[House Report 115-766]
[From the U.S. Government Publishing Office]


115th Congress    }                                    {        Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                    {       115-766

======================================================================

 
PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 6) TO PROVIDE FOR OPIOID 
    USE DISORDER PREVENTION, RECOVERY, AND TREATMENT, AND FOR OTHER 
PURPOSES; PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 5797) TO AMEND 
 TITLE XIX OF THE SOCIAL SECURITY ACT TO ALLOW STATES TO PROVIDE UNDER 
MEDICAID SERVICES FOR CERTAIN INDIVIDUALS WITH OPIOID USE DISORDERS IN 
 INSTITUTIONS FOR MENTAL DISEASES; AND PROVIDING FOR CONSIDERATION OF 
THE BILL (H.R. 6082) TO AMEND THE PUBLIC HEALTH SERVICE ACT TO PROTECT 
     THE CONFIDENTIALITY OF SUBSTANCE USE DISORDER PATIENT RECORDS

                                _______
                                

   June 19, 2018.--Referred to the House Calendar and ordered to be 
                                printed

                                _______
                                

               Mr. Burgess, from the Committee on Rules, 
                        submitted the following

                              R E P O R T

                       [To accompany H. Res. 949]

    The Committee on Rules, having had under consideration 
House Resolution 949, by a record vote of 7 to 3, report the 
same to the House with the recommendation that the resolution 
be adopted.

                SUMMARY OF PROVISIONS OF THE RESOLUTION

    The resolution provides for consideration of H.R. 6, the 
Substance Use-Disorder Prevention that Promotes Opioid Recovery 
and Treatment for Patients and Communities Act, under a 
structured rule. The resolution provides one hour of general 
debate equally divided and controlled by the chair and ranking 
minority member of the Committee on Committee on Energy and 
Commerce. The resolution waives all points of order against 
consideration of the bill. The resolution provides that an 
amendment in the nature of a substitute consisting of the text 
of Rules Committee Print 115-76, modified by Rules Committee 
Print 115-78 and the amendment printed in part A of this 
report, shall be considered as adopted and the bill, as 
amended, shall be considered as read. The resolution waives all 
points of order against provisions in the bill, as amended. The 
resolution makes in order only those further amendments printed 
in part B of this report. Each such amendment may be offered 
only in the order printed in this report, may be offered only 
by a Member designated in this report, shall be considered as 
read, shall be debatable for the time specified in this report 
equally divided and controlled by the proponent and an 
opponent, shall not be subject to amendment, and shall not be 
subject to a demand for division of the question in the House 
or in the Committee of the Whole. The resolution waives all 
points of order against the amendments printed in part B of 
this report. The resolution provides one motion to recommit 
with or without instructions.
    Section 2 of the resolution provides for consideration of 
H.R. 5797, the Individuals in Medicaid Deserve Care that is 
Appropriate and Responsible in its Delivery Act, under a 
structured rule. The resolution provides one hour of general 
debate equally divided and controlled by the chair and ranking 
minority member of the Committee on Energy and Commerce. The 
resolution waives all points of order against consideration of 
the bill. The resolution provides that the amendment in the 
nature of a substitute recommended by the Committee on Energy 
and Commerce now printed in the bill, modified by the amendment 
printed in part C of this report, shall be considered as 
adopted and the bill, as amended, shall be considered as read. 
The resolution waives all points of order against provisions in 
the bill, as amended. The resolution makes in order only those 
further amendments printed in part D of this report. Each such 
amendment may be offered only in the order printed in this 
report, may be offered only by a Member designated in this 
report, shall be considered as read, shall be debatable for the 
time specified in this report equally divided and controlled by 
the proponent and an opponent, shall not be subject to 
amendment, and shall not be subject to a demand for division of 
the question in the House or in the Committee of the Whole. The 
resolution waives all points of order against the amendments 
printed in part D of this report. The resolution provides one 
motion to recommit with or without instructions.
    Section 3 of the resolution provides for consideration of 
H.R. 6082, the Overdose Prevention and Patient Safety Act, 
under a closed rule. The resolution provides one hour of debate 
equally divided and controlled by the chair and ranking 
minority member of the Committee on Energy and Commerce. The 
resolution waives all points of order against consideration of 
the bill. The resolution provides that an amendment in the 
nature of a substitute consisting of the text of Rules 
Committee Print 115-75 shall be considered as adopted, and the 
bill, as amended, shall be considered as read. The resolution 
waives all points of order against provisions in the bill, as 
amended. The resolution provides one motion to recommit with or 
without instructions.
    Section 4 the resolution directs the Clerk to, in the 
engrossment of H.R. 6, add the text of H.R. 2851, H.R. 5735, 
and H.R. 5797 as passed by the House as a new matter at the end 
of H.R. 6 and make technical and conforming modifications in 
the engrossment.

                         EXPLANATION OF WAIVERS

    The waiver of all points of order against consideration of 
H.R. 6 includes a waiver of the following:
    Section 302(f) of the Congressional Budget Act, which 
prohibits consideration of legislation providing new budget 
authority in excess of a 302(a) allocation of such authority; 
and
    Section 306 of the Congressional Budget Act, which 
prohibits consideration of legislation within the jurisdiction 
of the Committee on the Budget unless referred to or reported 
by the Budget Committee; and
    Section 311 of the Congressional Budget Act, which 
prohibits consideration of legislation that would cause the 
level of total new budget authority for the first fiscal year 
to be exceeded, or would cause revenues to be less than the 
level of total revenues for the first fiscal year or for the 
total of that first fiscal year and the ensuing fiscal years 
for which allocations are provided.
    Although the resolution waives all points of order against 
provisions in H.R. 6, as amended, the Committee is not aware of 
any points of order. The waiver is prophylactic in nature.
    Although the resolution waives all points of order against 
the amendments to H.R. 6 printed in part B of this report, the 
Committee is not aware of any points of order. The waiver is 
prophylactic in nature.
    The waiver of all points of order against consideration of 
H.R. 5797 includes a waiver of the following:
    Section 302(f) of the Congressional Budget Act, which 
prohibits consideration of legislation providing new budget 
authority in excess of a 302(a) allocation of such authority; 
and
    Section 311 of the Congressional Budget Act, which 
prohibits consideration of legislation that would cause the 
level of total new budget authority for the first fiscal year 
to be exceeded.
    Although the resolution waives all points of order against 
provisions in H.R. 5797, as amended, the Committee is not aware 
of any points of order. The waiver is prophylactic in nature.
    Although the resolution waives all points of order against 
the amendments to H.R. 5797 printed in Part D of this report, 
the Committee is not aware of any points of order. The waiver 
is prophylactic in nature.
    Although the resolution waives all points of order against 
consideration of the H.R. 6082, the Committee is not aware of 
any points of order. The waiver is prophylactic in nature.
    Although the resolution waives all points of order against 
provisions in H.R. 6082, as amended, the Committee is not aware 
of any points of order. The waiver is prophylactic.

Rules Committee record vote No. 236

    Motion by Mr. McGovern to make in order and provide the 
appropriate waivers to amendment # 7 to H.R. 5797, offered by 
Rep. Kennedy (MA), which expands the eligible population to 
individuals with all substance use disorders; whereas the 
current bill only makes eligible those individuals with opioid 
use disorder. Additionally, it would require states to provide 
the full continuum of care so that patients have access to 
critical services when they are discharged from IMDs. Defeated: 
3-7

----------------------------------------------------------------------------------------------------------------
               Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Cole.....................................  ...............  Mr. McGovern...................             Yea
Mr. Woodall..................................             Nay   Mr. Hastings of Florida........             Yea
Mr. Burgess..................................             Nay   Mr. Polis......................  ...............
Mr. Collins..................................  ...............  Mrs. Torres....................             Yea
Mr. Byrne....................................             Nay
Mr. Newhouse.................................             Nay
Mr. Buck.....................................             Nay
Ms. Cheney...................................             Nay
Mr. Sessions, Chairman.......................             Nay
----------------------------------------------------------------------------------------------------------------

Rules Committee record vote No. 237

    Motion by Mr. Hastings of Florida to make in order and 
provide the appropriate waivers to amendment #9 to H.R. 5797, 
offered by Rep. Waters (CA), which requires states to expand 
Medicaid pursuant to the Affordable Care Act as a condition for 
using Medicaid funds to treat people with opioid abuse 
disorders in Institutions for Mental Disease (IMDs). Defeated: 
3-7

----------------------------------------------------------------------------------------------------------------
               Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Cole.....................................  ...............  Mr. McGovern...................             Yea
Mr. Woodall..................................             Nay   Mr. Hastings of Florida........             Yea
Mr. Burgess..................................             Nay   Mr. Polis......................  ...............
Mr. Collins..................................  ...............  Mrs. Torres....................             Yea
Mr. Byrne....................................             Nay
Mr. Newhouse.................................             Nay
Mr. Buck.....................................             Nay
Ms. Cheney...................................             Nay
Mr. Sessions, Chairman.......................             Nay
----------------------------------------------------------------------------------------------------------------

Rules Committee record vote No. 238

    Motion by Mr. Woodall to report the rule. Adopted: 7-3

----------------------------------------------------------------------------------------------------------------
               Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Cole.....................................  ...............  Mr. McGovern...................             Nay
Mr. Woodall..................................             Yea   Mr. Hastings of Florida........             Nay
Mr. Burgess..................................             Yea   Mr. Polis......................  ...............
Mr. Collins..................................  ...............  Mrs. Torres....................             Nay
Mr. Byrne....................................             Yea
Mr. Newhouse.................................             Yea
Mr. Buck.....................................             Yea
Ms. Cheney...................................             Yea
Mr. Sessions, Chairman.......................             Yea
----------------------------------------------------------------------------------------------------------------

   SUMMARY OF THE AMENDMENT TO H.R. 6 IN PART A CONSIDERED AS ADOPTED

    1. Walden (OR): Makes a technical correction to ensure that 
the matter incorporated into H.R. 6 is identical to the 
legislation previously adopted by the House.

      SUMMARY OF THE AMENDMENTS TO H.R. 6 IN PART B MADE IN ORDER

    1. Walden (OR), Pallone (NJ), Brady, Kevin (TX), Neal (MA): 
Calls for Medicaid, Medicare, and public health reforms to help 
combat the opioid crisis. The policies contained in H.R. 6 were 
advanced through regular order by the House Energy and Commerce 
and Ways and Means Committees. (10 minutes)
    2. Dunn (FL), Marshall (KS), Harris (MD), Roe (TN): Strikes 
language expanding the classes of health care workers who are 
authorized to dispense narcotics for narcotic treatment. (10 
minutes)
    3. Barton (TX), Meadows (NC), Kuster, Ann (NH): Directs the 
Commissioner of Food and Drugs to develop high-quality, 
evidence-based opioid analgesic prescribing guidelines for the 
indication-specific treatment of acute pain. In developing such 
guidelines, it would require the Commissioner of Food and Drugs 
to gather input through a public workshop and comment period, 
and to provide a report to Congress on how such guidelines will 
be used to protect the public health. (10 minutes)
    4. Curtis, John (UT): Requires a report from HHS on opioid 
prescribing practices and opioid misuse during pregnancy, and 
evaluating non-opiate pain management practices during 
pregnancy. (10 minutes)
    5. Keating (MA), Rothfus (PA): Directs HHS to issue 
guidelines for prescribing naloxone in situations involving any 
type of prescription or illicit opioid use. (10 minutes)
    6. Meadows (NC): Requires the Government Accountability 
Office to conduct a comprehensive report on health care policy 
changes that may have contributed to the increase in opioid 
overdoses and deaths. (10 minutes)
    7. Waters (CA): Directs the Secretary of Health and Human 
Services (HHS) to conduct a survey of organizations that 
provide substance abuse treatment services. Under the 
amendment, HHS is required to develop, and submit to Congress, 
a plan to direct appropriate resources to address inadequacies 
in services or funding for specific types of drug addictions 
identified through the survey. (10 minutes)
    8. Turner (OH), Kuster, Ann (NH): Eliminates Substance 
Abuse and Mental Health Services Administration's (SAMHSA) 
policy that prevents SAMHSA funding from going toward substance 
abuse treatment services for individuals who are incarcerated. 
(10 minutes)

 SUMMARY OF THE AMENDMENT TO H.R. 5797 IN PART C CONSIDERED AS ADOPTED

    1. Walters, Mimi (CA): Provides an incentive for states to 
voluntarily adopt a medical loss ratio (MLR) requirement for 
their Medicaid managed care organizations (MCOs) of 85 percent.

     SUMMARY OF THE AMENDMENTS TO H.R. 5797 IN PART D MADE IN ORDER

    1. Rush (IL): Expands treatment coverage to individuals 
suffering from cocaine use disorder (which includes crack 
cocaine). (10 minutes)
    2. Kildee (MI): Adds two requirements to the report that 
states are required to submit. The first would be information 
regarding the number of individuals suffering from co-occuring 
disorders and the disorders from which they suffer and the 
second would be information regarding access to community care 
for individuals suffering from a mental illness other than 
substance use disorder. (10 minutes)
    3. Fitzpatrick (PA): Provides flexibility for States to 
allow the State plan amendment to include assessments to 
determine level of care and length of stay recommendations 
based upon criteria established or endorsed by a State agency 
pursuant to 1932(b)(1)(A)(i) of the Public Health Service Act. 
(10 minutes)

       PART A--TEXT OF AMENDMENT TO H.R. 6 CONSIDERED AS ADOPTED

  Page 49, strike line 15 and all that follows through page 50, 
line 4, and insert the following:
          ``(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.''.
  Page 53, strike lines 16 through 24, and insert the 
following:
  (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.

           PART B--TEXT OF AMENDMENTS TO H.R. 6 MADE IN ORDER

1. An Amendment To Be Offered by Representative Walden of Oregon or His 
                   Designee, Debatable for 10 Minutes

  Page 65, line 18, insert ``(as described in paragraph 
(4)(F))'' after ``telehealth services''.
  Page 68, line 21, insert ``, as determined by the Secretary'' 
after ``clinical improvement''.
  Page 70, line 24, strike ``certified''.
  Page 70, after line 25, insert the following:
  (b) Clarification.--Nothing in the amendments made by 
subsection (a) 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.
   Page 71, line 1, redesignate the subsection (b) as a 
subsection (c).
  Page 71, strike line 21 and all that follows through page 72, 
line 2, and insert the following:
                          ``(ii) For purposes of clause (i), 
                        the term `targeted procedure' means a 
                        procedure to which Healthcare Common 
                        Procedure Coding System code 62310 (or, 
                        for years beginning after 2016, 62321), 
                        62311 (or, for years beginning after 
                        2016, 62323), 62264, 64490, 64493, or 
                        G0260, or any successor code, apply.''.
  Page 95, line 1, strike ``100 or more'' and insert ``more 
than 100''.
  Page 95, line 2, strike ``30 or more'' and insert ``more than 
30''.
  Page 95, line 13, insert ``the frequency of toxicology 
testing, including'' before ``the average''.
  page 96, line 10, strike ``2025'' and insert ``2024''.
  page 97, strike line 7, and insert ``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''.
                              ----------                              


2. An Amendment To Be Offered by Representative Dunn of Florida or His 
                   Designee, Debatable for 10 Minutes

  Page 93, strike lines 18 through 22 and insert the following:
          (2) in subclause (II), by striking ``during the 
        period beginning on the date of enactment of the 
        Comprehensive Addiction and Recovery Act of 2016 and 
        ending on October 1, 2021,''.
  Page 93, strike line 23 and all that follows through page 94, 
line 17.
  Page 94, line 18, strike ``(e)'' and insert ``(c)''.
                              ----------                              


3. An Amendment To Be Offered by Representative Barton of Texas or His 
                   Designee, Debatable for 10 Minutes

  At the end of title III, insert the following new section:

SEC. 304. HIGH-QUALITY, EVIDENCE-BASED OPIOID ANALGESIC PRESCRIBING 
                    GUIDELINES AND REPORT.

  (a) Guidelines.--The Commissioner of Food and Drugs shall 
develop high-quality, evidence-based opioid analgesic 
prescribing guidelines for the indication-specific treatment of 
acute pain in 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) conduct a public workshop, open to 
        representatives of State medical societies and medical 
        boards, various medical specialties including pain 
        medicine specialty societies, patient groups, 
        pharmacists, universities, and others; and
          (2) provide a period for the submission of comments 
        by the public.
  (c) Report.--Not later than the date that is 2 years after 
the date of enactment of this Act, 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 guidelines under subsection (a) will be utilized to 
protect the public health.
  (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 subsection (c).
  (e) Statement To Accompany Guidelines and Recommendations.--
The Commissioner of Food and Drugs shall ensure that any 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) should not be used by other parties, including 
        pharmacy benefit management companies, retail or 
        community pharmacies, or public and private payors, 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.
  (f) Definition.--In this section, the term ``evidence-based'' 
means informed by a robust and systemic review of treatment 
efficacy and clinical evidence.
                              ----------                              


 4. An Amendment To Be Offered by Representative Curtis of Utah or His 
                   Designee, Debatable for 10 Minutes

  Add at the end of title III the following:

SEC. 304. REPORT ON OPIOIDS PRESCRIBING PRACTICES FOR PREGNANT WOMEN.

  (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 coordination with the Centers for Disease Control 
and Prevention, the National Institutes of Health, and the 
Substance Abuse and Mental Health Services Administration shall 
develop and submit to the Congress a report--
          (1) on opioids prescribing practices for pregnant 
        women and recommendations for such practices;
          (2) that provides recommendations for identifying and 
        reducing opioids misuse during pregnancy;
          (3) on prescription opioid misuse during pregnancy in 
        urban and rural areas;
          (4) on prescription opioid use during pregnancy for 
        the purpose of medication-assisted treatment in urban 
        and rural areas;
          (5) evaluating current utilization of non-opiate pain 
        management practices in place of prescription opioids 
        during pregnancy;
          (6) providing guidelines encouraging the use of non-
        opioid pain management practices during pregnancy when 
        safe and effective; and
          (7) that provides recommendations for increasing 
        public awareness and education of opioid use disorder 
        in pregnancy, including available treatment resources 
        in urban and rural areas.
  (b) No Additional Funds.--No additional funds are authorized 
to be appropriated for purposes of carrying out subsection (a).
                              ----------                              


      5. An Amendment To Be Offered by Representative Keating of 
        Massachusetts or His Designee, Debatable for 10 Minutes

  Add at the end of title III the following:

SEC. 304. GUIDELINES FOR PRESCRIBING NALOXONE.

  (a) In General.--Not later than 180 days after the date of 
the enactment of this Act, the Secretary of Health and Human 
Services shall issue guidelines for prescribing an opioid 
overdose reversal drug.
  (b) Contents.--In issuing guidelines under subsection (a), 
the Secretary shall address the following:
          (1) Co-prescribing an opioid overdose reversal drug 
        in conjunction with any prescribed opioid.
          (2) Dosage safety.
          (3) Prescribing an opioid overdose reversal drug to 
        an individual other than a patient.
          (4) Standing orders.
          (5) Other distribution, education, and safety 
        measures as determined necessary.
                              ----------                              


   6. An Amendment To Be Offered by Representative Meadows of North 
           Carolina or His Designee, Debatable for 10 Minutes

  At the end of title III, insert the following new section:

SEC. 304. GAO STUDY AND REPORT ON POLICY CHANGES THAT MAY HAVE 
                    CONTRIBUTED TO THE OPIOID EPIDEMIC.

  Not later than 2 years after the date of enactment of this 
Act, the Comptroller General of the United States shall 
complete a study and submit a report to Congress on health care 
policy changes that may have contributed to the increase in 
opioid overdoses and deaths during the 10 years preceding the 
date of enactment of this Act. Such study shall include--
          (1) a review of health care-related legislative, 
        administrative, and judicial decisions by officers and 
        employees of the Federal Government that have affected 
        access to pain management strategies with an emphasis 
        on pharmaceuticals;
          (2) an analysis of what is known about the costs and 
        benefits, whether financial or nonfinancial, of 
        reversing or revising such decisions individually or in 
        combination, including whether the reversals or 
        revisions would be expected to achieve a reduction in 
        abuse of, addiction to, overdose on, and death from 
        opioids;
          (3) an analysis of the differences among State-based 
        prescription drug monitoring programs, including an 
        analysis of what is known about the effects of such 
        differences on monitoring for abuse of, addiction to, 
        overdose on, and death from opioids;
          (4) an analysis of what is known about positive and 
        negative impacts that prescribing limitations, both 
        State and Federal, have on patient medical outcomes, 
        including for chronic pain patients; and
          (5) an analysis of what is known about the costs and 
        benefits to payers of using abuse-deterrent 
        formulations of opioid pain medications, compared to 
        opioid pain medications without abuse-deterrent 
        features.
                              ----------                              


7. An Amendment To Be Offered by Representative Waters of California or 
                 Her Designee, Debatable for 10 Minutes

  Add at the end of title III the following new section:

SEC. ___. REQUIRING A SURVEY 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 survey of all entities that receive Federal funding 
for the purpose of providing substance use disorder treatment 
services. The survey shall direct such entities to provide the 
following information:
          (1) The length of time the entity has provided 
        substance use disorder treatment services.
          (2) A detailed description of the patient population 
        served by the entity, including but not limited to the 
        number of patients, type of addictions, geographic area 
        served, as well as gender, racial, ethnic and 
        socioeconomic demographics of such patients.
          (3) A detailed description of the types of addiction 
        for which the entity has the experience, capability, 
        and capacity to provide such services.
          (4) An explanation of how the entity handles patients 
        requiring treatment for a substance use disorder that 
        the organization is not able to treat.
          (5) A description of what is needed, in the opinion 
        of the entity, 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 through additional Federal, State, or 
        local government resources or funding to treat 
        addiction to methamphetamine, crack cocaine, other 
        types of cocaine, heroin, opioids, and other commonly 
        abused drugs.
  (b) Report.--Not later than 1 year 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).
                              ----------                              


 8. An Amendment To Be Offered by Representative Turner of Ohio or His 
                   Designee, Debatable for 10 Minutes

  Add at the end of title III the following:

SEC. 304. NO SAMSHA POLICY AGAINST SUBSTANCE ABUSE TREATMENT FOR 
                    INCARCERATED INDIVIDUALS.

  The Substance Abuse and Mental Health Services Administration 
shall not establish, maintain, or implement any memorandum of 
understanding or other policy that prohibits or restricts the 
Administration's provision or support of substance abuse 
treatment or related services for incarcerated individuals, so 
long as such provision or support--
          (1) is statutorily authorized (by provisions of law 
        other than this section) for such type of treatment or 
        services; and
          (2) not statutorily prohibited or restricted with 
        respect to incarcerated individuals.
                              ----------                              


      PART C--TEXT OF AMENDMENT TO H.R. 5796 CONSIDERED AS ADOPTED

  Add at the end the following:

SEC. 3. PROMOTING VALUE IN MEDICAID MANAGED CARE.

  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)(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 2025), 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 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).''.
                              ----------                              


         PART D--TEXT OF AMENDMENTS TO H.R. 5797 MADE IN ORDER

1. An Amendment To Be Offered by Representative Rush of Illinois or His 
                   Designee, Debatable for 10 Minutes

  In section 2, strike ``individuals with opioid use 
disorders'' and insert ``individuals with targeted suds''.
  In the subsection (l) proposed to be added by section 2 of 
the bill to section 1915 of the Social Security Act, strike 
``eligible individuals with opioid use disorders'' each place 
it appears and insert ``eligible individuals with targeted 
SUDs'' each such place.
  In the subsection (l) proposed to be added by section 2 of 
the bill to section 1915 of the Social Security Act, strike 
``eligible individual with an opioid use disorder'' each place 
it appears and insert ``eligible individual with a targeted 
SUD'' each such place.
  Page 5, beginning on line 19, strike ``individuals with 
opioid use disorder'' and insert ``eligible individuals with 
targeted SUDs''.
  Page 6, beginning on line 1, strike ``eligible individuals 
with an opioid use disorder'' and insert ``eligible individuals 
with targeted SUDs''.
  Page 6, line 7, insert before the period the following: ``and 
to determine the appropriate setting for such care''.
  Page 7, line 12, strike ``opioid use disorder'' and insert 
``targeted SUD''.
  In the subsection (l)(4) proposed to be added by section 2 of 
the bill to section 1915 of the Social Security Act, strike 
subparagraph (D), redesignate subparagraph (E) as subparagraph 
(D), and add at the end the following:
                  ``(E) Targeted sud.--
                          ``(i) In general.--The term `targeted 
                        SUD' means an opioid use disorder or a 
                        cocaine use disorder.
                          ``(ii) Cocaine use disorder.--The 
                        term `cocaine use disorder' means a 
                        disorder that meets the criteria of the 
                        Diagnostic and Statistical Manual of 
                        Mental Disorders, 4th Edition (or a 
                        successor edition), for either 
                        dependence or abuse for cocaine, 
                        including cocaine base (commonly 
                        referred to as `crack cocaine').
                          ``(iii) Opioid use disorder.--The 
                        term `opioid use disorder' means a 
                        disorder that meets the criteria of the 
                        Diagnostic and Statistical Manual of 
                        Mental Disorders, 4th Edition (or a 
                        successor edition), for heroin use 
                        disorder or pain reliever use disorder 
                        (including with respect to opioid 
                        prescription pain relievers).''.
  Strike all that follows after section 2 and insert the 
following:

SEC. 3. PROMOTING VALUE IN MEDICAID MANAGED CARE.

  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)(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 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).''.
                              ----------                              


 2. An Amendment To Be Offered by Representative Kildee of Michigan or 
                 His Designee, Debatable for 10 Minutes

  Page 6, line 19, strike ``and''.
  Page 6, line 23, strike the period at the end and insert ``; 
and''.
  Page 6, after line 23, insert the following:
                          ``(iv) the number of eligible 
                        individuals with any co-occuring 
                        disorders who received services 
                        pursuant to such State plan amendment 
                        and the co-occuring disorders from 
                        which they suffer; and
                          ``(v) information regarding the 
                        effects of a State plan amendment on 
                        access to community care for 
                        individuals suffering from a mental 
                        disease other than substance use 
                        disorder.''.
                              ----------                              


    3. An Amendment To Be Offered by Representative Fitzpatrick of 
         Pennsylvania or His Designee, Debatable for 10 Minutes

  Page 6, line 7, insert before the period the following: ``or 
criteria established or endorsed by the State agency identified 
by the State pursuant to section 1932(b)(1)(A)(i) of the Public 
Health Service Act''.

                                  [all]