this 
     subtitle or any amendment made by this subtitle.
       (b) Future Agreements.--
       (1) Consultations.--Before entering into, on or after the 
     date of the enactment of this Act, any postal treaty, 
     convention, or other international agreement related to 
     international postal services, or any amendment to such an 
     agreement, that is related to the ability of the United 
     States to secure the provision of advance electronic 
     information by foreign postal operators, the Secretary of 
     State should consult with the appropriate congressional 
     committees (as defined in section 8003(f)).
       (2) Expedited negotiation of new agreement.--To the extent 
     that any new postal treaty, convention, or other 
     international agreement related to international postal 
     services would improve the ability of the United States to 
     secure the provision of advance electronic information by 
     foreign postal operators as required by regulations 
     prescribed under section 343(a)(3)(K) of the Trade Act of 
     2002, as amended by section 8003(a)(1), the Secretary of 
     State should expeditiously conclude such an agreement.

[[Page H9226]]

  


     SEC. 8005. COST RECOUPMENT.

       (a) In General.--The United States Postal Service shall, to 
     the extent practicable and otherwise recoverable by law, 
     ensure that all costs associated with complying with this 
     subtitle and amendments made by this subtitle are charged 
     directly to foreign shippers or foreign postal operators.
       (b) Costs Not Considered Revenue.--The recovery of costs 
     under subsection (a) shall not be deemed revenue for purposes 
     of subchapter I and II of chapter 36 of title 39, United 
     States Code, or regulations prescribed under that chapter.

     SEC. 8006. DEVELOPMENT OF TECHNOLOGY TO DETECT ILLICIT 
                   NARCOTICS.

       (a) In General.--The Postmaster General and the 
     Commissioner of U.S. Customs and Border Protection, in 
     coordination with the heads of other agencies as appropriate, 
     shall collaborate to identify and develop technology for the 
     detection of illicit fentanyl, other synthetic opioids, and 
     other narcotics and psychoactive substances entering the 
     United States by mail.
       (b) Outreach to Private Sector.--The Postmaster General and 
     the Commissioner shall conduct outreach to private sector 
     entities to gather information regarding the current state of 
     technology to identify areas for innovation relating to the 
     detection of illicit fentanyl, other synthetic opioids, and 
     other narcotics and psychoactive substances entering the 
     United States.

     SEC. 8007. CIVIL PENALTIES FOR POSTAL SHIPMENTS.

       Section 436 of the Tariff Act of 1930 (19 U.S.C. 1436) is 
     amended by adding at the end the following new subsection:
       ``(e) Civil Penalties for Postal Shipments.--
       ``(1) Civil penalty.--A civil penalty shall be imposed 
     against the United States Postal Service if the Postal 
     Service accepts a shipment in violation of section 
     343(a)(3)(K)(vii)(I) of the Trade Act of 2002.
       ``(2) Modification of civil penalty.--
       ``(A) In general.--U.S. Customs and Border Protection shall 
     reduce or dismiss a civil penalty imposed pursuant to 
     paragraph (1) if U.S. Customs and Border Protection 
     determines that the United States Postal Service--
       ``(i) has a low error rate in compliance with section 
     343(a)(3)(K) of the Trade Act of 2002;
       ``(ii) is cooperating with U.S. Customs and Border 
     Protection with respect to the violation of section 
     343(a)(3)(K)(vii)(I) of the Trade Act of 2002; or
       ``(iii) has taken remedial action to prevent future 
     violations of section 343(a)(3)(K)(vii)(I) of the Trade Act 
     of 2002.
       ``(B) Written notification.--U.S. Customs and Border 
     Protection shall issue a written notification to the Postal 
     Service with respect to each exercise of the authority of 
     subparagraph (A) to reduce or dismiss a civil penalty imposed 
     pursuant to paragraph (1).
       ``(3) Ongoing lack of compliance.--If U.S. Customs and 
     Border Protection determines that the United States Postal 
     Service--
       ``(A) has repeatedly committed violations of section 
     343(a)(3)(K)(vii)(I) of the Trade Act of 2002,
       ``(B) has failed to cooperate with U.S. Customs and Border 
     Protection with respect to violations of section 
     343(a)(3)(K)(vii)(I) of the Trade Act of 2002, and
       ``(C) has an increasing error rate in compliance with 
     section 343(a)(3)(K) of the Trade Act of 2002,

     civil penalties may be imposed against the United States 
     Postal Service until corrective action, satisfactory to U.S. 
     Customs and Border Protection, is taken.''.

     SEC. 8008. REPORT ON VIOLATIONS OF ARRIVAL, REPORTING, ENTRY, 
                   AND CLEARANCE REQUIREMENTS AND FALSITY OR LACK 
                   OF MANIFEST.

       (a) In General.--The Commissioner of U.S. Customs and 
     Border Protection shall submit to the appropriate 
     congressional committees an annual report that contains the 
     information described in subsection (b) with respect to each 
     violation of section 436 of the Tariff Act of 1930 (19 U.S.C. 
     1436), as amended by section 8007, and section 584 of such 
     Act (19 U.S.C. 1584) that occurred during the previous year.
       (b) Information Described.--The information described in 
     this subsection is the following:
       (1) The name and address of the violator.
       (2) The specific violation that was committed.
       (3) The location or port of entry through which the items 
     were transported.
       (4) An inventory of the items seized, including a 
     description of the items and the quantity seized.
       (5) The location from which the items originated.
       (6) The entity responsible for the apprehension or seizure, 
     organized by location or port of entry.
       (7) The amount of penalties assessed by U.S. Customs and 
     Border Protection, organized by name of the violator and 
     location or port of entry.
       (8) The amount of penalties that U.S. Customs and Border 
     Protection could have levied, organized by name of the 
     violator and location or port of entry.
       (9) The rationale for negotiating lower penalties, 
     organized by name of the violator and location or port of 
     entry.
       (c) Appropriate Congressional Committees Defined.--In this 
     section, the term ``appropriate congressional committees'' 
     means--
       (1) the Committee on Finance and the Committee on Homeland 
     Security and Governmental Affairs of the Senate; and
       (2) the Committee on Ways and Means, the Committee on 
     Oversight and Government Reform, and the Committee on 
     Homeland Security of the House of Representatives.

     SEC. 8009. EFFECTIVE DATE; REGULATIONS.

       (a) Effective Date.--This subtitle and the amendments made 
     by this subtitle (other than the amendments made by section 
     8002) shall take effect on the date of the enactment of this 
     Act.
       (b) Regulations.--Not later than 1 year after the date of 
     the enactment of this Act, such regulations as are necessary 
     to carry out this subtitle and the amendments made by this 
     subtitle shall be prescribed.

         Subtitle B--Opioid Addiction Recovery Fraud Prevention

     SEC. 8021. SHORT TITLE.

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

     SEC. 8022. DEFINITIONS.

       For purposes of this subtitle only, and not be construed or 
     applied as to challenge or affect the characterization, 
     definition, or treatment under any other statute, regulation, 
     or rule:
       (1) Substance use disorder treatment product.--The term 
     ``substance use disorder treatment product'' means a product 
     for use or marketed for use in the treatment, cure, or 
     prevention of a substance use disorder, including an opioid 
     use disorder.
       (2) Substance use disorder treatment service.--The term 
     ``substance use disorder treatment service'' means a service 
     that purports to provide referrals to treatment, treatment, 
     or recovery housing for people diagnosed with, having, or 
     purporting to have a substance use disorder, including an 
     opioid use disorder.

     SEC. 8023. UNFAIR OR DECEPTIVE ACTS OR PRACTICES WITH RESPECT 
                   TO SUBSTANCE USE DISORDER TREATMENT SERVICE AND 
                   PRODUCTS.

       (a) Unlawful Activity.--It is unlawful to engage in an 
     unfair or deceptive act or practice with respect to any 
     substance use disorder treatment service or substance use 
     disorder treatment product.
       (b) Enforcement by the Federal Trade Commission.--
       (1) Unfair or deceptive acts or practices.--A violation of 
     subsection (a) shall be treated as a violation of a rule 
     under section 18 of the Federal Trade Commission Act (15 
     U.S.C. 57a) regarding unfair or deceptive acts or practices.
       (2) Powers of the federal trade commission.--
       (A) In general.--The Federal Trade Commission shall enforce 
     this section in the same manner, by the same means, and with 
     the same jurisdiction, powers, and duties as though all 
     applicable terms and provisions of the Federal Trade 
     Commission Act (15 U.S.C. 41 et seq.) were incorporated into 
     and made a part of this section.
       (B) Privileges and immunities.--Any person who violates 
     subsection (a) shall be subject to the penalties and entitled 
     to the privileges and immunities provided in the Federal 
     Trade Commission Act as though all applicable terms and 
     provisions of the Federal Trade Commission Act (15 U.S.C. 41 
     et seq.) were incorporated and made part of this section.
       (c) Authority Preserved.--Nothing in this subtitle shall be 
     construed to limit the authority of the Federal Trade 
     Commission or the Food and Drug Administration under any 
     other provision of law.

  Subtitle C--Addressing Economic and Workforce Impacts of the Opioid 
                                 Crisis

     SEC. 8041. ADDRESSING ECONOMIC AND WORKFORCE IMPACTS OF THE 
                   OPIOID CRISIS.

       (a) Definitions.--Except as otherwise expressly provided, 
     in this section:
       (1) WIOA definitions.--The terms ``core program'', 
     ``individual with a barrier to employment'', ``local area'', 
     ``local board'', ``one-stop operator'', ``outlying area'', 
     ``State'', ``State board'', and ``supportive services'' have 
     the meanings given the terms in section 3 of the Workforce 
     Innovation and Opportunity Act (29 U.S.C. 3102).
       (2) Education provider.--The term ``education provider'' 
     means--
       (A) an institution of higher education, as defined in 
     section 101 of the Higher Education Act of 1965 (20 U.S.C. 
     1001); or
       (B) a postsecondary vocational institution, as defined in 
     section 102(c) of such Act (20 U.S.C. 1002(c)).
       (3) Eligible entity.--The term ``eligible entity'' means--
       (A) a State workforce agency;
       (B) an outlying area; or
       (C) a Tribal entity.
       (4) Participating partnership.--The term ``participating 
     partnership'' means a partnership--
       (A) evidenced by a written contract or agreement; and
       (B) including, as members of the partnership, a local board 
     receiving a subgrant under subsection (d) and 1 or more of 
     the following:
       (i) The eligible entity.
       (ii) A treatment provider.
       (iii) An employer or industry organization.
       (iv) An education provider.
       (v) A legal service or law enforcement organization.
       (vi) A faith-based or community-based organization.

[[Page H9227]]

       (vii) Other State or local agencies, including counties or 
     local governments.
       (viii) Other organizations, as determined to be necessary 
     by the local board.
       (ix) Indian Tribes or tribal organizations.
       (5) Program participant.--The term ``program participant'' 
     means an individual who--
       (A) is a member of a population of workers described in 
     subsection (e)(2) that is served by a participating 
     partnership through the pilot program under this section; and
       (B) enrolls with the applicable participating partnership 
     to receive any of the services described in subsection 
     (e)(3).
       (6) Provider of peer recovery support services.--The term 
     ``provider of peer recovery support services'' means a 
     provider that delivers peer recovery support services through 
     an organization described in section 547(a) of the Public 
     Health Service Act (42 U.S.C. 290ee-2(a)).
       (7) Secretary.--The term ``Secretary'' means the Secretary 
     of Labor.
       (8) State workforce agency.--The term ``State workforce 
     agency'' means the lead State agency with responsibility for 
     the administration of a program under chapter 2 or 3 of 
     subtitle B of title I of the Workforce Innovation and 
     Opportunity Act (29 U.S.C. 3161 et seq., 3171 et seq.).
       (9) Substance use disorder.--The term ``substance use 
     disorder'' has the meaning given such term by the Assistant 
     Secretary for Mental Health and Substance Use.
       (10) Treatment provider.--The term ``treatment provider''--
       (A) means a health care provider that--
       (i) offers services for treating substance use disorders 
     and is licensed in accordance with applicable State law to 
     provide such services; and
       (ii) accepts health insurance for such services, including 
     coverage under title XIX of the Social Security Act (42 
     U.S.C. 1396 et seq.); and
       (B) may include--
       (i) a nonprofit provider of peer recovery support services;
       (ii) a community health care provider;
       (iii) a Federally qualified health center (as defined in 
     section 1861(aa) of the Social Security Act (42 U.S.C. 
     1395x));
       (iv) an Indian health program (as defined in section 3 of 
     the Indian Health Care Improvement Act (25 U.S.C. 1603)), 
     including an Indian health program that serves an urban 
     center (as defined in such section); and
       (v) a Native Hawaiian health center (as defined in section 
     12 of the Native Hawaiian Health Care Improvement Act (42 
     U.S.C. 11711)).
       (11) Tribal entity.--The term ``Tribal entity'' includes 
     any Indian Tribe, tribal organization, Indian-controlled 
     organization serving Indians, Native Hawaiian organization, 
     or Alaska Native entity, as such terms are defined or used in 
     section 166 of the Workforce Innovation and Opportunity Act 
     (29 U.S.C. 3221).
       (b) Pilot Program and Grants Authorized.--
       (1) In general.--The Secretary, in consultation with the 
     Secretary of Health and Human Services, shall carry out a 
     pilot program to address economic and workforce impacts 
     associated with a high rate of a substance use disorder. In 
     carrying out the pilot program, the Secretary shall make 
     grants, on a competitive basis, to eligible entities to 
     enable such entities to make subgrants to local boards to 
     address the economic and workforce impacts associated with a 
     high rate of a substance use disorder.
       (2) Grant amounts.--The Secretary shall make each such 
     grant in an amount that is not less than $500,000, and not 
     more than $5,000,000, for a fiscal year.
       (c) Grant Applications.--
       (1) In general.--An eligible entity applying for a grant 
     under this section shall submit an application to the 
     Secretary at such time and in such form and manner as the 
     Secretary may reasonably require, including the information 
     described in this subsection.
       (2) Significant impact on community by opioid and substance 
     use disorder-related problems.--
       (A) Demonstration.--An eligible entity shall include in the 
     application--
       (i) information that demonstrates significant impact on the 
     community by problems related to opioid abuse or another 
     substance use disorder, by--

       (I) identifying the counties, communities, regions, or 
     local areas that have been significantly impacted and will be 
     served through the grant (each referred to in this section as 
     a ``service area''); and
       (II) demonstrating for each such service area, an increase 
     equal to or greater than the national increase in such 
     problems, between--

       (aa) 1999; and
       (bb) 2016 or the latest year for which data are available; 
     and
       (ii) a description of how the eligible entity will 
     prioritize support for significantly impacted service areas 
     described in clause (i)(I).
       (B) Information.--To meet the requirements described in 
     subparagraph (A)(i)(II), the eligible entity may use 
     information including data on--
       (i) the incidence or prevalence of opioid abuse and other 
     substance use disorders;
       (ii) the age-adjusted rate of drug overdose deaths, as 
     determined by the Director of the Centers for Disease Control 
     and Prevention;
       (iii) the rate of non-fatal hospitalizations related to 
     opioid abuse or other substance use disorders;
       (iv) the number of arrests or convictions, or a relevant 
     law enforcement statistic, that reasonably shows an increase 
     in opioid abuse or another substance use disorder; or
       (v) in the case of an eligible entity described in 
     subsection (a)(3)(C), other alternative relevant data as 
     determined appropriate by the Secretary.
       (C) Support for state strategy.--The eligible entity may 
     include in the application information describing how the 
     proposed services and activities are aligned with the State, 
     outlying area, or Tribal strategy, as applicable, for 
     addressing problems described in subparagraph (A) in specific 
     service areas or across the State, outlying area, or Tribal 
     land.
       (3) Economic and employment conditions demonstrate 
     additional federal support needed.--
       (A) Demonstration.--An eligible entity shall include in the 
     application information that demonstrates that a high rate of 
     a substance use disorder has caused, or is coincident to--
       (i) an economic or employment downturn in the service area; 
     or
       (ii) persistent economically depressed conditions in such 
     service area.
       (B) Information.--To meet the requirements of subparagraph 
     (A), an eligible entity may use information including--
       (i) documentation of any layoff, announced future layoff, 
     legacy industry decline, decrease in an employment or labor 
     market participation rate, or economic impact, whether or not 
     the result described in this clause is overtly related to a 
     high rate of a substance use disorder;
       (ii) documentation showing decreased economic activity 
     related to, caused by, or contributing to a high rate of a 
     substance use disorder, including a description of how the 
     service area has been impacted, or will be impacted, by such 
     a decrease;
       (iii) information on economic indicators, labor market 
     analyses, information from public announcements, and 
     demographic and industry data;
       (iv) information on rapid response activities (as defined 
     in section 3 of the Workforce Innovation and Opportunity Act 
     (29 U.S.C. 3102)) that have been or will be conducted, 
     including demographic data gathered by employer or worker 
     surveys or through other methods;
       (v) data or documentation, beyond anecdotal evidence, 
     showing that employers face challenges filling job vacancies 
     due to a lack of skilled workers able to pass a drug test; or
       (vi) any additional relevant data or information on the 
     economy, workforce, or another aspect of the service area to 
     support the application.
       (d) Subgrant Authorization and Application Process.--
       (1) Subgrants authorized.--
       (A) In general.--An eligible entity receiving a grant under 
     subsection (b)--
       (i) may use not more than 5 percent of the grant funds for 
     the administrative costs of carrying out the grant;
       (ii) in the case of an eligible entity described in 
     subparagraph (A) or (B) of subsection (a)(3), shall use the 
     remaining grant funds to make subgrants to local entities in 
     the service area to carry out the services and activities 
     described in subsection (e); and
       (iii) in the case of an eligible entity described in 
     subsection (a)(3)(C), shall use the remaining grant funds to 
     carry out the services and activities described in subsection 
     (e).
       (B) Equitable distribution.--In making subgrants under this 
     subsection, an eligible entity shall ensure, to the extent 
     practicable, the equitable distribution of subgrants, based 
     on--
       (i) geography (such as urban and rural distribution); and
       (ii) significantly impacted service areas as described in 
     subsection (c)(2).
       (C) Timing of subgrant funds distribution.--An eligible 
     entity making subgrants under this subsection shall disburse 
     subgrant funds to a local board receiving a subgrant from the 
     eligible entity by the later of--
       (i) the date that is 90 days after the date on which the 
     Secretary makes the funds available to the eligible entity; 
     or
       (ii) the date that is 15 days after the date that the 
     eligible entity makes the subgrant under subparagraph 
     (A)(ii).
       (2) Subgrant application.--
       (A) In general.--A local board desiring to receive a 
     subgrant under this subsection from an eligible entity shall 
     submit an application at such time and in such manner as the 
     eligible entity may reasonably require, including the 
     information described in this paragraph.
       (B) Contents.--Each application described in subparagraph 
     (A) shall include--
       (i) an analysis of the estimated performance of the local 
     board in carrying out the proposed services and activities 
     under the subgrant--

       (I) based on--

       (aa) primary indicators of performance described in section 
     116(c)(1)(A)(i) of the Workforce Innovation and Opportunity 
     Act (29 U.S.C. 3141(c)(1)(A)(i), to assess estimated 
     effectiveness of the proposed services and activities, 
     including the estimated number of individuals with a 
     substance use disorder who may be served by the proposed 
     services and activities;
       (bb) the record of the local board in serving individuals 
     with a barrier to employment; and
       (cc) the ability of the local board to establish a 
     participating partnership; and

       (II) which may include or utilize--

[[Page H9228]]

       (aa) data from the National Center for Health Statistics of 
     the Centers for Disease Control and Prevention;
       (bb) data from the Center for Behavioral Health Statistics 
     and Quality of the Substance Abuse and Mental Health Services 
     Administration;
       (cc) State vital statistics;
       (dd) municipal police department records;
       (ee) reports from local coroners; or
       (ff) other relevant data; and
       (ii) in the case of a local board proposing to serve a 
     population described in subsection (e)(2)(B), a demonstration 
     of the workforce shortage in the professional area to be 
     addressed under the subgrant (which may include substance use 
     disorder treatment and related services, non-addictive pain 
     therapy and pain management services, mental health care 
     treatment services, emergency response services, or mental 
     health care), which shall include information that can 
     demonstrate such a shortage, such as--

       (I) the distance between--

       (aa) communities affected by opioid abuse or another 
     substance use disorder; and
       (bb) facilities or professionals offering services in the 
     professional area; or

       (II) the maximum capacity of facilities or professionals to 
     serve individuals in an affected community, or increases in 
     arrests related to opioid or another substance use disorder, 
     overdose deaths, or nonfatal overdose emergencies in the 
     community.

       (e) Subgrant Services and Activities.--
       (1) In general.--Each local board that receives a subgrant 
     under subsection (d) shall carry out the services and 
     activities described in this subsection through a 
     participating partnership.
       (2) Selection of population to be served.--A participating 
     partnership shall elect to provide services and activities 
     under the subgrant to one or both of the following 
     populations of workers:
       (A) Workers, including dislocated workers, individuals with 
     barriers to employment, new entrants in the workforce, or 
     incumbent workers (employed or underemployed), each of whom--
       (i) is directly or indirectly affected by a high rate of a 
     substance use disorder; and
       (ii) voluntarily confirms that the worker, or a friend or 
     family member of the worker, has a history of opioid abuse or 
     another substance use disorder.
       (B) Workers, including dislocated workers, individuals with 
     barriers to employment, new entrants in the workforce, or 
     incumbent workers (employed or underemployed), who--
       (i) seek to transition to professions that support 
     individuals with a substance use disorder or at risk for 
     developing such disorder, such as professions that provide--

       (I) substance use disorder treatment and related services;
       (II) services offered through providers of peer recovery 
     support services;
       (III) non-addictive pain therapy and pain management 
     services;
       (IV) emergency response services; or
       (V) mental health care; and

       (ii) need new or upgraded skills to better serve such a 
     population of struggling or at-risk individuals.
       (3) Services and activities.--Each participating 
     partnership shall use funds available through a subgrant 
     under this subsection to carry out 1 or more of the 
     following:
       (A) Engaging employers.--Engaging with employers to--
       (i) learn about the skill and hiring requirements of 
     employers;
       (ii) learn about the support needed by employers to hire 
     and retain program participants, and other individuals with a 
     substance use disorder, and the support needed by such 
     employers to obtain their commitment to testing creative 
     solutions to employing program participants and such 
     individuals;
       (iii) connect employers and workers to on-the-job or 
     customized training programs before or after layoff to help 
     facilitate reemployment;
       (iv) connect employers with an education provider to 
     develop classroom instruction to complement on-the-job 
     learning for program participants and such individuals;
       (v) help employers develop the curriculum design of a work-
     based learning program for program participants and such 
     individuals;
       (vi) help employers employ program participants or such 
     individuals engaging in a work-based learning program for a 
     transitional period before hiring such a program participant 
     or individual for full-time employment of not less than 30 
     hours a week; or
       (vii) connect employers to program participants receiving 
     concurrent outpatient treatment and job training services.
       (B) Screening services.--Providing screening services, 
     which may include--
       (i) using an evidence-based screening method to screen each 
     individual seeking participation in the pilot program to 
     determine whether the individual has a substance use 
     disorder;
       (ii) conducting an assessment of each such individual to 
     determine the services needed for such individual to obtain 
     or retain employment, including an assessment of strengths 
     and general work readiness; or
       (iii) accepting walk-ins or referrals from employers, labor 
     organizations, or other entities recommending individuals to 
     participate in such program.
       (C) Individual treatment and employment plan.--Developing 
     an individual treatment and employment plan for each program 
     participant--
       (i) in coordination, as appropriate, with other programs 
     serving the participant such as the core programs within the 
     workforce development system under the Workforce Innovation 
     and Opportunity Act (29 U.S.C. 3101 et seq.); and
       (ii) which shall include providing a case manager to work 
     with each participant to develop the plan, which may 
     include--

       (I) identifying employment and career goals;
       (II) exploring career pathways that lead to in-demand 
     industries and sectors, as determined by the State board and 
     the head of the State workforce agency or, as applicable, the 
     Tribal entity;
       (III) setting appropriate achievement objectives to attain 
     the employment and career goals identified under subclause 
     (I); or
       (IV) developing the appropriate combination of services to 
     enable the participant to achieve the employment and career 
     goals identified under subclause (I).

       (D) Outpatient treatment and recovery care.--In the case of 
     a participating partnership serving program participants 
     described in paragraph (2)(A) with a substance use disorder, 
     providing individualized and group outpatient treatment and 
     recovery services for such program participants that are 
     offered during the day and evening, and on weekends. Such 
     treatment and recovery services--
       (i) shall be based on a model that utilizes combined 
     behavioral interventions and other evidence-based or 
     evidence-informed interventions; and
       (ii) may include additional services such as--

       (I) health, mental health, addiction, or other forms of 
     outpatient treatment that may impact a substance use disorder 
     and co-occurring conditions;
       (II) drug testing for a current substance use disorder 
     prior to enrollment in career or training services or prior 
     to employment;
       (III) linkages to community services, including services 
     offered by partner organizations designed to support program 
     participants; or
       (IV) referrals to health care, including referrals to 
     substance use disorder treatment and mental health services.

       (E) Supportive services.--Providing supportive services, 
     which shall include services such as--
       (i) coordinated wraparound services to provide maximum 
     support for program participants to assist the program 
     participants in maintaining employment and recovery for not 
     less than 12 months, as appropriate;
       (ii) assistance in establishing eligibility for assistance 
     under Federal, State, Tribal, and local programs providing 
     health services, mental health services, vocational services, 
     housing services, transportation services, social services, 
     or services through early childhood education programs (as 
     defined in section 103 of the Higher Education Act of 1965 
     (20 U.S.C. 1003));
       (iii) services offered through providers of peer recovery 
     support services;
       (iv) networking and mentorship opportunities; or
       (v) any supportive services determined necessary by the 
     local board.
       (F) Career and job training services.--Offering career 
     services and training services, and related services, 
     concurrently or sequentially with the services provided under 
     subparagraphs (B) through (E). Such services shall include 
     the following:
       (i) Services provided to program participants who are in a 
     pre-employment stage of the program, which may include--

       (I) initial education and skills assessments;
       (II) traditional classroom training funded through 
     individual training accounts under chapter 3 of subtitle B of 
     title I of the Workforce Innovation and Opportunity Act (29 
     U.S.C. 3171 et seq.);
       (III) services to promote employability skills such as 
     punctuality, personal maintenance skills, and professional 
     conduct;
       (IV) in-depth interviewing and evaluation to identify 
     employment barriers and to develop individual employment 
     plans;
       (V) career planning that includes--

       (aa) career pathways leading to in-demand, high-wage jobs; 
     and
       (bb) job coaching, job matching, and job placement 
     services;

       (VI) provision of payments and fees for employment and 
     training-related applications, tests, and certifications; or
       (VII) any other appropriate career service or training 
     service described in section 134(c) of the Workforce 
     Innovation and Opportunity Act (29 U.S.C. 3174(c)).

       (ii) Services provided to program participants during their 
     first 6 months of employment to ensure job retention, which 
     may include--

       (I) case management and support services, including a 
     continuation of the services described in clause (i);
       (II) a continuation of skills training, and career and 
     technical education, described in clause (i) that is 
     conducted in collaboration with the employers of such 
     participants;
       (III) mentorship services and job retention support for 
     such participants; or
       (IV) targeted training for managers and workers working 
     with such participants (such as mentors), and human resource 
     representatives in the business in which such participants 
     are employed.

       (iii) Services to assist program participants in 
     maintaining employment for not less than 12 months, as 
     appropriate.

[[Page H9229]]

       (G) Proven and promising practices.--Leading efforts in the 
     service area to identify and promote proven and promising 
     strategies and initiatives for meeting the needs of employers 
     and program participants.
       (4) Limitations.--A participating partnership may not use--
       (A) more than 10 percent of the funds received under a 
     subgrant under subsection (d) for the administrative costs of 
     the partnership;
       (B) more than 10 percent of the funds received under such 
     subgrant for the provision of treatment and recovery 
     services, as described in paragraph (3)(D); and
       (C) more than 10 percent of the funds received under such 
     subgrant for the provision of supportive services described 
     in paragraph (3)(E) to program participants.
       (f) Performance Accountability.--
       (1) Reports.--The Secretary shall establish quarterly 
     reporting requirements for recipients of grants and subgrants 
     under this section that, to the extent practicable, are based 
     on the performance accountability system under section 116 of 
     the Workforce Innovation and Opportunity Act (29 U.S.C. 3141) 
     and, in the case of a grant awarded to an eligible entity 
     described in subsection (a)(3)(C), section 166(h) of such Act 
     (29 U.S.C. 3221(h)), including the indicators described in 
     subsection (c)(1)(A)(i) of such section 116 and the 
     requirements for local area performance reports under 
     subsection (d) of such section 116.
       (2) Evaluations.--
       (A) Authority to enter into agreements.--The Secretary 
     shall ensure that an independent evaluation is conducted on 
     the pilot program carried out under this section to determine 
     the impact of the program on employment of individuals with 
     substance use disorders. The Secretary shall enter into an 
     agreement with eligible entities receiving grants under this 
     section to pay for all or part of such evaluation.
       (B) Methodologies to be used.--The independent evaluation 
     required under this paragraph shall use experimental designs 
     using random assignment or, when random assignment is not 
     feasible, other reliable, evidence-based research 
     methodologies that allow for the strongest possible causal 
     inferences.
       (g) Funding.--
       (1) Covered fiscal year.--In this subsection, the term 
     ``covered fiscal year'' means any of fiscal years 2019 
     through 2023.
       (2) Using funding for national dislocated worker grants.--
     Subject to paragraph (4) and notwithstanding section 
     132(a)(2)(A) and subtitle D of the Workforce Innovation and 
     Opportunity Act (29 U.S.C. 3172(a)(2)(A), 3221 et seq.), the 
     Secretary may use, to carry out the pilot program under this 
     section for a covered fiscal year--
       (A) funds made available to carry out section 170 of such 
     Act (29 U.S.C. 3225) for that fiscal year;
       (B) funds made available to carry out section 170 of such 
     Act that remain available for that fiscal year; and
       (C) funds that remain available under section 172(f) of 
     such Act (29 U.S.C. 3227(f)).
       (3) Availability of funds.--Funds appropriated under 
     section 136(c) of such Act (29 U.S.C. 3181(c)) and made 
     available to carry out section 170 of such Act for a fiscal 
     year shall remain available for use under paragraph (2) for a 
     subsequent fiscal year until expended.
       (4) Limitation.--The Secretary may not use more than 
     $100,000,000 of the funds described in paragraph (2) for any 
     covered fiscal year under this section.

     Subtitle D--Peer Support Counseling Program for Women Veterans

     SEC. 8051. PEER SUPPORT COUNSELING PROGRAM FOR WOMEN 
                   VETERANS.

       (a) In General.--Section 1720F(j) of title 38, United 
     States Code, is amended by adding at the end the following 
     new paragraph:
       ``(4)(A) As part of the counseling program under this 
     subsection, the Secretary shall emphasize appointing peer 
     support counselors for women veterans. To the degree 
     practicable, the Secretary shall seek to recruit women peer 
     support counselors with expertise in--
       ``(i) female gender-specific issues and services;
       ``(ii) the provision of information about services and 
     benefits provided under laws administered by the Secretary; 
     or
       ``(iii) employment mentoring.
       ``(B) To the degree practicable, the Secretary shall 
     emphasize facilitating peer support counseling for women 
     veterans who are eligible for counseling and services under 
     section 1720D of this title, have post-traumatic stress 
     disorder or suffer from another mental health condition, are 
     homeless or at risk of becoming homeless, or are otherwise at 
     increased risk of suicide, as determined by the Secretary.
       ``(C) The Secretary shall conduct outreach to inform women 
     veterans about the program and the assistance available under 
     this paragraph.
       ``(D) In carrying out this paragraph, the Secretary shall 
     coordinate with such community organizations, State and local 
     governments, institutions of higher education, chambers of 
     commerce, local business organizations, organizations that 
     provide legal assistance, and other organizations as the 
     Secretary considers appropriate.
       ``(E) In carrying out this paragraph, the Secretary shall 
     provide adequate training for peer support counselors, 
     including training carried out under the national program of 
     training required by section 304(c) of the Caregivers and 
     Veterans Omnibus Health Services Act of 2010 (38 U.S.C. 1712A 
     note).''.
       (b) Funding.--The Secretary of Veterans Affairs shall carry 
     out paragraph (4) of section 1720F(j) of title 38, United 
     States Code, as added by subsection (a), using funds 
     otherwise made available to the Secretary. No additional 
     funds are authorized to be appropriated by reason of such 
     paragraph.
       (c) Report to Congress.--Not later than 2 years after the 
     date of the enactment of this Act, the Secretary of Veterans 
     Affairs shall submit to the Committees on Veterans' Affairs 
     of the Senate and House of Representatives a report on the 
     peer support counseling program under section 1720F(j) of 
     title 38, United States Code, as amended by this section. 
     Such report shall include--
       (1) the number of peer support counselors in the program;
       (2) an assessment of the effectiveness of the program; and
       (3) a description of the oversight of the program.

              Subtitle E--Treating Barriers to Prosperity

     SEC. 8061. SHORT TITLE.

       This subtitle may be cited as the ``Treating Barriers to 
     Prosperity Act of 2018''.

     SEC. 8062. DRUG ABUSE MITIGATION INITIATIVE.

       (a) In General.--Chapter 145 of title 40, United States 
     Code, is amended by inserting after section 14509 the 
     following:

     ``Sec. 14510. Drug abuse mitigation initiative

       ``(a) In General.--The Appalachian Regional Commission may 
     provide technical assistance to, make grants to, enter into 
     contracts with, or otherwise provide amounts to individuals 
     or entities in the Appalachian region for projects and 
     activities to address drug abuse, including opioid abuse, in 
     the region, including projects and activities--
       ``(1) to facilitate the sharing of best practices among 
     States, counties, and other experts in the region with 
     respect to reducing such abuse;
       ``(2) to initiate or expand programs designed to eliminate 
     or reduce the harm to the workforce and economic growth of 
     the region that results from such abuse;
       ``(3) to attract and retain relevant health care services, 
     businesses, and workers; and
       ``(4) to develop relevant infrastructure, including 
     broadband infrastructure that supports the use of 
     telemedicine.
       ``(b) Limitation on Available Amounts.--Of the cost of any 
     activity eligible for a grant under this section--
       ``(1) not more than 50 percent may be provided from amounts 
     appropriated to carry out this section; and
       ``(2) notwithstanding paragraph (1)--
       ``(A) in the case of a project to be carried out in a 
     county for which a distressed county designation is in effect 
     under section 14526, not more than 80 percent may be provided 
     from amounts appropriated to carry out this section; and
       ``(B) in the case of a project to be carried out in a 
     county for which an at-risk designation is in effect under 
     section 14526, not more than 70 percent may be provided from 
     amounts appropriated to carry out this section.
       ``(c) Sources of Assistance.--Subject to subsection (b), a 
     grant provided under this section may be provided from 
     amounts made available to carry out this section in 
     combination with amounts made available--
       ``(1) under any other Federal program (subject to the 
     availability of subsequent appropriations); or
       ``(2) from any other source.
       ``(d) Federal Share.--Notwithstanding any provision of law 
     limiting the Federal share under any other Federal program, 
     amounts made available to carry out this section may be used 
     to increase that Federal share, as the Appalachian Regional 
     Commission determines to be appropriate.''.
       (b) Clerical Amendment.--The analysis for chapter 145 of 
     title 40, United States Code, is amended by inserting after 
     the item relating to section 14509 the following:

``14510. Drug abuse mitigation initiative.''.

   Subtitle F--Pilot Program to Help Individuals in Recovery From a 
              Substance Use Disorder Become Stably Housed

     SEC. 8071. PILOT PROGRAM TO HELP INDIVIDUALS IN RECOVERY FROM 
                   A SUBSTANCE USE DISORDER BECOME STABLY HOUSED.

       (a) Authorization of Appropriations.--There is authorized 
     to be appropriated under this section such sums as may be 
     necessary for each of fiscal years 2019 through 2023 for 
     assistance to States to provide individuals in recovery from 
     a substance use disorder stable, temporary housing for a 
     period of not more than 2 years or until the individual 
     secures permanent housing, whichever is earlier.
       (b) Allocation of Appropriated Amounts.--
       (1) In general.--The amounts appropriated or otherwise made 
     available to States under this section shall be allocated 
     based on a funding formula established by the Secretary of 
     Housing and Urban Development (referred to in this section as 
     the ``Secretary'') not later than 60 days after the date of 
     enactment of this Act.
       (2) Criteria.--
       (A) In general.--The funding formula required under 
     paragraph (1) shall ensure that any amounts appropriated or 
     otherwise made

[[Page H9230]]

     available under this section are allocated to States with an 
     age-adjusted rate of drug overdose deaths that is above the 
     national overdose mortality rate, according to the Centers 
     for Disease Control and Prevention.
       (B) Priority.--
       (i) In general.--Among such States, priority shall be given 
     to States with the greatest need, as such need is determined 
     by the Secretary based on the following factors, and 
     weighting such factors as described in clause (ii):

       (I) The highest average rates of unemployment based on data 
     provided by the Bureau of Labor Statistics for calendar years 
     2013 through 2017.
       (II) The lowest average labor force participation rates 
     based on data provided by the Bureau of Labor Statistics for 
     calendar years 2013 through 2017.
       (III) The highest age-adjusted rates of drug overdose 
     deaths based on data from the Centers for Disease Control and 
     Prevention.

       (ii) Weighting.--The factors described in clause (i) shall 
     be weighted as follows:

       (I) The rate described in clause (i)(I) shall be weighted 
     at 15 percent.
       (II) The rate described in clause (i)(II) shall be weighted 
     at 15 percent.
       (III) The rate described in clause (i)(III) shall be 
     weighted at 70 percent.

       (3) Distribution.--Amounts appropriated or otherwise made 
     available under this section shall be distributed according 
     to the funding formula established by the Secretary under 
     paragraph (1) not later than 30 days after the establishment 
     of such formula.
       (c) Use of Funds.--
       (1) In general.--Any State that receives amounts pursuant 
     to this section shall expend at least 30 percent of such 
     funds within one year of the date funds become available to 
     the grantee for obligation.
       (2) Priority.--Any State that receives amounts pursuant to 
     this section shall distribute such amounts giving priority to 
     entities with the greatest need and ability to deliver 
     effective assistance in a timely manner.
       (3) Administrative costs.--Any State that receives amounts 
     pursuant to this section may use up to 5 percent of any grant 
     for administrative costs.
       (d) Rules of Construction.--
       (1) In general.--Except as otherwise provided by this 
     section, amounts appropriated, or amounts otherwise made 
     available to States under this section shall be treated as 
     though such funds were community development block grant 
     funds under title I of the Housing and Community Development 
     Act of 1974 (42 U.S.C. 5301 et seq.).
       (2) No match.--No matching funds shall be required in order 
     for a State to receive any amounts under this section.
       (e) Authority to Waive or Specify Alternative 
     Requirements.--
       (1) In general.--In administering any amounts appropriated 
     or otherwise made available under this section, the Secretary 
     may waive or specify alternative requirements to any 
     provision under title I of the Housing and Community 
     Development Act of 1974 (42 U.S.C. 5301 et seq.) except for 
     requirements related to fair housing, nondiscrimination, 
     labor standards, the environment, and requirements that 
     activities benefit persons of low- and moderate-income, upon 
     a finding that such a waiver is necessary to expedite or 
     facilitate the use of such funds.
       (2) Notice of intent.--The Secretary shall provide written 
     notice of its intent to exercise the authority to specify 
     alternative requirements under paragraph (1) to the Committee 
     on Banking, Housing, and Urban Affairs of the Senate and the 
     Committee on Financial Services of the House of 
     Representatives not later than 15 business days before such 
     exercise of authority occurs.
       (3) Notice to the public.--The Secretary shall provide 
     written notice of its intent to exercise the authority to 
     specify alternative requirements under paragraph (1) to the 
     public via notice, on the internet website of the Department 
     of Housing and Urban Development, and by other appropriate 
     means, not later than 15 business days before such exercise 
     of authority occurs.
       (f) Technical Assistance.--For the 2-year period following 
     the date of enactment of this Act, the Secretary may use not 
     more than 2 percent of the funds made available under this 
     section for technical assistance to grantees.
       (g) State.--For purposes of this section the term ``State'' 
     includes any State as defined in section 102 of the Housing 
     and Community Development Act of 1974 (42 U.S.C. 5302) and 
     the District of Columbia.

                       Subtitle G--Human Services

     SEC. 8081. SUPPORTING FAMILY-FOCUSED RESIDENTIAL TREATMENT.

       (a) Definitions.--In this section:
       (1) Family-focused residential treatment program.--The term 
     ``family-focused residential treatment program'' means a 
     trauma-informed residential program primarily for substance 
     use disorder treatment for pregnant and postpartum women and 
     parents and guardians that allows children to reside with 
     such women or their parents or guardians during treatment to 
     the extent appropriate and applicable.
       (2) Medicaid program.--The term ``Medicaid program'' means 
     the program established under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.).
       (3) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (4) Title iv-e program.--The term ``title IV-E program'' 
     means the program for foster care, prevention, and permanency 
     established under part E of title IV of the Social Security 
     Act (42 U.S.C. 670 et seq.).
       (b) Guidance on Family-focused Residential Treatment 
     Programs.--
       (1) In general.--Not later than 180 days after the date of 
     enactment of this Act, the Secretary, in consultation with 
     divisions of the Department of Health and Human Services 
     administering substance use disorder or child welfare 
     programs, shall develop and issue guidance to States 
     identifying opportunities to support family-focused 
     residential treatment programs for the provision of substance 
     use disorder treatment. Before issuing such guidance, the 
     Secretary shall solicit input from representatives of States, 
     health care providers with expertise in addiction medicine, 
     obstetrics and gynecology, neonatology, child trauma, and 
     child development, health plans, recipients of family-focused 
     treatment services, and other relevant stakeholders.
       (2) Additional requirements.--The guidance required under 
     paragraph (1) shall include descriptions of the following:
       (A) Existing opportunities and flexibilities under the 
     Medicaid program, including under waivers authorized under 
     section 1115 or 1915 of the Social Security Act (42 U.S.C. 
     1315, 1396n), for States to receive Federal Medicaid funding 
     for the provision of substance use disorder treatment for 
     pregnant and postpartum women and parents and guardians and, 
     to the extent applicable, their children, in family-focused 
     residential treatment programs.
       (B) How States can employ and coordinate funding provided 
     under the Medicaid program, the title IV-E program, and other 
     programs administered by the Secretary to support the 
     provision of treatment and services provided by a family-
     focused residential treatment facility such as substance use 
     disorder treatment and services, including medication-
     assisted treatment, family, group, and individual counseling, 
     case management, parenting education and skills development, 
     the provision, assessment, or coordination of care and 
     services for children, including necessary assessments and 
     appropriate interventions, non-emergency transportation for 
     necessary care provided at or away from a program site, 
     transitional services and supports for families leaving 
     treatment, and other services.
       (C) How States can employ and coordinate funding provided 
     under the Medicaid program and the title IV-E program 
     (including as amended by the Family First Prevention Services 
     Act enacted under title VII of division E of Public Law 115-
     123, and particularly with respect to the authority under 
     subsections (a)(2)(C) and (j) of section 472 and section 
     474(a)(1) of the Social Security Act (42 U.S.C. 672, 
     674(a)(1)) (as amended by section 50712 of Public Law 115-
     123) to provide foster care maintenance payments for a child 
     placed with a parent who is receiving treatment in a licensed 
     residential family-based treatment facility for a substance 
     use disorder) to support placing children with their parents 
     in family-focused residential treatment programs.

     SEC. 8082. IMPROVING RECOVERY AND REUNIFYING FAMILIES.

       (a) Family Recovery and Reunification Program Replication 
     Project.--Section 435 of the Social Security Act (42 U.S.C. 
     629e) is amended by adding at the end the following:
       ``(e) Family Recovery and Reunification Program Replication 
     Project.--
       ``(1) Purpose.--The purpose of this subsection is to 
     provide resources to the Secretary to support the conduct and 
     evaluation of a family recovery and reunification program 
     replication project (referred to in this subsection as the 
     `project') and to determine the extent to which such programs 
     may be appropriate for use at different intervention points 
     (such as when a child is at risk of entering foster care or 
     when a child is living with a guardian while a parent is in 
     treatment). The family recovery and reunification program 
     conducted under the project shall use a recovery coach model 
     that is designed to help reunify families and protect 
     children by working with parents or guardians with a 
     substance use disorder who have temporarily lost custody of 
     their children.
       ``(2) Program components.--The family recovery and 
     reunification program conducted under the project shall 
     adhere closely to the elements and protocol determined to be 
     most effective in other recovery coaching programs that have 
     been rigorously evaluated and shown to increase family 
     reunification and protect children and, consistent with such 
     elements and protocol, shall provide such items and services 
     as--
       ``(A) assessments to evaluate the needs of the parent or 
     guardian;
       ``(B) assistance in receiving the appropriate benefits to 
     aid the parent or guardian in recovery;
       ``(C) services to assist the parent or guardian in 
     prioritizing issues identified in assessments, establishing 
     goals for resolving such issues that are consistent with the 
     goals of the treatment provider, child welfare agency, 
     courts, and other agencies involved with the parent or 
     guardian or their children, and making a coordinated plan for 
     achieving such goals;
       ``(D) home visiting services coordinated with the child 
     welfare agency and treatment provider involved with the 
     parent or guardian or their children;

[[Page H9231]]

       ``(E) case management services to remove barriers for the 
     parent or guardian to participate and continue in treatment, 
     as well as to re-engage a parent or guardian who is not 
     participating or progressing in treatment;
       ``(F) access to services needed to monitor the parent's or 
     guardian's compliance with program requirements;
       ``(G) frequent reporting between the treatment provider, 
     child welfare agency, courts, and other agencies involved 
     with the parent or guardian or their children to ensure 
     appropriate information on the parent's or guardian's status 
     is available to inform decision-making; and
       ``(H) assessments and recommendations provided by a 
     recovery coach to the child welfare caseworker responsible 
     for documenting the parent's or guardian's progress in 
     treatment and recovery as well as the status of other areas 
     identified in the treatment plan for the parent or guardian, 
     including a recommendation regarding the expected safety of 
     the child if the child is returned to the custody of the 
     parent or guardian that can be used by the caseworker and a 
     court to make permanency decisions regarding the child.
       ``(3) Responsibilities of the secretary.--
       ``(A) In general.--The Secretary shall, through a grant or 
     contract with 1 or more entities, conduct and evaluate the 
     family recovery and reunification program under the project.
       ``(B) Requirements.--In identifying 1 or more entities to 
     conduct the evaluation of the family recovery and 
     reunification program, the Secretary shall--
       ``(i) determine that the area or areas in which the program 
     will be conducted have sufficient substance use disorder 
     treatment providers and other resources (other than those 
     provided with funds made available to carry out the project) 
     to successfully conduct the program;
       ``(ii) determine that the area or areas in which the 
     program will be conducted have enough potential program 
     participants, and will serve a sufficient number of parents 
     or guardians and their children, so as to allow for the 
     formation of a control group, evaluation results to be 
     adequately powered, and preliminary results of the evaluation 
     to be available within 4 years of the program's 
     implementation;
       ``(iii) provide the entity or entities with technical 
     assistance for the program design, including by working with 
     1 or more entities that are or have been involved in recovery 
     coaching programs that have been rigorously evaluated and 
     shown to increase family reunification and protect children 
     so as to make sure the program conducted under the project 
     adheres closely to the elements and protocol determined to be 
     most effective in such other recovery coaching programs;
       ``(iv) assist the entity or entities in securing adequate 
     coaching, treatment, child welfare, court, and other 
     resources needed to successfully conduct the family recovery 
     and reunification program under the project; and
       ``(v) ensure the entity or entities will be able to monitor 
     the impacts of the program in the area or areas in which it 
     is conducted for at least 5 years after parents or guardians 
     and their children are randomly assigned to participate in 
     the program or to be part of the program's control group.
       ``(4) Evaluation requirements.--
       ``(A) In general.--The Secretary, in consultation with the 
     entity or entities conducting the family recovery and 
     reunification program under the project, shall conduct an 
     evaluation to determine whether the program has been 
     implemented effectively and resulted in improvements for 
     children and families. The evaluation shall have 3 
     components: a pilot phase, an impact study, and an 
     implementation study.
       ``(B) Pilot phase.--The pilot phase component of the 
     evaluation shall consist of the Secretary providing technical 
     assistance to the entity or entities conducting the family 
     recovery and reunification program under the project to 
     ensure--
       ``(i) the program's implementation adheres closely to the 
     elements and protocol determined to be most effective in 
     other recovery coaching programs that have been rigorously 
     evaluated and shown to increase family reunification and 
     protect children; and
       ``(ii) random assignment of parents or guardians and their 
     children to be participants in the program or to be part of 
     the program's control group is being carried out.
       ``(C) Impact study.--The impact study component of the 
     evaluation shall determine the impacts of the family recovery 
     and reunification program conducted under the project on the 
     parents and guardians and their children participating in the 
     program. The impact study component shall--
       ``(i) be conducted using an experimental design that uses a 
     random assignment research methodology;
       ``(ii) consistent with previous studies of other recovery 
     coaching programs that have been rigorously evaluated and 
     shown to increase family reunification and protect children, 
     measure outcomes for parents and guardians and their children 
     over multiple time periods, including for a period of 5 
     years; and
       ``(iii) include measurements of family stability and 
     parent, guardian, and child safety for program participants 
     and the program control group that are consistent with 
     measurements of such factors for participants and control 
     groups from previous studies of other recovery coaching 
     programs so as to allow results of the impact study to be 
     compared with the results of such prior studies, including 
     with respect to comparisons between program participants and 
     the program control group regarding--

       ``(I) safe family reunification;
       ``(II) time to reunification;
       ``(III) permanency (such as through measures of 
     reunification, adoption, or placement with guardians);
       ``(IV) safety (such as through measures of subsequent 
     maltreatment);
       ``(V) parental or guardian treatment persistence and 
     engagement;
       ``(VI) parental or guardian substance use;
       ``(VII) juvenile delinquency;
       ``(VIII) cost; and
       ``(IX) other measurements agreed upon by the Secretary and 
     the entity or entities operating the family recovery and 
     reunification program under the project.

       ``(D) Implementation study.--The implementation study 
     component of the evaluation shall be conducted concurrently 
     with the conduct of the impact study component and shall 
     include, in addition to such other information as the 
     Secretary may determine, descriptions and analyses of--
       ``(i) the adherence of the family recovery and 
     reunification program conducted under the project to other 
     recovery coaching programs that have been rigorously 
     evaluated and shown to increase family reunification and 
     protect children; and
       ``(ii) the difference in services received or proposed to 
     be received by the program participants and the program 
     control group.
       ``(E) Report.--The Secretary shall publish on an internet 
     website maintained by the Secretary the following 
     information:
       ``(i) A report on the pilot phase component of the 
     evaluation.
       ``(ii) A report on the impact study component of the 
     evaluation.
       ``(iii) A report on the implementation study component of 
     the evaluation.
       ``(iv) A report that includes--

       ``(I) analyses of the extent to which the program has 
     resulted in increased reunifications, increased permanency, 
     case closures, net savings to the State or States involved 
     (taking into account both costs borne by States and the 
     Federal government), or other outcomes, or if the program did 
     not produce such outcomes, an analysis of why the replication 
     of the program did not yield such results;
       ``(II) if, based on such analyses, the Secretary determines 
     the program should be replicated, a replication plan; and
       ``(III) such recommendations for legislation and 
     administrative action as the Secretary determines 
     appropriate.

       ``(5) Appropriation.--In addition to any amounts otherwise 
     made available to carry out this subpart, out of any money in 
     the Treasury of the United States not otherwise appropriated, 
     there are appropriated $15,000,000 for fiscal year 2019 to 
     carry out the project, which shall remain available through 
     fiscal year 2026.''.
       (b) Clarification of Payer of Last Resort Application to 
     Child Welfare Prevention and Family Services.--Section 
     471(e)(10) of the Social Security Act (42 U.S.C. 671(e)(10)), 
     as added by section 50711(a)(2) of division E of Public Law 
     115-123, is amended--
       (1) in subparagraph (A), by inserting ``, nor shall the 
     provision of such services or programs be construed to permit 
     the State to reduce medical or other assistance available to 
     a recipient of such services or programs'' after ``under this 
     Act''; and
       (2) by adding at the end the following:
       ``(C) Payer of last resort.--In carrying out its 
     responsibilities to ensure access to services or programs 
     under this subsection, the State agency shall not be 
     considered to be a legally liable third party for purposes of 
     satisfying a financial commitment for the cost of providing 
     such services or programs with respect to any individual for 
     whom such cost would have been paid for from another public 
     or private source but for the enactment of this subsection 
     (except that whenever considered necessary to prevent a delay 
     in the receipt of appropriate early intervention services by 
     a child or family in a timely fashion, funds provided under 
     section 474(a)(6) may be used to pay the provider of services 
     or programs pending reimbursement from the public or private 
     source that has ultimate responsibility for the payment).''.
       (c) Effective Date.--The amendments made by subsection (b) 
     shall take effect as if included in section 50711 of division 
     E of Public Law 115-123.

     SEC. 8083. BUILDING CAPACITY FOR FAMILY-FOCUSED RESIDENTIAL 
                   TREATMENT.

       (a) Definitions.--In this section:
       (1) Eligible entity.--The term ``eligible entity'' means a 
     State, county, local, or tribal health or child welfare 
     agency, a private nonprofit organization, a research 
     organization, a treatment service provider, an institution of 
     higher education (as defined under section 101 of the Higher 
     Education Act of 1965 (20 U.S.C. 1001)), or another entity 
     specified by the Secretary.
       (2) Family-focused residential treatment program.--The term 
     ``family-focused residential treatment program'' means a 
     trauma-informed residential program primarily for substance 
     use disorder treatment for pregnant and postpartum women and 
     parents and guardians that allows children to reside with 
     such women or their parents or guardians during treatment to 
     the extent appropriate and applicable.

[[Page H9232]]

       (3) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (b) Support for the Development of Evidence-based Family-
     focused Residential Treatment Programs.--
       (1) Authority to award grants.--The Secretary shall award 
     grants to eligible entities for purposes of developing, 
     enhancing, or evaluating family-focused residential treatment 
     programs to increase the availability of such programs that 
     meet the requirements for promising, supported, or well-
     supported practices specified in section 471(e)(4)(C) of the 
     Social Security Act (42 U.S.C. 671(e)(4)(C))) (as added by 
     the Family First Prevention Services Act enacted under title 
     VII of division E of Public Law 115-123).
       (2) Evaluation requirement.--The Secretary shall require 
     any evaluation of a family-focused residential treatment 
     program by an eligible entity that uses funds awarded under 
     this section for all or part of the costs of the evaluation 
     be designed to assist in the determination of whether the 
     program may qualify as a promising, supported, or well-
     supported practice in accordance with the requirements of 
     such section 471(e)(4)(C).
       (c) Authorization of Appropriations.--There is authorized 
     to be appropriated to the Secretary to carry out this 
     section, $20,000,000 for fiscal year 2019, which shall remain 
     available through fiscal year 2023.

Subtitle H--Reauthorizing and Extending Grants for Recovery From Opioid 
                              Use Programs

     SEC. 8091. SHORT TITLE.

       This subtitle may be cited as the ``Reauthorizing and 
     Extending Grants for Recovery from Opioid Use Programs Act of 
     2018'' or the ``REGROUP Act of 2018''.

     SEC. 8092. REAUTHORIZATION OF THE COMPREHENSIVE OPIOID ABUSE 
                   GRANT PROGRAM.

       Section 1001(a)(27) of the Omnibus Crime Control and Safe 
     Streets Act of 1968 (34 U.S.C. 10261(a)(27)) is amended by 
     striking ``through 2021'' and inserting ``and 2018, and 
     $330,000,000 for each of fiscal years 2019 through 2023''.

          Subtitle I--Fighting Opioid Abuse in Transportation

     SEC. 8101. SHORT TITLE.

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

     SEC. 8102. ALCOHOL AND CONTROLLED SUBSTANCE TESTING OF 
                   MECHANICAL EMPLOYEES.

       (a) In General.--Not later than 2 years after the date of 
     enactment of this Act, the Secretary of Transportation shall 
     publish a rule in the Federal Register revising the 
     regulations promulgated under section 20140 of title 49, 
     United States Code, to cover all employees of railroad 
     carriers who perform mechanical activities.
       (b) Definition of Mechanical Activities.--For the purposes 
     of the rule under subsection (a), the Secretary shall define 
     the term ``mechanical activities'' by regulation.

     SEC. 8103. DEPARTMENT OF TRANSPORTATION PUBLIC DRUG AND 
                   ALCOHOL TESTING DATABASE.

       (a) In General.--Subject to subsection (c), the Secretary 
     of Transportation shall--
       (1) not later than March 31, 2019, establish and make 
     publicly available on its website a database of the drug and 
     alcohol testing data reported by employers for each mode of 
     transportation; and
       (2) update the database annually.
       (b) Contents.--The database under subsection (a) shall 
     include, for each mode of transportation--
       (1) the total number of drug and alcohol tests by type of 
     substance tested;
       (2) the drug and alcohol test results by type of substance 
     tested;
       (3) the reason for the drug or alcohol test, such as pre-
     employment, random, post-accident, reasonable suspicion or 
     cause, return-to-duty, or follow-up, by type of substance 
     tested; and
       (4) the number of individuals who refused testing.
       (c) Commercially Sensitive Data.--The Department of 
     Transportation shall not release any commercially sensitive 
     data or personally identifiable data furnished by an employer 
     under this section unless the data is aggregated or otherwise 
     in a form that does not identify the employer providing the 
     data.
       (d) Savings Clause.--Nothing in this section may be 
     construed as limiting or otherwise affecting the requirements 
     of the Secretary of Transportation to adhere to requirements 
     applicable to confidential business information and sensitive 
     security information, consistent with applicable law.

     SEC. 8104. GAO REPORT ON DEPARTMENT OF TRANSPORTATION'S 
                   COLLECTION AND USE OF DRUG AND ALCOHOL TESTING 
                   DATA.

       (a) In General.--Not later than 2 years after the date the 
     Department of Transportation public drug and alcohol testing 
     database is established under section 8103, the Comptroller 
     General of the United States shall--
       (1) review the Department of Transportation Drug and 
     Alcohol Testing Management Information System; and
       (2) submit to the Committee on Commerce, Science, and 
     Transportation of the Senate and the Committee on 
     Transportation and Infrastructure of the House of 
     Representatives a report on the review, including 
     recommendations under subsection (c).
       (b) Contents.--The report under subsection (a) shall 
     include--
       (1) a description of the process the Department of 
     Transportation uses to collect and record drug and alcohol 
     testing data submitted by employers for each mode of 
     transportation;
       (2) an assessment of whether and, if so, how the Department 
     of Transportation uses the data described in paragraph (1) in 
     carrying out its responsibilities; and
       (3) an assessment of the Department of Transportation 
     public drug and alcohol testing database under section 8103.
       (c) Recommendations.--The report under subsection (a) may 
     include recommendations regarding--
       (1) how the Department of Transportation can best use the 
     data described in subsection (b)(1);
       (2) any improvements that could be made to the process 
     described in subsection (b)(1);
       (3) whether and, if so, how the Department of 
     Transportation public drug and alcohol testing database under 
     section 8103 could be made more effective; and
       (4) such other recommendations as the Comptroller General 
     considers appropriate.

     SEC. 8105. TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING 
                   PROGRAM; ADDITION OF FENTANYL AND OTHER 
                   SUBSTANCES.

       (a) Mandatory Guidelines for Federal Workplace Drug Testing 
     Programs.--
       (1) In general.--Not later than 180 days after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall--
       (A) determine whether a revision of the Mandatory 
     Guidelines for Federal Workplace Drug Testing Programs to 
     expand the opiate category on the list of authorized 
     substance testing to include fentanyl is justified, based on 
     the reliability and cost-effectiveness of available testing; 
     and
       (B) consider whether to include with the determination 
     under subparagraph (A) a separate determination on whether a 
     revision of the Mandatory Guidelines for Federal Workplace 
     Drug Testing Programs to expand the list of substances 
     authorized for testing to include any other drugs or other 
     substances listed in schedule I and II of section 202 of the 
     Controlled Substances Act (21 U.S.C. 812) is justified based 
     on the criteria described in subparagraph (A).
       (2) Revision of guidelines.--If an expansion of the 
     substance list is determined to be justified under paragraph 
     (1), the Secretary of Health and Human Services shall--
       (A) notify the Committee on Commerce, Science, and 
     Transportation of the Senate and the Committee on 
     Transportation and Infrastructure of the House of 
     Representatives of the determination; and
       (B) publish in the Federal Register, not later than 18 
     months after the date of the determination under that 
     paragraph, a final notice of the revision of the Mandatory 
     Guidelines for Federal Workplace Drug Testing Programs to 
     expand the list of substances authorized to be tested to 
     include the substance or substances determined to be 
     justified for inclusion.
       (3) Report.--If an expansion of the substance list is 
     determined not to be justified under paragraph (1), the 
     Secretary of Health and Human Services shall submit to the 
     Committee on Commerce, Science, and Transportation of the 
     Senate and the Committee on Transportation and Infrastructure 
     of the House of Representatives a report explaining, in 
     detail, the reasons the expansion of the list of authorized 
     substances is not justified.
       (b) Department of Transportation Drug-testing Panel.--If an 
     expansion is determined to be justified under subsection 
     (a)(1), the Secretary of Transportation shall publish in the 
     Federal Register, not later than 18 months after the date the 
     final notice is published under subsection (a)(2), a final 
     rule revising part 40 of title 49, Code of Federal 
     Regulations, to include such substances in the Department of 
     Transportation's drug-testing panel, consistent with the 
     Mandatory Guidelines for Federal Workplace Drug Testing 
     Programs as revised by the Secretary of Health and Human 
     Services under subsection (a).
       (c) Savings Provision.--Nothing in this section may be 
     construed as--
       (1) delaying the publication of the notices described in 
     sections 8106 and 8107 of this Act until the Secretary of 
     Health and Human Services makes a determination or publishes 
     a notice under this section; or
       (2) limiting or otherwise affecting any authority of the 
     Secretary of Health and Human Services or the Secretary of 
     Transportation to expand the list of authorized substance 
     testing to include an additional substance.

     SEC. 8106. STATUS REPORTS ON HAIR TESTING GUIDELINES.

       (a) In General.--Not later than 60 days after the date of 
     enactment of this Act, and annually thereafter until the date 
     that the Secretary of Health and Human Services publishes in 
     the Federal Register a final notice of scientific and 
     technical guidelines for hair testing in accordance with 
     section 5402(b) of the Fixing America's Surface 
     Transportation Act (Public Law 114-94; 129 Stat. 1312), the 
     Secretary of Health and Human Services shall submit to the 
     Committee on Commerce, Science, and Transportation of the 
     Senate and the Committee on Transportation and Infrastructure 
     of the House of Representatives a report on--
       (1) the status of the hair testing guidelines;
       (2) an explanation for why the hair testing guidelines have 
     not been issued; and

[[Page H9233]]

       (3) an estimated date of completion of the hair testing 
     guidelines.
       (b) Requirement.--To the extent practicable and consistent 
     with the objective of the hair testing described in 
     subsection (a) to detect illegal or unauthorized use of 
     substances by the individual being tested, the final notice 
     of scientific and technical guidelines under that subsection, 
     as determined by the Secretary of Health and Human Services, 
     shall eliminate the risk of positive test results, of the 
     individual being tested, caused solely by the drug use of 
     others and not caused by the drug use of the individual being 
     tested.

     SEC. 8107. MANDATORY GUIDELINES FOR FEDERAL WORKPLACE DRUG 
                   TESTING PROGRAMS USING ORAL FLUID.

       (a) Deadline.--Not later than December 31, 2018, the 
     Secretary of Health and Human Services shall publish in the 
     Federal Register a final notice of the Mandatory Guidelines 
     for Federal Workplace Drug Testing Programs using Oral Fluid, 
     based on the notice of proposed mandatory guidelines 
     published in the Federal Register on May 15, 2015 (94 FR 
     28054).
       (b) Requirement.--To the extent practicable and consistent 
     with the objective of the testing described in subsection (a) 
     to detect illegal or unauthorized use of substances by the 
     individual being tested, the final notice of scientific and 
     technical guidelines under that subsection, as determined by 
     the Secretary of Health and Human Services, shall eliminate 
     the risk of positive test results, of the individual being 
     tested, caused solely by the drug use of others and not 
     caused by the drug use of the individual being tested.
       (c) Rule of Construction.--Nothing in this section may be 
     construed as requiring the Secretary of Health and Human 
     Services to reissue a notice of proposed mandatory guidelines 
     to carry out subsection (a).

     SEC. 8108. ELECTRONIC RECORDKEEPING.

       (a) Deadline.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall--
       (1) ensure that each certified laboratory that requests 
     approval for the use of completely paperless electronic 
     Federal Drug Testing Custody and Control Forms from the 
     National Laboratory Certification Program's Electronic 
     Custody and Control Form systems receives approval for those 
     completely paperless electronic forms instead of forms that 
     include any combination of electronic traditional handwritten 
     signatures executed on paper forms; and
       (2) establish a deadline for a certified laboratory to 
     request approval under paragraph (1).
       (b) Savings Clause.--Nothing in this section may be 
     construed as limiting or otherwise affecting any authority of 
     the Secretary of Health and Human Services to grant approval 
     to a certified laboratory for use of completely paperless 
     electronic Federal Drug Testing Custody and Control Forms, 
     including to grant approval outside of the process under 
     subsection (a).
       (c) Electronic Signatures.--Not later than 18 months after 
     the date of the deadline under subsection (a)(2), the 
     Secretary of Transportation shall issue a final rule revising 
     part 40 of title 49, Code of Federal Regulations, to 
     authorize, to the extent practicable, the use of electronic 
     signatures or digital signatures executed to electronic forms 
     instead of traditional handwritten signatures executed on 
     paper forms.

     SEC. 8109. STATUS REPORTS ON COMMERCIAL DRIVER'S LICENSE DRUG 
                   AND ALCOHOL CLEARINGHOUSE.

       (a) In General.--Not later than 60 days after the date of 
     enactment of this Act, and annually thereafter until the 
     compliance date, the Administrator of the Federal Motor 
     Carrier Safety Administration shall submit to the Committee 
     on Commerce, Science, and Transportation of the Senate and 
     the Committee on Transportation and Infrastructure of the 
     House of Representatives a status report on implementation of 
     the final rule for the Commercial Driver's License Drug and 
     Alcohol Clearinghouse (81 FR 87686), including--
       (1) an updated schedule, including benchmarks, for 
     implementing the final rule as soon as practicable, but not 
     later than the compliance date; and
       (2) a description of each action the Federal Motor Carrier 
     Safety Administration is taking to implement the final rule 
     before the compliance date.
       (b) Definition of Compliance Date.--In this section, the 
     term ``compliance date'' means the earlier of--
       (1) January 6, 2020; or
       (2) the date that the national clearinghouse required under 
     section 31306a of title 49, United States Code, is 
     operational.

             Subtitle J--Eliminating Kickbacks in Recovery

     SEC. 8121. SHORT TITLE.

       This subtitle may be cited as the ``Eliminating Kickbacks 
     in Recovery Act of 2018''.

     SEC. 8122. CRIMINAL PENALTIES.

       (a) In General.--Chapter 11 of title 18, United States 
     Code, is amended by inserting after section 219 the 
     following:

     ``Sec. 220. Illegal remunerations for referrals to recovery 
       homes, clinical treatment facilities, and laboratories

       ``(a) Offense.--Except as provided in subsection (b), 
     whoever, with respect to services covered by a health care 
     benefit program, in or affecting interstate or foreign 
     commerce, knowingly and willfully--
       ``(1) solicits or receives any remuneration (including any 
     kickback, bribe, or rebate) directly or indirectly, overtly 
     or covertly, in cash or in kind, in return for referring a 
     patient or patronage to a recovery home, clinical treatment 
     facility, or laboratory; or
       ``(2) pays or offers any remuneration (including any 
     kickback, bribe, or rebate) directly or indirectly, overtly 
     or covertly, in cash or in kind--
       ``(A) to induce a referral of an individual to a recovery 
     home, clinical treatment facility, or laboratory; or
       ``(B) in exchange for an individual using the services of 
     that recovery home, clinical treatment facility, or 
     laboratory,

     shall be fined not more than $200,000, imprisoned not more 
     than 10 years, or both, for each occurrence.
       ``(b) Applicability.--Subsection (a) shall not apply to--
       ``(1) a discount or other reduction in price obtained by a 
     provider of services or other entity under a health care 
     benefit program if the reduction in price is properly 
     disclosed and appropriately reflected in the costs claimed or 
     charges made by the provider or entity;
       ``(2) a payment made by an employer to an employee or 
     independent contractor (who has a bona fide employment or 
     contractual relationship with such employer) for employment, 
     if the employee's payment is not determined by or does not 
     vary by--
       ``(A) the number of individuals referred to a particular 
     recovery home, clinical treatment facility, or laboratory;
       ``(B) the number of tests or procedures performed; or
       ``(C) the amount billed to or received from, in part or in 
     whole, the health care benefit program from the individuals 
     referred to a particular recovery home, clinical treatment 
     facility, or laboratory;
       ``(3) a discount in the price of an applicable drug of a 
     manufacturer that is furnished to an applicable beneficiary 
     under the Medicare coverage gap discount program under 
     section 1860D-14A(g) of the Social Security Act (42 U.S.C. 
     1395w-114a(g));
       ``(4) a payment made by a principal to an agent as 
     compensation for the services of the agent under a personal 
     services and management contract that meets the requirements 
     of section 1001.952(d) of title 42, Code of Federal 
     Regulations, as in effect on the date of enactment of this 
     section;
       ``(5) a waiver or discount (as defined in section 
     1001.952(h)(5) of title 42, Code of Federal Regulations, or 
     any successor regulation) of any coinsurance or copayment by 
     a health care benefit program if--
       ``(A) the waiver or discount is not routinely provided; and
       ``(B) the waiver or discount is provided in good faith;
       ``(6) a remuneration described in section 1128B(b)(3)(I) of 
     the Social Security Act (42 U.S.C. 1320a-7b(b)(3)(I));
       ``(7) a remuneration made pursuant to an alternative 
     payment model (as defined in section 1833(z)(3)(C) of the 
     Social Security Act) or pursuant to a payment arrangement 
     used by a State, health insurance issuer, or group health 
     plan if the Secretary of Health and Human Services has 
     determined that such arrangement is necessary for care 
     coordination or value-based care; or
       ``(8) any other payment, remuneration, discount, or 
     reduction as determined by the Attorney General, in 
     consultation with the Secretary of Health and Human Services, 
     by regulation.
       ``(c) Regulations.--The Attorney General, in consultation 
     with the Secretary of Health and Human Services, may 
     promulgate regulations to clarify the exceptions described in 
     subsection (b).
       ``(d) Preemption.--
       ``(1) Federal law.--This section shall not apply to conduct 
     that is prohibited under section 1128B of the Social Security 
     Act (42 U.S.C. 1320a-7b).
       ``(2) State law.--Nothing in this section shall be 
     construed to occupy the field in which any provisions of this 
     section operate to the exclusion of State laws on the same 
     subject matter.
       ``(e) Definitions.--In this section--
       ``(1) the terms `applicable beneficiary' and `applicable 
     drug' have the meanings given those terms in section 1860D-
     14A(g) of the Social Security Act (42 U.S.C. 1395w-114a(g));
       ``(2) the term `clinical treatment facility' means a 
     medical setting , other than a hospital, that provides 
     detoxification, risk reduction, outpatient treatment and 
     care, residential treatment, or rehabilitation for substance 
     use, pursuant to licensure or certification under State law;
       ``(3) the term `health care benefit program' has the 
     meaning given the term in section 24(b);
       ``(4) the term `laboratory' has the meaning given the term 
     in section 353 of the Public Health Service Act (42 U.S.C. 
     263a); and
       ``(5) the term `recovery home' means a shared living 
     environment that is, or purports to be, free from alcohol and 
     illicit drug use and centered on peer support and connection 
     to services that promote sustained recovery from substance 
     use disorders.''.
       (b) Clerical Amendment.--The table of sections for chapter 
     11 of title 18, United States Code, is amended by inserting 
     after the item related to section 219 the following:

``220. Illegal remunerations for referrals to recovery homes, clinical 
              treatment facilities, and laboratories.''.

[[Page H9234]]

  


                 Subtitle K--Substance Abuse Prevention

     SEC. 8201. SHORT TITLE.

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

     SEC. 8202. REAUTHORIZATION OF THE OFFICE OF NATIONAL DRUG 
                   CONTROL POLICY.

       (a) Office of National Drug Control Policy Reauthorization 
     Act of 1998.--
       (1) In general.--The Office of National Drug Control Policy 
     Reauthorization Act of 1998 (21 U.S.C. 1701 et seq.), as in 
     effect on September 29, 2003, and as amended by the laws 
     described in paragraph (2), is revived and restored.
       (2) Laws described.--The laws described in this paragraph 
     are:
       (A) The Office of National Drug Control Policy 
     Reauthorization Act of 2006 (Public Law 109-469; 120 Stat. 
     3502).
       (B) The Presidential Appointment Efficiency and 
     Streamlining Act of 2011 (Public Law 112-166; 126 Stat. 
     1283).
       (b) Reauthorization.--
       (1) In general.--Section 714 of the Office of National Drug 
     Control Policy Reauthorization Act of 1998 (21 U.S.C. 1711) 
     is amended by striking ``such sums as may be necessary for 
     each of fiscal years 2006 through 2010'' and inserting 
     ``$18,400,000 for each of fiscal years 2018 through 2023''.
       (2) Repeal of termination.--The Office of National Drug 
     Control Policy Reauthorization Act of 1998 (21 U.S.C. 1701 et 
     seq.) is amended by striking section 715 (21 U.S.C. 1712).

     SEC. 8203. REAUTHORIZATION OF THE DRUG-FREE COMMUNITIES 
                   PROGRAM.

       (a) Revival of National Narcotics Leadership Act of 1988.--
       (1) In general.--Chapter 2 of the National Narcotics 
     Leadership Act of 1988 (21 U.S.C. 1521 et seq.), except for 
     subchapter II (21 U.S.C. 1541 et seq.), as in effect on 
     September 29, 1997, and as amended by the laws described in 
     paragraph (2), is revived and restored.
       (2) Laws described.--The laws described in this paragraph 
     are:
       (A) Public Law 107-82 (115 Stat. 814).
       (B) The Office of National Drug Control Policy 
     Reauthorization Act of 2006 (Public Law 109-469: 120 Stat. 
     3502), as amended by paragraph (4).
       (3) Amendment to termination provision.--Section 1009 of 
     the National Narcotics Leadership Act of 1988 (21 U.S.C. 
     1056) is amended by inserting ``and sections 1021 through 
     1035'' after ``section 1007''.
       (4) Technical correction.--
       (A) In general.--Title VIII of the Office of National Drug 
     Control Policy Reauthorization Act of 2006 (Public Law 109-
     469; 120 Stat. 3535) is amended by striking ``Drug-Free 
     Communities Act of 1997'' each place it appears and inserting 
     ``National Narcotics Leadership Act of 1988''.
       (B) Effective date.--The amendments made by subparagraph 
     (A) shall take effect as though enacted as part of the Office 
     of National Drug Control Policy Reauthorization Act of 2006 
     (Public Law 109-469; 120 Stat. 3502).
       (b) Amendment to National Narcotics Leadership Act of 
     1988.--Chapter 2 of subtitle A of title I of the National 
     Narcotics Leadership Act of 1988 (21 U.S.C. 1521 et seq.) is 
     amended--
       (1) in section 1022 (21 U.S.C. 1522), by striking 
     ``substance abuse'' each place it appears and inserting 
     ``substance use and misuse'';
       (2) in section 1023 (21 U.S.C. 1523), by striking paragraph 
     (9) and inserting the following:
       ``(9) Substance use and misuse.--The term `substance use 
     and misuse' means--
       ``(A) the illegal use or misuse of drugs, including 
     substances for which a listing is effect under any of 
     schedules I through V under section 202 of the Controlled 
     Substances Act (21 U.S.C. 812);
       ``(B) the misuse of inhalants or over-the-counter drugs; or
       ``(C) the use of alcohol, tobacco, or other related product 
     as such use is prohibited by State or local law.'';
       (3) in section 1024 (21 U.S.C. 1524), by striking 
     subsections (a) and (b) and inserting the following:
       ``(a) In General.--There is authorized to be appropriated 
     to the Office of National Drug Control Policy to carry out 
     this chapter $99,000,000 for each of fiscal years 2018 
     through 2023.
       ``(b) Administrative Costs.--Not more than 8 percent of the 
     funds appropriated to carry out this chapter may be used by 
     the Office of National Drug Control Policy to pay 
     administrative costs associated with the responsibilities of 
     the Office under this chapter.'';
       (4) in subchapter I (21 U.S.C. 1531 et seq.)--
       (A) by striking ``substance abuse'' each place it appears 
     and inserting ``substance use and misuse''; and
       (B) in section 1032(b)(1)(A) (21 U.S.C. 1532(b)(1)(A)), by 
     striking clause (iii) and inserting the following:
       ``(iii) Renewal grants.--Subject to clause (iv), the 
     Administrator may award a renewal grant to a grant recipient 
     under this subparagraph for each fiscal year of the 4-fiscal-
     year period following the first fiscal year for which the 
     initial additional grant is awarded in an amount not to 
     exceed the following:

       ``(I) For the first and second fiscal years of the 4-
     fiscal-year period, the amount of the non-Federal funds, 
     including in-kind contributions, raised by the coalition for 
     the applicable fiscal year is not less than 125 percent of 
     the amount awarded.
       ``(II) For the third and fourth fiscal tears of the 4-
     fiscal-year period, the amount of the non-Federal funds, 
     including in-kind contributions, raised by the coalition for 
     the applicable fiscal year is not less than 150 percent of 
     the amount awarded.''; and

       (5) by striking subchapter II (21 U.S.C. 1541 et seq.).

     SEC. 8204. REAUTHORIZATION OF THE NATIONAL COMMUNITY ANTI-
                   DRUG COALITION INSTITUTE.

       Section 4 of Public Law 107-82 (21 U.S.C. 1521 note) is 
     amended to read as follows:

     ``SEC. 4. AUTHORIZATION FOR NATIONAL COMMUNITY ANTIDRUG 
                   COALITION INSTITUTE.

       ``(a) In General.--The Director shall, using amounts 
     authorized to be appropriated by subsection (d), make a 
     competitive grant to provide for the continuation of the 
     National Community Anti-drug Coalition Institute.
       ``(b) Eligible Organizations.--An organization eligible for 
     the grant under subsection (a) is any national nonprofit 
     organization that represents, provides technical assistance 
     and training to, and has special expertise and broad, 
     national-level experience in community antidrug coalitions 
     under this subchapter.
       ``(c) Use of Grant Amount.--The organization that receives 
     the grant under subsection (a) shall continue a National 
     Community Anti-Drug Coalition Institute to--
       ``(1) provide education, training, and technical assistance 
     for coalition leaders and community teams, with emphasis on 
     the development of coalitions serving economically 
     disadvantaged areas;
       ``(2) develop and disseminate evaluation tools, mechanisms, 
     and measures to better assess and document coalition 
     performance measures and outcomes; and
       ``(3) bridge the gap between research and practice by 
     translating knowledge from research into practical 
     information.
       ``(d) Authorization of Appropriations.--The Director shall, 
     using amounts authorized to be appropriated by section 1032 
     of the National Narcotics Leadership Act of 1988 (15 U.S.C. 
     1532), make a grant of $2 million under subsection (a), for 
     each of the fiscal years 2018 through 2023.''.

     SEC. 8205. REAUTHORIZATION OF THE HIGH-INTENSITY DRUG 
                   TRAFFICKING AREA PROGRAM.

       Section 707 of the Office of National Drug Control Policy 
     Reauthorization Act of 1998 (21 U.S.C. 1706) is amended--
       (1) in subsection (f), by striking ``no Federal'' and all 
     that follows through ``programs.'' and inserting the 
     following: ``not more than a total of 5 percent of Federal 
     funds appropriated for the Program are expended for substance 
     use disorder treatment programs and drug prevention 
     programs.'';
       (2) in subsection (p)--
       (A) in paragraph (4), by striking ``and'' at the end;
       (B) in paragraph (5), by striking the period at the end and 
     inserting ``; and''; and
       (C) by adding at the end the following:
       ``(6) $280,000,000 for each of fiscal years 2018 through 
     2023.''; and
       (3) in subsection (q)--
       (A) by striking paragraph (2) and inserting the following:
       ``(2) Required uses.--The funds used under paragraph (1) 
     shall be used to ensure the safety of neighborhoods and the 
     protection of communities, including the prevention of the 
     intimidation of witnesses of illegal drug distribution and 
     related activities and the establishment of, or support for, 
     programs that provide protection or assistance to witnesses 
     in court proceedings.''; and
       (B) by adding at the end the following:
       ``(3) Best practice models.--The Director shall work with 
     HIDTAs to develop and maintain best practice models to assist 
     State, local, and Tribal governments in addressing witness 
     safety, relocation, financial and housing assistance, or any 
     other services related to witness protection or assistance in 
     cases of illegal drug distribution and related activities. 
     The Director shall ensure dissemination of the best practice 
     models to each HIDTA.''.

     SEC. 8206. REAUTHORIZATION OF DRUG COURT PROGRAM.

       Section 1001(a)(25)(A) of title I of the Omnibus Crime 
     Control and Safe Streets Act of 1968 (34 U.S.C. 
     10261(a)(25)(A)) is amended by striking ``Except as 
     provided'' and all that follows and inserting the following: 
     ``Except as provided in subparagraph (C), there is authorized 
     to be appropriated to carry out part EE $75,000,000 for each 
     of fiscal years 2018 through 2023.''.

     SEC. 8207. DRUG COURT TRAINING AND TECHNICAL ASSISTANCE.

       Section 705 of the Office of National Drug Control Policy 
     Reauthorization Act of 1998 (21 U.S.C. 1704) is amended by 
     adding at the end the following:
       ``(e) Drug Court Training and Technical Assistance 
     Program.--
       ``(1) Grants authorized.--The Director may make a grant to 
     a nonprofit organization for the purpose of providing 
     training and technical assistance to drug courts.
       ``(2) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection $2,000,000 
     for each of fiscal years 2018 through 2023.''.

     SEC. 8208. DRUG OVERDOSE RESPONSE STRATEGY.

       Section 707 of the Office of National Drug Control Policy 
     Reauthorization Act of 1998 (21 U.S.C. 1706) is amended by 
     adding at the end the following:
       ``(r) Drug Overdose Response Strategy Implementation.--The 
     Director may use

[[Page H9235]]

     funds appropriated to carry out this section to implement a 
     drug overdose response strategy in high intensity drug 
     trafficking areas on a nationwide basis by--
       ``(1) coordinating multi-disciplinary efforts to prevent, 
     reduce, and respond to drug overdoses, including the uniform 
     reporting of fatal and non-fatal overdoses to public health 
     and safety officials;
       ``(2) increasing data sharing among public safety and 
     public health officials concerning drug-related abuse trends, 
     including new psychoactive substances, and related crime; and
       ``(3) enabling collaborative deployment of prevention, 
     intervention, and enforcement resources to address substance 
     use addiction and narcotics trafficking.''.

     SEC. 8209. PROTECTING LAW ENFORCEMENT OFFICERS FROM 
                   ACCIDENTAL EXPOSURE.

       Section 707 of the Office of National Drug Control Policy 
     Reauthorization Act of 1998 (21 U.S.C. 1706), as amended by 
     section 8208, is amended by adding at the end the following:
       ``(s) Supplemental Grants.--The Director is authorized to 
     use not more than $10,000,000 of the amounts otherwise 
     appropriated to carry out this section to provide 
     supplemental competitive grants to high intensity drug 
     trafficking areas that have experienced high seizures of 
     fentanyl and new psychoactive substances for the purposes 
     of--
       ``(1) purchasing portable equipment to test for fentanyl 
     and other substances;
       ``(2) training law enforcement officers and other first 
     responders on best practices for handling fentanyl and other 
     substances; and
       ``(3) purchasing protective equipment, including overdose 
     reversal drugs.''.

     SEC. 8210. COPS ANTI-METH PROGRAM.

       Section 1701 of title I of the Omnibus Crime Control and 
     Safe Streets Act of 1968 (34 U.S.C. 10381) is amended--
       (1) by redesignating subsection (k) as subsection (l); and
       (2) by inserting after subsection (j) the following:
       ``(k) COPS Anti-Meth Program.--The Attorney General shall 
     use amounts otherwise appropriated to carry out this section 
     for a fiscal year (beginning with fiscal year 2019) to make 
     competitive grants, in amounts of not less than $1,000,000 
     for such fiscal year, to State law enforcement agencies with 
     high seizures of precursor chemicals, finished 
     methamphetamine, laboratories, and laboratory dump seizures 
     for the purpose of locating or investigating illicit 
     activities, such as precursor diversion, laboratories, or 
     methamphetamine traffickers.''.

     SEC. 8211. COPS ANTI-HEROIN TASK FORCE PROGRAM.

       Section 1701 of title I of the Omnibus Crime Control and 
     Safe Streets Act of 1968 (34 U.S.C. 10381) is amended--
       (1) by redesignating subsection (l), as so redesignated by 
     section 8210, as subsection (m); and
       (2) by inserting after subsection (k), as added by section 
     8210, the following:
       ``(l) Cops Anti-heroin Task Force Program.--The Attorney 
     General shall use amounts otherwise appropriated to carry out 
     this section, or other amounts as appropriated, for a fiscal 
     year (beginning with fiscal year 2019) to make competitive 
     grants to State law enforcement agencies in States with high 
     per capita rates of primary treatment admissions, for the 
     purpose of locating or investigating illicit activities, 
     through Statewide collaboration, relating to the distribution 
     of heroin, fentanyl, or carfentanil or relating to the 
     unlawful distribution of prescription opioids.''.

     SEC. 8212. COMPREHENSIVE ADDICTION AND RECOVERY ACT EDUCATION 
                   AND AWARENESS.

       Title VII of the Comprehensive Addiction and Recovery Act 
     of 2016 (Public Law 114-198; 130 Stat. 735) is amended by 
     adding at the end the following:

     ``SEC. 709. SERVICES FOR FAMILIES AND PATIENTS IN CRISIS.

       ``(a) In General.--The Secretary of Health and Human 
     Services may make grants to entities that focus on addiction 
     and substance use disorders and specialize in family and 
     patient services, advocacy for patients and families, and 
     educational information.
       ``(b) Allowable Uses.--A grant awarded under this section 
     may be used for nonprofit national, State, or local 
     organizations that engage in the following activities:
       ``(1) Expansion of resource center services with 
     professional, clinical staff that provide, for families and 
     individuals impacted by a substance use disorder, support, 
     access to treatment resources, brief assessments, medication 
     and overdose prevention education, compassionate listening 
     services, recovery support or peer specialists, bereavement 
     and grief support, and case management.
       ``(2) Continued development of health information 
     technology systems that leverage new and upcoming technology 
     and techniques for prevention, intervention, and filling 
     resource gaps in communities that are underserved.
       ``(3) Enhancement and operation of treatment and recovery 
     resources, easy-to-read scientific and evidence-based 
     education on addiction and substance use disorders, and other 
     informational tools for families and individuals impacted by 
     a substance use disorder and community stakeholders, such as 
     law enforcement agencies.
       ``(4) Provision of training and technical assistance to 
     State and local governments, law enforcement agencies, health 
     care systems, research institutions, and other stakeholders.
       ``(5) Expanding upon and implementing educational 
     information using evidence-based information on substance use 
     disorders.
       ``(6) Expansion of training of community stakeholders, law 
     enforcement officers, and families across a broad-range of 
     addiction, health, and related topics on substance use 
     disorders, local issues and community-specific issues related 
     to the drug epidemic.
       ``(7) Program evaluation.''.

     SEC. 8213. REIMBURSEMENT OF SUBSTANCE USE DISORDER TREATMENT 
                   PROFESSIONALS.

       Not later than January 1, 2020, the Comptroller General of 
     the United States shall submit to Congress a report examining 
     how substance use disorder services are reimbursed.

     SEC. 8214. SOBRIETY TREATMENT AND RECOVERY TEAMS (START).

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

     ``SEC. 550. SOBRIETY TREATMENT AND RECOVERY TEAMS.

       ``(a) In General.--The Secretary may make grants to States, 
     units of local government, or tribal governments to establish 
     or expand Sobriety Treatment And Recovery Team (referred to 
     in this section as `START') or other similar programs to 
     determine the effectiveness of pairing social workers or 
     mentors with families that are struggling with a substance 
     use disorder and child abuse or neglect in order to help 
     provide peer support, intensive treatment, and child welfare 
     services to such families.
       ``(b) Allowable Uses.--A grant awarded under this section 
     may be used for one or more of the following activities:
       ``(1) Training eligible staff, including social workers, 
     social services coordinators, child welfare specialists, 
     substance use disorder treatment professionals, and mentors.
       ``(2) Expanding access to substance use disorder treatment 
     services and drug testing.
       ``(3) Enhancing data sharing with law enforcement agencies, 
     child welfare agencies, substance use disorder treatment 
     providers, judges, and court personnel.
       ``(4) Program evaluation and technical assistance.
       ``(c) Program Requirements.--A State, unit of local 
     government, or tribal government receiving a grant under this 
     section shall--
       ``(1) serve only families for which--
       ``(A) there is an open record with the child welfare 
     agency; and
       ``(B) substance use disorder was a reason for the record or 
     finding described in paragraph (1); and
       ``(2) coordinate any grants awarded under this section with 
     any grant awarded under section 437(f) of the Social Security 
     Act focused on improving outcomes for children affected by 
     substance abuse.
       ``(d) Technical Assistance.--The Secretary may reserve not 
     more than 5 percent of funds provided under this section to 
     provide technical assistance on the establishment or 
     expansion of programs funded under this section from the 
     National Center on Substance Abuse and Child Welfare.''.

     SEC. 8215. PROVIDER EDUCATION.

       Not later than 60 days after the date of enactment of this 
     Act, the Attorney General, in consultation with the Secretary 
     of Health and Human Services, shall complete the plan related 
     to medical registration coordination required by Senate 
     Report 114-239, which accompanied the Veterans Care Financial 
     Protection Act of 2017 (Public Law 115-131; 132 Stat. 334).

     SEC. 8216. DEFINITIONS.

       Section 702 of the Office of National Drug Control Policy 
     Reauthorization Act of 1998 (21 U.S.C. 1701) is amended--
       (1) by striking paragraphs (5), (12), and (13);
       (2) by redesignating paragraph (11) as paragraph (17);
       (3) by redesignating paragraphs (9) and (10) as paragraphs 
     (14) and (15), respectively;
       (4) by redesignating paragraphs (6), (7), and (8) as 
     paragraphs (10), (11), and (12), respectively;
       (5) by redesignating paragraphs (1), (2), (3), and (4) as 
     paragraphs (3), (4), (5), and (6), respectively;
       (6) by inserting before paragraph (3), as so redesignated, 
     the following:
       ``(1) Agency.--The term `agency' has the meaning given the 
     term `executive agency' in section 102 of title 31, United 
     States Code.
       ``(2) Appropriate congressional committees.--
       ``(A) In general.--The term `appropriate congressional 
     committees' means--
       ``(i) the Committee on the Judiciary, the Committee on 
     Appropriations, and the Committee on Health, Education, 
     Labor, and Pensions of the Senate; and
       ``(ii) the Committee on Oversight and Government Reform, 
     the Committee on the Judiciary, the Committee on Energy and 
     Commerce, and the Committee on Appropriations of the House of 
     Representatives.
       ``(B) Submission to congress.--Any submission to Congress 
     shall mean submission to the appropriate congressional 
     committees.'';
       (7) by amending paragraph (3), as so redesignated, to read 
     as follows:
       ``(3) Demand reduction.--The term `demand reduction' means 
     any activity conducted by a National Drug Control Program 
     Agency, other than an enforcement activity,

[[Page H9236]]

     that is intended to reduce or prevent the use of drugs or 
     support, expand, or provide treatment and recovery efforts, 
     including--
       ``(A) education about the dangers of illicit drug use;
       ``(B) services, programs, or strategies to prevent 
     substance use disorder, including evidence-based education 
     campaigns, community-based prevention programs, collection 
     and disposal of unused prescription drugs, and services to 
     at-risk populations to prevent or delay initial use of an 
     illicit drug;
       ``(C) substance use disorder treatment;
       ``(D) support for long-term recovery from substance use 
     disorders;
       ``(E) drug-free workplace programs;
       ``(F) drug testing, including the testing of employees;
       ``(G) interventions for illicit drug use and dependence;
       ``(H) expanding availability of access to health care 
     services for the treatment of substance use disorders;
       ``(I) international drug control coordination and 
     cooperation with respect to activities described in this 
     paragraph;
       ``(J) pre- and post-arrest criminal justice interventions 
     such as diversion programs, drug courts, and the provision of 
     evidence-based treatment to individuals with substance use 
     disorders who are arrested or under some form of criminal 
     justice supervision, including medication assisted treatment;
       ``(K) other coordinated and joint initiatives among 
     Federal, State, local, and Tribal agencies to promote 
     comprehensive drug control strategies designed to reduce the 
     demand for, and the availability of, illegal drugs;
       ``(L) international illicit drug use education, prevention, 
     treatment, recovery, research, rehabilitation activities, and 
     interventions for illicit drug use and dependence; and
       ``(M) research related to illicit drug use and any of the 
     activities described in this paragraph.'';
       (8) by inserting after paragraph (6), as so redesignated, 
     the following:
       ``(7) Emerging drug threat.--The term `emerging drug 
     threat' means the occurrence of a new and growing trend in 
     the use of an illicit drug or class of drugs, including rapid 
     expansion in the supply of or demand for such drug.
       ``(8) Illicit drug use; illicit drugs; illegal drugs.--The 
     terms `illicit drug use', `illicit drugs', and `illegal 
     drugs' include the illegal or illicit use of prescription 
     drugs.
       ``(9) Law enforcement.--The term `law enforcement' or `drug 
     law enforcement' means all efforts by a Federal, State, 
     local, or Tribal government agency to enforce the drug laws 
     of the United States or any State, including investigation, 
     arrest, prosecution, and incarceration or other punishments 
     or penalties.'';
       (9) by amending paragraph (11), as so redesignated, to read 
     as follows:
       ``(11) National drug control program agency.--The term 
     `National Drug Control Program Agency' means any agency (or 
     bureau, office, independent agency, board, division, 
     commission, subdivision, unit, or other component thereof) 
     that is responsible for implementing any aspect of the 
     National Drug Control Strategy, including any agency that 
     receives Federal funds to implement any aspect of the 
     National Drug Control Strategy, but does not include any 
     agency that receives funds for drug control activity solely 
     under the National Intelligence Program or the Joint Military 
     Intelligence Program.'';
       (10) in paragraph (12), as so redesignated--
       (A) by inserting ``or `Strategy' '' before ``means''; and
       (B) by inserting ``, including any report, plan, or 
     strategy required to be incorporated into or issued 
     concurrently with such strategy'' before the period at the 
     end;
       (11) by inserting after paragraph (12), as so redesignated, 
     the following:
       ``(13) Nonprofit organization.--The term `nonprofit 
     organization' means an organization that is described in 
     section 501(c)(3) of the Internal Revenue Code of 1986 and 
     exempt from tax under section 501(a) of such Code.'';
       (12) in paragraph (14), as so redesignated, by striking 
     ``Unless the context clearly indicates otherwise, the'' and 
     inserting ``The'';
       (13) by inserting after paragraph (15), as so redesignated, 
     the following:
       ``(16) Substance use disorder treatment.--The term 
     `substance use disorder treatment' means an evidence-based, 
     professionally directed, deliberate, and planned regimen 
     including evaluation, observation, medical monitoring, and 
     rehabilitative services and interventions such as 
     pharmacotherapy, behavioral therapy, and individual and group 
     counseling, on an inpatient or outpatient basis, to help 
     patients with substance use disorder reach recovery.''; and
       (14) in paragraph (17), as so redesignated--
       (A) by redesignating subparagraphs (B), (C), (D), and (E), 
     as subparagraphs (C), (D), (E), and (F), respectively;
       (B) by inserting after subparagraph (A) the following:
       ``(B) domestic law enforcement;'';
       (C) in subparagraph (E), as so redesignated, by striking 
     ``and'' at the end;
       (D) in subparagraph (F), as so redesignated, by striking 
     the period at the end and inserting a semicolon; and
       (E) by adding at the end the following:
       ``(G) activities to prevent the diversion of drugs for 
     their illicit use; and
       ``(H) research related to any of the activities described 
     in this paragraph.''.

     SEC. 8217. AMENDMENTS TO ADMINISTRATION OF THE OFFICE.

       (a) Responsibilities of Office.--Section 703(a) of the 
     Office of National Drug Control Policy Reauthorization Act of 
     1998 (21 U.S.C. 1702(a)) is amended--
       (1) by striking paragraph (1) and inserting the following:
       ``(1) lead the national drug control effort, including 
     coordinating with the National Drug Control Program 
     Agencies;'';
       (2) in paragraph (2), by inserting before the semicolon the 
     following: ``, including the National Drug Control 
     Strategy'';
       (3) in paragraph (3), by striking ``and'' at the end; and
       (4) by striking paragraph (4) and all that follows through 
     ``the National Academy of Sciences.'' and inserting the 
     following:
       ``(4) evaluate the effectiveness of national drug control 
     policy efforts, including the National Drug Control Program 
     Agencies' program, by developing and applying specific goals 
     and performance measurements and monitoring the agencies' 
     program-level spending;
       ``(5) identify and respond to emerging drug threats related 
     to illicit drug use;
       ``(6) administer the Drug-Free Communities Program, the 
     High-Intensity Drug Trafficking Areas Program, and other 
     grant programs directly authorized to be administered by the 
     Office in furtherance of the National Drug Control Strategy; 
     and
       ``(7) facilitate broad-scale information sharing and data 
     standardization among Federal, State, and local entities to 
     support the national drug control efforts.''.
       (b) Ethics Guidelines.--Section 703(d) of the Office of 
     National Drug Control Policy Reauthorization Act of 1998 (21 
     U.S.C. 1702(d)) is amended by adding at the end the 
     following:
       ``(4) Ethics guidelines.--The Director shall establish 
     written guidelines setting forth the criteria to be used in 
     determining whether a gift or donation should be declined 
     under this subsection because the acceptance of the gift or 
     donation would--
       ``(A) reflect unfavorably upon the ability of the Director 
     or the Office, or any employee of the Office, to carry out 
     responsibilities or official duties under this chapter in a 
     fair and objective manner; or
       ``(B) compromise the integrity or the appearance of 
     integrity of programs or services provided under this chapter 
     or of any official involved in those programs or services.
       ``(5) Registry of gifts.--The Director shall maintain a 
     list of--
       ``(A) the source and amount of each gift or donation 
     accepted by the Office; and
       ``(B) the source and amount of each gift or donation 
     accepted by a contractor to be used in its performance of a 
     contract for the Office.
       ``(6) Report to congress.--The Director shall include in 
     the annual assessment under section 706(g) a copy of the 
     registry maintained under paragraph (5).''.
       (c) Appointment of Director and Deputy Director.--Section 
     704(a) of the Office of National Drug Control Policy 
     Reauthorization Act of 1998 (21 U.S.C. 1703(a)) is amended--
       (1) in paragraph (1), by striking subparagraphs (A), (B), 
     and (C), and inserting the following:
       ``(A) Director.--
       ``(i) In general.--There shall be at the head of the Office 
     a Director who shall hold the same rank and status as the 
     head of an executive department listed in section 101 of 
     title 5, United States Code.
       ``(ii) Appointment.--The Director shall be appointed by the 
     President, by and with the advice and consent of the Senate, 
     and shall serve at the pleasure of the President.
       ``(B) Deputy director.--There shall be a Deputy Director 
     who shall report directly to the Director, and who shall be 
     appointed by the President, and shall serve at the pleasure 
     of the President.
       ``(C) Coordinators.--The following coordinators shall be 
     appointed by the Director:
       ``(i) Performance Budget Coordinator, as described in 
     section 704(c)(4).
       ``(ii) Interdiction Coordinator, as described in section 
     711.
       ``(iii) Emerging and Continuing Threats Coordinator, as 
     described in section 709.
       ``(iv) State, Local, and Tribal Affairs Coordinator, to 
     carry out the activities described in section 704(j).
       ``(v) Demand Reduction Coordinator, as described in 
     subparagraph (D).
       ``(D) Demand reduction coordinator.--The Director shall 
     designate or appoint a United States Demand Reduction 
     Coordinator to be responsible for the activities described in 
     section 702(3). The Director shall determine whether the 
     coordinator position is a noncareer appointee in the Senior 
     Executive Service or a career appointee in a position at 
     level 15 of the General Schedule (or equivalent).'';
       (2) in paragraph (5), by striking ``such official'' and 
     inserting ``such officer or employee''; and
       (3) by adding at the end the following:
       ``(6) Prohibition on the use of funds for ballot 
     initiatives.--No funds authorized under this title may be 
     obligated for the purpose of expressly advocating the passage 
     or defeat of a State or local ballot initiative.''.
       (d) Consultation.--Section 704(b) of the Office of National 
     Drug Control Policy Reauthorization Act of 1998 (21 U.S.C. 
     1703(b)) is amended--

[[Page H9237]]

       (1) in paragraph (19), by striking ``; and'' and inserting 
     a semicolon;
       (2) in paragraph (20), by striking the period at the end 
     and inserting ``; and''; and
       (3) by adding at the end the following:
       ``(21) in order to formulate the national drug control 
     policies, goals, objectives, and priorities--
       ``(A) shall consult with and assist--
       ``(i) State and local governments;
       ``(ii) National Drug Control Program Agencies;
       ``(iii) each committee, working group, council, or other 
     entity established under this chapter, as appropriate;
       ``(iv) the public;
       ``(v) appropriate congressional committees; and
       ``(vi) any other person in the discretion of the Director; 
     and
       ``(B) may--
       ``(i) establish advisory councils;
       ``(ii) acquire data from agencies; and
       ``(iii) request data from any other entity.''.
       (e) National Drug Control Program Budget.--Section 704(c) 
     of the Office of National Drug Control Policy Reauthorization 
     Act of 1998 (21 U.S.C. 1703(c)) is amended--
       (1) in paragraph (2)--
       (A) in subparagraph (A), by striking ``paragraph (1)(C);'' 
     and inserting the following: ``paragraph (1)(C) and include--
       ``(i) the funding level for each National Drug Control 
     Program agency; and
       ``(ii) alternative funding structures that could improve 
     progress on achieving the goals fo the National Drug Control 
     Strategy; and'';
       (B) in subparagraph (B), strike ``the President; and'' and 
     inserting ``the President and Congress.''; and
       (C) by striking subparagraph (C);
       (2) in paragraph (3)(E), by striking clause (ii) and 
     inserting the following:
       ``(ii) Certification.--The Director shall--

       ``(I) review each budget submission submitted under 
     subparagraph (A);
       ``(II) based on the review under clause (i), make a 
     determination as to whether the budget submission of a 
     National Drug Control Program agency includes the funding 
     levels and initiatives described in subparagraph (B); and
       ``(III) submit to the appropriate congressional 
     committees--

       ``(aa) a written statement that either--
       ``(AA) certifies that the budget submission includes 
     sufficient funding; or
       ``(BB) decertifies the budget submission as not including 
     sufficient funding;
       ``(bb) a copy of the description made under subparagraph 
     (B); and
       ``(cc) the budget recommendations made under subsection 
     (b)(8).''; and
       (3) by adding at the end the following:
       ``(5) Performance-budget coordinator.--
       ``(A) Designation.--The Director shall designate or appoint 
     a United States Performance-Budget Coordinator to--
       ``(i) ensure the Director has sufficient information 
     necessary to analyze the performance of each National Drug 
     Control Program Agency, the impact Federal funding has had on 
     the goals in the Strategy, and the likely contributions to 
     the goals of the Strategy based on funding levels of each 
     National Drug Control Program Agency, to make an independent 
     assessment of the budget request of each agency under this 
     subsection;
       ``(ii) advise the Director on agency budgets, performance 
     measures and targets, and additional data and research needed 
     to make informed policy decisions under this section and 
     section 706; and
       ``(iii) other duties as may be determined by the Director 
     with respect to measuring or assessing performance or agency 
     budgets.
       ``(B) Determination of position.--The Director shall 
     determine whether the coordinator position is a noncareer 
     appointee in the Senior Executive Service or a career 
     appointee in a position at level 15 of the General Schedule 
     (or equivalent).
       ``(6) Budget estimate or request submission to congress.--
     Whenever the Director submits any budget estimate or request 
     to the President or the Office of Management and Budget, the 
     Director shall concurrently transmit to the appropriate 
     congressional committees a detailed statement of the 
     budgetary needs of the Office to execute its mission based on 
     the good-faith assessment of the Director.''.
       (f) Powers and Responsibilities of the Director.--Section 
     704 of the Office of National Drug Control Policy 
     Reauthorization Act of 1998 (21 U.S.C. 1703) is amended--
       (1) in subsection (d)(8)--
       (A) in subparagraph (D), by striking ``and'' at the end;
       (B) in subparagraph (E)--
       (i) in clause (i)--

       (I) by striking ``Congress, including to the Committees on 
     Appropriations of the Senate and the House of 
     Representatives, the authorizing committees for the Office,'' 
     and inserting ``the appropriate congressional committees''; 
     and
       (II) by striking ``or agencies'';

       (ii) in clause (ii)--

       (I) by striking ``Congress'' and inserting ``the 
     appropriate congressional committees''; and
       (II) by adding ``and'' at the end; and

       (iii) by adding at the end the following:
       ``(iii) funds may only be used for--

       ``(I) expansion of demand reduction activities;
       ``(II) interdiction of illicit drugs on the high seas, in 
     United States territorial waters, and at United States ports 
     of entry by officers and employees of National Drug Control 
     Program Agencies and domestic and foreign law enforcement 
     officers;
       ``(III) accurate assessment and monitoring of international 
     drug production and interdiction programs and policies;
       ``(IV) activities to facilitate and enhance the sharing of 
     domestic and foreign intelligence information among National 
     Drug Control Program Agencies related to the production and 
     trafficking of drugs in the United States and foreign 
     countries; and
       ``(V) research related to any of these activities.'';

       (2) in subsection (e)(2)(A), by striking ``Notwithstanding 
     any other provision of law'' and inserting ``Subject to the 
     availability of appropriations''; and
       (3) by adding at the end the following:
       ``(i) Model Acts Program.--
       ``(1) In general.--The Director shall provide for or shall 
     enter into an agreement with a nonprofit organization to--
       ``(A) advise States on establishing laws and policies to 
     address illicit drug use issues; and
       ``(B) revise such model State drug laws and draft 
     supplementary model State laws to take into consideration 
     changes in illicit drug use issues in the State involved.
       ``(2) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection $1,250,000 
     for each of fiscal years 2018 through 2023.
       ``(j) State, Local, and Tribal Affairs Coordinator.--The 
     Director shall designate or appoint a United States State, 
     Local, and Tribal Affairs Coordinator to perform the duties 
     of the Office outlined in this section and 706 and such other 
     duties as may be determined by the Director with respect to 
     coordination of drug control efforts between agencies and 
     State, local, and Tribal governments. The Director shall 
     determine whether the coordinator position is a noncareer 
     appointee in the Senior Executive Service or a career 
     appointee in a position at level 15 of the General Schedule 
     (or equivalent).
       ``(k) Harm Reduction Programs .--When developing the 
     national drug control policy, any policy of the Director, 
     including policies relating to syringe exchange programs for 
     intravenous drug users, shall be based on the best available 
     medical and scientific evidence regarding the effectiveness 
     of such policy in promoting individual health and preventing 
     the spread of infectious disease and the impact of such 
     policy on drug addiction and use. In making any policy 
     relating to harm reduction programs, the Director shall 
     consult with the National Institutes of Health and the 
     National Academy of Sciences.''.
       (g) Accounting of Funds Expended.--Section 705 of the 
     Office of National Drug Control Policy Reauthorization Act of 
     1998 (21 U.S.C. 1704(d)), as amended by section 8207 is 
     further amended--
       (1) by amending subsection (d) to read as follows:
       ``(d) Accounting of Funds Expended.--
       ``(1) In general.--Not later than February 1 of each year, 
     in accordance with guidance issued by the Director, the head 
     of each National Drug Control Program Agency shall submit to 
     the Director a detailed accounting of all funds expended by 
     the agency for National Drug Control Program activities 
     during the previous fiscal year and shall ensure such 
     detailed accounting is authenticated for the previous fiscal 
     year by the Inspector General for such agency prior to the 
     submission to the Director as frequently as determined by the 
     Inspector General but not less frequently that every 3 years.
       ``(2) Submission to congress.--The Director shall submit to 
     Congress not later than April 1 of each year the information 
     submitted to the Director under paragraph (1).''; and
       (2) by adding at the end the following:
       ``(f) Tracking System for Federally Funded Grant 
     Programs.--
       ``(1) Establishment.--The Director, or the head of an 
     agency designated by the Director, in coordination with the 
     Secretary of Health and Human Services, shall track 
     federally-funded grant programs to--
       ``(A) ensure the public has electronic access to 
     information identifying:
       ``(i) all drug control grants and pertinent identifying 
     information for each grant;
       ``(ii) any available performance metrics, evaluations, or 
     other information indicating the effectiveness of such 
     programs;
       ``(B) facilitate efforts to identify duplication, overlap, 
     or gaps in funding to provide increased accountability of 
     Federally-funded grants for substance use disorder treatment, 
     prevention, and enforcement; and
       ``(C) identify barriers in the grant application process 
     impediments that applicants currently have in the grant 
     application process with applicable agencies.
       ``(2) National drug control agencies.--The head of each 
     National Drug Control Program Agency shall provide to the 
     Director a complete list of all drug control program grant 
     programs and any other relevant information for inclusion in 
     the system developed under paragraph (1) and annually update 
     such list.
       ``(3) Updating existing systems.--The Director may meet the 
     requirements of this subsection by utilizing, updating, or 
     improving existing Federal information systems to ensure they 
     meet the requirements of this subsection.
       ``(4) Report.--Not later than 3 years after the date of 
     enactment of this subsection, the Comptroller General of the 
     United States shall submit to Congress a report examining 
     implementation of this subsection.''.

[[Page H9238]]

       (h) Technical and Conforming Amendment.--Section 1105 of 
     the Office of National Drug Control Policy Reauthorization 
     Act of 2006 (21 U.S.C. 1701 note) is repealed.

     SEC. 8218. EMERGING THREATS COMMITTEE, PLAN, AND MEDIA 
                   CAMPAIGN.

       (a) In General.--Section 709 of the Office of National Drug 
     Control Policy Reauthorization Act of 1998 (21 U.S.C. 1708) 
     is amended to read as follows:

     ``SEC. 709. EMERGING THREATS COMMITTEE, PLAN, AND MEDIA 
                   CAMPAIGN.

       ``(a) Emerging Threats Coordinator.--The Director shall 
     designate or appoint a United States Emerging and Continuing 
     Threats Coordinator to perform the duties of that position 
     described in this section and such other duties as may be 
     determined by the Director. The Director shall determine 
     whether the coordinator position is a noncareer appointee in 
     the Senior Executive Service or a career appointee in a 
     position at level 15 of the General Schedule (or equivalent).
       ``(b) Emerging Threats Committee.--
       ``(1) In general.--The Emerging Threats Committee shall--
       ``(A) monitor evolving and emerging drug threats in the 
     United States;
       ``(B) identify and discuss evolving and emerging drug 
     trends in the United States using the criteria required to be 
     established under paragraph (6);
       ``(C) assist in the formulation of and oversee 
     implementation of any plan described in subsection (d);
       ``(D) provide such other advice to the Coordinator and 
     Director concerning strategy and policies for emerging drug 
     threats and trends as the Committee determines to be 
     appropriate; and
       ``(E) disseminate and facilitate the sharing with Federal, 
     State, local, and Tribal officials and other entities as 
     determined by the Director of pertinent information and data 
     relating to--
       ``(i) recent trends in drug supply and demand;
       ``(ii) fatal and nonfatal overdoses;
       ``(iii) demand for and availability of evidence-based 
     substance use disorder treatment, including the extent of the 
     unmet treatment need, and treatment admission trends;
       ``(iv) recent trends in drug interdiction, supply, and 
     demand from State, local, and Tribal law enforcement 
     agencies; and
       ``(v) other subject matter as determined necessary by the 
     Director.
       ``(2) Chairperson.--The Director shall designate one of the 
     members of the Emerging Threats Committee to serve as 
     Chairperson.
       ``(3) Members.--The Director shall appoint other members of 
     the Committee, which shall include--
       ``(A) representatives from National Drug Control Program 
     Agencies or other agencies;
       ``(B) representatives from State, local, and Tribal 
     governments; and
       ``(C) representatives from other entities as designated by 
     the Director.
       ``(4) Meetings.--The members of the Emerging Threats 
     Committee shall meet, in person and not through any delegate 
     or representative, not less frequently than once per calendar 
     year, before June 1. At the call of the Director or the 
     Chairperson, the Emerging Threats Committee may hold 
     additional meetings as the members may choose.
       ``(5) Contract, agreement, and other authority.--The 
     Director may award contracts, enter into interagency 
     agreements, manage individual projects, and conduct other 
     activities in support of the identification of emerging drug 
     threats and in support of the development, implementation, 
     and assessment of any Emerging Threat Response Plan.
       ``(6) Criteria to identify emerging drug threats.--Not 
     later than 180 days after the date on which the Committee 
     first meets, the Committee shall develop and recommend to the 
     Director criteria to be used to identify an emerging drug 
     threat or the termination of an emerging drug threat 
     designation based on information gathered by the Committee, 
     statistical data, and other evidence.
       ``(c) Designation.--
       ``(1) In general.--The Director, in consultation with the 
     Coordinator, the Committee, and the head of each National 
     Drug Control Program Agency, may designate an emerging drug 
     threat in the United States.
       ``(2) Standards for designation.--The Director, in 
     consultation with the Coordinator, shall promulgate and make 
     publicly available standards by which a designation under 
     paragraph (1) and the termination of such designation may be 
     made. In developing such standards, the Director shall 
     consider the recommendations of the committee and other 
     criteria the Director considers to be appropriate.
       ``(3) Public statement required.--The Director shall 
     publish a public written statement on the portal of the 
     Office explaining the designation of an emerging drug threat 
     or the termination of such designation and shall notify the 
     appropriate congressional committees of the availability of 
     such statement when a designation or termination of such 
     designation has been made.
       ``(d) Plan.--
       ``(1) Public availability of plan.--Not later than 90 days 
     after making a designation under subsection (c), the Director 
     shall publish and make publicly available an Emerging Threat 
     Response Plan and notify the President and the appropriate 
     congressional committees of such plan's availability.
       ``(2) Timing.--Concurrently with the annual submissions 
     under section 706(g), the Director shall update the plan and 
     report on implementation of the plan, until the Director 
     issues the public statement required under subsection (c)(3) 
     to terminate the emerging drug threat designation.
       ``(3) Contents of an emerging threat response plan.--The 
     Director shall include in the plan required under this 
     subsection--
       ``(A) a comprehensive strategic assessment of the emerging 
     drug threat, including the current availability of, demand 
     for, and effectiveness of evidence-based prevention, 
     treatment, and enforcement programs and efforts to respond to 
     the emerging drug threat;
       ``(B) comprehensive, research-based, short- and long-term, 
     quantifiable goals for addressing the emerging drug threat, 
     including for reducing the supply of the drug designated as 
     the emerging drug threat and for expanding the availability 
     and effectiveness of evidence-based substance use disorder 
     treatment and prevention programs to reduce the demand for 
     the emerging drug threat;
       ``(C) performance measures pertaining to the plan's goals, 
     including quantifiable and measurable objectives and specific 
     targets;
       ``(D) the level of funding needed to implement the plan, 
     including whether funding is available to be reprogrammed or 
     transferred to support implementation of the plan or whether 
     additional appropriations are necessary to implement the 
     plan;
       ``(E) an implementation strategy for the media campaign 
     under subsection (f), including goals as described under 
     subparagraph (B) of this paragraph and performance measures, 
     objectives, and targets, as described under subparagraph (C) 
     of this paragraph; and
       ``(F) any other information necessary to inform the public 
     of the status, progress, or response of an emerging drug 
     threat.
       ``(4) Implementation.--
       ``(A) In general.--Not later than 120 days after the date 
     on which a designation is made under subsection (c), the 
     Director, in consultation with the President, the appropriate 
     congressional committees, and the head of each National Drug 
     Control Program Agency, shall issue guidance on 
     implementation of the plan described in this subsection to 
     the National Drug Control Program Agencies and any other 
     relevant agency determined to be necessary by the Director.
       ``(B) Coordinator's responsibilities.--The Coordinator 
     shall--
       ``(i) direct the implementation of the plan among the 
     agencies identified in the plan, State, local, and Tribal 
     governments, and other relevant entities;
       ``(ii) facilitate information-sharing between agencies 
     identified in the plan, State, local, and Tribal governments, 
     and other relevant entities; and
       ``(iii) monitor implementation of the plan by coordinating 
     the development and implementation of collection and 
     reporting systems to support performance measurement and 
     adherence to the plan by agencies identified in plan, where 
     appropriate.
       ``(C) Reporting.--Not later than 180 days after the date on 
     which a designation is made under subsection (c) and in 
     accordance with subparagraph (A), the head of each agency 
     identified in the plan shall submit to the Coordinator a 
     report on implementation of the plan.
       ``(e) Evaluation of Media Campaign.--Upon designation of an 
     emerging drug threat, the Director shall evaluate whether a 
     media campaign would be appropriate to address that threat.
       ``(f) National Anti-drug Media Campaign.--
       ``(1) In general.--The Director shall, to the extent 
     feasible and appropriate, conduct a national anti-drug media 
     campaign (referred to in this subtitle as the `national media 
     campaign') in accordance with this subsection for the 
     purposes of--
       ``(A) preventing substance abuse among people in the United 
     States;
       ``(B) educating the public about the dangers and negative 
     consequences of substance use and abuse, including patient 
     and family education about the characteristics and hazards of 
     substance abuse and methods to safeguard against substance 
     use, to include the safe disposal of prescription 
     medications;
       ``(C) supporting evidence-based prevention programs 
     targeting the attitudes, perception, and beliefs of persons 
     concerning substance use and intentions to initiate or 
     continue such use;
       ``(D) encouraging individuals affected by substance use 
     disorders to seek treatment and providing such individuals 
     with information on--
       ``(i) how to recognize addiction issues;
       ``(ii) what forms of evidence-based treatment options are 
     available; and
       ``(iii) how to access such treatment;
       ``(E) combating the stigma of addiction and substance use 
     disorders, including the stigma of treating such disorders 
     with medication-assisted treatment therapies; and
       ``(F) informing the public about the dangers of any drug 
     identified by the Director as an emerging drug threat as 
     appropriate.
       ``(2) Use of funds.--
       ``(A) In general.--Amounts made available to carry out this 
     subsection for the national media campaign may only be used 
     for the following:
       ``(i) The purchase of media time and space, including the 
     strategic planning for, tracking, and accounting of, such 
     purchases.

[[Page H9239]]

       ``(ii) Creative and talent costs, consistent with 
     subparagraph (B)(i).
       ``(iii) Advertising production costs, which may include 
     television, radio, internet, social media, and other 
     commercial marketing venues.
       ``(iv) Testing and evaluation of advertising.
       ``(v) Evaluation of the effectiveness of the national media 
     campaign.
       ``(vi) Costs of contracts to carry out activities 
     authorized by this subsection.
       ``(vii) Partnerships with professional and civic groups, 
     community-based organizations, including faith-based 
     organizations, and government organizations related to the 
     national media campaign.
       ``(viii) Entertainment industry outreach, interactive 
     outreach, media projects and activities, public information, 
     news media outreach, and corporate sponsorship and 
     participation.
       ``(ix) Operational and management expenses.
       ``(B) Specific requirements.--
       ``(i) Creative services.--In using amounts for creative and 
     talent costs under subparagraph (A)(ii), the Director shall 
     use creative services donated at no cost to the Government 
     wherever feasible and may only procure creative services for 
     advertising--

       ``(I) responding to high-priority or emergent campaign 
     needs that cannot timely be obtained at no cost; or
       ``(II) intended to reach a minority, ethnic, or other 
     special audience that cannot reasonably be obtained at no 
     cost.

       ``(ii) Testing and evaluation of advertising.--In using 
     amounts for testing and evaluation of advertising under 
     subparagraph (A)(iv), the Director shall test all 
     advertisements prior to use in the national media campaign to 
     ensure that the advertisements are effective with the target 
     audience and meet industry-accepted standards. The Director 
     may waive this requirement for advertisements using no more 
     than 10 percent of the purchase of advertising time purchased 
     under this subsection in a fiscal year and no more than 10 
     percent of the advertising space purchased under this 
     subsection in a fiscal year, if the advertisements respond to 
     emergent and time-sensitive campaign needs or the 
     advertisements will not be widely utilized in the national 
     media campaign.
       ``(iii) Consultation.--For the planning of the campaign 
     under paragraph (1), the Director may consult with--

       ``(I) the head of any appropriate National Drug Control 
     Program Agency;
       ``(II) experts on the designated drug;
       ``(III) State, local, and Tribal government officials and 
     relevant agencies;
       ``(IV) communications professionals;
       ``(V) the public; and
       ``(VI) appropriate congressional committees.

       ``(iv) Evaluation of effectiveness of national media 
     campaign.--In using amounts for the evaluation of the 
     effectiveness of the national media campaign under 
     subparagraph (A)(v), the Director shall--

       ``(I) designate an independent entity to evaluate by April 
     20 of each year the effectiveness of the national media 
     campaign based on data from--

       ``(aa) the Monitoring the Future Study published by the 
     Department of Health and Human Services;
       ``(bb) the National Survey on Drug Use and Health; and
       ``(cc) other relevant studies or publications, as 
     determined by the Director, including tracking and evaluation 
     data collected according to marketing and advertising 
     industry standards; and

       ``(II) ensure that the effectiveness of the national media 
     campaign is evaluated in a manner that enables consideration 
     of whether the national media campaign has contributed to 
     changes in attitude or behaviors among the target audience 
     with respect to substance use and such other measures of 
     evaluation as the Director determines are appropriate.

       ``(3) Advertising.--In carrying out this subsection, the 
     Director shall ensure that sufficient funds are allocated to 
     meet the stated goals of the national media campaign.
       ``(4) Responsibilities and functions under the program.--
       ``(A) In general.--The Director shall determine the overall 
     purposes and strategy of the national media campaign.
       ``(B) Director.--
       ``(i) In general.--The Director shall approve--

       ``(I) the strategy of the national media campaign;
       ``(II) all advertising and promotional material used in the 
     national media campaign; and
       ``(III) the plan for the purchase of advertising time and 
     space for the national media campaign.

       ``(ii) Implementation.--The Director shall be responsible 
     for implementing a focused national media campaign to meet 
     the purposes set forth in paragraph (1) and shall ensure--

       ``(I) information disseminated through the campaign is 
     accurate and scientifically valid; and
       ``(II) the campaign is designed using strategies 
     demonstrated to be the most effective at achieving the goals 
     and requirements of paragraph (1), which may include--

       ``(aa) a media campaign, as described in paragraph (2);
       ``(bb) local, regional, or population specific messaging;
       ``(cc) the development of websites to publicize and 
     disseminate information;
       ``(dd) conducting outreach and providing educational 
     resources for parents;
       ``(ee) collaborating with law enforcement agencies; and
       ``(ff) providing support for school-based public health 
     education classes to improve teen knowledge about the effects 
     of substance use.
       ``(5) Prohibitions.--None of the amounts made available 
     under paragraph (2) may be obligated or expended for any of 
     the following:
       ``(A) To supplant current anti-drug community-based 
     coalitions.
       ``(B) To supplant pro bono public service time donated by 
     national and local broadcasting networks for other public 
     service campaigns.
       ``(C) For partisan political purposes, or to express 
     advocacy in support of or to defeat any clearly identified 
     candidate, clearly identified ballot initiative, or clearly 
     identified legislative or regulatory proposal.
       ``(D) To fund advertising that features any elected 
     officials, persons seeking elected office, cabinet level 
     officials, or other Federal officials employed pursuant to 
     section 213 of Schedule C of title 5, Code of Federal 
     Regulations.
       ``(E) To fund advertising that does not contain a primary 
     message intended to reduce or prevent substance use.
       ``(F) To fund advertising containing a primary message 
     intended to promote support for the national media campaign 
     or private sector contributions to the national media 
     campaign.
       ``(6) Matching requirement.--
       ``(A) In general.--Amounts made available under paragraph 
     (2) for media time and space shall be matched by an equal 
     amount of non-Federal funds for the national media campaign, 
     or be matched with in-kind contributions of the same value.
       ``(B) No-cost match advertising direct relationship 
     requirement.--The Director shall ensure that not less than 85 
     percent of no-cost match advertising directly relates to 
     substance abuse prevention consistent with the specific 
     purposes of the national media campaign.
       ``(C) No-cost match advertising not directly related.--The 
     Director shall ensure that no-cost match advertising that 
     does not directly relate to substance abuse prevention 
     consistent with the purposes of the national media campaign 
     includes a clear anti-drug message. Such message is not 
     required to be the primary message of the match advertising.
       ``(7) Financial and performance accountability.--The 
     Director shall cause to be performed--
       ``(A) audits and reviews of costs of the national media 
     campaign pursuant to section 4706 of title 41, United States 
     Code; and
       ``(B) an audit to determine whether the costs of the 
     national media campaign are allowable under chapter 43 of 
     title 41, United States Code.
       ``(8) Report to congress.--The Director shall submit on an 
     annual basis a report to Congress that describes--
       ``(A) the strategy of the national media campaign and 
     whether specific objectives of the national media campaign 
     were accomplished;
       ``(B) steps taken to ensure that the national media 
     campaign operates in an effective and efficient manner 
     consistent with the overall strategy and focus of the 
     national media campaign;
       ``(C) plans to purchase advertising time and space;
       ``(D) policies and practices implemented to ensure that 
     Federal funds are used responsibly to purchase advertising 
     time and space and eliminate the potential for waste, fraud, 
     and abuse;
       ``(E) all contracts entered into with a corporation, 
     partnership, or individual working on behalf of the national 
     media campaign;
       ``(F) the results of any financial audit of the national 
     media campaign;
       ``(G) a description of any evidence used to develop the 
     national media campaign;
       ``(H) specific policies and steps implemented to ensure 
     compliance with this section;
       ``(I) a detailed accounting of the amount of funds 
     obligated during the previous fiscal year for carrying out 
     the national media campaign, including each recipient of 
     funds, the purpose of each expenditure, the amount of each 
     expenditure, any available outcome information, and any other 
     information necessary to provide a complete accounting of the 
     funds expended; and
       ``(J) a review and evaluation of the effectiveness of the 
     national media campaign strategy for the past year.
       ``(9) Required notice for communication from the office.--
     Any communication, including an advertisement, paid for or 
     otherwise disseminated by the Office directly or through a 
     contract awarded by the Office shall include a prominent 
     notice informing the audience that the communication was paid 
     for by the Office.
       ``(g) Authorization of Appropriations.--There is authorized 
     to be appropriated to the Office to carry out this section, 
     $25,000,000 for each of fiscal years 2018 through 2023.''.
       (b) Technical and Conforming Amendment.--Subsection (a) of 
     section 203 of the Office of National Drug Control Policy 
     Reauthorization Act of 2006 (21 U.S.C. 1708a) is repealed.

[[Page H9240]]

  


     SEC. 8219. DRUG INTERDICTION.

       (a) Repeal.--This first section 711 of the Office of 
     National Drug Control Policy Reauthorization Act of 1998 (21 
     U.S.C. 1710) is repealed.
       (b) Amendments.--Section 711 of the Office of National Drug 
     Control Policy Reauthorization Act of 1998 (21 U.S.C. 1710), 
     as added by Public Law 109-469 (120 Stat. 3507), is amended--
       (1) in subsection (a)--
       (A) in paragraph (1)--
       (i) by striking ``The United'' and inserting ``The Director 
     shall designate or appoint an appointee in the Senior 
     Executive Service or an appointee in a position at level 15 
     of the General Schedule (or equivalent) as the United''; and
       (ii) by striking ``shall'' and inserting ``to'';
       (B) in paragraph (2)(B)--
       (i) by striking ``March 1'' and inserting ``September 1''; 
     and
       (ii) by striking ``paragraph (3)'' and inserting 
     ``paragraph (4)'';
       (C) in paragraph (3)--
       (i) by striking ``also, at his discretion,''; and
       (ii) by striking ``the Office of Supply Reduction for that 
     purpose'' and inserting ``assist in carrying out such 
     responsibilities''; and
       (D) in paragraph (4)--
       (i) in subparagraph (B), by striking ``The United'' and 
     inserting ``Before submission of the National Drug Control 
     Strategy or annual assessment required under section 706, as 
     applicable, the United'';
       (ii) by striking subparagraphs (C) and (E);
       (iii) by redesignating subparagraph (D) as subparagraph 
     (C);
       (iv) in subparagraph (C), as so redesignated--

       (I) in the matter preceding clause (i)--

       (aa) by striking ``March 1'' and inserting ``September 1'';
       (bb) by inserting ``the Director, acting through'' before 
     ``the United States'';
       (cc) by inserting a comma after ``Coordinator'';
       (dd) by striking ``a report on behalf of the Director''; 
     and
       (ee) by striking ``, which shall include'' and inserting 
     ``a report that'';

       (II) by redesignating clauses (i), (ii), and (iii) as 
     subclauses (I), (II), and (III), and adjusting the margins 
     accordingly;
       (III) by inserting before subclause (I), as so 
     redesignated, the following:

       ``(i) includes--'';

       (IV) in clause (i), as so redesignated--

       (aa) in subclause (I), as so redesignated, by inserting ``, 
     including information about how each National Drug Control 
     Program agency conducting drug interdiction activities is 
     engaging with relevant international partners'' after 
     ``Plan'';
       (bb) in subclause (II), as so redesignated, by striking ``, 
     as well as'' and inserting ``and'';
       (cc) in subclause III, as so redesignated--
       (AA) by striking ``, as well as'' and inserting ``and''; 
     and
       (BB) by striking the period at the end and inserting ``; 
     and''; and

       (V) by adding at the end the following:

       ``(ii) may include recommendations for changes to existing 
     agency authorities or laws governing interagency 
     relationships.''; and
       (v) by adding at the end the following:
       ``(D) Classified annex.--Each report required to be 
     submitted under subparagraph (C) shall be in unclassified 
     form, but may include a classified annex.'';
       (2) in subsection (b)--
       (A) in paragraph (1)(B), by inserting ``and how to 
     strengthen international partnerships to better achieve the 
     goals of that plan'' after ``that plan'';
       (B) in paragraph (2)--
       (i) in the paragraph heading, by striking ``Chairman'' and 
     inserting ``Chairperson''; and
       (ii) by striking ``chairman'' and inserting 
     ``Chairperson'';
       (C) in paragraph (3)--
       (i) by striking ``prior to March 1'' and inserting ``before 
     June 1'';
       (ii) by striking ``either'' each place it appears;
       (iii) by striking ``current chairman'' and inserting 
     ``Chairperson''; and
       (iv) by striking ``they'' and inserting ``the members''; 
     and
       (D) in paragraph (4)--
       (i) by striking ``chairman'' each place it appears and 
     inserting ``Chairperson'';
       (ii) in the first sentence, by striking ``a report'';
       (iii) by inserting ``a report'' after ``committees''; and
       (iv) by striking the second sentence and inserting the 
     following: ``The report required under this paragraph shall 
     be in unclassified form, but may include a classified 
     annex.''; and
       (3) by adding at the end the following:
       ``(c) International Coordination.--The Director may 
     facilitate international drug control coordination 
     efforts.''.

     SEC. 8220. GAO AUDIT.

       Not later than 4 years after the date of enactment of this 
     Act, and every 4 years thereafter, the Comptroller General of 
     the United States shall--
       (1) conduct an audit relating to the programs and 
     operations of--
       (A) the Office; and
       (B) certain programs within the Office, including--
       (i) the High Intensity Drug Trafficking Areas Program;
       (ii) the Drug-Free Communities Program; and
       (iii) the campaign under section 709(f) of the Office of 
     National Drug Control Policy Reauthorization Act of 1998 (21 
     U.S.C. 1708(f)); and
       (2) submit to the Director and the appropriate 
     congressional committees a report containing an evaluation of 
     and recommendations on the--
       (A) policies and activities of the programs and operations 
     subject to the audit;
       (B) economy, efficiency, and effectiveness in the 
     administration of the reviewed programs and operations; and
       (C) policy or management changes needed to prevent and 
     detect fraud and abuse in such programs and operations.

     SEC. 8221. NATIONAL DRUG CONTROL STRATEGY.

       (a) In General.--Section 706 of the Office of National Drug 
     Control Policy Reauthorization Act of 1998 (21 U.S.C. 1705) 
     is amended to read as follows:

     ``SEC. 706. NATIONAL DRUG CONTROL STRATEGY.

       ``(a) In General.--
       ``(1) Statement of drug policy priorities.--The Director 
     shall release a statement of drug control policy priorities 
     in the calendar year of a Presidential inauguration following 
     the inauguration, but not later than April 1.
       ``(2) National drug control strategy submitted by the 
     president.--Not later than the first Monday in February 
     following the year in which the term of the President 
     commences, and every 2 years thereafter, the President shall 
     submit to Congress a National Drug Control Strategy.
       ``(b) Development of the National Drug Control Strategy.--
       ``(1) Promulgation.--The Director shall promulgate the 
     National Drug Control Strategy, which shall set forth a 
     comprehensive plan to reduce illicit drug use and the 
     consequences of such illicit drug use in the United States by 
     limiting the availability of and reducing the demand for 
     illegal drugs and promoting prevention, early intervention, 
     treatment, and recovery support for individuals with 
     substance use disorders.
       ``(2) State and local commitment.--The Director shall seek 
     the support and commitment of State, local, and Tribal 
     officials in the formulation and implementation of the 
     National Drug Control Strategy.
       ``(3) Strategy based on evidence.--The Director shall 
     ensure the National Drug Control Strategy is based on the 
     best available evidence regarding the policies that are most 
     effective in reducing the demand for and supply of illegal 
     drugs.
       ``(4) Process for development and submission of national 
     drug control strategy.--In developing and effectively 
     implementing the National Drug Control Strategy, the 
     Director--
       ``(A) shall consult with--
       ``(i) the heads of the National Drug Control Program 
     Agencies;
       ``(ii) each Coordinator listed in section 704;
       ``(iii) the Interdiction Committee and the Emerging Threats 
     Committee;
       ``(iv) the appropriate congressional committees and any 
     other committee of jurisdiction;
       ``(v) State, local, and Tribal officials;
       ``(vi) private citizens and organizations, including 
     community and faith-based organizations, with experience and 
     expertise in demand reduction;
       ``(vii) private citizens and organizations with experience 
     and expertise in supply reduction; and
       ``(viii) appropriate representatives of foreign 
     governments; and
       ``(B) in satisfying the requirements of subparagraph (A), 
     shall ensure, to the maximum extent possible, that State, 
     local, and Tribal officials and relevant private 
     organizations commit to support and take steps to achieve the 
     goals and objectives of the National Drug Control Strategy.
       ``(c) Contents of the National Drug Control Strategy.--
       ``(1) In general.--The National Drug Control Strategy 
     submitted under subsection (a)(2) shall include the 
     following:
       ``(A) A mission statement detailing the major functions of 
     the National Drug Control Program.
       ``(B) Comprehensive, research-based, long-range, 
     quantifiable goals for reducing illicit drug use, and the 
     consequences of illicit drug use in the United States.
       ``(C) Annual quantifiable and measurable objectives and 
     specific targets to accomplish long-term quantifiable goals 
     that the Director determines may be achieved during each year 
     beginning on the date on which the National Drug Control 
     Strategy is submitted.
       ``(D) A 5-year projection for the National Drug Control 
     Program and budget priorities.
       ``(E) A review of international, State, local, and private 
     sector drug control activities to ensure that the United 
     States pursues coordinated and effective drug control at all 
     levels of government.
       ``(F) A description of how each goal established under 
     subparagraph (B) will be achieved, including for each goal--
       ``(i) a list of each relevant National Drug Control Program 
     Agency and each such agency's related programs, activities, 
     and available assets and the role of each such program, 
     activity, and asset in achieving such goal;
       ``(ii) a list of relevant stakeholders and each such 
     stakeholder's role in achieving such goal;

[[Page H9241]]

       ``(iii) an estimate of Federal funding and other resources 
     needed to achieve such goal;
       ``(iv) a list of each existing or new coordinating 
     mechanism needed to achieve such goal; and
       ``(v) a description of the Office's role in facilitating 
     the achievement of such goal.
       ``(G) For each year covered by the Strategy, a performance 
     evaluation plan for each goal established under subparagraph 
     (B) for each National Drug Control Program Agency, 
     including--
       ``(i) specific performance measures for each National Drug 
     Control Program Agency;
       ``(ii) annual and, to the extent practicable, quarterly 
     objectives and targets for each performance measure; and
       ``(iii) an estimate of Federal funding and other resources 
     needed to achieve each performance objective and target.
       ``(H) A list identifying existing data sources or a 
     description of data collection needed to evaluate 
     performance, including a description of how the Director will 
     obtain such data.
       ``(I) A list of any anticipated challenges to achieving the 
     National Drug Control Strategy goals and planned actions to 
     address such challenges.
       ``(J) A description of how each goal established under 
     subparagraph (B) was determined, including--
       ``(i) a description of each required consultation and a 
     description of how such consultation was incorporated; and
       ``(ii) data, research, or other information used to inform 
     the determination to establish the goal.
       ``(K) A description of the current prevalence of illicit 
     drug use in the United States, including both the 
     availability of illicit drugs and the prevalence of substance 
     use disorders.
       ``(L) Such other statistical data and information as the 
     Director considers appropriate to demonstrate and assess 
     trends relating to illicit drug use, the effects and 
     consequences of illicit drug use (including the effects on 
     children), supply reduction, demand reduction, drug-related 
     law enforcement, and the implementation of the National Drug 
     Control Strategy.
       ``(M) A systematic plan for increasing data collection to 
     enable real time surveillance of drug control threats, 
     developing analysis and monitoring capabilities, and 
     identifying and addressing policy questions related to the 
     National Drug Control Strategy and Program, which shall 
     include--
       ``(i) a list of policy-relevant questions for which the 
     Director and each National Drug Control Program Agency 
     intends to develop evidence to support the National Drug 
     Control Program and Strategy;
       ``(ii) a list of data the Director and each National Drug 
     Control Program Agency intends to collect, use, or acquire to 
     facilitate the use of evidence in drug control policymaking 
     and monitoring;
       ``(iii) a list of methods and analytical approaches that 
     may be used to develop evidence to support the National Drug 
     Control Program and Strategy and related policy;
       ``(iv) a list of any challenges to developing evidence to 
     support policymaking, including any barriers to accessing, 
     collecting, or using relevant data;
       ``(v) a description of the steps the Director and the head 
     of each National Drug Control Program Agency will take to 
     effectuate the plan; and
       ``(vi) any other relevant information as determined by the 
     Director.
       ``(N) A plan to expand treatment of substance use 
     disorders, which shall--
       ``(i) identify unmet needs for treatment for substance use 
     disorders and a strategy for closing the gap between 
     available and needed treatment;
       ``(ii) describe the specific roles and responsibilities of 
     the relevant National Drug Control Programs for implementing 
     the plan;
       ``(iii) identify the specific resources required to enable 
     the relevant National Drug Control Agencies to implement that 
     strategy; and
       ``(iv) identify the resources, including private sources, 
     required to eliminate the unmet need for evidence-based 
     substance use disorder treatment.
       ``(2) Consultation.--In developing the plan required under 
     paragraph (1), the Director shall consult with the following:
       ``(A) The public.
       ``(B) Any evaluation or analysis units and personnel of the 
     Office.
       ``(C) Office officials responsible for implementing privacy 
     policy.
       ``(D) Office officials responsible for data governance.
       ``(E) The appropriate congressional committees.
       ``(F) Any other individual or entity as determined by the 
     Director.
       ``(3) Additional strategies.--
       ``(A) In general.--The Director shall include in the 
     National Drug Control Strategy the additional strategies 
     described under this paragraph and shall comply with the 
     following:
       ``(i) Provide a copy of the additional strategies to the 
     appropriate congressional committees and to the Committee on 
     Armed Services and the Committee on Homeland Security of the 
     House of Representatives, and the Committee on Homeland 
     Security and Governmental Affairs and the Committee on Armed 
     Services of the Senate.
       ``(ii) Issue the additional strategies in consultation with 
     the head of each relevant National Drug Control Program 
     Agency, any relevant official of a State, local, or Tribal 
     government, and the government of other relevant countries.
       ``(iii) Not change any existing agency authority or 
     construe any strategy described under this paragraph to amend 
     or modify any law governing interagency relationship but may 
     include recommendations about changes to such authority or 
     law.
       ``(iv) Present separately from the rest of any strategy 
     described under this paragraph any information classified 
     under criteria established by an Executive order, or whose 
     public disclosure, as determined by the Director or the head 
     of any relevant National Drug Control Program Agency, would 
     be detrimental to the law enforcement or national security 
     activities of any Federal, State, local, or Tribal agency.
       ``(B) Requirement for southwest border counternarcotics 
     strategy.--
       ``(i) Purposes.--The Southwest Border Counternarcotics 
     Strategy shall--

       ``(I) set forth the Government's strategy for preventing 
     the illegal trafficking of drugs across the international 
     border between the United States and Mexico, including 
     through ports of entry and between ports of entry on that 
     border;
       ``(II) state the specific roles and responsibilities of the 
     relevant National Drug Control Program Agencies for 
     implementing that strategy; and
       ``(III) identify the specific resources required to enable 
     the relevant National Drug Control Program Agencies to 
     implement that strategy.

       ``(ii) Specific content related to drug tunnels between the 
     united states and mexico.--The Southwest Border 
     Counternarcotics Strategy shall include--

       ``(I) a strategy to end the construction and use of tunnels 
     and subterranean passages that cross the international border 
     between the United States and Mexico for the purpose of 
     illegal trafficking of drugs across such border; and
       ``(II) recommendations for criminal penalties for persons 
     who construct or use such a tunnel or subterranean passage 
     for such a purpose.

       ``(C) Requirement for northern border counternarcotics 
     strategy.--
       ``(i) Purposes.--The Northern Border Counternarcotics 
     Strategy shall--

       ``(I) set forth the strategy of the Federal Government for 
     preventing the illegal trafficking of drugs across the 
     international border between the United States and Canada, 
     including through ports of entry and between ports of entry 
     on the border;
       ``(II) state the specific roles and responsibilities of 
     each relevant National Drug Control Program Agency for 
     implementing the strategy;
       ``(III) identify the specific resources required to enable 
     the relevant National Drug Control Program Agencies to 
     implement the strategy;
       ``(IV) be designed to promote, and not hinder, legitimate 
     trade and travel; and
       ``(V) reflect the unique nature of small communities along 
     the international border between the United States and 
     Canada, ongoing cooperation and coordination with Canadian 
     law, enforcement authorities, and variations in the volumes 
     of vehicles and pedestrians crossing through ports of entry 
     along the international border between the United States and 
     Canada.

       ``(ii) Specific content related to cross-border indian 
     reservations.--The Northern Border Counternarcotics Strategy 
     shall include--

       ``(I) a strategy to end the illegal trafficking of drugs to 
     or through Indian reservations on or near the international 
     border between the United States and Canada; and
       ``(II) recommendations for additional assistance, if any, 
     needed by Tribal law enforcement agencies relating to the 
     strategy, including an evaluation of Federal technical and 
     financial assistance, infrastructure capacity building, and 
     interoperability deficiencies.

       ``(4) Classified information.--Any contents of the National 
     Drug Control Strategy that involve information properly 
     classified under criteria established by an Executive order 
     shall be presented to Congress separately from the rest of 
     the National Drug Control Strategy.
       ``(5) Selection of data and information.--In selecting data 
     and information for inclusion in the Strategy, the Director 
     shall ensure--
       ``(A) the inclusion of data and information that will 
     permit analysis of current trends against previously compiled 
     data and information where the Director believes such 
     analysis enhances long-term assessment of the National Drug 
     Control Strategy; and
       ``(B) the inclusion of data and information to permit a 
     standardized and uniform assessment of the effectiveness of 
     drug treatment programs in the United States.
       ``(d) Submission of Revised Strategy.--The President may 
     submit to Congress a revised National Drug Control Strategy 
     that meets the requirements of this section--
       ``(1) at any time, upon a determination of the President, 
     in consultation with the Director, that the National Drug 
     Control Strategy in effect is not sufficiently effective; or
       ``(2) if a new President or Director takes office.
       ``(e) Failure of Director to Submit National Drug Control 
     Strategy.--If the Director does not submit a National Drug 
     Control Strategy to Congress in accordance with subsection 
     (a)(2), not later than five days

[[Page H9242]]

     after the first Monday in February following the year in 
     which the term of the President commences, the Director shall 
     send a notification to the appropriate congressional 
     committees--
       ``(1) explaining why the Strategy was not submitted; and
       ``(2) specifying the date by which the Strategy will be 
     submitted.
       ``(f) Drug Control Data Dashboard.--
       ``(1) In general.--The Director shall collect and 
     disseminate, as appropriate, such information as the Director 
     determines is appropriate, but not less than the information 
     described in this subsection. The data shall be publicly 
     available in a machine-readable format on the online portal 
     of the Office, and to the extent practicable on the Drug 
     Control Data Dashboard.
       ``(2) Establishment.--The Director shall publish to the 
     online portal of the office in a machine-readable, sortable, 
     and searchable format, or to the extent practicable, 
     establish and maintain a data dashboard on the online portal 
     of the Office to be known as the `Drug Control Data 
     Dashboard'. To the extent practicable, when establishing the 
     Drug Control Dashboard, the Director shall ensure the user 
     interface of the dashboard is constructed with modern design 
     standards. To the extent practicable, the data made available 
     on the dashboard shall be publicly available in a machine-
     readable format and searchable by year, agency, drug, and 
     location.
       ``(3) Data.--The data included in the Drug Control Data 
     Dashboard shall be updated quarterly to the extent 
     practicable, but not less frequently than annually and shall 
     include, at a minimum, the following:
       ``(A) For each substance identified by the Director as 
     having a significant impact on the prevalence of illicit drug 
     use--
       ``(i) data sufficient to show the quantities of such 
     substance available in the United States, including--

       ``(I) the total amount seized and disrupted in the calendar 
     year and each of the previous 3 calendar years, including to 
     the extent practicable the amount seized by State, local, and 
     Tribal governments;
       ``(II) the known and estimated flows into the United States 
     from all sources in the calendar year and each of the 
     previous 3 calendar years;
       ``(III) the total amount of known flows that could not be 
     interdicted or disrupted in the calendar year and each of the 
     previous 3 calendar years;
       ``(IV) the known and estimated levels of domestic 
     production in the calendar year and each of the previous 
     three calendar years, including the levels of domestic 
     production if the drug is a prescription drug, as determined 
     under the Federal Food, Drug, and Cosmetic Act, for which a 
     listing is in effect under section 202 of the Controlled 
     Substances Act (21 U.S.C. 812);
       ``(V) the average street price for the calendar year and 
     the highest known street price during the preceding 10-year 
     period; and
       ``(VI) to the extent practicable, related prosecutions by 
     State, local, and Tribal governments;

       ``(ii) data sufficient to show the frequency of use of such 
     substance, including--

       ``(I) use of such substance in the workplace and 
     productivity lost by such use;
       ``(II) use of such substance by arrestees, probationers, 
     and parolees;
       ``(III) crime and criminal activity related to such 
     substance;
       ``(IV) to the extent practicable, related prosecutions by 
     State, local, and Tribal governments;

       ``(B) For the calendar year and each of the previous three 
     years data sufficient to show, disaggregated by State and, to 
     the extent feasible, by region within a State, county, or 
     city, the following:
       ``(i) The number of fatal and non-fatal overdoses caused by 
     each drug identified under subparagraph (A)(i).
       ``(ii) The prevalence of substance use disorders.
       ``(iii) The number of individuals who have received 
     substance use disorder treatment, including medication 
     assisted treatment, for a substance use disorder, including 
     treatment provided through publicly-financed health care 
     programs.
       ``(iv) The extent of the unmet need for substance use 
     disorder treatment, including the unmet need for medication-
     assisted treatment.
       ``(C) Data sufficient to show the extent of prescription 
     drug diversion, trafficking, and misuse in the calendar year 
     and each of the previous 3 calendar years.
       ``(D) Any quantifiable measures the Director determines to 
     be appropriate to detail progress toward the achievement of 
     the goals of the National Drug Control Strategy.
       ``(g) Development of an Annual National Drug Control 
     Assessment.--
       ``(1) Timing.--Not later than the first Monday in February 
     of each year, the Director shall submit to the President, 
     Congress, and the appropriate congressional committees, a 
     report assessing the progress of each National Drug Control 
     Program Agency toward achieving each goal, objective, and 
     target contained in the National Drug Control Strategy 
     applicable to the prior fiscal year.
       ``(2) Process for development of the annual assessment.--
     Not later than November 1 of each year, the head of each 
     National Drug Control Program Agency shall submit, in 
     accordance with guidance issued by the Director, to the 
     Director an evaluation of progress by the agency with respect 
     to the National Drug Control Strategy goals using the 
     performance measures for the agency developed under this 
     title, including progress with respect to--
       ``(A) success in achieving the goals of the National Drug 
     Control Strategy;
       ``(B) success in reducing domestic and foreign sources of 
     illegal drugs;
       ``(C) success in expanding access to and increasing the 
     effectiveness of substance use disorder treatment;
       ``(D) success in protecting the borders of the United 
     States (and in particular the Southwestern border of the 
     United States) from penetration by illegal narcotics;
       ``(E) success in reducing crime associated with drug use in 
     the United States;
       ``(F) success in reducing the negative health and social 
     consequences of drug use in the United States;
       ``(G) implementation of evidence-based substance use 
     disorder treatment and prevention programs in the United 
     States and improvements in the adequacy and effectiveness of 
     such programs; and
       ``(H) success in increasing the prevention of illicit drug 
     use.
       ``(3) Contents of the annual assessment.--The Director 
     shall include in the annual assessment required under 
     paragraph (1)--
       ``(A) a summary of each evaluation received by the Director 
     under paragraph (2);
       ``(B) a summary of the progress of each National Drug 
     Control Program Agency toward the National Drug Control 
     Strategy goals of the agency using the performance measures 
     for the agency developed under this chapter;
       ``(C) an assessment of the effectiveness of each National 
     Drug Control Program Agency and program in achieving the 
     National Drug Control Strategy for the previous year, 
     including a specific evaluation of whether the applicable 
     goals, measures, objectives, and targets for the previous 
     year were met; and
       ``(D) the assessments required under this subsection shall 
     be based on the Performance Measurement System.''.
       (b) Technical and Conforming Amendments.--
       (1) Section 704(b) of the Office of National Drug Control 
     Policy Reauthorization Act of 1998 (21 U.S.C. 1703(b)) is 
     amended--
       (A) by striking paragraphs (13) and (17); and
       (B) in paragraph (14)(A), by striking ``paragraph (13)'' 
     and inserting ``section 706(g)(2)''.
       (2) The Office of National Drug Control Policy 
     Reauthorization Act of 2006 (Public Law 109-469; 120 Stat. 
     3502) is amended by striking sections 1110 and 1110A.

     SEC. 8222. TECHNICAL AND CONFORMING AMENDMENTS TO THE OFFICE 
                   OF NATIONAL DRUG CONTROL POLICY REAUTHORIZATION 
                   ACT OF 1998.

       The Office of National Drug Control Policy Reauthorization 
     Act of 1998 (21 U.S.C. 1701 et seq.) is amended--
       (1) by striking section 703(b) (21 U.S.C. 1702(b));
       (2) in section 704 (21 U.S.C. 1703)--
       (A) in subsection (c)--
       (i) in paragraph (3)(C)--

       (I) in the matter before clause (i), by inserting 
     ``requests a level of funding that will not enable 
     achievement of the goals of the National Drug Control 
     Strategy, including'' after ``request that'';
       (II) in clause (iii)--

       (aa) by striking ``drug treatment'' and inserting 
     ``substance use disorder prevention and treatment''; and
       (bb) by striking the semicolon at the end and inserting ``; 
     and'';

       (III) by striking clauses (iv), (vi), and (vii);
       (IV) by redesignating clause (v) as clause (iv); and
       (V) in clause (iv), as so redesignated, by striking the 
     semicolon and inserting a period;

       (ii) in paragraph (4)(A), by striking ``$1,000,000'' and 
     inserting ``$5,000,000 or 10 percent of a specific program or 
     account''; and
       (B) in subsection (f)--
       (i) by striking the first paragraph (5); and
       (ii) by striking the second paragraph (4); and
       (3) by striking section 708 (21 U.S.C. 1707).

                     Subtitle L--Budgetary Effects

     SEC. 8231. BUDGETARY EFFECT.

       (a) In General.--The budgetary effects of this Act shall 
     not be entered on either PAYGO scorecard maintained pursuant 
     to section 4(d) of the Statutory Pay-As-You-Go Act of 2010 (2 
     U.S.C. 933(d)).
       (b) Senate PAYGO Scorecards.--The budgetary effects of this 
     Act shall not be entered on any PAYGO scorecard maintained 
     for purposes of section 4106 of H. Con. Res. 71 (115th 
     Congress).

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Oregon (Mr. Walden) and the gentleman from New Jersey (Mr. Pallone) 
each will control 20 minutes.
  The Chair recognizes the gentleman from Oregon.


                             General Leave

  Mr. WALDEN. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
insert extraneous material in the Record on the resolution.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Oregon?

[[Page H9243]]

  There was no objection.
  Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
  I have dozens and dozens of letters of support for this legislation; 
90 or 100 different letters of support from different groups, 124 
names, it looks like, that I will include in the Record.

       Statements and Letters of Support from:
       U.S. Chamber--Key Vote Alert, American Society of Addiction 
     Medicine--Statement, Advocates for Opioid Recovery--advocacy 
     e-mail, Corporate Health Care Coalition--support letter, 
     First Focus Campaign for Children--statement, National 
     Association for Behavioral Healthcare--Statement, National 
     Association of Community Health Centers--Letter, Catholic 
     Health Association--Letter, American Benefits Council--
     Letter, A Coalition letter signed by 124 addiction advocacy 
     groups:
       1. A New PATH, San Diego, California
       2. Addiction Policy Forum
       3. AIDS United
       4. Alabama, Addiction Policy Forum
       5. Alaska, Addiction Policy Forum
       6. American Correctional Association
       7. Arizona, Addiction Policy Forum
       8. Association of Prosecuting Attorneys
       9. Beyond Addiction Ministry, WI
       10. Brave Health
       11. CADA of Northwest Louisiana
       12. California Consortium of Addiction Programs & 
     Professionals (CCAPP)
       13. California, Addiction Policy Forum
       14. Campaign for Youth Justice
       15. Caron Treatment Centers
       16. CFC Loud N Clear Foundation, Farmingdale, New Jersey
       17. Chicago Recovering Communities Coalition, Chicago, 
     Illinois
       18. Colorado, Addiction Policy Forum
       19. Community Anti-Drug Coalitions of America (CADCA)
       20. Connecticut Certification Board
       21. Connecticut Community for Addiction Recovery (CCAR), 
     Hartford, Connecticut
       22. Connecticut, Addiction Policy Forum
       23. COPES
       24. DarJune Recovery Support Services & Cafe, Green Bay, 
     Wisconsin
       25. Delaware, Addiction Policy Forum
       26. Delphi Behavioral Health Group
       27. DisposeRx
       28. El Paso Alliance, El Paso, Texas
       29. Faces & Voices of Recovery
       30. FAVOR Low Country, Charleston, South Carolina
       31. FAVOR Tri-County, Rock Hill, South Carolina
       32. FedCURE
       33. Fellowship Foundation Recovery Community Organization, 
     Margate, Florida
       34. Floridians for Recovery, West Palm Beach, Florida
       35. Foundation for Recovery, Las Vegas, Nevada
       36. Friends of Emmett
       37. H.O.P.E.S. Forever
       38. Healthcare Leadership Council
       39. IC & RC
       40. Idaho, Addiction Policy Forum
       41. Illinois Association of Behavioral Health
       42. Illinois, Addiction Policy Forum
       43. Indiana, Addiction Policy Forum
       44. Institute for Behavior and Health (IBH)
       45. Iowa, Addiction Policy Forum
       46. Jackson Area Recovery Community, Jackson, Michigan
       47. Kansas, Addiction Policy Forum
       48. Kentucky, Addiction Policy Forum
       49. Kingston NH Lions Foundation
       50. Lifehouse Recovery Connection, San Diego, California
       51. Maine Alliance for Addiction Recovery, Augusta, Maine
       52. Maine, Addiction Policy Forum
       53. Maryland House Detox
       54. Maryland, Addiction Policy Forum
       55. Massachusetts, Addiction Policy Forum
       56. Michigan, Addiction Policy Forum
       57. Minnesota Recovery Connection, Minneapolis, Minnesota
       58. Minnesota, Addiction Policy Forum
       59. Missouri Recovery Network, Jefferson City, Missouri
       60. Missouri, Addiction Policy Forum
       61. Montana, Addiction Policy Forum
       62. National Association of Social Workers (NASW)
       63. National Prevention Science Coalition
       64. National Safety Council
       65. Navigate Recovery Gwinnett, Gwinnett County, Georgia
       66. Navigating Recovery of the Lakes Region, Laconia, New 
     Hampshire
       67. Nevada, Addiction Policy Forum
       68. New Hampshire, Addiction Policy Forum
       69. New Jersey, Addiction Policy Forum
       70. New Mexico, Addiction Policy Forum
       71. New York, Addiction Policy Forum
       72. North Carolina, Addiction Policy Forum
       73. North Dakota, Addiction Policy Forum
       74. Ohio Citizen Advocates for Addiction Recovery, 
     Columbus, Ohio
       75. Ohio, Addiction Policy Forum
       76. Oklahoma, Addiction Policy Forum
       77. Oregon, Addiction Policy Forum
       78. PEER Wellness Center
       79. PEER360 Recovery Alliance, Bay City, Michigan
       80. Pennsylvania Recovery Organization, Achieving Community 
     Together (PRO-ACT), Philadelphia, Pennsylvania
       81. Pennsylvania, Addiction Policy Forum
       82. People Advocating Recovery, Louisville, Kentucky
       83. Phoenix House Recovery Residences
       84. PLR Athens, Athens, Georgia
       85. Reality Check, Jaffrey, New Hampshire
       86. Recover Wyoming, Cheyenne, Wyoming
       87. Recovery Communities of North Carolina, Raleigh, North 
     Carolina
       88. Recovery Community Connection, Williamsport, 
     Pennsylvania
       89. Recovery Community of Durham, Durham, North Carolina
       90. Recovery Data Solutions
       91. Rhode Island, Addiction Policy Forum
       92. ROCovery Fitness, Rochester, New York
       93. Shatterproof
       94. Smart Approaches to Marijuana Action (SAM Action)
       95. SMART Recovery, Nationwide
       96. Sobriety Matters
       97. Solutions Recovery, Oshkosh, Wisconsin
       98. South Dakota, Addiction Policy Forum
       99. SpiritWorks Foundation, Williamsburg, Virginia
       100. Springs Recovery Connection, Colorado Springs, 
     Colorado
       101. Strengthening the Mid-Atlantic Region for Tomorrow 
     (SMART)
       102. Tennessee, Addiction Policy Forum
       103. Texas, Addiction Policy Forum
       104. The DOOR--DeKalb Open Opportunity for Recovery, 
     Decatur, Georgia
       105. The McShin Foundation, Richmond, Virginia
       106. The Moyer Foundation
       107. The Phoenix, Nationwide
       108. The RASE Project, Harrisburg, Pennsylvania
       109. The Solano Project, Fairfield, California
       110. Treatment Communities of America
       111. Trilogy Recovery Community, Walla Walla, Washington
       112. Trust for America's Health
       113. Utah, Addiction Policy Forum
       114. Vermont, Addiction Policy Forum
       115. Virginia, Addiction Policy Forum
       116. Voices of Hope Lexington, Lexington, Kentucky
       117. Voices of Recovery San Mateo County, San Mateo, 
     California
       118. WAI-IAM, Inc. and RISE Recovery Community, Lansing, 
     Michigan
       119. Washington, Addiction Policy Forum
       120. Washtenaw Recovery Advocacy Project (WRAP), Ann Arbor, 
     Michigan
       121. West Virginia, Addiction Policy Forum
       122. Wisconsin Voices for Recovery, Madison, Wisconsin
       123. Wisconsin, Addiction Policy Forum
       124. Wyoming, Addiction Policy Forum

  Mr. WALDEN. Mr. Speaker, I rise today in support of H.R. 6. This is 
the SUPPORT for Patients and Communities Act that your Energy and 
Commerce Committee has worked on diligently for nearly 2 years.
  In my own case, in 10 roundtables throughout Oregon, I have heard 
from everyday people on the frontlines of this fight in our 
communities. They are the victims. They are the families. They are 
medical providers and treatment advocates. They are local law 
enforcement, and they are first responders. They are our neighbors. 
They are our loved ones.
  Each of these people puts a name and a face to what I would say is 
the worst drug epidemic we have seen in America, the opioid crisis.
  I have heard from Oregon families, I have heard from Mike and Winnie, 
from Grants Pass, who have seen their loved one struggle with 
addiction. Mike's sister who died, she was a nurse, became addicted, 
and overdosed. He told me that at a townhall in a community forum. 
Their son struggles with his addiction to this day from a sports injury 
starting with opioids, ending with heroin.
  We will never know what could have become of the 72,000 Americans who 
died last year.
  Every 24 hours, 1,000 people go to emergency rooms overdosing from 
opioids. Roughly 115 die.
  I heard it from Paula, whose two sons and stepson struggle with their 
opioid addiction today.
  As a parent, I can only imagine what parents of children with opioid 
addiction must feel every time the phone rings. They think it may be 
that call.
  For the millions of people currently struggling with addiction, 
please know, don't give up. It is never too late to seek help. We stand 
with you.
  Mr. Speaker, this legislation is a product of months of bipartisan, 
bicameral work, eight House committees involved, I think probably every 
Member of this House, five Senate committees, dozen and dozens of 
Members of Congress.
  And the faces that we came to know are the parents and the children 
whom they lost, Amanda Beatrice Gray being one of them, a beautiful 
young woman, talented, struggling with her issues, overdosed on heroin 
heavily laced with fentanyl.
  We are here for them, Mr. Speaker. We are here for our neighbors, for 
our

[[Page H9244]]

loved ones, who deal with this crisis every day of their life, and in 
the great joined cause of those who lost.
  Mr. Speaker, because we are going to hear from a lot of our Members 
who have put so much work into this, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  I rise today in support of H.R. 6, the SUPPORT for Patients and 
Communities Act. This bill is the product of many months of hard work 
by several committees in the House and Senate. It is important that we 
pass this bill today as another step in addressing the opioid crisis 
that is ravaging every community in our Nation.
  Last year, a record 72,000 Americans died of drug overdoses; that is 
about 200 people dying every day, and this is a national crisis that is 
devastating families and that this Congress must act on.
  And while this legislation will not solve every problem, I do believe 
it includes important policies that will help turn the tide of this 
tragic opioid epidemic. It will also improve treatment options for 
those battling other substance-use disorders.
  I am proud that H.R. 6 builds upon CARA, the Comprehensive Addiction 
and Recovery Act, by including a provision championed by my colleague, 
Congressman Tonko, that would allow all advanced practice registered 
nurses to treat patients with bupe for opioid-use disorder. It also 
gives nurse practitioners and physician assistants the authority to 
treat patients with bupe permanently, and it codifies the 275 patient 
physician cap. This is a critical step in expanding access to the 
treatment of these drugs, one of the major challenges that we continue 
to face in the fight against this epidemic.
  Mr. Speaker, the legislation also expands access to coverage. It 
includes an important provision that I worked on with Ways and Means 
Committee Ranking Member Neal that expands Medicare coverage of opioid 
treatment programs and medication-assisted treatment.
  In the Medicaid space, I am pleased to see the inclusion of several 
Democratic priorities. This bill requires State Medicaid programs to 
cover all forms of medication-assisted treatment, which plays a 
critical and lifesaving role in treating opioid use disorder.
  It provides grants to State Medicaid programs to help increase the 
number of substance use disorder providers and services. It increases 
access to mental health and substance use disorder treatment for 
children and pregnant women covered by CHIP, and it ensures former 
foster youth are able to keep their Medicaid coverage across State 
lines up to the age of 26. And it improves the continuity of Medicaid 
coverage for juveniles in the justice system.
  I am also pleased that we have been able to improve upon the House-
passed IMD policy. This bill adds new safeguards to ensure that States 
continue to provide an adequate level of outpatient services and offer 
medication-assisted treatment. It does this by making clear that this 
policy does not impact the more comprehensive efforts to provide care 
in IMDs that is ongoing in many States today.

                              {time}  1045

  H.R. 6 also includes provisions from my legislation, the SCREEN Act, 
that would give the Food and Drug Administration the ability to take 
action against illicit controlled substances coming in through 
international mail facilities across the country.
  FDA will now be able to prohibit the importation of drugs by people 
who have repeatedly imported illicit drugs. It also allows the agency 
to cease distribution of or recall controlled substances, like opioids, 
if they are endangering patients.
  These provisions also provide FDA expanded authority and capacity 
needed to more effectively combat the influx of deadly synthetic 
opioids, like fentanyl, from reaching our shores through the mail in 
the first place.
  It also provides the Federal Trade Commission with stronger 
enforcement tools to go after bad actors that are taking advantage of 
the suffering of individuals combating addictions.
  Mr. Speaker, there is one provision that is concerning and that I do 
want to mention. It did not go through regular order and was not 
properly vetted. In fact, it was added at the very last minute. That is 
a proposal by Senator Rubio to create a new criminal antikickback 
statute.
  I know this proposal is well-intentioned in addressing the serious 
problem of patient brokers who are taking advantage of individuals with 
opioid use disorders and referring them to substandard or fraudulent 
providers in exchange for kickbacks. This is an issue, but since the 
bill was introduced last Tuesday night, multiple stakeholders have 
raised concerns that the language does not do what we think it does. It 
may have unintended consequences.
  Mr. Speaker, I hope this is a good lesson to all of us that passing 
legislation that has not been properly vetted, and that the public has 
not had an adequate chance to review, is unwise. I hope to get a 
commitment from Chairman Walden and Chairman Goodlatte to work to 
address any technical problems with this provision in the upcoming 
months.
  In closing, Mr. Speaker, these are all policies that have the 
potential to make a real impact on this epidemic, but our work here is 
not complete. An epidemic of this size will take a long-term commitment 
to improving health insurance coverage, treatment, access, and 
affordability.
  This bill is an important step, but I want to stress that we have to 
do a lot more. The opioid crisis continues to get worse. A lot more 
needs to be done to provide treatment and expand the treatment 
infrastructure. More resources are needed to support the families and 
communities impacted by this crisis. So what we are doing today is 
clearly helpful, but it is not enough.
  Mr. Speaker, I reserve the balance of my time.
  Mr. WALDEN. Mr. Speaker, I am honored to yield 1 minute to the 
gentleman from Texas (Mr. Brady), the distinguished and talented 
chairman of the House Ways and Means Committee.
  Mr. BRADY of Texas. Mr. Speaker, I thank Chairman Walden and Ranking 
Member Pallone for their work. The opioid crisis, as you know, has 
impacted every community in America, has robbed countless individuals 
of their full potential. We all know someone who lost a loved one 
because they were exposed to opioids and then quickly addicted, and I 
know that sometimes, in routine surgery, they didn't even need it.
  This can be prevented, and that is why I rise today in support of 
H.R. 6. This is bicameral and bipartisan. It addresses this crisis by 
putting in place many commonsense measures to reduce the unnecessary 
prescribing of opioids and get people treatment once they become 
addicted.
  Mr. Speaker, I want to thank the ranking member of the Ways and Means 
Committee, Mr. Neal; the ranking member of the Health Subcommittee, Mr. 
Levin; as well as leaders on our side and Mr. Roskam, Mr. Curbelo, Mr. 
Paulsen, and Mr. Bishop for authorizing key provisions of H.R. 6. They 
will save lives and heal communities.
  Mr. PALLONE. Mr. Speaker, I yield 4 minutes to the gentleman from 
Massachusetts (Mr. Neal), the ranking member of the Ways and Means 
Committee who worked so hard on this legislation as well.
  Mr. NEAL. Mr. Speaker, I rise in support of H.R. 6, the SUPPORT for 
Patients and Communities Act, and I want to acknowledge Mr. Pallone, 
Mr. Walden, and Mr. Brady, the chairman of the Ways and Means 
Committee, for the good work that they have offered on this as well.
  The opioid crisis is not a partisan issue. It is a health, safety, 
family, community, and economic issue. Everybody in this Chamber today 
has a family member or knows someone close to them who is connected to 
the opioid crisis.
  H.R. 6 represents the best of bipartisan and bicameral negotiation. 
This is, indeed, the way policy can and should be done.
  The bill includes a number of Democratic priorities to expand 
treatment options for our neighbors, family members, and friends 
suffering from opioid use disorders. It includes my bill, with Member 
Pallone, that would require Medicare to cover opioid treatment programs 
so that our Nation's seniors might have more outpatient options for 
treatment.

[[Page H9245]]

  Opioid use disorders are rapidly growing among Medicare 
beneficiaries. In 13 States, the highest rate of opioid-related 
inpatient hospital stays is amongst those over 65. This policy would 
give Medicare beneficiaries increased access to a range of medication 
and behavioral treatment options, leading to more hope for long-term 
recovery.
  I am also pleased that H.R. 6 includes the Securing the International 
Mail Against Opioids Act, which would help to stop the flow of opioids 
through the United States. This legislation stems from the STOP Act, a 
bill that I worked on with Mr. Tiberi before his retirement earlier 
this year. I want to commend him, in addition to Trade Subcommittee 
Ranking Member Pascrell, for their work on this bipartisan legislation.
  While the bill before us is a step in the right direction, this 
epidemic is not going to turn around overnight. It needs a thoughtful, 
long-term, sustainable approach that requires significant Federal 
investments. H.R. 6 represents the initial step in addressing this 
crisis, but it cannot be the end. Part of that long-term approach must 
include protecting and strengthening Medicaid and the Affordable Care 
Act.

  I want to take a moment to thank the staff on both sides of the aisle 
for their usual good work in this Chamber, for the weeks of hard effort 
they put in bringing this bill to fruition. The effort exemplifies 
bipartisan cooperation, and a particular thanks to House and Senate 
legislative counsel who worked long nights and weekends to finish the 
bill.
  Thanks also to the CMS Office of Legislation and the staff of the 
Congressional Budget Office who played a critical role in finalizing 
the bill.
  This is a complicated issue, and H.R. 6 is not going to solve the 
public health epidemic or its impact on society at the moment, but it 
certainly is a good step. I encourage all of us here in this Chamber 
today and in Congress to continue to work together to develop policy 
solutions for members of our community who are suffering from this 
terrible epidemic.
  Mr. WALDEN. Mr. Speaker, I yield 30 seconds to the gentlewoman from 
Indiana (Mrs. Brooks), and concur in my colleague's comments in praise 
of the staff that we worked with to get this done. The gentlewoman has 
been a real leader.
  Mrs. BROOKS of Indiana. Mr. Speaker, the opioid and heroin crisis 
continues to hit Hoosiers hard. Sadly, we haven't turned the tide yet.
  It is robbing the futures of Americans in every State in our Nation. 
We must support those battling addiction.
  I have met with so many Hoosiers battling addiction. I visited 
treatment centers and recovery houses like the La Verna Lodge for men 
and Ohana House Sober Living for women. I have talked with addicts and 
those battling addiction about what is working and what is not working 
with different recovery options.
  Passing the strong bipartisan bill before us today is critically 
important. It will help ensure that more people have better access to 
treatments, and we can try to save more lives across this country.
  Mr. PALLONE. Mr. Speaker, I yield 4 minutes the gentleman from 
Maryland (Mr. Cummings), the ranking member of the Oversight and 
Government Reform Committee.
  Mr. CUMMINGS. Mr. Speaker, I want to thank Mr. Pallone for yielding, 
and for his great work on this legislation.
  Mr. Speaker, I rise in support of provisions in this package 
reauthorizing and reforming the Office of National Drug Control Policy 
to improve coordination of our national response to the drug crisis.
  At my request, the bill creates a demand reduction coordinator 
position, parallel to the existing interdiction coordinator, to 
strengthen demand reduction initiatives, including efforts to expand 
treatment.
  Among other critical reforms, this legislation also requires ONDCP to 
report whether drug control program agency budgets are adequate to 
achieve the goals of the National Drug Control Strategy. It requires 
the compilation of essential data on overdoses, deaths, and 
interdiction in a data dashboard, so the American people have a clear, 
accessible picture of the effectiveness of efforts to combat the drug 
crisis.
  I thank Chairman Gowdy, Chairman Meadows, and Vice Ranking Member 
Connolly for working with me to develop legislation that will reform 
ONDCP. I thank Chairman Grassley, Ranking Member Feinstein, and Senator 
Cornyn for their leadership.
  Let me also give special thanks to the committee staff and, I must 
say, to the majority and the minority staff. They did a phenomenal job 
working hard in conference and throughout this effort. Without their 
extraordinary efforts, this legislation would not be in this package 
today.
  Mr. Speaker, I close with a simple warning. There are a lot of people 
suffering. Almost 198 people die a day--a day. Those are the people who 
are dying, but there are a lot of people in the pipeline who are in so 
much pain, they don't even know they are in pain.
  So while the provisions of H.R. 6 are important, without 
significantly expanding access to treatment and wraparound services 
through long-term, sustained funding, we continue to nibble at the 
edges of our national crisis, and the crisis will continue to worsen.
  Mr. Speaker, I thank the gentleman for yielding.
  Mr. WALDEN. Mr. Speaker, it is my great honor and high privilege to 
yield 1 minute to the gentleman from Wisconsin (Mr. Ryan), the Speaker 
of the House and my dear friend and classmate from the class of `98.
  Mr. RYAN of Wisconsin. Mr. Speaker, I thank the gentleman for 
yielding.
  Mr. Speaker, I rise today to talk about something that is really 
close to all of our hearts. We have reached a point in this country 
where opioid overdoses claim more than 100 lives each and every single 
day.
  Think about that for a moment, more than 100 lives every day. Mothers 
and fathers are burying sons and daughters, or in some cases, sons and 
daughters are burying mothers and fathers.
  I bring this up simply to impart the gravity of the situation, which 
makes our response all the more urgent. But while the situation is 
certainly grave, that does not mean that we should ever lose hope.
  As we have worked on this legislation we will soon send to the 
President, we all had to go out and gain an understanding of the facts 
on this issue. Everybody on both sides of the aisle spent so much time 
on this bill. In doing that, we have gleaned so much understanding.
  And that is, after all, how our Republic works. That is what the 
people's House does. We learn from our constituents. We hear their 
stories. We see the suffering, and then we act.
  This is a fantastic moment of people coming together to solve a 
problem. I think, in this process, we gained something very special.
  Many of us heard the stories from incredible souls who have known 
unspeakable loneliness and who struggle with drug addiction. They made 
it through to the other side.

  We met family members and friends who have known the pain and the 
fear that accompanies loving someone wrestling with addiction. Every 
one of us knows somebody or is related to somebody who has gone through 
this.
  We met those who will never again have the chance to see the ones 
that they love so much.
  Amid the overwhelming darkness, we have gotten to see their spark, 
their strength. From this pain has come something more powerful: 
resolve and a passion to make sure that others have a safe place to 
turn, that this doesn't happen to their family.
  Witnessing this kind of strength, witnessing this kind of resilience, 
that is what helped produce this legislation. Through these bills, we 
are trying to ensure that anyone who needs help is not too isolated to 
receive it.
  We are giving our communities the resources that they need to provide 
stronger treatment networks and support systems. That is where the 
healing happens. That is where Americans are at our best.
  If this legislation can save one life and bring help to one person, 
that is what matters.
  It is going to do far more than that.

                              {time}  1100

  So I want to thank all of those who were brave enough to share their 
stories with all of us. I want to thank all of those people who all of 
us met with

[[Page H9246]]

for being brave, for coming here, for meeting us, and for testifying 
and giving us their stories. And for all of those who are continuing to 
struggle in silence, I want them to know that there is no shame in 
their trials. In our own ways, we all fall.
  In our Catholic tradition, we look to St. Jude as the patron saint of 
lost causes, a keeper of those who some in society may have written 
off. To me, his guardianship is written in this legislation. There are 
no lost causes. No one is permanently down. It is about offering a 
helping hand, and it is about opening our hearts.
  Mr. Speaker, I am very proud of this legislation. I am so thankful to 
my colleagues on both sides of the aisle who came together to put these 
families and to put these communities first.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentleman from New 
York (Mr. Tonko), a member of the committee.
  Mr. TONKO. Mr. Speaker, I thank the gentleman for yielding.
  Mr. Speaker, all across my district, I have encountered stories of 
individuals and families whose lives have been irrevocably changed by 
the scourge of the opioid epidemic: a father who lost his daughter too 
young and is pouring his grief into advocacy, a former neighbor and a 
dad who left behind two young children, a young man who is walking the 
hard path of recovery and showing others how to do the same.
  These are the stories I hear day in and day out. They fill my heart; 
they fill my voice. And it is because of them that I am so very proud 
to cast a vote in favor of H.R. 6 today. It is my hope that this 
legislation will be another small step for our Nation on its road of 
recovery from this epidemic.
  I am particularly proud that this bill incorporates legislation that 
I have introduced, along with my good friend Representative Ben Ray 
Lujan of New Mexico, which will provide a meaningful expansion to high-
quality addiction treatment by allowing additional healthcare 
providers, such as nurse midwives, to prescribe buprenorphine, a 
medication-assisted treatment for opioid use disorder.
  In addition, this provision will make permanent buprenorphine-
prescribing authority for nurse practitioners and physician assistants 
and allow certain providers to treat more patients in the first year of 
their license.
  These changes will make a big difference for individuals struggling 
from addiction across our country, especially in rural areas, and for 
vulnerable populations like pregnant and postpartum women and the 
13,000 babies born each year with neonatal abstinence syndrome.
  I also want to highlight the inclusion of my Medicaid Reentry Act 
into this bill, which aims to improve care for individuals who are 
leaving jail or prison and reentering a community setting.
  The SPEAKER pro tempore (Mr. Jody B. Hice of Georgia). The time of 
the gentleman has expired.
  Mr. PALLONE. Mr. Speaker, I yield an additional 30 seconds to the 
gentleman from New York.
  Mr. TONKO. These individuals are highly vulnerable to opioid overdose 
due to lack of effective addiction treatment while incarcerated. By 
passing this legislation, we will allow States to engage in 
demonstration projects to improve medical care and transition-related 
services to Medicaid-eligible incarcerated individuals in the 30 days 
prior to their release, reducing the risk of overdose as individuals 
are coming back into the community for a second chance. I truly believe 
that this provision will transform lives.
  I thank Ranking Member Pallone, Chairman Walden, and their staffs for 
their continued efforts in this process. Without their dedicated, 
bipartisan work, we would not be making this progress today.
  Mr. Speaker, I urge my colleagues to support H.R. 6.
  Mr. WALDEN. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from Texas (Mr. Burgess). The country is well served by his 
chairmanship of the Subcommittee on Health.
  Mr. BURGESS. Mr. Speaker, I thank the gentleman for yielding.
  Mr. Speaker, H.R. 6 is by far the most comprehensive legislation to 
address this national crisis. While more work remains--and I am the 
first to admit it--it provides meaningful solutions and vital resources 
for our States and localities.
  Many of the priorities developed by the Energy and Commerce Committee 
are included in H.R. 6, like the 21st Century Tools for Pain and 
Addiction Treatment Act, partially repealing the institutions for 
mental disease exclusion and strengthening interagency coordination at 
our international mail facilities so that, perhaps, once and for all, 
we can do something about this poison coming into our country from 
eastern Asia to the detriment of our citizens.
  I believe H.R. 6 could have been stronger. It could have included 
language aligning 42 CFR Part 2 with HIPAA. That stand-alone bill 
received 357 votes in this House. And I promise you, you will see it 
again. I am concerned about expanding prescriptive authority for 
nonphysicians, and I hope we will be able to look at that again in the 
future.
  But I cannot let the perfect be the enemy of the good. I urge our 
Members to support this product today.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Michigan (Mrs. Dingell), also a member of the committee.
  Mrs. DINGELL. Mr. Speaker, I thank Ranking Member Pallone for 
yielding and Chairman Walden for his leadership in bringing this bill 
to the floor.
  Mr. Speaker, I rise in strong support of H.R. 6, the SUPPORT for 
Patients and Communities Act. This is a critical first step in 
addressing the opioid epidemic.
  I have lived on all sides of this. I lived in a home with a father 
who was an opioid addict before anyone knew what it was. I had a sister 
who died of a drug overdose. Yet I also live with a man who has very 
serious chronic pain and needs opioids to live his life comfortably.

  We cannot let the pendulum swing too far in either direction, and we 
cannot be denying medication to those who need it. I am confident that 
this legislation strikes the right balance.
  This bill has four provisions which I authored included in it:
  The ACE Research Act, which I cosponsored with my friend Mr. Upton, 
will spur innovative research into nonopioid pain medications at NIH 
and will help lead the next big breakthrough and bring benefits to 
patients. We need nonaddictive pain drugs.
  I am also pleased that Jessie's Law, which I have worked on for years 
with Mr. Walberg, is in this. This provision, which is named after a 
young woman we lost far too soon, would require HHS to establish best 
practices to ensure that medical professionals have full knowledge of 
their patient's opioid history.
  The Safe Disposal of Unused Medication Act fixes a critical gap in 
our laws by permitting hospice employees from disposing of unused 
opioids after a patient has passed away or the medication is no longer 
needed.
  Finally, I was pleased to work on language with Dr. Bucshon to ensure 
that the Welcome to Medicare wellness exam includes a review of the 
beneficiary's current opioid prescriptions and screening for potential 
substance use disorder.
  As we pass this legislation to combat this epidemic which has claimed 
so many lives, we cannot forget the 25 million people who do live in 
pain. We cannot let the pendulum go either way.
  Mr. WALDEN. Mr. Speaker, it is now my privilege to yield 30 seconds 
to the gentleman from Ohio (Mr. Latta), the very effective chairman of 
our Digital Commerce and Consumer Protection Subcommittee.
  Mr. LATTA. Mr. Speaker, I thank the gentleman for yielding.
  Mr. Speaker, I rise today in support of H.R. 6. This legislation will 
make a significant difference to tens of thousands of Americans who are 
struggling with addiction.
  I am pleased that my bill, the INFO Act, is part of the fight against 
the opioid crisis. The INFO Act is essential to ensuring we are 
providing behavioral health professionals, advocates, physicians, and 
families with the tools, resources, and funding information they need 
to prevent, identify, and treat addiction.
  Furthermore, H.R. 6 is critically important to stop the flow of 
illegal opioids, prevent the misuse of drugs, and help those who are 
addicted. With 190 Americans dying every day from overdoses, it is time 
to act now.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentleman from 
Texas

[[Page H9247]]

(Mr. Gene Green), the ranking member of our Health Subcommittee.
  Mr. GENE GREEN of Texas. Mr. Speaker, I thank the ranking member for 
yielding to me.
  Mr. Speaker, I rise in support of the SUPPORT for Patients and 
Communities Act, bipartisan legislation that will help stem the tide 
against the Nation's opioid crisis and support Americans overcoming 
opioid addiction.
  In 2016 alone, 42,000 Americans died from opioids, including 
prescription pain relievers and illicit opioids like fentanyl. This is 
a serious national crisis that affects public health and the social and 
economic welfare of communities throughout our great country.
  The Energy and Commerce Health Subcommittee, which I am proud to 
serve on as ranking member, held several hearings on the opioid crisis 
last spring. I am proud to see our committee and both Chambers of 
Congress come together and support the package before us today that 
includes the Comprehensive Opioid Recovery Centers Act that I 
introduced, along with my friend Representative Brett Guthrie from 
Kentucky, earlier this year.
  This legislation would fund designated treatment centers where 
Americans suffering from opioid abuse can receive comprehensive 
patient-centered care. The bill would allow designated treatment 
centers to provide wraparound services, including mental health, 
counseling, recovery housing, and job training and placement to support 
reintegration into the workforce. These wraparound services have been 
shown to help many Americans successfully overcome opioid addition.
  The SUPPORT for Patients and Communities Act includes several 
provisions to combat this crisis, including strengthening the Federal 
Government's authority to restrict illegal drugs entering our country, 
and providing Medicaid for at-risk youth and former foster children.
  Mr. Speaker, I ask my colleagues to join me and support this 
important legislation.
  Mr. WALDEN. Mr. Speaker, I am privileged to yield 30 seconds to the 
gentleman from New Jersey (Mr. Lance).
  Mr. LANCE. Mr. Speaker, I rise in strong support of H.R. 6, which 
delivers greater resources, treatment, and mitigation tools to fight 
opioid addiction.
  I am especially pleased that a bill that I sponsored related to 
infectious diseases is included in the final package. I commend the 
Congressman from Massachusetts, Mr. Joe Kennedy, for being my lead 
cosponsor on this part of the overall whole.
  Infectious diseases complicate the lifelong path toward addiction 
recovery. H.R. 6 is one of the most important measures to pass this 
Congress. It should be supported unanimously.
  Mr. PALLONE. Mr. Speaker, may I inquire as to how much time remains 
on each side.
  The SPEAKER pro tempore. The gentleman from New Jersey has 3 minutes 
remaining.
  Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentleman from New 
Mexico (Mr. Ben Ray Lujan).
  Mr. BEN RAY LUJAN of New Mexico. Mr. Speaker, I rise today in support 
of H.R. 6, the SUPPORT for Patients and Communities Act.
  This is an important step forward in the fight against the Nation's 
opioid epidemic. However, this Congress must acknowledge that this is 
not the end.
  Healthcare is a right, not a privilege. There is much more work to do 
to ensure that families get the help that they deserve.

  I am pleased that this package includes language that I have 
championed to address gaps in prevention and gaps in access to 
treatment. In addition, this bill will create pathways to behavioral 
healthcare jobs in communities like New Mexico.
  Still, Congress must do more. As we have heard from Representative 
Cummings, this is going to take much more money, investment, and 
comprehensive legislation.
  Mr. WALDEN. Mr. Speaker, I am privileged to yield 30 seconds to the 
gentleman from Kentucky (Mr. Guthrie).
  Mr. GUTHRIE. Mr. Speaker, I rise in support of the SUPPORT for 
Patients and Communities Act.
  One of the main things I hear back home is how our Nation's ongoing 
opioid crisis has affected either themselves, their loved ones, or 
their community.
  Mothers, fathers, children, bankers, dentists, bus drivers, or high 
school athletes, anyone can fall victim to opioid use disorder. That is 
why I am proud to work with my colleagues in support of the act so that 
we can help these people who are suffering from this terrible epidemic.
  Mr. Speaker, I urge my colleagues to support this critical 
legislation so that we can deliver relief to those communities.

                              {time}  1115

  Mr. PALLONE. Mr. Speaker, I yield myself 1 minute.
  Mr. Speaker, before we conclude debate, let me just take a moment to 
thank everyone for all of their hard work getting this bill across the 
finish line.
  This bill represents a collection of Member ideas and policies across 
the political spectrum. Many people may not know this, but the staff of 
the House and Senate committees negotiated this bill in a matter of 
weeks, and that is no small feat. It took a lot of effort, long hours 
and weekend work to pull this off. It is a product we can all be proud 
of.
  So let me thank all legislative counsel and CBO for their efforts as 
well.
  Mr. Speaker, I reserve the balance of my time.
  Mr. WALDEN. Mr. Speaker, I yield 30 seconds to the gentleman from 
Florida (Mr. Bilirakis) to speak about the legislation.
  Mr. BILIRAKIS. Mr. Speaker, the SUPPORT for Patients and Communities 
Act is the product of a year of hearings and investigations into 
America's opioid crisis.
  This thoughtful bipartisan legislation will provide more tools to our 
communities to help them. I am proud that we included my legislative 
efforts to help Medicare beneficiaries, begin reforms to the sober home 
industry, and address the problem of patient brokering.
  We need to pass this bill and give our constituents the help they 
need.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, I yield 30 seconds to the gentleman from 
Ohio (Mr. Johnson), who is a leader on this issue.
  Mr. JOHNSON of Ohio. Mr. Speaker, today is the culmination of months 
of tireless work driven by heartbreaking stories of people whose lives 
were destroyed by opioid addiction, and, just as importantly, the 
powerful stories of hope and recovery.
  I am grateful for the hard work of my colleagues and our Energy and 
Commerce staff. I am proud that my legislation to improve how health 
professional students are taught to recognize, prevent, and address 
addiction, as well as to expand the availability of telehealth and peer 
support services for those struggling with addiction is included.
  Mr. Speaker, I am looking forward to continuing the hard work ahead 
on this very important issue, and I urge support for the bill.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, I yield 30 seconds to the gentleman from 
Indiana (Mr. Bucshon), who is a talented physician on our committee.
  Mr. BUCSHON: Mr. Speaker, I rise today in support of H.R. 6, the 
SUPPORT for Patients and Communities Act.
  This bipartisan bill will help our struggling communities to combat 
the opioid epidemic by increasing access and improving care to those in 
need and preventing new occurrences of opioid misuse and abuse.
  Section 2002, which I authored, would provide screening for chronic 
pain, address possible non-opioid pain alternatives, and increase early 
detection of opioid use disorder in seniors as they enter Medicare.
  Mr. Speaker, I am proud to have worked with my colleagues on 
solutions to this serious epidemic, and I urge support of H.R. 6.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, I yield 30 seconds to the gentleman from 
Michigan (Mr. Walberg) to speak on the measure.

[[Page H9248]]

  

  Mr. WALBERG. Mr. Speaker, I rise today in strong support of this 
bipartisan package to address the opioid crisis devastating our 
communities.
  This legislation includes two provisions authored by myself and my 
good friend from Michigan, Congresswoman Debbie Dingell.
  One will help safely dispose of unused drugs and prevent their 
diversion into the community. The other, Jessie's Law, honors the 
memory of Jessie Grubb and will help prevent future overdose tragedies 
under medical care.
  Mr. Speaker, this critical legislation will help save and rebuild 
lives. I urge its passage today, and I look forward to its quickly 
advancing to the President's desk.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, I yield 30 seconds to the gentleman from 
Georgia (Mr. Carter), who is our resident pharmacist on the Energy and 
Commerce Committee.
  Mr. CARTER of Georgia. Mr. Speaker, I would like to thank Chairmen 
Walden and Burgess for working so hard with our partners across the 
aisle as well as across the Capitol to come to a consensus on this 
critical legislation necessary to combat the opioid epidemic.
  As the only pharmacist currently serving in Congress, I have seen 
families saved by pain medications and have seen families torn apart by 
the same drugs.
  Since this body began tackling the opioid epidemic, I have said there 
are three major components to this crisis: prevention, law enforcement, 
and treatment.
  This legislation touches all three prongs of the opioid crisis with a 
number creative solutions in addition to providing offsets to ensure 
that solving a public health crisis does not lead to a fiscal one.
  This package is not a silver bullet, but as legislators we need to do 
everything in our capacity to prevent the addiction and overdoses that 
occur every day in the United States.
  Mr. Speaker, I would like to thank Chairman Walden and Burgess for 
working so hard with our partners across the aisle as well as across 
the Capitol to come to a consensus on this critical legislation 
necessary to combat the opioid epidemic.
  As the only pharmacist in Congress, I have seen families saved by 
pain medications and have seen families torn apart by the same drugs.
  Since this body began tackling the opioid epidemic, I have said there 
are three major parts to the crisis: prevention, law enforcement, and 
treatment.
  This legislation touches all three prongs of the opioid crisis with a 
number of creative solutions in addition to providing offsets to ensure 
that solving a public health crisis does not lead to a fiscal one.
  I voted for many of these bills when they came before Energy and 
Commerce for markup, and once again I want to offer my full support for 
this legislation.
  I am pleased that this package includes three of my own bills, the 
Special Registration for Telemedicine Clarification Act, the Abuse 
Deterrent Access Act, and the Empowering Pharmacists in the Fight 
Against Opioid Abuse Act.
  This package is not a silver bullet--but as legislators we need to do 
everything in our capacity to prevent the addiction and overdoses that 
occur every day in the United States.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, I yield 30 seconds to the gentleman from 
Illinois (Mr. Roskam).
  Mr. ROSKAM. Mr. Speaker, what a joy it is to be on the floor today. 
What a joy it is to be amongst a group of people who have set aside 
partisanship and have come together to address a crisis that is 
crushing our constituents. What a joy it is to be a part of the process 
and among a group of people who are trying to find common ground.
  This is a good day, Mr. Speaker. There is good work that is 
happening. I chair the Health Subcommittee, and it was incredible to 
see the work that that subcommittee did on the Ways and Means 
Committee.
  Mr. Speaker, I am pleased to strongly endorse this bill, and I urge 
its passage.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, I am honored to yield 30 seconds to the 
gentleman from Minnesota (Mr. Paulsen), who has worked so hard for 
these issues.
  Mr. PAULSEN. Mr. Speaker, I am excited to support this legislation. 
It is bipartisan.
  Minnesotans and those who are on the front lines of the opioid crisis 
will be helped, and it will aid the millions of American families who 
are affected by this epidemic.
  It includes a bipartisan measure that I authored that will help 
prevent opioid addiction among seniors by educating them on alternative 
pain management treatments, and the proper, safe disposal of 
prescription painkillers. It will help more than 90,000 at-risk seniors 
from descending into a deadly spiral of addiction.
  The end result will be less addiction, fewer overdoses, and safer 
Minnesota communities.
  Mr. Speaker, I thank the chairman for yielding time.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, I yield 30 seconds to the gentleman from 
Ohio (Mr. Renacci) to speak on the measure.
  Mr. RENACCI. Mr. Speaker, I rise in support of this legislation which 
includes my bipartisan bill, the Strengthening Partnerships to Prevent 
Opioid Abuse Act.
  The opioid epidemic has hit my home State of Ohio particularly hard, 
with thousands of Ohioans dying from drug overdoses every year.
  This bill will make it easier for Medicare Advantage Part D drug 
plans, and HHS to combat fraud, waste, and abuse and prevent the 
overprescribing of opioids to vulnerable seniors.
  I would like to thank members of this conference committee as well as 
their staff for including my bill in this package and for their hard 
work to pass legislation to address the opioid epidemic.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, may I inquire as to how much time each side 
has remaining?
  The SPEAKER pro tempore. The gentleman from Oregon has 8\1/2\ minutes 
remaining. The gentleman from New Jersey has 1\1/2\ minutes remaining.
  Mr. WALDEN. Mr. Speaker, I yield 30 seconds to the distinguished 
gentleman from Michigan (Mr. Bishop.)
  Mr. BISHOP of Michigan. Mr. Speaker, I rise in strong support of H.R. 
6 which will make great strides toward ending the opioid crisis once 
and for all.
  I am pleased this package includes my bill, the STOP Act, which is 
targeted legislation to help stop synthetic opioids like fentanyl and 
carfentanil from entering our country through the international mail 
system.
  I want to make sure I thank all the parents, educators, law 
enforcement, emergency response personnel, healthcare professionals, 
victims, and those suffering from addiction who have been working with 
me to ensure this legislation gets signed into law. Your hard work has 
made a real difference.
  Mr. Speaker, I also want to thank my colleagues for their support, 
and I urge a ``yes'' vote on the underlying bill, H.R. 6.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, few States have been harder hit than 
Kentucky in this effort on opioids, a terrible tragedy.
  Mr. Speaker, I yield 30 seconds to the distinguished gentleman from 
Kentucky (Mr. Barr).
  Mr. BARR. Mr. Speaker, on behalf of the families of the Commonwealth 
of Kentucky which suffers from the third highest opioid overdose 
mortality rate in the Nation, I rise today in support of H.R. 6, and I 
thank the chairman for his leadership on this.
  This legislation marks a critical investment to help individuals and 
families struggling with addiction rise above addiction and transition 
back into the workforce.
  Specifically, H.R. 6 includes my legislation, the CAREER Act, which 
creates a demonstration program to promote evidence-based transitional 
housing that pairs recovery support with life skills, workforce 
training, and job placement.
  I would like to thank the many nonprofits in my home State of 
Kentucky for inspiring this legislation.

[[Page H9249]]

  

  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, I yield 30 seconds to the gentleman from 
Pennsylvania (Mr. Barletta). There is a lot of enthusiasm for this 
legislation, Mr. Speaker. We want to hear from Mr. Barletta about his 
thoughts on it. He has been a real leader on it.
  Mr. BARLETTA. Mr. Speaker, I rise today in support of H.R. 6 which 
includes my bill, the Treating Barriers to Prosperity Act.
  The Appalachian region, including much of my home State of 
Pennsylvania, has an overdose death rate 65 percent higher than the 
rest of the country for people ages 15 to 64.
  My legislation will allow communities to use Appalachian Regional 
Commission funding for everything from attracting doctors to putting in 
broadband for telemedicine. It will spur economic growth in communities 
hit hardest by the opioid epidemic, while also helping those struggling 
with addiction by breaking down barriers to employment.

  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, I yield 30 seconds to the gentlewoman from 
California (Mrs. Mimi Walters) who is from the West Coast and is a real 
leader on our committee.
  Mrs. MIMI WALTERS of California. Mr. Speaker, I rise in support of 
H.R. 6 and the IMD exclusion repeal probation modeled after my bill, 
the IMD CARE Act.
  I fought to ensure the IMD exclusion repeal was part of this final 
agreement because increasing inpatient treatment options is essential 
in our fight against the opioid epidemic.
  The Orange County Board of Supervisors agrees with leading addiction 
treatment groups: the IMD exclusion repeal and the IMD CARE Act are the 
most important steps we can take to end drug overdose deaths in Orange 
County.
  Mr. Speaker, I urge my colleagues to support this legislation to 
address this public health crisis.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, I yield 30 seconds to the gentlewoman from 
Indiana (Mrs. Walorski), who is also a real worker on this legislation, 
to speak on the measure.
  Mrs. WALORSKI. Mr. Speaker, I rise today in support of H.R. 6, the 
SUPPORT for Patients and Communities Act. It includes my bill, named 
for Dr. Todd Graham, who was senselessly murdered last year over an 
opioid prescription.
  With this legislation, we build on Dr. Graham's legacy of treating 
patients not only for their pain, but for their underlying causes. 
Today we are taking bipartisan action to expand access to nonopioid 
alternatives and give our communities better tools to prevent and treat 
addiction.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, I yield 30 seconds to the gentleman from 
Michigan (Mr. Mitchell).
  Mr. MITCHELL. Mr. Speaker, I rise today in support of H.R. 6 as did 
my colleagues.
  The opioid crisis has impacted nearly every community across this 
country, and in order to most effectively combat this crisis, we must 
establish a comprehensive response plan.
  I am pleased this bill includes a version of my amendment offered in 
committee to establish a system to track Federal funding for drug 
control efforts, ensuring the government knows exactly where the money 
is being spent, how it is being used, and if it is working.
  Mr. Speaker, I support this bill, and I ask my colleagues to do so as 
well.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, we have heard from doctors, we heard from 
pharmacists, and we have heard from many family members. Now we will 
hear from somebody who has a distinguished career in law enforcement.
  Mr. Speaker, I yield 30 seconds to the gentleman from California (Mr. 
Knight) to speak on this legislation.
  Mr. KNIGHT. Mr. Speaker, as a police officer and a street cop in 
L.A., I have seen the problems that the opioid epidemic has done to our 
communities. It has literally destroyed families and hurt our 
communities to no end. H.R. 6 is a much-needed display of 
bipartisanship to address the ongoing opioid crisis and epidemic.
  Many of the issues that have come out of this bill spur development 
of national best practices for substance abuse recovery housing and 
incorporates my bill, the Eliminating Kickbacks in Recovery Act, to 
establish meaningful penalties for profiteering off other people's pain 
and addiction through illicit referrals.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, I yield 30 seconds to the gentleman from 
Virginia (Mr. Brat) to speak on the measure.
  Mr. BRAT. Mr. Speaker, I rise today to thank Chairman Brady, 
Chairwoman Foxx, and Chairman Walden for addressing opioid and 
substance abuse disorders and their work on H.R. 6, the SUPPORT for 
Patients and Communities Act. I am grateful to my colleagues for 
treating the crisis with the urgency it deserves.
  In my district, this crisis has affected way too many. I am also 
grateful that my bill, H.R. 5889, the Recognizing Early Childhood 
Trauma Related to Substance Abuse Act of 2018 was included in the final 
package before us today.
  Mr. PALLONE. Mr. Speaker, I continue to reserve the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, I don't believe I have any other speakers on 
my side of the aisle pending, so with that, I reserve the balance of my 
time.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I do urge support for this legislation. It is a good 
bill. It expands access in a number of ways in coverage. But I do also 
want to point out that there are limitations to the bill. In other 
words, we do need to do a lot more.

                              {time}  1130

  For example, we still haven't expanded Medicaid coverage in many 
States. Medicaid coverage is crucial, in terms of providing treatment.
  The bottom line is that the treatment infrastructure in our country 
is very much inadequate. Many people really do not have access to 
treatment in many parts of the country, including my home State.
  I want to close by urging everyone to support this bipartisan and 
bicameral bill, because it does do a lot. At the same time, I remind my 
colleagues that we have a lot more to do if we are going to address 
this opioid crisis, which actually is getting worse instead of better.
  Mr. Speaker, I yield back the balance of my time.
  Mr. WALDEN. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, before I close, I want to especially thank our staff on 
both sides of the aisle for their incredible work. They have worked day 
and night, literally, and all through the weekend--also, the folks at 
the Congressional Budget Office and Legislative Counsel. But I 
especially thank our team: Josh Trent, Kristen Shatynski, Caleb Graff, 
Dan Butler, James Paluskiewicz, Danielle Steele, Adam Buckalew, Melissa 
Froelich, Bijan Koohmaraie, Ryan Long, Peter Keilty, and Jenn Sherman, 
and the whole team at the Energy and Commerce Committee on both sides 
of the aisle.
  We worked through a lot of difficult issues, issues where we didn't 
start on the same side, but we ended on the same page as we listened to 
each other, as we listened to our constituents at home.
  Seldom are there times when you are legislating that you can say what 
you are doing will actually save lives. This is one of those times. 
What we are doing here today is saving lives.
  We will lift people out of addiction who are trapped there today. We 
will prevent people from ending up in that emergency room because they 
overdosed. Maybe they will find a better path. We will go after those 
who perpetrated this on the country and after those who try to smuggle 
in the illicit synthetics and fentanyl that are cut with heroin and 
kill our people.
  So today's effort is about people like Amanda, who left this world 
tragically

[[Page H9250]]

at a very young age through an overdose. And it is about her parents. 
It is about Mike and Winnie. It is about Paula, and it is about her 
sons and sister. It is about a woman I met in Hermiston who had to 
travel 5 hours to find a physician who could oversee her treatment on 
Suboxone because nobody was available. We help fix that in this 
legislation.
  It is about my friends at Winding Waters in Enterprise, Oregon, who I 
was with last week, and the sheriff and others, who talked about the 
continuing problems and challenges they face and who have given me 
great guidance on these and other issues.
  From one end of my district to another, from one end of our country 
to another, we have all listened. We have heard. Frankly, we have cried 
as we have heard the stories of parents who help their children through 
addiction, only to drop them off at college and a matter of days later 
retrieve a body.
  That is what brings us together here today, Mr. Speaker. It is their 
stories that are woven deeply into this legislation. It is because of 
them that we will make a difference and we will do it right.
  We will know that, as we pass this today and the Senate after us, 
that more work does remain to be done. We are on a journey together, 
though, and we will find solutions.
  Mr. Speaker, I thank my colleagues on both sides of the aisle. I 
thank our staffs. I thank the American people who have reached out to 
us, counseled us, and helped us.
  Mr. Speaker, I urge my colleagues to strongly support passage of the 
SUPPORT Act. For patients and for communities, H.R. 6 needs to become 
law, and it will shortly.
  Mr. Speaker, I yield back the balance of my time.
  Ms. MAXINE WATERS of California. Mr. Speaker, I rise to support H.R. 
6, the SUPPORT for Patients and Communities Act, a bipartisan bill to 
address opioid addiction and other forms of substance abuse.
  A comprehensive, common-sense, and compassionate approach to 
substance use disorders is long overdue. For far too long, many 
communities throughout the United States have been devastated by 
substance use disorders. However, despite the widespread suffering that 
millions of people--particularly African Americans during the crack 
cocaine epidemic--endured and still endure today, our federal, state, 
and local governments, in many instances, have pursued punitive 
measures in lieu of effective solutions to ensure that all communities 
can adequately heal from the devastating impacts of addiction.
  I am especially pleased that this bill now includes my amendment to 
the House version of H.R. 6, which requires the Department of Health 
and Human Services (HHS) to conduct a review of the organizations, 
government agencies, and other entities that receive federal funding to 
provide substance use disorder treatment services. In addition, the 
amendment directs HHS to develop, and submit to Congress, a plan to 
direct appropriate resources to address the inadequacies in services or 
funding identified through the review.
  I am also pleased that this bill addresses concerns that I raised 
about the opioid legislation in the House that allowed states to use 
Medicaid funds to provide treatment to persons with opioid use 
disorders in Institutions for Mental Disease (IMDs), but did not allow 
similar treatment for persons with other types of substance use 
disorders. In order to seriously address substance use disorders in 
communities throughout the United States, it is critical that we 
include persons who suffer from all types of substance use disorders, 
including those that involve alcohol, cocaine, and methamphetamine, as 
well as opioids.
  I offered an amendment to the legislation in the House aimed at 
addressing my concern about the exclusion of non-opioid forms of 
substance use disorders from treatment in IMDs. While my amendment was 
not accepted, I am pleased that efforts were made to address my 
concern. The final version of H.R. 6 allows states to provide Medicaid 
coverage in IMDs for persons with all types of substance use disorders 
and also includes safeguards to ensure that states do not reduce the 
availability of community-based treatment for persons suffering from 
substance use disorders.
  While I appreciate the work that has been done on many components of 
this bill, I still have some important concerns. As the Ranking Member 
of the House Committee on Financial Services, which has jurisdiction 
over housing programs, I am concerned that this bill falls short when 
it comes to providing housing for people with substance use disorders. 
The bill includes a provision that creates a new grant program to 
provide temporary housing assistance to help people with substance use 
disorders, but this new funding will only be available in half of the 
states. This will leave the other half of the states continuing to 
struggle with the challenges of helping people with substance use 
disorders who are in need of housing. Furthermore, this bill does 
nothing to address the overly punitive and unfair policies governing 
our federal housing programs that create unnecessary barriers to 
housing for people who have criminal backgrounds related to substance 
use disorders.
  I am encouraged that there is bipartisan support for addressing the 
housing needs of persons suffering from substance use disorders, but I 
am disheartened that Congress continues to fall short in its efforts to 
provide comprehensive solutions that will help people suffering from 
substance use disorders in every state of the country. As we work to 
address the opioid crisis at hand, let's not forget that Congress still 
has a lot of work to do in the way of criminal justice reform to 
address the ongoing harmful and discriminatory impacts of the war on 
drugs era.
  Despite these concerns, I believe this bill includes some valuable 
bipartisan solutions that represent a step in the right direction. I 
urge all of my colleagues to support H.R. 6, and I look forward to 
continuing to work with my colleagues to address the scourge of 
substance use disorders in communities throughout the United States.
  Mr. WALDEN. Mr. Speaker, I include the following letters in the 
Record.

                              Corporate Health Care Coalition,

                                               September 26, 2018.
     Hon. Paul Ryan,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. Mitch McConnell,
     Majority Leader, U.S. Senate,
     Washington, DC.
     Hon. Nancy Pelosi,
     Minority Leader, House of Representatives,
     Washington, DC.
     Hon. Charles Schumer,
     Minority Leader, House of Representatives,
     Washington, DC.
       Dear Speaker Ryan, Leader McConnell, Leader Pelosi and 
     Leader Schumer: The Corporate Health Care Coalition (CHCC) is 
     writing to commend both the House of Representatives and the 
     Senate on finalizing the SUPPORT for Patients and Communities 
     Act (H.R. 6), bipartisan legislation to address the nation's 
     opioid crisis. CHCC is comprised of companies from varying 
     industries that compete in the global marketplace and sponsor 
     health plans for the benefit of our employees and other 
     beneficiaries. Collectively, CHCC member companies provide 
     health benefits for nearly 5 million Americans across every 
     state in the nation.
       The depth and devastation associated with the opioid crisis 
     is being felt by families and communities nationwide. CHCC 
     therefore applauds lawmakers for working on a bipartisan 
     basis to reach consensus on H.R. 6, which represents a 
     critical step forward in providing necessary resources for 
     treatment and prevention efforts related to opioids.
       We urge the House and Senate to pass this important 
     legislation.
           Sincerely,
     Corporate Health Care Coalition.
                                  ____


      [From the First Focus Campaign for Children, Sept. 27, 2018]

   Statement: First Focus Campaign for Children Applauds Bipartisan, 
               Bicameral Agreement on Opioid Legislation

                           (By Simona Combi)

       Washington, D.C., Sept. 27, 2018.--First Focus Campaign for 
     Children is delighted to see bipartisan agreement on tackling 
     the opioid addiction epidemic and helping those affected by 
     it. In June, the House passed H.R. 6, the SUPPORT for 
     Patients and Communities Act by a vote of 39614. On September 
     17th, the Senate passed the Opioid Crisis Response Act of 
     2018 by a vote of 99-1.
       ``It is crucial that families and foster youth affected by 
     this devastating crisis get the help they need to overcome 
     opioid addiction and put their lives back on track,'' said 
     Bruce Lesley, First Focus president. ``We are particularly 
     heartened that this bipartisan bill offers substantive help 
     and hope both sides of the aisle will make children a 
     priority going forward.''
       The opioid crisis affects foster children and youth in two 
     ways: First, children enter the child welfare and foster 
     system often as a result of substance abuse by their parents, 
     and secondly, foster youth who age out of care are at an 
     increased risk of substance use disorders. We therefore 
     commend Congress for including numerous provisions in the 
     bipartisan, bicameral opioid package that will improve the 
     lives of foster children and youth impacted by the opioid 
     crisis, including:
       Continuous Health Insurance for former foster youth: This 
     provision, which corrects a glitch in existing law, allows 
     foster youth who have aged out of care to remain on Medicaid 
     through age 26, regardless of whether they relocate to other 
     states. This provision recognizes the critical importance of 
     health coverage for former foster youth as they transition 
     into adulthood. Earlier this

[[Page H9251]]

     month, First Focus, the State Policy and Advocacy Reform 
     Center, and FosterClub held a congressional briefing on the 
     importance of Medicaid to foster children and youth.
       Family-Focused Residential Treatment: This provision 
     promotes family-based residential treatment for substance use 
     disorders by requiring the HHS Secretary to issue guidance to 
     states on how they can support such treatment facilities.
       Recovery and Reunifying Families: This provision promotes 
     the replication of effective recovery coach programs to 
     improve outcomes for children and families in the child 
     welfare system who are impacted by substance use disorders.
       Family-Focused Residential Treatment: This provision 
     creates a grant program to promote family-based residential 
     treatment programs, which are critical to helping parents and 
     families get the treatment they need to overcome addiction.
       Plans of Safe Care: This provision provides grants to 
     states to improve and coordinate their response to ensure the 
     safety, permanency, and well-being of infants affected by 
     substance use.
       Trauma-Informed Care: This provision gives the Center for 
     Disease Control (CDC) authority to work with states to 
     collect and report data on adverse childhood experiences. It 
     also directs the CDC to form a task force to promote best 
     practices in treating children impacted by trauma and to 
     recommend best practices to federal agencies regarding its 
     coordination and response to substance use disorders and 
     other forms of trauma that affect children and families.
       At-Risk Youth Medicaid Protection: This legislation would 
     ensure that incarcerated youth are simply suspended, rather 
     than terminated, from Medicaid while they are incarcerated. 
     It would require states to automatically restore full 
     eligibility to youth upon release from incarceration, and to 
     take any steps necessary to make sure that youth begin 
     receiving medical assistance benefits immediately.
       The Fiscal Year 2019 annual spending bill for the 
     Departments of Labor, Health and Human Services, Education 
     and Related Agencies (H.R. 6157) includes $3.8 billion for 
     combatting the opioid crisis, and the bill should be signed 
     into law soon. Adequate federal funding for these new 
     programs benefitting our foster children is critical. Looking 
     ahead to Fiscal Year 2020, though, these gains for our 
     children could be jeopardized if Congress fails to lift the 
     budget cap for non-defense discretionary spending established 
     by the 2011 Budget Control Act. If budget caps are allowed, 
     this type of spending will go down by $55 billion. Congress 
     must prioritize children in our federal budget decisions.

  Mr. WALDEN. Mr. Speaker, I include the following letters in the 
Record.

                                    American Benefits Council,

                               Washington, DC, September 27, 2018.
     Hon. Mitch McConnell,
     Majority Leader, U.S. Senate,
     Washington, DC.
     Hon. Chuck Schumer,
     Minority Leader, U.S. Senate,
     Washington, DC.
     Hon. Paul Ryan,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. Nancy Pelosi,
     Minority Leader, House of Representatives,
     Washington, DC.
       Dear Leader McConnell, Leader Schumer, Speaker Ryan and 
     Leader Pelosi: The American Benefits Council (the Council) 
     supports the Substance Use-Disorder Prevention that Promotes 
     Opioid Recovery and Treatment (SUPPORT) for Patients and 
     Communities Act (H.R. 6). We urge Congress to approve this 
     measure as an important step toward addressing the nation's 
     opioid addiction crisis.
       The Council is a public policy organization representing 
     principally Fortune 500 companies and other organizations 
     that assist employers of all sizes in providing employee 
     benefits. Collectively, the Council's members sponsor 
     directly or provide services to retirement and health plans 
     covering over 100 million Americans.
       The opioid epidemic has touched workers and families across 
     the country and employers have been on the front lines of 
     this battle, striving to stem the tide of prescription drug 
     abuse through innovative plan design and outreach. A Kaiser 
     Family Foundation analysis found that the use of prescription 
     opioids among people with employer-based health coverage 
     declined in 2016 to its lowest levels in over a decade.
       Nevertheless, the annual cost of treating addiction and 
     overdoses has increased more than eight-fold since 2004, from 
     $0.3 billion dollars to $2.6 billion in 2016, and pain-
     related conditions have resulted in up to $635 billion in 
     medical costs and lost productivity for employers.
       H.R. 6 makes a number of important improvements to current 
     law by reducing the use and supply of opioids, encouraging 
     recovery, supporting caregivers and families and driving 
     innovation and long-term solutions to the opioid addiction 
     epidemic. The bill also imposes tighter control on opioid 
     prescription and treatment under the Medicare and Medicaid 
     programs while also clarifying FDA regulation of nonaddictive 
     pain and addiction therapies and allowing for more 
     flexibility with respect to medication-assisted treatment.
       We are particularly pleased that the conference committee 
     wisely excluded from the bill a harmful, unrelated provision 
     that would have revised the Medicare secondary payer rules to 
     require private insurers--including employer plans--to pay 
     for an additional three months of care for end-stage renal 
     disease (ESRD) patients before Medicare assumes 
     responsibility for the payments.
       The Council strongly opposed this provision, as employers 
     already shoulder significant costs for workers and family 
     members and should not be required to bear unrelated 
     additional costs by expanding the length of time plans must 
     cover ESRD.
       We applaud Congress for developing legislation that will 
     make America healthier, including many of the 181 million 
     people covered by employer-provided health plans.
           Sincerely,
                                                   James A. Klein,
     President.
                                  ____


       [From the National Association for Behavioral Healthcare]

   NABH Applauds Congress for Reaching Agreement on Opioid-Response 
                                Package

       Washington, D.C., Sept. 26, 2018.--On behalf of more than 
     1,000 mental health hospitals and addiction treatment 
     centers, the National Association for Behavioral Healthcare 
     thanks Congress for reaching an agreement to address 
     America's deadly opioid crisis.
       The final package includes many NABH-supported measures and 
     contains the first substantive change to the Medicaid 
     program's burdensome Institutions for Mental Diseases (IMD) 
     exclusion since the early 1970s.
       ``NABH thanks House Energy and Commerce Chairman Greg 
     Walden (R-Ore.) for his strong leadership in the House, which 
     helped ensure that his colleagues paid close attention to the 
     IMD exclusion, an antiquated regulation that has denied 
     access to inpatient treatment for those who need it,'' NABH 
     President and CEO Mark Covall said in a statement. ``We also 
     thank Reps. Mimi Walters (R-Calif.) and Paul Tonko (D-N.Y.) 
     and Sens. Rob Portman (R-Ohio) and Ben Cardin (D-Md.) for 
     their tireless efforts to understand the IMD exclusion--and 
     do all they can to repeal this provision and remove access 
     barriers to behavioral healthcare services for millions of 
     Americans.''
       NABH is also pleased with several other provisions in the 
     final package and urges lawmakers to pass this legislation as 
     soon as possible. Lives depend on it.
                                  ____

                                           National Association of


                                     Community Health Centers,

                                               September 27, 2018.
     Hon. Mitch McConnell,
     Senate Majority Leader,
     Washington, DC.
     Hon. Paul Ryan,
     Speaker of the United States House of Representatives, 
         Washington, DC.
     Hon. Chuck Schumer
     Senate Minority Leader,
     Washington, DC.
     Hon. Nancy Pelosi,
     Minority Leader of the United States House of 
         Representatives, Washington, DC.
       Dear Senators McConnell and Schumer and Representatives 
     Ryan and Pelosi: The National Association of Community Health 
     Centers (NACHC) appreciates Congress' ongoing efforts and 
     dedication to addressing the opioid crisis, and is pleased to 
     offer our support for H.R. 6, SUPPORT for Patients and 
     Communities Act, and urge all House and Senate members to 
     pass this important legislation.
       NACHC is the national membership organization for federally 
     qualified health centers (also known as FQHCs or ``health 
     centers''). Health centers play a critical role in the health 
     care system, serving as the health home for over 28 million 
     people, the majority of whom live under the Federal Poverty 
     Level. With over 11,000 sites nationwide, FQHCs provide 
     affordable, high quality comprehensive primary care to 
     medically underserved individuals, regardless of their 
     insurance status or ability to pay.
       Substance use disorder (SUD), including opioid use disorder 
     (OUD), is a top public health concern in the United States, 
     and health centers have firsthand knowledge of the 
     consequences. As opioid use disorder has become more 
     prevalent, health centers are on the frontlines working to 
     address the comprehensive needs of people at risk of 
     developing SUD, as well as assisting those who are in need of 
     treatment for existing SUD/OUD. From 2010 to 2017, health 
     centers experienced a five-fold increase in patients 
     receiving treatment for opioids or other substance abuse 
     disorders. Since 2010, health centers have more than doubled 
     their behavioral health workforce because of the increased 
     demand for services, with 3,000 health center providers now 
     authorized to provide Medication-Assisted Treatment (MAT.) In 
     fact, in 2017, nearly 65,000 health center patients received 
     MAT from health center providers.
       Health centers stand ready to serve their patients who are 
     struggling with substance use disorder but there is a clear 
     need for additional support and policy changes to enable them 
     to do so more effectively.
       We appreciate Congress' consideration of a multitude of 
     critical policy issues in its response to the opioid 
     epidemic, including several provisions included in H.R. 6 to:
       bolster the SUD workforce, including through new loan 
     repayment opportunities for SUD providers

[[Page H9252]]

       create comprehensive opioid recovery centers (CORCs)
       Improve access to telehealth services
       Streamline Medicaid coverage for incarcerated youth and 
     former foster youth
       Ensure mental health parity for pregnant women and children 
     within the CHIP program
       Codify MAT prescribing regulations allowing Nurse 
     Practitioners and Physician Assistants to prescribe 
     buprenorphine as well as increased flexibility for patient 
     caps, and allowing additional advanced practice nurses to 
     prescribe for a period of 5 years
       We particularly want to highlight our strong support for 
     Section 6083 of the bill, which authorizes $8 million to 
     support expanded access to MAT at FQHCs and rural health 
     clinics under the Medicare program. We believe this provision 
     will be of great assistance to health centers who are 
     initiating and expanding opioid use disorder treatment 
     programs in underserved areas across the country.
       Thank you again for all your hard work to bring this bill 
     to fruition. We know there is more work we can do together to 
     turn the tide on this public health crisis and look forward 
     to continuing to work with you to address the needs of 
     communities across the country.
           Sincerely,
                                                 Tom Van Coverden,
                                       President and CEO of NACHC.

  Mr. WALDEN. Mr. Speaker, I include the following letters in the 
Record.

                                               September 26, 2018.
       To The Members of the U.S. House of Representatives: The 
     U.S. Chamber of Commerce strongly supports the bipartisan 
     H.R. 6, the ``Opioid Crisis Response Act of 2018.'' The 
     Chamber will consider including votes related to this bill in 
     our annual How They Voted scorecard.
       The opioid epidemic is ravaging families and destroying the 
     lives of thousands each year, and it is crippling 
     communities' and employers' efforts to staff workforce needs, 
     create new jobs, and expand commerce.
       We applaud Congress for crafting comprehensive legislation 
     to tackle the myriad of causes, such as the flood of illicit 
     drugs into the United States, while removing a litany of 
     barriers that inhibit prevention, recovery, and treatment 
     options.
       The Chamber is pleased that H.R. 6 does not include the end 
     stage renal disease (ESRD) provision included in an earlier 
     version of the bill. That policy would have burdened 
     employers already struggling to provide robust health 
     benefits with hundreds of millions of dollars in additional 
     health care costs.
       While H.R. 6 is important, more remains to be done. The 
     Chamber urges Congress to address the 42 CFR Part 2 statute 
     as hundreds of health care organizations have called for. 
     Congress should align currently conflicting protections and 
     allow providers access to a patient's entire medical record, 
     including substance use disorder information, at a patient's 
     request.
       We urge you to support H.R. 6.
           Sincerely,

                                             Suzanne P. Clark,

                                  Senior Executive Vice President,
     U.S. Chamber of Commerce.
                                  ____


                 Advocates for Opioid Recovery (e-mail)

       Medicare beneficiaries have the highest and fastest growing 
     rate of opioid use disorder (OUD), with more than 300,000 
     Medicare beneficiaries having been diagnosed with OUD. 
     However, Medicare does not cover the most cost effective, 
     evidence-based treatment modality--opioid treatment programs 
     (OTPs).
       OTPs are highly-regulated, highly-effective, comprehensive 
     treatment programs that provide Medication-Assisted Treatment 
     (MAT)--the combination of medication with behavioral therapy 
     and support, and the most effective solution to treat OUD. 
     There are roughly 1,500 OTPs across the United States 
     providing treatment to approximately 400,000 patients. These 
     programs are certified by the Substance Abuse and Mental 
     Health Services Administration (SAMHSA).
       Studies have shown that people who receive MAT are 75 
     percent less likely to have an addiction-related death than 
     those who do not receive MAT. Most patients in OTPs are 
     currently treated with methadone, which can only be used for 
     treatment of addiction through a licensed OTP.
       America's seniors and people with disabilities deserve 
     better. As your constituent, I encourage you to vote for H.R. 
     6, which would permanently expand Medicare coverage of OTPs.
       For more information about why congressional action is 
     necessary, visit Advocates for Opioid Recovery's website at 
     opioidrecovery org.
                                  ____

                                       Catholic Health Association


                                         of the United States,

                               Washington, DC, September 26, 2018.
     U.S. House,
     Washington, DC.
     U.S. Senate,
     Washington, DC.
       On behalf of the Catholic Health Association of the United 
     States (CHA), the national leadership organization of more 
     than 2,000 Catholic health care systems, hospitals, long-term 
     care facilities, sponsors, and related organizations, I 
     commend the members of the House and Senate for approving 
     their versions of legislation to address the nation's opioid 
     crisis and to urge your support for the final bill, the 
     Support for Patients and Communities Act (HR 6).
       Catholic health providers recognize that each human life is 
     sacred and possesses inalienable worth, and that health care 
     is essential to promoting and protecting the inherent dignity 
     of every individual. We also recognize that supportive and 
     readily available substance use disorder (SUD) treatments are 
     essential facets of holistic, person-centered and effective 
     health care. The first principle in our Vision for U.S. 
     Health Care affirms our call to pay special attention to 
     those most likely to lack access to health care, many of whom 
     are in desperate need of SUD services. This commitment is why 
     the Catholic health ministry strongly supports efforts to 
     increase access to these services and ensure that they become 
     fully integrated into our health care system.
       CHA has supported many of the provisions included in HR 6, 
     particularly those that would increase access to care under 
     Medicaid and care for such vulnerable populations as children 
     and pregnant women, as well as provisions to increase the use 
     of telehealth services. We are particularly pleased that the 
     final version of this legislation includes the IMD Care Act, 
     to provide state Medicaid programs with the option to cover 
     care during FY2019-23 in certain Institutions for Mental 
     Diseases (IMD) that may be otherwise non-federally-
     reimbursable under the IMD exclusion. We are also pleased 
     that the bill includes measures to ensure access to mental 
     health and substance use disorder services for children and 
     pregnant women under the Children's Health Insurance Program 
     (CHIP).
       However, we are disappointed that legislation introduced in 
     the Senate (S. 1850, the Protecting Jessica Grubb's Legacy 
     Act) and overwhelmingly approved in the House (HR 6082) to 
     align current regulations for SUD treatment records with 
     existing patient protections under HIPAA for treatment, 
     payment and health care operations was not included in HR 6. 
     For health providers, the alignment of SUD records with other 
     medical records is essential to providing whole-person care. 
     It enables the essential flow of patient information among 
     providers that is critical to the timely and effective 
     delivery of health care and critical to patient safety and 
     quality. Given the broad and bipartisan support for HR 6082, 
     we continue to urge the Senate to approve this bill as well 
     before the end of the 115th Congress.
       Thank you again for your attention to the urgent matter of 
     opioid and other substance use disorders. We know that you 
     share the goal of our Catholic health ministry in providing 
     the best possible care and treatment for those who need it, 
     and we hope approval of the Support for Patients and 
     Communities Act will provide effective additional resources 
     for doing so.
           Sincerely,
                                             Sr. Carol Keehan, DC,
                                                President and CEO.

  Mr. WALDEN. Mr. Speaker, I include the following letters in the 
Record.

           [From the American Society of Addiction Medicine]

                                Rockville, MD, September 26, 2018.

   American Society of Addiction Medicine Applauds Inclusion of Key 
           Provisions in Historic Opioid Legislative Package


Key Provisions to Teach, Standardize, and Cover Addiction Medicine Will 
Help Close Treatment Gap and Save Lives, Addiction Medicine Experts Say

       The American Society of Addiction Medicine (ASAM) today 
     applauds US House and Senate leaders for announcing a 
     bipartisan agreement on an opioid legislative package that 
     includes key provisions to bolster the country's addiction 
     treatment workforce, help provide standardized evidence-based 
     treatment for individuals with a substance use disorder 
     (SUD), and help ensure coverage and payment models facilitate 
     comprehensive, coordinated care for patients seeking 
     treatment for a SUD.
       ``On behalf of America's addiction medicine physicians and 
     other clinicians on the frontlines of this crisis, ASAM 
     applauds our Congressional leaders for working together to 
     include key provisions that will help close the current 
     treatment gap, bolster the addiction medicine workforce, and 
     save more lives,'' said Kelly J. Clark, MD, MBA, DFASAM, 
     president of ASAM. ``Reversing course on the deadly opioid 
     overdose crisis requires bold policy solutions that help 
     teach, standardize, and cover addiction medicine so more 
     patients benefit from evidence-based treatment. The agreement 
     reached last night is an important step toward realizing this 
     critical goal.''
       Key provisions in the legislative package to teach, 
     standardize, and cover evidence-based addiction medicine 
     include:
       Making permanent buprenorphine prescribing authority for 
     physician assistants and nurse practitioners and allowing 
     waivered practitioners to treat immediately up to 100 
     patients at a time (in lieu of 30) if the practitioner is 
     board certified in addiction medicine or addiction 
     psychiatry; or if the practitioner provides medication 
     assisted treatment (MAT) in a qualified practice setting. 
     Certain qualified physicians would also be allowed to treat 
     up to 275 patients at a time with buprenorphine, codifying an 
     existing rule;
       Allowing physicians who have recently graduated in good 
     standing from an accredited school of allopathic or 
     osteopathic medicine, and who meet the other training 
     requirements during school to prescribe MAT, to obtain a 
     waiver to prescribe MAT;

[[Page H9253]]

       Providing loan repayment relief to addiction treatment 
     professionals who practice in high-need areas;
       Creating a Medicare demonstration program to increase 
     access to evidence-based outpatient treatment for 
     beneficiaries with opioid use disorder that includes 
     medication as well as psychosocial supports, care management, 
     and treatment planning;
       Partially repealing the Institutions for Mental Diseases 
     (IMD) exclusion and allowing state Medicaid programs to cover 
     care in certain IMDs that can deliver services consistent 
     with certain requirements, including evidence-based 
     assessments and levels of care;
       Directing the Departments of Justice and Health and Human 
     Services to finalize special registration regulations 
     concerning the prescribing of medications for addiction via 
     telemedicine within one year of enactment;
       Expanding Medicare coverage to include payment for Opioid 
     Treatment Programs through bundled payments for wholistic 
     services;
       Convening a stakeholder group to produce a report of best 
     practices for states to consider in health care related 
     transitions for inmates of public correctional facilities; 
     and
       Requiring the Substance Abuse and Mental Health Services 
     Administration (SAMHSA) to provide information to SAMHSA 
     grantees to encourage the implementation and replication of 
     evidence-based practices.
       ``Substance use disorder is both treatable and 
     preventable--but from where we stand today, delivering high-
     quality care to the millions of Americans who live with the 
     disease of addiction will require significant investments in 
     our workforce, coverage, and payment models that facilitate 
     coordinated and comprehensive care, and structural changes 
     that incentivize the use of evidence-based approaches,'' said 
     Clark. ``And while we celebrate this bipartisan announcement 
     today, ASAM knows there is still much more work to be done to 
     ensure all Americans living with a substance use disorder get 
     the treatment they need. ASAM will continue to advocate for 
     building an addiction treatment system that fully integrates 
     mental health, substance use disorder, and primary care 
     services in order to produce the best patient outcomes. This 
     includes supporting final passage of legislation that would 
     more closely align 42 CFR Part 2 with the Health Insurance 
     Portability and Accountability Act.''
       For more information about the American Society of 
     Addiction Medicine, please visit www.ASAM.org.
                                  ____

                                               September 27, 2018.
     Hon. Mitch McConnell,
     Majority Leader, U.S. Senate, Washington, DC.
     Hon. Chuck Schumer,
     Minority Leader, U.S. Senate, Washington, DC.
     Hon. Paul Ryan,
     Speaker of the House,
     House of Representatives, Washington, DC.
     Hon. Nancy Pelosi,
     Minority Leader,
     House of Representatives, Washington. DC.
       Dear Majority Leader McConnell, Minority Leader Schumer, 
     Speaker Ryan and Minority Leader Pelosi: We the undersigned, 
     representing the major groups across all disciplines working 
     on a comprehensive response to address addiction, write in 
     support of the final conference agreement of the Substance 
     Use-Disorder Prevention that Promotes Opioid Recovery and 
     Treatment (SUPPORT) for Patients and Communities Act (H.R. 6) 
     and urge for quick passage of this package.
       As you know, the Centers for Disease Control and Prevention 
     recently reported that more than 72,000 Americans died of a 
     drug overdose in 2017, a staggering increase from 63,600 in 
     2016. With nearly 200 Americans dying each day as a result of 
     drug overdose, the opioid crisis is an urgent and serious 
     public health and safety issue that needs to be addressed 
     through a comprehensive response.
       We are grateful to Congress for addressing this urgent need 
     to improve policies and resources to curtail opioid misuse 
     and to help the millions impacted by addiction nationwide. We 
     thank Members on both sides of the aisle and the 13 
     congressional committees for their work to construct this 
     thoughtful, evidence-based legislation. We strongly support 
     the SUPPORT for Patients and Communities Act and its 
     multifaceted, nuanced approach to addressing the opioid 
     crisis and all substance use disorders.
       Key provisions include:


                         Healthcare Integration

       Treatment, Education, and Community Help To Combat 
     Addiction (Section 7101)--Expands medical education and 
     training resources for healthcare providers to better address 
     addiction, pain, and the opioid crisis;
       Preventing Overdoses While in Emergency Rooms (Section 
     7081)--Improves emergency departments ability to effectively 
     screen, treat, and connect substance use disorder patients 
     with care;
       Alternatives to Opioids in the Emergency Department 
     (Section 7091)--Explores alternative pain management 
     protocols in order to limit the use of opioid medications in 
     emergency departments;
       Inclusion of opioid addiction history in patient records 
     (Section 7051)--Requires HHS to develop best practices for 
     prominently displaying substance use disorder treatment 
     information in electronic health records, when requested by 
     the patient.


                      Treatment Capacity Expansion

       IMD CARE Act (Section 5052)--Expands Medicaid coverage up 
     to 30 days for individuals between 21 and 65 years old 
     receiving care in a treatment facility for all substance use 
     disorders, lifting the 16 bed restriction;
       Expansion of Telehealth Services (Section 1009, 2001, 
     3232)--Expands access to substance use disorder treatment and 
     other services through the use of telehealth;
       Comprehensive Opioid Recovery Centers (Section 7121)--
     Establishes model comprehensive treatment and recovery 
     centers to ensure individuals have access to quality 
     treatment and recovery services;
       Supporting family-focused residential treatment (Section 
     8081, 8083)--Enhanced family-focused residential treatment; 
     $20 million in funding for HHS to award to states to develop, 
     enhance, or evaluate family-focused treatment programs to 
     increase the number of evidence-based programs.


                     Treatment Workforce Expansion

       Substance Use Disorder Workforce Loan Repayment (Section 
     7071)--Enhances the substance use disorder treatment 
     workforce by creating a student loan repayment program for 
     healthcare professionals;
       Addressing economic and workforce impacts of the opioid 
     crisis (Section 8041)--Awards grants to states to support 
     substance use disorder and mental health treatment workforce 
     shortages.


                     Medication Assisted Treatment

       More Flexibility for Prescribing Medication Assisted 
     Treatment (Section 3201, 3202)--Increases the number of 
     waivered health care providers that can prescribe or dispense 
     treatment for substance use disorders, such as certified 
     nurses and accredited physicians;
       Grants to enhance access to substance use disorder 
     treatment (Section 3203)--Authorizes grants to support the 
     development of curriculum that will help health care 
     practitioners obtain a waiver to prescribe MAT;
       Delivery of a Controlled Substance by a Pharmacy to be 
     Administered by Injection or Implantation (Section 3204)--
     Allows pharmacies to deliver implantable or injectable 
     medications to treat substance use disorders directly to 
     health care providers.
       Expanding Access to Medication in In-Patient Facilities 
     (Section 5052)--Expanded Medicaid coverage up to 30 days for 
     in-patient facilities applies to providers who provide a 
     minimum of two types of medicines to treat opioid use 
     disorder.


                    Ending Illegal Patient Brokering

       Criminal penalties (Section 8122)--This provision makes it 
     illegal to pay or receive kickbacks in return for referring a 
     patient to recovery homes or clinical treatment facilities.


                           Recovery Supports

       CAREER Act (Section 7183)--Improves resources and wrap-
     around support services for individuals in recovery from a 
     substance use disorder who are transitioning from treatment 
     programs to independent living and the workforce;
       Ensuring Access to Quality Sober Living (Section 7031)--
     Develops and disseminates best practices for operating 
     recovery housing to ensure individuals are living in a safe 
     and supportive environment;
       Building Communities of Recovery (Section 7151, 7152)--
     Awards grants to recovery community organizations to provide 
     regional training and technical assistance in order to expand 
     peer recovery support services nationwide;
       Improving recovery and reunifying families (Section 8082)--
     Provides $15 million to HHS to replicate a ``recovery coach'' 
     program for parents with children in foster care due to 
     parental substance use.


                               Prevention

       Drug-Free Communities Reauthorization (Section 8203)--
     Reauthorizes the Drug-Free Communities Program to mobilize 
     communities to prevent youth substance use and extends the 
     National Community Anti-Drug Coalition Institute.


                        Helping Moms and Babies

       Sobriety Treatment and Recovery Teams (START; Section 
     8214)--Establishes and expands the implementation of the 
     START program, which pairs social workers and family mentors 
     with a small number of families, providing peer support, 
     intensive treatment and child welfare services;
       Caring Recovery for Infants and Babies (Section 1007)--
     Expands Medicaid coverage for infants with neonatal 
     abstinence syndrome who are receiving care in residential 
     pediatric recovery centers;
       Health Insurance for Former Foster Youth (Section 1002)--
     Allows former foster youth to keep their Medicaid coverage 
     across state lines until age 26;
       Modifies IMD Exclusion for Pregnant and Postpartum Women 
     (Section 1012)--Allows for pregnant and postpartum women who 
     are receiving care for substance use disorder in a treatment 
     facility to receive other Medicaid-covered care, such as 
     prenatal services;
       Report on addressing maternal and infant health in the 
     opioid crisis (Section 7061)--Studies best practices of pain 
     management, prevention, identification, and reduction of 
     opioid and other substance use disorders during pregnancy;
       Early interventions for pregnant women and infants (Section 
     7063)--Develops and disseminates educational materials for 
     clinicians to use with pregnant women for shared decision-
     making regarding pain management during pregnancy;
       Prenatal and postnatal health (Section 7064)--Authorizes 
     data collection and analysis of neonatal abstinence syndrome 
     and

[[Page H9254]]

     other outcomes related to prenatal substance abuse and 
     misuse, including prenatal opioid abuse and misuse;
       Plans of safe care (Section 7065)--Supports states in 
     collaboration and improving plans of safe care for substance-
     exposed infants.


                Helping Patients and Families in Crisis

       Communication with families during emergencies (Section 
     7052)--Reminds healthcare providers annually that they are 
     allowed under current federal privacy laws to notify 
     families, caregivers, and health care providers of overdose 
     emergencies involving a loved one;
       Families and Patients in Crisis (Section 8212)--Grants to 
     expand services for patient and families impacted by 
     substance use disorder and in crisis.


                            Law Enforcement

       Reauthorization of Key Law Enforcement Programs (Section 
     8205-8212)--Reauthorizes law enforcement programs through the 
     Office of National Drug Control Policy, such as programs such 
     as the High Intensity Drug Trafficking Area programs, drug 
     courts, COPS Anti-Meth Program, and COPS anti-heroin task 
     force program;
       First Responder Training (Section 7002)--Expands first 
     responder training, authorized through the Comprehensive 
     Addiction and Recovery Act, to include training on safety 
     around fentanyl and other synthetic and dangerous substances;
       Public Health Laboratories Detecting Fentanyl and Other 
     Synthetic Opioids (Section 7011)--Improves coordination 
     between public health laboratories and laboratories operated 
     by law enforcement to improve detection of fentanyl and other 
     synthetic opioids;
       Synthetics Trafficking and Overdose Prevention (Section 
     8006, 8007)--Improves Federal agencies ability to detect 
     synthetic opioids and other substances from entering the 
     United States through the mail;
       Opioid Addiction Recovery Fraud Prevention (Sections 8021-
     8023)--Subjects those who engage in unfair or deceptive acts 
     with respect to substance use disorder treatment services or 
     substance use disorder treatment products to civil penalties 
     for first time violations by the FTC; includes a savings 
     clause for existing FTC and FDA authorities;
       Reauthorization of the comprehensive opioid abuse grant 
     program (Section 8092)--Reauthorize the comprehensive opioid 
     abuse grant program at the Department of Justice.


              Prescription Medication Safety and Disposal

       Empowering Pharmacists in the Fight Against Opioid Abuse 
     (Section 3212)--Develops and disseminates training resources 
     to help pharmacists better detect fraudulent attempts to fill 
     prescription medications;
       Safe Disposal of Unused Medication (Section 3222)--Allows 
     hospice workers to dispose of unused medications on site or 
     in patients homes;
       Access to Increased Drug Disposal (Section 3251-3260)--
     Awards grants to states to enhances access of prescription 
     drug disposal programs;
       Safety-enhancing Packaging and Disposal Features (Section 
     3032)--Requires certain opioids to be packaged into 3 or 7 
     day supplies and requires safe prescription drug disposal 
     options to be given to patients upon receiving medications.


                            Prisoner Reentry

       Promoting State innovations to ease transitions integration 
     to the community for certain individuals (Section 5032)--
     Requires the HHS Secretary to convene a stakeholder group to 
     produce a report of best practices for states to consider in 
     health care related transitions for inmates of public 
     institutions.
       We commend Congress for its leadership and the bipartisan, 
     bicameral work it has undertaken to address the ever 
     worsening opioid crisis. We are pleased that this package 
     contains a truly comprehensive approach to addressing the 
     opioid crisis, across the entire continuum of care 
     prevention, treatment and recovery support. In addition, it 
     fully recognizes addiction as the medical condition that it 
     is and contains meaningful programs aimed at helping patients 
     and families struggling with this disease. For all of these 
     reasons, we urge the quick passage of the final agreement of 
     the SUPPORT for Patients and Communities Act (H.R. 6).
           Sincerely,
       1. A New PATH, San Diego, California
       2. Addiction Policy Forum
       3. AIDS United
       4. Alabama, Addiction Policy Forum
       5. Alaska, Addiction Policy Forum
       6. American Correctional Association
       7. Arizona, Addiction Policy Forum
       8. Association of Prosecuting Attorneys
       9. Beyond Addiction Ministry, WI
       10. Brave Health
       11. CADA of Northwest Louisiana
       12. California Consortium of Addiction Programs & 
     Professionals (CCAPP)
       13. California, Addiction Policy Forum
       14. Campaign for Youth Justice
       15. Caron Treatment Centers
       16. CFC Loud N Clear Foundation, Farmingdale, New Jersey
       17. Chicago Recovering Communities Coalition, Chicago, 
     Illinois
       18. Colorado, Addiction Policy Forum
       19. Community Anti- Drug Coalitions of America (CADCA)
       20. Connecticut Certification Board
       21. Connecticut Community for Addiction Recovery (CCAR), 
     Hartford, Connecticut
       22. Connecticut, Addiction Policy Forum
       23. COPES
       24. DarJune Recovery Support Services & Cafe, Green Bay, 
     Wisconsin
       25. Delaware, Addiction Policy Forum
       26. Delphi Behavioral Health Group
       27. DisposeRx
       28. El Paso Alliance, El Paso, Texas
       29. Faces & Voices of Recovery
       30. FAVOR Low Country, Charleston, South Carolina
       31. FAVOR Tri-County, Rock Hill, South Carolina
       32. FedCURE
       33. Fellowship Foundation Recovery Community Organization, 
     Margate. Florida
       34. Floridians for Recovery, West Palm Beach, Florida
       35. Foundation for Recovery, Las Vegas, Nevada
       36. Friends of Emmett
       37. H.O.P.E.S. Forever
       38. Healthcare Leadership Council
       39. IC & RC
       40. Idaho, Addiction Policy Forum
       41. Illinois Association of Behavioral Health
       42. Illinois, Addiction Policy Forum
       43. Indiana, Addiction Policy Forum
       44. Institute for Behavior and Health (IBH)
       45. Iowa, Addiction Policy Forum
       46. Jackson Area Recovery Community, Jackson, Michigan
       47. Kansas, Addiction Policy Forum
       48. Kentucky, Addiction Policy Forum
       49. Kingston NH Lions Foundation
       50. Lifehouse Recovery Connection, San Diego, California
       51. Maine Alliance for Addiction Recovery, Augusta, Maine
       52. Maine, Addiction Policy Forum
       53. Maryland House Detox
       54. Maryland, Addiction Policy Forum
       55. Massachusetts, Addiction Policy Forum
       56. Michigan, Addiction Policy Forum
       57. Minnesota Recovery Connection, Minneapolis, Minnesota
       58. Minnesota, Addiction Policy Forum
       59. Missouri Recovery Network, Jefferson City, Missouri
       60. Missouri, Addiction Policy Forum
       61. Montana, Addiction Policy Forum
       62. National Association of Social Workers (NASW)
       63. National Prevention Science Coalition
       64. National Safety Council
       65. Navigate Recovery Gwinnett, Gwinnett County, Georgia
       66. Navigating Recovery of the Lakes Region, Laconia, New 
     Hampshire
       67. Nevada, Addiction Policy Forum
       68. New Hampshire, Addiction Policy Forum
       69. New Jersey, Addiction Policy Forum
       70. New Mexico, Addiction Policy Forum
       71. New York, Addiction Policy Forum
       72. North Carolina, Addiction Policy Forum
       73. North Dakota, Addiction Policy Forum
       74. Ohio Citizen Advocates for Addiction Recovery, 
     Columbus, Ohio
       75. Ohio, Addiction Policy Forum
       76. Oklahoma, Addiction Policy Forum
       77. Oregon, Addiction Policy Forum
       78. PEER Wellness Center
       79. PEER360 Recovery Alliance, Bay City, Michigan
       80. Pennsylvania Recovery Organization, Achieving Community 
     Together (PRO-ACT), Philadelphia, Pennsylvania
       81. Pennsylvania, Addiction Policy Forum
       82. People Advocating Recovery, Louisville, Kentucky
       83. Phoenix House Recovery Residences
       84. PLR Athens, Athens, Georgia
       85. Reality Check, Jaffrey, New Hampshire
       86. Recover Wyoming, Cheyenne, Wyoming
       87. Recovery Communities of North Carolina, Raleigh, North 
     Carolina
       88. Recovery Community Connection, Williamsport, 
     Pennsylvania
       89. Recovery Community of Durham, Durham, North Carolina
       90. Recovery Data Solutions
       91. Rhode Island, Addiction Policy Forum
       92. ROCovery Fitness, Rochester, New York
       93. Shatterproof
       94. Smart Approaches to Marijuana Action (SAM Action)
       95. SMART Recovery, Nationwide
       96. Sobriety Matters
       97. Solutions Recovery, Oshkosh, Wisconsin
       98. South Dakota, Addiction Policy Forum
       99. SpiritWorks Foundation, Williamsburg, Virginia
       100. Springs Recovery Connection, Colorado Springs, 
     Colorado
       101. Strengthening the Mid-Atlantic Region for Tomorrow 
     (SMART)
       102. Tennessee, Addiction Policy Forum
       103. Texas, Addiction Policy Forum
       104. The DOOR--DeKalb Open Opportunity for Recovery, 
     Decatur, Georgia
       105. The McShin Foundation, Richmond, Virginia
       106. The Moyer Foundation
       107. The Phoenix, Nationwide
       108. The RASE Project, Harrisburg, Pennsylvania
       109. The Solano Project, Fairfield, California
       110. Treatment Communities of America
       111. Trilogy Recovery Community, Walla Walla, Washington
       112. Trust for America's Health
       113. Utah, Addiction Policy Forum
       114. Vermont, Addiction Policy Forum
       115. Virginia, Addiction Policy Forum
       116. Voices of Hope Lexington, Lexington, Kentucky
       117. Voices of Recovery San Mateo County, San Mateo, 
     California
       118. WAI-IAM, Inc. and RISE Recovery Community, Lansing, 
     Michigan

[[Page H9255]]

  

       119. Washington, Addiction Policy Forum
       120. Washtenaw Recovery Advocacy Project (WRAP), Ann Arbor, 
     Michigan
       121. West Virginia, Addiction Policy Forum
       122. Wisconsin Voices for Recovery, Madison, Wisconsin
       123. Wisconsin, Addiction Policy Forum
       124. Wyoming, Addiction Policy Forum

  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Oregon (Mr. Walden) that the House suspend the rules and 
agree to the resolution, H. Res. 1099.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. WALDEN. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this motion will be postponed.

                          ____________________