    [House Report 117-364]
    [From the U.S. Government Publishing Office]

    117th Congress     }	                             {  Rept. 117-364
                  		HOUSE OF REPRESENTATIVES
      2d Session       }                                 {      Part 1
    _______________________________________________________________________

          RESTORING HOPE FOR MENTAL HEALTH AND WELL-BEING ACT OF 2022

                                   ----------

                                  R E P O R T

                                     of the

                        COMMITTEE ON ENERGY AND COMMERCE

                             To accompany H.R. 7666

    		[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

     June 13, 2022.--Committed to the Committee of the Whole House on the
                  State of the Union and ordered to be printed

          RESTORING HOPE FOR MENTAL HEALTH AND WELL-BEING ACT OF 2022

    117th Congress     }	                             {  Rept. 117-364
                  		HOUSE OF REPRESENTATIVES
      2d Session       }                                 {      Part 1
    _______________________________________________________________________

          RESTORING HOPE FOR MENTAL HEALTH AND WELL-BEING ACT OF 2022

                                   __________

                                  R E P O R T

                                     of the

                        COMMITTEE ON ENERGY AND COMMERCE

                             To accompany H.R. 7666

    		[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

     June 13, 2022.--Committed to the Committee of the Whole House on the
                  State of the Union and ordered to be printed

    			      __________

    		     U.S. GOVERNMENT PUBLISHING OFFICE

    47-779			   WASHINGTON : 2022

    117th Congress   }                                    {Rept. 117-364
                            HOUSE OF REPRESENTATIVES
     2d Session      }                                    {    Part 1

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

          RESTORING HOPE FOR MENTAL HEALTH AND WELL-BEING ACT OF 2022

                                    _______

     June 13, 2022.--Committed to the Committee of the Whole House on the
                  State of the Union and ordered to be printed

                                    _______

     Mr. Pallone, from the Committee on Energy and Commerce, submitted the
                                   following

                                  R E P O R T

                            [To accompany H.R. 7666]

        The Committee on Energy and Commerce, to whom was referred
    the bill (H.R. 7666) to amend the Public Health Service Act to
    reauthorize certain programs relating to mental health and
    substance use disorders, and for other purposes, having
    considered the same, reports favorably thereon with an
    amendment and recommends that the bill as amended do pass.

                                    CONTENTS

                                                                       Page
       I. Purpose and Summary............................................42
      II. Background and Need for the Legislation........................43
     III. Committee Hearings.............................................49
      IV. Committee Consideration........................................49
       V. Committee Votes................................................50
      VI. Oversight Findings.............................................56
     VII. New Budget Authority, Entitlement Authority, and Tax Expenditur56
    VIII. Federal Mandates Statement.....................................56
      IX. Statement of General Performance Goals and Objectives..........56
       X. Duplication of Federal Programs................................56
      XI. Committee Cost Estimate........................................56
     XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits....56
    XIII. Advisory Committee Statement...................................57
     XIV. Applicability to Legislative Branch............................57
      XV. Section-by-Section Analysis of the Legislation.................57
     XVI. Changes in Existing Law Made by the Bill, as Reported..........66
    XVII. Communications from Other Committees..........................456

        The amendment is as follows:
      Strike all after the enacting clause and insert the
    following:

    SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

      (a) Short Title.--This Act may be cited as the ``Restoring Hope for
    Mental Health and Well-Being Act of 2022''.
      (b) Table of Contents.--The table of contents for this Act is as
    follows:

    Sec. 1. Short title; table of contents.

                  TITLE I--MENTAL HEALTH AND CRISIS CARE NEEDS

           Subtitle A--Crisis Care Services and 9-8-8 Implementation

    Sec. 101. Behavioral Health Crisis Coordinating Office.
    Sec. 102. Crisis response continuum of care.

    Subtitle B--Into the Light for Maternal Mental Health and Substance Use
                                   Disorders

    Sec. 111. Screening and treatment for maternal mental health and
    substance use disorders.
    Sec. 112. Maternal mental health hotline.
    Sec. 113. Task force on maternal mental health.

       Subtitle C--Reaching Improved Mental Health Outcomes for Patients

    Sec. 121. Innovation for mental health.
    Sec. 122. Crisis care coordination.
    Sec. 123. Treatment of serious mental illness.

                         Subtitle D--Anna Westin Legacy

    Sec. 131. Maintaining education and training on eating disorders.

           Subtitle E--Community Mental Health Services Block Grant
                                Reauthorization

    Sec. 141. Reauthorization of block grants for community mental health
    services.

               Subtitle F--Peer-Supported Mental Health Services

    Sec. 151. Peer-supported mental health services.

     TITLE II--SUBSTANCE USE DISORDER PREVENTION, TREATMENT, AND RECOVERY
                                    SERVICES

            Subtitle A--Native Behavioral Health Access Improvement

    Sec. 201. Behavioral health and substance use disorder services for
    Native Americans.

         Subtitle B--Summer Barrow Prevention, Treatment, and Recovery

    Sec. 211. Grants for the benefit of homeless individuals.
    Sec. 212. Priority substance abuse treatment needs of regional and
    national significance.
    Sec. 213. Evidence-based prescription opioid and heroin treatment and
    interventions demonstration.
    Sec. 214. Priority substance use disorder prevention needs of regional
    and national significance.
    Sec. 215. Sober Truth on Preventing (STOP) Underage Drinking
    Reauthorization.
    Sec. 216. Grants for jail diversion programs.
    Sec. 217. Formula grants to States.
    Sec. 218. Projects for Assistance in Transition From Homelessness.
    Sec. 219. Grants for reducing overdose deaths.
    Sec. 220. Opioid overdose reversal medication access and education
    grant programs.
    Sec. 221. State demonstration grants for comprehensive opioid abuse
    response.
    Sec. 222. Emergency department alternatives to opioids.

                   Subtitle C--Excellence in Recovery Housing

    Sec. 231. Clarifying the role of SAMHSA in promoting the availability
    of high-quality recovery housing.
    Sec. 232. Developing guidelines for States to promote the availability
    of high-quality recovery housing.
    Sec. 233. Coordination of Federal activities to promote the
    availability of recovery housing.
    Sec. 234. NAS study and report.
    Sec. 235. Grants for States to promote the availability of recovery
    housing and services.
    Sec. 236. Funding.
    Sec. 237. Technical correction.

    Subtitle D--Substance Use Prevention, Treatment, and Recovery Services
                                  Block Grant

    Sec. 241. Eliminating stigmatizing language relating to substance use.
    Sec. 242. Authorized activities.
    Sec. 243. Requirements relating to certain infectious diseases and
    human immunodeficiency virus.
    Sec. 244. State plan requirements.
    Sec. 245. Updating certain language relating to Tribes.
    Sec. 246. Block grants for substance use prevention, treatment, and
    recovery services.
    Sec. 247. Requirement of reports and audits by States.
    Sec. 248. Study on assessment for use in distribution of limited State
    resources.

              Subtitle E--Timely Treatment for Opioid Use Disorder

    Sec. 251. Study on exemptions for treatment of opioid use disorder
    through opioid treatment programs during the COVID-19 public health
    emergency.
    Sec. 252. Changes to Federal opioid treatment standards.

       Subtitle F--Additional Provisions Relating to Addiction Treatment

    Sec. 261. Prohibition.
    Sec. 262. Eliminating additional requirements for dispensing narcotic
    drugs in schedule III, IV, and V for maintenance or detoxification
    treatment.
    Sec. 263. Requiring prescribers of controlled substances to complete
    training.

              TITLE III--ACCESS TO MENTAL HEALTH CARE AND COVERAGE

           Subtitle A--Collaborate in an Orderly and Cohesive Manner

    Sec. 301. Increasing uptake of the collaborative care model.

            Subtitle B--Helping Enable Access to Lifesaving Services

    Sec. 311. Reauthorization and provision of certain programs to
    strengthen the health care workforce.

    Subtitle C--Eliminating the Opt-Out for Nonfederal Governmental Health
                                     Plans

    Sec. 321. Eliminating the opt-out for nonfederal governmental health
    plans.

          Subtitle D--Mental Health and Substance Use Disorder Parity
                                 Implementation

    Sec. 331. Grants to support mental health and substance use disorder
    parity implementation.

                          TITLE IV--CHILDREN AND YOUTH

          Subtitle A--Supporting Children's Mental Health Care Access

    Sec. 401. Pediatric mental health care access grants.
    Sec. 402. Infant and early childhood mental health promotion,
    intervention, and treatment.

              Subtitle B--Continuing Systems of Care for Children

    Sec. 411. Comprehensive Community Mental Health Services for Children
    with Serious Emotional Disturbances.
    Sec. 412. Substance Use Disorder Treatment and Early Intervention
    Services for Children and Adolescents.

             Subtitle C--Garrett Lee Smith Memorial Reauthorization

    Sec. 421. Suicide prevention technical assistance center.
    Sec. 422. Youth suicide early intervention and prevention strategies.
    Sec. 423. Mental health and substance use disorder services for
    students in higher education.
    Sec. 424. Mental and behavioral health outreach and education at
    institutions of higher education.

                  TITLE I--MENTAL HEALTH AND CRISIS CARE NEEDS

           Subtitle A--Crisis Care Services and 9-8-8 Implementation

    SEC. 101. BEHAVIORAL HEALTH CRISIS COORDINATING OFFICE.

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

    ``SEC. 506B. BEHAVIORAL HEALTH CRISIS COORDINATING OFFICE.

      ``(a) In General.--The Secretary shall establish, within the
    Substance Abuse and Mental Health Services Administration, an office to
    coordinate work relating to behavioral health crisis care across the
    operating divisions and agencies of the Department of Health and Human
    Services, including the Substance Abuse and Mental Health Services
    Administration, the Centers for Medicare & Medicaid Services, and the
    Health Resources and Services Administration, and external
    stakeholders.
      ``(b) Duty.--The office established under subsection (a) shall--
              ``(1) convene Federal, State, Tribal, local, and private
            partners;
              ``(2) launch and manage Federal workgroups charged with
            making recommendations regarding behavioral health crisis
            issues, including with respect to health care best practices,
            workforce development, mental health disparities, data
            collection, technology, program oversight, public awareness,
            and engagement; and
              ``(3) support technical assistance, data analysis, and
            evaluation functions in order to assist States, localities,
            Territories, Tribes, and Tribal communities to develop crisis
            care systems and establish nationwide best practices with the
            objective of expanding the capacity of, and access to, local
            crisis call centers, mobile crisis care, crisis stabilization,
            psychiatric emergency services, and rapid post-crisis follow-up
            care provided by--
                      ``(A) the National Suicide Prevention and Mental
                    Health Crisis Hotline and Response System;
                      ``(B) community mental health centers (as defined in
                    section 1861(ff)(3)(B) of the Social Security Act);
                      ``(C) certified community behavioral health clinics,
                    as described in section 223 of the Protecting Access to
                    Medicare Act of 2014; and
                      ``(D) other community mental health and substance use
                    disorder providers.
      ``(c) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section $5,000,000 for each of fiscal
    years 2023 through 2027.''.

    SEC. 102. CRISIS RESPONSE CONTINUUM OF CARE.

      Subpart 3 of part B of title V of the Public Health Service Act (42
    U.S.C. 290bb-31 et seq.) is amended by adding at the end the following:

    ``SEC. 520N. CRISIS RESPONSE CONTINUUM OF CARE.

      ``(a) In General.--The Secretary shall publish best practices for a
    crisis response continuum of care for use by health care providers,
    crisis services administrators, and crisis services providers in
    responding to individuals (including children and adolescents)
    experiencing mental health crises, substance-related crises, and crises
    arising from co-occurring disorders.
      ``(b) Best Practices.--
              ``(1) Scope of best practices.--The best practices published
            under subsection (a) shall define--
                      ``(A) a minimum set of core crisis response services,
                    as determined by the Secretary, for each entity that
                    furnishes such services, that--
                              ``(i) do not require prior authorization from
                            an insurance provider or group health plan nor
                            a referral from a health care provider prior to
                            the delivery of services;
                              ``(ii) provide for serving all individuals
                            regardless of age or ability to pay;
                              ``(iii) provide for operating 24 hours a day,
                            7 days a week; and
                              ``(iv) provide for care and support through
                            resources described in paragraph (2)(A) until
                            the individual has been stabilized or
                            transferred to the next level of crisis care;
                            and
                      ``(B) psychiatric stabilization, including the point
                    at which a case may be closed for--
                              ``(i) individuals screened over the phone;
                            and
                              ``(ii) individuals stabilized on the scene by
                            mobile teams.
              ``(2) Identification of essential functions.--The best
            practices published under subsection (a) shall identify the
            essential functions of each service in the crisis response
            continuum, which shall include at least the following:
                      ``(A) Identification of resources for referral and
                    enrollment in continuing mental health, substance use,
                    or other human services relevant for the individual in
                    crisis where necessary.
                      ``(B) Delineation of access and entry points to
                    services within the crisis response continuum.
                      ``(C) Development of protocols and agreements for the
                    transfer and receipt of individuals to and from other
                    segments of the crisis response continuum segments as
                    needed, and from outside referrals including health
                    care providers, first responders including law
                    enforcement, paramedics, and firefighters, education
                    institutions, and community-based organizations.
                      ``(D) Description of the qualifications of crisis
                    services staff, including roles for physicians,
                    licensed clinicians, case managers, and peers (in
                    accordance with State licensing requirements or
                    requirements applicable to Tribal health
                    professionals).
                      ``(E) The convening of collaborative meetings of
                    crisis response service providers, first responders
                    including law enforcement, paramedics, and
                    firefighters, and community partners (including
                    National Suicide Prevention Lifeline or 9-8-8 call
                    centers, 9-1-1 public service answering points, and
                    local mental health and substance use disorder
                    treatment providers) operating in a common region for
                    the discussion of case management, best practices, and
                    general performance improvement.
              ``(3) Service capacity and quality best practices.--The best
            practices under subsection (a) shall include recommendations
            on--
                      ``(A) adequate volume of services to meet population
                    need;
                      ``(B) appropriate timely response; and
                      ``(C) capacity to meet the needs of different patient
                    populations that may experience a mental health or
                    substance use crisis, including children, families, and
                    all age groups, cultural and linguistic minorities,
                    individuals with co-occurring mental health and
                    substance use disorders, individuals with cognitive
                    disabilities, individuals with developmental delays,
                    and individuals with chronic medical conditions and
                    physical disabilities.
              ``(4) Implementation timeframe.--The Secretary shall--
                      ``(A) not later than 1 year after the date of
                    enactment of this section, publish and maintain the
                    best practices required by subsection (a); and
                      ``(B) every two years thereafter, publish updates.
              ``(5) Data collection and evaluations.--The Secretary,
            directly or through grants, contracts, or interagency
            agreements, shall collect data and conduct evaluations with
            respect to the provision of services and programs offered on
            the crisis response continuum for purposes of assessing the
            extent to which the provision of such services and programs
            meet certain objectives and outcomes measures as determined by
            the Secretary. Such objectives shall include--
                      ``(A) a reduction in reliance on law enforcement
                    response, as appropriate, to individuals in crisis who
                    would be more appropriately served by a mobile crisis
                    team capable of responding to mental health and
                    substance-related crises;
                      ``(B) a reduction in boarding or extended holding of
                    patients in emergency room facilities who require
                    further psychiatric care, including care for substance
                    use disorders;
                      ``(C) evidence of adequate access to crisis care
                    centers and crisis bed services; and
                      ``(D) evidence of adequate linkage to appropriate
                    post-crisis care and longitudinal treatment for mental
                    health or substance use disorder when relevant.''.

    Subtitle B--Into the Light for Maternal Mental Health and Substance Use
                                   Disorders

    SEC. 111. SCREENING AND TREATMENT FOR MATERNAL MENTAL HEALTH AND
                        SUBSTANCE USE DISORDERS.

      (a) In General.--Section 317L-1 of the Public Health Service Act (42
    U.S.C. 247b-13a) is amended--
              (1) in the section heading, by striking ``maternal
            depression'' and inserting ``maternal mental health and
            substance use disorders''; and
              (2) in subsection (a)--
                      (A) by inserting ``, Indian Tribes and Tribal
                    organizations (as such terms are defined in section 4
                    of the Indian Self-Determination and Education
                    Assistance Act), and Urban Indian organizations (as
                    such term is defined under the Federally Recognized
                    Indian Tribe List Act of 1994)'' after ``States''; and
                      (B) by striking ``for women who are pregnant, or who
                    have given birth within the preceding 12 months, for
                    maternal depression'' and inserting ``for women who are
                    postpartum, pregnant, or have given birth within the
                    preceding 12 months, for maternal mental health and
                    substance use disorders''.
      (b) Application.--Subsection (b) of section 317L-1 of the Public
    Health Service Act (42 U.S.C. 247b-13a) is amended--
              (1) by striking ``a State shall submit'' and inserting ``an
            entity listed in subsection (a) shall submit''; and
              (2) in paragraphs (1) and (2), by striking ``maternal
            depression'' each place it appears and inserting ``maternal
            mental health and substance use disorders''.
      (c) Priority.--Subsection (c) of section 317L-1 of the Public Health
    Service Act (42 U.S.C. 247b-13a) is amended--
              (1) by striking ``may give priority to States proposing to
            improve or enhance access to screening'' and inserting the
            following: ``shall give priority to entities listed in
            subsection (a) that--
              ``(1) are proposing to create, improve, or enhance screening,
            prevention, and treatment'';
              (2) by striking ``maternal depression'' and inserting
            ``maternal mental health and substance use disorders'';
              (3) by striking the period at the end of paragraph (1), as so
            designated, and inserting a semicolon; and
              (4) by inserting after such paragraph (1) the following:
              ``(2) are currently partnered with, or will partner with, a
            community-based organization to address maternal mental health
            and substance use disorders;
              ``(3) are located in an area with high rates of adverse
            maternal health outcomes or significant health, economic,
            racial, or ethnic disparities in maternal health and substance
            use disorder outcomes; and
              ``(4) operate in a health professional shortage area
            designated under section 332.''.
      (d) Use of Funds.--Subsection (d) of section 317L-1 of the Public
    Health Service Act (42 U.S.C. 247b-13a) is amended--
              (1) in paragraph (1)--
                      (A) in subparagraph (A), by striking ``to health care
                    providers; and'' and inserting ``on maternal mental
                    health and substance use disorder screening, brief
                    intervention, treatment (as applicable for health care
                    providers), and referrals for treatment to health care
                    providers in the primary care setting and nonclinical
                    perinatal support workers;'';
                      (B) in subparagraph (B), by striking ``to health care
                    providers, including information on maternal depression
                    screening, treatment, and followup support services,
                    and linkages to community-based resources; and'' and
                    inserting ``on maternal mental health and substance use
                    disorder screening, brief intervention, treatment (as
                    applicable for health care providers) and referrals for
                    treatment, follow-up support services, and linkages to
                    community-based resources to health care providers in
                    the primary care setting and clinical perinatal support
                    workers; and''; and
                      (C) by adding at the end the following:
                      ``(C) enabling health care providers (such as
                    obstetrician-gynecologists, nurse practitioners, nurse
                    midwives, pediatricians, psychiatrists, mental and
                    other behavioral health care providers, and adult
                    primary care clinicians) to provide or receive real-
                    time psychiatric consultation (in-person or remotely),
                    including through the use of technology-enabled
                    collaborative learning and capacity building models (as
                    defined in section 330N), to aid in the treatment of
                    pregnant and postpartum women; and''; and
              (2) in paragraph (2)--
                      (A) by striking subparagraph (A) and redesignating
                    subparagraphs (B) and (C) as subparagraphs (A) and (B),
                    respectively;
                      (B) in subparagraph (A), as redesignated, by striking
                    ``and'' at the end;
                      (C) in subparagraph (B), as redesignated--
                              (i) by inserting ``, including'' before ``for
                            rural areas''; and
                              (ii) by striking the period at the end and
                            inserting a semicolon; and
                      (D) by inserting after subparagraph (B), as
                    redesignated, the following:
                      ``(C) providing assistance to pregnant and postpartum
                    women to receive maternal mental health and substance
                    use disorder treatment, including patient consultation,
                    care coordination, and navigation for such treatment;
                      ``(D) coordinating with maternal and child health
                    programs of the Federal Government and State, local,
                    and Tribal governments, including child psychiatric
                    access programs;
                      ``(E) conducting public outreach and awareness
                    regarding grants under subsection (a);
                      ``(F) creating multistate consortia to carry out the
                    activities required or authorized under this
                    subsection; and
                      ``(G) training health care providers in the primary
                    care setting and nonclinical perinatal support workers
                    on trauma-informed care, culturally and linguistically
                    appropriate services, and best practices related to
                    training to improve the provision of maternal mental
                    health and substance use disorder care for racial and
                    ethnic minority populations, including with respect to
                    perceptions and biases that may affect the approach to,
                    and provision of, care.''.
      (e) Additional Provisions.--Section 317L-1 of the Public Health
    Service Act (42 U.S.C. 247b-13a) is amended--
              (1) by redesignating subsection (e) as subsection (h); and
              (2) by inserting after subsection (d) the following:
      ``(e) Technical Assistance.--The Secretary shall provide technical
    assistance to grantees and entities listed in subsection (a) for
    carrying out activities pursuant to this section.
      ``(f) Dissemination of Best Practices.--The Secretary, based on
    evaluation of the activities funded pursuant to this section, shall
    identify and disseminate evidence-based or evidence-informed best
    practices for screening, assessment, and treatment services for
    maternal mental health and substance use disorders, including
    culturally and linguistically appropriate services, for women during
    pregnancy and 12 months following pregnancy.
      ``(g) Matching Requirement.--The Federal share of the cost of the
    activities for which a grant is made to an entity under subsection (a)
    shall not exceed 90 percent of the total cost of such activities.''.
      (f) Authorization of Appropriations.--Subsection (h) of section 317L-
    1 (42 U.S.C. 247b-13a) of the Public Health Service Act, as
    redesignated, is further amended--
              (1) by striking ``$5,000,000'' and inserting ``$24,000,000'';
            and
              (2) by striking ``2018 through 2022'' and inserting ``2023
            through 2027''.

    SEC. 112. MATERNAL MENTAL HEALTH HOTLINE.

      Part P of title III of the Public Health Service Act (42 U.S.C. 280g
    et seq.) is amended by adding at the end the following:

    ``SEC. 399V-7. MATERNAL MENTAL HEALTH HOTLINE.

      ``(a) In General.--The Secretary shall maintain, directly or by grant
    or contract, a national hotline to provide emotional support,
    information, brief intervention, and mental health and substance use
    disorder resources to pregnant and postpartum women at risk of, or
    affected by, maternal mental health and substance use disorders, and to
    their families or household members.
      ``(b) Requirements for Hotline.--The hotline under subsection (a)
    shall--
              ``(1) be a 24/7 real-time hotline;
              ``(2) provide voice and text support;
              ``(3) be staffed by certified peer specialists, licensed
            health care professionals, or licensed mental health
            professionals who are trained on--
                      ``(A) maternal mental health and substance use
                    disorder prevention, identification, and intervention;
                    and
                      ``(B) providing culturally and linguistically
                    appropriate support; and
              ``(4) provide maternal mental health and substance use
            disorder assistance and referral services to meet the needs of
            underserved populations, individuals with disabilities, and
            family and household members of pregnant or postpartum women at
            risk of experiencing maternal mental health and substance use
            disorders.
      ``(c) Additional Requirements.--In maintaining the hotline under
    subsection (a), the Secretary shall--
              ``(1) consult with the Domestic Violence Hotline, National
            Suicide Prevention Lifeline, and Veterans Crisis Line to ensure
            that pregnant and postpartum women are connected in real-time
            to the appropriate specialized hotline service, when
            applicable;
              ``(2) conduct a public awareness campaign for the hotline;
            and
              ``(3) consult with Federal departments and agencies,
            including the Centers of Excellence of the Substance Abuse and
            Mental Health Services Administration and the Department of
            Veterans Affairs, to increase awareness regarding the hotline.
      ``(d) Annual Report.--The Secretary shall submit an annual report to
    the Congress on the hotline under subsection (a) and implementation of
    this section, including--
              ``(1) an evaluation of the effectiveness of activities
            conducted or supported under subsection (a);
              ``(2) a directory of entities or organizations to which staff
            maintaining the hotline funded under this section may make
            referrals; and
              ``(3) such additional information as the Secretary determines
            appropriate.
      ``(e) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated $10,000,000 for each of fiscal
    years 2023 through 2027.''.

    SEC. 113. TASK FORCE ON MATERNAL MENTAL HEALTH.

      Part B of title III of the Public Health Service Act (42 U.S.C. 243
    et seq.) is amended by inserting after section 317L-1 (42 U.S.C. 247b-
    13a) the following:

    ``SEC. 317L-2. TASK FORCE ON MATERNAL MENTAL HEALTH.

      ``(a) Establishment.--Not later than 180 days after the date of
    enactment of the Restoring Hope for the Mental Health and Well-Being
    Act of 2022, the Secretary, for purposes of identifying, evaluating,
    and making recommendations to coordinate and improve Federal responses
    to maternal mental health conditions, shall--
              ``(1) establish a task force to be known as the Task Force on
            Maternal Mental Health (in this section referred to as the
            `Task Force'); or
              ``(2) incorporate the duties, public meetings, and reports
            specified in subsections (c) through (f) into existing Federal
            policy forums, including the Maternal Health Interagency Policy
            Committee and the Maternal Health Working Group, as
            appropriate.
      ``(b) Membership.--
              ``(1) Composition.--The Task Force shall be composed of--
                      ``(A) the Federal members under paragraph (2); and
                      ``(B) the non-Federal members under paragraph (3).
              ``(2) Federal members.--The Federal members of the Task Force
            shall consist of the following heads of Federal departments and
            agencies (or their designees):
                      ``(A) The Assistant Secretary for Health of the
                    Department of Health and Human Services, who shall
                    serve as Chair.
                      ``(B) The Assistant Secretary for Planning and
                    Evaluation of the Department of Health and Human
                    Services.
                      ``(C) The Assistant Secretary of the Administration
                    for Children and Families.
                      ``(D) The Director of the Centers for Disease Control
                    and Prevention.
                      ``(E) The Administrator of the Centers for Medicare &
                    Medicaid Services.
                      ``(F) The Administrator of the Health Resources and
                    Services Administration.
                      ``(G) The Director of the Indian Health Service.
                      ``(H) The Assistant Secretary for Mental Health and
                    Substance Use.
                      ``(I) Such other Federal departments and agencies as
                    the Secretary determines appropriate that serve
                    individuals with maternal mental health conditions.
              ``(3) Non-federal members.--The non-Federal members of the
            Task Force shall--
                      ``(A) compose not more than one-half, and not less
                    than one-third, of the total membership of the Task
                    Force;
                      ``(B) be appointed by the Secretary; and
                      ``(C) include--
                              ``(i) representatives of medical societies
                            with expertise in maternal or mental health;
                              ``(ii) representatives of nonprofit
                            organizations with expertise in maternal or
                            mental health;
                              ``(iii) relevant industry representatives;
                            and
                              ``(iv) other representatives, as appropriate.
              ``(4) Deadline for designating designees.--If the Assistant
            Secretary for Health, or the head of a Federal department or
            agency serving as a member of the Task Force under paragraph
            (2), chooses to be represented on the Task Force by a designee,
            the Assistant Secretary or department or agency head shall
            designate such designee not later than 90 days after the date
            of the enactment of this section.
      ``(c) Duties.--The Task Force shall--
              ``(1) prepare and regularly update a report that analyzes and
            evaluates the state of national maternal mental health policy
            and programs at the Federal, State, and local levels, and
            identifies best practices with respect to maternal mental
            health policy, including--
                      ``(A) a set of evidence-based, evidence-informed, and
                    promising practices with respect to--
                              ``(i) prevention strategies for individuals
                            at risk of experiencing a maternal mental
                            health condition, including strategies and
                            recommendations to address health inequities;
                              ``(ii) the identification, screening,
                            diagnosis, intervention, and treatment of
                            individuals and families affected by a maternal
                            mental health condition;
                              ``(iii) the expeditious referral to, and
                            implementation of, practices and supports that
                            prevent and mitigate the effects of a maternal
                            mental health condition, including strategies
                            and recommendations to eliminate the racial and
                            ethnic disparities that exist in maternal
                            mental health; and
                              ``(iv) community-based or multigenerational
                            practices that support individuals and families
                            affected by a maternal mental health condition;
                            and
                      ``(B) Federal and State programs and activities to
                    prevent, screen, diagnose, intervene, and treat
                    maternal mental health conditions;
              ``(2) develop and regularly update a national strategy for
            maternal mental health, taking into consideration the findings
            of the report under paragraph (1), on how the Task Force and
            Federal departments and agencies represented on the Task Force
            may prioritize options for, and may implement a coordinated
            approach to, addressing maternal mental health conditions,
            including by--
                      ``(A) increasing prevention, screening, diagnosis,
                    intervention, treatment, and access to care, including
                    clinical and nonclinical care such as peer-support and
                    community health workers, through the public and
                    private sectors;
                      ``(B) providing support for pregnant or postpartum
                    individuals who are at risk for or experiencing a
                    maternal mental health condition, and their families,
                    as appropriate;
                      ``(C) reducing racial, ethnic, geographic, and other
                    health disparities for prevention, diagnosis,
                    intervention, treatment, and access to care;
                      ``(D) identifying options for modifying,
                    strengthening, and coordinating Federal programs and
                    activities, such as the Medicaid program under title
                    XIX of the Social Security Act and the State Children's
                    Health Insurance Program under title XXI of such Act,
                    including existing infant and maternity programs, in
                    order to increase research, prevention, identification,
                    intervention, and treatment with respect to maternal
                    mental health; and
                      ``(E) planning, data sharing, and communication
                    within and across Federal departments, agencies,
                    offices, and programs;
              ``(3) solicit public comments from stakeholders for the
            report under paragraph (1) and the national strategy under
            paragraph (2), including comments from frontline service
            providers, mental health professionals, researchers, experts in
            maternal mental health, institutions of higher education,
            public health agencies (including maternal and child health
            programs), and industry representatives, in order to inform the
            activities and reports of the Task Force; and
              ``(4) disaggregate any data collected under this section by
            race, ethnicity, geographical location, age, marital status,
            socioeconomic level, and other factors, as the Secretary
            determines appropriate.
      ``(d) Meetings.--The Task Force shall--
              ``(1) meet not less than two times each year; and
              ``(2) convene public meetings, as appropriate, to fulfill its
            duties under this section.
      ``(e) Reports to Public and Federal Leaders.--The Task Force shall
    make publicly available and submit to the heads of relevant Federal
    departments and agencies, the Committee on Energy and Commerce of the
    House of Representatives, the Committee on Health, Education, Labor,
    and Pensions of the Senate, and other relevant congressional
    committees, the following:
              ``(1) Not later than 1 year after the first meeting of the
            Task Force, an initial report under subsection (c)(1).
              ``(2) Not later than 2 years after the first meeting of the
            Task Force, an initial national strategy under subsection
            (c)(2).
              ``(3) Each year thereafter--
                      ``(A) an updated report under subsection (c)(1);
                      ``(B) an updated national strategy under subsection
                    (c)(2); or
                      ``(C) if no update is made under subsection (c)(1) or
                    (c)(2), a report summarizing the activities of the Task
                    Force.
      ``(f) Reports to Governors.--Upon finalizing the initial national
    strategy under subsection (c)(2), and upon making relevant updates to
    such strategy, the Task Force shall submit a report to the Governors of
    all States describing opportunities for local- and State-level
    partnerships identified under subsection (c)(2)(D).
      ``(g) Sunset.--The Task Force shall terminate on September 30, 2027.
      ``(h) Nonduplication of Federal Efforts.--The Secretary may relieve
    the Task Force, in carrying out subsections (c) through (f), from
    responsibility for carrying out such activities as may be specified by
    the Secretary as duplicative with other activities carried out by the
    Department of Health and Human Services.''.

       Subtitle C--Reaching Improved Mental Health Outcomes for Patients

    SEC. 121. INNOVATION FOR MENTAL HEALTH.

      (a) National Mental Health and Substance Use Policy Laboratory.--
    Section 501A of the Public Health Service Act (42 U.S.C. 290aa-0) is
    amended--
              (1) in subsection (e)(1), by striking ``Indian tribes or
            tribal organizations'' and inserting ``Indian Tribes or Tribal
            organizations'';
              (2) by striking subsection (e)(3); and
              (3) by adding at the end the following:
      ``(f) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $10,000,000 for each of fiscal
    years 2023 through 2027.''.
      (b) Interdepartmental Serious Mental Illness Coordinating
    Committee.--
              (1) In general.--Part A of title V of the Public Health
            Service Act (42 U.S.C. 290aa et seq.) is amended by inserting
            after section 501A (42 U.S.C. 290aa-0) the following:

    ``SEC. 501B. INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING
                        COMMITTEE.

      ``(a) Establishment.--
              ``(1) In general.--The Secretary of Health and Human
            Services, or the designee of the Secretary, shall establish a
            committee to be known as the Interdepartmental Serious Mental
            Illness Coordinating Committee (in this section referred to as
            the `Committee').
              ``(2) Federal advisory committee act.--Except as provided in
            this section, the provisions of the Federal Advisory Committee
            Act (5 U.S.C. App.) shall apply to the Committee.
      ``(b) Meetings.--The Committee shall meet not fewer than 2 times each
    year.
      ``(c) Responsibilities.--The Committee shall submit, on a biannual
    basis, to Congress and any other relevant Federal department or agency
    a report including--
              ``(1) a summary of advances in serious mental illness and
            serious emotional disturbance research related to the
            prevention of, diagnosis of, intervention in, and treatment and
            recovery of serious mental illnesses, serious emotional
            disturbances, and advances in access to services and support
            for adults with a serious mental illness or children with a
            serious emotional disturbance;
              ``(2) an evaluation of the effect Federal programs related to
            serious mental illness have on public health, including public
            health outcomes such as--
                      ``(A) rates of suicide, suicide attempts, incidence
                    and prevalence of serious mental illnesses, serious
                    emotional disturbances, and substance use disorders,
                    overdose, overdose deaths, emergency hospitalizations,
                    emergency room boarding, preventable emergency room
                    visits, interaction with the criminal justice system,
                    homelessness, and unemployment;
                      ``(B) increased rates of employment and enrollment in
                    educational and vocational programs;
                      ``(C) quality of mental and substance use disorders
                    treatment services; or
                      ``(D) any other criteria as may be determined by the
                    Secretary; and
              ``(3) specific recommendations for actions that agencies can
            take to better coordinate the administration of mental health
            services for adults with a serious mental illness or children
            with a serious emotional disturbance.
      ``(d) Membership.--
              ``(1) Federal members.--The Committee shall be composed of
            the following Federal representatives, or the designees of such
            representatives--
                      ``(A) the Secretary of Health and Human Services, who
                    shall serve as the Chair of the Committee;
                      ``(B) the Assistant Secretary for Mental Health and
                    Substance Use;
                      ``(C) the Attorney General;
                      ``(D) the Secretary of Veterans Affairs;
                      ``(E) the Secretary of Defense;
                      ``(F) the Secretary of Housing and Urban Development;
                      ``(G) the Secretary of Education;
                      ``(H) the Secretary of Labor;
                      ``(I) the Administrator of the Centers for Medicare &
                    Medicaid Services; and
                      ``(J) the Commissioner of Social Security.
              ``(2) Non-federal members.--The Committee shall also include
            not less than 14 non-Federal public members appointed by the
            Secretary of Health and Human Services, of which--
                      ``(A) at least 2 members shall be an individual who
                    has received treatment for a diagnosis of a serious
                    mental illness;
                      ``(B) at least 1 member shall be a parent or legal
                    guardian of an adult with a history of a serious mental
                    illness or a child with a history of a serious
                    emotional disturbance;
                      ``(C) at least 1 member shall be a representative of
                    a leading research, advocacy, or service organization
                    for adults with a serious mental illness;
                      ``(D) at least 2 members shall be--
                              ``(i) a licensed psychiatrist with experience
                            in treating serious mental illnesses;
                              ``(ii) a licensed psychologist with
                            experience in treating serious mental illnesses
                            or serious emotional disturbances;
                              ``(iii) a licensed clinical social worker
                            with experience treating serious mental
                            illnesses or serious emotional disturbances; or
                              ``(iv) a licensed psychiatric nurse, nurse
                            practitioner, or physician assistant with
                            experience in treating serious mental illnesses
                            or serious emotional disturbances;
                      ``(E) at least 1 member shall be a licensed mental
                    health professional with a specialty in treating
                    children and adolescents with a serious emotional
                    disturbance;
                      ``(F) at least 1 member shall be a mental health
                    professional who has research or clinical mental health
                    experience in working with minorities;
                      ``(G) at least 1 member shall be a mental health
                    professional who has research or clinical mental health
                    experience in working with medically underserved
                    populations;
                      ``(H) at least 1 member shall be a State certified
                    mental health peer support specialist;
                      ``(I) at least 1 member shall be a judge with
                    experience in adjudicating cases related to criminal
                    justice or serious mental illness;
                      ``(J) at least 1 member shall be a law enforcement
                    officer or corrections officer with extensive
                    experience in interfacing with adults with a serious
                    mental illness, children with a serious emotional
                    disturbance, or individuals in a mental health crisis;
                    and
                      ``(K) at least 1 member shall have experience
                    providing services for homeless individuals and working
                    with adults with a serious mental illness, children
                    with a serious emotional disturbance, or individuals in
                    a mental health crisis.
              ``(3) Terms.--A member of the Committee appointed under
            paragraph (2) shall serve for a term of 3 years, and may be
            reappointed for 1 or more additional 3-year terms. Any member
            appointed to fill a vacancy for an unexpired term shall be
            appointed for the remainder of such term. A member may serve
            after the expiration of the member's term until a successor has
            been appointed.
      ``(e) Working Groups.--In carrying out its functions, the Committee
    may establish working groups. Such working groups shall be composed of
    Committee members, or their designees, and may hold such meetings as
    are necessary.
      ``(f) Sunset.--The Committee shall terminate on September 30,
    2027.''.
              (2) Conforming amendments.--
                      (A) Section 501(l)(2) of the Public Health Service
                    Act (42 U.S.C. 290aa(l)(2)) is amended by striking
                    ``section 6031 of such Act'' and inserting ``section
                    501B of this Act''.
                      (B) Section 6031 of the Helping Families in Mental
                    Health Crisis Reform Act of 2016 (Division B of Public
                    Law 114-255) is repealed (and by conforming the item
                    relating to such section in the table of contents in
                    section 1(b)).
      (c) Priority Mental Health Needs of Regional and National
    Significance.--Section 520A of the Public Health Service Act (42 U.S.C.
    290bb-32) is amended--
              (1) in subsection (a), by striking ``Indian tribes or tribal
            organizations'' and inserting ``Indian Tribes or Tribal
            organizations''; and
              (2) in subsection (f), by striking ``$394,550,000 for each of
            fiscal years 2018 through 2022'' and inserting ``$599,036,000
            for each of fiscal years 2023 through 2027''.

    SEC. 122. CRISIS CARE COORDINATION.

      (a) Strengthening Community Crisis Response Systems.--Section 520F of
    the Public Health Service Act (42 U.S.C. 290bb-37) is amended to read
    as follows:

    ``SEC. 520F. MENTAL HEALTH CRISIS RESPONSE PARTNERSHIP PILOT PROGRAM.

      ``(a) In General.--The Secretary shall establish a pilot program
    under which the Secretary will award competitive grants to States,
    localities, territories, Indian Tribes, and Tribal organizations to
    establish new, or enhance existing, mobile crisis response teams that
    divert the response for mental health and substance use crises from law
    enforcement to mobile crisis teams, as described in subsection (b).
      ``(b) Mobile Crisis Teams Described.--A mobile crisis team described
    in this subsection is a team of individuals--
              ``(1) that is available to respond to individuals in crisis
            and provide immediate stabilization, referrals to community-
            based mental health and substance use disorder services and
            supports, and triage to a higher level of care if medically
            necessary;
              ``(2) which may include licensed counselors, clinical social
            workers, physicians, paramedics, crisis workers, peer support
            specialists, or other qualified individuals; and
              ``(3) which may provide support to divert behavioral health
            crisis calls from the 9-1-1 system to the 9-8-8 system.
      ``(c) Priority.--In awarding grants under this section, the Secretary
    shall prioritize applications which account for the specific needs of
    the communities to be served, including children and families,
    veterans, rural and underserved populations, and other groups at
    increased risk of death from suicide or overdose.
      ``(d) Report.--
              ``(1) Initial report.--Not later than September 30, 2024, the
            Secretary shall submit to Congress a report on steps taken by
            the entities specified in subsection (a) as of such date of
            enactment to strengthen the partnerships among mental health
            providers, substance use disorder treatment providers, primary
            care physicians, mental health and substance use crisis teams,
            paramedics, law enforcement officers, and other first
            responders.
              ``(2) Progress reports.--Not later than one year after the
            date on which the first grant is awarded to carry out this
            section, and for each year thereafter, the Secretary shall
            submit to Congress a report on the grants made during the year
            covered by the report, which shall include--
                      ``(A) impact data on the teams and people served by
                    such programs, including demographic information of
                    individuals served, volume, and types of service
                    utilization;
                      ``(B) outcomes of the number of linkages to
                    community-based resources, short-term crisis receiving
                    and stabilization facilities, and diversion from law
                    enforcement or hospital emergency department settings;
                      ``(C) data consistent with the State block grant
                    requirements for continuous evaluation and quality
                    improvement, and other relevant data as determined by
                    the Secretary; and
                      ``(D) the Secretary's recommendations and best
                    practices for--
                              ``(i) States and localities providing mobile
                            crisis response and stabilization services for
                            youth and adults; and
                              ``(ii) improvements to the program
                            established under this section.
      ``(e) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section, $10,000,000 for each of fiscal
    years 2023 through 2027.''.
      (b) Mental Health Awareness Training Grants.--
              (1) In general.--Section 520J(b) of the Public Health Service
            Act (42 U.S.C. 290bb-41(b)) is amended--
                      (A) in paragraph (1), by striking ``Indian tribes,
                    tribal organizations'' and inserting ``Indian Tribes,
                    Tribal organizations'';
                      (B) in paragraph (4), by striking ``Indian tribe,
                    tribal organization'' and inserting ``Indian Tribe,
                    Tribal organization'';
                      (C) in paragraph (5)--
                              (i) by striking ``Indian tribe, tribal
                            organization'' and inserting ``Indian Tribe,
                            Tribal organization'';
                              (ii) in subparagraph (A), by striking ``and''
                            at the end;
                              (iii) in subparagraph (B)(ii), by striking
                            the period at the end and inserting ``; and'';
                            and
                              (iv) by adding at the end the following:
                      ``(C) suicide intervention and prevention, including
                    recognizing warning signs and how to refer someone for
                    help.'';
                      (D) in paragraph (6), by striking ``Indian tribe,
                    tribal organization'' and inserting ``Indian Tribe,
                    Tribal organization''; and
                      (E) in paragraph (7), by striking ``$14,693,000 for
                    each of fiscal years 2018 through 2022'' and inserting
                    ``$24,963,000 for each of fiscal years 2023 through
                    2027''.
              (2) Technical corrections.--Section 520J(b) of the Public
            Health Service Act (42 U.S.C. 290bb-41(b)) is amended--
                      (A) in the heading of paragraph (2), by striking
                    ``Emergency Services Personnel'' and inserting
                    ``Emergency services personnel''; and
                      (B) in the heading of paragraph (3), by striking
                    ``Distribution of Awards'' and inserting ``Distribution
                    of awards''.
      (c) Adult Suicide Prevention.--Section 520L of the Public Health
    Service Act (42 U.S.C. 290bb-43) is amended--
              (1) in subsection (a)--
                      (A) in paragraph (2)--
                              (i) by striking ``Indian tribe'' each place
                            it appears and inserting ``Indian Tribe''; and
                              (ii) by striking ``tribal organization'' each
                            place it appears and inserting ``Tribal
                            organization''; and
                      (B) by amending paragraph (3)(C) to read as follows:
                      ``(C) Raising awareness of suicide prevention
                    resources, promoting help seeking among those at risk
                    for suicide.''; and
              (2) in subsection (d), by striking ``$30,000,000 for the
            period of fiscal years 2018 through 2022'' and inserting
            ``$30,000,000 for each of fiscal years 2023 through 2027''.

    SEC. 123. TREATMENT OF SERIOUS MENTAL ILLNESS.

      (a) Assertive Community Treatment Grant Program.--
              (1) Technical amendment.--Section 520M(b) of the Public
            Health Service Act (42 U.S.C. 290bb-44(b)) is amended by
            striking ``Indian tribe or tribal organization'' and inserting
            ``Indian Tribe or Tribal organization''.
              (2) Report to congress.--Section 520M(d)(1) of the Public
            Health Service Act (42 U.S.C. 290bb-44(d)(1)) is amended by
            striking ``not later than the end of fiscal year 2021'' and
            inserting ``not later than the end of fiscal year 2026''.
              (3) Authorization of appropriations.--Section 520M(e)(1) of
            the Public Health Service Act (42 U.S.C. 290bb-44(d)(1)) is
            amended by striking ``$5,000,000 for the period of fiscal years
            2018 through 2022'' and inserting ``$9,000,000 for each of
            fiscal years 2023 through 2027''.
      (b) Assisted Outpatient Treatment.--Section 224 of the Protecting
    Access to Medicare Act of 2014 (42 U.S.C. 290aa note) is amended to
    read as follows:

    ``SEC. 224. ASSISTED OUTPATIENT TREATMENT GRANT PROGRAM FOR INDIVIDUALS
                        WITH SERIOUS MENTAL ILLNESS.

      ``(a) In General.--The Secretary shall carry out a program to award
    grants to eligible entities for assisted outpatient treatment programs
    for individuals with serious mental illness.
      ``(b) Consultation.--The Secretary shall carry out this section in
    consultation with the Director of the National Institute of Mental
    Health, the Attorney General of the United States, the Administrator of
    the Administration for Community Living, and the Assistant Secretary
    for Mental Health and Substance Use.
      ``(c) Selecting Among Applicants.--In awarding grants under this
    section, the Secretary--
              ``(1) may give preference to applicants that have not
            previously implemented an assisted outpatient treatment
            program; and
              ``(2) shall evaluate applicants based on their potential to
            reduce hospitalization, homelessness, incarceration, and
            interaction with the criminal justice system while improving
            the health and social outcomes of the patient.
      ``(d) Program Requirements.--An assisted outpatient treatment program
    funded with a grant awarded under this section shall include--
              ``(1) evaluating the medical and social needs of the patients
            who are participating in the program;
              ``(2) preparing and executing treatment plans for such
            patients that--
                      ``(A) include criteria for completion of court-
                    ordered treatment if applicable; and
                      ``(B) provide for monitoring of the patient's
                    compliance with the treatment plan, including
                    compliance with medication and other treatment
                    regimens;
              ``(3) providing for case management services that support the
            treatment plan;
              ``(4) ensuring appropriate referrals to medical and social
            services providers;
              ``(5) evaluating the process for implementing the program to
            ensure consistency with the patient's needs and State law; and
              ``(6) measuring treatment outcomes, including health and
            social outcomes such as rates of incarceration, health care
            utilization, and homelessness.
      ``(e) Report.--Not later than the end of fiscal year 2027, the
    Secretary shall submit a report to the appropriate congressional
    committees on the grant program under this section. Such report shall
    include an evaluation of the following:
              ``(1) Cost savings and public health outcomes such as
            mortality, suicide, substance abuse, hospitalization, and use
            of services.
              ``(2) Rates of incarceration of patients.
              ``(3) Rates of homelessness of patients.
              ``(4) Patient and family satisfaction with program
            participation.
              ``(5) Demographic information regarding participation of
            those served by the grant compared to demographic information
            in the population of the grant recipient.
      ``(f) Definitions.--In this section:
              ``(1) The term `assisted outpatient treatment' means
            medically prescribed mental health treatment that a patient
            receives while living in a community under the terms of a law
            authorizing a State or local civil court to order such
            treatment.
              ``(2) The term `eligible entity' means a county, city, mental
            health system, mental health court, or any other entity with
            authority under the law of the State in which the entity is
            located to implement, monitor, and oversee an assisted
            outpatient treatment program.
      ``(g) Funding.--
              ``(1) Amount of grants.--
                      ``(A) Maximum amount.--The amount of a grant under
                    this section shall not exceed $1,000,000 for any fiscal
                    year.
                      ``(B) Determination.--Subject to subparagraph (A),
                    the Secretary shall determine the amount of each grant
                    under this section based on the population of the area
                    to be served through the grant and an estimate of the
                    number of patients to be served.
              ``(2) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this section $22,000,000 for
            each of fiscal years 2023 through 2027.''.

                         Subtitle D--Anna Westin Legacy

    SEC. 131. MAINTAINING EDUCATION AND TRAINING ON EATING DISORDERS.

       Subpart 3 of part B of title V of the Public Health Service Act (42
    U.S.C. 290bb-31 et seq.), as amended by section 102, is further amended
    by adding at the end the following:

    ``SEC. 520O. CENTER OF EXCELLENCE FOR EATING DISORDERS FOR EDUCATION
                        AND TRAINING ON EATING DISORDERS.

      ``(a) In General.--The Secretary, acting through the Assistant
    Secretary, shall maintain, by competitive grant or contract, a Center
    of Excellence for Eating Disorders (referred to in this section as the
    `Center') to improve the identification of, interventions for, and
    treatment of eating disorders in a manner that is developmentally,
    culturally, and linguistically appropriate.
      ``(b) Subgrants and Subcontracts.--The Center shall coordinate and
    implement the activities under subsection (c), in whole or in part, by
    awarding competitive subgrants or subcontracts--
              ``(1) across geographical regions; and
              ``(2) in a manner that is not duplicative.
      ``(c) Activities.--The Center--
              ``(1) shall--
                      ``(A) provide training and technical assistance for--
                              ``(i) primary care and behavioral health care
                            providers to carry out screening, brief
                            intervention, and referral to treatment for
                            individuals experiencing, or at risk for,
                            eating disorders; and
                              ``(ii) nonclinical community support workers
                            to identify and support individuals with, or at
                            disproportionate risk for, eating disorders;
                      ``(B) develop and provide training materials to
                    health care providers, including primary care and
                    behavioral health care providers, in the effective
                    treatment and ongoing support of individuals with
                    eating disorders, including children and marginalized
                    populations at disproportionate risk for eating
                    disorders;
                      ``(C) provide collaboration and coordination to other
                    centers of excellence, technical assistance centers,
                    and psychiatric consultation lines of the Substance
                    Abuse and Mental Health Services Administration and the
                    Health Resources and Services Administration on the
                    identification, effective treatment, and ongoing
                    support of individuals with eating disorders; and
                      ``(D) coordinate with the Director of the Centers for
                    Disease Control and Prevention and the Administrator of
                    the Health Resources and Services Administration to
                    disseminate training to primary care and behavioral
                    health care providers; and
              ``(2) may--
                      ``(A) coordinate with electronic health record
                    systems for the integration of protocols pertaining to
                    screening, brief intervention, and referral to
                    treatment for individuals experiencing, or at risk for,
                    eating disorders;
                      ``(B) develop and provide training materials to
                    health care providers, including primary care and
                    behavioral health care providers, in the effective
                    treatment and ongoing support for members of the Armed
                    Forces and veterans experiencing, or at risk for,
                    eating disorders; and
                      ``(C) consult with the Secretary of Defense and the
                    Secretary of Veterans Affairs on prevention,
                    identification, intervention for, and treatment of
                    eating disorders.
      ``(d) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $1,000,000 for each of fiscal
    years 2023 through 2027.''.

           Subtitle E--Community Mental Health Services Block Grant
                                Reauthorization

    SEC. 141. REAUTHORIZATION OF BLOCK GRANTS FOR COMMUNITY MENTAL HEALTH
                        SERVICES.

      (a) Funding.--Section 1920(a) of the Public Health Service Act (42
    U.S.C. 300x-9(a)) is amended by striking ``$532,571,000 for each of
    fiscal years 2018 through 2022'' and inserting ``$857,571,000 for each
    of fiscal years 2023 through 2027''.
      (b) Set-Aside for Evidence-based Crisis Care Services.--Section 1920
    of the Public Health Service Act (42 U.S.C. 300x-9) is amended by
    adding at the end the following:
      ``(d) Crisis Care.--
              ``(1) In general.--Except as provided in paragraph (3), a
            State shall expend at least 5 percent of the amount the State
            receives pursuant to section 1911 for each fiscal year to
            support evidenced-based programs that address the crisis care
            needs of--
                      ``(A) individuals, including children and
                    adolescents, experiencing mental health crises,
                    substance-related crises, or crises arising from co-
                    occurring disorders; and
                      ``(B) persons with intellectual and developmental
                    disabilities.
              ``(2) Core elements.--At the discretion of the single State
            agency responsible for the administration of the program of the
            State under a grant under section 1911, funds expended pursuant
            to paragraph (1) may be used to fund some or all of the core
            crisis care service components, delivered according to
            evidence-based principles, including the following:
                      ``(A) Crisis call centers.
                      ``(B) 24/7 mobile crisis services.
                      ``(C) Crisis stabilization programs offering acute
                    care or subacute care in a hospital or appropriately
                    licensed facility, as determined by the Substance Abuse
                    and Mental Health Services Administration, with
                    referrals to inpatient or outpatient care.
              ``(3) State flexibility.--In lieu of expending 5 percent of
            the amount the State receives pursuant to section 1911 for a
            fiscal year to support evidence-based programs as required by
            paragraph (1), a State may elect to expend not less than 10
            percent of such amount to support such programs by the end of
            two consecutive fiscal years.
              ``(4) Rule of construction.--With respect to funds expended
            pursuant to the set-aside in paragraph (1), section
            1912(b)(1)(A)(vi) shall not apply.''.
      (c) Early Intervention.--
              (1) State plan option.--Section 1912(b)(1)(A)(vii) of the
            Public Health Service Act (42 U.S.C. 300x-1(b)(1)(A)(vii)) is
            amended--
                      (A) in subclause (III), by striking ``and'' at the
                    end;
                      (B) in subclause (IV), by striking the period at the
                    end and inserting ``; and''; and
                      (C) by adding at the end the following:
                                      ``(V) a description of any evidence-
                                    based early intervention strategies and
                                    programs the State provides to prevent,
                                    delay, or reduce the severity and onset
                                    of mental illness and behavioral
                                    problems, including for children and
                                    adolescents, irrespective of
                                    experiencing a serious mental illness
                                    or serious emotional disturbance, as
                                    defined under subsection (c)(1).''.
              (2) Allocation allowance; reports.--Section 1920 of the
            Public Health Service Act (42 U.S.C. 300x-9), as amended by
            subsection (c), is further amended by adding at the end the
            following:
      ``(e) Early Intervention Services.--In the case of a State with a
    State plan that provides for strategies and programs specified in
    section 1912(b)(1)(A)(vii)(VI), such State may expend not more than 5
    percent of the amount of the allotment of the State pursuant to a
    funding agreement under section 1911 for each fiscal year to support
    such strategies and programs.
      ``(f) Reports to Congress.--Not later than September 30, 2025, and
    biennially thereafter, the Secretary shall provide a report to the
    Congress on the crisis care and early intervention strategies and
    programs pursued by States pursuant to subsections (d) and (e). Each
    such report shall include--
              ``(1) a description of the each State's crisis care and early
            intervention activities;
              ``(2) the population served, including information on
            demographics, including age;
              ``(3) the outcomes of such activities, including--
                      ``(A) how such activities reduced hospitalizations
                    and hospital stays;
                      ``(B) how such activities reduced incidents of
                    suicidal ideation and behaviors; and
                      ``(C) how such activities reduced the severity of
                    onset of serious mental illness and serious emotional
                    disturbance; and
              ``(4) any other relevant information the Secretary deems
            necessary.''.

               Subtitle F--Peer-Supported Mental Health Services

    SEC. 151. PEER-SUPPORTED MENTAL HEALTH SERVICES.

      Subpart 3 of part B of title V of the Public Health Service Act (42
    U.S.C. 290bb--31 et seq.) is amended by inserting after section 520G
    (42 U.S.C. 290bb--38) the following:

    ``SEC. 520H. PEER-SUPPORTED MENTAL HEALTH SERVICES.

      ``(a) Grants Authorized.--The Secretary, acting through the Director
    of the Center for Mental Health Services, shall award grants to
    eligible entities to enable such entities to develop, expand, and
    enhance access to mental health peer-delivered services.
      ``(b) Use of Funds.--Grants awarded under subsection (a) shall be
    used to develop, expand, and enhance national, statewide, or community-
    focused programs, including virtual peer-support services and
    infrastructure, including by--
              ``(1) carrying out workforce development, recruitment, and
            retention activities, to train, recruit, and retain peer-
            support providers;
              ``(2) building connections between mental health treatment
            programs, including between community organizations and peer-
            support networks, including virtual peer-support networks, and
            with other mental health support services;
              ``(3) reducing stigma associated with mental health
            disorders;
              ``(4) expanding and improving virtual peer mental health
            support services, including adoption of technologies to expand
            access to virtual peer mental health support services,
            including by acquiring--
                      ``(A) appropriate physical hardware for such virtual
                    services;
                      ``(B) software and programs to efficiently run peer-
                    support services virtually; and
                      ``(C) other technology for establishing virtual
                    waiting rooms and virtual video platforms for meetings;
                    and
              ``(5) conducting research on issues relating to mental
            illness and the impact peer-support has on resiliency,
            including identifying--
                      ``(A) the signs of mental illness;
                      ``(B) the resources available to individuals with
                    mental illness and to their families; and
                      ``(C) the resources available to help support
                    individuals living with mental illness.
      ``(c) Special Consideration.--In carrying out this section, the
    Secretary shall give special consideration to the unique needs of rural
    areas.
      ``(d) Definition.--In this section, the term `eligible entity'
    means--
              ``(1) a nonprofit consumer-run organization that--
                      ``(A) is principally governed by people living with a
                    mental health condition; and
                      ``(B) mobilizes resources within and outside of the
                    mental health community, which may include through
                    peer-support networks, to increase the prevalence and
                    quality of long-term wellness of individuals living
                    with a mental health condition, including those with a
                    co-occurring substance use disorder; or
              ``(2) a Federally recognized Tribe, Tribal organization,
            Urban Indian organization, or consortium of Tribes or Tribal
            organizations.
      ``(e) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section $13,000,000 for each of fiscal
    years 2023 through 2027.''.

     TITLE II--SUBSTANCE USE DISORDER PREVENTION, TREATMENT, AND RECOVERY
                                    SERVICES

            Subtitle A--Native Behavioral Health Access Improvement

    SEC. 201. BEHAVIORAL HEALTH AND SUBSTANCE USE DISORDER SERVICES FOR
                        NATIVE AMERICANS.

      Section 506A of the Public Health Service Act (42 U.S.C. 290aa-5a) is
    amended to read as follows:

    ``SEC. 506A. BEHAVIORAL HEALTH AND SUBSTANCE USE DISORDER SERVICES FOR
                        NATIVE AMERICANS.

      ``(a) Definitions.--In this section:
              ``(1) The term `eligible entity' means an Indian Tribe, a
            Tribal organization, an Urban Indian organization, and a Native
            Hawaiian health organization.
              ``(2) The terms `Indian Tribe', `Tribal organization', and
            `Urban Indian organization' have the meanings given to the
            terms `Indian tribe', `tribal organization', and `Urban Indian
            organization' in section 4 of the Indian Health Care
            Improvement Act.
              ``(3) The term `Native Hawaiian health organization' means
            `Papa Ola Lokahi' as defined in section 12 of the Native
            Hawaiian Health Care Improvement Act.
      ``(b) Formula Funds.--
              ``(1) In general.--The Secretary, in consultation with the
            Director of the Indian Health Service, as appropriate, shall
            award funds to eligible entities, in amounts determined
            pursuant to the formula described in paragraph (2), to be used
            by the eligible entity to provide culturally appropriate mental
            health and substance use disorder prevention, treatment, and
            recovery services to American Indians, Alaska Natives, and
            Native Hawaiians.
              ``(2) Formula.--The Secretary, using the process described in
            subsection (d), shall develop a formula to determine the amount
            of an award under paragraph (1). Such formula shall take into
            account the populations of eligible entities whose rates of
            overdose deaths or suicide are substantially higher relative to
            the populations of other Indian Tribes, Tribal organizations,
            Urban Indian organizations, or Native Hawaiian health
            organizations, as applicable.
      ``(c) Technical Assistance and Program Evaluation.--
              ``(1) In general.--The Secretary shall--
                      ``(A) provide technical assistance to applicants and
                    awardees under this section; and
                      ``(B) collect and evaluate information on the program
                    carried out under this section.
              ``(2) Consultation on evaluation measures, and data
            submission and reporting requirements.--The Secretary shall,
            using the process described in subsection (d), develop
            evaluation measures and data submission and reporting
            requirements for purposes of the collection and evaluation of
            information.
              ``(3) Data submission and reporting.--As a condition on
            receipt of funds under this section, an applicant shall agree
            to submit data and reports in a timely manner consistent with
            the evaluation measures and data submission and reporting
            requirements developed under subsection (d).
      ``(d) Regulations.--
              ``(1) Promulgation.--Not later than 180 days after the date
            of enactment of the Restoring Hope for Mental Health and Well-
            Being Act of 2022, the Secretary shall initiate procedures
            under subchapter III of chapter 5 of title 5, United States
            Code, to negotiate and promulgate such regulations as are
            necessary to carry out this section, including development of
            the funding formula described in subsection (b) and the program
            evaluation and reporting requirements under subsection (c).
              ``(2) Publication.--Not later than 18 months after the date
            of enactment of the Restoring Hope for Mental Health and Well-
            Being Act of 2022, the Secretary shall publish in the Federal
            Register proposed regulations to implement this section.
              ``(3) Committee.--A negotiated rulemaking committee
            established pursuant to section 565 of title 5, United States
            Code, to carry out this subsection shall have as its members
            only representatives of the Federal Government, Tribal
            Governments, and Urban Indian organizations. For purposes of
            such rulemaking, the Indian Health Service shall be the lead
            agency for the Department.
              ``(4) Adaptation of procedures.--In carrying out this
            subsection, the Secretary shall adapt any negotiated rulemaking
            procedures to the unique context of the government-to-
            government relationship between the United States and Indian
            Tribes.
              ``(5) Effect.--The lack of promulgated regulations under this
            subsection shall not limit the effect or implementation of this
            section.
      ``(e) Application.--An entity desiring an award under subsection (b)
    shall submit an application to the Secretary at such time, in such
    manner, and accompanied by such information as the Secretary may
    reasonably require.
      ``(f) Report.--Not later than 3 years after the date of the enactment
    of the Restoring Hope for Mental Health and Well-Being Act of 2022, and
    annually thereafter, the Secretary shall prepare 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 describing the services provided pursuant to this section.
      ``(g) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section, $40,000,000 for each of fiscal
    years 2023 through 2027.''.

         Subtitle B--Summer Barrow Prevention, Treatment, and Recovery

    SEC. 211. GRANTS FOR THE BENEFIT OF HOMELESS INDIVIDUALS.

      Section 506(e) of the Public Health Service Act (42 U.S.C. 290aa-
    5(e)) is amended by striking ``2018 through 2022'' and inserting ``2023
    through 2027''.

    SEC. 212. PRIORITY SUBSTANCE ABUSE TREATMENT NEEDS OF REGIONAL AND
                        NATIONAL SIGNIFICANCE.

      Section 509 of the Public Health Service Act (42 U.S.C. 290bb-2) is
    amended--
              (1) in the section heading, by striking ``abuse'' and
            inserting ``use disorder'';
              (2) in subsection (a)--
                      (A) by striking ``tribes and tribal organizations (as
                    the terms `Indian tribes' and `tribal organizations'
                    are defined'' and inserting ``Tribes and Tribal
                    organizations (as such terms are defined''; and
                      (B) in paragraph (3), by striking ``in substance
                    abuse'';
              (3) in subsection (b), in the subsection heading, by striking
            ``Abuse'' and inserting ``Use Disorder''; and
              (4) in subsection (f), by striking ``$333,806,000 for each of
            fiscal years 2018 through 2022'' and inserting ``$521,517,000
            for each of fiscal years 2023 through 2027''.

    SEC. 213. EVIDENCE-BASED PRESCRIPTION OPIOID AND HEROIN TREATMENT AND
                        INTERVENTIONS DEMONSTRATION.

      Section 514B of the Public Health Service Act (42 U.S.C. 290bb-10) is
    amended--
              (1) in subsection (a)(1)--
                      (A) by striking ``substance abuse'' and inserting
                    ``substance use disorder'';
                      (B) by striking ``tribes and tribal organizations''
                    and inserting ``Tribes and Tribal organizations''; and
                      (C) by striking ``addiction'' and inserting
                    ``substance use disorders'';
              (2) in subsection (e)(3), by striking ``tribes and tribal
            organizations'' and inserting ``Tribes and Tribal
            organizations''; and
              (3) in subsection (f), by striking ``2017 through 2021'' and
            inserting ``2023 through 2027''.

    SEC. 214. PRIORITY SUBSTANCE USE DISORDER PREVENTION NEEDS OF REGIONAL
                        AND NATIONAL SIGNIFICANCE.

      Section 516 of the Public Health Service Act (42 U.S.C. 290bb-22) is
    amended--
              (1) in subsection (a)--
                      (A) in paragraph (3), by striking ``abuse'' and
                    inserting ``use''; and
                      (B) in the matter following paragraph (3), by
                    striking ``tribes or tribal organizations'' and
                    inserting ``Tribes or Tribal organizations'';
              (2) in subsection (b), in the subsection heading, by striking
            ``Abuse'' and inserting ``Use Disorder''; and
              (3) in subsection (f), by striking ``$211,148,000 for each of
            fiscal years 2018 through 2022'' and inserting ``$218,219,000
            for each of fiscal years 2023 through 2027''.

    SEC. 215. SOBER TRUTH ON PREVENTING (STOP) UNDERAGE DRINKING
                        REAUTHORIZATION.

      Section 519B of the Public Health Service Act (42 U.S.C. 290bb-25b)
    is amended--
              (1) by amending subsection (a) to read as follows:
      ``(a) Definitions.--For purposes of this section:
              ``(1) The term `alcohol beverage industry' means the brewers,
            vintners, distillers, importers, distributors, and retail or
            online outlets that sell or serve beer, wine, and distilled
            spirits.
              ``(2) The term `school-based prevention' means programs,
            which are institutionalized, and run by staff members or
            school-designated persons or organizations in any grade of
            school, kindergarten through 12th grade.
              ``(3) The term `youth' means persons under the age of 21.'';
            and
              (2) by striking subsections (c) through (g) and inserting the
            following:
      ``(c) Interagency Coordinating Committee; Annual Report on State
    Underage Drinking Prevention and Enforcement Activities.--
              ``(1) Interagency coordinating committee on the prevention of
            underage drinking.--
                      ``(A) In general.--The Secretary, in collaboration
                    with the Federal officials specified in subparagraph
                    (B), shall continue to support and enhance the efforts
                    of the interagency coordinating committee, that began
                    operating in 2004, focusing on underage drinking
                    (referred to in this subsection as the `Committee').
                      ``(B) Other agencies.--The officials referred to in
                    subparagraph (A) are the Secretary of Education, the
                    Attorney General, the Secretary of Transportation, the
                    Secretary of the Treasury, the Secretary of Defense,
                    the Surgeon General, the Director of the Centers for
                    Disease Control and Prevention, the Director of the
                    National Institute on Alcohol Abuse and Alcoholism, the
                    Assistant Secretary for Mental Health and Substance
                    Use, the Director of the National Institute on Drug
                    Abuse, the Assistant Secretary for Children and
                    Families, the Director of the Office of National Drug
                    Control Policy, the Administrator of the National
                    Highway Traffic Safety Administration, the
                    Administrator of the Office of Juvenile Justice and
                    Delinquency Prevention, the Chairman of the Federal
                    Trade Commission, and such other Federal officials as
                    the Secretary of Health and Human Services determines
                    to be appropriate.
                      ``(C) Chair.--The Secretary of Health and Human
                    Services shall serve as the chair of the Committee.
                      ``(D) Duties.--The Committee shall guide policy and
                    program development across the Federal Government with
                    respect to underage drinking, provided, however, that
                    nothing in this section shall be construed as
                    transferring regulatory or program authority from an
                    Agency to the Coordinating Committee.
                      ``(E) Consultations.--The Committee shall actively
                    seek the input of and shall consult with all
                    appropriate and interested parties, including States,
                    public health research and interest groups,
                    foundations, and alcohol beverage industry trade
                    associations and companies.
                      ``(F) Annual report.--
                              ``(i) In general.--The Secretary, on behalf
                            of the Committee, shall annually submit to the
                            Congress a report that summarizes--
                                      ``(I) all programs and policies of
                                    Federal agencies designed to prevent
                                    and reduce underage drinking, focusing
                                    particularly on programs and policies
                                    that support the adoption and
                                    enforcement of State policies designed
                                    to prevent and reduce underage drinking
                                    as specified in paragraph (2);
                                      ``(II) the extent of progress in
                                    preventing and reducing underage
                                    drinking at State and national levels;
                                      ``(III) data that the Secretary shall
                                    collect with respect to the information
                                    specified in clause (ii); and
                                      ``(IV) such other information
                                    regarding underage drinking as the
                                    Secretary determines to be appropriate.
                              ``(ii) Certain information.--The report under
                            clause (i) shall include information on the
                            following:
                                      ``(I) Patterns and consequences of
                                    underage drinking as reported in
                                    research and surveys such as, but not
                                    limited to, Monitoring the Future,
                                    Youth Risk Behavior Surveillance
                                    System, the National Survey on Drug Use
                                    and Health, and the Fatality Analysis
                                    Reporting System.
                                      ``(II) Measures of the availability
                                    of alcohol from commercial and non-
                                    commercial sources to underage
                                    populations.
                                      ``(III) Measures of the exposure of
                                    underage populations to messages
                                    regarding alcohol in advertising,
                                    social media, and the entertainment
                                    media.
                                      ``(IV) Surveillance data, including
                                    information on the onset and prevalence
                                    of underage drinking, consumption
                                    patterns, beverage preferences,
                                    prevalence of drinking among students
                                    at institutions of higher education,
                                    correlations between adult and youth
                                    drinking, and the means of underage
                                    access, including trends over time for
                                    these surveillance data. The Secretary
                                    shall develop a plan to improve the
                                    collection, measurement, and
                                    consistency of reporting Federal
                                    underage alcohol data.
                                      ``(V) Any additional findings
                                    resulting from research conducted or
                                    supported under subsection (f).
                                      ``(VI) Evidence-based best practices
                                    to prevent and reduce underage drinking
                                    including a review of the research
                                    literature related to State laws,
                                    regulations, and policies designed to
                                    prevent and reduce underage drinking,
                                    as described in paragraph (2)(B)(i).
              ``(2) Annual report on state underage drinking prevention and
            enforcement activities.--
                      ``(A) In general.--The Secretary shall, with input
                    and collaboration from other appropriate Federal
                    agencies, States, Indian Tribes, territories, and
                    public health, consumer, and alcohol beverage industry
                    groups, annually issue a report on each State's
                    performance in enacting, enforcing, and creating laws,
                    regulations, and policies to prevent or reduce underage
                    drinking based on an assessment of best practices
                    developed pursuant to paragraph (1)(F)(ii)(VI) and
                    subparagraph (B)(i). For purposes of this paragraph,
                    each such report, with respect to a year, shall be
                    referred to as the `State Report'. Each State Report
                    shall be designed as a resource tool for Federal
                    agencies assisting States in the their underage
                    drinking prevention efforts, State public health and
                    law enforcement agencies, State and local policymakers,
                    and underage drinking prevention coalitions including
                    those receiving grants pursuant to subsection (e).
                      ``(B) State performance measures.--
                              ``(i) In general.--The Secretary shall
                            develop, in consultation with the Committee, a
                            set of measures to be used in preparing the
                            State Report on best practices as they relate
                            to State laws, regulations, policies, and
                            enforcement practices.
                              ``(ii) State report content.--The State
                            Report shall include updates on State laws,
                            regulations, and policies included in previous
                            reports to Congress, including with respect to
                            the following:
                                      ``(I) Whether or not the State has
                                    comprehensive anti-underage drinking
                                    laws such as for the illegal sale,
                                    purchase, attempt to purchase,
                                    consumption, or possession of alcohol;
                                    illegal use of fraudulent ID; illegal
                                    furnishing or obtaining of alcohol for
                                    an individual under 21 years; the
                                    degree of strictness of the penalties
                                    for such offenses; and the prevalence
                                    of the enforcement of each of these
                                    infractions.
                                      ``(II) Whether or not the State has
                                    comprehensive liability statutes
                                    pertaining to underage access to
                                    alcohol such as dram shop, social host,
                                    and house party laws, and the
                                    prevalence of enforcement of each of
                                    these laws.
                                      ``(III) Whether or not the State
                                    encourages and conducts comprehensive
                                    enforcement efforts to prevent underage
                                    access to alcohol at retail outlets,
                                    such as random compliance checks and
                                    shoulder tap programs, and the number
                                    of compliance checks within alcohol
                                    retail outlets measured against the
                                    number of total alcohol retail outlets
                                    in each State, and the result of such
                                    checks.
                                      ``(IV) Whether or not the State
                                    encourages training on the proper
                                    selling and serving of alcohol for all
                                    sellers and servers of alcohol as a
                                    condition of employment.
                                      ``(V) Whether or not the State has
                                    policies and regulations with regard to
                                    direct sales to consumers and home
                                    delivery of alcoholic beverages.
                                      ``(VI) Whether or not the State has
                                    programs or laws to deter adults from
                                    purchasing alcohol for minors; and the
                                    number of adults targeted by these
                                    programs.
                                      ``(VII) Whether or not the State has
                                    enacted graduated drivers licenses and
                                    the extent of those provisions.
                              ``(iii) Additional categories.--In addition
                            to the updates on State laws, regulations, and
                            policies listed in clause (ii), the Secretary
                            shall consider the following:
                                      ``(I) Whether or not States have
                                    adopted laws, regulations, and policies
                                    that deter underage alcohol use, as
                                    described in `The Surgeon General's
                                    Call to Action to Prevent and Reduce
                                    Underage Drinking' issued in 2007 and
                                    `Facing Addiction in America: The
                                    Surgeon General's Report on Alcohol,
                                    Drugs and Health' issued in 2016,
                                    including restrictions on low-price,
                                    high-volume drink specials, and
                                    wholesaler pricing provisions.
                                      ``(II) Whether or not States have
                                    adopted laws, regulations, and policies
                                    designed to reduce alcohol advertising
                                    messages attractive to youth and youth
                                    exposure to alcohol advertising and
                                    marketing in measured and unmeasured
                                    media and digital and social media.
                                      ``(III) Whether or not States have
                                    laws and policies that promote underage
                                    drinking prevention policy development
                                    by local jurisdictions.
                                      ``(IV) Whether or not States have
                                    adopted laws, regulations, and policies
                                    to restrict youth access to alcoholic
                                    beverages that may pose special risks
                                    to youth, including but not limited to
                                    alcoholic mists, gelatins, freezer
                                    pops, premixed caffeinated alcoholic
                                    beverages, and flavored malt beverages.
                                      ``(V) Whether or not States have
                                    adopted uniform best practices
                                    protocols for conducting compliance
                                    checks and shoulder tap programs.
                                      ``(VI) Whether or not States have
                                    adopted uniform best practices penalty
                                    protocols for violations of laws
                                    prohibiting retail licensees from
                                    selling or furnishing of alcohol to
                                    minors.
                              ``(iv) Uniform data system.--For performance
                            measures related to enforcement of underage
                            drinking laws as specified in clauses (ii) and
                            (iii), the Secretary shall develop and test a
                            uniform data system for reporting State
                            enforcement data, including the development of
                            a pilot program for this purpose. The pilot
                            program shall include procedures for collecting
                            enforcement data from both State and local law
                            enforcement jurisdictions.
              ``(3) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection $1,000,000 for
            each of fiscal years 2023 through 2027.
      ``(d) National Media Campaign To Prevent Underage Drinking.--
              ``(1) In general.--The Secretary, in consultation with the
            National Highway Traffic Safety Administration, shall develop
            an intensive, multifaceted, adult-oriented national media
            campaign to reduce underage drinking by influencing attitudes
            regarding underage drinking, increasing the willingness of
            adults to take actions to reduce underage drinking, and
            encouraging public policy changes known to decrease underage
            drinking rates.
              ``(2) Purpose.--The purpose of the national media campaign
            described in this section shall be to achieve the following
            objectives:
                      ``(A) Instill a broad societal commitment to reduce
                    underage drinking.
                      ``(B) Increase specific actions by adults that are
                    meant to discourage or inhibit underage drinking.
                      ``(C) Decrease adult conduct that tends to facilitate
                    or condone underage drinking.
              ``(3) Components.--When implementing the national media
            campaign described in this section, the Secretary shall--
                      ``(A) educate the public about the public health and
                    safety benefits of evidence-based policies to reduce
                    underage drinking, including minimum legal drinking age
                    laws, and build public and parental support for and
                    cooperation with enforcement of such policies;
                      ``(B) educate the public about the negative
                    consequences of underage drinking;
                      ``(C) promote specific actions by adults that are
                    meant to discourage or inhibit underage drinking,
                    including positive behavior modeling, general parental
                    monitoring, and consistent and appropriate discipline;
                      ``(D) discourage adult conduct that tends to
                    facilitate underage drinking, including the hosting of
                    underage parties with alcohol and the purchasing of
                    alcoholic beverages on behalf of underage youth;
                      ``(E) establish collaborative relationships with
                    local and national organizations and institutions to
                    further the goals of the campaign and assure that the
                    messages of the campaign are disseminated from a
                    variety of sources;
                      ``(F) conduct the campaign through multi-media
                    sources; and
                      ``(G) conduct the campaign with regard to changing
                    demographics and cultural and linguistic factors.
              ``(4) Consultation requirement.--In developing and
            implementing the national media campaign described in this
            section, the Secretary shall consult recommendations for
            reducing underage drinking published by the National Academy of
            Sciences and the Surgeon General. The Secretary shall also
            consult with interested parties including medical, public
            health, and consumer and parent groups, law enforcement,
            institutions of higher education, community organizations and
            coalitions, and other stakeholders supportive of the goals of
            the campaign.
              ``(5) Annual report.--The Secretary shall produce an annual
            report on the progress of the development or implementation of
            the media campaign described in this subsection, including
            expenses and projected costs, and, as such information is
            available, report on the effectiveness of such campaign in
            affecting adult attitudes toward underage drinking and adult
            willingness to take actions to decrease underage drinking.
              ``(6) Research on youth-oriented campaign.--The Secretary
            may, based on the availability of funds, conduct research on
            the potential success of a youth-oriented national media
            campaign to reduce underage drinking. The Secretary shall
            report any such results to Congress with policy recommendations
            on establishing such a campaign.
              ``(7) Administration.--The Secretary may enter into a
            subcontract with another Federal agency to delegate the
            authority for execution and administration of the adult-
            oriented national media campaign.
              ``(8) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this section $2,500,000 for
            each of fiscal years 2023 through 2027.
      ``(e) Community-Based Coalition Enhancement Grants To Prevent
    Underage Drinking.--
              ``(1) Authorization of program.--The Assistant Secretary for
            Mental Health and Substance Use, in consultation with the
            Director of the Office of National Drug Control Policy, shall
            award enhancement grants to eligible entities to design,
            implement, evaluate, and disseminate comprehensive strategies
            to maximize the effectiveness of community-wide approaches to
            preventing and reducing underage drinking. This subsection is
            subject to the availability of appropriations.
              ``(2) Purposes.--The purposes of this subsection are to--
                      ``(A) prevent and reduce alcohol use among youth in
                    communities throughout the United States;
                      ``(B) strengthen collaboration among communities, the
                    Federal Government, Tribal Governments, and State and
                    local governments;
                      ``(C) enhance intergovernmental cooperation and
                    coordination on the issue of alcohol use among youth;
                      ``(D) serve as a catalyst for increased citizen
                    participation and greater collaboration among all
                    sectors and organizations of a community that first
                    demonstrates a long-term commitment to reducing alcohol
                    use among youth;
                      ``(E) implement state-of-the-art science-based
                    strategies to prevent and reduce underage drinking by
                    changing local conditions in communities; and
                      ``(F) enhance, not supplant, effective local
                    community initiatives for preventing and reducing
                    alcohol use among youth.
              ``(3) Application.--An eligible entity desiring an
            enhancement grant under this subsection shall submit an
            application to the Assistant Secretary at such time, and in
            such manner, and accompanied by such information and
            assurances, as the Assistant Secretary may require. Each
            application shall include--
                      ``(A) a complete description of the entity's current
                    underage alcohol use prevention initiatives and how the
                    grant will appropriately enhance the focus on underage
                    drinking issues; or
                      ``(B) a complete description of the entity's current
                    initiatives, and how it will use this grant to enhance
                    those initiatives by adding a focus on underage
                    drinking prevention.
              ``(4) Uses of funds.--Each eligible entity that receives a
            grant under this subsection shall use the grant funds to carry
            out the activities described in such entity's application
            submitted pursuant to paragraph (3) and obtain specialized
            training and technical assistance by the entity funded under
            section 4 of Public Law 107-82, as amended (21 U.S.C. 1521
            note). Grants under this subsection shall not exceed $60,000
            per year and may not exceed four years.
              ``(5) Supplement not supplant.--Grant funds provided under
            this subsection shall be used to supplement, not supplant,
            Federal and non-Federal funds available for carrying out the
            activities described in this subsection.
              ``(6) Evaluation.--Grants under this subsection shall be
            subject to the same evaluation requirements and procedures as
            the evaluation requirements and procedures imposed on
            recipients of drug-free community grants.
              ``(7) Definitions.--For purposes of this subsection, the term
            `eligible entity' means an organization that is currently
            receiving or has received grant funds under the Drug-Free
            Communities Act of 1997.
              ``(8) Administrative expenses.--Not more than 6 percent of a
            grant under this subsection may be expended for administrative
            expenses.
              ``(9) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection $11,500,000 for
            each of fiscal years 2023 through 2027.
      ``(f) Grants to Professional Pediatric Provider Organizations To
    Reduce Underage Drinking Through Screening and Brief Interventions.--
              ``(1) In general.--The Secretary, acting through the
            Assistant Secretary for Mental Health and Substance Use, shall
            make one or more grants to professional pediatric provider
            organizations to increase among the members of such
            organizations effective practices to reduce the prevalence of
            alcohol use among individuals under the age of 21, including
            college students.
              ``(2) Purposes.--Grants under this subsection shall be made
            to promote the practices of--
                      ``(A) screening adolescents for alcohol use;
                      ``(B) offering brief interventions to adolescents to
                    discourage such use;
                      ``(C) educating parents about the dangers of and
                    methods of discouraging such use;
                      ``(D) diagnosing and treating alcohol use disorders;
                    and
                      ``(E) referring patients, when necessary, to other
                    appropriate care.
              ``(3) Use of funds.--A professional pediatric provider
            organization receiving a grant under this section may use the
            grant funding to promote the practices specified in paragraph
            (2) among its members by--
                      ``(A) providing training to health care providers;
                      ``(B) disseminating best practices, including
                    culturally and linguistically appropriate best
                    practices, and developing, printing, and distributing
                    materials; and
                      ``(C) supporting other activities approved by the
                    Assistant Secretary.
              ``(4) Application.--To be eligible to receive a grant under
            this subsection, a professional pediatric provider organization
            shall submit an application to the Assistant Secretary at such
            time, and in such manner, and accompanied by such information
            and assurances as the Secretary may require. Each application
            shall include--
                      ``(A) a description of the pediatric provider
                    organization;
                      ``(B) a description of the activities to be completed
                    that will promote the practices specified in paragraph
                    (2);
                      ``(C) a description of the organization's
                    qualifications for performing such practices; and
                      ``(D) a timeline for the completion of such
                    activities.
              ``(5) Definitions.--For the purpose of this subsection:
                      ``(A) Brief intervention.--The term `brief
                    intervention' means, after screening a patient,
                    providing the patient with brief advice and other brief
                    motivational enhancement techniques designed to
                    increase the insight of the patient regarding the
                    patient's alcohol use, and any realized or potential
                    consequences of such use to effect the desired related
                    behavioral change.
                      ``(B) Adolescents.--The term `adolescents' means
                    individuals under 21 years of age.
                      ``(C) Professional pediatric provider organization.--
                    The term `professional pediatric provider organization'
                    means an organization or association that--
                              ``(i) consists of or represents pediatric
                            health care providers; and
                              ``(ii) is qualified to promote the practices
                            specified in paragraph (2).
                      ``(D) Screening.--The term `screening' means using
                    validated patient interview techniques to identify and
                    assess the existence and extent of alcohol use in a
                    patient.
              ``(6) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection $3,000,000 for
            each of fiscal years 2023 through 2027.
      ``(g) Data Collection and Research.--
              ``(1) Additional research on underage drinking.--
                      ``(A) In general.--The Secretary shall, subject to
                    the availability of appropriations, collect data, and
                    conduct or support research that is not duplicative of
                    research currently being conducted or supported by the
                    Department of Health and Human Services, on underage
                    drinking, with respect to the following:
                              ``(i) Improve data collection in support of
                            evaluation of the effectiveness of
                            comprehensive community-based programs or
                            strategies and statewide systems to prevent and
                            reduce underage drinking, across the underage
                            years from early childhood to age 21, such as
                            programs funded and implemented by governmental
                            entities, public health interest groups and
                            foundations, and alcohol beverage companies and
                            trade associations, through the development of
                            models of State-level epidemiological
                            surveillance of underage drinking by funding in
                            States or large metropolitan areas new
                            epidemiologists focused on excessive drinking
                            including underage alcohol use.
                              ``(ii) Obtain and report more precise
                            information than is currently collected on the
                            scope of the underage drinking problem and
                            patterns of underage alcohol consumption,
                            including improved knowledge about the problem
                            and progress in preventing, reducing, and
                            treating underage drinking, as well as
                            information on the rate of exposure of youth to
                            advertising and other media messages
                            encouraging and discouraging alcohol
                            consumption.
                              ``(iii) Synthesize, expand on, and widely
                            disseminate existing research on effective
                            strategies for reducing underage drinking,
                            including translational research, and make this
                            research easily accessible to the general
                            public.
                              ``(iv) Improve and conduct public health
                            surveillance on alcohol use and alcohol-related
                            conditions in States by increasing the use of
                            surveys, such as the Behavioral Risk Factor
                            Surveillance System, to monitor binge and
                            excessive drinking and related harms among
                            individuals who are at least 18 years of age,
                            but not more than 20 years of age, including
                            harm caused to self or others as a result of
                            alcohol use that is not duplicative of research
                            currently being conducted or supported by the
                            Department of Health and Human Services.
                      ``(B) Authorization of appropriations.--There is
                    authorized to be appropriated to carry out this
                    paragraph $5,000,000 for each of fiscal years 2023
                    through 2027.
              ``(2) National academy of sciences study.--
                      ``(A) In general.--Not later than 12 months after the
                    enactment of the Restoring Hope for Mental Health and
                    Well-Being Act of 2022, the Secretary shall--
                              ``(i) contract with the National Academy of
                            Sciences to study developments in research on
                            underage drinking and the public policy
                            implications of these developments; and
                              ``(ii) report to the Congress on the results
                            of such review.
                      ``(B) Authorization of appropriations.--There is
                    authorized to be appropriated to carry out this
                    paragraph $500,000 for fiscal year 2023.''.

    SEC. 216. GRANTS FOR JAIL DIVERSION PROGRAMS.

      Section 520G of the Public Health Service Act (42 U.S.C. 290bb-38) is
    amended--
              (1) in subsection (a)--
                      (A) by striking ``up to 125''; and
                      (B) by striking ``tribes and tribal organizations''
                    and inserting ``Tribes and Tribal organizations'';
              (2) in subsection (b)(2), by striking ``tribes, and tribal
            organizations'' and inserting ``Tribes, and Tribal
            organizations'';
              (3) in subsection (c)--
                      (A) in paragraph (1), by striking ``tribe or tribal
                    organization'' and inserting ``Tribe or Tribal
                    organization, health facility or program described in
                    subsection (a), or public or nonprofit entity referred
                    to in subsection (a)''; and
                      (B) in paragraph (2)(A)(iii), by striking ``tribe, or
                    tribal organization'' and inserting ``Tribe, or Tribal
                    organization'';
              (4) in subsection (e)--
                      (A) in the matter preceding paragraph (1), by
                    striking ``tribe, or tribal organization'' and
                    inserting ``Tribe, or Tribal organization''; and
                      (B) in paragraph (5), by striking ``or arrest'' and
                    inserting ``, arrest, or release'';
              (5) in subsection (f), by striking ``tribe, or tribal
            organization'' each place it appears and inserting ``Tribe, or
            Tribal organization'';
              (6) in subsection (h), by striking ``tribe, or tribal
            organization'' and inserting ``Tribe, or Tribal organization'';
            and
              (7) in subsection (j), by striking ``$4,269,000 for each of
            fiscal years 2018 through 2022'' and inserting ``$14,000,000
            for each of fiscal years 2023 through 2027''.

    SEC. 217. FORMULA GRANTS TO STATES.

      Section 521 of the Public Health Service Act (42 U.S.C. 290cc-21) is
    amended by striking ``2018 through 2022'' and inserting ``2023 through
    2027''.

    SEC. 218. PROJECTS FOR ASSISTANCE IN TRANSITION FROM HOMELESSNESS.

      Section 535(a) of the Public Health Service Act (42 U.S.C. 290cc-
    35(a)) is amended by striking ``2018 through 2022'' and inserting
    ``2023 through 2027''.

    SEC. 219. GRANTS FOR REDUCING OVERDOSE DEATHS.

      (a) Grants.--
              (1) Repeal of maximum grant amount.--Paragraph (2) of section
            544(a) of the Public Health Service Act (42 U.S.C. 290dd-3(a))
            is hereby repealed.
              (2) Eligible entity; subgrants.--Section 544(a) of the Public
            Health Service Act (42 U.S.C. 290dd-3(a)) is amended by
            striking paragraph (3) and inserting the following:
              ``(2) Eligible entity.--For purposes of this section, the
            term `eligible entity' means a State, Territory, locality,
            Indian Tribe (as defined in the Federally Recognized Indian
            Tribe List Act of 1994), Tribal organization, or Urban Indian
            organization (as those terms are defined in section 4 of the
            Indian Health Care Improvement Act).
              ``(3) Subgrants.--For the purposes for which a grant is
            awarded under this section, the eligible entity receiving the
            grant may award subgrants to a Federally qualified health
            center (as defined in section 1861(aa) of the Social Security
            Act), an opioid treatment program (as defined in section 8.2 of
            title 42, Code of Federal Regulations (or any successor
            regulations)), any practitioner dispensing narcotic drugs
            pursuant to section 303(g) of the Controlled Substances Act, or
            any nonprofit organization that the Secretary deems
            appropriate.''.
              (3) Prescribing.--Section 544(a)(4) of the Public Health
            Service Act (42 U.S.C. 290dd-3(a)(4)) is amended--
                      (A) in subparagraph (A), by inserting ``, including
                    patients prescribed with both an opioid and a
                    benzodiazepine'' before the semicolon at the end; and
                      (B) in subparagraph (D), by striking ``drug
                    overdose'' and inserting ``substance overdose''.
              (4) Use of funds.--Paragraph (5) of section 544(c) of the
            Public Health Service Act (42 U.S.C. 290dd-3(c)) is amended to
            read as follows:
              ``(5) To establish protocols to connect patients who have
            experienced an overdose with appropriate treatment, including
            overdose reversal medications, medication assisted treatment,
            and appropriate counseling and behavioral therapies.''.
              (5) Improving access to overdose treatment.--Section 544 of
            the Public Health Service Act (42 U.S.C. 290dd-3) is amended--
                      (A) by redesignating subsections (d) through (f) as
                    subsections (e) through (g), respectively;
                      (B) in subsection (f), as so redesignated, by
                    striking ``subsection (d)'' and inserting ``subsection
                    (e)''; and
                      (C) by inserting after subsection (c) the following:
      ``(d) Improving Access to Overdose Treatment.--
              ``(1) Information on best practices.--
                      ``(A) Health and human services.--The Secretary of
                    Health and Human Services may provide information to
                    States, localities, Indian Tribes, Tribal
                    organizations, and Urban Indian organizations on best
                    practices for prescribing or co-prescribing a drug or
                    device approved, cleared, or otherwise authorized under
                    the Federal Food, Drug, and Cosmetic Act for emergency
                    treatment of known or suspected opioid overdose,
                    including for patients receiving chronic opioid therapy
                    and patients being treated for opioid use disorders.
                      ``(B) Defense.--The Secretary of Defense may provide
                    information to prescribers within Department of Defense
                    medical facilities on best practices for prescribing or
                    co-prescribing a drug or device approved, cleared, or
                    otherwise authorized under the Federal Food, Drug, and
                    Cosmetic Act for emergency treatment of known or
                    suspected opioid overdose, including for patients
                    receiving chronic opioid therapy and patients being
                    treated for opioid use disorders.
                      ``(C) Veterans affairs.--The Secretary of Veterans
                    Affairs may provide information to prescribers within
                    Department of Veterans Affairs medical facilities on
                    best practices for prescribing or co-prescribing a drug
                    or device approved, cleared, or otherwise authorized
                    under the Federal Food, Drug, and Cosmetic Act for
                    emergency treatment of known or suspected opioid
                    overdose, including for patients receiving chronic
                    opioid therapy and patients being treated for opioid
                    use disorders.
              ``(2) Rule of construction.--Nothing in this subsection shall
            be construed as establishing or contributing to a medical
            standard of care.''.
              (6) Authorization of appropriations.--Section 544(g) of the
            Public Health Service Act (42 U.S.C. 290dd-3), as redesignated,
            is amended by striking ``fiscal years 2017 through 2021'' and
            inserting ``fiscal years 2023 through 2027''.
              (7) Technical amendments.--
                      (A) Section 544 of the Public Health Service Act (42
                    U.S.C. 290dd-3), as amended, is further amended by
                    striking ``approved or cleared'' each place it appears
                    and inserting ``approved, cleared, or otherwise
                    authorized''.
                      (B) Section 107 of the Comprehensive Addiction and
                    Recovery Act of 2016 (Public Law 114-198) is amended by
                    striking subsection (b).

    SEC. 220. OPIOID OVERDOSE REVERSAL MEDICATION ACCESS AND EDUCATION
                        GRANT PROGRAMS.

      (a) Grants.--Section 545 of the Public Health Service Act (42 U.S.C.
    290ee) is amended--
              (1) in the section heading, by striking ``access and
            education grant programs'' and inserting ``access, education,
            and co-prescribing grant programs'';
              (2) in the heading of subsection (a), by striking ``Grants to
            States'' and inserting ``Grants'';
              (3) in subsection (a), by striking ``shall make grants to
            States'' and inserting ``shall make grants to States,
            localities, Indian Tribes (as defined by the Federally
            Recognized Indian Tribe List Act of 1994), Tribal
            organizations, and Urban Indian organizations (as those terms
            are defined in section 4 of the Indian Health Care Improvement
            Act)'';
              (4) in subsection (a)(1), by striking ``implement strategies
            for pharmacists to dispense a drug or device'' and inserting
            ``implement strategies that increase access to drugs or
            devices'';
              (5) by redesignating paragraphs (3) and (4) as paragraphs (4)
            and (5), respectively; and
              (6) by inserting after paragraph (2) the following:
              ``(3) encourage health care providers to co-prescribe, as
            appropriate, drugs or devices approved, cleared, or otherwise
            authorized under the Federal Food, Drug, and Cosmetic Act for
            emergency treatment of known or suspected opioid overdose;''.
      (b) Grant Period.--Section 545(d)(2) of the Public Health Service Act
    (42 U.S.C. 290ee(d)(2)) is amended by striking ``3 years'' and
    inserting ``5 years''.
      (c) Limitation.--Paragraph (3) of section 545(d) of the Public Health
    Service Act (42 U.S.C. 290ee(d)) is amended to read as follows:
              ``(3) Limitations.--A State may--
                      ``(A) use not more than 10 percent of a grant under
                    this section for educating the public pursuant to
                    subsection (a)(5); and
                      ``(B) use not less than 20 percent of a grant under
                    this section to offset cost-sharing for distribution
                    and dispensing of drugs or devices approved, cleared,
                    or otherwise authorized under the Federal Food, Drug,
                    and Cosmetic Act for emergency treatment of known or
                    suspected opioid overdose.''.
      (d) Authorization of Appropriations.--Section 545(h)(1) of the Public
    Health Service Act, is amended by striking ``fiscal years 2017 through
    2019'' and inserting ``fiscal years 2023 through 2027''.
      (e) Technical Amendment.--Section 545 of the Public Health Service
    Act (42 U.S.C. 290ee), as amended, is further amended by striking
    ``approved or cleared'' each place it appears and inserting ``approved,
    cleared, or otherwise authorized''.

    SEC. 221. STATE DEMONSTRATION GRANTS FOR COMPREHENSIVE OPIOID ABUSE
                        RESPONSE.

      Section 548 of the Public Health Service Act (42 U.S.C. 290ee-3) is
    amended--
              (1) in the section heading, by striking ``abuse'' and
            inserting ``use disorder'';
              (2) in subsection (b)--
                      (A) in the subsection heading, by striking ``Abuse''
                    and inserting ``Use Disorder'';
                      (B) in paragraph (1), by striking ``abuse'' and
                    inserting ``use disorder'';
                      (C) in paragraph (2)--
                              (i) in the matter preceding subparagraph (A),
                            by striking ``abuse'' and inserting ``use
                            disorder'';
                              (ii) in subparagraph (A), by striking
                            ``opioid use, treatment, and addiction
                            recovery'' and inserting ``opioid use
                            disorders, and treatment for, and recovery from
                            opioid use disorders'';
                              (iii) in subparagraph (C), by striking
                            ``addiction'' each place it appears and
                            inserting ``use disorder'';
                              (iv) by amending subparagraph (D) to read as
                            follows:
                      ``(D) developing, implementing, and expanding efforts
                    to prevent overdose death from opioid or other
                    prescription medication use disorders; and''; and
                              (v) in subparagraph (E), by striking
                            ``abuse'' and inserting ``use disorders''; and
                      (D) in paragraph (4), by striking ``abuse'' each
                    place it appears and inserting ``use disorders''; and
              (3) by striking ``2017 through 2021'' and inserting ``2023
            through 2027''.

    SEC. 222. EMERGENCY DEPARTMENT ALTERNATIVES TO OPIOIDS.

      Section 7091 of the SUPPORT for Patients and Communities Act (Public
    Law 115-271) is amended--
              (1) in the section heading, by striking ``demonstration''
            (and by conforming the item relating to such section in the
            table of contents in section 1(b));
              (2) in subsection (a)--
                      (A) by amending the subsection heading to read as
                    follows: ``Grant Program''; and
                      (B) in paragraph (1), by striking ``demonstration'';
              (3) in subsection (b), in the subsection heading, by striking
            ``Demonstration'';
              (4) in subsection (d)(4), by striking ``tribal'' and
            inserting ``Tribal'';
              (5) in subsection (f), by striking ``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 inserting ``Not
            later than the end of each of fiscal years 2024 and 2027, the
            Secretary shall submit to the Congress a report on the results
            of the program''; and
              (6) in subsection (g), by striking ``2019 through 2021'' and
            inserting ``2023 through 2027''.

                   Subtitle C--Excellence in Recovery Housing

    SEC. 231. CLARIFYING THE ROLE OF SAMHSA IN PROMOTING THE AVAILABILITY
                        OF HIGH-QUALITY RECOVERY HOUSING.

      Section 501(d) of the Public Health Service Act (42 U.S.C. 290aa) is
    amended--
              (1) in paragraph (24)(E), by striking ``and'' at the end;
              (2) in paragraph (25), by striking the period at the end and
            inserting ``; and''; and
              (3) by adding at the end the following:
              ``(26) collaborate with national accrediting entities,
            reputable providers, organizations or individuals with
            established expertise in delivery of recovery housing services,
            States, Federal agencies (including the Department of Health
            and Human Services, the Department of Housing and Urban
            Development, and the agencies listed in section 550(e)(2)(B)),
            and other relevant stakeholders, to promote the availability of
            high-quality recovery housing and services for individuals with
            a substance use disorder.''.

    SEC. 232. DEVELOPING GUIDELINES FOR STATES TO PROMOTE THE AVAILABILITY
                        OF HIGH-QUALITY RECOVERY HOUSING.

      Section 550(a) of the Public Health Service Act (42 U.S.C. 290ee-
    5(a)) (relating to national recovery housing best practices) is
    amended--
              (1) by amending paragraph (1) to read as follows:
              ``(1) In general.--The Secretary, in consultation with the
            individuals and entities specified in paragraph (2), shall
            build on existing best practices and previously developed
            guidelines to develop and periodically update consensus-based
            best practices, which may include model laws for implementing
            suggested minimum standards for operating, and promoting the
            availability of, high-quality recovery housing.'';
              (2) in paragraph (2)--
                      (A) by striking subparagraphs (A) and (B) and
                    inserting the following:
                      ``(A) Officials representing the agencies described
                    in subsection (e)(2).''; and
                      (B) by redesignating subparagraphs (C) through (G) as
                    subparagraphs (B) through (F), respectively; and
              (3) by adding at the end the following:
              ``(3) Availability.--The best practices referred to in
            paragraph (1) shall be--
                      ``(A) made publicly available; and
                      ``(B) published on the public website of the
                    Substance Abuse and Mental Health Services
                    Administration.
              ``(4) Exclusion of guideline on treatment services.--In
            developing the guidelines under paragraph (1), the Secretary
            may not include any guidelines with respect to substance use
            disorder treatment services.''.

    SEC. 233. COORDINATION OF FEDERAL ACTIVITIES TO PROMOTE THE
                        AVAILABILITY OF RECOVERY HOUSING.

      Section 550 of the Public Health Service Act (42 U.S.C. 290ee-5)
    (relating to national recovery housing best practices) is amended--
              (1) by redesignating subsections (e), (f), and (g) as
            subsections (g), (h), and (i), respectively; and
              (2) by inserting after subsection (d) the following:
      ``(e) Coordination of Federal Activities To Promote the Availability
    of Housing for Individuals Experiencing Homelessness, Individuals With
    a Mental Illness, and Individuals With a Substance Use Disorder.--
              ``(1) In general.--The Secretary, acting through the
            Assistant Secretary, and the Secretary of Housing and Urban
            Development shall convene an interagency working group for the
            following purposes:
                      ``(A) To increase collaboration, cooperation, and
                    consultation among the Department of Health and Human
                    Services, the Department of Housing and Urban
                    Development, and the Federal agencies listed in
                    paragraph (2)(B), with respect to promoting the
                    availability of housing, including recovery housing,
                    for individuals experiencing homelessness, individuals
                    with mental illnesses, and individuals with substance
                    use disorder.
                      ``(B) To align the efforts of such agencies and avoid
                    duplication of such efforts by such agencies.
                      ``(C) To develop objectives, priorities, and a long-
                    term plan for supporting State, Tribal, and local
                    efforts with respect to the operation of recovery
                    housing that is consistent with the best practices
                    developed under this section.
                      ``(D) To coordinate enforcement of fair housing
                    practices, as appropriate, among Federal and State
                    agencies.
                      ``(E) To coordinate data collection on the quality of
                    recovery housing.
              ``(2) Composition.--The interagency working group under
            paragraph (1) shall be composed of--
                      ``(A) the Secretary, acting through the Assistant
                    Secretary, and the Secretary of Housing and Urban
                    Development, who shall serve as the co-chairs; and
                      ``(B) representatives of each of the following
                    Federal agencies:
                              ``(i) The Centers for Medicare & Medicaid
                            Services.
                              ``(ii) The Substance Abuse and Mental Health
                            Services Administration.
                              ``(iii) The Health Resources and Services
                            Administration.
                              ``(iv) The Office of Inspector General.
                              ``(v) The Indian Health Service.
                              ``(vi) The Department of Agriculture.
                              ``(vii) The Department of Justice.
                              ``(viii) The Office of National Drug Control
                            Policy.
                              ``(ix) The Bureau of Indian Affairs.
                              ``(x) The Department of Labor.
                              ``(xi) The Department of Veterans Affairs.
                              ``(xii) Any other Federal agency as the co-
                            chairs determine appropriate.
              ``(3) Meetings.--The working group shall meet on a quarterly
            basis.
              ``(4) Reports to congress.--Not later than 4 years after the
            date of the enactment of this section, the working group shall
            submit to the Committee on Energy and Commerce, the Committee
            on Ways and Means, the Committee on Agriculture, and the
            Committee on Financial Services of the House of Representatives
            and the Committee on Health, Education, Labor, and Pensions,
            the Committee on Agriculture, Nutrition, and Forestry, and the
            Committee on Finance of the Senate a report describing the work
            of the working group and any recommendations of the working
            group to improve Federal, State, and local coordination with
            respect to recovery housing and other housing resources and
            operations for individuals experiencing homelessness,
            individuals with a mental illness, and individuals with a
            substance use disorder.''.

    SEC. 234. NAS STUDY AND REPORT.

      (a) In General.--Not later than 60 days after the date of enactment
    of this Act, the Secretary of Health and Human Services, acting through
    the Assistant Secretary for Mental Health and Substance Use shall--
              (1) contract with the National Academies of Sciences,
            Engineering, and Medicine--
                      (A) to study the quality and effectiveness of
                    recovery housing in the United States and whether the
                    availability of such housing meets demand; and
                      (B) to identify recommendations to promote the
                    availability of high-quality recovery housing; and
              (2) report to the Congress on the results of such review.
      (b) Authorization of Appropriations.--To carry out this section there
    is authorized to be appropriated $1,500,000 for fiscal year 2023.

    SEC. 235. GRANTS FOR STATES TO PROMOTE THE AVAILABILITY OF RECOVERY
                        HOUSING AND SERVICES.

      Section 550 of the Public Health Service Act (42 U.S.C. 290ee-5)
    (relating to national recovery housing best practices), as amended by
    sections 232 and 233, is further amended by inserting after subsection
    (e) (as inserted by section 233) the following:
      ``(f) Grants for Implementing National Recovery Housing Best
    Practices.--
              ``(1) In general.--The Secretary shall award grants to States
            (and political subdivisions thereof), Tribes, and territories--
                      ``(A) for the provision of technical assistance to
                    implement the guidelines and recommendations developed
                    under subsection (a); and
                      ``(B) to promote--
                              ``(i) the availability of recovery housing
                            for individuals with a substance use disorder;
                            and
                              ``(ii) the maintenance of recovery housing in
                            accordance with best practices developed under
                            this section.
              ``(2) State promotion plans.--Not later than 90 days after
            receipt of a grant under paragraph (1), and every 2 years
            thereafter, each State (or political subdivisions thereof,)
            Tribe, or territory receiving a grant under paragraph (1) shall
            submit to the Secretary, and publish on a publicly accessible
            internet website of the State (or political subdivisions
            thereof), Tribe, or territory--
                      ``(A) the plan of the State (or political
                    subdivisions thereof), Tribe, or territory, with
                    respect to the promotion of recovery housing for
                    individuals with a substance use disorder located
                    within the jurisdiction of such State (or political
                    subdivisions thereof), Tribe, or territory; and
                      ``(B) a description of how such plan is consistent
                    with the best practices developed under this
                    section.''.

    SEC. 236. FUNDING.

      Subsection (i) of section 550 of the Public Health Service Act (42
    U.S.C. 290ee-5) (relating to national recovery housing best practices),
    as redesignated by section 233, is amended by striking ``$3,000,000 for
    the period of fiscal years 2019 through 2021'' and inserting
    ``$5,000,000 for the period of fiscal years 2023 through 2027''.

    SEC. 237. TECHNICAL CORRECTION.

      Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) is
    amended--
              (1) by redesignating section 550 (relating to Sobriety
            Treatment and Recovery Teams) (42 U.S.C. 290ee-10), as added by
            section 8214 of Public Law 115-271, as section 550A; and
              (2) by moving such section so it appears after section 550
            (relating to national recovery housing best practices).

    Subtitle D--Substance Use Prevention, Treatment, and Recovery Services
                                  Block Grant

    SEC. 241. ELIMINATING STIGMATIZING LANGUAGE RELATING TO SUBSTANCE USE.

      (a) Block Grants for Prevention and Treatment of Substance Use.--Part
    B of title XIX of the Public Health Service Act (42 U.S.C. 300x et
    seq.) is amended--
              (1) in the part heading, by striking ``substance abuse'' and
            inserting ``substance use'';
              (2) in subpart II, by amending the subpart heading to read as
            follows: ``Block Grants for Substance Use Prevention,
            Treatment, and Recovery Services'';
              (3) in section 1922(a) (42 U.S.C. 300x-22(a))--
                      (A) in paragraph (1), in the matter preceding
                    subparagraph (A), by striking ``substance abuse'' and
                    inserting ``substance use disorders''; and
                      (B) by striking ``such abuse'' each place it appears
                    in paragraphs (1) and (2) and inserting ``such
                    disorders'';
              (4) in section 1923 (42 U.S.C. 300x-23)--
                      (A) in the section heading, by striking ``substance
                    abuse'' and inserting ``substance use''; and
                      (B) in subsection (a), by striking ``drug abuse'' and
                    inserting ``substance use disorders'';
              (5) in section 1925(a)(1) (42 U.S.C. 300x-25(a)(1)), by
            striking ``alcohol or drug abuse'' and inserting ``alcohol or
            other substance use disorders'';
              (6) in section 1926(b)(2)(B) (42 U.S.C. 300x-26(b)(2)(B)), by
            striking ``substance abuse'';
              (7) in section 1931(b)(2) (42 U.S.C. 300x-31(b)(2)), by
            striking ``substance abuse'' and inserting ``substance use
            disorders'';
              (8) in section 1933(d)(1) (42 U.S.C. 300x-33(d)), in the
            matter following subparagraph (B), by striking ``abuse of
            alcohol and other drugs'' and inserting ``use of substances'';
              (9) by amending paragraph (4) of section 1934 (42 U.S.C.
            300x-34) to read as follows:
              ``(4) The term `substance use disorder' means the recurrent
            use of alcohol or other drugs that causes clinically
            significant impairment.'';
              (10) in section 1935 (42 U.S.C. 300x-35)--
                      (A) in subsection (a), by striking ``substance
                    abuse'' and inserting ``substance use disorders''; and
                      (B) in subsection (b)(1), by striking ``substance
                    abuse'' each place it appears and inserting ``substance
                    use disorders'';
              (11) in section 1949 (42 U.S.C. 300x-59), by striking
            ``substance abuse'' each place it appears in subsections (a)
            and (d) and inserting ``substance use disorders'';
              (12) in section 1954(b)(4) (42 U.S.C. 300x-64(b)(4))--
                      (A) by striking ``substance abuse'' and inserting
                    ``substance use disorders''; and
                      (B) by striking ``such abuse'' and inserting ``such
                    disorders'';
              (13) in section 1955 (42 U.S.C. 300x-65), by striking
            ``substance abuse'' each place it appears and inserting
            ``substance use disorder''; and
              (14) in section 1956 (42 U.S.C. 300x-66), by striking
            ``substance abuse'' and inserting ``substance use disorders''.
      (b) Certain Programs Regarding Mental Health and Substance Abuse.--
    Part C of title XIX of the Public Health Service Act (42 U.S.C. 300y et
    seq.) is amended--
              (1) in the part heading, by striking ``substance abuse'' and
            inserting ``substance use'';
              (2) in section 1971 (42 U.S.C. 300y), by striking ``substance
            abuse'' each place it appears in subsections (a), (b), and (f)
            and inserting ``substance use''; and
              (3) in section 1976 (42 U.S.C. 300y-11), by striking
            ``intravenous abuse'' each place it appears and inserting
            ``intravenous use''.

    SEC. 242. AUTHORIZED ACTIVITIES.

      Section 1921(b) of the Public Health Service Act (42 U.S.C. 300x-
    21(b)) is amended by striking ``prevent and treat substance use
    disorders'' and inserting ``prevent, treat, and provide recovery
    support services for substance use disorders''.

    SEC. 243. REQUIREMENTS RELATING TO CERTAIN INFECTIOUS DISEASES AND
                        HUMAN IMMUNODEFICIENCY VIRUS.

      Section 1924 of the Public Health Service Act (42 U.S.C. 300x-24) is
    amended--
              (1) in the section heading, by striking ``tuberculosis and
            human immunodeficiency virus'' and inserting ``tuberculosis,
            viral hepatitis, and human immunodeficiency virus'';
              (2) by amending subsection (a)(2) to read as follows:
              ``(2) Designated states.--
                      ``(A) Fiscal years through fiscal year 2024.--For
                    purposes of this subsection, through September 30,
                    2024, a State described in this paragraph is any State
                    whose rate of cases of acquired immune deficiency
                    syndrome is 10 or more such cases per 100,000
                    individuals (as indicated by the number of such cases
                    reported to and confirmed by the Director of the
                    Centers for Disease Control and Prevention for the most
                    recent calendar year for which such data are
                    available).
                      ``(B) Fiscal year 2025 and succeeding fiscal years.--
                              ``(i) In general.--Beginning with fiscal year
                            2025, for purposes of this subsection, a State
                            described in this paragraph is any State whose
                            rate of cases of human immunodeficiency virus
                            is 10 or more such cases per 100,000
                            individuals (as indicated by the number of such
                            cases newly reported to and confirmed by the
                            Director of the Centers for Disease Control and
                            Prevention for the most recent calendar year
                            for which such data are available).
                              ``(ii) Continuation of designated state
                            status.--In the case of a State whose rate of
                            cases of human immunodeficiency virus falls
                            below the threshold specified in clause (i) for
                            a calendar year, such State shall,
                            notwithstanding clause (i), continue to be
                            described in this paragraph unless the rate of
                            cases falls below such threshold for three
                            consecutive calendar years.''.
              (3) by redesignating subsections (c) and (d) as subsections
            (d) and (e), respectively; and
              (4) by inserting after subsection (b) the following:
      ``(c) Viral Hepatitis.--
              ``(1) In general.--A funding agreement for a grant under
            section 1921 is that the State involved will require that any
            entity receiving amounts from the grant for operating a program
            of treatment for substance use disorders--
                      ``(A) will, directly or through arrangements with
                    other public or nonprofit private entities, routinely
                    make available viral hepatitis services to each
                    individual receiving treatment for such disorders; and
                      ``(B) in the case of an individual in need of such
                    treatment who is denied admission to the program on the
                    basis of the lack of the capacity of the program to
                    admit the individual, will refer the individual to
                    another provider of viral hepatitis services.
              ``(2) Viral hepatitis services.--For purposes of paragraph
            (1), the term `viral hepatitis services', with respect to an
            individual, means--
                      ``(A) screening the individual for viral hepatitis;
                    and
                      ``(B) referring the individual to a provider whose
                    practice includes viral hepatitis vaccination and
                    treatment.''.

    SEC. 244. STATE PLAN REQUIREMENTS.

      Section 1932(b)(1)(A) of the Public Health Service Act (42 U.S.C.
    300x-32(b)(1)(A)) is amended--
              (1) by redesignating clauses (vi) through (ix) as clauses
            (vii) through (x), respectively; and
              (2) by inserting after clause (v) the following:
                              ``(vi) provides a description of--
                                      ``(I) the State's comprehensive
                                    statewide recovery support services
                                    activities, including the number of
                                    individuals being served, target
                                    populations, and priority needs; and
                                      ``(II) the amount of funds received
                                    under this subpart expended on recovery
                                    support services, disaggregated by the
                                    amount expended for type of service
                                    activity;''.

    SEC. 245. UPDATING CERTAIN LANGUAGE RELATING TO TRIBES.

      Section 1933(d) of the Public Health Service Act (42 U.S.C. 300x-
    33(d)) is amended--
              (1) in paragraph (1)--
                      (A) in subparagraph (A)--
                              (i) by striking ``of an Indian tribe or
                            tribal organization'' and inserting ``of an
                            Indian Tribe or Tribal organization''; and
                              (ii) by striking ``such tribe'' and inserting
                            ``such Tribe'';
                      (B) in subparagraph (B)--
                              (i) by striking ``tribe or tribal
                            organization'' and inserting ``Tribe or Tribal
                            organization''; and
                              (ii) by striking ``Secretary under this'' and
                            inserting ``Secretary under this subpart''; and
                      (C) in the matter following subparagraph (B), by
                    striking ``tribe or tribal organization'' and inserting
                    ``Tribe or Tribal organization'';
              (2) by amending paragraph (2) to read as follows:
              ``(2) Indian tribe or tribal organization as grantee.--The
            amount reserved by the Secretary on the basis of a
            determination under this subsection shall be granted to the
            Indian Tribe or Tribal organization serving the individuals for
            whom such a determination has been made.'';
              (3) in paragraph (3), by striking ``tribe or tribal
            organization'' and inserting ``Tribe or Tribal organization'';
            and
              (4) in paragraph (4)--
                      (A) in the paragraph heading, by striking
                    ``Definition'' and inserting ``Definitions''; and
                      (B) by striking ``The terms'' and all that follows
                    through ``given such terms'' and inserting the
                    following: ``The terms `Indian Tribe' and `Tribal
                    organization' have the meanings given the terms `Indian
                    tribe' and `tribal organization'''.

    SEC. 246. BLOCK GRANTS FOR SUBSTANCE USE PREVENTION, TREATMENT, AND
                        RECOVERY SERVICES.

      (a) In General.--Section 1935(a) of the Public Health Service Act (42
    U.S.C. 300x-35(a)), as amended by section 241, is further amended by
    striking ``appropriated'' and all that follows through ``2022..'' and
    inserting the following: ``appropriated $1,908,079,000 for each of
    fiscal years 2023 through 2027.''.
      (b) Technical Corrections.--Section 1935(b)(1)(B) of the Public
    Health Service Act (42 U.S.C. 300x-35(b)(1)(B)) is amended by striking
    ``the collection of data in this paragraph is''.

    SEC. 247. REQUIREMENT OF REPORTS AND AUDITS BY STATES.

      Section 1942(a) of the Public Health Service Act (42 U.S.C. 300x-
    52(a)) is amended--
              (1) in paragraph (1), by striking ``and'' at the end;
              (2) in paragraph (2), by striking the period at the end and
            inserting ``; and''; and
              (3) by adding at the end the following:
              ``(3) the amount provided to each recipient in the previous
            fiscal year.''.

    SEC. 248. STUDY ON ASSESSMENT FOR USE IN DISTRIBUTION OF LIMITED STATE
                        RESOURCES.

      (a) In General.--The Secretary of Health and Human Services, acting
    through the Assistant Secretary for Mental Health and Substance Use (in
    this section referred to as the ``Secretary''), shall, in consultation
    with States and other local entities providing prevention, treatment,
    or recovery support services related to substance use, conduct a study
    to develop a model needs assessment process for States to consider to
    help determine how best to allocate block grant funding received under
    subpart II of part B of title XIX of the Public Health Service Act (42
    U.S.C. 300x-21) to provide services to substance use disorder
    prevention, treatment, and recovery support. The study shall include
    cost estimates with each model needs assessment process.
      (b) Report.--Not later than 2 years after the date of the enactment
    of this Act, the Secretary 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 results of
    the study conducted under paragraph (1).

              Subtitle E--Timely Treatment for Opioid Use Disorder

    SEC. 251. STUDY ON EXEMPTIONS FOR TREATMENT OF OPIOID USE DISORDER
                        THROUGH OPIOID TREATMENT PROGRAMS DURING THE COVID-
                        19 PUBLIC HEALTH EMERGENCY.

      (a) Study.--The Assistant Secretary for Mental Health and Substance
    Use shall conduct a study, in consultation with patients and other
    stakeholders, on activities carried out pursuant to exemptions
    granted--
              (1) to a State (including the District of Columbia or any
            territory of the United States) or an opioid treatment program;
              (2) pursuant to section 8.11(h) of title 42, Code of Federal
            Regulations; and
              (3) during the period--
                      (A) beginning on the declaration of the public health
                    emergency for the COVID-19 pandemic under section 319
                    of the Public Health Service Act (42 U.S.C. 247d); and
                      (B) ending on the earlier of--
                              (i) the termination of such public health
                            emergency, including extensions thereof
                            pursuant to such section 319; and
                              (ii) the end of calendar year 2022.
      (b) Privacy.--The section does not authorize the disclosure by the
    Department of Health and Human Services of individually identifiable
    information about patients.
      (c) Feedback.--In conducting the study under subsection (a), the
    Assistant Secretary for Mental Health and Substance Use shall gather
    feedback from the States and opioid treatment programs on their
    experiences in implementing exemptions described in subsection (a).
      (d) Report.--Not later than 180 days after the end of the period
    described in subsection (a)(3)(B), and subject to subsection (c), the
    Assistant Secretary for Mental Health and Substance Use shall publish a
    report on the results of the study under this section.

    SEC. 252. CHANGES TO FEDERAL OPIOID TREATMENT STANDARDS.

      (a) Mobile Medication Units.--Section 302(e) of the Controlled
    Substances Act (21 U.S.C. 822(e)) is amended by adding at the end the
    following:
      ``(3) Notwithstanding paragraph (1), a registrant that is dispensing
    pursuant to section 303(g) narcotic drugs to individuals for
    maintenance treatment or detoxification treatment shall not be required
    to have a separate registration to incorporate one or more mobile
    medication units into the registrant's practice to dispense such
    narcotics at locations other than the registrant's principal place of
    business or professional practice described in paragraph (1), so long
    as the registrant meets such standards for operation of a mobile
    medication unit as the Attorney General may establish.''.
      (b) Revise Opioid Treatment Program Admission Criteria to Eliminate
    Requirement That Patients Have an Opioid Use Disorder for at Least 1
    Year.--Not later than 18 months after the date of enactment of this
    Act, the Secretary of Health and Human Services shall revise section
    8.12(e)(1) of title 42, Code of Federal Regulations (or successor
    regulations), to eliminate the requirement that an opioid treatment
    program only admit an individual for treatment under the program if the
    individual has been addicted to opioids for at least 1 year before
    being so admitted for treatment.
      (c) Final Regulation on Periods for Take-Home Supply Requirements.--
              (1) In general.--Not later than 18 months after the date of
            enactment of this Act, the Secretary of Health and Human
            Services shall promulgate a final regulation amending
            paragraphs (i)(3)(i) through (i)(3)(vi) of section 8.12 of
            title 42, Code of Federal Regulations, as appropriate based on
            the findings of the study under section 251 of this Act.
              (2) Criteria.--The regulation under paragraph (1) shall
            establish relevant criteria for the medical director or an
            appropriately licensed practitioner of an opioid treatment
            program, to determine whether a patient is stable and may
            qualify for unsupervised use, which criteria may allow for
            consideration of each of the following:
                      (A) Whether the benefits of providing unsupervised
                    doses to a patient outweigh the risks.
                      (B) The patient's demonstrated adherence to their
                    treatment plan.
                      (C) The patient's history of negative toxicology
                    tests.
                      (D) Whether there is an absence of serious behavioral
                    problems.
                      (E) The patient's stability in living arrangements
                    and social relationships.
                      (F) Whether there is an absence of substance misuse-
                    related behaviors.
                      (G) Whether there is an absence of recent diversion
                    activity.
                      (H) Whether there is an assurance that the medication
                    can be safely stored by the patient.
                      (I) Any other criterion the Secretary of Health and
                    Human Services determines appropriate.
              (3) Prohibited sole consideration.--The regulation under
            paragraph (1) shall prohibit the medical director of an opioid
            treatment program from considering, as the sole consideration
            in determining whether a patient is sufficiently responsible in
            handling opioid drugs for unsupervised use, whether the patient
            has an absence of recent misuse of drugs (whether narcotic or
            nonnarcotic), including alcohol.

       Subtitle F--Additional Provisions Relating to Addiction Treatment

    SEC. 261. PROHIBITION.

      Notwithstanding any provision of this Act and the amendments made by
    this Act, no funds made available to carry out this Act or any
    amendment made by this Act shall be used to purchase, procure, or
    distribute pipes or cylindrical objects intended to be used to smoke or
    inhale illegal scheduled substances.

    SEC. 262. ELIMINATING ADDITIONAL REQUIREMENTS FOR DISPENSING NARCOTIC
                        DRUGS IN SCHEDULE III, IV, AND V FOR MAINTENANCE OR
                        DETOXIFICATION TREATMENT.

      (a) In General.--Section 303(g) of the Controlled Substances Act (21
    U.S.C. 823(g)) is amended--
              (1) by striking paragraph (2);
              (2) by striking ``(g)(1) Except as provided in paragraph (2),
            practitioners who dispense narcotic drugs to individuals for
            maintenance treatment or detoxification treatment'' and
            inserting ``(g) Practitioners who dispense narcotic drugs
            (other than narcotic drugs in schedule III, IV, or V) to
            individuals for maintenance treatment or detoxification
            treatment'';
              (3) by redesignating subparagraphs (A), (B), and (C) as
            paragraphs (1), (2), and (3), respectively; and
              (4) in paragraph (2), as so redesignated--
                      (A) by striking ``(i) security of stocks'' and
                    inserting ``(A) security of stocks''; and
                      (B) by striking ``(ii) the maintenance of records''
                    and inserting ``(B) the maintenance of records''.
      (b) Conforming Changes.--
              (1) Subsections (a) and (d)(1) of section 304 of the
            Controlled Substances Act (21 U.S.C. 824) are each amended by
            striking ``303(g)(1)'' each place it appears and inserting
            ``303(g)''.
              (2) Section 309A(a)(2) of the Controlled Substances Act (21
            U.S.C. 829a) is amended--
                      (A) in the matter preceding subparagraph (A), by
                    striking ``the controlled substance is to be
                    administered for the purpose of maintenance or
                    detoxification treatment under section 303(g)(2)'' and
                    inserting ``the controlled substance is a narcotic drug
                    in schedule III, IV, or V to be administered for the
                    purpose of maintenance or detoxification treatment'';
                    and
                      (B) by striking ``and--'' and all that follows
                    through ``is to be administered by injection or
                    implantation;'' and inserting ``and is to be
                    administered by injection or implantation;''.
              (3) Section 520E-4(c) of the Public Health Service Act (42
            U.S.C. 290bb-36d(c)) is amended by striking ``information on
            any qualified practitioner that is certified to prescribe
            medication for opioid dependency under section 303(g)(2)(B) of
            the Controlled Substances Act'' and inserting ``information on
            any practitioner who prescribes narcotic drugs in schedule III,
            IV, or V of section 202 of the Controlled Substances Act for
            the purpose of maintenance or detoxification treatment''.
              (4) Section 544(a)(3) of the Public Health Service Act (42
            U.S.C. 290dd-3), as added by section 219(a)(2), is amended by
            striking ``any practitioner dispensing narcotic drugs pursuant
            to section 303(g) of the Controlled Substances Act'' and
            inserting ``any practitioner dispensing narcotic drugs for the
            purpose of maintenance or detoxification treatment''.
              (5) Section 1833(bb)(3)(B) of the Social Security Act (42
            U.S.C. 1395l(bb)(3)(B)) is amended by striking ``first receives
            a waiver under section 303(g) of the Controlled Substances Act
            on or after January 1, 2019'' and inserting ``first begins
            prescribing narcotic drugs in schedule III, IV, or V of section
            202 of the Controlled Substances Act for the purpose of
            maintenance or detoxification treatment on or after January 1,
            2021''.
              (6) Section 1834(o)(3)(C)(ii) of the Social Security Act (42
            U.S.C. 1395m(o)(3)(C)(ii)) is amended by striking ``first
            receives a waiver under section 303(g) of the Controlled
            Substances Act on or after January 1, 2019'' and inserting
            ``first begins prescribing narcotic drugs in schedule III, IV,
            or V of section 202 of the Controlled Substances Act for the
            purpose of maintenance or detoxification treatment on or after
            January 1, 2021''.
              (7) Section 1866F(c)(3) of the Social Security Act (42 U.S.C.
            1395cc-6(c)(3)) is amended--
                      (A) in subparagraph (A), by adding ``and'' at the
                    end;
                      (B) in subparagraph (B), by striking ``; and'' and
                    inserting a period; and
                      (C) by striking subparagraph (C).
              (8) Section 1903(aa)(2)(C) of the Social Security Act (42
            U.S.C. 1396b(aa)(2)(C)) is amended--
                      (A) in clause (i), by adding ``and'' at the end;
                      (B) by striking clause (ii); and
                      (C) by redesignating clause (iii) as clause (ii).

    SEC. 263. REQUIRING PRESCRIBERS OF CONTROLLED SUBSTANCES TO COMPLETE
                        TRAINING.

      Section 303 of the Controlled Substances Act (21 U.S.C. 823) is
    amended by adding at the end the following:
      ``(l) Required Training for Prescribers.--
              ``(1) Training required.--As a condition on registration
            under this section to dispense controlled substances in
            schedule II, III, IV, or V, the Attorney General shall require
            any qualified practitioner, beginning with the first applicable
            registration for the practitioner, to meet the following:
                      ``(A) If the practitioner is a physician, the
                    practitioner meets one or more of the following
                    conditions:
                              ``(i) The physician holds a board
                            certification in addiction psychiatry or
                            addiction medicine from the American Board of
                            Medical Specialties.
                              ``(ii) The physician holds a board
                            certification from the American Board of
                            Addiction Medicine.
                              ``(iii) The physician holds a board
                            certification in addiction medicine from the
                            American Osteopathic Association.
                              ``(iv) The physician has, with respect to the
                            treatment and management of patients with
                            opioid or other substance use disorders,
                            completed not less than 8 hours of training
                            (through classroom situations, seminars at
                            professional society meetings, electronic
                            communications, or otherwise) that is provided
                            by--
                                      ``(I) the American Society of
                                    Addiction Medicine, the American
                                    Academy of Addiction Psychiatry, the
                                    American Medical Association, the
                                    American Osteopathic Association, the
                                    American Psychiatric Association, or
                                    any other organization accredited by
                                    the Accreditation Council for
                                    Continuing Medical Education (commonly
                                    known as the `ACCME');
                                      ``(II) any organization accredited by
                                    a State medical society accreditor that
                                    is recognized by the ACCME;
                                      ``(III) any organization accredited
                                    by the American Osteopathic Association
                                    to provide continuing medical
                                    education; or
                                      ``(IV) any organization approved by
                                    the Assistant Secretary for Mental
                                    Health and Substance Abuse or the
                                    ACCME.
                              ``(v) 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 first registers or renews under this
                            section and has successfully completed a
                            comprehensive allopathic or osteopathic
                            medicine curriculum or accredited medical
                            residency that included not less than 8 hours
                            of training on treating and managing patients
                            with opioid and other substance use disorders,
                            including the appropriate clinical use of all
                            drugs approved by the Food and Drug
                            Administration for the treatment of a substance
                            use disorder.
                      ``(B) If the practitioner is not a physician, the
                    practitioner meets one or more of the following
                    conditions:
                              ``(i) The practitioner has completed not
                            fewer than 8 hours of training with respect to
                            the treatment and management of patients with
                            opioid or other substance use disorders
                            (through classroom situations, seminars at
                            professional society meetings, electronic
                            communications, or otherwise) provided by the
                            American Society of Addiction Medicine, the
                            American Academy of Addiction Psychiatry, the
                            American Medical Association, the American
                            Osteopathic Association, the American Nurses
                            Credentialing Center, the American Psychiatric
                            Association, the American Association of Nurse
                            Practitioners, the American Academy of
                            Physician Associates, or any other organization
                            approved or accredited by the Assistant
                            Secretary for Mental Health and Substance Abuse
                            or the or the Accreditation Council for
                            Continuing Medical Education.
                              ``(ii) The practitioner has graduated in good
                            standing from an accredited physician assistant
                            school or accredited school of advanced
                            practice nursing in the United States during
                            the 5-year period immediately preceding the
                            date on which the practitioner first registers
                            or renews under this section and has
                            successfully completed a comprehensive
                            physician assistant or advanced practice
                            nursing curriculum that included not fewer than
                            8 hours of training on treating and managing
                            patients with opioid and other substance use
                            disorders, including the appropriate clinical
                            use of all drugs approved by the Food and Drug
                            Administration for the treatment of a substance
                            use disorder.
              ``(2) One-time training.--The Attorney General shall not
            require any qualified practitioner to complete the training
            described in clause (iv) or (v) of paragraph (1)(A) or clause
            (i) or (ii) of paragraph (1)(B) more than once.
              ``(3) Rule of construction.--Nothing in this subsection shall
            be construed to preclude the use, by a qualified practitioner,
            of training received pursuant to this subsection to satisfy
            registration requirements of a State or for some other lawful
            purpose.
              ``(4) Definitions.--In this section:
                      ``(A) First applicable registration.--The term `first
                    applicable registration' means the first registration
                    or renewal of registration by a qualified practitioner
                    under this section that occurs on or after the date
                    that is 180 days after the date of enactment of the
                    Restoring Hope for Mental Health and Well-Being Act of
                    2022.
                      ``(B) Qualified practitioner.--In this subsection,
                    the term `qualified practitioner' means a practitioner
                    who--
                              ``(i) is licensed under State law to
                            prescribe controlled substances; and
                              ``(ii) is not solely a veterinarian.''.

              TITLE III--ACCESS TO MENTAL HEALTH CARE AND COVERAGE

           Subtitle A--Collaborate in an Orderly and Cohesive Manner

    SEC. 301. INCREASING UPTAKE OF THE COLLABORATIVE CARE MODEL.

      Section 520K of the Public Health Service Act (42 U.S.C. 290bb-42) is
    amended to read as follows:

    ``SEC. 520K. INTEGRATION INCENTIVE GRANTS AND COOPERATIVE AGREEMENTS.

      ``(a) Definitions.--In this section:
              ``(1) Collaborative care model.--The term `collaborative care
            model' means the evidence-based, integrated behavioral health
            service delivery method that includes--
                      ``(A) care directed by the primary care team;
                      ``(B) structured care management;
                      ``(C) regular assessments of clinical status using
                    developmentally appropriate, validated tools; and
                      ``(D) modification of treatment as appropriate.
              ``(2) Eligible entity.--The term `eligible entity' means a
            State, or an appropriate State agency, in collaboration with--
                      ``(A) 1 or more qualified community programs as
                    described in section 1913(b)(1);
                      ``(B) 1 or more health centers (as defined in section
                    330(a)), a rural health clinic (as defined in section
                    1961(aa) of the Social Security Act), or a Federally
                    qualified health center (as defined in such section);
                    or
                      ``(C) 1 or more primary health care practices.
              ``(3) Integrated care; bidirectional integrated care.--
                      ``(A) The term `integrated care' means models or
                    practices for coordinating and jointly delivering
                    behavioral and physical health services, which may
                    include practices that share the same space in the same
                    facility.
                      ``(B) The term `bidirectional integrated care' means
                    the integration of behavioral health care and specialty
                    physical health care, as well as the integration of
                    primary and physical health care with specialty
                    behavioral health settings, including within primary
                    health care settings.
              ``(4) Primary health care provider.--The term `primary health
            care provider' means a provider who--
                      ``(A) provides health services related to family
                    medicine, internal medicine, pediatrics, obstetrics,
                    gynecology, or geriatrics; or
                      ``(B) is a doctor of medicine or osteopathy,
                    physician assistant, or nurse practitioner, who is
                    licensed to practice medicine by the State in which
                    such physician, assistant, or practitioner primarily
                    practices, including within primary health care
                    settings.
              ``(5) Primary health care practice.--The term `primary health
            care practice' means a medical practice of primary health care
            providers, including a practice within a larger health care
            system.
              ``(6) Special population.--The term `special population', for
            an eligible entity that is collaborating with an entity
            described in subparagraph (A) or (B) of paragraph (3), means--
                      ``(A) adults with a serious mental illness who have a
                    co-occurring physical health condition or chronic
                    disease;
                      ``(B) children and adolescents with a mental illness
                    who have a co-occurring physical health condition or
                    chronic disease;
                      ``(C) individuals with a substance use disorder; or
                      ``(D) individuals with a mental illness who have a
                    co-occurring substance use disorder.
      ``(b) Grants and Cooperative Agreements.--
              ``(1) In general.--The Secretary may award grants and
            cooperative agreements to eligible entities to support the
            improvement of integrated care for physical and behavioral
            health care in accordance with paragraph (2).
              ``(2) Use of funds.--A grant or cooperative agreement awarded
            under this section shall be used--
                      ``(A) in the case of an eligible entity that is
                    collaborating with an entity described in subparagraph
                    (A) or (B) of subsection (a)(2)--
                              ``(i) to promote full integration and
                            collaboration in clinical practices between
                            physical and behavioral health care for special
                            populations including each population listed in
                            subsection (a)(7);
                              ``(ii) to support the improvement of
                            integrated care models for physical and
                            behavioral health care to improve the overall
                            wellness and physical health status of--
                                      ``(I) adults with a serious mental
                                    illness or children with a serious
                                    emotional disturbance; and
                                      ``(II) individuals with a substance
                                    use disorder; and
                              ``(iii) to promote bidirectional integrated
                            care services including screening, diagnosis,
                            prevention, treatment, and recovery of mental
                            and substance use disorders, and co-occurring
                            physical health conditions and chronic
                            diseases; and
                      ``(B) in the case of an eligible entity that is
                    collaborating with a primary health care practice, to
                    support the uptake of the collaborative care model,
                    including by--
                              ``(i) hiring staff;
                              ``(ii) identifying and formalizing
                            contractual relationships with other health
                            care providers, including providers who will
                            function as psychiatric consultants and
                            behavioral health care managers in providing
                            behavioral health integration services through
                            the collaborative care model;
                              ``(iii) purchasing or upgrading software and
                            other resources needed to appropriately provide
                            behavioral health integration services through
                            the collaborative care model, including
                            resources needed to establish a patient
                            registry and implement measurement-based care;
                            and
                              ``(iv) for such other purposes as the
                            Secretary determines to be necessary.
      ``(c) Applications.--
              ``(1) In general.--An eligible entity that is collaborating
            with an entity described in subparagraph (A) or (B) of
            subsection (a)(2) seeking a grant or cooperative agreement
            under subsection (b)(2)(A) shall submit an application to the
            Secretary at such time, in such manner, and accompanied by such
            information as the Secretary may require, including the
            contents described in paragraph (2).
              ``(2) Contents.--Any such application of an eligible entity
            described in subparagraph (A) or (B) of subsection (a)(2) shall
            include--
                      ``(A) a description of a plan to achieve fully
                    collaborative agreements to provide bidirectional
                    integrated care to special populations;
                      ``(B) a document that summarizes the policies, if
                    any, that are barriers to the provision of integrated
                    care, and the specific steps, if applicable, that will
                    be taken to address such barriers;
                      ``(C) a description of partnerships or other
                    arrangements with local health care providers to
                    provide services to special populations;
                      ``(D) an agreement and plan to report to the
                    Secretary performance measures necessary to evaluate
                    patient outcomes and facilitate evaluations across
                    participating projects;
                      ``(E) a description of how validated rating scales
                    will be implemented to support the improvement of
                    patient outcomes using measurement-based care,
                    including those related to depression screening,
                    patient follow-up, and symptom remission; and
                      ``(F) a plan for sustainability beyond the grant or
                    cooperative agreement period under subsection (e).
              ``(3) Collaborative care model grants.--An eligible entity
            that is collaborating with a primary health care practice
            seeking a grant pursuant to subsection (b)(2)(B) shall submit
            an application to the Secretary at such time, in such manner,
            and accompanied by such information as the Secretary may
            require.
      ``(d) Grant and Cooperative Agreement Amounts.--
              ``(1) Target amount.--The target amount that an eligible
            entity may receive for a year through a grant or cooperative
            agreement under this section shall be--
                      ``(A) $2,000,000 for an eligible entity described in
                    subparagraph (A) or (B) of subsection (a)(2); or
                      ``(B) $100,000 or less for an eligible entity
                    described in subparagraph (C) of subsection (a)(2).
              ``(2) Adjustment permitted.--The Secretary, taking into
            consideration the quality of an eligible entity's application
            and the number of eligible entities that received grants under
            this section prior to the date of enactment of the Restoring
            Hope for Mental Health and Well-Being Act of 2022, may adjust
            the target amount that an eligible entity may receive for a
            year through a grant or cooperative agreement under this
            section.
              ``(3) Limitation.--An eligible entity that is collaborating
            with an entity described in subparagraph (A) or (B) of
            subsection (a)(2) receiving funding under this section--
                      ``(A) may not allocate more than 20 percent of the
                    funds awarded to such eligible entity under this
                    section to administrative functions; and
                      ``(B) shall allocate the remainder of such funding to
                    health facilities that provide integrated care.
      ``(e) Duration.--A grant or cooperative agreement under this section
    shall be for a period not to exceed 5 years.
      ``(f) Report on Program Outcomes.--An eligible entity receiving a
    grant or cooperative agreement under this section--
              ``(1) that is collaborating with an entity described in
            subparagraph (A) or (B) of subsection (a)(2) shall submit an
            annual report to the Secretary that includes--
                      ``(A) the progress made to reduce barriers to
                    integrated care as described in the entity's
                    application under subsection (c); and
                      ``(B) a description of outcomes with respect to each
                    special population listed in subsection (a)(7),
                    including outcomes related to education, employment,
                    and housing; or
              ``(2) that is collaborating with a primary health care
            practice shall submit an annual report to the Secretary that
            includes--
                      ``(A) the progress made to improve access;
                      ``(B) the progress made to improve patient outcomes;
                    and
                      ``(C) the progress made to reduce referrals to
                    specialty care.
      ``(g) Technical Assistance for Primary-Behavioral Health Care
    Integration.--
              ``(1) Certain recipients.--The Secretary may provide
            appropriate information, training, and technical assistance to
            eligible entities that are collaborating with an entity
            described in subparagraph (A) or (B) of subsection (a)(2) that
            receive a grant or cooperative agreement under this section, in
            order to help such entities meet the requirements of this
            section, including assistance with--
                      ``(A) development and selection of integrated care
                    models;
                      ``(B) dissemination of evidence-based interventions
                    in integrated care;
                      ``(C) establishment of organizational practices to
                    support operational and administrative success; and
                      ``(D) other activities, as the Secretary determines
                    appropriate.
              ``(2) Collaborative care model recipients.--The Secretary
            shall provide appropriate information, training, and technical
            assistance to eligible entities that are collaborating with
            primary health care practices that receive funds under this
            section to help such entities implement the collaborative care
            model, including--
                      ``(A) developing financial models and budgets for
                    implementing and maintaining a collaborative care
                    model, based on practice size;
                      ``(B) developing staffing models for essential staff
                    roles;
                      ``(C) providing strategic advice to assist practices
                    seeking to utilize other clinicians for additional
                    psychotherapeutic interventions;
                      ``(D) providing information technology expertise to
                    assist with building the collaborative care model into
                    electronic health records, including assistance with
                    care manager tools, patient registry, ongoing patient
                    monitoring, and patient records;
                      ``(E) training support for all key staff and
                    operational consultation to develop practice workflows;
                      ``(F) establishing methods to ensure the sharing of
                    best practices and operational knowledge among primary
                    health care physicians and primary health care
                    practices that provide behavioral health integration
                    services through the collaborative care model; and
                      ``(G) providing guidance and instruction to primary
                    health care physicians and primary health care
                    practices on developing and maintaining relationships
                    with community-based mental health and substance use
                    disorder facilities for referral and treatment of
                    patients whose clinical presentation or diagnosis is
                    best suited for treatment at such facilities.
              ``(3) Additional dissemination of technical information.--In
            addition to providing the assistance described in paragraphs
            (1) and (2) to recipients of a grant or cooperative agreement
            under this section, the Secretary may also provide such
            assistance to other States and political subdivisions of
            States, Indian Tribes and Tribal organizations (as defined
            under the Federally Recognized Indian Tribe List Act of 1994),
            outpatient mental health and addiction treatment centers,
            community mental health centers that meet the criteria under
            section 1913(c), certified community behavioral health clinics
            described in section 223 of the Protecting Access to Medicare
            Act of 2014, primary care organizations such as Federally
            qualified health centers or rural health clinics as defined in
            section 1861(aa) of the Social Security Act, primary health
            care practices, other community-based organizations, and other
            entities engaging in integrated care activities, as the
            Secretary determines appropriate.
      ``(h) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $60,000,000 for each of fiscal
    years 2023 through 2027.''.

            Subtitle B--Helping Enable Access to Lifesaving Services

    SEC. 311. REAUTHORIZATION AND PROVISION OF CERTAIN PROGRAMS TO
                        STRENGTHEN THE HEALTH CARE WORKFORCE.

      (a) Liability Protections for Health Professional Volunteers.--
    Section 224(q)(6) of the Public Health Service Act (42 U.S.C.
    233(q)(6)) is amended by striking ``October 1, 2022'' and inserting
    ``October 1, 2027''.
      (b) Minority Fellowships in Crisis Care Management.--Section 597(b)
    of the Public Health Service Act (42 U.S.C. 290ll(b)) is amended by
    striking ``in the fields of psychiatry,'' and inserting ``in the fields
    of crisis care management, psychiatry,''.
      (c) Mental and Behavioral Health Education and Training Grants.--
    Section 756 of the Public Health Service Act (42 U.S.C. 294e-1) is
    amended--
              (1) in subsection (a)(1), by inserting ``(which may include
            master's and doctoral level programs)'' after ``occupational
            therapy''; and
              (2) in subsection (f), by striking ``For each of fiscal years
            2019 through 2023'' and inserting ``For each of fiscal years
            2023 through 2027''.
      (d) Training Demonstration Program.--Section 760(g) of the Public
    Health Service Act (42 U.S.C. 294k(g)) is amended by inserting ``and
    $31,700,000 for each of fiscal years 2023 through 2027'' before the
    period at the end.

    Subtitle C--Eliminating the Opt-Out for Nonfederal Governmental Health
                                     Plans

    SEC. 321. ELIMINATING THE OPT-OUT FOR NONFEDERAL GOVERNMENTAL HEALTH
                        PLANS.

      Section 2722(a)(2) of the Public Health Service Act (42 U.S.C. 300gg-
    21(a)(2)) is amended by adding at the end the following new
    subparagraph:
                      ``(F) Sunset of election option.--
                              ``(i) In general.--Notwithstanding the
                            preceding provisions of this paragraph--
                                      ``(I) no election described in
                                    subparagraph (A) with respect to
                                    section 2726 may be made on or after
                                    the date of the enactment of this
                                    subparagraph; and
                                      ``(II) except as provided in clause
                                    (ii), no such election with respect to
                                    section 2726 expiring on or after the
                                    date that is 180 days after the date of
                                    such enactment may be renewed.
                              ``(ii) Exception for certain collectively
                            bargained plans.--Notwithstanding clause
                            (i)(II), a plan described in subparagraph
                            (B)(ii) that is subject to multiple agreements
                            described in such subparagraph of varying
                            lengths and that has an election described in
                            subparagraph (A) with respect to section 2726
                            in effect as of the date of the enactment of
                            this subparagraph that expires on or after the
                            date that is 180 days after the date of such
                            enactment may extend such election until the
                            date on which the term of the last such
                            agreement expires.''.

          Subtitle D--Mental Health and Substance Use Disorder Parity
                                 Implementation

    SEC. 331. GRANTS TO SUPPORT MENTAL HEALTH AND SUBSTANCE USE DISORDER
                        PARITY IMPLEMENTATION.

      (a) In General.--Section 2794(c) of the Public Health Service Act (42
    U.S.C. 300gg-94(c)) (as added by section 1003 of the Patient Protection
    and Affordable Care Act (Public Law 111-148)) is amended by adding at
    the end the following:
              ``(3) Parity implementation.--
                      ``(A) In general.--Beginning during the first fiscal
                    year that begins after the date of enactment of this
                    paragraph, the Secretary shall, out of funds made
                    available pursuant to subparagraph (C), award grants to
                    eligible States to enforce and ensure compliance with
                    the mental health and substance use disorder parity
                    provisions of section 2726.
                      ``(B) Eligible state.--A State shall be eligible for
                    a grant awarded under this paragraph only if such
                    State--
                              ``(i) submits to the Secretary an application
                            for such grant at such time, in such manner,
                            and containing such information as specified by
                            the Secretary; and
                              ``(ii) agrees to request and review from
                            health insurance issuers offering group or
                            individual health insurance coverage the
                            comparative analyses and other information
                            required of such health insurance issuers under
                            subsection (a)(8)(A) of section 2726 relating
                            to the design and application of
                            nonquantitative treatment limitations imposed
                            on mental health or substance use disorder
                            benefits.
                      ``(C) Authorization of appropriations.--There are
                    authorized to be appropriated $10,000,000 for each of
                    the first five fiscal years beginning after the date of
                    the enactment of this paragraph, to remain available
                    until expended, for purposes of awarding grants under
                    subparagraph (A).''.
      (b) Technical Amendment.--Section 2794 of the Public Health Service
    Act (42 U.S.C. 300gg-95), as added by section 6603 of the Patient
    Protection and Affordable Care Act (Public Law 111-148) is redesignated
    as section 2795.

                          TITLE IV--CHILDREN AND YOUTH

          Subtitle A--Supporting Children's Mental Health Care Access

    SEC. 401. PEDIATRIC MENTAL HEALTH CARE ACCESS GRANTS.

      Section 330M of the Public Health Service Act (42 U.S.C. 254c-19) is
    amended--
              (1) in the section enumerator, by striking ``330M'' and
            inserting ``330M.'';
              (2) in subsection (a)--
                      (A) by striking ``Indian tribes and tribal
                    organizations'' and inserting ``Indian Tribes and
                    Tribal organizations''; and
                      (B) by inserting ``or, in the case of a State that
                    does not submit an application, a nonprofit entity that
                    has the support of the State'' after ``450b))'';
              (3) in subsection (b)--
                      (A) in paragraph (1)--
                              (i) in subparagraph (G), by inserting
                            ``developmental-behavioral pediatricians,''
                            after ``adolescent psychiatrists,'';
                              (ii) in subparagraph (H), by striking ``;
                            and'' at the end and inserting a semicolon;
                              (iii) by redesignating subparagraph (I) as
                            subparagraph (J); and
                              (iv) by inserting after subparagraph (H) the
                            following:
                      ``(I) maintain an up-to-date list of community-based
                    supports for children with mental health problems;
                    and'';
                      (B) by redesignating paragraph (2) as paragraph (4);
                      (C) by inserting after paragraph (1) the following:
              ``(2) Support to schools and emergency departments.--In
            addition to the activities required by paragraph (1), a
            pediatric mental health care telehealth access program referred
            to in subsection (a), with respect to which a grant under such
            subsection may be used, may provide support to schools and
            emergency departments.
              ``(3) Priority.--In awarding grants under this section, the
            Secretary shall give priority to applicants proposing to--
                      ``(A) continue existing programs that meet the
                    requirements of paragraph (1);
                      ``(B) establish a pediatric mental health care
                    telehealth access program in the jurisdiction of a
                    State, Territory, Indian Tribe, or Tribal organization
                    that does not yet have such a program; or
                      ``(C) expand a pediatric mental health care
                    telehealth access program to include one or more new
                    sites of care, such as a school or emergency
                    department.''; and
                      (D) in paragraph (4), as redesignated by subparagraph
                    (B), by inserting ``Such a team may include a
                    developmental-behavioral pediatrician.'' after ``mental
                    health counselor.'';
              (4) in subsections (c), (d), and (f), by striking ``Indian
            tribe, or tribal organization'' each place it appears and
            inserting ``Indian Tribe, Tribal organization, or nonprofit
            entity''; and
              (5) by striking subsection (g) and inserting the following:
      ``(g) Technical Assistance.--The Secretary shall award grants or
    contracts to one or more eligible entities (as defined by the
    Secretary) for the purposes of providing technical assistance and
    evaluation support to grantees under subsection (a).
      ``(h) Authorization of Appropriations.--To carry out this section,
    there are authorized to be appropriated--
              ``(1) $14,000,000 for each of fiscal years 2023 through 2025;
            and
              ``(2) $30,000,000 for each of fiscal years 2026 through
            2027.''.

    SEC. 402. INFANT AND EARLY CHILDHOOD MENTAL HEALTH PROMOTION,
                        INTERVENTION, AND TREATMENT.

      Section 399Z-2(f) of the Public Health Service Act (42 U.S.C. 280h-
    6(f)) is amended by striking ``$20,000,000 for the period of fiscal
    years 2018 through 2022'' and inserting ``$50,000,000 for the period of
    fiscal years 2023 through 2027''.

              Subtitle B--Continuing Systems of Care for Children

    SEC. 411. COMPREHENSIVE COMMUNITY MENTAL HEALTH SERVICES FOR CHILDREN
                        WITH SERIOUS EMOTIONAL DISTURBANCES.

      (a) Definition of Family.--Section 565(d)(2)(B) of the Public Health
    Service Act (42 U.S.C. 290ff-4(d)(2)(B)) is amended by striking ``as
    appropriate regarding mental health services for the child, the parents
    of the child (biological or adoptive, as the case may be) and any
    foster parents of the child'' and inserting ``as appropriate regarding
    mental health services for the child and the parents or kinship
    caregivers of the child''.
      (b) Authorization of Appropriations.--Paragraph (1) of section 565(f)
    of the Public Health Service Act (42 U.S.C. 290ff-4(f)) is amended--
              (1) by moving the margin of such paragraph 2 ems to the
            right; and
              (2) by striking ``$119,026,000 for each of fiscal years 2018
            through 2022'' and inserting ``$125,000,000 for each of fiscal
            years 2023 through 2027''.

    SEC. 412. SUBSTANCE USE DISORDER TREATMENT AND EARLY INTERVENTION
                        SERVICES FOR CHILDREN AND ADOLESCENTS.

      Section 514 of the Public Health Service Act (42 U.S.C. 290bb-7) is
    amended--
              (1) in subsection (a), by striking ``Indian tribes or tribal
            organizations'' and inserting ``Indian Tribes or Tribal
            organizations''; and
              (2) in subsection (f), by striking ``2018 through 2022'' and
            inserting ``2023 through 2027''.

             Subtitle C--Garrett Lee Smith Memorial Reauthorization

    SEC. 421. SUICIDE PREVENTION TECHNICAL ASSISTANCE CENTER.

      (a) Technical Amendment.--Section 520C of the Public Health Service
    Act (42 U.S.C. 290bb-34) is amended--
              (1) by striking ``tribes'' and inserting ``Tribes''; and
              (2) by striking ``tribal'' each place it appears and
            inserting ``Tribal''.
      (b) Authorization of Appropriations.--Section 520C(c) of the Public
    Health Service Act (42 U.S.C. 290bb-34(c)) is amended by striking
    ``$5,988,000 for each of fiscal years 2018 through 2022'' and inserting
    ``$9,000,000 for each of fiscal years 2023 through 2027''.
      (c) Annual Report.--Section 520C(d) of the Public Health Service Act
    (42 U.S.C. 290bb-34(d)) is amended by striking ``Not later than 2 years
    after the date of enactment of this subsection'' and inserting ``Not
    later than 2 years after the date of enactment of the Restoring Hope
    for Mental Health and Well-Being Act of 2022''.

    SEC. 422. YOUTH SUICIDE EARLY INTERVENTION AND PREVENTION STRATEGIES.

      Section 520E of the Public Health Service Act (42 U.S.C. 290bb-36) is
    amended--
              (1) by striking ``tribe'' and inserting ``Tribe'';
              (2) by striking ``tribal'' each place it appears and
            inserting ``Tribal'';
              (3) in subsection (a)(1), by inserting ``pediatric health
            programs,'' after ``foster care systems,'';
              (4) by amending subsection (b)(1)(B) to read as follows:
                      ``(B) a public organization or private nonprofit
                    organization designated by a State or Indian Tribe (as
                    defined under the Federally Recognized Indian Tribe
                    List Act of 1994) to develop or direct the State-
                    sponsored statewide or Tribal youth suicide early
                    intervention and prevention strategy; or'';
              (5) in subsection (c)--
                      (A) in paragraph (1), by inserting ``pediatric health
                    programs,'' after ``foster care systems,'';
                      (B) in paragraph (7), by inserting ``pediatric health
                    programs,'' after ``foster care systems,'';
                      (C) in paragraph (9), by inserting ``pediatric health
                    programs,'' after ``educational institutions,'';
                      (D) in paragraph (13), by striking ``and'' at the
                    end;
                      (E) in paragraph (14), by striking the period at the
                    end and inserting ``; and''; and
                      (F) by adding at the end the following:
              ``(15) provide to parents, legal guardians, and family
            members of youth, supplies to securely store means commonly
            used in suicide, if applicable, within the household.'';
              (6) in subsection (d)--
                      (A) in the heading, by striking ``Direct Services''
                    and inserting ``Suicide Prevention Activities''; and
                      (B) by striking ``direct services, of which not less
                    than 5 percent shall be used for activities authorized
                    under subsection (a)(3)'' and inserting ``suicide
                    prevention activities'';
              (7) in subsection (e)(3)(A), by inserting ``and Department of
            Education'' after ``Department of Health and Human Services'';
              (8) in subsection (g)--
                      (A) in paragraph (1), by striking ``18'' and
                    inserting ``24''; and
                      (B) in paragraph (2), by striking ``2 years after the
                    date of enactment of Helping Families in Mental Health
                    Crisis Reform Act of 2016'' and inserting ``3 years
                    after December 31, 2022'';
              (9) in subsection (l)(4), by striking ``between 10 and 24
            years of age'' and inserting ``up to 24 years of age''; and
              (10) in subsection (m), by striking ``$30,000,000 for each of
            fiscal years 2018 through 2022'' and inserting ``$40,000,000
            for each of fiscal years 2023 through 2027''.

    SEC. 423. MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES FOR
                        STUDENTS IN HIGHER EDUCATION.

      Section 520E-2 of the Public Health Service Act (42 U.S.C. 290bb-36b)
    is amended--
              (1) in the heading, by striking ``on campus'' and inserting
            ``for students in higher education''; and
              (2) in subsection (i), by striking ``2018 through 2022'' and
            inserting ``2023 through 2027''.

    SEC. 424. MENTAL AND BEHAVIORAL HEALTH OUTREACH AND EDUCATION AT
                        INSTITUTIONS OF HIGHER EDUCATION.

      Section 549 of the Public Health Service Act (42 U.S.C. 290ee-4) is
    amended--
              (1) in the heading, by striking ``on college campuses'' and
            inserting ``at institutions of higher education'';
              (2) in subsection (c)(2), by inserting ``, including
            minority-serving institutions as described in section 371(a) of
            the Higher Education Act of 1965 (20 U.S.C. 1067q) and
            community colleges'' after ``higher education''; and
              (3) in subsection (f), by striking ``2018 through 2022'' and
            inserting ``2023 through 2027''.

                             I. Purpose and Summary

        H.R. 7666, the ``Restoring Hope for Mental Health and Well-
    Being Act of 2022,'' amends the Public Health Service Act to
    reauthorize and establish certain mental health and substance
    use disorder programs at the Substance Abuse and Mental Health
    Services Administration (SAMHSA) and the Health Resources and
    Services Administration (HRSA) through fiscal year 2027, for
    the purposes of improving Americans' mental health and
    addressing substance use disorders. H.R. 7666 includes
    provisions to support crisis care and other mental health
    services for a range of populations, as well as substance use
    disorder prevention, treatment, and recovery support services.
    The legislation provides increased support for youth suicide
    prevention, maternal mental health, and jail diversion
    programs. Further, the bill includes provisions to assist in
    addiction and overdose prevention and treatment, including
    expanded access to medication-assisted treatment and provider
    training. H.R. 7666 also facilitates further integration of
    mental health and primary care services, bolsters the mental
    health care workforce, applies mental health parity
    requirements to self-funded, non-governmental plans, and
    supports enforcement of mental health parity requirements.

                    II. Background and Need for Legislation

        Americans have been in the midst of a mental health and
    substance use disorder crisis predating the emergence of the
    coronavirus disease of 2019 (COVID-19). Increased social
    isolation and stress caused by the pandemic further exacerbated
    these challenges,\1\ with American adults reporting elevated
    levels of mental illness (AMI) including anxiety, depression,
    and suicidal ideation.\2\ Children and teens have also
    experienced major increases in adverse mental health
    symptoms.\3\ Among youth ages 10 and older, the national
    suicide rate increased by more than 25 percent since 1999,
    nearly doubling in some states.\4\ In addition, one out of five
    women will experience maternal mental health conditions, such
    as depression, anxiety, or substance use disorder, during
    pregnancy or the first year following childbirth.\5\ Suicide
    and substance use disorder are some of the leading causes of
    death in the first year postpartum.\6\
    ---------------------------------------------------------------------------
        \1\Kaiser Family Foundation, The implications of COVID-19 for
    mental health and substance use (Feb. 10, 2021).
        \2\Centers for Disease Control and Prevention, Morbidity and
    Mortality Weekly Report, Mental Health, Substance Use, and Suicidal
    Ideation During the COVID-19 Pandemic--United States, June 24-30, 2020
    (Aug. 14, 2020).
        \3\Surgeon General, Protecting Youth Mental Health: The U.S.
    Surgeon General's Advisory (Dec. 7, 2021).
        \4\Centers for Disease Control and Prevention, Supplementary Table.
    Trends in Suicide Rates among Persons  10 Years of Age, by State and
    Sex, National Vital Statistics System, 1999-2016 (June 8, 2018)
    (https://stacks.cdc.gov/view/cdc/53785).
        \5\Obstetrics & Gynecology, ACOG Committee Opinion No. 757,
    Screening for Perinatal Depression (journals.lww.com/greenjournal/
    Fulltext/2018/11000/ACOG_Committee_Opinion_No_757_
    Screening_for.42.aspx); Fawcett, et. al, The Prevalence of Anxiety
    Disorders During Pregnancy and the Postpartum Period, J. Clin
    Psychiatry (July 23, 2019) (pubmed.ncbi.nlm.nih.gov/31347796/).
        \6\See Pregnancy-Related Deaths; Data from 14 U.S. Maternal
    Mortality Review Committees, 2008-2017 (www.cdc.gov/reproductivehealth/
    maternal-mortality/erase-mm/MMR-Data-Brief_2019-h.pdf).
    ---------------------------------------------------------------------------
        The state of substance use disorders in the United States
    has followed a similar upward trajectory in recent years.
    Nearly 108,000 people died due to drug overdose in 2021, a
    record-breaking number that followed a 30 percent increase in
    the rate of overdose deaths from 2019 to 2020.\7\ Additionally,
    substance use disorders frequently co-occur with mental health
    disorders, such as anxiety and depression.\8\ Nearly 50 percent
    of individuals who develop a mental health disorder will also
    experience a substance use disorder, and vice versa.\9\
    ---------------------------------------------------------------------------
        \7\Centers for Disease Control and Prevention, Vital Statistics
    Rapid Release (www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm)
    (accessed June 6, 2022); Overdose Deaths Continue Rising, With Fentanyl
    and Meth Key Culprits, New York Times (May 11, 2022).
        \8\National Institute on Drug Abuse, Common Comorbidities with
    Substance Use Disorders Research Report (April 2020).
        \9\Id.
    ---------------------------------------------------------------------------
        Despite high rates of mental health conditions and
    substance use disorders, access to treatment and services
    remains limited. In 2020, for instance, only 1.4 percent of
    individuals who were classified as in need of substance use
    treatment, and just 46.2 percent of adults with any mental
    illness, received treatment.\10\ Major barriers to treatment
    include the shortage of mental health professionals which
    affects one-third of Americans.\11\ The treatment burden of
    mental illnesses is particularly acute among those who
    experience disability due to serious mental illness (SMI). SMI
    is defined as a mental, behavioral, or emotional disorder
    resulting in serious functional impairment, which substantially
    interferes with or limits one or more major life
    activities.\12\ Those living with SMI--including bipolar
    disorder, schizophrenia, and severe depression--are jailed more
    than 2 million times each year, often for misdemeanor
    crimes.\13\ The U.S. criminal justice system has witnessed
    dramatic increases in its mentally ill population during the
    past years, with decreasing numbers of psychiatric beds being
    identified as one of the major causes.\14\ One-third of the
    total homeless population consists of individuals with
    untreated SMI, with the rates being even higher in homeless
    women and individuals who are chronically homeless.\15\
    ---------------------------------------------------------------------------
        \10\Substance Abuse and Mental Health Services Administration. Key
    substance use and mental health indicators in the United States:
    Results from the 2020 National Survey on Drug Use and Health, Center
    for Behavioral Health Statistics and Quality, Substance Abuse and
    Mental Health Services Administration (June 1, 2022).
        \11\USA FACTS, Over one-third of Americans live in areas lacking
    mental health professionals (June 9, 2021) (https://usafacts.org/
    articles/over-one-third-of-americans-live-in-areas-lacking-mental-
    health-professionals/); U.S. Department of Labor, U.S. Departments of
    Labor, Health and Human Services, Treasury Issue 2022 Mental Health
    Parity and Addiction Equity Act Report to Congress (June 1, 2022).
        \12\National Institute of Mental Health, Mental Illness
    (www.nimh.nih.gov/health/statistics/mental-illness) (accessed June 8,
    2022).
        \13\The Pew Charitable Trusts, Project: Mental Health and Justice
    Partnerships (www.pewtrusts.org/en/projects/mental-health-and-justice-
    partnerships) (accessed June 8, 2022).
        \14\Y. Nina Gao, Relationship Between Psychiatric Inpatient Beds
    and Jail Populations in the United States, Journal of Psychiatric
    Practice (Jan. 21, 2021).
        \15\Treatment Advocacy Center Office of Research & Public Affairs,
    Serious Mental Illness and Homelessness (Sept. 2016) (https://
    www.treatmentadvocacycenter.org/storage/documents/backgrounders/smi-
    and-homelessness.pdf).
    ---------------------------------------------------------------------------
        H.R. 7666 reauthorizes 35 SAMHSA and HRSA grant programs
    that provide critical support for mental health and substance
    use disorder activities at a time when increased services for
    these conditions are needed more than ever. These programs were
    established or most recently reauthorized through the 21st
    Century Cures Act,\16\ the Comprehensive Addiction and Recovery
    Act,\17\ or the Substance Use-Disorder Prevention that Promotes
    Opioid Recovery and Treatment (SUPPORT) for Patients and
    Communities Act,\18\ in efforts to curb rising rates of mental
    health conditions and substance use disorders.
    ---------------------------------------------------------------------------
        \16\Pub. L. 114-255.
        \17\Pub. L. 114-198.
        \18\Pub. L. 115-271.
    ---------------------------------------------------------------------------
        Collectively, through funding to states, territories,
    Tribes, Tribal organizations, community-based and consumer-led
    organizations, and a range of providers, these programs--
    including the respective Community Mental Health Services Block
    Grants and the Substance Use Disorder Treatment and Recovery
    Services Block Grants--target communities and populations at
    increased need for mental health support or services and
    substance use disorder prevention, treatment, or recovery
    support services--such as for children and adolescents, college
    students, pregnant or postpartum women, people of color,
    Veterans, those experiencing homelessness, those facing or at
    risk of incarceration, and rural communities.
        In addition, to respond to the urgent mental health crisis
    care needs of Americans, and in preparation of the 9-8-8
    National Suicide Prevention Lifeline dialing code launch in
    July 2022, H.R. 7666 establishes the SAMHSA Behavioral Health
    Crisis Coordinating Office to convene partners and provide
    technical assistance to enhance access to crisis care. Further,
    the bill requires the Secretary of Health and Human Services
    (HHS) to publish best practices for a crisis response continuum
    of care, and replaces the reauthorization of the Community
    Crisis Response Systems Grants with a Mental Health Crisis
    Response Partnership Pilot Program.
        To address the rising maternal mental health and substance
    use disorder needs across the country, H.R. 7666 establishes a
    national hotline to provide information, interventions, and
    resources to pregnant and postpartum women at risk of, or
    affected by, maternal mental health and substance use
    disorders, and establishes a task force to make recommendations
    to coordinate and inform a national strategy to improve Federal
    and State responses to maternal mental health conditions.
        Further, as nearly 29 million Americans have had or will
    have an eating disorder at some point in their lives,\19\ the
    bill meets an ongoing specific mental health disorder need and
    establishes an authorization for the SAMHSA National Center of
    Excellence for Eating Disorders. It also authorizes grants to
    consumer-led nonprofits and Tribal entities to provide peer-
    supported mental health services, including virtual peer
    support.
    ---------------------------------------------------------------------------
        \19\Deloitte Access Economic. The Social and Economic Cost of
    Eating Disorders in the United States of America: A Report for the
    Strategic Training Initiative for the Prevention of Eating Disorders
    and the Academy for Eating Disorders (June 2020).
    ---------------------------------------------------------------------------
        H.R. 7666 also rises to meet the needs of young Americans
    disproportionately impacted by mental health challenges and
    substance use disorders. Prior to the COVID-19 pandemic, mental
    health crises experienced by adolescents were already on the
    rise, with 13.2 percent of American children between the ages
    of three and 17 experiencing a current, diagnosed mental or
    behavioral health condition from 2018 to 2019.\20\ In addition,
    suicide rates for Americans ages 10 to 24 has jumped nearly 60
    percent between 2007 and 2018.\21\ These trends were
    exacerbated by the pandemic, so much so that on December 7,
    2021, the Surgeon General issued an advisory on the impact that
    COVID-19 has had on the ongoing children's mental health
    crisis.\22\ The bill takes numerous steps aimed to address
    youth mental health, including: reauthorizing HRSA's Pediatric
    Mental Health Care Access grant program, which promotes
    behavioral health integration into pediatric primary care by
    supporting pediatric mental health care telehealth access
    programs in states, and SAMHSA's Infant and Early Childhood
    Mental Health Grant Program, which helps to improve outcomes
    for children from birth to age 12 by developing, maintaining,
    or enhancing mental health promotion, intervention, and
    treatment services. The bill further supports continuing mental
    health and substance use disorder systems of care for children
    through the five-year reauthorization of the Comprehensive
    Community Mental Health Services for Children with Serious
    Emotional Disturbances Grants and the Enhancement and Expansion
    of Treatment and Recovery Services for Adolescents,
    Transitional Aged Youth, and their Families--known as the Youth
    and Family TREE Grants.
    ---------------------------------------------------------------------------
        \20\Health Resources and Services Administration, Mental and
    Behavioral Health, NSCH Data Brief (Oct. 2020) (mchb.hrsa.gov/sites/
    default/files/mchb/data-research/nsch-data-brief-2019-mental-bh.pdf)
        \21\Centers for Disease Control and Prevention, National Vital
    Statistics Reports, Volume 69, Number 11: State Suicide Rates Among
    Adolescents and Young Adults Aged 10-24: United States, 2000-2018
    (Sept. 11, 2020) (www.cdc.gov/nchs/data/nvsr/nvsr69/nvsr-69-11-
    508.pdf).
        \22\Department of Health and Human Services, U.S. Surgeon General
    Issues Advisory on Youth Mental Health Crisis Further Exposed by COVID-
    19 Pandemic (Dec. 7, 2021) (press release).
    ---------------------------------------------------------------------------
        Many of the millions of older adolescents and young adults
    living with a mental or substance use disorder may not realize
    they have one or know how to seek help.\23\ H.R. 7666 further
    supports youth and young adults across the country through the
    reauthorization of the Garrett Lee Smith Memorial Act programs
    including the Suicide Prevention Resource Center, the State and
    Tribal Youth Suicide Prevention and Early Intervention Grants
    Program, the Mental Health Youth Suicide Prevention Campus
    Grants, and the Mental and Behavioral Health Public Outreach
    and Education at Institutions of Higher Education program.
    ---------------------------------------------------------------------------
        \23\Substance Abuse and Mental Health Services Administration,
    Mental Illness and Substance Use in Young Adults (www.samhsa.gov.young-
    adults) (accessed June 7, 2022).
    ---------------------------------------------------------------------------
        In addition, H.R. 7666 reauthorizes the Sober Truth on
    Prevention Underage Drinking Programs, supporting a national
    media campaign, community-based coalition enhancement grants,
    and grants for pediatric provider screening and brief
    interventions as well as data collection and research to
    prevent and address underage drinking at a time when alcohol
    remains the most widely used substance among America's young
    people.\24\ The bill reauthorizes a range of other substance-
    or intervention-specific programs, such as the grants for
    reducing overdose deaths and the emergency department
    alternatives to opioids grant program. Further, the bill
    requires that the Secretary of HHS, acting through the SAMHSA
    Assistant Secretary, collaborate with federal agencies and
    stakeholders to update, disseminate and promote through grants
    high-quality recovery housing best practices.
    ---------------------------------------------------------------------------
        \24\National Institutes of Health, Underage Drinking
    (www.niaaa.nih.gov/publications/brochures-and-fact-sheets/underage-
    drinking) (accessed June 7, 2022).
    ---------------------------------------------------------------------------
        The climbing rate of Americans experiencing mental health
    conditions is projected to put a strain on the mental and
    behavioral health workforce--according to HRSA's Bureau of
    Health Workforce, a majority of states will experience
    shortages of licensed mental health counselors by 2030.\25\ In
    addition, as of March 2021, about 122 million Americans were
    living in areas experiencing mental health professional
    shortages.\26\ H.R. 7666 includes a number of programs to
    bolster mental and behavioral health workforce capacity,
    including Liability Protections for Health Professional
    Volunteers, Mental and Behavioral Health Education and Training
    Grants (including updates to the education reference for
    occupational therapist), the Training Demonstration Program,
    and expansion of the Integration Incentive Grants and
    Cooperative Agreements to increase uptake of the collaborate
    care model.
    ---------------------------------------------------------------------------
        \25\Health Resources and Services Administration, Behavioral Health
    Workforce Projections, 2017-2030 (bhw.hrsa.gov/sites/default/files/
    bureau-health-workforce/data-research/bh-workforce-projections-fact-
    sheet.pdf) (accessed June 7, 2022).
        \26\U.S. News and World Report, Many States Face Shortage of Mental
    Health Providers (June 10, 2021) (www.usnews.com/news/best-states/
    articles/2021-06-10/northeastern-states-have-fewest-mental-health-
    provider-shortages).
    ---------------------------------------------------------------------------
        Even with access to mental health and substance use
    disorder prevention, treatment, and care, consumers with health
    care coverage face numerous challenges accessing mental health
    and substance disorder benefits provided by their health
    insurance plans.\27\ The Paul Wellstone and Pete Domenici
    Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)
    requires parity between mental health and substance use
    disorder benefits and medical/surgical benefits of health
    plans.\28\ The MHPAEA prohibits coverage requirements for
    mental health and substance disorder benefits from being more
    restrictive than those for medical/surgical benefits, and
    prevents health insurance plans that provide mental health or
    substance use disorder benefits from imposing less favorable
    financial requirements and treatment limitations on those
    benefits than on medical/surgical benefits. However, some
    health insurance plans fail to comply with parity requirements
    of the MHPAEA, and as a result, consumers face more coverage
    limitations for behavioral health services than for medical/
    surgical benefits.\29\ A recent report by the Departments of
    HHS, Treasury, and Labor found that some health plans and
    health insurance issuers are failing to deliver parity for
    mental health and substance use disorder benefits to those they
    cover.\30\ H.R. 7666 authorizes funding to assist States to
    enforce and ensure compliance with mental health parity, and
    requires self-funded, non-federal governmental plans to comply
    with mental health parity requirements.
    ---------------------------------------------------------------------------
        \27\Government Accountability Office, Mental Health Care: Consumers
    with Coverage Face Access Challenges (Mar. 30, 2022).
        \28\Pub. L. 110-343.
        \29\Id; Department of Treasury, Realizing Parity, Reducing Stigma,
    and Raising Awareness: Increasing Access to Mental Health and Substance
    Use Disorder Coverage (2022) www.dol.gov/sites/dolgov/files/EBSA/laws-
    and-regulations/laws/mental-health-parity/report-to-congress-2022-
    realizing-parity-reducing-stigma-and-raising-awareness.pdf (Report to
    Congress).
        \30\Id.
    ---------------------------------------------------------------------------
        It is estimated that more than 2 million people in the
    United States have an opioid use disorder (OUD), a chronic
    brain disease caused by prolonged use of opioids, such as
    fentanyl, oxycodone, and heroin.\31\ There are three FDA-
    approved medications used to treat OUD, methadone,
    buprenorphine, and extended-release naltrexone; these
    medications reduce cravings and reduce the risk future use,
    which greatly reduces the risk of fatal overdose.\32\ However,
    access to these medications is not widely available to those
    who may benefit the most, and there are disparities in access
    across different populations.\33\ The bill includes provisions
    that reduce regulatory barriers, enhance provider education,
    and increase access to medication-assisted treatment for OUD.
    ---------------------------------------------------------------------------
        \31\National Academy of Sciences, Engineering, and Science (NASEM),
    Consensus Study Report: Medications for Opioid Use Disorder Save Lives
    (2019) (https://bit.ly/2NJnNXQ).
        \32\
        \33\Id.
    ---------------------------------------------------------------------------
        Scientific literature shows that regulatory and
    administrative burdens create barriers to accessing treatment
    for OUD. For example, methadone is only accessible through
    specialty treatment facilities known as opioid treatment
    programs (OTPs). OTPs are strictly regulated by the Drug
    Enforcement Administration (DEA) and SAMHSA.\34\ Limits to how,
    where, and when patients can access OUD treatment limits uptake
    of life-saving medications.\35\ During the public health
    emergency declared to respond to the COVID-19 pandemic,
    regulatory flexibilities were provided to OTPs and
    practitioners seeking to dispense medications to treat OUD. In
    2020, SAMHSA implemented regulatory flexibilities for take-
    home-methadone doses; preliminary studies show that methadone
    uptake among patients with OUD nearly doubled and was not
    associated with negative health outcomes, such as increased
    fatal drug overdoses.36,37 Provisions in this bill
    allow OTPs to operate mobile medication units to dispense
    methadone without a separate DEA registration; eliminate the
    requirement that patients have OUD for one year before becoming
    eligible for admission into an OTP; direct SAMHSA to study the
    regulatory flexibilities exercised during the COVID-19 pandemic
    and submit a report to Congress with their findings; and
    requires SAMHSA to develop criteria and update regulations for
    OTPs to dispense take-home methadone doses.
    ---------------------------------------------------------------------------
        \34\42 CFR 8.12.
        \35\Id.
        \36\Substance Abuse and Mental Health Services Administration,
    SAMHSA Extends the Methadone Take-Home Flexibility for One Year While
    Working Toward a Permanent Solution (2021) (www.samhsa.gov/newsroom/
    press-announcements/202111181000).
        \37\American Journal of Drug and Alcohol Abuse, The impact of
    relaxation of methadone take-home protocols on treatment outcomes in
    the COVID-19 era (Nov. 2021) (pubmed.ncbi.nlm.nih.gov/34670453/).
    ---------------------------------------------------------------------------
        Buprenorphine can be prescribed in office-based settings by
    providers who apply for a special DEA waiver, known as the ``X
    Waiver.''\38\ It is estimated that one in ten medical providers
    hold these waivers and many do not prescribe at the allotted
    cap due to perceptions of regulatory complexity.\39\ Further,
    studies show that lack of provider education about medication-
    assisted treatment for OUD compounds stigma and leads to
    reduced patient access.\40\ Integrating OUD treatment education
    into mainstream health systems and reducing regulatory barriers
    is likely to increase provider knowledge and patient
    access.\41\ During the COVID-19 pandemic, SAMHSA has also
    allowed practitioners to treat up to 30 patients with
    buprenorphine for OUD without a separate DEA registration,
    citing it as an important first step in decreasing barriers to
    treatment.\42\
    ---------------------------------------------------------------------------
        \38\End Substance Use Disorder, Federal barriers to prescribing
    buprenorphine (the X-Waiver) (www.endsud.org/mat-act-federal-barriers/
    #mat-act).
        \39\Id.
        \40\National Academy of Sciences, Engineering, and Science,
    Consensus Study Report: Medications for Opioid Use Disorder Save Lives
    (2019) (https://nap.nationalacademies.org/catalog/25310/medications-
    for-opioid-use-disorder-save-lives).
        \41\Id.
        \42\Substance Abuse and Mental Health Services Administration, FAQs
    About the New Buprenorphine Practice Guidelines (2021) (www.samhsa.gov/
    medication-assisted-treatment/become-buprenorphine-waivered-
    practitioner/new-practice-guidelines-faqs).
    ---------------------------------------------------------------------------
        The legislation eliminates the requirement for health
    practitioners to apply for the ``X-waiver'' in order to
    prescribe buprenorphine. It further requires health
    practitioners to meet a one-time, eight-hour training
    requirement on treating and identifying patients with substance
    use disorders as a condition of receiving or renewing a DEA
    registration to dispense controlled substances.

                            III. Committee Hearings

        For the purposes of section 3(c) of rule XIII of the Rules
    of the House of Representatives, the following hearing was used
    to develop or consider H.R. 7666:
        The Subcommittee on Health held a legislative hearing on
    April 5, 2022, entitled ``Communities in Need: Legislation to
    Support Mental Health and Well-Being.'' The Subcommittee
    received testimony from the following witnesses:
        Panel I:
               Miriam E. Delphin-Rittmon, Ph.D., Assistant
            Secretary for Mental Health and Substance Use,
            Substance Abuse and Mental Health Services
            Administration; and
               Carole Johnson, M.A., Administrator, Health
            Resources and Services Administration.
        Panel II:
               Rebecca W. Brendel, M.D., J.D., President-
            Elect, American Psychiatric Association;
               Sandy L. Chung, M.D., F.A.A.P., F.A.C.H.E.,
            President-Elect, American Academy of Pediatrics;
               Steven Adelsheim, M.D., Clinical Professor
            of Psychiatry and Director, Stanford Center for Youth
            Mental Health and Wellbeing, Stanford University School
            of Medicine, Stanford Children's Health;
               Debra Pinals, M.D., Medical Director,
            Behavioral Health and Forensic Programs, Michigan
            Department of Health and Human Services, On behalf of
            the National Association of State Mental Health Program
            Directors;
               Cassandra Price, M.B.A., Director, Office of
            Addictive Diseases, Georgia Department of Behavioral
            Health and Developmental Disabilities, On behalf of the
            National Association of State Alcohol and Drug Abuse
            Directors; and
               LeVail W. Smith, C.P.S.S., Peer Support
            Specialist Instructor and Mentor.

                          IV. Committee Consideration

        H.R. 7666, the ``Restoring Hope for Mental Health and Well-
    Being Act of 2022,'' was introduced on May 6, 2022, by
    Representatives Pallone (D-NJ) and Rodgers (R-WA) and referred
    to the Committee on Energy and Commerce. Subsequently, on May
    9, 2022, the bill was referred to the Subcommittee on Health.
        On May 11, 2022, the Subcommittee on Health met in open
    markup session, pursuant to notice, to consider H.R. 7666 and
    five other bills. During consideration of the bill, no
    amendments were offered. Upon conclusion of consideration of
    the bill, the Subcommittee on Health agreed to report the bill
    favorably to the full Committee, without amendment, by a roll
    call vote of 32 yeas to zero nays.
        On May 18, 2022, the full Committee met in open markup
    session, pursuant to notice, to consider H.R. 7666 and five
    other bills. An amendment in the nature of a substitute (AINS),
    offered by Representative Pallone, was agreed to by a voice
    vote. An amendment to the AINS, offered by Representative Tonko
    (D-NY), was agreed to by a roll call vote of 45 yeas to 10
    nays. An amendment to the Tonko amendment to the AINS, offered
    by Representative Burgess (R-TX), was withdrawn. An amendment
    to the AINS, offered by Representative Trahan (D-MA), was
    agreed to by a roll call vote of 46 yeas to 8 nays. An
    amendment to the AINS, offered by Representative Upton (R-MI),
    was agreed to by a roll call vote of 55 yeas to one nay. An
    amendment to the AINS, offered by Representative Cardenas (D-
    CA), was agreed to by a roll call vote of 31 yeas to 24 nays.
    An amendment to the bill, offered by Representative Curtis (R-
    UT), was withdrawn. Upon conclusion of consideration of the
    bill, the full Committee agreed to a motion on final passage
    offered by Representative Pallone, Chairman of the Committee,
    to order H.R. 7666 reported favorably to the House, amended, by
    a voice vote.

                               V. Committee Votes

        Clause 3(b) of rule XIII of the Rules of the House of
    Representatives requires the Committee to list each record vote
    on the motion to report legislation and amendments thereto. The
    Committee advises that there were five record votes taken on
    H.R. 7666. The motion on final passage of the bill ordering
    H.R. 7666 favorably reported to the House, amended, was
    approved by a voice vote. The following are the record votes
    taken during Committee consideration, including the names of
    those members voting for and against:

    	[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                             VI. Oversight Findings

        Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1)
    of rule X of the Rules of the House of Representatives, the
    oversight findings and recommendations of the Committee are
    reflected in the descriptive portion of the report.

     VII. New Budget Authority, Entitlement Authority, and Tax Expenditures

        Pursuant to 3(c)(2) of rule XIII of the Rules of the House
    of Representatives, the Committee adopts as its own the
    estimate of new budget authority, entitlement authority, or tax
    expenditures or revenues contained in the cost estimate
    prepared by the Director of the Congressional Budget Office
    pursuant to section 402 of the Congressional Budget Act of
    1974.
        The Committee has requested but not received from the
    Director of the Congressional Budget Office a statement as to
    whether this bill contains any new budget authority, spending
    authority, credit authority, or an increase or decrease in
    revenues or tax expenditures.

                        VIII. Federal Mandates Statement

        The Committee adopts as its own the estimate of Federal
    mandates prepared by the Director of the Congressional Budget
    Office pursuant to section 423 of the Unfunded Mandates Reform
    Act.

           IX. Statement of General Performance Goals and Objectives

        Pursuant to clause 3(c)(4) of rule XIII, the general
    performance goal or objective of this legislation is to amend
    the Public Health Service Act to reauthorize certain programs
    relating to mental health and substance use disorders to
    support the mental health of Americans.

                       X. Duplication of Federal Programs

        Pursuant to clause 3(c)(5) of rule XIII, no provision of
    H.R. 7666 is known to be duplicative of another Federal
    program, including any program that was included in a report to
    Congress pursuant to section 21 of Public Law 111-139 or the
    most recent Catalog of Federal Domestic Assistance.

                          XI. Committee Cost Estimate

        Pursuant to clause 3(d)(1) of rule XIII, the Committee
    adopts as its own the cost estimate prepared by the Director of
    the Congressional Budget Office pursuant to section 402 of the
    Congressional Budget Act of 1974.

        XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits

        Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the
    Committee finds that H.R. 7666 contains no earmarks, limited
    tax benefits, or limited tariff benefits.

                       XIII. Advisory Committee Statement

        No advisory committee within the meaning of section 5(b) of
    the Federal Advisory Committee Act was created by this
    legislation.

                    XIV. Applicability to Legislative Branch

        The Committee finds that the legislation does not relate to
    the terms and conditions of employment or access to public
    services or accommodations within the meaning of section
    102(b)(3) of the Congressional Accountability Act.

               XV. Section-by-Section Analysis of the Legislation

    Section. 1. Short title; Table of contents

        Section 1 designates that the short title may be cited as
    the ``Restoring Hope for Mental Health and Well-Being Act of
    2022.''

                  TITLE I: MENTAL HEALTH AND CRISIS CARE NEEDS

           SUBTITLE A--CRISIS CARE SERVICES AND 9-8-8 IMPLEMENTATION

    Sec. 101. Behavioral Health Crisis Coordinating Office

        Section 101 establishes the Behavioral Health Crisis
    Coordinating Office within the Substance Abuse and Mental
    Health Services Administration (SAMHSA) to convene partners and
    provide technical assistance to enhance access to crisis care,
    authorized at $5 million annually for fiscal years 2023 through
    2027.

    Sec. 102. Crisis response continuum of care

        Section 102 requires the Secretary of HHS to publish best
    practices for a crisis response continuum of care not later
    than one year after the date of enactment for use by health
    care providers, crisis services administrators, and crisis
    services providers.

    SUBTITLE B--INTO THE LIGHT FOR MATERNAL MENTAL HEALTH AND SUBSTANCE USE
                                   DISORDERS

    Sec. 111. Screening and treatment for maternal mental health and
            substance use disorders

        Section 111 reauthorizes section 317L-1 of the Public
    Health Service Act (PHSA) to award Screening and Treatment for
    Maternal Mental Health and Substance Use Disorders grants to
    states to establish, improve, or maintain programs for
    screening, assessment, and treatment services for women who are
    postpartum, pregnant, or have given birth within the preceding
    12 months, for maternal mental health and substance use
    disorders. The grants are authorized at $24 million annually
    for fiscal years 2023 through 2027.

    Sec. 112. Maternal mental health hotline

        Section 112 establishes a national hotline to provide
    information, brief intervention, and mental health and
    substance use disorder resources to pregnant and postpartum
    women at risk of, or affected by, maternal mental health and
    substance use disorders, and authorizes $10 million annually
    for fiscal years 2023 through 2027.

    Sec. 113. Task force on maternal mental health

        Section 113 establishes a task force to make
    recommendations to coordinate and inform a national strategy to
    improve federal and state responses to maternal mental health
    conditions and requires a report to Congress and to governors
    and state leaders two years after the first meeting of the task
    force.

       SUBTITLE C--REACHING IMPROVED MENTAL HEALTH OUTCOMES FOR PATIENTS

    Sec. 121. Innovation for mental health

        Section 121 replaces the unfunded Community Crisis Response
    Systems Grants authorization with an authorization of $10
    million annually for fiscal years 2023 through 2027 for the
    establishment of a Mental Health Crisis Response Partnership
    Pilot Program.

    Sec. 122. Crisis care coordination

        Section 122 reauthorizes five additional SAMHSA programs to
    address mental health needs, provide crisis response care, and
    prevent suicide among adults for fiscal years 2023 through
    2027, including: National Mental Health and Substance Abuse
    Policy Laboratory, authorized at $10 million for each fiscal
    year; Interdepartmental Serious Mental Illness Coordinating
    Committee; Mental Health Needs Priority Regions of National
    Significance (PRNS), authorized at $599.036 million for each
    fiscal year; Mental Health Awareness Training (MHAT) Grants,
    authorized at $24.963 million for each fiscal year; and Adult
    Suicide Prevention, authorized at $30 million for each fiscal
    year.

    Sec. 123. Treatment of serious mental illness

        Section 123 reauthorizes two programs for the treatment of
    serious mental illness, the Assertive Community Treatment
    Grants, authorized at $9 million for each fiscal year for
    fiscal years 2023 through 2027 and the Assisted Outpatient
    Treatment Grant Program for Individuals with Serious Mental
    Illness, authorized at $22 million for each fiscal year for the
    same period.

                         SUBTITLE D--ANNA WESTIN LEGACY

    Sec. 131. Maintaining education and training on eating disorders

        Section 131 establishes an authorization for the SAMHSA
    National Center of Excellence for Eating Disorders at $1
    million annually for fiscal years 2023 through 2027 to award
    competitive subgrants or subcontracts for the development and
    provision of training and technical assistance to primary and
    behavioral health providers and non-clinical community support
    workers as well as collaboration and coordination with SAMHSA,
    the Centers for Disease Control and Prevention, and the Health
    Resources and Services Administration (HRSA) on the
    identification, effective treatment, and ongoing support of
    individuals with eating disorders.

           SUBTITLE E--COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT
                                REAUTHORIZATION

    Sec. 141. Reauthorization of block grants for community mental health
            services

        Section 141 reauthorizes the Community Mental Health
    Services Block Grants for states, territories, Tribes, and
    Tribal organizations to support community mental health
    services for adults with serious mental illness and children
    with serious emotional disturbance and to support the
    collection of performance and outcome data. This section also
    requires that five percent of the funds granted be used for
    crisis-care services and allows for up to five percent of funds
    for early intervention activities. This section authorizes
    $857.571 million annually for fiscal years 2023 through 2027.

               SUBTITLE F--PEER-SUPPORTED MENTAL HEALTH SERVICES

    Sec. 151. Peer-supported mental health services

        Section 151 authorizes $13 million annually for fiscal
    years 2023 through 2027 for grants to consumer-led nonprofits,
    Tribes and Tribal organizations, Urban Indian organizations, or
    Tribal consortium to provide peer-supported mental health
    services, including virtual peer support.

     TITLE II: SUBSTANCE USE DISORDER PREVENTION, TREATMENT, AND RECOVERY
                                    SERVICES

            SUBTITLE A--NATIVE BEHAVIORAL HEALTH ACCESS IMPROVEMENT

    Sec. 201. Behavioral health and substance use disorder services for
            Native Americans

        Section 201 reauthorizes the Alcohol and Drug Prevention or
    Treatment Services for Indians and Native Alaskans Grant
    Program to provide culturally appropriate mental health and
    substance use disorder prevention, treatment, and recovery
    services to American Indians, Alaska Natives, and Native
    Hawaiians. This section requires the convening of a negotiated
    rulemaking committee composed of representatives of the federal
    government, Tribal Governments, and Urban Indian Organizations
    to establish a funding formula and program evaluation
    standards. This section authorizes $40 million annually for
    fiscal years 2023 through 2027.

         SUBTITLE B--SUMMER BARROW PREVENTION, TREATMENT, AND RECOVERY

    Sec. 211. Grants for the benefit of homeless individuals

        Section 211 reauthorizes formula grants for the benefit of
    homeless individuals, administered through SAMHSA, authorized
    at $41.304 million for each fiscal year for fiscal years 2023
    through 2027.

    Sec. 212. Priority substance abuse treatment needs of regional and
            national significance

        Section 212 reauthorizes the SAMHSA Substance Use Disorder
    Treatment Programs of Regional and National Significance
    (PRNS), authorized at $521.517 million for each fiscal year for
    fiscal years 2023 through 2027.

    Sec. 213. Evidence-based prescription opioid and heroin treatment and
            interventions demonstration

        Section 213 reauthorizes the Prescription Opioid and Heroin
    Treatment and Interventions Demonstration Grants, administered
    by SAMHSA, authorized at $25 million for each fiscal year for
    fiscal years 2023 through 2027.

    Sec. 214. Priority substance use disorder prevention needs of regional
            and national significance

        Section 214 reauthorizes the SAMHSA Substance Use Disorder
    Prevention PRNS, authorized at $218.219 million for each fiscal
    year for fiscal years 2023 through 2027.

    Sec. 215. Sober Truth on Preventing (STOP) Underage Drinking
            Reauthorization

        Section 215 reauthorizes programs to reduce underage
    drinking, including requiring an annual report, a national
    media campaign, extending Community-based Coalition Enhancement
    Grants to Prevent Underage Drinking, Pediatric Provider
    Screening and Brief Intervention Grants, and data collection
    and research, collectively authorized at $23 million for each
    fiscal year for fiscal years 2023 through 2027. This section
    also requires a National Academy of Sciences review and report
    to Congress authorized at $500,000 for fiscal year 2023.

    Sec. 216. Grants for jail diversion programs

        Section 216 reauthorizes the SAMHSA Jail Diversion Program
    and Grants, authorized at $14 million each fiscal year for
    fiscal years 2023 through 2027.

    Sec. 217. Formula grants to States

        Section 217 authorizes formula grants to states from fiscal
    years 2023 through 2027.

    Sec. 218. Projects for Assistance in Transition From Homelessness

        Section 218 reauthorizes SAMHSA's Projects for Assistance
    in Transition from Homelessness Program, authorized at $64.635
    million each fiscal year for fiscal years 2023 through 2027.

    Sec. 219. Grants for reducing overdose deaths

        Section 219 reauthorizes SAMHSA grants for reducing
    overdose deaths, including supporting the development of
    strategic opioid crisis response plans, authorized at $5
    million each fiscal year for fiscal years 2023 through 2027.

    Sec. 220. Opioid overdose reversal medication access and education
            grant programs

        Section 220 reauthorizes Opioid Overdose Reversal
    Medication Access, Education, and Co-prescribing Grants,
    requiring health care practitioners to prescribe an opioid
    reversal drug when prescribing an opioid for certain patients,
    authorized at $5 million each fiscal year for fiscal years 2023
    through 2027.

    Sec. 221. State demonstration grants for comprehensive opioid abuse
            response

        Section 221 reauthorizes SAMHSA grants for State and Local
    Integrated Comprehensive Opioid Use Disorder Response,
    authorized at $5 million each fiscal year for fiscal years 2023
    through 2027.

    Sec. 222. Emergency department alternatives to opioids

        Section 222 reauthorizes Emergency Department Alternatives
    to Opioids Demonstration Grants, authorized at $10 million each
    fiscal year for fiscal years 2023 through 2027.

                   SUBTITLE C--EXCELLENCE IN RECOVERY HOUSING

    Sec. 231. Clarifying the role of SAMHSA in promoting the availability
            of high-quality recovery housing

        Section 231 requires the Secretary, acting through the
    SAMHSA Assistant Secretary, to collaborate with federal
    agencies and relevant stakeholders to promote the availability
    of high-quality recovery housing and services for individuals
    with substance use disorder.

    Sec. 232. Developing guidelines for States to promote the availability
            of high-quality recovery housing

        Section 232 requires the Secretary to develop and
    periodically update consensus based best practices for
    operating, and promoting the availability of, high-quality
    recovery housing.

    Sec. 233. Coordination of Federal activities to promote the
            availability of recovery housing

        Section 233 requires the Secretary, acting through the
    SAMHSA Assistant Secretary, and the Secretary of Housing and
    Urban Development, to convene an interagency working group and
    report to Congress on its activities to increase federal
    collaboration and coordination, develop a long-term plan to
    support state, Tribal, and local efforts to operate recovery
    housing consistent with best practices, and coordinate fair
    housing practices and data collection on the quality of
    recovery housing.

    Sec. 234. NAS study and report

        Section 234 requires the Secretary, acting through the
    Assistant Secretary for Mental Health and Substance Use, to
    contract with the National Academy of Sciences, Engineering,
    and Medicine to study the quality and effectiveness of recovery
    housing in the United States and identify recommendations, and
    to report to Congress the results of the review. This section
    authorizes $1.5 million for fiscal year 2023.

    Sec. 235. Grants for States to promote the availability of recovery
            housing and services

        Section 235 permits SAMHSA to provide grants to states,
    Tribes, and territories for technical assistance to promote and
    maintain recovery housing according to best practices and to
    develop related state promotion plans.

    Sec. 236. Funding

        Section 236 reauthorizes $5 million for the period of
    fiscal years 2023 through 2027 for the activities described in
    sections 231 through 235.

    Sec. 237. Technical correction

        Section 237 makes technical conforming corrections to the
    Public Health Services Act (PHSA).

    SUBTITLE D--SUBSTANCE USE PREVENTION, TREATMENT, AND RECOVERY SERVICES
                                  BLOCK GRANT

    Sec. 241. Eliminating stigmatizing language relating to substance use

        Section 241 renames SAMHSA's Substance Abuse Prevention and
    Treatment Block Grant as the ``Substance Use Prevention,
    Treatment, and Recovery Services Block Grant,'' and replaces
    ``substance abuse'' with ``substance use'' throughout the
    program.

    Sec. 242. Authorized activities

        Section 242 is expanded to specify that providing recovery
    support services is an authorized activity under the block
    grant use of funds.

    Sec. 243. Requirements relating to certain infectious diseases and
            human immunodeficiency virus

        Section 243 updates the basis by which states are
    designated as required to provide HIV related services based on
    HIV case rate rather than AIDS case rate effective fiscal year
    2025. This section also requires states receiving block grant
    funds to provide viral hepatitis screening and referrals to
    providers whose practice includes viral hepatitis vaccination
    and treatment.

    Sec. 244. State plan requirements

        Section 233 requires that states' plans describe the
    recovery support service activities supported by block grant
    funds, including the number of individuals served, target
    populations, priority needs, and the amount of funds allocated
    to recovery support service disaggregated by type of activity.

    Sec. 245. Updating certain language relating to Tribes

        Section 245 updates statutory language to recognize Tribes
    and Tribal organizations as proper nouns.

    Sec. 246. Block grants for substance use prevention, treatment, and
            recovery services

        Section 246 authorizes the Substance Use Prevention,
    Treatment, and Recovery Services Block Grants at $1.908 billion
    annually for fiscal years 2023 through 2027. The section also
    makes a technical correction to the PHSA.

    Sec. 247. Requirement of reports and audits by States

        Section 247 requires states' report to include the amount
    of funds provided to each grant recipient the previous fiscal
    year.

    Sec. 248. Study on assessment for use in distribution of limited State
            resources

        Section 248 requires the Secretary to conduct a study to
    develop a model needs assessment process for states.

              SUBTITLE E--TIMELY TREATMENT FOR OPIOID USE DISORDER

    Sec. 251. Study on exemptions for treatment of opioid use disorder
            through opioid treatment programs during the COVID-19 public
            health emergency

        Section 251 requires the Assistant Secretary for Mental
    Health and Substance Use to conduct a study and report within
    180 days on the impact of treatment flexibilities allowed
    during the pandemic on an OTP's effectiveness and safety.

    Sec. 252. Changes to Federal opioid treatment standards

        Section 252 changes the federal opioid treatment standards
    to allow an OTP to operate one or more mobile units to dispense
    medications at locations other than the registrant's principal
    place of business or professional practice under the same
    registration. Previously, each mobile unit had to be separately
    registered. This section eliminates the requirement that an
    individual be addicted to opioids for at least one year before
    being admitted for treatment by an OTP. This section also
    requires the Secretary to establish criteria for OTP to allow
    certain patients to receive take home medications.

       SUBTITLE F--ADDITIONAL PROVISIONS RELATING TO ADDICTION TREATMENT

    Sec. 261. Prohibition

        Section 261 prohibits funds authorized or amended by this
    Act from being used to purchase, procure, or distribute pipes
    or cylindrical objects intended to be used to smoke or inhale
    illegal schedule substances.

    Sec. 262. Eliminating additional requirements for dispensing narcotic
            drugs in schedule III, IV, and V for maintenance or
            detoxification treatment

        Section 262 eliminates the requirement for registered
    health care practitioners to apply for a separate waiver
    through the Drug Enforcement Administration to dispense certain
    narcotic drugs (e.g., buprenorphine) for maintenance or
    detoxification treatment.

    Sec. 263. Requiring prescribers of controlled substances to complete
            training

        Section 263 requires health care providers, as a condition
    of receiving or renewing a registration to prescribe controlled
    substances, to meet a one-time eight-hour training requirement
    on treating patients with substance use disorders.

              TITLE III: ACCESS TO MENTAL HEALTH CARE AND COVERAGE

           SUBTITLE A--COLLABORATE IN AN ORDERLY AND COHESIVE MANNER

    Sec. 301. Increasing uptake of the collaborative care model

        Section 301 reauthorizes a program that allows HHS to award
    grants to states that partner with a community program, a
    health center, a Federally Qualified Health Center or rural
    health clinic, or a primary health care physician practice to
    implement and evaluate specified models of care that integrate
    behavioral health and primary care services. Recipients who
    provide care to medically underserved populations and in areas
    where the prevalence of behavioral health conditions exceeds
    the national average are given priority for these grants. This
    section establishes incentive payments for recipients that use
    appropriate billing codes and quality measures for behavioral
    health services as well as grants for national and regional
    organizations that provide technical assistance to improve
    integration. This section authorizes $60 million annually for
    fiscal years 2023 through 2027.

            SUBTITLE B--HELPING ENABLE ACCESS TO LIFESAVING SERVICES

    Sec. 311. Reauthorization and provision of certain programs to
            strengthen the health care workforce

        Section 311 reauthorizes multiple programs to support and
    strengthen the health care workforce, including Liability
    Protections for Health Professional Volunteers, reauthorized
    through October 1, 2027; Mental and Behavioral Health Education
    and Training Grants including updates to the education
    reference for occupational therapist, reauthorized at $50
    million for fiscal years 2023 through 2027; and the Training
    Demonstration Program, reauthorized at $37.1 million annually
    for fiscal years 2023 through 2027. This section updates the
    Minority Fellowship Program to include those ``in the fields of
    crisis care management.''

    SUBTITLE C--ELIMINATING THE OPT-OUT FOR NONFEDERAL GOVERNMENTAL HEALTH
                                     PLANS

    Sec. 321. Eliminating the opt-out for nonfederal governmental health
            plans

        Section 321 requires self-funded, non-federal governmental
    plans to comply with mental health parity requirements starting
    six months after the date of enactment or longer contingent on
    the terms of the plan agreement.

          SUBTITLE D--MENTAL HEALTH AND SUBSTANCE USE DISORDER PARITY
                                 IMPLEMENTATION

    Sec. 331. Grants to support mental health and substance use disorder
            parity implementation

        Section 331 authorizes $10 million annually for fiscal
    years 2023 through 2027 for grants to states to enforce and
    ensure compliance with mental health parity.

                          TITLE IV: CHILDREN AND YOUTH

          SUBTITLE A--SUPPORTING CHILDREN'S MENTAL HEALTH CARE ACCESS

    Sec. 401. Pediatric mental health care access grants

        Section 401 reauthorizes HRSA's Pediatric Mental Health
    Care Access grant program that promotes behavioral health
    integration into pediatric primary care by supporting pediatric
    mental health care telehealth access programs in states at $14
    million annually for fiscal years 2023 through 2025 and $30
    million annually for fiscal years 2026 through 2027.

    Sec. 402. Infant and early childhood mental health promotion,
            intervention, and treatment

        Section 402 reauthorizes SAMHSA's Infant and Early
    Childhood Mental Health Grant Program, which is intended to
    improve outcomes for children from birth to age 12 by
    developing, maintaining, or enhancing mental health promotion,
    intervention, and treatment services at $50 million for the
    period of fiscal years 2023 through 2027.

              SUBTITLE B--CONTINUING SYSTEMS OF CARE FOR CHILDREN

    Sec. 411. Comprehensive Community Mental Health Services for Children
            with Serious Emotional Disturbances

        Section 411 reauthorizes the Comprehensive Community Mental
    Health Services for Children with Serious Emotional
    Disturbances Grants, maintaining the existing program structure
    with the exception of redefining ``parents or kinship
    caregivers,'' authorized at $125 million annually for fiscal
    years 2023 through 2027.

    Sec. 412. Substance Use Disorder Treatment and Early Intervention
            Services for Children and Adolescents

        Section 412 reauthorizes the Enhancement and Expansion of
    Treatment and Recovery Services for Adolescents, Transitional
    Aged Youth, and their Families (Youth and Family TREE) Grants
    at $29.605 million annually for fiscal years 2023 through 2027.

             SUBTITLE C--GARRETT LEE SMITH MEMORIAL REAUTHORIZATION

    Sec. 421. Suicide prevention technical assistance center

        Section 421 reauthorizes the Suicide Prevention Resource
    Center at $9 million annually for fiscal years 2023 through
    2027.

    Sec. 422. Youth suicide early intervention and prevention strategies

        Section 422 reauthorizes the State and Tribal Youth Suicide
    Prevention and Early Intervention Grants Program at $40 million
    annually for fiscal years 2023 through 2027 and provides the
    allowable use of funds for supplies to securely store commonly
    used means of suicide within a household.

    Sec. 423. Mental health and substance use disorder services for
            students in higher education

        Section 423 reauthorizes the Mental Health Youth Suicide
    Prevention Campus Grants at $7 million for each fiscal year for
    fiscal years 2023 through 2027.

    Sec. 424. Mental and behavioral health outreach and education at
            institutions of higher education

        Section 424 reauthorizes and renames the Mental and
    Behavioral Health Public Outreach and Education at Institutions
    of Higher Education program at $1 million for fiscal years 2023
    through 2027 and specifies that representatives from minority-
    serving institutions and community colleges be included on the
    program's working group.

           XVI. Changes in Existing Law Made by the Bill, as Reported

      In compliance with clause 3(e) of rule XIII of the Rules of
    the House of Representatives, changes in existing law made by
    the bill, as reported, are shown as follows (existing law
    proposed to be omitted is enclosed in black brackets, new
    matter is printed in italics, and existing law in which no
    change is proposed is shown in roman):

                           PUBLIC HEALTH SERVICE ACT

               *       *       *       *       *       *       *
             TITLE II--ADMINISTRATION AND MISCELLANEOUS PROVISIONS

    Part A--Administration

               *       *       *       *       *       *       *

              defense of certain malpractice and negligence suits

      Sec. 224. (a) The remedy against the United States provided
    by sections 1346(b) and 2672 of title 28, or by alternative
    benefits provided by the United States where the availability
    of such benefits precludes a remedy under section 1346(b) of
    title 28, for damage for personal injury, including death,
    resulting from the performance of medical, surgical, dental, or
    related functions, including the conduct of clinical studies or
    investigation, by any commissioned officer or employee of the
    Public Health Service while acting within the scope of his
    office or employment, shall be exclusive of any other civil
    action or proceeding by reason of the same subject-matter
    against the officer or employee (or his estate) whose act or
    omission gave rise to the claim.
      (b) The Attorney General shall defend any civil action or
    proceeding brought in any court against any person referred to
    in subsection (a) of this section (or his estate) for any such
    damage or injury. Any such person against whom such civil
    action or proceeding is brought shall deliver within such time
    after date of service or knowledge of service as determined by
    the Attorney General, all process served upon him or an
    attested true copy thereof to his immediate superior or to
    whomever was designated by the Secretary to receive such papers
    and such persons shall promptly furnish copies of the pleading
    and process therein to the United States attorney for the
    district embracing the place wherein the proceeding is brought,
    to the Attorney General, and to the Secretary.
      (c) Upon a certification by the Attorney General that the
    defendant was acting in the scope of his employment at the time
    of the incident out of which the suit arose, any such civil
    action or proceeding commenced in a State court shall be
    removed without bond at any time before trial by the Attorney
    General to the district court of the United States of the
    district and division embracing the place wherein it is pending
    and the proceeding deemed a tort action brought against the
    United States under the provisions of title 28 and all
    references thereto. Should a United States district court
    determine on a hearing on a motion to remand held before a
    trial on the merit that the case so removed is one in which a
    remedy by suit within the meaning of subsection (a) of this
    section is not available against the United States, the case
    shall be remanded to the State Court: Provided, That where such
    a remedy is precluded because of the availability of a remedy
    through proceedings for compensation or other benefits from the
    United States as provided by any other law, the case shall be
    dismissed, but in the event the running of any limitation of
    time for commencing, or filing an application or claim in, such
    proceedings for compensation or other benefits shall be deemed
    to have been suspended during the pendency of the civil action
    or proceeding under this section.
      (d) The Attorney General may compromise or settle any claim
    asserted in such civil action or proceeding in the manner
    provided in section 2677 of title 28 and with the same effect.
      (e) For purposes of this section, the provisions of section
    2680(h) of title 28 shall not apply to assault or battery
    arising out of negligence in the performance of medical,
    surgical, dental, or related functions, including the conduct
    of clinical studies or investigations.
      (f) The Secretary or his designee may, to the extent that he
    deems appropriate, hold harmless or provide liability insurance
    for any officer or employee of the Public Health Service for
    damage for personal injury, including death, negligently caused
    by such officer or employee while acting within the scope of
    his office or employment and as a result of the performance of
    medical, surgical, dental, or related functions, including the
    conduct of clinical studies or investigations, if such employee
    is assigned to a foreign country or detailed to a State or
    political subdivision thereof or to a non-profit institution,
    and if the circumstances are such as are likely to preclude the
    remedies of third persons against the United States described
    in section 2679(b) of title 28, for such damage or injury.
      (g)(1)(A) For purposes of this section and subject to the
    approval by the Secretary of an application under subparagraph
    (D), an entity described in paragraph (4), and any officer,
    governing board member, or employee of such an entity, and any
    contractor of such an entity who is a physician or other
    licensed or certified health care practitioner (subject to
    paragraph (5)), shall be deemed to be an employee of the Public
    Health Service for a calendar year that begins during a fiscal
    year for which a transfer was made under subsection (k)(3)
    (subject to paragraph (3)). The remedy against the United
    States for an entity described in paragraph (4) and any
    officer, governing board member, employee, or contractor
    (subject to paragraph (5)) of such an entity who is deemed to
    be an employee of the Public Health Service pursuant to this
    paragraph shall be exclusive of any other civil action or
    proceeding to the same extent as the remedy against the United
    States is exclusive pursuant to subsection (a).
      (B) The deeming of any entity or officer, governing board
    member, employee, or contractor of the entity to be an employee
    of the Public Health Service for purposes of this section shall
    apply with respect to services provided--
              (i) to all patients of the entity, and
              (ii) subject to subparagraph (C), to individuals who
            are not patients of the entity.
      (C) Subparagraph (B)(ii) applies to services provided to
    individuals who are not patients of an entity if the Secretary
    determines, after reviewing an application submitted under
    subparagraph (D), that the provision of the services to such
    individuals--
              (i) benefits patients of the entity and general
            populations that could be served by the entity through
            community-wide intervention efforts within the
            communities served by such entity;
              (ii) facilitates the provision of services to
            patients of the entity; or
              (iii) are otherwise required under an employment
            contract (or similar arrangement) between the entity
            and an officer, governing board member, employee, or
            contractor of the entity.
      (D) The Secretary may not under subparagraph (A) deem an
    entity or an officer, governing board member, employee, or
    contractor of the entity to be an employee of the Public Health
    Service for purposes of this section, and may not apply such
    deeming to services described in subparagraph (B)(ii), unless
    the entity has submitted an application for such deeming to the
    Secretary in such form and such manner as the Secretary shall
    prescribe. The application shall contain detailed information,
    along with supporting documentation, to verify that the entity,
    and the officer, governing board member, employee, or
    contractor of the entity, as the case may be, meets the
    requirements of subparagraphs (B) and (C) of this paragraph and
    that the entity meets the requirements of paragraphs (1)
    through (4) of subsection (h).
      (E) The Secretary shall make a determination of whether an
    entity or an officer, governing board member, employee, or
    contractor of the entity is deemed to be an employee of the
    Public Health Service for purposes of this section within 30
    days after the receipt of an application under subparagraph
    (D). The determination of the Secretary that an entity or an
    officer, governing board member, employee, or contractor of the
    entity is deemed to be an employee of the Public Health Service
    for purposes of this section shall apply for the period
    specified by the Secretary under subparagraph (A).
      (F) Once the Secretary makes a determination that an entity
    or an officer, governing board member, employee, or contractor
    of an entity is deemed to be an employee of the Public Health
    Service for purposes of this section, the determination shall
    be final and binding upon the Secretary and the Attorney
    General and other parties to any civil action or proceeding.
    Except as provided in subsection (i), the Secretary and the
    Attorney General may not determine that the provision of
    services which are the subject of such a determination are not
    covered under this section.
      (G) In the case of an entity described in paragraph (4) that
    has not submitted an application under subparagraph (D):
              (i) The Secretary may not consider the entity in
            making estimates under subsection (k)(1).
              (ii) This section does not affect any authority of
            the entity to purchase medical malpractice liability
            insurance coverage with Federal funds provided to the
            entity under section 329, 330, or 340A.
      (H) In the case of an entity described in paragraph (4) for
    which an application under subparagraph (D) is in effect, the
    entity may, through notifying the Secretary in writing, elect
    to terminate the applicability of this subsection to the
    entity. With respect to such election by the entity:
              (i) The election is effective upon the expiration of
            the 30-day period beginning on the date on which the
            entity submits such notification.
              (ii) Upon taking effect, the election terminates the
            applicability of this subsection to the entity and each
            officer, governing board member, employee, and
            contractor of the entity.
              (iii) Upon the effective date for the election,
            clauses (i) and (ii) of subparagraph (G) apply to the
            entity to the same extent and in the same manner as
            such clauses apply to an entity that has not submitted
            an application under subparagraph (D).
              (iv) If after making the election the entity submits
            an application under subparagraph (D), the election
            does not preclude the Secretary from approving the
            application (and thereby restoring the applicability of
            this subsection to the entity and each officer,
            governing board member, employee, and contractor of the
            entity, subject to the provisions of this subsection
            and the subsequent provisions of this section.
      (2) If, with respect to an entity or person deemed to be an
    employee for purposes of paragraph (1), a cause of action is
    instituted against the United States pursuant to this section,
    any claim of the entity or person for benefits under an
    insurance policy with respect to medical malpractice relating
    to such cause of action shall be subrogated to the United
    States.
      (3) This subsection shall apply with respect to a cause of
    action arising from an act or omission which occurs on or after
    January 1, 1993.
      (4) An entity described in this paragraph is a public or non-
    profit private entity receiving Federal funds under section
    330.
      (5) For purposes of paragraph (1), an individual may be
    considered a contractor of an entity described in paragraph (4)
    only if--
              (A) the individual normally performs on average at
            least 32\1/2\ hours of service per week for the entity
            for the period of the contract; or
              (B) in the case of an individual who normally
            performs an average of less than 32\1/2\ hours of
            services per week for the entity for the period of the
            contract, the individual is a licensed or certified
            provider of services in the fields of family practice,
            general internal medicine, general pediatrics, or
            obstetrics and gynecology.
      (h) The Secretary may not approve an application under
    subsection (g)(1)(D) unless the Secretary determines that the
    entity--
              (1) has implemented appropriate policies and
            procedures to reduce the risk of malpractice and the
            risk of lawsuits arising out of any health or health-
            related functions performed by the entity;
              (2) has reviewed and verified the professional
            credentials, references, claims history, fitness,
            professional review organization findings, and license
            status of its physicians and other licensed or
            certified health care practitioners, and, where
            necessary, has obtained the permission from these
            individuals to gain access to this information;
              (3) has no history of claims having been filed
            against the United States as a result of the
            application of this section to the entity or its
            officers, employees, or contractors as provided for
            under this section, or, if such a history exists, has
            fully cooperated with the Attorney General in defending
            against any such claims and either has taken, or will
            take, any necessary corrective steps to assure against
            such claims in the future; and
              (4) will fully cooperate with the Attorney General in
            providing information relating to an estimate described
            under subsection (k).
      (i)(1) Notwithstanding subsection (g)(1), the Attorney
    General, in consultation with the Secretary, may on the record
    determine, after notice and opportunity for a full and fair
    hearing, that an individual physician or other licensed or
    certified health care practitioner who is an officer, employee,
    or contractor of an entity described in subsection (g)(4) shall
    not be deemed to be an employee of the Public Health Service
    for purposes of this section, if treating such individual as
    such an employee would expose the Government to an unreasonably
    high degree of risk of loss because such individual--
              (A) does not comply with the policies and procedures
            that the entity has implemented pursuant to subsection
            (h)(1);
              (B) has a history of claims filed against him or her
            as provided for under this section that is outside the
            norm for licensed or certified health care
            practitioners within the same specialty;
              (C) refused to reasonably cooperate with the Attorney
            General in defending against any such claim;
              (D) provided false information relevant to the
            individual's performance of his or her duties to the
            Secretary, the Attorney General, or an applicant for or
            recipient of funds under this Act; or
              (E) was the subject of disciplinary action taken by a
            State medical licensing authority or a State or
            national professional society.
      (2) A final determination by the Attorney General under this
    subsection that an individual physician or other licensed or
    certified health care professional shall not be deemed to be an
    employee of the Public Health Service shall be effective upon
    receipt by the entity employing such individual of notice of
    such determination, and shall apply only to acts or omissions
    occurring after the date such notice is received.
      (j) In the case of a health care provider who is an officer,
    employee, or contractor of an entity described in subsection
    (g)(4), section 335(e) shall apply with respect to the provider
    to the same extent and in the same manner as such section
    applies to any member of the National Health Service Corps.
      (k)(1)(A) For each fiscal year, the Attorney General, in
    consultation with the Secretary, shall estimate by the
    beginning of the year the amount of all claims which are
    expected to arise under this section (together with related
    fees and expenses of witnesses) for which payment is expected
    to be made in accordance with section 1346 and chapter 171 of
    title 28, United States Code, from the acts or omissions,
    during the calendar year that begins during that fiscal year,
    of entities described in subsection (g)(4) and of officers,
    employees, or contractors (subject to subsection (g)(5)) of
    such entities.
      (B) The estimate under subparagraph (A) shall take into
    account--
              (i) the value and frequency of all claims for damage
            for personal injury, including death, resulting from
            the performance of medical, surgical, dental, or
            related functions by entities described in subsection
            (g)(4) or by officers, employees, or contractors
            (subject to subsection (g)(5)) of such entities who are
            deemed to be employees of the Public Health Service
            under subsection (g)(1) that, during the preceding 5-
            year period, are filed under this section or, with
            respect to years occurring before this subsection takes
            effect, are filed against persons other than the United
            States,
              (ii) the amounts paid during that 5-year period on
            all claims described in clause (i), regardless of when
            such claims were filed, adjusted to reflect payments
            which would not be permitted under section 1346 and
            chapter 171 of title 28, United States Code, and
              (iii) amounts in the fund established under paragraph
            (2) but unspent from prior fiscal years.
      (2) Subject to appropriations, for each fiscal year, the
    Secretary shall establish a fund of an amount equal to the
    amount estimated under paragraph (1) that is attributable to
    entities receiving funds under each of the grant programs
    described in paragraph (4) of subsection (g), but not to exceed
    a total of $10,000,000 for each such fiscal year.
    Appropriations for purposes of this paragraph shall be made
    separate from appropriations made for purposes of sections 329,
    330 and 340A.
      (3) In order for payments to be made for judgments against
    the United States (together with related fees and expenses of
    witnesses) pursuant to this section arising from the acts or
    omissions of entities described in subsection (g)(4) and of
    officers, employees, or contractors (subject to subsection
    (g)(5)) of such entities, the total amount contained within the
    fund established by the Secretary under paragraph (2) for a
    fiscal year shall be transferred not later than the December 31
    that occurs during the fiscal year to the appropriate accounts
    in the Treasury.
      (l)(1) If a civil action or proceeding is filed in a State
    court against any entity described in subsection (g)(4) or any
    officer, governing board member, employee, or any contractor of
    such an entity for damages described in subsection (a), the
    Attorney General, within 15 days after being notified of such
    filing, shall make an appearance in such court and advise such
    court as to whether the Secretary has determined under
    subsections (g) and (h), that such entity, officer, governing
    board member, employee, or contractor of the entity is deemed
    to be an employee of the Public Health Service for purposes of
    this section with respect to the actions or omissions that are
    the subject of such civil action or proceeding. Such advice
    shall be deemed to satisfy the provisions of subsection (c)
    that the Attorney General certify that an entity, officer,
    governing board member, employee, or contractor of the entity
    was acting within the scope of their employment or
    responsibility.
      (2) If the Attorney General fails to appear in State court
    within the time period prescribed under paragraph (1), upon
    petition of any entity or officer, governing board member,
    employee, or contractor of the entity named, the civil action
    or proceeding shall be removed to the appropriate United States
    district court. The civil action or proceeding shall be stayed
    in such court until such court conducts a hearing, and makes a
    determination, as to the appropriate forum or procedure for the
    assertion of the claim for damages described in subsection (a)
    and issues an order consistent with such determination.
      (m)(1) An entity or officer, governing board member,
    employee, or contractor of an entity described in subsection
    (g)(1) shall, for purposes of this section, be deemed to be an
    employee of the Public Health Service with respect to services
    provided to individuals who are enrollees of a managed care
    plan if the entity contracts with such managed care plan for
    the provision of services.
      (2) Each managed care plan which enters into a contract with
    an entity described in subsection (g)(4) shall deem the entity
    and any officer, governing board member, employee, or
    contractor of the entity as meeting whatever malpractice
    coverage requirements such plan may require of contracting
    providers for a calendar year if such entity or officer,
    governing board member, employee, or contractor of the entity
    has been deemed to be an employee of the Public Health Service
    for purposes of this section for such calendar year. Any plan
    which is found by the Secretary on the record, after notice and
    an opportunity for a full and fair hearing, to have violated
    this subsection shall upon such finding cease, for a period to
    be determined by the Secretary, to receive and to be eligible
    to receive any Federal funds under titles XVIII or XIX of the
    Social Security Act.
      (3) For purposes of this subsection, the term ``managed care
    plan'' shall mean health maintenance organizations and similar
    entities that contract at-risk with payors for the provision of
    health services or plan enrollees and which contract with
    providers (such as entities described in subsection (g)(4)) for
    the delivery of such services to plan enrollees.
      (n)(1) Not later than one year after the date of the
    enactment of the Federally Supported Health Centers Assistance
    Act of 1995, the Comptroller General of the United States shall
    submit to the Congress a report on the following:
              (A) The medical malpractice liability claims
            experience of entities that have been deemed to be
            employees for purposes of this section.
              (B) The risk exposure of such entities.
              (C) The value of private sector risk-management
            services, and the value of risk-management services and
            procedures required as a condition of receiving a grant
            under section 329, 330, or 340A.
              (D) A comparison of the costs and the benefits to
            taxpayers of maintaining medical malpractice liability
            coverage for such entities pursuant to this section,
            taking into account--
                      (i) a comparison of the costs of premiums
                    paid by such entities for private medical
                    malpractice liability insurance with the cost
                    of coverage pursuant to this section; and
                      (ii) an analysis of whether the cost of
                    premiums for private medical malpractice
                    liability insurance coverage is consistent with
                    the liability claims experience of such
                    entities.
      (2) The report under paragraph (1) shall include the
    following:
              (A) A comparison of--
                      (i) an estimate of the aggregate amounts that
                    such entities (together with the officers,
                    governing board members, employees, and
                    contractors of such entities who have been
                    deemed to be employees for purposes of this
                    section) would have directly or indirectly paid
                    in premiums to obtain medical malpractice
                    liability insurance coverage if this section
                    were not in effect; with
                      (ii) the aggregate amounts by which the
                    grants received by such entities under this Act
                    were reduced pursuant to subsection (k)(2).
              (B) A comparison of--
                      (i) an estimate of the amount of privately
                    offered such insurance that such entities
                    (together with the officers, governing board
                    members, employees, and contractors of such
                    entities who have been deemed to be employees
                    for purposes of this section) purchased during
                    the three-year period beginning on January 1,
                    1993; with
                      (ii) an estimate of the amount of such
                    insurance that such entities (together with the
                    officers, governing board members, employees,
                    and contractors of such entities who have been
                    deemed to be employees for purposes of this
                    section) will purchase after the date of the
                    enactment of the Federally Supported Health
                    Centers Assistance Act of 1995.
              (C) An estimate of the medical malpractice liability
            loss history of such entities for the 10-year period
            preceding October 1, 1996, including but not limited to
            the following:
                      (i) Claims that have been paid and that are
                    estimated to be paid, and legal expenses to
                    handle such claims that have been paid and that
                    are estimated to be paid, by the Federal
                    Government pursuant to deeming entities as
                    employees for purposes of this section.
                      (ii) Claims that have been paid and that are
                    estimated to be paid, and legal expenses to
                    handle such claims that have been paid and that
                    are estimated to be paid, by private medical
                    malpractice liability insurance.
              (D) An analysis of whether the cost of premiums for
            private medical malpractice liability insurance
            coverage is consistent with the liability claims
            experience of entities that have been deemed as
            employees for purposes of this section.
      (3) In preparing the report under paragraph (1), the
    Comptroller General of the United States shall consult with
    public and private entities with expertise on the matters with
    which the report is concerned.
      (o)(1) For purposes of this section, a free clinic health
    professional shall in providing a qualifying health service to
    an individual, or an officer, governing board member, employee,
    or contractor of a free clinic shall in providing services for
    the free clinic, be deemed to be an employee of the Public
    Health Service for a calendar year that begins during a fiscal
    year for which a transfer was made under paragraph (6)(D). The
    preceding sentence is subject to the provisions of this
    subsection.
      (2) In providing a health service to an individual, a health
    care practitioner shall for purposes of this subsection be
    considered to be a free clinic health professional if the
    following conditions are met:
              (A) The service is provided to the individual at a
            free clinic, or through offsite programs or events
            carried out by the free clinic.
              (B) The free clinic is sponsoring the health care
            practitioner pursuant to paragraph (5)(C).
              (C) The service is a qualifying health service (as
            defined in paragraph (4)).
              (D) Neither the health care practitioner nor the free
            clinic receives any compensation for the service from
            the individual or from any third-party payor (including
            reimbursement under any insurance policy or health
            plan, or under any Federal or State health benefits
            program). With respect to compliance with such
            condition:
                      (i) The health care practitioner may receive
                    repayment from the free clinic for reasonable
                    expenses incurred by the health care
                    practitioner in the provision of the service to
                    the individual.
                      (ii) The free clinic may accept voluntary
                    donations for the provision of the service by
                    the health care practitioner to the individual.
              (E) Before the service is provided, the health care
            practitioner or the free clinic provides written notice
            to the individual of the extent to which the legal
            liability of the health care practitioner is limited
            pursuant to this subsection (or in the case of an
            emergency, the written notice is provided to the
            individual as soon after the emergency as is
            practicable). If the individual is a minor or is
            otherwise legally incompetent, the condition under this
            subparagraph is that the written notice be provided to
            a legal guardian or other person with legal
            responsibility for the care of the individual.
              (F) At the time the service is provided, the health
            care practitioner is licensed or certified in
            accordance with applicable law regarding the provision
            of the service.
      (3)(A) For purposes of this subsection, the term ``free
    clinic'' means a health care facility operated by a nonprofit
    private entity meeting the following requirements:
              (i) The entity does not, in providing health services
            through the facility, accept reimbursement from any
            third-party payor (including reimbursement under any
            insurance policy or health plan, or under any Federal
            or State health benefits program).
              (ii) The entity, in providing health services through
            the facility, either does not impose charges on the
            individuals to whom the services are provided, or
            imposes a charge according to the ability of the
            individual involved to pay the charge.
              (iii) The entity is licensed or certified in
            accordance with applicable law regarding the provision
            of health services.
      (B) With respect to compliance with the conditions under
    subparagraph (A), the entity involved may accept voluntary
    donations for the provision of services.
      (4) For purposes of this subsection, the term ``qualifying
    health service'' means any medical assistance required or
    authorized to be provided in the program under title XIX of the
    Social Security Act, without regard to whether the medical
    assistance is included in the plan submitted under such program
    by the State in which the health care practitioner involved
    provides the medical assistance. References in the preceding
    sentence to such program shall as applicable be considered to
    be references to any successor to such program.
      (5) Subsection (g) (other than paragraphs (3) through (5))
    and subsections (h), (i), and (l) apply to a health care
    practitioner for purposes of this subsection to the same extent
    and in the same manner as such subsections apply to an officer,
    governing board member, employee, or contractor of an entity
    described in subsection (g)(4), subject to paragraph (6) and
    subject to the following:
              (A) The first sentence of paragraph (1) applies in
            lieu of the first sentence of subsection (g)(1)(A).
              (B) This subsection may not be construed as deeming
            any free clinic to be an employee of the Public Health
            Service for purposes of this section.
              (C) With respect to a free clinic, a health care
            practitioner is not a free clinic health professional
            unless the free clinic sponsors the health care
            practitioner. For purposes of this subsection, the free
            clinic shall be considered to be sponsoring the health
            care practitioner if--
                      (i) with respect to the health care
                    practitioner, the free clinic submits to the
                    Secretary an application meeting the
                    requirements of subsection (g)(1)(D); and
                      (ii) the Secretary, pursuant to subsection
                    (g)(1)(E), determines that the health care
                    practitioner is deemed to be an employee of the
                    Public Health Service.
              (D) In the case of a health care practitioner who is
            determined by the Secretary pursuant to subsection
            (g)(1)(E) to be a free clinic health professional, this
            subsection applies to the health care practitioner
            (with respect to the free clinic sponsoring the health
            care practitioner pursuant to subparagraph (C)) for any
            cause of action arising from an act or omission of the
            health care practitioner occurring on or after the date
            on which the Secretary makes such determination.
              (E) Subsection (g)(1)(F) applies to a health care
            practitioner for purposes of this subsection only to
            the extent that, in providing health services to an
            individual, each of the conditions specified in
            paragraph (2) is met.
      (6)(A) For purposes of making payments for judgments against
    the United States (together with related fees and expenses of
    witnesses) pursuant to this section arising from the acts or
    omissions of free clinic health professionals, there is
    authorized to be appropriated $10,000,000 for each fiscal year.
      (B) The Secretary shall establish a fund for purposes of this
    subsection. Each fiscal year amounts appropriated under
    subparagraph (A) shall be deposited in such fund.
      (C) Not later than May 1 of each fiscal year, the Attorney
    General, in consultation with the Secretary, shall submit to
    the Congress a report providing an estimate of the amount of
    claims (together with related fees and expenses of witnesses)
    that, by reason of the acts or omissions of free clinic health
    professionals, will be paid pursuant to this section during the
    calendar year that begins in the following fiscal year.
    Subsection (k)(1)(B) applies to the estimate under the
    preceding sentence regarding free clinic health professionals
    to the same extent and in the same manner as such subsection
    applies to the estimate under such subsection regarding
    officers, governing board members, employees, and contractors
    of entities described in subsection (g)(4).
      (D) Not later than December 31 of each fiscal year, the
    Secretary shall transfer from the fund under subparagraph (B)
    to the appropriate accounts in the Treasury an amount equal to
    the estimate made under subparagraph (C) for the calendar year
    beginning in such fiscal year, subject to the extent of amounts
    in the fund.
      (7)(A) This subsection takes effect on the date of the
    enactment of the first appropriations Act that makes an
    appropriation under paragraph (6)(A), except as provided in
    subparagraph (B)(i).
      (B)(i) Effective on the date of the enactment of the Health
    Insurance Portability and Accountability Act of 1996--
              (I) the Secretary may issue regulations for carrying
            out this subsection, and the Secretary may accept and
            consider applications submitted pursuant to paragraph
            (5)(C); and
              (II) reports under paragraph (6)(C) may be submitted
            to the Congress.
      (ii) For the first fiscal year for which an appropriation is
    made under subparagraph (A) of paragraph (6), if an estimate
    under subparagraph (C) of such paragraph has not been made for
    the calendar year beginning in such fiscal year, the transfer
    under subparagraph (D) of such paragraph shall be made
    notwithstanding the lack of the estimate, and the transfer
    shall be made in an amount equal to the amount of such
    appropriation.
      (p) Administration of Smallpox Countermeasures by Health
    Professionals.--
              (1) In general.--For purposes of this section, and
            subject to other provisions of this subsection, a
            covered person shall be deemed to be an employee of the
            Public Health Service with respect to liability arising
            out of administration of a covered countermeasure
            against smallpox to an individual during the effective
            period of a declaration by the Secretary under
            paragraph (2)(A).
              (2) Declaration by secretary concerning
            countermeasure against smallpox.--
                      (A) Authority to issue declaration.--
                              (i) In general.--The Secretary may
                            issue a declaration, pursuant to this
                            paragraph, concluding that an actual or
                            potential bioterrorist incident or
                            other actual or potential public health
                            emergency makes advisable the
                            administration of a covered
                            countermeasure to a category or
                            categories of individuals.
                              (ii) Covered countermeasure.--The
                            Secretary shall specify in such
                            declaration the substance or substances
                            that shall be considered covered
                            countermeasures (as defined in
                            paragraph (7)(A)) for purposes of
                            administration to individuals during
                            the effective period of the
                            declaration.
                              (iii) Effective period.--The
                            Secretary shall specify in such
                            declaration the beginning and ending
                            dates of the effective period of the
                            declaration, and may subsequently amend
                            such declaration to shorten or extend
                            such effective period, provided that
                            the new closing date is after the date
                            when the declaration is amended.
                              (iv) Publication.--The Secretary
                            shall promptly publish each such
                            declaration and amendment in the
                            Federal Register.
                      (B) Liability of united states only for
                    administrations within scope of declaration.--
                    Except as provided in paragraph (5)(B)(ii), the
                    United States shall be liable under this
                    subsection with respect to a claim arising out
                    of the administration of a covered
                    countermeasure to an individual only if--
                              (i) the countermeasure was
                            administered by a qualified person, for
                            a purpose stated in paragraph
                            (7)(A)(i), and during the effective
                            period of a declaration by the
                            Secretary under subparagraph (A) with
                            respect to such countermeasure; and
                              (ii)(I) the individual was within a
                            category of individuals covered by the
                            declaration; or
                              (II) the qualified person
                            administering the countermeasure had
                            reasonable grounds to believe that such
                            individual was within such category.
                      (C) Presumption of administration within
                    scope of declaration in case of accidental
                    vaccinia inoculation.--
                              (i) In general.--If vaccinia vaccine
                            is a covered countermeasure specified
                            in a declaration under subparagraph
                            (A), and an individual to whom the
                            vaccinia vaccine is not administered
                            contracts vaccinia, then, under the
                            circumstances specified in clause (ii),
                            the individual--
                                      (I) shall be rebuttably
                                    presumed to have contracted
                                    vaccinia from an individual to
                                    whom such vaccine was
                                    administered as provided by
                                    clauses (i) and (ii) of
                                    subparagraph (B); and
                                      (II) shall (unless such
                                    presumption is rebutted) be
                                    deemed for purposes of this
                                    subsection to be an individual
                                    to whom a covered
                                    countermeasure was administered
                                    by a qualified person in
                                    accordance with the terms of
                                    such declaration and as
                                    described by subparagraph (B).
                              (ii) Circumstances in which
                            presumption applies.--The presumption
                            and deeming stated in clause (i) shall
                            apply if--
                                      (I) the individual contracts
                                    vaccinia during the effective
                                    period of a declaration under
                                    subparagraph (A) or by the date
                                    30 days after the close of such
                                    period; or
                                      (II) the individual has
                                    resided with, or has had
                                    contact with, an individual to
                                    whom such vaccine was
                                    administered as provided by
                                    clauses (i) and (ii) of
                                    subparagraph (B) and contracts
                                    vaccinia after such date.
                      (D) Acts and omissions deemed to be within
                    scope of employment.--
                              (i) In general.--In the case of a
                            claim arising out of alleged
                            transmission of vaccinia from an
                            individual described in clause (ii),
                            acts or omissions by such individual
                            shall be deemed to have been taken
                            within the scope of such individual's
                            office or employment for purposes of--
                                      (I) subsection (a); and
                                      (II) section 1346(b) and
                                    chapter 171 of title 28, United
                                    States Code.
                              (ii) Individuals to whom deeming
                            applies.--An individual is described by
                            this clause if--
                                      (I) vaccinia vaccine was
                                    administered to such individual
                                    as provided by subparagraph
                                    (B); and
                                      (II) such individual was
                                    within a category of
                                    individuals covered by a
                                    declaration under subparagraph
                                    (A)(i).
              (3) Exhaustion; exclusivity; offset.--
                      (A) Exhaustion.--
                              (i) In general.--A person may not
                            bring a claim under this subsection
                            unless such person has exhausted such
                            remedies as are available under part C
                            of this title, except that if the
                            Secretary fails to make a final
                            determination on a request for benefits
                            or compensation filed in accordance
                            with the requirements of such part
                            within 240 days after such request was
                            filed, the individual may seek any
                            remedy that may be available under this
                            section.
                              (ii) Tolling of statute of
                            limitations.--The time limit for filing
                            a claim under this subsection, or for
                            filing an action based on such claim,
                            shall be tolled during the pendency of
                            a request for benefits or compensation
                            under part C of this title.
                              (iii) Construction.--This subsection
                            shall not be construed as superseding
                            or otherwise affecting the application
                            of a requirement, under chapter 171 of
                            title 28, United States Code, to
                            exhaust administrative remedies.
                      (B) Exclusivity.--The remedy provided by
                    subsection (a) shall be exclusive of any other
                    civil action or proceeding for any claim or
                    suit this subsection encompasses, except for a
                    proceeding under part C of this title.
                      (C) Offset.--The value of all compensation
                    and benefits provided under part C of this
                    title for an incident or series of incidents
                    shall be offset against the amount of an award,
                    compromise, or settlement of money damages in a
                    claim or suit under this subsection based on
                    the same incident or series of incidents.
              (4) Certification of action by attorney general.--
            Subsection (c) applies to actions under this
            subsection, subject to the following provisions:
                      (A) Nature of certification.--The
                    certification by the Attorney General that is
                    the basis for deeming an action or proceeding
                    to be against the United States, and for
                    removing an action or proceeding from a State
                    court, is a certification that the action or
                    proceeding is against a covered person and is
                    based upon a claim alleging personal injury or
                    death arising out of the administration of a
                    covered countermeasure.
                      (B) Certification of attorney general
                    conclusive.--The certification of the Attorney
                    General of the facts specified in subparagraph
                    (A) shall conclusively establish such facts for
                    purposes of jurisdiction pursuant to this
                    subsection.
              (5) Covered person to cooperate with united states.--
                      (A) In general.--A covered person shall
                    cooperate with the United States in the
                    processing and defense of a claim or action
                    under this subsection based upon alleged acts
                    or omissions of such person.
                      (B) Consequences of failure to cooperate.--
                    Upon the motion of the United States or any
                    other party and upon finding that such person
                    has failed to so cooperate--
                              (i) the court shall substitute such
                            person as the party defendant in place
                            of the United States and, upon motion,
                            shall remand any such suit to the court
                            in which it was instituted if it
                            appears that the court lacks subject
                            matter jurisdiction;
                              (ii) the United States shall not be
                            liable based on the acts or omissions
                            of such person; and
                              (iii) the Attorney General shall not
                            be obligated to defend such action.
              (6) Recourse against covered person in case of gross
            misconduct or contract violation.--
                      (A) In general.--Should payment be made by
                    the United States to any claimant bringing a
                    claim under this subsection, either by way of
                    administrative determination, settlement, or
                    court judgment, the United States shall have,
                    notwithstanding any provision of State law, the
                    right to recover for that portion of the
                    damages so awarded or paid, as well as interest
                    and any costs of litigation, resulting from the
                    failure of any covered person to carry out any
                    obligation or responsibility assumed by such
                    person under a contract with the United States
                    or from any grossly negligent, reckless, or
                    illegal conduct or willful misconduct on the
                    part of such person.
                      (B) Venue.--The United States may maintain an
                    action under this paragraph against such person
                    in the district court of the United States in
                    which such person resides or has its principal
                    place of business.
              (7) Definitions.--As used in this subsection, terms
            have the following meanings:
                      (A) Covered countermeasure.--The term
                    ``covered countermeasure'' or ``covered
                    countermeasure against smallpox'', means a
                    substance that is--
                              (i)(I) used to prevent or treat
                            smallpox (including the vaccinia or
                            another vaccine); or
                                      (II) used to control or treat
                                    the adverse effects of vaccinia
                                    inoculation or of
                                    administration of another
                                    covered countermeasure; and
                              (ii) specified in a declaration under
                            paragraph (2).
                      (B) Covered person.--The term ``covered
                    person'', when used with respect to the
                    administration of a covered countermeasure,
                    means a person who is--
                              (i) a manufacturer or distributor of
                            such countermeasure;
                              (ii) a health care entity under whose
                            auspices--
                                      (I) such countermeasure was
                                    administered;
                                      (II) a determination was made
                                    as to whether, or under what
                                    circumstances, an individual
                                    should receive a covered
                                    countermeasure;
                                      (III) the immediate site of
                                    administration on the body of a
                                    covered countermeasure was
                                    monitored, managed, or cared
                                    for; or
                                      (IV) an evaluation was made
                                    of whether the administration
                                    of a countermeasure was
                                    effective;
                              (iii) a qualified person who
                            administered such countermeasure;
                              (iv) a State, a political subdivision
                            of a State, or an agency or official of
                            a State or of such a political
                            subdivision, if such State,
                            subdivision, agency, or official has
                            established requirements, provided
                            policy guidance, supplied technical or
                            scientific advice or assistance, or
                            otherwise supervised or administered a
                            program with respect to administration
                            of such countermeasures;
                              (v) in the case of a claim arising
                            out of alleged transmission of vaccinia
                            from an individual--
                                      (I) the individual who
                                    allegedly transmitted the
                                    vaccinia, if vaccinia vaccine
                                    was administered to such
                                    individual as provided by
                                    paragraph (2)(B) and such
                                    individual was within a
                                    category of individuals covered
                                    by a declaration under
                                    paragraph (2)(A)(i); or
                                      (II) an entity that employs
                                    an individual described by
                                    clause (I) or where such
                                    individual has privileges or is
                                    otherwise authorized to provide
                                    health care;
                              (vi) an official, agent, or employee
                            of a person described in clause (i),
                            (ii), (iii), or (iv);
                              (vii) a contractor of, or a volunteer
                            working for, a person described in
                            clause (i), (ii), or (iv), if the
                            contractor or volunteer performs a
                            function for which a person described
                            in clause (i), (ii), or (iv) is a
                            covered person; or
                              (viii) an individual who has
                            privileges or is otherwise authorized
                            to provide health care under the
                            auspices of an entity described in
                            clause (ii) or (v)(II).
                      (C) Qualified person.--The term ``qualified
                    person'', when used with respect to the
                    administration of a covered countermeasure,
                    means a licensed health professional or other
                    individual who--
                              (i) is authorized to administer such
                            countermeasure under the law of the
                            State in which the countermeasure was
                            administered; or
                              (ii) is otherwise authorized by the
                            Secretary to administer such
                            countermeasure.
                      (D) Arising out of administration of a
                    covered countermeasure.--The term ``arising out
                    of administration of a covered
                    countermeasure'', when used with respect to a
                    claim or liability, includes a claim or
                    liability arising out of--
                              (i) determining whether, or under
                            what conditions, an individual should
                            receive a covered countermeasure;
                              (ii) obtaining informed consent of an
                            individual to the administration of a
                            covered countermeasure;
                              (iii) monitoring, management, or care
                            of an immediate site of administration
                            on the body of a covered
                            countermeasure, or evaluation of
                            whether the administration of the
                            countermeasure has been effective; or
                              (iv) transmission of vaccinia virus
                            by an individual to whom vaccinia
                            vaccine was administered as provided by
                            paragraph (2)(B).
      (q)(1) For purposes of this section, a health professional
    volunteer at a deemed entity described in subsection (g)(4)
    shall, in providing a health professional service eligible for
    funding under section 330 to an individual, be deemed to be an
    employee of the Public Health Service for a calendar year that
    begins during a fiscal year for which a transfer was made under
    paragraph (4)(C). The preceding sentence is subject to the
    provisions of this subsection.
      (2) In providing a health service to an individual, a health
    care practitioner shall for purposes of this subsection be
    considered to be a health professional volunteer at an entity
    described in subsection (g)(4) if the following conditions are
    met:
              (A) The service is provided to the individual at the
            facilities of an entity described in subsection (g)(4),
            or through offsite programs or events carried out by
            the entity.
              (B) The entity is sponsoring the health care
            practitioner pursuant to paragraph (3)(B).
              (C) The health care practitioner does not receive any
            compensation for the service from the individual, the
            entity described in subsection (g)(4), or any third-
            party payer (including reimbursement under any
            insurance policy or health plan, or under any Federal
            or State health benefits program), except that the
            health care practitioner may receive repayment from the
            entity described in subsection (g)(4) for reasonable
            expenses incurred by the health care practitioner in
            the provision of the service to the individual, which
            may include travel expenses to or from the site of
            services.
              (D) Before the service is provided, the health care
            practitioner or the entity described in subsection
            (g)(4) posts a clear and conspicuous notice at the site
            where the service is provided of the extent to which
            the legal liability of the health care practitioner is
            limited pursuant to this subsection.
              (E) At the time the service is provided, the health
            care practitioner is licensed or certified in
            accordance with applicable Federal and State laws
            regarding the provision of the service.
              (F) At the time the service is provided, the entity
            described in subsection (g)(4) maintains relevant
            documentation certifying that the health care
            practitioner meets the requirements of this subsection.
      (3) Subsection (g) (other than paragraphs (3) and (5)) and
    subsections (h), (i), and (l) apply to a health care
    practitioner for purposes of this subsection to the same extent
    and in the same manner as such subsections apply to an officer,
    governing board member, employee, or contractor of an entity
    described in subsection (g)(4), subject to paragraph (4), and
    subject to the following:
              (A) The first sentence of paragraph (1) applies in
            lieu of the first sentence of subsection (g)(1)(A).
              (B) With respect to an entity described in subsection
            (g)(4), a health care practitioner is not a health
            professional volunteer at such entity unless the entity
            sponsors the health care practitioner. For purposes of
            this subsection, the entity shall be considered to be
            sponsoring the health care practitioner if--
                      (i) with respect to the health care
                    practitioner, the entity submits to the
                    Secretary an application meeting the
                    requirements of subsection (g)(1)(D); and
                      (ii) the Secretary, pursuant to subsection
                    (g)(1)(E), determines that the health care
                    practitioner is deemed to be an employee of the
                    Public Health Service.
              (C) In the case of a health care practitioner who is
            determined by the Secretary pursuant to subsection
            (g)(1)(E) to be a health professional volunteer at such
            entity, this subsection applies to the health care
            practitioner (with respect to services performed on
            behalf of the entity sponsoring the health care
            practitioner pursuant to subparagraph (B)) for any
            cause of action arising from an act or omission of the
            health care practitioner occurring on or after the date
            on which the Secretary makes such determination.
              (D) Subsection (g)(1)(F) applies to a health care
            practitioner for purposes of this subsection only to
            the extent that, in providing health services to an
            individual, each of the conditions specified in
            paragraph (2) is met.
      (4)(A) Amounts in the fund established under subsection
    (k)(2) shall be available for transfer under subparagraph (C)
    for purposes of carrying out this subsection.
      (B)(i) Not later than May 1 of each fiscal year, the Attorney
    General, in consultation with the Secretary, shall submit to
    the Congress a report providing an estimate of the amount of
    claims (together with related fees and expenses of witnesses)
    that, by reason of the acts or omissions of health professional
    volunteers, will be paid pursuant to this section during the
    calendar year that begins in the following fiscal year.
      (ii) Subsection (k)(1)(B) applies to the estimate under
    clause (i) regarding health professional volunteers to the same
    extent and in the same manner as such subsection applies to the
    estimate under such subsection regarding officers, governing
    board members, employees, and contractors of entities described
    in subsection (g)(4).
      (iii) The report shall include a summary of the data relied
    upon for the estimate in clause (i), including the number of
    claims filed and paid from the previous calendar year.
      (C) Not later than December 31 of each fiscal year, the
    Secretary shall transfer from the fund under subsection (k)(2)
    to the appropriate accounts in the Treasury an amount equal to
    the estimate made under subparagraph (B) for the calendar year
    beginning in such fiscal year, subject to the extent of amounts
    in the fund.
      (5)(A) This subsection shall take effect on October 1, 2017,
    except as provided in subparagraph (B) and paragraph (6).
      (B) Effective on the date of the enactment of this
    subsection--
              (i) the Secretary may issue regulations for carrying
            out this subsection, and the Secretary may accept and
            consider applications submitted pursuant to paragraph
            (3)(B); and
              (ii) reports under paragraph (4)(B) may be submitted
            to Congress.
      (6) Beginning on [October 1, 2022] October 1, 2027, this
    subsection shall cease to have any force or effect.

               *       *       *       *       *       *       *

    TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

               *       *       *       *       *       *       *

    Part B--Federal-State Cooperation

               *       *       *       *       *       *       *

    SEC. 317L-1. SCREENING AND TREATMENT FOR [MATERNAL DEPRESSION]
                        MATERNAL MENTAL HEALTH AND SUBSTANCE USE DISORDERS.

      (a) Grants.--The Secretary shall make grants to States,
    Indian Tribes and Tribal organizations (as such terms are
    defined in section 4 of the Indian Self-Determination and
    Education Assistance Act), and Urban Indian organizations (as
    such term is defined under the Federally Recognized Indian
    Tribe List Act of 1994) to establish, improve, or maintain
    programs for screening, assessment, and treatment services,
    including culturally and linguistically appropriate services,
    as appropriate, [for women who are pregnant, or who have given
    birth within the preceding 12 months, for maternal depression]
    for women who are postpartum, pregnant, or have given birth
    within the preceding 12 months, for maternal mental health and
    substance use disorders.
      (b) Application.--To seek a grant under this section, [a
    State shall submit] an entity listed in subsection (a) shall
    submit an application to the Secretary at such time, in such
    manner, and containing such information as the Secretary may
    require. At a minimum, any such application shall include
    explanations of--
              (1) how a program, or programs, will increase the
            percentage of women screened and treated, as
            appropriate, for [maternal depression] maternal mental
            health and substance use disorders in 1 or more
            communities; and
              (2) how a program, or programs, if expanded, would
            increase access to screening and treatment services for
            [maternal depression] maternal mental health and
            substance use disorders.
      (c) Priority.--In awarding grants under this section, the
    Secretary [may give priority to States proposing to improve or
    enhance access to screening] shall give priority to entities
    listed in subsection (a) that--
              (1) are proposing to create, improve, or enhance
            screening, prevention, and treatment  services for
            [maternal depression] maternal mental health and
            substance use disorders in primary care settings[.];
              (2) are currently partnered with, or will partner
            with, a community-based organization to address
            maternal mental health and substance use disorders;
              (3) are located in an area with high rates of adverse
            maternal health outcomes or significant health,
            economic, racial, or ethnic disparities in maternal
            health and substance use disorder outcomes; and
              (4) operate in a health professional shortage area
            designated under section 332.
      (d) Use of Funds.--The activities eligible for funding
    through a grant under subsection (a)--
              (1) shall include--
                      (A) providing appropriate training [to health
                    care providers; and] on maternal mental health
                    and substance use disorder screening, brief
                    intervention, treatment (as applicable for
                    health care providers), and referrals for
                    treatment to health care providers in the
                    primary care setting and nonclinical perinatal
                    support workers;
                      (B) providing information [to health care
                    providers, including information on maternal
                    depression screening, treatment, and followup
                    support services, and linkages to community-
                    based resources; and] on maternal mental health
                    and substance use disorder screening, brief
                    intervention, treatment (as applicable for
                    health care providers) and referrals for
                    treatment, follow-up support services, and
                    linkages to community-based resources to health
                    care providers in the primary care setting and
                    clinical perinatal support workers; and
                      (C) enabling health care providers (such as
                    obstetrician-gynecologists, nurse
                    practitioners, nurse midwives, pediatricians,
                    psychiatrists, mental and other behavioral
                    health care providers, and adult primary care
                    clinicians) to provide or receive real-time
                    psychiatric consultation (in-person or
                    remotely), including through the use of
                    technology-enabled collaborative learning and
                    capacity building models (as defined in section
                    330N), to aid in the treatment of pregnant and
                    postpartum women; and
              (2) may include--
                      [(A) enabling health care providers
                    (including obstetrician-gynecologists,
                    pediatricians, psychiatrists, mental health
                    care providers, and adult primary care
                    clinicians) to provide or receive real-time
                    psychiatric consultation (in-person or
                    remotely) to aid in the treatment of pregnant
                    and parenting women;]
                      [(B)] (A) establishing linkages with and
                    among community-based resources, including
                    mental health resources, primary care
                    resources, and support groups; [and]
                      [(C)] (B) utilizing telehealth services,
                    including for rural areas and medically
                    underserved areas (as defined in section
                    330I(a))[.];
                      (C) providing assistance to pregnant and
                    postpartum women to receive maternal mental
                    health and substance use disorder treatment,
                    including patient consultation, care
                    coordination, and navigation for such
                    treatment;
                      (D) coordinating with maternal and child
                    health programs of the Federal Government and
                    State, local, and Tribal governments, including
                    child psychiatric access programs;
                      (E) conducting public outreach and awareness
                    regarding grants under subsection (a);
                      (F) creating multistate consortia to carry
                    out the activities required or authorized under
                    this subsection; and
                      (G) training health care providers in the
                    primary care setting and nonclinical perinatal
                    support workers on trauma-informed care,
                    culturally and linguistically appropriate
                    services, and best practices related to
                    training to improve the provision of maternal
                    mental health and substance use disorder care
                    for racial and ethnic minority populations,
                    including with respect to perceptions and
                    biases that may affect the approach to, and
                    provision of, care.
      (e) Technical Assistance.--The Secretary shall provide
    technical assistance to grantees and entities listed in
    subsection (a) for carrying out activities pursuant to this
    section.
      (f) Dissemination of Best Practices.--The Secretary, based on
    evaluation of the activities funded pursuant to this section,
    shall identify and disseminate evidence-based or evidence-
    informed best practices for screening, assessment, and
    treatment services for maternal mental health and substance use
    disorders, including culturally and linguistically appropriate
    services, for women during pregnancy and 12 months following
    pregnancy.
      (g) Matching Requirement.--The Federal share of the cost of
    the activities for which a grant is made to an entity under
    subsection (a) shall not exceed 90 percent of the total cost of
    such activities.
      [(e)] (h) Authorization of Appropriations.--To carry out this
    section, there are authorized to be appropriated [$5,000,000]
    $24,000,000 for each of fiscal years [2018 through 2022] 2023
    through 2027.

    SEC. 317L-2. TASK FORCE ON MATERNAL MENTAL HEALTH.

      (a) Establishment.--Not later than 180 days after the date of
    enactment of the Restoring Hope for the Mental Health and Well-
    Being Act of 2022, the Secretary, for purposes of identifying,
    evaluating, and making recommendations to coordinate and
    improve Federal responses to maternal mental health conditions,
    shall--
              (1) establish a task force to be known as the Task
            Force on Maternal Mental Health (in this section
            referred to as the ``Task Force''); or
              (2) incorporate the duties, public meetings, and
            reports specified in subsections (c) through (f) into
            existing Federal policy forums, including the Maternal
            Health Interagency Policy Committee and the Maternal
            Health Working Group, as appropriate.
      (b) Membership.--
              (1) Composition.--The Task Force shall be composed
            of--
                      (A) the Federal members under paragraph (2);
                    and
                      (B) the non-Federal members under paragraph
                    (3).
              (2) Federal members.--The Federal members of the Task
            Force shall consist of the following heads of Federal
            departments and agencies (or their designees):
                      (A) The Assistant Secretary for Health of the
                    Department of Health and Human Services, who
                    shall serve as Chair.
                      (B) The Assistant Secretary for Planning and
                    Evaluation of the Department of Health and
                    Human Services.
                      (C) The Assistant Secretary of the
                    Administration for Children and Families.
                      (D) The Director of the Centers for Disease
                    Control and Prevention.
                      (E) The Administrator of the Centers for
                    Medicare & Medicaid Services.
                      (F) The Administrator of the Health Resources
                    and Services Administration.
                      (G) The Director of the Indian Health
                    Service.
                      (H) The Assistant Secretary for Mental Health
                    and Substance Use.
                      (I) Such other Federal departments and
                    agencies as the Secretary determines
                    appropriate that serve individuals with
                    maternal mental health conditions.
              (3) Non-federal members.--The non-Federal members of
            the Task Force shall--
                      (A) compose not more than one-half, and not
                    less than one-third, of the total membership of
                    the Task Force;
                      (B) be appointed by the Secretary; and
                      (C) include--
                              (i) representatives of medical
                            societies with expertise in maternal or
                            mental health;
                              (ii) representatives of nonprofit
                            organizations with expertise in
                            maternal or mental health;
                              (iii) relevant industry
                            representatives; and
                              (iv) other representatives, as
                            appropriate.
              (4) Deadline for designating designees.--If the
            Assistant Secretary for Health, or the head of a
            Federal department or agency serving as a member of the
            Task Force under paragraph (2), chooses to be
            represented on the Task Force by a designee, the
            Assistant Secretary or department or agency head shall
            designate such designee not later than 90 days after
            the date of the enactment of this section.
      (c) Duties.--The Task Force shall--
              (1) prepare and regularly update a report that
            analyzes and evaluates the state of national maternal
            mental health policy and programs at the Federal,
            State, and local levels, and identifies best practices
            with respect to maternal mental health policy,
            including--
                      (A) a set of evidence-based, evidence-
                    informed, and promising practices with respect
                    to--
                              (i) prevention strategies for
                            individuals at risk of experiencing a
                            maternal mental health condition,
                            including strategies and
                            recommendations to address health
                            inequities;
                              (ii) the identification, screening,
                            diagnosis, intervention, and treatment
                            of individuals and families affected by
                            a maternal mental health condition;
                              (iii) the expeditious referral to,
                            and implementation of, practices and
                            supports that prevent and mitigate the
                            effects of a maternal mental health
                            condition, including strategies and
                            recommendations to eliminate the racial
                            and ethnic disparities that exist in
                            maternal mental health; and
                              (iv) community-based or
                            multigenerational practices that
                            support individuals and families
                            affected by a maternal mental health
                            condition; and
                      (B) Federal and State programs and activities
                    to prevent, screen, diagnose, intervene, and
                    treat maternal mental health conditions;
              (2) develop and regularly update a national strategy
            for maternal mental health, taking into consideration
            the findings of the report under paragraph (1), on how
            the Task Force and Federal departments and agencies
            represented on the Task Force may prioritize options
            for, and may implement a coordinated approach to,
            addressing maternal mental health conditions, including
            by--
                      (A) increasing prevention, screening,
                    diagnosis, intervention, treatment, and access
                    to care, including clinical and nonclinical
                    care such as peer-support and community health
                    workers, through the public and private
                    sectors;
                      (B) providing support for pregnant or
                    postpartum individuals who are at risk for or
                    experiencing a maternal mental health
                    condition, and their families, as appropriate;
                      (C) reducing racial, ethnic, geographic, and
                    other health disparities for prevention,
                    diagnosis, intervention, treatment, and access
                    to care;
                      (D) identifying options for modifying,
                    strengthening, and coordinating Federal
                    programs and activities, such as the Medicaid
                    program under title XIX of the Social Security
                    Act and the State Children's Health Insurance
                    Program under title XXI of such Act, including
                    existing infant and maternity programs, in
                    order to increase research, prevention,
                    identification, intervention, and treatment
                    with respect to maternal mental health; and
                      (E) planning, data sharing, and communication
                    within and across Federal departments,
                    agencies, offices, and programs;
              (3) solicit public comments from stakeholders for the
            report under paragraph (1) and the national strategy
            under paragraph (2), including comments from frontline
            service providers, mental health professionals,
            researchers, experts in maternal mental health,
            institutions of higher education, public health
            agencies (including maternal and child health
            programs), and industry representatives, in order to
            inform the activities and reports of the Task Force;
            and
              (4) disaggregate any data collected under this
            section by race, ethnicity, geographical location, age,
            marital status, socioeconomic level, and other factors,
            as the Secretary determines appropriate.
      (d) Meetings.--The Task Force shall--
              (1) meet not less than two times each year; and
              (2) convene public meetings, as appropriate, to
            fulfill its duties under this section.
      (e) Reports to Public and Federal Leaders.--The Task Force
    shall make publicly available and submit to the heads of
    relevant Federal departments and agencies, the Committee on
    Energy and Commerce of the House of Representatives, the
    Committee on Health, Education, Labor, and Pensions of the
    Senate, and other relevant congressional committees, the
    following:
              (1) Not later than 1 year after the first meeting of
            the Task Force, an initial report under subsection
            (c)(1).
              (2) Not later than 2 years after the first meeting of
            the Task Force, an initial national strategy under
            subsection (c)(2).
              (3) Each year thereafter--
                      (A) an updated report under subsection
                    (c)(1);
                      (B) an updated national strategy under
                    subsection (c)(2); or
                      (C) if no update is made under subsection
                    (c)(1) or (c)(2), a report summarizing the
                    activities of the Task Force.
      (f) Reports to Governors.--Upon finalizing the initial
    national strategy under subsection (c)(2), and upon making
    relevant updates to such strategy, the Task Force shall submit
    a report to the Governors of all States describing
    opportunities for local- and State-level partnerships
    identified under subsection (c)(2)(D).
      (g) Sunset.--The Task Force shall terminate on September 30,
    2027.
      (h) Nonduplication of Federal Efforts.--The Secretary may
    relieve the Task Force, in carrying out subsections (c) through
    (f), from responsibility for carrying out such activities as
    may be specified by the Secretary as duplicative with other
    activities carried out by the Department of Health and Human
    Services.

               *       *       *       *       *       *       *

                          Part D--Primary Health Care

    Subpart I--Health Centers

               *       *       *       *       *       *       *

    SEC. 330M. PEDIATRIC MENTAL HEALTH CARE ACCESS GRANTS.

      (a) In General.--The Secretary, acting through the
    Administrator of the Health Resources and Services
    Administration and in coordination with other relevant Federal
    agencies, shall award grants to States, political subdivisions
    of States, and [Indian tribes and tribal organizations] Indian
    Tribes and Tribal organizations (for purposes of this section,
    as such terms are defined in section 4 of the Indian Self-
    Determination and Education Assistance Act (25 U.S.C. 450b))
    or, in the case of a State that does not submit an application,
    a nonprofit entity that has the support of the State to promote
    behavioral health integration in pediatric primary care by--
              (1) supporting the development of statewide or
            regional pediatric mental health care telehealth access
            programs; and
              (2) supporting the improvement of existing statewide
            or regional pediatric mental health care telehealth
            access programs.
      (b) Program Requirements.--
              (1) In general.--A pediatric mental health care
            telehealth access program referred to in subsection
            (a), with respect to which a grant under such
            subsection may be used, shall--
                      (A) be a statewide or regional network of
                    pediatric mental health teams that provide
                    support to pediatric primary care sites as an
                    integrated team;
                      (B) support and further develop organized
                    State or regional networks of pediatric mental
                    health teams to provide consultative support to
                    pediatric primary care sites;
                      (C) conduct an assessment of critical
                    behavioral consultation needs among pediatric
                    providers and such providers' preferred
                    mechanisms for receiving consultation,
                    training, and technical assistance;
                      (D) develop an online database and
                    communication mechanisms, including telehealth,
                    to facilitate consultation support to pediatric
                    practices;
                      (E) provide rapid statewide or regional
                    clinical telephone or telehealth consultations
                    when requested between the pediatric mental
                    health teams and pediatric primary care
                    providers;
                      (F) conduct training and provide technical
                    assistance to pediatric primary care providers
                    to support the early identification, diagnosis,
                    treatment, and referral of children with
                    behavioral health conditions;
                      (G) provide information to pediatric
                    providers about, and assist pediatric providers
                    in accessing, pediatric mental health care
                    providers, including child and adolescent
                    psychiatrists, developmental-behavioral
                    pediatricians, and licensed mental health
                    professionals, such as psychologists, social
                    workers, or mental health counselors and in
                    scheduling and conducting technical assistance;
                      (H) assist with referrals to specialty care
                    and community or behavioral health resources[;
                    and];
                      (I) maintain an up-to-date list of community-
                    based supports for children with mental health
                    problems; and
                      [(I)] (J) establish mechanisms for measuring
                    and monitoring increased access to pediatric
                    mental health care services by pediatric
                    primary care providers and expanded capacity of
                    pediatric primary care providers to identify,
                    treat, and refer children with mental health
                    problems.
              (2) Support to schools and emergency departments.--In
            addition to the activities required by paragraph (1), a
            pediatric mental health care telehealth access program
            referred to in subsection (a), with respect to which a
            grant under such subsection may be used, may provide
            support to schools and emergency departments.
              (3) Priority.--In awarding grants under this section,
            the Secretary shall give priority to applicants
            proposing to--
                      (A) continue existing programs that meet the
                    requirements of paragraph (1);
                      (B) establish a pediatric mental health care
                    telehealth access program in the jurisdiction
                    of a State, Territory, Indian Tribe, or Tribal
                    organization that does not yet have such a
                    program; or
                      (C) expand a pediatric mental health care
                    telehealth access program to include one or
                    more new sites of care, such as a school or
                    emergency department.
              [(2)] (4) Pediatric mental health teams.--In this
            subsection, the term ``pediatric mental health team''
            means a team consisting of at least one case
            coordinator, at least one child and adolescent
            psychiatrist, and at least one licensed clinical mental
            health professional, such as a psychologist, social
            worker, or mental health counselor. Such a team may
            include a developmental-behavioral pediatrician. Such a
            team may be regionally based.
      (c) Application.--A State, political subdivision of a State,
    [Indian tribe, or tribal organization] Indian Tribe, Tribal
    organization, or nonprofit entity seeking a grant under this
    section shall submit an application to the Secretary at such
    time, in such manner, and containing such information as the
    Secretary may require, including a plan for the comprehensive
    evaluation of activities that are carried out with funds
    received under such grant.
      (d) Evaluation.--A State, political subdivision of a State,
    [Indian tribe, or tribal organization] Indian Tribe, Tribal
    organization, or nonprofit entity that receives a grant under
    this section shall prepare and submit an evaluation of
    activities that are carried out with funds received under such
    grant to the Secretary at such time, in such manner, and
    containing such information as the Secretary may reasonably
    require, including a process and outcome evaluation.
      (e) Access to Broadband.--In administering grants under this
    section, the Secretary may coordinate with other agencies to
    ensure that funding opportunities are available to support
    access to reliable, high-speed Internet for providers.
      (f) Matching Requirement.--The Secretary may not award a
    grant under this section unless the State, political
    subdivision of a State, [Indian tribe, or tribal organization]
    Indian Tribe, Tribal organization, or nonprofit entity involved
    agrees, with respect to the costs to be incurred by the State,
    political subdivision of a State, [Indian tribe, or tribal
    organization] Indian Tribe, Tribal organization, or nonprofit
    entity in carrying out the purpose described in this section,
    to make available non-Federal contributions (in cash or in
    kind) toward such costs in an amount that is not less than 20
    percent of Federal funds provided in the grant.
      [(g) Authorization of Appropriations.--To carry out this
    section, there are authorized to be appropriated, $9,000,000
    for the period of fiscal years 2018 through 2022.]
      (g) Technical Assistance.--The Secretary shall award grants
    or contracts to one or more eligible entities (as defined by
    the Secretary) for the purposes of providing technical
    assistance and evaluation support to grantees under subsection
    (a).
      (h) Authorization of Appropriations.--To carry out this
    section, there are authorized to be appropriated--
              (1) $14,000,000 for each of fiscal years 2023 through
            2025; and
              (2) $30,000,000 for each of fiscal years 2026 through
            2027.

               *       *       *       *       *       *       *

    PART P--ADDITIONAL PROGRAMS

               *       *       *       *       *       *       *

    SEC. 399V-7. MATERNAL MENTAL HEALTH HOTLINE.

      (a) In General.--The Secretary shall maintain, directly or by
    grant or contract, a national hotline to provide emotional
    support, information, brief intervention, and mental health and
    substance use disorder resources to pregnant and postpartum
    women at risk of, or affected by, maternal mental health and
    substance use disorders, and to their families or household
    members.
      (b) Requirements for Hotline.--The hotline under subsection
    (a) shall--
              (1) be a 24/7 real-time hotline;
              (2) provide voice and text support;
              (3) be staffed by certified peer specialists,
            licensed health care professionals, or licensed mental
            health professionals who are trained on--
                      (A) maternal mental health and substance use
                    disorder prevention, identification, and
                    intervention; and
                      (B) providing culturally and linguistically
                    appropriate support; and
              (4) provide maternal mental health and substance use
            disorder assistance and referral services to meet the
            needs of underserved populations, individuals with
            disabilities, and family and household members of
            pregnant or postpartum women at risk of experiencing
            maternal mental health and substance use disorders.
      (c) Additional Requirements.--In maintaining the hotline
    under subsection (a), the Secretary shall--
              (1) consult with the Domestic Violence Hotline,
            National Suicide Prevention Lifeline, and Veterans
            Crisis Line to ensure that pregnant and postpartum
            women are connected in real-time to the appropriate
            specialized hotline service, when applicable;
              (2) conduct a public awareness campaign for the
            hotline; and
              (3) consult with Federal departments and agencies,
            including the Centers of Excellence of the Substance
            Abuse and Mental Health Services Administration and the
            Department of Veterans Affairs, to increase awareness
            regarding the hotline.
      (d) Annual Report.--The Secretary shall submit an annual
    report to the Congress on the hotline under subsection (a) and
    implementation of this section, including--
              (1) an evaluation of the effectiveness of activities
            conducted or supported under subsection (a);
              (2) a directory of entities or organizations to which
            staff maintaining the hotline funded under this section
            may make referrals; and
              (3) such additional information as the Secretary
            determines appropriate.
      (e) Authorization of Appropriations.--To carry out this
    section, there are authorized to be appropriated $10,000,000
    for each of fiscal years 2023 through 2027.

    PART Q--PROGRAMS TO IMPROVE THE HEALTH OF CHILDREN

               *       *       *       *       *       *       *

    SEC. 399Z-2. INFANT AND EARLY CHILDHOOD MENTAL HEALTH PROMOTION,
                        INTERVENTION, AND TREATMENT.

      (a) Grants.--The Secretary shall--
              (1) award grants to eligible entities to develop,
            maintain, or enhance infant and early childhood mental
            health promotion, intervention, and treatment programs,
            including--
                      (A) programs for infants and children at
                    significant risk of developing, showing early
                    signs of, or having been diagnosed with mental
                    illness, including a serious emotional
                    disturbance; and
                      (B) multigenerational therapy and other
                    services that support the caregiving
                    relationship; and
              (2) ensure that programs funded through grants under
            this section are evidence-informed or evidence-based
            models, practices, and methods that are, as
            appropriate, culturally and linguistically appropriate,
            and can be replicated in other appropriate settings.
      (b) Eligible Children and Entities.--In this section:
              (1) Eligible child.--The term ``eligible child''
            means a child from birth to not more than 12 years of
            age who--
                      (A) is at risk for, shows early signs of, or
                    has been diagnosed with a mental illness,
                    including a serious emotional disturbance; and
                      (B) may benefit from infant and early
                    childhood intervention or treatment programs or
                    specialized preschool or elementary school
                    programs that are evidence-based or that have
                    been scientifically demonstrated to show
                    promise but would benefit from further applied
                    development.
              (2) Eligible entity.--The term ``eligible entity''
            means a human services agency or nonprofit institution
            that--
                      (A) employs licensed mental health
                    professionals who have specialized training and
                    experience in infant and early childhood mental
                    health assessment, diagnosis, and treatment, or
                    is accredited or approved by the appropriate
                    State agency, as applicable, to provide for
                    children from infancy to 12 years of age mental
                    health promotion, intervention, or treatment
                    services; and
                      (B) provides services or programs described
                    in subsection (a) that are evidence-based or
                    that have been scientifically demonstrated to
                    show promise but would benefit from further
                    applied development.
      (c) Application.--An eligible entity seeking a grant 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) Use of Funds for Early Intervention and Treatment
    Programs.--An eligible entity may use amounts awarded under a
    grant under subsection (a)(1) to carry out the following:
              (1) Provide age-appropriate mental health promotion
            and early intervention services or mental illness
            treatment services, which may include specialized
            programs, for eligible children at significant risk of
            developing, showing early signs of, or having been
            diagnosed with a mental illness, including a serious
            emotional disturbance. Such services may include social
            and behavioral services as well as multigenerational
            therapy and other services that support the caregiving
            relationship.
              (2) Provide training for health care professionals
            with expertise in infant and early childhood mental
            health care with respect to appropriate and relevant
            integration with other disciplines such as primary care
            clinicians, early intervention specialists, child
            welfare staff, home visitors, early care and education
            providers, and others who work with young children and
            families.
              (3) Provide mental health consultation to personnel
            of early care and education programs (including
            licensed or regulated center-based and home-based child
            care, home visiting, preschool special education, and
            early intervention programs) who work with children and
            families.
              (4) Provide training for mental health clinicians in
            infant and early childhood in promising and evidence-
            based practices and models for infant and early
            childhood mental health treatment and early
            intervention, including with regard to practices for
            identifying and treating mental illness and behavioral
            disorders of infants and children resulting from
            exposure or repeated exposure to adverse childhood
            experiences or childhood trauma.
              (5) Provide age-appropriate assessment, diagnostic,
            and intervention services for eligible children,
            including early mental health promotion, intervention,
            and treatment services.
      (e) Matching Funds.--The Secretary may not award a grant
    under this section to an eligible entity unless the eligible
    entity agrees, with respect to the costs to be incurred by the
    eligible entity in carrying out the activities described in
    subsection (d), to make available non-Federal contributions (in
    cash or in kind) toward such costs in an amount that is not
    less than 10 percent of the total amount of Federal funds
    provided in the grant.
      (f) Authorization of Appropriations.--To carry out this
    section, there are authorized to be appropriated [$20,000,000
    for the period of fiscal years 2018 through 2022] $50,000,000
    for the period of fiscal years 2023 through 2027.

               *       *       *       *       *       *       *

       TITLE V--SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

                  Part A--Organization and General Authorities

    SEC. 501. SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION.

      (a) Establishment.--The Substance Abuse and Mental Health
    Services Administration (hereafter referred to in this title as
    the ``Administration'') is an agency of the Service.
      (b) Centers.--The following Centers are agencies of the
    Administration:
              (1) The Center for Substance Abuse Treatment.
              (2) The Center for Substance Abuse Prevention.
              (3) The Center for Mental Health Services.
      (c) Assistant Secretary and Deputy Assistant Secretary.--
              (1) Assistant secretary.--The Administration shall be
            headed by an official to be known as the Assistant
            Secretary for Mental Health and Substance Use
            (hereinafter in this title referred to as the
            ``Assistant Secretary'') who shall be appointed by the
            President, by and with the advice and consent of the
            Senate.
              (2) Deputy assistant secretary.--The Assistant
            Secretary, with the approval of the Secretary, may
            appoint a Deputy Assistant Secretary and may employ and
            prescribe the functions of such officers and employees,
            including attorneys, as are necessary to administer the
            activities to be carried out through the
            Administration.
      (d) Authorities.--The Secretary, acting through the Assistant
    Secretary, shall--
              (1) supervise the functions of the Centers of the
            Administration in order to assure that the programs
            carried out through each such Center receive
            appropriate and equitable support and that there is
            cooperation among the Centers in the implementation of
            such programs;
              (2) establish and implement, through the respective
            Centers, a comprehensive program to improve the
            provision of treatment and related services to
            individuals with respect to substance use disorders and
            mental illness and to improve prevention services,
            promote mental health and protect the legal rights of
            individuals with mental illnesses and individuals with
            substance use disorders;
              (3) carry out the administrative and financial
            management, policy development and planning,
            evaluation, knowledge dissemination, and public
            information functions that are required for the
            implementation of this title;
              (4) assure that the Administration conduct and
            coordinate demonstration projects, evaluations, and
            service system assessments and other activities
            necessary to improve the availability and quality of
            treatment, prevention and related services;
              (5) support activities that will improve the
            provision of treatment, prevention and related
            services, including the development of national mental
            health and substance use disorder goals and model
            programs;
              (6) in cooperation with the National Institutes of
            Health, the Centers for Disease Control and Prevention,
            and the Health Resources and Services Administration,
            develop educational materials and intervention
            strategies to reduce the risks of HIV, hepatitis,
            tuberculosis, and other communicable diseases among
            individuals with mental or substance use disorders, and
            to develop appropriate mental health services for
            individuals with such diseases or disorders;
              (7) coordinate Federal policy with respect to the
            provision of treatment services for substance use
            disorders, including services that utilize drugs or
            devices approved or cleared by the Food and Drug
            Administration for the treatment of substance use
            disorders;
              (8) conduct programs, and assure the coordination of
            such programs with activities of the National
            Institutes of Health and the Agency for Healthcare
            Research and Quality, as appropriate, to evaluate the
            process, outcomes and community impact of prevention
            and treatment services and systems of care in order to
            identify the manner in which such services can most
            effectively be provided;
              (9) collaborate with the Director of the National
            Institutes of Health in the development and maintenance
            of a system by which the relevant research findings of
            the National Institute on Drug Abuse, the National
            Institute on Alcohol Abuse and Alcoholism, the National
            Institute of Mental Health, and, as appropriate, the
            Agency for Healthcare Research and Quality are
            disseminated to service providers in a manner designed
            to improve the delivery and effectiveness of
            prevention, treatment, and recovery support services
            and are appropriately incorporated into programs
            carried out by the Administration;
              (10) encourage public and private entities that
            provide health insurance to provide benefits for
            substance use disorder and mental health services;
              (11) work with relevant agencies of the Department of
            Health and Human Services on integrating mental health
            promotion and substance use disorder prevention with
            general health promotion and disease prevention and
            integrating mental and substance use disorders
            treatment services with physical health treatment
            services;
              (12) monitor compliance by hospitals and other
            facilities with the requirements of sections 542 and
            543;
              (13) with respect to grant programs authorized under
            this title or part B of title XIX, or grant programs
            otherwise funded by the Administration--
                      (A) require that all grants that are awarded
                    for the provision of services are subject to
                    performance and outcome evaluations;
                      (B) ensure that the director of each Center
                    of the Administration consistently documents
                    the application of criteria when awarding
                    grants and the ongoing oversight of grantees
                    after such grants are awarded;
                      (C) require that all grants that are awarded
                    to entities other than States are awarded only
                    after the State in which the entity intends to
                    provide services--
                              (i) is notified of the pendency of
                            the grant application; and
                              (ii) is afforded an opportunity to
                            comment on the merits of the
                            application; and
                      (D) inform a State when any funds are awarded
                    through such a grant to any entity within such
                    State;
              (14) assure that services provided with amounts
            appropriated under this title are provided bilingually,
            if appropriate;
              (15) improve coordination among prevention programs,
            treatment facilities and nonhealth care systems such as
            employers, labor unions, and schools, and encourage the
            adoption of employee assistance programs and student
            assistance programs;
              (16) maintain a clearinghouse for substance use
            disorder information, including evidence-based and
            promising best practices for prevention, treatment, and
            recovery support services for individuals with mental
            and substance use disorders, to assure the widespread
            dissemination of such information to States, political
            subdivisions, educational agencies and institutions,
            treatment providers, and the general public;
              (17) in collaboration with the National Institute on
            Aging, and in consultation with the National Institute
            on Drug Abuse, the National Institute on Alcohol Abuse
            and Alcoholism and the National Institute of Mental
            Health, as appropriate, promote and evaluate substance
            use disorder services for older Americans in need of
            such services, and mental health services for older
            Americans who are seriously mentally ill;
              (18) promote the coordination of service programs
            conducted by other departments, agencies, organizations
            and individuals that are or may be related to the
            problems of individuals suffering from mental illness
            or substance abuse, including liaisons with the Social
            Security Administration, Centers for Medicare &
            Medicaid Services, and other programs of the
            Department, as well as liaisons with the Department of
            Education, Department of Justice, and other Federal
            Departments and offices, as appropriate;
              (19) consult with State, local, and tribal
            governments, nongovernmental entities, and individuals
            with mental illness, particularly adults with a serious
            mental illness, children with a serious emotional
            disturbance, and the family members of such adults and
            children, with respect to improving community-based and
            other mental health services;
              (20) collaborate with the Secretary of Defense and
            the Secretary of Veterans Affairs to improve the
            provision of mental and substance use disorder services
            provided by the Department of Defense and the
            Department of Veterans Affairs to members of the Armed
            Forces, veterans, and the family members of such
            members and veterans, including through the provision
            of services using the telehealth capabilities of the
            Department of Defense and the Department of Veterans
            Affairs;
              (21) collaborate with the heads of relevant Federal
            agencies and departments, States, communities, and
            nongovernmental experts to improve mental and substance
            use disorders services for chronically homeless
            individuals, including by designing strategies to
            provide such services in supportive housing;
              (22) work with States and other stakeholders to
            develop and support activities to recruit and retain a
            workforce addressing mental and substance use
            disorders;
              (23) collaborate with the Attorney General and
            representatives of the criminal justice system to
            improve mental and substance use disorders services for
            individuals who have been arrested or incarcerated;
              (24) after providing an opportunity for public input,
            set standards for grant programs under this title for
            mental and substance use disorders services and
            prevention programs, which standards may address--
                      (A) the capacity of the grantee to implement
                    the award;
                      (B) requirements for the description of the
                    program implementation approach;
                      (C) the extent to which the grant plan
                    submitted by the grantee as part of its
                    application must explain how the grantee will
                    reach the population of focus and provide a
                    statement of need, which may include
                    information on how the grantee will increase
                    access to services and a description of
                    measurable objectives for improving outcomes;
                      (D) the extent to which the grantee must
                    collect and report on required performance
                    measures; and
                      (E) the extent to which the grantee is
                    proposing to use evidence-based practices;
                    [and]
              (25) advance, through existing programs, the use of
            performance metrics, including those based on the
            recommendations on performance metrics from the
            Assistant Secretary for Planning and Evaluation under
            section 6021(d) of the Helping Families in Mental
            Health Crisis Reform Act of 2016[.]; and
              (26) collaborate with national accrediting entities,
            reputable providers, organizations or individuals with
            established expertise in delivery of recovery housing
            services, States, Federal agencies (including the
            Department of Health and Human Services, the Department
            of Housing and Urban Development, and the agencies
            listed in section 550(e)(2)(B)), and other relevant
            stakeholders, to promote the availability of high-
            quality recovery housing and services for individuals
            with a substance use disorder.
      (e) Associate Administrator for Alcohol Prevention and
    Treatment Policy.--
              (1) In general.--There may be in the Administration
            an Associate Administrator for Alcohol Prevention and
            Treatment Policy to whom the Assistant Secretary may
            delegate the functions of promoting, monitoring, and
            evaluating service programs for the prevention and
            treatment of alcoholism and alcohol abuse within the
            Center for Substance Abuse Prevention, the Center for
            Substance Abuse Treatment and the Center for Mental
            Health Services, and coordinating such programs among
            the Centers, and among the Centers and other public and
            private entities. The Associate Administrator also may
            ensure that alcohol prevention, education, and policy
            strategies are integrated into all programs of the
            Centers that address substance abuse prevention,
            education, and policy, and that the Center for
            Substance Abuse Prevention addresses the Healthy People
            2010 goals and the National Dietary Guidelines of the
            Department of Health and Human Services and the
            Department of Agriculture related to alcohol
            consumption.
              (2) Plan.--
                      (A) The Assistant Secretary, acting through
                    the Associate Administrator for Alcohol
                    Prevention and Treatment Policy, shall develop,
                    and periodically review and as appropriate
                    revise, a plan for programs and policies to
                    treat and prevent alcoholism and alcohol abuse.
                    The plan shall be developed (and reviewed and
                    revised) in collaboration with the Directors of
                    the Centers of the Administration and in
                    consultation with members of other Federal
                    agencies and public and private entities.
                      (B) Not later than 1 year after the date of
                    the enactment of the ADAMHA Reorganization Act,
                    the Assistant Secretary shall submit to the
                    Congress the first plan developed under
                    subparagraph (A).
              (3) Report.--
                      (A) Not less than once during each 2 years,
                    the Assistant Secretary, acting through the
                    Associate Administrator for Alcohol Prevention
                    and Treatment Policy, shall prepare a report
                    describing the alcoholism and alcohol abuse
                    prevention and treatment programs undertaken by
                    the Administration and its agencies, and the
                    report shall include a detailed statement of
                    the expenditures made for the activities
                    reported on and the personnel used in
                    connection with such activities.
                      (B) Each report under subparagraph (A) shall
                    include a description of any revisions in the
                    plan under paragraph (2) made during the
                    preceding 2 years.
                      (C) Each report under subparagraph (A) shall
                    be submitted to the Assistant Secretary for
                    inclusion in the biennial report under
                    subsection (m).
      (f) Associate Administrator for Women's Services.--
              (1) Appointment.--The Assistant Secretary, with the
            approval of the Secretary, shall appoint an Associate
            Administrator for Women's Services who shall report
            directly to the Assistant Secretary.
              (2) Duties.--The Associate Administrator appointed
            under paragraph (1) shall--
                      (A) establish a committee to be known as the
                    Coordinating Committee for Women's Services
                    (hereafter in this subparagraph referred to as
                    the ``Coordinating Committee''), which shall be
                    composed of the Directors of the agencies of
                    the Administration (or the designees of the
                    Directors);
                      (B) acting through the Coordinating
                    Committee, with respect to women's substance
                    abuse and mental health services--
                              (i) identify the need for such
                            services, and make an estimate each
                            fiscal year of the funds needed to
                            adequately support the services;
                              (ii) identify needs regarding the
                            coordination of services;
                              (iii) encourage the agencies of the
                            Administration to support such
                            services; and
                              (iv) assure that the unique needs of
                            minority women, including Native
                            American, Hispanic, African-American
                            and Asian women, are recognized and
                            addressed within the activities of the
                            Administration; and
                      (C) establish an advisory committee to be
                    known as the Advisory Committee for Women's
                    Services, which shall be composed of not more
                    than 10 individuals, a majority of whom shall
                    be women, who are not officers or employees of
                    the Federal Government, to be appointed by the
                    Assistant Secretary from among physicians,
                    practitioners, treatment providers, and other
                    health professionals, whose clinical practice,
                    specialization, or professional expertise
                    includes a significant focus on women's
                    substance abuse and mental health conditions,
                    that shall--
                              (i) advise the Associate
                            Administrator on appropriate activities
                            to be undertaken by the agencies of the
                            Administration with respect to women's
                            substance abuse and mental health
                            services, including services which
                            require a multidisciplinary approach;
                              (ii) collect and review data,
                            including information provided by the
                            Secretary (including the material
                            referred to in paragraph (3)), and
                            report biannually to the Assistant
                            Secretary regarding the extent to which
                            women are represented among senior
                            personnel, and make recommendations
                            regarding improvement in the
                            participation of women in the workforce
                            of the Administration; and
                              (iii) prepare, for inclusion in the
                            biennial report required pursuant to
                            subsection (m), a description of
                            activities of the Committee, including
                            findings made by the Committee
                            regarding--
                                      (I) the extent of
                                    expenditures made for women's
                                    substance abuse and mental
                                    health services by the agencies
                                    of the Administration; and
                                      (II) the estimated level of
                                    funding needed for substance
                                    abuse and mental health
                                    services to meet the needs of
                                    women;
                      (D) improve the collection of data on women's
                    health by--
                              (i) reviewing the current data at the
                            Administration to determine its
                            uniformity and applicability;
                              (ii) developing standards for all
                            programs funded by the Administration
                            so that data are, to the extent
                            practicable, collected and reported
                            using common reporting formats,
                            linkages and definitions; and
                              (iii) reporting to the Assistant
                            Secretary a plan for incorporating the
                            standards developed under clause (ii)
                            in all Administration programs and a
                            plan to assure that the data so
                            collected are accessible to health
                            professionals, providers, researchers,
                            and members of the public; and
                      (E) shall establish, maintain, and operate a
                    program to provide information on women's
                    substance abuse and mental health services.
              (3) Study.--
                      (A) The Secretary, acting through the
                    Assistant Secretary for Personnel, shall
                    conduct a study to evaluate the extent to which
                    women are represented among senior personnel at
                    the Administration.
                      (B) Not later than 90 days after the date of
                    the enactment of the ADAMHA Reorganization Act,
                    the Assistant Secretary for Personnel shall
                    provide the Advisory Committee for Women's
                    Services with a study plan, including the
                    methodology of the study and any sampling
                    frames. Not later than 180 days after such date
                    of enactment, the Assistant Secretary shall
                    prepare and submit directly to the Advisory
                    Committee a report concerning the results of
                    the study conducted under subparagraph (A).
                      (C) The Secretary shall prepare and provide
                    to the Advisory Committee for Women's Services
                    any additional data as requested.
              (4) Office.--Nothing in this subsection shall be
            construed to preclude the Secretary from establishing
            within the Substance Abuse and Mental Health
            Administration an Office of Women's Health.
              (5) Definition.--For purposes of this subsection, the
            term ``women's substance abuse and mental health
            conditions'', with respect to women of all age, ethnic,
            and racial groups, means all aspects of substance abuse
            and mental illness--
                      (A) unique to or more prevalent among women;
                    or
                      (B) with respect to which there have been
                    insufficient services involving women or
                    insufficient data.
      (g) Chief Medical Officer.--
              (1) In general.--The Assistant Secretary, with the
            approval of the Secretary, shall appoint a Chief
            Medical Officer to serve within the Administration.
              (2) Eligible candidates.--The Assistant Secretary
            shall select the Chief Medical Officer from among
            individuals who--
                      (A) have a doctoral degree in medicine or
                    osteopathic medicine;
                      (B) have experience in the provision of
                    mental or substance use disorder services;
                      (C) have experience working with mental or
                    substance use disorder programs;
                      (D) have an understanding of biological,
                    psychosocial, and pharmaceutical treatments of
                    mental or substance use disorders; and
                      (E) are licensed to practice medicine in one
                    or more States.
              (3) Duties.--The Chief Medical Officer shall--
                      (A) serve as a liaison between the
                    Administration and providers of mental and
                    substance use disorders prevention, treatment,
                    and recovery services;
                      (B) assist the Assistant Secretary in the
                    evaluation, organization, integration, and
                    coordination of programs operated by the
                    Administration;
                      (C) promote evidence-based and promising best
                    practices, including culturally and
                    linguistically appropriate practices, as
                    appropriate, for the prevention and treatment
                    of, and recovery from, mental and substance use
                    disorders, including serious mental illness and
                    serious emotional disturbances;
                      (D) participate in regular strategic planning
                    with the Administration;
                      (E) coordinate with the Assistant Secretary
                    for Planning and Evaluation to assess the use
                    of performance metrics to evaluate activities
                    within the Administration related to mental and
                    substance use disorders; and
                      (F) coordinate with the Assistant Secretary
                    to ensure mental and substance use disorders
                    grant programs within the Administration
                    consistently utilize appropriate performance
                    metrics and evaluation designs.
      (h) Services of Experts.--
              (1) In general.--The Assistant Secretary may obtain
            (in accordance with section 3109 of title 5, United
            States Code, but without regard to the limitation in
            such section on the number of days or the period of
            service) the services of not more than 20 experts or
            consultants who have professional qualifications. Such
            experts and consultants shall be obtained for the
            Administration and for each of its agencies.
              (2) Compensation and expenses.--
                      (A) Experts and consultants whose services
                    are obtained under paragraph (1) shall be paid
                    or reimbursed for their expenses associated
                    with traveling to and from their assignment
                    location in accordance with sections 5724,
                    5724a(a), 5724a(c), and 5726(c) of title 5,
                    United States Code.
                      (B) Expenses specified in subparagraph (A)
                    may not be allowed in connection with the
                    assignment of an expert or consultant whose
                    services are obtained under paragraph (1),
                    unless and until the expert or consultant
                    agrees in writing to complete the entire period
                    of assignment or one year, whichever is
                    shorter, unless separated or reassigned for
                    reasons beyond the control of the expert or
                    consultant that are acceptable to the
                    Secretary. If the expert or consultant violates
                    the agreement, the money spent by the United
                    States for the expenses specified in
                    subparagraph (A) is recoverable from the expert
                    or consultant as a debt of the United States.
                    The Secretary may waive in whole or in part a
                    right of recovery under this subparagraph.
      (i) Peer Review Groups.--The Assistant Secretary shall,
    without regard to the provisions of title 5, United States
    Code, governing appointments in the competitive service, and
    without regard to the provisions of chapter 51 and subchapter
    III of chapter 53 of such title, relating to classification and
    General Schedule pay rates, establish such peer review groups
    and program advisory committees as are needed to carry out the
    requirements of this title and appoint and pay members of such
    groups, except that officers and employees of the United States
    shall not receive additional compensation for services as
    members of such groups. The Federal Advisory Committee Act
    shall not apply to the duration of a peer review group
    appointed under this subsection.
      (j) Voluntary Services.--The Assistant Secretary may accept
    voluntary and uncompensated services.
      (k) Administration.--The Assistant Secretary shall ensure
    that programs and activities assigned under this title to the
    Administration are fully administered by the respective Centers
    to which such programs and activities are assigned.
      (l) Strategic Plan.--
              (1) In general.--Not later than September 30, 2018,
            and every 4 years thereafter, the Assistant Secretary
            shall develop and carry out a strategic plan in
            accordance with this subsection for the planning and
            operation of activities carried out by the
            Administration, including evidence-based programs.
              (2) Coordination.--In developing and carrying out the
            strategic plan under this subsection, the Assistant
            Secretary shall take into consideration the findings
            and recommendations of the Assistant Secretary for
            Planning and Evaluation under section 6021(d) of the
            Helping Families in Mental Health Crisis Reform Act of
            2016 and the report of the Interdepartmental Serious
            Mental Illness Coordinating Committee under [section
            6031 of such Act] section 501B of this Act.
              (3) Publication of plan.--Not later than September
            30, 2018, and every 4 years thereafter, the Assistant
            Secretary shall--
                      (A) submit the strategic plan developed under
                    paragraph (1) to the Committee on Energy and
                    Commerce and the Committee on Appropriations of
                    the House of Representatives and the Committee
                    on Health, Education, Labor, and Pensions and
                    the Committee on Appropriations of the Senate;
                    and
                      (B) post such plan on the Internet website of
                    the Administration.
              (4) Contents.--The strategic plan developed under
            paragraph (1) shall--
                      (A) identify strategic priorities, goals, and
                    measurable objectives for mental and substance
                    use disorders activities and programs operated
                    and supported by the Administration, including
                    priorities to prevent or eliminate the burden
                    of mental and substance use disorders;
                      (B) identify ways to improve the quality of
                    services for individuals with mental and
                    substance use disorders, and to reduce
                    homelessness, arrest, incarceration, violence,
                    including self-directed violence, and
                    unnecessary hospitalization of individuals with
                    a mental or substance use disorder, including
                    adults with a serious mental illness or
                    children with a serious emotional disturbance;
                      (C) ensure that programs provide, as
                    appropriate, access to effective and evidence-
                    based prevention, diagnosis, intervention,
                    treatment, and recovery services, including
                    culturally and linguistically appropriate
                    services, as appropriate, for individuals with
                    a mental or substance use disorder;
                      (D) identify opportunities to collaborate
                    with the Health Resources and Services
                    Administration to develop or improve--
                              (i) initiatives to encourage
                            individuals to pursue careers
                            (especially in rural and underserved
                            areas and with rural and underserved
                            populations) as psychiatrists,
                            including child and adolescent
                            psychiatrists, psychologists,
                            psychiatric nurse practitioners,
                            physician assistants, clinical social
                            workers, certified peer support
                            specialists, licensed professional
                            counselors, or other licensed or
                            certified mental health or substance
                            use disorder professionals, including
                            such professionals specializing in the
                            diagnosis, evaluation, or treatment of
                            adults with a serious mental illness or
                            children with a serious emotional
                            disturbance; and
                              (ii) a strategy to improve the
                            recruitment, training, and retention of
                            a workforce for the treatment of
                            individuals with mental or substance
                            use disorders, or co-occurring
                            disorders;
                      (E) identify opportunities to improve
                    collaboration with States, local governments,
                    communities, and Indian tribes and tribal
                    organizations (as such terms are defined in
                    section 4 of the Indian Self-Determination and
                    Education Assistance Act); and
                      (F) specify a strategy to disseminate
                    evidence-based and promising best practices
                    related to prevention, diagnosis, early
                    intervention, treatment, and recovery services
                    related to mental illness, particularly for
                    adults with a serious mental illness and
                    children with a serious emotional disturbance,
                    and for individuals with a substance use
                    disorder.
      (m) Biennial Report Concerning Activities and Progress.--Not
    later than September 30, 2020, and every 2 years thereafter,
    the Assistant Secretary shall prepare and submit to the
    Committee on Energy and Commerce and the Committee on
    Appropriations of the House of Representatives and the
    Committee on Health, Education, Labor, and Pensions and the
    Committee on Appropriations of the Senate, and post on the
    Internet website of the Administration, a report containing at
    a minimum--
              (1) a review of activities conducted or supported by
            the Administration, including progress toward strategic
            priorities, goals, and objectives identified in the
            strategic plan developed under subsection (l);
              (2) an assessment of programs and activities carried
            out by the Assistant Secretary, including the extent to
            which programs and activities under this title and part
            B of title XIX meet identified goals and performance
            measures developed for the respective programs and
            activities;
              (3) a description of the progress made in addressing
            gaps in mental and substance use disorders prevention,
            treatment, and recovery services and improving outcomes
            by the Administration, including with respect to
            serious mental illnesses, serious emotional
            disturbances, and co-occurring disorders;
              (4) a description of the manner in which the
            Administration coordinates and partners with other
            Federal agencies and departments related to mental and
            substance use disorders, including activities related
            to--
                      (A) the implementation and dissemination of
                    research findings into improved programs,
                    including with respect to how advances in
                    serious mental illness and serious emotional
                    disturbance research have been incorporated
                    into programs;
                      (B) the recruitment, training, and retention
                    of a mental and substance use disorders
                    workforce;
                      (C) the integration of mental disorder
                    services, substance use disorder services, and
                    physical health services;
                      (D) homelessness; and
                      (E) veterans;
              (5) a description of the manner in which the
            Administration promotes coordination by grantees under
            this title, and part B of title XIX, with State or
            local agencies; and
              (6) a description of the activities carried out under
            section 501A(e), with respect to mental and substance
            use disorders, including--
                      (A) the number and a description of grants
                    awarded;
                      (B) the total amount of funding for grants
                    awarded;
                      (C) a description of the activities supported
                    through such grants, including outcomes of
                    programs supported; and
                      (D) information on how the National Mental
                    Health and Substance Use Policy Laboratory is
                    consulting with the Assistant Secretary for
                    Planning and Evaluation and collaborating with
                    the Center for Substance Abuse Treatment, the
                    Center for Substance Abuse Prevention, the
                    Center for Behavioral Health Statistics and
                    Quality, and the Center for Mental Health
                    Services to carry out such activities; and
              (7) recommendations made by the Assistant Secretary
            for Planning and Evaluation under section 6021 of the
            Helping Families in Mental Health Crisis Reform Act of
            2016 to improve programs within the Administration, and
            actions taken in response to such recommendations to
            improve programs within the Administration.
    The Assistant Secretary may meet reporting requirements
    established under this title by providing the contents of such
    reports as an addendum to the biennial report established under
    this subsection, notwithstanding the timeline of other
    reporting requirements in this title. Nothing in this
    subsection shall be construed to alter the content requirements
    of such reports or authorize the Assistant Secretary to alter
    the timeline of any such reports to be less frequent than
    biennially, unless as specified in this title.
      (n) Applications for Grants and Contracts.--With respect to
    awards of grants, cooperative agreements, and contracts under
    this title, the Assistant Secretary, or the Director of the
    Center involved, as the case may be, may not make such an award
    unless--
              (1) an application for the award is submitted to the
            official involved;
              (2) with respect to carrying out the purpose for
            which the award is to be provided, the application
            provides assurances of compliance satisfactory to such
            official; and
              (3) the application is otherwise in such form, is
            made in such manner, and contains such agreements,
            assurances, and information as the official determines
            to be necessary to carry out the purpose for which the
            award is to be provided.
      (o) Emergency Response.--
              (1) In general.--Notwithstanding section 504 and
            except as provided in paragraph (2), the Secretary may
            use not to exceed 2.5 percent of all amounts
            appropriated under this title for a fiscal year to make
            noncompetitive grants, contracts or cooperative
            agreements to public entities to enable such entities
            to address emergency substance abuse or mental health
            needs in local communities.
              (2) Exceptions.--Amounts appropriated under part C
            shall not be subject to paragraph (1).
              (3) Emergencies.--The Secretary shall establish
            criteria for determining that a substance abuse or
            mental health emergency exists and publish such
            criteria in the Federal Register prior to providing
            funds under this subsection.
              (4) Emergency response.--Amounts made available for
            carrying out this subsection shall remain available
            through the end of the fiscal year following the fiscal
            year for which such amounts are appropriated.
      (p) Limitation on the Use of Certain Information.--No
    information, if an establishment or person supplying the
    information or described in it is identifiable, obtained in the
    course of activities undertaken or supported under section 505
    may be used for any purpose other than the purpose for which it
    was supplied unless such establishment or person has consented
    (as determined under regulations of the Secretary) to its use
    for such other purpose. Such information may not be published
    or released in other form if the person who supplied the
    information or who is described in it is identifiable unless
    such person has consented (as determined under regulations of
    the Secretary) to its publication or release in other form.
      (q) Authorization of Appropriations.--For the purpose of
    providing grants, cooperative agreements, and contracts under
    this section, there are authorized to be appropriated
    $25,000,000 for fiscal year 2001, and such sums as may be
    necessary for each of the fiscal years 2002 and 2003.

    SEC. 501A. NATIONAL MENTAL HEALTH AND SUBSTANCE USE POLICY LABORATORY.

      (a) In General.--There shall be established within the
    Administration a National Mental Health and Substance Use
    Policy Laboratory (referred to in this section as the
    ``Laboratory'').
      (b) Responsibilities.--The Laboratory shall--
              (1) continue to carry out the authorities and
            activities that were in effect for the Office of
            Policy, Planning, and Innovation as such Office existed
            prior to the date of enactment of the Helping Families
            in Mental Health Crisis Reform Act of 2016;
              (2) identify, coordinate, and facilitate the
            implementation of policy changes likely to have a
            significant effect on mental health, mental illness,
            recovery supports, and the prevention and treatment of
            substance use disorder services;
              (3) work with the Center for Behavioral Health
            Statistics and Quality to collect, as appropriate,
            information from grantees under programs operated by
            the Administration in order to evaluate and disseminate
            information on evidence-based practices, including
            culturally and linguistically appropriate services, as
            appropriate, and service delivery models;
              (4) provide leadership in identifying and
            coordinating policies and programs, including evidence-
            based programs, related to mental and substance use
            disorders;
              (5) periodically review programs and activities
            operated by the Administration relating to the
            diagnosis or prevention of, treatment for, and recovery
            from, mental and substance use disorders to--
                      (A) identify any such programs or activities
                    that are duplicative;
                      (B) identify any such programs or activities
                    that are not evidence-based, effective, or
                    efficient; and
                      (C) formulate recommendations for
                    coordinating, eliminating, or improving
                    programs or activities identified under
                    subparagraph (A) or (B) and merging such
                    programs or activities into other successful
                    programs or activities;
              (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
              (7) carry out other activities as deemed necessary to
            continue to encourage innovation and disseminate
            evidence-based programs and practices.
      (c) Evidence-based Practices and Service Delivery Models.--
              (1) In general.--In carrying out subsection (b)(3),
            the Laboratory--
                      (A) may give preference to models that
                    improve--
                              (i) the coordination between mental
                            health and physical health providers;
                              (ii) the coordination among such
                            providers and the justice and
                            corrections system; and
                              (iii) the cost effectiveness,
                            quality, effectiveness, and efficiency
                            of health care services furnished to
                            adults with a serious mental illness,
                            children with a serious emotional
                            disturbance, or individuals in a mental
                            health crisis; and
                      (B) may include clinical protocols and
                    practices that address the needs of individuals
                    with early serious mental illness.
              (2) Consultation.--In carrying out this section, the
            Laboratory shall consult with--
                      (A) the Chief Medical Officer appointed under
                    section 501(g);
                      (B) representatives of the National Institute
                    of Mental Health, the National Institute on
                    Drug Abuse, and the National Institute on
                    Alcohol Abuse and Alcoholism, on an ongoing
                    basis;
                      (C) other appropriate Federal agencies;
                      (D) clinical and analytical experts with
                    expertise in psychiatric medical care and
                    clinical psychological care, health care
                    management, education, corrections health care,
                    and mental health court systems, as
                    appropriate; and
                      (E) other individuals and agencies as
                    determined appropriate by the Assistant
                    Secretary.
      (d) Deadline for Beginning Implementation.--The Laboratory
    shall begin implementation of this section not later than
    January 1, 2018.
      (e) Promoting Innovation.--
              (1) In general.--The Assistant Secretary, in
            coordination with the Laboratory, may award grants to
            States, local governments, [Indian tribes or tribal
            organizations] Indian Tribes or Tribal organizations
            (as such terms are defined in section 4 of the Indian
            Self-Determination and Education Assistance Act),
            educational institutions, and nonprofit organizations
            to develop evidence-based interventions, including
            culturally and linguistically appropriate services, as
            appropriate, for--
                      (A) evaluating a model that has been
                    scientifically demonstrated to show promise,
                    but would benefit from further applied
                    development, for--
                              (i) enhancing the prevention,
                            diagnosis, intervention, and treatment
                            of, and recovery from, mental illness,
                            serious emotional disturbances,
                            substance use disorders, and co-
                            occurring illness or disorders; or
                              (ii) integrating or coordinating
                            physical health services and mental and
                            substance use disorders services; and
                      (B) expanding, replicating, or scaling
                    evidence-based programs across a wider area to
                    enhance effective screening, early diagnosis,
                    intervention, and treatment with respect to
                    mental illness, serious mental illness, serious
                    emotional disturbances, and substance use
                    disorders, primarily by--
                              (i) applying such evidence-based
                            programs to the delivery of care,
                            including by training staff in
                            effective evidence-based treatments; or
                              (ii) integrating such evidence-based
                            programs into models of care across
                            specialties and jurisdictions.
              (2) Consultation.--In awarding grants under this
            subsection, the Assistant Secretary shall, as
            appropriate, consult with the Chief Medical Officer,
            appointed under section 501(g), the advisory councils
            described in section 502, the National Institute of
            Mental Health, the National Institute on Drug Abuse,
            and the National Institute on Alcohol Abuse and
            Alcoholism, as appropriate.
              [(3) Authorization of appropriations.--There are
            authorized to be appropriated--
                      [(A) to carry out paragraph (1)(A),
                    $7,000,000 for the period of fiscal years 2018
                    through 2020; and
                      [(B) to carry out paragraph (1)(B),
                    $7,000,000 for the period of fiscal years 2018
                    through 2020.]
      (f) Authorization of Appropriations.--To carry out this
    section, there is authorized to be appropriated $10,000,000 for
    each of fiscal years 2023 through 2027.

    SEC. 501B. INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING
                        COMMITTEE.

      (a) Establishment.--
              (1) In general.--The Secretary of Health and Human
            Services, or the designee of the Secretary, shall
            establish a committee to be known as the
            Interdepartmental Serious Mental Illness Coordinating
            Committee (in this section referred to as the
            ``Committee'').
              (2) Federal advisory committee act.--Except as
            provided in this section, the provisions of the Federal
            Advisory Committee Act (5 U.S.C. App.) shall apply to
            the Committee.
      (b) Meetings.--The Committee shall meet not fewer than 2
    times each year.
      (c) Responsibilities.--The Committee shall submit, on a
    biannual basis, to Congress and any other relevant Federal
    department or agency a report including--
              (1) a summary of advances in serious mental illness
            and serious emotional disturbance research related to
            the prevention of, diagnosis of, intervention in, and
            treatment and recovery of serious mental illnesses,
            serious emotional disturbances, and advances in access
            to services and support for adults with a serious
            mental illness or children with a serious emotional
            disturbance;
              (2) an evaluation of the effect Federal programs
            related to serious mental illness have on public
            health, including public health outcomes such as--
                      (A) rates of suicide, suicide attempts,
                    incidence and prevalence of serious mental
                    illnesses, serious emotional disturbances, and
                    substance use disorders, overdose, overdose
                    deaths, emergency hospitalizations, emergency
                    room boarding, preventable emergency room
                    visits, interaction with the criminal justice
                    system, homelessness, and unemployment;
                      (B) increased rates of employment and
                    enrollment in educational and vocational
                    programs;
                      (C) quality of mental and substance use
                    disorders treatment services; or
                      (D) any other criteria as may be determined
                    by the Secretary; and
              (3) specific recommendations for actions that
            agencies can take to better coordinate the
            administration of mental health services for adults
            with a serious mental illness or children with a
            serious emotional disturbance.
      (d) Membership.--
              (1) Federal members.--The Committee shall be composed
            of the following Federal representatives, or the
            designees of such representatives--
                      (A) the Secretary of Health and Human
                    Services, who shall serve as the Chair of the
                    Committee;
                      (B) the Assistant Secretary for Mental Health
                    and Substance Use;
                      (C) the Attorney General;
                      (D) the Secretary of Veterans Affairs;
                      (E) the Secretary of Defense;
                      (F) the Secretary of Housing and Urban
                    Development;
                      (G) the Secretary of Education;
                      (H) the Secretary of Labor;
                      (I) the Administrator of the Centers for
                    Medicare & Medicaid Services; and
                      (J) the Commissioner of Social Security.
              (2) Non-federal members.--The Committee shall also
            include not less than 14 non-Federal public members
            appointed by the Secretary of Health and Human
            Services, of which--
                      (A) at least 2 members shall be an individual
                    who has received treatment for a diagnosis of a
                    serious mental illness;
                      (B) at least 1 member shall be a parent or
                    legal guardian of an adult with a history of a
                    serious mental illness or a child with a
                    history of a serious emotional disturbance;
                      (C) at least 1 member shall be a
                    representative of a leading research, advocacy,
                    or service organization for adults with a
                    serious mental illness;
                      (D) at least 2 members shall be--
                              (i) a licensed psychiatrist with
                            experience in treating serious mental
                            illnesses;
                              (ii) a licensed psychologist with
                            experience in treating serious mental
                            illnesses or serious emotional
                            disturbances;
                              (iii) a licensed clinical social
                            worker with experience treating serious
                            mental illnesses or serious emotional
                            disturbances; or
                              (iv) a licensed psychiatric nurse,
                            nurse practitioner, or physician
                            assistant with experience in treating
                            serious mental illnesses or serious
                            emotional disturbances;
                      (E) at least 1 member shall be a licensed
                    mental health professional with a specialty in
                    treating children and adolescents with a
                    serious emotional disturbance;
                      (F) at least 1 member shall be a mental
                    health professional who has research or
                    clinical mental health experience in working
                    with minorities;
                      (G) at least 1 member shall be a mental
                    health professional who has research or
                    clinical mental health experience in working
                    with medically underserved populations;
                      (H) at least 1 member shall be a State
                    certified mental health peer support
                    specialist;
                      (I) at least 1 member shall be a judge with
                    experience in adjudicating cases related to
                    criminal justice or serious mental illness;
                      (J) at least 1 member shall be a law
                    enforcement officer or corrections officer with
                    extensive experience in interfacing with adults
                    with a serious mental illness, children with a
                    serious emotional disturbance, or individuals
                    in a mental health crisis; and
                      (K) at least 1 member shall have experience
                    providing services for homeless individuals and
                    working with adults with a serious mental
                    illness, children with a serious emotional
                    disturbance, or individuals in a mental health
                    crisis.
              (3) Terms.--A member of the Committee appointed under
            paragraph (2) shall serve for a term of 3 years, and
            may be reappointed for 1 or more additional 3-year
            terms. Any member appointed to fill a vacancy for an
            unexpired term shall be appointed for the remainder of
            such term. A member may serve after the expiration of
            the member's term until a successor has been appointed.
      (e) Working Groups.--In carrying out its functions, the
    Committee may establish working groups. Such working groups
    shall be composed of Committee members, or their designees, and
    may hold such meetings as are necessary.
      (f) Sunset.--The Committee shall terminate on September 30,
    2027.

               *       *       *       *       *       *       *

    SEC. 506. GRANTS FOR THE BENEFIT OF HOMELESS INDIVIDUALS.

      (a) In General.--The Secretary shall award grants, contracts
    and cooperative agreements to community-based public and
    private nonprofit entities for the purposes of providing mental
    health and substance use disorder services for homeless
    individuals. In carrying out this section, the Secretary shall
    consult with the Interagency Council on the Homeless,
    established under section 201 of the Stewart B. McKinney
    Homeless Assistance Act (42 U.S.C. 11311).
      (b) Preferences.--In awarding grants, contracts, and
    cooperative agreements under subsection (a), the Secretary
    shall give a preference to--
              (1) entities that provide integrated primary health,
            substance use disorder, and mental health services to
            homeless individuals;
              (2) entities that demonstrate effectiveness in
            serving runaway, homeless, and street youth;
              (3) entities that have experience in providing
            substance use disorder and mental health services to
            homeless individuals;
              (4) entities that demonstrate experience in providing
            housing for individuals in treatment for or in recovery
            from mental illness or a substance use disorder; and
              (5) entities that demonstrate effectiveness in
            serving homeless veterans.
      (c) Services for Certain Individuals.--In awarding grants,
    contracts, and cooperative agreements under subsection (a), the
    Secretary shall not--
              (1) prohibit the provision of services under such
            subsection to homeless individuals who are suffering
            from a substance use disorder and are not suffering
            from a mental health disorder; and
              (2) make payments under subsection (a) to any entity
            that has a policy of--
                      (A) excluding individuals from mental health
                    services due to the existence or suspicion of a
                    substance use disorder; or
                      (B) has a policy of excluding individuals
                    from substance use disorder services due to the
                    existence or suspicion of mental illness.
      (d) Term of the Awards.--No entity may receive a grant,
    contract, or cooperative agreement under subsection (a) for
    more than 5 years.
      (e) Authorization of Appropriations.--There is authorized to
    be appropriated to carry out this section$41,304,000 for each
    of fiscal years [2018 through 2022] 2023 through 2027.

    [SEC. 506A. ALCOHOL AND DRUG PREVENTION OR TREATMENT SERVICES FOR
                        INDIANS AND NATIVE ALASKANS.

      [(a) In General.--The Secretary shall award grants,
    contracts, or cooperative agreements to public and private
    nonprofit entities, including Native Alaskan entities and
    Indian tribes and tribal organizations, for the purpose of
    providing alcohol and drug prevention or treatment services for
    Indians and Native Alaskans.
      [(b) Priority.--In awarding grants, contracts, or cooperative
    agreements under subsection (a), the Secretary shall give
    priority to applicants that--
              [(1) propose to provide alcohol and drug prevention
            or treatment services on reservations;
              [(2) propose to employ culturally-appropriate
            approaches, as determined by the Secretary, in
            providing such services; and
              [(3) have provided prevention or treatment services
            to Native Alaskan entities and Indian tribes and tribal
            organizations for at least 1 year prior to applying for
            a grant under this section.
      [(c) Duration.--The Secretary shall award grants, contracts,
    or cooperative agreements under subsection (a) for a period not
    to exceed 5 years.
      [(d) Application.--An entity desiring a grant, contract, or
    cooperative agreement under subsection (a) shall submit an
    application to the Secretary at such time, in such manner, and
    accompanied by such information as the Secretary may reasonably
    require.
      [(e) Evaluation.--An entity that receives a grant, contract,
    or cooperative agreement under subsection (a) shall submit, in
    the application for such grant, a plan for the evaluation of
    any project undertaken with funds provided under this section.
    Such entity shall provide the Secretary with periodic
    evaluations of the progress of such project and such evaluation
    at the completion of such project as the Secretary determines
    to be appropriate. The final evaluation submitted by such
    entity shall include a recommendation as to whether such
    project shall continue.
      [(f) Report.--Not later than 3 years after the date of the
    enactment of this section and annually thereafter, the
    Secretary shall prepare and submit, to the Committee on Health,
    Education, Labor, and Pensions of the Senate, a report
    describing the services provided pursuant to this section.
      [(g) Authorization of Appropriations.--There are authorized
    to be appropriated to carry out this section, $15,000,000 for
    fiscal year 2001, and such sums as may be necessary for fiscal
    years 2002 and 2003.]

    SEC. 506A. BEHAVIORAL HEALTH AND SUBSTANCE USE DISORDER SERVICES FOR
                        NATIVE AMERICANS.

      (a) Definitions.--In this section:
              (1) The term ``eligible entity'' means an Indian
            Tribe, a Tribal organization, an Urban Indian
            organization, and a Native Hawaiian health
            organization.
              (2) The terms ``Indian Tribe'', ``Tribal
            organization'', and ``Urban Indian organization'' have
            the meanings given to the terms ``Indian tribe'',
            ``tribal organization'', and ``Urban Indian
            organization'' in section 4 of the Indian Health Care
            Improvement Act.
              (3) The term ``Native Hawaiian health organization''
            means ``Papa Ola Lokahi'' as defined in section 12 of
            the Native Hawaiian Health Care Improvement Act.
      (b) Formula Funds.--
              (1) In general.--The Secretary, in consultation with
            the Director of the Indian Health Service, as
            appropriate, shall award funds to eligible entities, in
            amounts determined pursuant to the formula described in
            paragraph (2), to be used by the eligible entity to
            provide culturally appropriate mental health and
            substance use disorder prevention, treatment, and
            recovery services to American Indians, Alaska Natives,
            and Native Hawaiians.
              (2) Formula.--The Secretary, using the process
            described in subsection (d), shall develop a formula to
            determine the amount of an award under paragraph (1).
            Such formula shall take into account the populations of
            eligible entities whose rates of overdose deaths or
            suicide are substantially higher relative to the
            populations of other Indian Tribes, Tribal
            organizations, Urban Indian organizations, or Native
            Hawaiian health organizations, as applicable.
      (c) Technical Assistance and Program Evaluation.--
              (1) In general.--The Secretary shall--
                      (A) provide technical assistance to
                    applicants and awardees under this section; and
                      (B) collect and evaluate information on the
                    program carried out under this section.
              (2) Consultation on evaluation measures, and data
            submission and reporting requirements.--The Secretary
            shall, using the process described in subsection (d),
            develop evaluation measures and data submission and
            reporting requirements for purposes of the collection
            and evaluation of information.
              (3) Data submission and reporting.--As a condition on
            receipt of funds under this section, an applicant shall
            agree to submit data and reports in a timely manner
            consistent with the evaluation measures and data
            submission and reporting requirements developed under
            subsection (d).
      (d) Regulations.--
              (1) Promulgation.--Not later than 180 days after the
            date of enactment of the Restoring Hope for Mental
            Health and Well-Being Act of 2022, the Secretary shall
            initiate procedures under subchapter III of chapter 5
            of title 5, United States Code, to negotiate and
            promulgate such regulations as are necessary to carry
            out this section, including development of the funding
            formula described in subsection (b) and the program
            evaluation and reporting requirements under subsection
            (c).
              (2) Publication.--Not later than 18 months after the
            date of enactment of the Restoring Hope for Mental
            Health and Well-Being Act of 2022, the Secretary shall
            publish in the Federal Register proposed regulations to
            implement this section.
              (3) Committee.--A negotiated rulemaking committee
            established pursuant to section 565 of title 5, United
            States Code, to carry out this subsection shall have as
            its members only representatives of the Federal
            Government, Tribal Governments, and Urban Indian
            organizations. For purposes of such rulemaking, the
            Indian Health Service shall be the lead agency for the
            Department.
              (4) Adaptation of procedures.--In carrying out this
            subsection, the Secretary shall adapt any negotiated
            rulemaking procedures to the unique context of the
            government-to-government relationship between the
            United States and Indian Tribes.
              (5) Effect.--The lack of promulgated regulations
            under this subsection shall not limit the effect or
            implementation of this section.
      (e) Application.--An entity desiring an award under
    subsection (b) shall submit an application to the Secretary at
    such time, in such manner, and accompanied by such information
    as the Secretary may reasonably require.
      (f) Report.--Not later than 3 years after the date of the
    enactment of the Restoring Hope for Mental Health and Well-
    Being Act of 2022, and annually thereafter, the Secretary shall
    prepare 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
    describing the services provided pursuant to this section.
      (g) Authorization of Appropriations.--There are authorized to
    be appropriated to carry out this section, $40,000,000 for each
    of fiscal years 2023 through 2027.

    SEC. 506B. BEHAVIORAL HEALTH CRISIS COORDINATING OFFICE.

      (a) In General.--The Secretary shall establish, within the
    Substance Abuse and Mental Health Services Administration, an
    office to coordinate work relating to behavioral health crisis
    care across the operating divisions and agencies of the
    Department of Health and Human Services, including the
    Substance Abuse and Mental Health Services Administration, the
    Centers for Medicare & Medicaid Services, and the Health
    Resources and Services Administration, and external
    stakeholders.
      (b) Duty.--The office established under subsection (a)
    shall--
              (1) convene Federal, State, Tribal, local, and
            private partners;
              (2) launch and manage Federal workgroups charged with
            making recommendations regarding behavioral health
            crisis issues, including with respect to health care
            best practices, workforce development, mental health
            disparities, data collection, technology, program
            oversight, public awareness, and engagement; and
              (3) support technical assistance, data analysis, and
            evaluation functions in order to assist States,
            localities, Territories, Tribes, and Tribal communities
            to develop crisis care systems and establish nationwide
            best practices with the objective of expanding the
            capacity of, and access to, local crisis call centers,
            mobile crisis care, crisis stabilization, psychiatric
            emergency services, and rapid post-crisis follow-up
            care provided by--
                      (A) the National Suicide Prevention and
                    Mental Health Crisis Hotline and Response
                    System;
                      (B) community mental health centers (as
                    defined in section 1861(ff)(3)(B) of the Social
                    Security Act);
                      (C) certified community behavioral health
                    clinics, as described in section 223 of the
                    Protecting Access to Medicare Act of 2014; and
                      (D) other community mental health and
                    substance use disorder providers.
      (c) Authorization of Appropriations.--There is authorized to
    be appropriated to carry out this section $5,000,000 for each
    of fiscal years 2023 through 2027.

                          Part B--Centers and Programs

    Subpart 1--Center for Substance Abuse Treatment

               *       *       *       *       *       *       *

    SEC. 509. PRIORITY SUBSTANCE [ABUSE]  USE DISORDER TREATMENT NEEDS OF
                        REGIONAL AND NATIONAL SIGNIFICANCE.

      (a) Projects.--The Secretary shall address priority substance
    use disorder treatment needs of regional and national
    significance (as determined under subsection (b)) through the
    provision of or through assistance for--
              (1) knowledge development and application projects
            for treatment and rehabilitation and the conduct or
            support of evaluations of such projects;
              (2) training and technical assistance; and
              (3) targeted capacity response programs that permit
            States, local governments, communities, and Indian
            [tribes and tribal organizations (as the terms ``Indian
            tribes'' and ``tribal organizations'' are defined]
            Tribes and Tribal organizations (as such terms are
            defined in section 4 of the Indian Self-Determination
            and Education Assistance Act) to focus on emerging
            trends [in substance abuse] and co-occurrence of
            substance use disorders with mental illness or other
            conditions.
    The Secretary may carry out the activities described in this
    section directly or through grants, contracts, or cooperative
    agreements with States, political subdivisions of States,
    Indian tribes or tribal organizations (as such terms are
    defined in section 4 of the Indian Self-Determination and
    Education Assistance Act), health facilities, or programs
    operated by or in accordance with a contract or grant with the
    Indian Health Service, or other public or nonprofit private
    entities.
      (b) Priority Substance [Abuse] Use Disorder Treatment
    Needs.--
              (1) In general.--Priority substance use disorder
            treatment needs of regional and national significance
            shall be determined by the Secretary after consultation
            with States and other interested groups. The Secretary
            shall meet with the States and interested groups on an
            annual basis to discuss program priorities.
              (2) Special consideration.--In developing program
            priorities under paragraph (1), the Secretary shall
            give special consideration to promoting the integration
            of substance use disorder treatment services into
            primary health care systems.
      (c) Requirements.--
              (1) In general.--Recipients of grants, contracts, or
            cooperative agreements under this section shall comply
            with information and application requirements
            determined appropriate by the Secretary.
              (2) Duration of award.--With respect to a grant,
            contract, or cooperative agreement awarded under this
            section, the period during which payments under such
            award are made to the recipient may not exceed 5 years.
              (3) Matching funds.--The Secretary may, for projects
            carried out under subsection (a), require that entities
            that apply for grants, contracts, or cooperative
            agreements under that project provide non-Federal
            matching funds, as determined appropriate by the
            Secretary, to ensure the institutional commitment of
            the entity to the projects funded under the grant,
            contract, or cooperative agreement. Such non-Federal
            matching funds may be provided directly or through
            donations from public or private entities and may be in
            cash or in kind, fairly evaluated, including plant,
            equipment, or services.
              (4) Maintenance of effort.--With respect to
            activities for which a grant, contract, or cooperative
            agreement is awarded under this section, the Secretary
            may require that recipients for specific projects under
            subsection (a) agree to maintain expenditures of non-
            Federal amounts for such activities at a level that is
            not less than the level of such expenditures maintained
            by the entity for the fiscal year preceding the fiscal
            year for which the entity receives such a grant,
            contract, or cooperative agreement.
      (d) Evaluation.--The Secretary shall evaluate each project
    carried out under subsection (a)(1) and shall disseminate the
    findings with respect to each such evaluation to appropriate
    public and private entities.
      (e) Information and Education.--The Secretary shall establish
    comprehensive information and education programs to disseminate
    and apply the findings of the knowledge development and
    application, training and technical assistance programs, and
    targeted capacity response programs under this section to the
    general public, to health professionals and other interested
    groups. The Secretary shall make every effort to provide
    linkages between the findings of supported projects and State
    agencies responsible for carrying out substance use disorder
    prevention and treatment programs.
      (f) Authorization of Appropriation.--There are authorized to
    be appropriated to carry out this section, [$333,806,000 for
    each of fiscal years 2018 through 2022] $521,517,000 for each
    of fiscal years 2023 through 2027.

               *       *       *       *       *       *       *

    SEC. 514. SUBSTANCE USE DISORDER TREATMENT AND EARLY INTERVENTION
                        SERVICES FOR CHILDREN, ADOLESCENTS, AND YOUNG
                        ADULTS.

      (a) In General.--The Secretary shall award grants, contracts,
    or cooperative agreements to public and private nonprofit
    entities, including [Indian tribes or tribal organizations]
    Indian Tribes or Tribal organizations (as such terms are
    defined in section 4 of the Indian Self-Determination and
    Education Assistance Act), or health facilities or programs
    operated by or in accordance with a contract or grant with the
    Indian Health Service, for the purpose of--
              (1) providing early identification and services to
            meet the needs of children, adolescents, and young
            adults who are at risk of substance use disorders;
              (2) providing substance use disorder treatment
            services for children, adolescents, and young adults,
            includingchildren, adolescents, and young adults with
            co-occurring mental illness and substance use
            disorders; and
              (3) providing assistance to pregnant women, and
            parenting women, with substance use disorders, in
            obtaining treatment services, linking mothers to
            community resources to support independent family
            lives, and staying in recovery so that children are in
            safe, stable home environments and receive appropriate
            health care services.
      (b) Priority.--In awarding grants, contracts, or cooperative
    agreements under subsection (a), the Secretary shall give
    priority to applicants who propose to--
              (1) apply evidence-based and cost-effective methods;
              (2) coordinate the provision of services with other
            social service agencies in the community, including
            educational, juvenile justice, child welfare, substance
            abuse, and mental health agencies;
              (3) provide a continuum of integrated treatment
            services, including case management, for children,
            adolescents, and young adults with substance use
            disorders, including children, adolescents, and young
            adults with co-occurring mental illness and substance
            use disorders, and their families;
              (4) provide treatment that is gender-specific and
            culturally appropriate;
              (5) involve and work with families of children,
            adolescents, and young adults receiving services; and
              (6) provide aftercare services for children,
            adolescents, and young adults and their families after
            completion of treatment.
      (c) Duration of Grants.--The Secretary shall award grants,
    contracts, or cooperative agreements under subsection (a) for
    periods not to exceed 5 fiscal years.
      (d) Application.--An entity desiring a grant, contract, or
    cooperative agreement under subsection (a) shall submit an
    application to the Secretary at such time, in such manner, and
    accompanied by such information as the Secretary may reasonably
    require.
      (e) Evaluation.--An entity that receives a grant, contract,
    or cooperative agreement under subsection (a) shall submit, in
    the application for such grant, contract, or cooperative
    agreement, a plan for the evaluation of any project undertaken
    with funds provided under this section. Such entity shall
    provide the Secretary with periodic evaluations of the progress
    of such project and such evaluation at the completion of such
    project as the Secretary determines to be appropriate.
      (f) Authorization of Appropriations.--There are authorized to
    be appropriated to carry out this section, $29,605,000 for each
    of fiscal years [2018 through 2022] 2023 through 2027.

    SEC. 514B. EVIDENCE-BASED PRESCRIPTION OPIOID AND HEROIN TREATMENT AND
                        INTERVENTIONS DEMONSTRATION.

      (a) Grants to Expand Access.--
              (1) Authority to award grants.--The Secretary shall
            award grants, contracts, or cooperative agreements to
            State [substance abuse] substance use disorder
            agencies, units of local government, nonprofit
            organizations, and Indian [tribes and tribal
            organizations] Tribes and Tribal organizations (as
            defined in section 4 of the Indian Self-Determination
            and Education Assistance Act) that have a high rate, or
            have had a rapid increase, in the use of heroin or
            other opioids, in order to permit such entities to
            expand activities, including an expansion in the
            availability of evidence-based medication-assisted
            treatment and other clinically appropriate services,
            with respect to the treatment of [addiction] substance
            use disorders in the specific geographical areas of
            such entities where there is a high rate or rapid
            increase in the use of heroin or other opioids, such as
            in rural areas.
              (2) Nature of activities.--Funds awarded under
            paragraph (1) shall be used for activities that are
            based on reliable scientific evidence of efficacy in
            the treatment of problems related to heroin or other
            opioids.
      (b) Application.--To be eligible for a grant, contract, or
    cooperative agreement under subsection (a), an entity shall
    submit an application to the Secretary at such time, in such
    manner, and accompanied by such information as the Secretary
    may reasonably require.
      (c) Evaluation.--An entity that receives a grant, contract,
    or cooperative agreement under subsection (a) shall submit, in
    the application for such grant, contract, or agreement a plan
    for the evaluation of any project undertaken with funds
    provided under this section. Such entity shall provide the
    Secretary with periodic evaluations of the progress of such
    project and an evaluation at the completion of such project as
    the Secretary determines to be appropriate.
      (d) Geographic Distribution.--In awarding grants, contracts,
    and cooperative agreements under this section, the Secretary
    shall ensure that not less than 15 percent of funds are awarded
    to eligible entities that are not located in metropolitan
    statistical areas (as defined by the Office of Management and
    Budget). The Secretary shall take into account the unique needs
    of rural communities, including communities with an incidence
    of individuals with opioid use disorder that is above the
    national average and communities with a shortage of prevention
    and treatment services.
      (e) Additional Activities.--In administering grants,
    contracts, and cooperative agreements under subsection (a), the
    Secretary shall--
              (1) evaluate the activities supported under such
            subsection;
              (2) disseminate information, as appropriate, derived
            from evaluations as the Secretary considers
            appropriate;
              (3) provide States, Indian [tribes and tribal
            organizations] Tribes and Tribal organizations, and
            providers with technical assistance in connection with
            the provision of treatment of problems related to
            heroin and other opioids; and
              (4) fund only those applications that specifically
            support recovery services as a critical component of
            the program involved.
      (f) Authorization of Appropriations.--To carry out this
    section, there are authorized to be appropriated $25,000,000
    for each of fiscal years [2017 through 2021] 2023 through 2027.

    Subpart 2--Center for Substance Abuse Prevention

               *       *       *       *       *       *       *

    SEC. 516. PRIORITY SUBSTANCE USE DISORDER PREVENTION NEEDS OF REGIONAL
                        AND NATIONAL SIGNIFICANCE.

      (a) Projects.--The Secretary shall address priority substance
    use disorder prevention needs of regional and national
    significance (as determined under subsection (b)) through the
    provision of or through assistance for--
              (1) knowledge development and application projects
            for prevention and the conduct or support of
            evaluations of such projects;
              (2) training and technical assistance; and
              (3) targeted capacity response programs, including
            such programs that focus on emerging drug [abuse] use
            issues.
    The Secretary may carry out the activities described in this
    section directly or through grants, contracts, or cooperative
    agreements with States, political subdivisions of States,
    Indian [tribes or tribal organizations] Tribes or Tribal
    organizations (as such terms are defined in section 4 of the
    Indian Self-Determination and Education Assistance Act), health
    facilities, or programs operated by or in accordance with a
    contract or grant with the Indian Health Service, or other
    public or nonprofit private entities.
      (b) Priority Substance [Abuse] Use Disorder Prevention
    Needs.--
              (1) In general.--Priority substance use disorder
            prevention needs of regional and national significance
            shall be determined by the Secretary in consultation
            with the States and other interested groups. The
            Secretary shall meet with the States and interested
            groups on an annual basis to discuss program
            priorities.
              (2) Special consideration.--In developing program
            priorities under paragraph (1), the Secretary shall
            give special consideration to--
                      (A) applying the most promising strategies
                    and research-based primary prevention
                    approaches;
                      (B) promoting the integration of substance
                    use disorder prevention information and
                    activities into primary health care systems;
                    and
                      (C) substance use disorder prevention among
                    high-risk groups.
      (c) Requirements.--
              (1) In general.--Recipients of grants, contracts, and
            cooperative agreements under this section shall comply
            with information and application requirements
            determined appropriate by the Secretary.
              (2) Duration of award.--With respect to a grant,
            contract, or cooperative agreement awarded under this
            section, the period during which payments under such
            award are made to the recipient may not exceed 5 years.
              (3) Matching funds.--The Secretary may, for projects
            carried out under subsection (a), require that entities
            that apply for grants, contracts, or cooperative
            agreements under that project provide non-Federal
            matching funds, as determined appropriate by the
            Secretary, to ensure the institutional commitment of
            the entity to the projects funded under the grant,
            contract, or cooperative agreement. Such non-Federal
            matching funds may be provided directly or through
            donations from public or private entities and may be in
            cash or in kind, fairly evaluated, including plant,
            equipment, or services.
              (4) Maintenance of effort.--With respect to
            activities for which a grant, contract, or cooperative
            agreement is awarded under this section, the Secretary
            may require that recipients for specific projects under
            subsection (a) agree to maintain expenditures of non-
            Federal amounts for such activities at a level that is
            not less than the level of such expenditures maintained
            by the entity for the fiscal year preceding the fiscal
            year for which the entity receives such a grant,
            contract, or cooperative agreement.
      (d) Evaluation.--The Secretary shall evaluate each project
    carried out under subsection (a)(1) and shall disseminate the
    findings with respect to each such evaluation to appropriate
    public and private entities.
      (e) Information and Education.--The Secretary shall establish
    comprehensive information and education programs to disseminate
    the findings of the knowledge development and application,
    training and technical assistance programs, and targeted
    capacity response programs under this section to the general
    public and to health professionals. The Secretary shall make
    every effort to provide linkages between the findings of
    supported projects and State agencies responsible for carrying
    out substance use disorder prevention and treatment programs.
      (f) Authorization of Appropriation.--There are authorized to
    be appropriated to carry out this section, [$211,148,000 for
    each of fiscal years 2018 through 2022] $218,219,000 for each
    of fiscal years 2023 through 2027.

    SEC. 519B. PROGRAMS TO REDUCE UNDERAGE DRINKING.

      [(a) Definitions.--For purposes of this section:
              [(1) The term ``alcohol beverage industry'' means the
            brewers, vintners, distillers, importers, distributors,
            and retail or online outlets that sell or serve beer,
            wine, and distilled spirits.
              [(2) The term ``school-based prevention'' means
            programs, which are institutionalized, and run by staff
            members or school-designated persons or organizations
            in any grade of school, kindergarten through 12th
            grade.
              [(3) The term ``youth'' means persons under the age
            of 21.
              [(4) The term ``IOM report'' means the report
            released in September 2003 by the National Research
            Council, Institute of Medicine, and entitled ``Reducing
            Underage Drinking: A Collective Responsibility''.]
      (a) Definitions.--For purposes of this section:
              (1) The term ``alcohol beverage industry'' means the
            brewers, vintners, distillers, importers, distributors,
            and retail or online outlets that sell or serve beer,
            wine, and distilled spirits.
              (2) The term ``school-based prevention'' means
            programs, which are institutionalized, and run by staff
            members or school-designated persons or organizations
            in any grade of school, kindergarten through 12th
            grade.
              (3) The term ``youth'' means persons under the age of
            21.
      (b) Sense of Congress.--It is the sense of the Congress that:
              (1) A multi-faceted effort is needed to more
            successfully address the problem of underage drinking
            in the United States. A coordinated approach to
            prevention, intervention, treatment, enforcement, and
            research is key to making progress. This Act recognizes
            the need for a focused national effort, and addresses
            particulars of the Federal portion of that effort, as
            well as Federal support for State activities.
              (2) The Secretary of Health and Human Services shall
            continue to conduct research and collect data on the
            short and long-range impact of alcohol use and abuse
            upon adolescent brain development and other organ
            systems.
              (3) States and communities, including colleges and
            universities, are encouraged to adopt comprehensive
            prevention approaches, including--
                      (A) evidence-based screening, programs and
                    curricula;
                      (B) brief intervention strategies;
                      (C) consistent policy enforcement; and
                      (D) environmental changes that limit underage
                    access to alcohol.
              (4) Public health groups, consumer groups, and the
            alcohol beverage industry should continue and expand
            evidence-based efforts to prevent and reduce underage
            drinking.
              (5) The entertainment industries have a powerful
            impact on youth, and they should use rating systems and
            marketing codes to reduce the likelihood that underage
            audiences will be exposed to movies, recordings, or
            television programs with unsuitable alcohol content.
              (6) The National Collegiate Athletic Association, its
            member colleges and universities, and athletic
            conferences should affirm a commitment to a policy of
            discouraging alcohol use among underage students and
            other young fans.
              (7) Alcohol is a unique product and should be
            regulated differently than other products by the States
            and Federal Government. States have primary authority
            to regulate alcohol distribution and sale, and the
            Federal Government should support and supplement these
            State efforts. States also have a responsibility to
            fight youth access to alcohol and reduce underage
            drinking. Continued State regulation and licensing of
            the manufacture, importation, sale, distribution,
            transportation and storage of alcoholic beverages are
            clearly in the public interest and are critical to
            promoting responsible consumption, preventing illegal
            access to alcohol by persons under 21 years of age from
            commercial and non-commercial sources, maintaining
            industry integrity and an orderly marketplace, and
            furthering effective State tax collection.
      [(c) Interagency Coordinating Committee; Annual Report on
    State Underage Drinking Prevention and Enforcement
    Activities.--
              [(1) Interagency coordinating committee on the
            prevention of underage drinking.--
                      [(A) In general.--The Secretary, in
                    collaboration with the Federal officials
                    specified in subparagraph (B), shall formally
                    establish and enhance the efforts of the
                    interagency coordinating committee, that began
                    operating in 2004, focusing on underage
                    drinking (referred to in this subsection as the
                    ``Committee'').
                      [(B) Other agencies.--The officials referred
                    to in paragraph (1) are the Secretary of
                    Education, the Attorney General, the Secretary
                    of Transportation, the Secretary of the
                    Treasury, the Secretary of Defense, the Surgeon
                    General, the Director of the Centers for
                    Disease Control and Prevention, the Director of
                    the National Institute on Alcohol Abuse and
                    Alcoholism, the Assistant Secretary for Mental
                    Health and Substance Use, the Director of the
                    National Institute on Drug Abuse, the Assistant
                    Secretary for Children and Families, the
                    Director of the Office of National Drug Control
                    Policy, the Administrator of the National
                    Highway Traffic Safety Administration, the
                    Administrator of the Office of Juvenile Justice
                    and Delinquency Prevention, the Chairman of the
                    Federal Trade Commission, and such other
                    Federal officials as the Secretary of Health
                    and Human Services determines to be
                    appropriate.
                      [(C) Chair.--The Secretary of Health and
                    Human Services shall serve as the chair of the
                    Committee.
                      [(D) Duties.--The Committee shall guide
                    policy and program development across the
                    Federal Government with respect to underage
                    drinking, provided, however, that nothing in
                    this section shall be construed as transferring
                    regulatory or program authority from an Agency
                    to the Coordinating Committee.
                      [(E) Consultations.--The Committee shall
                    actively seek the input of and shall consult
                    with all appropriate and interested parties,
                    including States, public health research and
                    interest groups, foundations, and alcohol
                    beverage industry trade associations and
                    companies.
                      [(F) Annual report.--
                              [(i) In general.--The Secretary, on
                            behalf of the Committee, shall annually
                            submit to the Congress a report that
                            summarizes--
                                      [(I) all programs and
                                    policies of Federal agencies
                                    designed to prevent and reduce
                                    underage drinking;
                                      [(II) the extent of progress
                                    in preventing and reducing
                                    underage drinking nationally;
                                      [(III) data that the
                                    Secretary shall collect with
                                    respect to the information
                                    specified in clause (ii); and
                                      [(IV) such other information
                                    regarding underage drinking as
                                    the Secretary determines to be
                                    appropriate.
                              [(ii) Certain information.--The
                            report under clause (i) shall include
                            information on the following:
                                      [(I) Patterns and
                                    consequences of underage
                                    drinking as reported in
                                    research and surveys such as,
                                    but not limited to Monitoring
                                    the Future, Youth Risk Behavior
                                    Surveillance System, the
                                    National Survey on Drug Use and
                                    Health, and the Fatality
                                    Analysis Reporting System.
                                      [(II) Measures of the
                                    availability of alcohol from
                                    commercial and non-commercial
                                    sources to underage
                                    populations.
                                      [(III) Measures of the
                                    exposure of underage
                                    populations to messages
                                    regarding alcohol in
                                    advertising and the
                                    entertainment media as reported
                                    by the Federal Trade
                                    Commission.
                                      [(IV) Surveillance data,
                                    including information on the
                                    onset and prevalence of
                                    underage drinking, consumption
                                    patterns and the means of
                                    underage access. The Secretary
                                    shall develop a plan to improve
                                    the collection, measurement and
                                    consistency of reporting
                                    Federal underage alcohol data.
                                      [(V) Any additional findings
                                    resulting from research
                                    conducted or supported under
                                    subsection (f).
                                      [(VI) Evidence-based best
                                    practices to prevent and reduce
                                    underage drinking and provide
                                    treatment services to those
                                    youth who need them.
              [(2) Annual report on state underage drinking
            prevention and enforcement activities.--
                      [(A) In general.--The Secretary shall, with
                    input and collaboration from other appropriate
                    Federal agencies, States, Indian tribes,
                    territories, and public health, consumer, and
                    alcohol beverage industry groups, annually
                    issue a report on each State's performance in
                    enacting, enforcing, and creating laws,
                    regulations, and programs to prevent or reduce
                    underage drinking.
                      [(B) State performance measures.--
                              [(i) In general.--The Secretary shall
                            develop, in consultation with the
                            Committee, a set of measures to be used
                            in preparing the report on best
                            practices.
                              [(ii) Categories.--In developing
                            these measures, the Secretary shall
                            consider categories including, but not
                            limited to:
                                      [(I) Whether or not the State
                                    has comprehensive anti-underage
                                    drinking laws such as for the
                                    illegal sale, purchase, attempt
                                    to purchase, consumption, or
                                    possession of alcohol; illegal
                                    use of fraudulent ID; illegal
                                    furnishing or obtaining of
                                    alcohol for an individual under
                                    21 years; the degree of
                                    strictness of the penalties for
                                    such offenses; and the
                                    prevalence of the enforcement
                                    of each of these infractions.
                                      [(II) Whether or not the
                                    State has comprehensive
                                    liability statutes pertaining
                                    to underage access to alcohol
                                    such as dram shop, social host,
                                    and house party laws, and the
                                    prevalence of enforcement of
                                    each of these laws.
                                      [(III) Whether or not the
                                    State encourages and conducts
                                    comprehensive enforcement
                                    efforts to prevent underage
                                    access to alcohol at retail
                                    outlets, such as random
                                    compliance checks and shoulder
                                    tap programs, and the number of
                                    compliance checks within
                                    alcohol retail outlets measured
                                    against the number of total
                                    alcohol retail outlets in each
                                    State, and the result of such
                                    checks.
                                      [(IV) Whether or not the
                                    State encourages training on
                                    the proper selling and serving
                                    of alcohol for all sellers and
                                    servers of alcohol as a
                                    condition of employment.
                                      [(V) Whether or not the State
                                    has policies and regulations
                                    with regard to direct sales to
                                    consumers and home delivery of
                                    alcoholic beverages.
                                      [(VI) Whether or not the
                                    State has programs or laws to
                                    deter adults from purchasing
                                    alcohol for minors; and the
                                    number of adults targeted by
                                    these programs.
                                      [(VII) Whether or not the
                                    State has programs targeted to
                                    youths, parents, and caregivers
                                    to deter underage drinking; and
                                    the number of individuals
                                    served by these programs.
                                      [(VIII) Whether or not the
                                    State has enacted graduated
                                    drivers licenses and the extent
                                    of those provisions.
                                      [(IX) The amount that the
                                    State invests, per youth
                                    capita, on the prevention of
                                    underage drinking, further
                                    broken down by the amount spent
                                    on--
                                              [(aa) compliance
                                            check programs in
                                            retail outlets,
                                            including providing
                                            technology to prevent
                                            and detect the use of
                                            false identification by
                                            minors to make alcohol
                                            purchases;
                                              [(bb) checkpoints and
                                            saturation patrols that
                                            include the goal of
                                            reducing and deterring
                                            underage drinking;
                                              [(cc) community-
                                            based, school-based,
                                            and higher-education-
                                            based programs to
                                            prevent underage
                                            drinking;
                                              [(dd) underage
                                            drinking prevention
                                            programs that target
                                            youth within the
                                            juvenile justice and
                                            child welfare systems;
                                            and
                                              [(ee) other State
                                            efforts or programs as
                                            deemed appropriate.
              [(3) Authorization of appropriations.--There are
            authorized to be appropriated to carry out this
            subsection $1,000,000 for each of the fiscal years 2018
            through 2022.
      [(d) National Media Campaign To Prevent Underage Drinking.--
              [(1) Scope of the campaign.--The Secretary shall
            continue to fund and oversee the production,
            broadcasting, and evaluation of the national adult-
            oriented media public service campaign if the Secretary
            determines that such campaign is effective in achieving
            the media campaign's measurable objectives.
              [(2) Report.--The Secretary shall provide a report to
            the Congress annually detailing the production,
            broadcasting, and evaluation of the campaign referred
            to in paragraph (1), and to detail in the report the
            effectiveness of the campaign in reducing underage
            drinking, the need for and likely effectiveness of an
            expanded adult-oriented media campaign, and the
            feasibility and the likely effectiveness of a national
            youth-focused media campaign to combat underage
            drinking.
              [(3) Consultation requirement.--In carrying out the
            media campaign, the Secretary shall direct the entity
            carrying out the national adult-oriented media public
            service campaign to consult with interested parties
            including both the alcohol beverage industry and public
            health and consumer groups. The progress of this
            consultative process is to be covered in the report
            under paragraph (2).
              [(4) Authorization of appropriations.--There are
            authorized to be appropriated to carry out this
            subsection, $1,000,000 for each of the fiscal years
            2018 through 2022.
      [(e) Interventions.--
              [(1) Community-based coalition enhancement grants to
            prevent underage drinking.--
                      [(A) Authorization of program.--The Assistant
                    Secretary for Mental Health and Substance Use,
                    in consultation with the Director of the Office
                    of National Drug Control Policy, shall award,
                    if the Assistant Secretary determines that the
                    Department of Health and Human Services is not
                    currently conducting activities that duplicate
                    activities of the type described in this
                    subsection, ``enhancement grants'' to eligible
                    entities to design, test, evaluate and
                    disseminate effective strategies to maximize
                    the effectiveness of community-wide approaches
                    to preventing and reducing underage drinking.
                    This subsection is subject to the availability
                    of appropriations.
                      [(B) Purposes.--The purposes of this
                    paragraph are to--
                              [(i) prevent and reduce alcohol use
                            among youth in communities throughout
                            the United States;
                              [(ii) strengthen collaboration among
                            communities, the Federal Government,
                            and State, local, and tribal
                            governments;
                              [(iii) enhance intergovernmental
                            cooperation and coordination on the
                            issue of alcohol use among youth;
                              [(iv) serve as a catalyst for
                            increased citizen participation and
                            greater collaboration among all sectors
                            and organizations of a community that
                            first demonstrates a long-term
                            commitment to reducing alcohol use
                            among youth;
                              [(v) disseminate to communities
                            timely information regarding state-of-
                            the-art practices and initiatives that
                            have proven to be effective in
                            preventing and reducing alcohol use
                            among youth; and
                              [(vi) enhance, not supplant,
                            effective local community initiatives
                            for preventing and reducing alcohol use
                            among youth.
                      [(C) Application.--An eligible entity
                    desiring an enhancement grant under this
                    paragraph shall submit an application to the
                    Assistant Secretary at such time, and in such
                    manner, and accompanied by such information as
                    the Assistant Secretary may require. Each
                    application shall include--
                              [(i) a complete description of the
                            entity's current underage alcohol use
                            prevention initiatives and how the
                            grant will appropriately enhance the
                            focus on underage drinking issues; or
                              [(ii) a complete description of the
                            entity's current initiatives, and how
                            it will use this grant to enhance those
                            initiatives by adding a focus on
                            underage drinking prevention.
                      [(D) Uses of funds.--Each eligible entity
                    that receives a grant under this paragraph
                    shall use the grant funds to carry out the
                    activities described in such entity's
                    application submitted pursuant to subparagraph
                    (C). Grants under this paragraph shall not
                    exceed $50,000 per year and may not exceed four
                    years.
                      [(E) Supplement not supplant.--Grant funds
                    provided under this paragraph shall be used to
                    supplement, not supplant, Federal and non-
                    Federal funds available for carrying out the
                    activities described in this paragraph.
                      [(F) Evaluation.--Grants under this paragraph
                    shall be subject to the same evaluation
                    requirements and procedures as the evaluation
                    requirements and procedures imposed on
                    recipients of drug free community grants.
                      [(G) Definitions.--For purposes of this
                    paragraph, the term ``eligible entity'' means
                    an organization that is currently receiving or
                    has received grant funds under the Drug-Free
                    Communities Act of 1997 (21 U.S.C. 1521 et
                    seq.).
                      [(H) Administrative expenses.--Not more than
                    6 percent of a grant under this paragraph may
                    be expended for administrative expenses.
                      [(I) Authorization of appropriations.--There
                    are authorized to be appropriated to carry out
                    this paragraph $5,000,000 for each of the
                    fiscal years 2018 through 2022.
              [(2) Grants directed at preventing and reducing
            alcohol abuse at institutions of higher education.--
                      [(A) Authorization of program.--The Secretary
                    shall award grants to eligible entities to
                    enable the entities to prevent and reduce the
                    rate of underage alcohol consumption including
                    binge drinking among students at institutions
                    of higher education.
                      [(B) Applications.--An eligible entity that
                    desires to receive a grant under this paragraph
                    shall submit an application to the Secretary at
                    such time, in such manner, and accompanied by
                    such information as the Secretary may require.
                    Each application shall include--
                              [(i) a description of how the
                            eligible entity will work to enhance an
                            existing, or where none exists to build
                            a, statewide coalition;
                              [(ii) a description of how the
                            eligible entity will target underage
                            students in the State;
                              [(iii) a description of how the
                            eligible entity intends to ensure that
                            the statewide coalition is actually
                            implementing the purpose of this
                            section and moving toward indicators
                            described in subparagraph (D);
                              [(iv) a list of the members of the
                            statewide coalition or interested
                            parties involved in the work of the
                            eligible entity;
                              [(v) a description of how the
                            eligible entity intends to work with
                            State agencies on substance abuse
                            prevention and education;
                              [(vi) the anticipated impact of funds
                            provided under this paragraph in
                            preventing and reducing the rates of
                            underage alcohol use;
                              [(vii) outreach strategies, including
                            ways in which the eligible entity
                            proposes to--
                                      [(I) reach out to students
                                    and community stakeholders;
                                      [(II) promote the purpose of
                                    this paragraph;
                                      [(III) address the range of
                                    needs of the students and the
                                    surrounding communities; and
                                      [(IV) address community norms
                                    for underage students regarding
                                    alcohol use; and
                              [(viii) such additional information
                            as required by the Secretary.
                      [(C) Uses of funds.--Each eligible entity
                    that receives a grant under this paragraph
                    shall use the grant funds to carry out the
                    activities described in such entity's
                    application submitted pursuant to subparagraph
                    (B).
                      [(D) Accountability.--On the date on which
                    the Secretary first publishes a notice in the
                    Federal Register soliciting applications for
                    grants under this paragraph, the Secretary
                    shall include in the notice achievement
                    indicators for the program authorized under
                    this paragraph. The achievement indicators
                    shall be designed--
                              [(i) to measure the impact that the
                            statewide coalitions assisted under
                            this paragraph are having on the
                            institutions of higher education and
                            the surrounding communities, including
                            changes in the number of incidents of
                            any kind in which students have abused
                            alcohol or consumed alcohol while under
                            the age of 21 (including violations,
                            physical assaults, sexual assaults,
                            reports of intimidation, disruptions of
                            school functions, disruptions of
                            student studies, mental health
                            referrals, illnesses, or deaths);
                              [(ii) to measure the quality and
                            accessibility of the programs or
                            information offered by the eligible
                            entity; and
                              [(iii) to provide such other measures
                            of program impact as the Secretary
                            determines appropriate.
                      [(E) Supplement not supplant.--Grant funds
                    provided under this paragraph shall be used to
                    supplement, and not supplant, Federal and non-
                    Federal funds available for carrying out the
                    activities described in this paragraph.
                      [(F) Definitions.--For purposes of this
                    paragraph:
                              [(i) Eligible entity.--The term
                            ``eligible entity'' means a State,
                            institution of higher education, or
                            nonprofit entity.
                              [(ii) Institution of higher
                            education.--The term ``institution of
                            higher education'' has the meaning
                            given the term in section 101(a) of the
                            Higher Education Act of 1965 (20 U.S.C.
                            1001(a)).
                              [(iii) Secretary.--The term
                            ``Secretary'' means the Secretary of
                            Education.
                              [(iv) State.--The term ``State''
                            means each of the 50 States, the
                            District of Columbia, and the
                            Commonwealth of Puerto Rico.
                              [(v) Statewide coalition.--The term
                            ``statewide coalition'' means a
                            coalition that--
                                      [(I) includes, but is not
                                    limited to--
                                              [(aa) institutions of
                                            higher education within
                                            a State; and
                                              [(bb) a nonprofit
                                            group, a community
                                            underage drinking
                                            prevention coalition,
                                            or another substance
                                            abuse prevention group
                                            within a State; and
                                      [(II) works toward lowering
                                    the alcohol abuse rate by
                                    targeting underage students at
                                    institutions of higher
                                    education throughout the State
                                    and in the surrounding
                                    communities.
                              [(vi) Surrounding community.--The
                            term ``surrounding community'' means
                            the community--
                                      [(I) that surrounds an
                                    institution of higher education
                                    participating in a statewide
                                    coalition;
                                      [(II) where the students from
                                    the institution of higher
                                    education take part in the
                                    community; and
                                      [(III) where students from
                                    the institution of higher
                                    education live in off-campus
                                    housing.
                      [(G) Administrative expenses.--Not more than
                    5 percent of a grant under this paragraph may
                    be expended for administrative expenses.
                      [(H) Authorization of appropriations.--There
                    are authorized to be appropriated to carry out
                    this paragraph $5,000,000 for fiscal year 2007,
                    and $5,000,000 for each of the fiscal years
                    2008 through 2010.
      [(f) Additional Research.--
              [(1) Additional research on underage drinking.--
                      [(A) In general.--The Secretary shall,
                    subject to the availability of appropriations,
                    collect data, and conduct or support research
                    that is not duplicative of research currently
                    being conducted or supported by the Department
                    of Health and Human Services, on underage
                    drinking, with respect to the following:
                              [(i) Comprehensive community-based
                            programs or strategies and statewide
                            systems to prevent and reduce underage
                            drinking, across the underage years
                            from early childhood to age 21,
                            including programs funded and
                            implemented by government entities,
                            public health interest groups and
                            foundations, and alcohol beverage
                            companies and trade associations.
                              [(ii) Annually obtain and report more
                            precise information than is currently
                            collected on the scope of the underage
                            drinking problem and patterns of
                            underage alcohol consumption, including
                            improved knowledge about the problem
                            and progress in preventing, reducing
                            and treating underage drinking; as well
                            as information on the rate of exposure
                            of youth to advertising and other media
                            messages encouraging and discouraging
                            alcohol consumption.
                              [(iii) Compiling information on the
                            involvement of alcohol in unnatural
                            deaths of persons ages 12 to 20 in the
                            United States, including suicides,
                            homicides, and unintentional injuries
                            such as falls, drownings, burns,
                            poisonings, and motor vehicle crash
                            deaths.
                      [(B) Certain matters.--The Secretary shall
                    carry out activities toward the following
                    objectives with respect to underage drinking:
                              [(i) Obtaining new epidemiological
                            data within the national or targeted
                            surveys that identify alcohol use and
                            attitudes about alcohol use during pre-
                            and early adolescence, including harm
                            caused to self or others as a result of
                            adolescent alcohol use such as
                            violence, date rape, risky sexual
                            behavior, and prenatal alcohol
                            exposure.
                              [(ii) Developing or identifying
                            successful clinical treatments for
                            youth with alcohol problems.
                      [(C) Peer review.--Research under
                    subparagraph (A) shall meet current Federal
                    standards for scientific peer review.
              [(2) Authorization of appropriations.--There are
            authorized to be appropriated to carry out this
            subsection $3,000,000 for each of the fiscal years 2018
            through 2022
      [(g) Reducing Underage Drinking Through Screening and Brief
    Intervention.--
              [(1) Grants to pediatric health care providers to
            reduce underage drinking.--The Assistant Secretary may
            make grants to eligible entities to increase
            implementation of practices for reducing the prevalence
            of alcohol use among individuals under the age of 21,
            including college students.
              [(2) Purposes.--Grants under this subsection shall be
            made to improve--
                      [(A) screening children and adolescents for
                    alcohol use;
                      [(B) offering brief interventions to children
                    and adolescents to discourage such use;
                      [(C) educating parents about the dangers of,
                    and methods of discouraging, such use;
                      [(D) diagnosing and treating alcohol use
                    disorders; and
                      [(E) referring patients, when necessary, to
                    other appropriate care.
              [(3) Use of funds.--An entity receiving a grant under
            this subsection may use such funding for the purposes
            identified in paragraph (2) by--
                      [(A) providing training to health care
                    providers;
                      [(B) disseminating best practices, including
                    culturally and linguistically appropriate best
                    practices, as appropriate, and developing and
                    distributing materials; and
                      [(C) supporting other activities, as
                    determined appropriate by the Assistant
                    Secretary.
              [(4) Application.--To be eligible to receive a grant
            under this subsection, an entity shall submit an
            application to the Assistant Secretary at such time,
            and in such manner, and accompanied by such information
            as the Assistant Secretary may require. Each
            application shall include--
                      [(A) a description of the entity;
                      [(B) a description of activities to be
                    completed;
                      [(C) a description of how the services
                    specified in paragraphs (2) and (3) will be
                    carried out and the qualifications for
                    providing such services; and
                      [(D) a timeline for the completion of such
                    activities.
              [(5) Definitions.--For the purpose of this
            subsection:
                      [(A) Brief intervention.--The term ``brief
                    intervention'' means, after screening a
                    patient, providing the patient with brief
                    advice and other brief motivational enhancement
                    techniques designed to increase the insight of
                    the patient regarding the patient's alcohol
                    use, and any realized or potential consequences
                    of such use, to effect the desired related
                    behavioral change.
                      [(B) Children and adolescents.--The term
                    ``children and adolescents'' means any person
                    under 21 years of age.
                      [(C) Eligible entity.--The term ``eligible
                    entity'' means an entity consisting of
                    pediatric health care providers and that is
                    qualified to support or provide the activities
                    identified in paragraph (2).
                      [(D) Pediatric health care provider.--The
                    term ``pediatric health care provider'' means a
                    provider of primary health care to individuals
                    under the age of 21 years.
                      [(E) Screening.--The term ``screening'' means
                    using validated patient interview techniques to
                    identify and assess the existence and extent of
                    alcohol use in a patient.]
      (c) Interagency Coordinating Committee; Annual Report on
    State Underage Drinking Prevention and Enforcement
    Activities.--
              (1) Interagency coordinating committee on the
            prevention of underage drinking.--
                      (A) In general.--The Secretary, in
                    collaboration with the Federal officials
                    specified in subparagraph (B), shall continue
                    to support and enhance the efforts of the
                    interagency coordinating committee, that began
                    operating in 2004, focusing on underage
                    drinking (referred to in this subsection as the
                    ``Committee'').
                      (B) Other agencies.--The officials referred
                    to in subparagraph (A) are the Secretary of
                    Education, the Attorney General, the Secretary
                    of Transportation, the Secretary of the
                    Treasury, the Secretary of Defense, the Surgeon
                    General, the Director of the Centers for
                    Disease Control and Prevention, the Director of
                    the National Institute on Alcohol Abuse and
                    Alcoholism, the Assistant Secretary for Mental
                    Health and Substance Use, the Director of the
                    National Institute on Drug Abuse, the Assistant
                    Secretary for Children and Families, the
                    Director of the Office of National Drug Control
                    Policy, the Administrator of the National
                    Highway Traffic Safety Administration, the
                    Administrator of the Office of Juvenile Justice
                    and Delinquency Prevention, the Chairman of the
                    Federal Trade Commission, and such other
                    Federal officials as the Secretary of Health
                    and Human Services determines to be
                    appropriate.
                      (C) Chair.--The Secretary of Health and Human
                    Services shall serve as the chair of the
                    Committee.
                      (D) Duties.--The Committee shall guide policy
                    and program development across the Federal
                    Government with respect to underage drinking,
                    provided, however, that nothing in this section
                    shall be construed as transferring regulatory
                    or program authority from an Agency to the
                    Coordinating Committee.
                      (E) Consultations.--The Committee shall
                    actively seek the input of and shall consult
                    with all appropriate and interested parties,
                    including States, public health research and
                    interest groups, foundations, and alcohol
                    beverage industry trade associations and
                    companies.
                      (F) Annual report.--
                              (i) In general.--The Secretary, on
                            behalf of the Committee, shall annually
                            submit to the Congress a report that
                            summarizes--
                                      (I) all programs and policies
                                    of Federal agencies designed to
                                    prevent and reduce underage
                                    drinking, focusing particularly
                                    on programs and policies that
                                    support the adoption and
                                    enforcement of State policies
                                    designed to prevent and reduce
                                    underage drinking as specified
                                    in paragraph (2);
                                      (II) the extent of progress
                                    in preventing and reducing
                                    underage drinking at State and
                                    national levels;
                                      (III) data that the Secretary
                                    shall collect with respect to
                                    the information specified in
                                    clause (ii); and
                                      (IV) such other information
                                    regarding underage drinking as
                                    the Secretary determines to be
                                    appropriate.
                              (ii) Certain information.--The report
                            under clause (i) shall include
                            information on the following:
                                      (I) Patterns and consequences
                                    of underage drinking as
                                    reported in research and
                                    surveys such as, but not
                                    limited to, Monitoring the
                                    Future, Youth Risk Behavior
                                    Surveillance System, the
                                    National Survey on Drug Use and
                                    Health, and the Fatality
                                    Analysis Reporting System.
                                      (II) Measures of the
                                    availability of alcohol from
                                    commercial and non-commercial
                                    sources to underage
                                    populations.
                                      (III) Measures of the
                                    exposure of underage
                                    populations to messages
                                    regarding alcohol in
                                    advertising, social media, and
                                    the entertainment media.
                                      (IV) Surveillance data,
                                    including information on the
                                    onset and prevalence of
                                    underage drinking, consumption
                                    patterns, beverage preferences,
                                    prevalence of drinking among
                                    students at institutions of
                                    higher education, correlations
                                    between adult and youth
                                    drinking, and the means of
                                    underage access, including
                                    trends over time for these
                                    surveillance data. The
                                    Secretary shall develop a plan
                                    to improve the collection,
                                    measurement, and consistency of
                                    reporting Federal underage
                                    alcohol data.
                                      (V) Any additional findings
                                    resulting from research
                                    conducted or supported under
                                    subsection (f).
                                      (VI) Evidence-based best
                                    practices to prevent and reduce
                                    underage drinking including a
                                    review of the research
                                    literature related to State
                                    laws, regulations, and policies
                                    designed to prevent and reduce
                                    underage drinking, as described
                                    in paragraph (2)(B)(i).
              (2) Annual report on state underage drinking
            prevention and enforcement activities.--
                      (A) In general.--The Secretary shall, with
                    input and collaboration from other appropriate
                    Federal agencies, States, Indian Tribes,
                    territories, and public health, consumer, and
                    alcohol beverage industry groups, annually
                    issue a report on each State's performance in
                    enacting, enforcing, and creating laws,
                    regulations, and policies to prevent or reduce
                    underage drinking based on an assessment of
                    best practices developed pursuant to paragraph
                    (1)(F)(ii)(VI) and subparagraph (B)(i). For
                    purposes of this paragraph, each such report,
                    with respect to a year, shall be referred to as
                    the ``State Report''. Each State Report shall
                    be designed as a resource tool for Federal
                    agencies assisting States in the their underage
                    drinking prevention efforts, State public
                    health and law enforcement agencies, State and
                    local policymakers, and underage drinking
                    prevention coalitions including those receiving
                    grants pursuant to subsection (e).
                      (B) State performance measures.--
                              (i) In general.--The Secretary shall
                            develop, in consultation with the
                            Committee, a set of measures to be used
                            in preparing the State Report on best
                            practices as they relate to State laws,
                            regulations, policies, and enforcement
                            practices.
                              (ii) State report content.--The State
                            Report shall include updates on State
                            laws, regulations, and policies
                            included in previous reports to
                            Congress, including with respect to the
                            following:
                                      (I) Whether or not the State
                                    has comprehensive anti-underage
                                    drinking laws such as for the
                                    illegal sale, purchase, attempt
                                    to purchase, consumption, or
                                    possession of alcohol; illegal
                                    use of fraudulent ID; illegal
                                    furnishing or obtaining of
                                    alcohol for an individual under
                                    21 years; the degree of
                                    strictness of the penalties for
                                    such offenses; and the
                                    prevalence of the enforcement
                                    of each of these infractions.
                                      (II) Whether or not the State
                                    has comprehensive liability
                                    statutes pertaining to underage
                                    access to alcohol such as dram
                                    shop, social host, and house
                                    party laws, and the prevalence
                                    of enforcement of each of these
                                    laws.
                                      (III) Whether or not the
                                    State encourages and conducts
                                    comprehensive enforcement
                                    efforts to prevent underage
                                    access to alcohol at retail
                                    outlets, such as random
                                    compliance checks and shoulder
                                    tap programs, and the number of
                                    compliance checks within
                                    alcohol retail outlets measured
                                    against the number of total
                                    alcohol retail outlets in each
                                    State, and the result of such
                                    checks.
                                      (IV) Whether or not the State
                                    encourages training on the
                                    proper selling and serving of
                                    alcohol for all sellers and
                                    servers of alcohol as a
                                    condition of employment.
                                      (V) Whether or not the State
                                    has policies and regulations
                                    with regard to direct sales to
                                    consumers and home delivery of
                                    alcoholic beverages.
                                      (VI) Whether or not the State
                                    has programs or laws to deter
                                    adults from purchasing alcohol
                                    for minors; and the number of
                                    adults targeted by these
                                    programs.
                                      (VII) Whether or not the
                                    State has enacted graduated
                                    drivers licenses and the extent
                                    of those provisions.
                              (iii) Additional categories.--In
                            addition to the updates on State laws,
                            regulations, and policies listed in
                            clause (ii), the Secretary shall
                            consider the following:
                                      (I) Whether or not States
                                    have adopted laws, regulations,
                                    and policies that deter
                                    underage alcohol use, as
                                    described in ``The Surgeon
                                    General's Call to Action to
                                    Prevent and Reduce Underage
                                    Drinking'' issued in 2007 and
                                    ``Facing Addiction in America:
                                    The Surgeon General's Report on
                                    Alcohol, Drugs and Health''
                                    issued in 2016, including
                                    restrictions on low-price,
                                    high-volume drink specials, and
                                    wholesaler pricing provisions.
                                      (II) Whether or not States
                                    have adopted laws, regulations,
                                    and policies designed to reduce
                                    alcohol advertising messages
                                    attractive to youth and youth
                                    exposure to alcohol advertising
                                    and marketing in measured and
                                    unmeasured media and digital
                                    and social media.
                                      (III) Whether or not States
                                    have laws and policies that
                                    promote underage drinking
                                    prevention policy development
                                    by local jurisdictions.
                                      (IV) Whether or not States
                                    have adopted laws, regulations,
                                    and policies to restrict youth
                                    access to alcoholic beverages
                                    that may pose special risks to
                                    youth, including but not
                                    limited to alcoholic mists,
                                    gelatins, freezer pops,
                                    premixed caffeinated alcoholic
                                    beverages, and flavored malt
                                    beverages.
                                      (V) Whether or not States
                                    have adopted uniform best
                                    practices protocols for
                                    conducting compliance checks
                                    and shoulder tap programs.
                                      (VI) Whether or not States
                                    have adopted uniform best
                                    practices penalty protocols for
                                    violations of laws prohibiting
                                    retail licensees from selling
                                    or furnishing of alcohol to
                                    minors.
                              (iv) Uniform data system.--For
                            performance measures related to
                            enforcement of underage drinking laws
                            as specified in clauses (ii) and (iii),
                            the Secretary shall develop and test a
                            uniform data system for reporting State
                            enforcement data, including the
                            development of a pilot program for this
                            purpose. The pilot program shall
                            include procedures for collecting
                            enforcement data from both State and
                            local law enforcement jurisdictions.
              (3) Authorization of appropriations.--There is
            authorized to be appropriated to carry out this
            subsection $1,000,000 for each of fiscal years 2023
            through 2027.
      (d) National Media Campaign To Prevent Underage Drinking.--
              (1) In general.--The Secretary, in consultation with
            the National Highway Traffic Safety Administration,
            shall develop an intensive, multifaceted, adult-
            oriented national media campaign to reduce underage
            drinking by influencing attitudes regarding underage
            drinking, increasing the willingness of adults to take
            actions to reduce underage drinking, and encouraging
            public policy changes known to decrease underage
            drinking rates.
              (2) Purpose.--The purpose of the national media
            campaign described in this section shall be to achieve
            the following objectives:
                      (A) Instill a broad societal commitment to
                    reduce underage drinking.
                      (B) Increase specific actions by adults that
                    are meant to discourage or inhibit underage
                    drinking.
                      (C) Decrease adult conduct that tends to
                    facilitate or condone underage drinking.
              (3) Components.--When implementing the national media
            campaign described in this section, the Secretary
            shall--
                      (A) educate the public about the public
                    health and safety benefits of evidence-based
                    policies to reduce underage drinking, including
                    minimum legal drinking age laws, and build
                    public and parental support for and cooperation
                    with enforcement of such policies;
                      (B) educate the public about the negative
                    consequences of underage drinking;
                      (C) promote specific actions by adults that
                    are meant to discourage or inhibit underage
                    drinking, including positive behavior modeling,
                    general parental monitoring, and consistent and
                    appropriate discipline;
                      (D) discourage adult conduct that tends to
                    facilitate underage drinking, including the
                    hosting of underage parties with alcohol and
                    the purchasing of alcoholic beverages on behalf
                    of underage youth;
                      (E) establish collaborative relationships
                    with local and national organizations and
                    institutions to further the goals of the
                    campaign and assure that the messages of the
                    campaign are disseminated from a variety of
                    sources;
                      (F) conduct the campaign through multi-media
                    sources; and
                      (G) conduct the campaign with regard to
                    changing demographics and cultural and
                    linguistic factors.
              (4) Consultation requirement.--In developing and
            implementing the national media campaign described in
            this section, the Secretary shall consult
            recommendations for reducing underage drinking
            published by the National Academy of Sciences and the
            Surgeon General. The Secretary shall also consult with
            interested parties including medical, public health,
            and consumer and parent groups, law enforcement,
            institutions of higher education, community
            organizations and coalitions, and other stakeholders
            supportive of the goals of the campaign.
              (5) Annual report.--The Secretary shall produce an
            annual report on the progress of the development or
            implementation of the media campaign described in this
            subsection, including expenses and projected costs,
            and, as such information is available, report on the
            effectiveness of such campaign in affecting adult
            attitudes toward underage drinking and adult
            willingness to take actions to decrease underage
            drinking.
              (6) Research on youth-oriented campaign.--The
            Secretary may, based on the availability of funds,
            conduct research on the potential success of a youth-
            oriented national media campaign to reduce underage
            drinking. The Secretary shall report any such results
            to Congress with policy recommendations on establishing
            such a campaign.
              (7) Administration.--The Secretary may enter into a
            subcontract with another Federal agency to delegate the
            authority for execution and administration of the
            adult-oriented national media campaign.
              (8) Authorization of appropriations.--There is
            authorized to be appropriated to carry out this section
            $2,500,000 for each of fiscal years 2023 through 2027.
      (e) Community-Based Coalition Enhancement Grants To Prevent
    Underage Drinking.--
              (1) Authorization of program.--The Assistant
            Secretary for Mental Health and Substance Use, in
            consultation with the Director of the Office of
            National Drug Control Policy, shall award enhancement
            grants to eligible entities to design, implement,
            evaluate, and disseminate comprehensive strategies to
            maximize the effectiveness of community-wide approaches
            to preventing and reducing underage drinking. This
            subsection is subject to the availability of
            appropriations.
              (2) Purposes.--The purposes of this subsection are
            to--
                      (A) prevent and reduce alcohol use among
                    youth in communities throughout the United
                    States;
                      (B) strengthen collaboration among
                    communities, the Federal Government, Tribal
                    Governments, and State and local governments;
                      (C) enhance intergovernmental cooperation and
                    coordination on the issue of alcohol use among
                    youth;
                      (D) serve as a catalyst for increased citizen
                    participation and greater collaboration among
                    all sectors and organizations of a community
                    that first demonstrates a long-term commitment
                    to reducing alcohol use among youth;
                      (E) implement state-of-the-art science-based
                    strategies to prevent and reduce underage
                    drinking by changing local conditions in
                    communities; and
                      (F) enhance, not supplant, effective local
                    community initiatives for preventing and
                    reducing alcohol use among youth.
              (3) Application.--An eligible entity desiring an
            enhancement grant under this subsection shall submit an
            application to the Assistant Secretary at such time,
            and in such manner, and accompanied by such information
            and assurances, as the Assistant Secretary may require.
            Each application shall include--
                      (A) a complete description of the entity's
                    current underage alcohol use prevention
                    initiatives and how the grant will
                    appropriately enhance the focus on underage
                    drinking issues; or
                      (B) a complete description of the entity's
                    current initiatives, and how it will use this
                    grant to enhance those initiatives by adding a
                    focus on underage drinking prevention.
              (4) Uses of funds.--Each eligible entity that
            receives a grant under this subsection shall use the
            grant funds to carry out the activities described in
            such entity's application submitted pursuant to
            paragraph (3) and obtain specialized training and
            technical assistance by the entity funded under section
            4 of Public Law 107-82, as amended (21 U.S.C. 1521
            note). Grants under this subsection shall not exceed
            $60,000 per year and may not exceed four years.
              (5) Supplement not supplant.--Grant funds provided
            under this subsection shall be used to supplement, not
            supplant, Federal and non-Federal funds available for
            carrying out the activities described in this
            subsection.
              (6) Evaluation.--Grants under this subsection shall
            be subject to the same evaluation requirements and
            procedures as the evaluation requirements and
            procedures imposed on recipients of drug-free community
            grants.
              (7) Definitions.--For purposes of this subsection,
            the term ``eligible entity'' means an organization that
            is currently receiving or has received grant funds
            under the Drug-Free Communities Act of 1997.
              (8) Administrative expenses.--Not more than 6 percent
            of a grant under this subsection may be expended for
            administrative expenses.
              (9) Authorization of appropriations.--There is
            authorized to be appropriated to carry out this
            subsection $11,500,000 for each of fiscal years 2023
            through 2027.
      (f) Grants to Professional Pediatric Provider Organizations
    To Reduce Underage Drinking Through Screening and Brief
    Interventions.--
              (1) In general.--The Secretary, acting through the
            Assistant Secretary for Mental Health and Substance
            Use, shall make one or more grants to professional
            pediatric provider organizations to increase among the
            members of such organizations effective practices to
            reduce the prevalence of alcohol use among individuals
            under the age of 21, including college students.
              (2) Purposes.--Grants under this subsection shall be
            made to promote the practices of--
                      (A) screening adolescents for alcohol use;
                      (B) offering brief interventions to
                    adolescents to discourage such use;
                      (C) educating parents about the dangers of
                    and methods of discouraging such use;
                      (D) diagnosing and treating alcohol use
                    disorders; and
                      (E) referring patients, when necessary, to
                    other appropriate care.
              (3) Use of funds.--A professional pediatric provider
            organization receiving a grant under this section may
            use the grant funding to promote the practices
            specified in paragraph (2) among its members by--
                      (A) providing training to health care
                    providers;
                      (B) disseminating best practices, including
                    culturally and linguistically appropriate best
                    practices, and developing, printing, and
                    distributing materials; and
                      (C) supporting other activities approved by
                    the Assistant Secretary.
              (4) Application.--To be eligible to receive a grant
            under this subsection, a professional pediatric
            provider organization shall submit an application to
            the Assistant Secretary at such time, and in such
            manner, and accompanied by such information and
            assurances as the Secretary may require. Each
            application shall include--
                      (A) a description of the pediatric provider
                    organization;
                      (B) a description of the activities to be
                    completed that will promote the practices
                    specified in paragraph (2);
                      (C) a description of the organization's
                    qualifications for performing such practices;
                    and
                      (D) a timeline for the completion of such
                    activities.
              (5) Definitions.--For the purpose of this subsection:
                      (A) Brief intervention.--The term ``brief
                    intervention'' means, after screening a
                    patient, providing the patient with brief
                    advice and other brief motivational enhancement
                    techniques designed to increase the insight of
                    the patient regarding the patient's alcohol
                    use, and any realized or potential consequences
                    of such use to effect the desired related
                    behavioral change.
                      (B) Adolescents.--The term ``adolescents''
                    means individuals under 21 years of age.
                      (C) Professional pediatric provider
                    organization.--The term ``professional
                    pediatric provider organization'' means an
                    organization or association that--
                              (i) consists of or represents
                            pediatric health care providers; and
                              (ii) is qualified to promote the
                            practices specified in paragraph (2).
                      (D) Screening.--The term ``screening'' means
                    using validated patient interview techniques to
                    identify and assess the existence and extent of
                    alcohol use in a patient.
              (6) Authorization of appropriations.--There is
            authorized to be appropriated to carry out this
            subsection $3,000,000 for each of fiscal years 2023
            through 2027.
      (g) Data Collection and Research.--
              (1) Additional research on underage drinking.--
                      (A) In general.--The Secretary shall, subject
                    to the availability of appropriations, collect
                    data, and conduct or support research that is
                    not duplicative of research currently being
                    conducted or supported by the Department of
                    Health and Human Services, on underage
                    drinking, with respect to the following:
                              (i) Improve data collection in
                            support of evaluation of the
                            effectiveness of comprehensive
                            community-based programs or strategies
                            and statewide systems to prevent and
                            reduce underage drinking, across the
                            underage years from early childhood to
                            age 21, such as programs funded and
                            implemented by governmental entities,
                            public health interest groups and
                            foundations, and alcohol beverage
                            companies and trade associations,
                            through the development of models of
                            State-level epidemiological
                            surveillance of underage drinking by
                            funding in States or large metropolitan
                            areas new epidemiologists focused on
                            excessive drinking including underage
                            alcohol use.
                              (ii) Obtain and report more precise
                            information than is currently collected
                            on the scope of the underage drinking
                            problem and patterns of underage
                            alcohol consumption, including improved
                            knowledge about the problem and
                            progress in preventing, reducing, and
                            treating underage drinking, as well as
                            information on the rate of exposure of
                            youth to advertising and other media
                            messages encouraging and discouraging
                            alcohol consumption.
                              (iii) Synthesize, expand on, and
                            widely disseminate existing research on
                            effective strategies for reducing
                            underage drinking, including
                            translational research, and make this
                            research easily accessible to the
                            general public.
                              (iv) Improve and conduct public
                            health surveillance on alcohol use and
                            alcohol-related conditions in States by
                            increasing the use of surveys, such as
                            the Behavioral Risk Factor Surveillance
                            System, to monitor binge and excessive
                            drinking and related harms among
                            individuals who are at least 18 years
                            of age, but not more than 20 years of
                            age, including harm caused to self or
                            others as a result of alcohol use that
                            is not duplicative of research
                            currently being conducted or supported
                            by the Department of Health and Human
                            Services.
                      (B) Authorization of appropriations.--There
                    is authorized to be appropriated to carry out
                    this paragraph $5,000,000 for each of fiscal
                    years 2023 through 2027.
              (2) National academy of sciences study.--
                      (A) In general.--Not later than 12 months
                    after the enactment of the Restoring Hope for
                    Mental Health and Well-Being Act of 2022, the
                    Secretary shall--
                              (i) contract with the National
                            Academy of Sciences to study
                            developments in research on underage
                            drinking and the public policy
                            implications of these developments; and
                              (ii) report to the Congress on the
                            results of such review.
                      (B) Authorization of appropriations.--There
                    is authorized to be appropriated to carry out
                    this paragraph $500,000 for fiscal year 2023.

               *       *       *       *       *       *       *

    Subpart 3--Center for Mental Health Services

               *       *       *       *       *       *       *

    SEC. 520A. PRIORITY MENTAL HEALTH NEEDS OF REGIONAL AND NATIONAL
                        SIGNIFICANCE.

      (a) Projects.--The Secretary shall address priority mental
    health needs of regional and national significance (as
    determined under subsection (b)) through the provision of or
    through assistance for--
              (1) knowledge development and application projects
            for prevention, treatment, and rehabilitation, and the
            conduct or support of evaluations of such projects;
              (2) training and technical assistance programs;
              (3) targeted capacity response programs; and
              (4) systems change grants including statewide family
            network grants and client-oriented and consumer run
            self-help activities, which may include technical
            assistance centers.
    The Secretary may carry out the activities described in this
    subsection directly or through grants, contracts, or
    cooperative agreements with States, political subdivisions of
    States, [Indian tribes or tribal organizations] Indian Tribes
    or Tribal organizations (as such terms are defined in section 4
    of the Indian Self-Determination and Education Assistance Act),
    health facilities, or programs operated by or in accordance
    with a contract or grant with the Indian Health Service, or,
    other public or private nonprofit entities.
      (b) Priority Mental Health Needs.--
              (1) Determination of needs.--Priority mental health
            needs of regional and national significance shall be
            determined by the Secretary in consultation with States
            and other interested groups. The Secretary shall meet
            with the States and interested groups on an annual
            basis to discuss program priorities.
              (2) Special consideration.--In developing program
            priorities described in paragraph (1), the Secretary
            shall give special consideration to promoting the
            integration of mental health services into primary
            health care systems.
      (c) Requirements.--
              (1) In general.--Recipients of grants, contracts, and
            cooperative agreements under this section shall comply
            with information and application requirements
            determined appropriate by the Secretary.
              (2) Duration of award.--With respect to a grant,
            contract, or cooperative agreement awarded under this
            section, the period during which payments under such
            award are made to the recipient may not exceed 5 years.
              (3) Matching funds.--The Secretary may, for projects
            carried out under subsection (a), require that entities
            that apply for grants, contracts, or cooperative
            agreements under this section provide non-Federal
            matching funds, as determined appropriate by the
            Secretary, to ensure the institutional commitment of
            the entity to the projects funded under the grant,
            contract, or cooperative agreement. Such non-Federal
            matching funds may be provided directly or through
            donations from public or private entities and may be in
            cash or in kind, fairly evaluated, including plant,
            equipment, or services.
              (4) Maintenance of effort.--With respect to
            activities for which a grant, contract or cooperative
            agreement is awarded under this section, the Secretary
            may require that recipients for specific projects under
            subsection (a) agree to maintain expenditures of non-
            Federal amounts for such activities at a level that is
            not less than the level of such expenditures maintained
            by the entity for the fiscal year preceding the fiscal
            year for which the entity receives such a grant,
            contract, or cooperative agreement.
      (d) Evaluation.--The Secretary shall evaluate each project
    carried out under subsection (a)(1) and shall disseminate the
    findings with respect to each such evaluation to appropriate
    public and private entities.
      (e) Information and Education.--
              (1) In general.--The Secretary shall establish
            information and education programs to disseminate and
            apply the findings of the knowledge development and
            application, training, and technical assistance
            programs, and targeted capacity response programs,
            under this section to the general public, to health
            care professionals, and to interested groups. The
            Secretary shall make every effort to provide linkages
            between the findings of supported projects and State
            agencies responsible for carrying out mental health
            services.
              (2) Rural and underserved areas.--In disseminating
            information on evidence-based practices in the
            provision of children's mental health services under
            this subsection, the Secretary shall ensure that such
            information is distributed to rural and medically
            underserved areas.
              (3) Geriatric mental disorders.--The Secretary shall,
            as appropriate, provide technical assistance to
            grantees regarding evidence-based practices for the
            prevention and treatment of geriatric mental disorders
            and co-occurring mental health and substance use
            disorders among geriatric populations, as well as
            disseminate information about such evidence-based
            practices to States and nongrantees throughout the
            United States.
      (f) Authorization of Appropriations.--There are authorized to
    be appropriated to carry out this section [$394,550,000 for
    each of fiscal years 2018 through 2022] $599,036,000 for each
    of fiscal years 2023 through 2027.

               *       *       *       *       *       *       *

    SEC. 520C. SUICIDE PREVENTION TECHNICAL ASSISTANCE CENTER.

      (a) Program Authorized.--The Secretary, acting through the
    Assistant Secretary, shall establish a research, training, and
    technical assistance resource center to provide appropriate
    information, training, and technical assistance to States,
    political subdivisions of States, federally recognized Indian
    [tribes] Tribes, [tribal] Tribal organizations, institutions of
    higher education, public organizations, or private nonprofit
    organizations regarding the prevention of suicide among all
    ages, particularly among groups that are at a high risk for
    suicide.
      (b) Responsibilities of the Center.--The center established
    under subsection (a) shall conduct activities for the purpose
    of--
              (1) developing and continuing statewide or [tribal]
            Tribal suicide early intervention and prevention
            strategies for all ages, particularly among groups that
            are at a high risk for suicide;
              (2) ensuring the surveillance of suicide early
            intervention and prevention strategies for all ages,
            particularly among groups that are at a high risk for
            suicide;
              (3) studying the costs and effectiveness of statewide
            and tribalsuicide early intervention and prevention
            strategies in order to provide information concerning
            relevant issues of importance to State, [tribal]
            Tribal, and national policymakers;
              (4) further identifying and understanding causes and
            associated risk factors for suicide;
              (5) analyzing the efficacy of new and existing
            suicide early intervention and prevention techniques
            and technology;
              (6) ensuring the surveillance of suicidal behaviors
            and nonfatal suicidal attempts;
              (7) studying the effectiveness of State-sponsored
            statewide and [tribal] Tribal suicide early
            intervention and prevention strategies on the overall
            wellness and health promotion strategies related to
            suicide attempts;
              (8) promoting the sharing of data regarding suicide
            with Federal agencies involved with suicide early
            intervention and prevention, and State-sponsored
            statewide or [tribal] Tribal suicide early intervention
            and prevention strategies for the purpose of
            identifying previously unknown mental health causes and
            associated risk factors for suicide;
              (9) evaluating and disseminating outcomes and best
            practices of mental health and substance use disorder
            services at institutions of higher education; and
              (10) conducting other activities determined
            appropriate by the Secretary.
      (c) Authorization of Appropriations.--For the purpose of
    carrying out this section, there are authorized to be
    appropriated [$5,988,000 for each of fiscal years 2018 through
    2022] $9,000,000 for each of fiscal years 2023 through 2027.
      (d) Annual Report.--[Not later than 2 years after the date of
    enactment of this subsection] Not later than 2 years after the
    date of enactment of the Restoring Hope for Mental Health and
    Well-Being Act of 2022, the Secretary shall submit to Congress
    a report on the activities carried out by the center
    established under subsection (a) during the year involved,
    including the potential effects of such activities, and the
    States, organizations, and institutions that have worked with
    the center.

    SEC. 520E. YOUTH SUICIDE EARLY INTERVENTION AND PREVENTION STRATEGIES.

      (a) In General.--The Secretary, acting through the Assistant
    Secretary for Mental Health and Substance Use, shall award
    grants or cooperative agreements to eligible entities to--
              (1) develop and implement State-sponsored statewide
            or [tribal] Tribal youth suicide early intervention and
            prevention strategies in schools, educational
            institutions, juvenile justice systems, substance use
            disorder programs, mental health programs, foster care
            systems, pediatric health programs, and other child and
            youth support organizations;
              (2) support public organizations and private
            nonprofit organizations actively involved in State-
            sponsored statewide or [tribal] Tribal youth suicide
            early intervention and prevention strategies and in the
            development and continuation of State-sponsored
            statewide youth suicide early intervention and
            prevention strategies;
              (3) provide grants to institutions of higher
            education to coordinate the implementation of State-
            sponsored statewide or [tribal] Tribal youth suicide
            early intervention and prevention strategies;
              (4) collect and analyze data on State-sponsored
            statewide or [tribal] Tribal youth suicide early
            intervention and prevention services that can be used
            to monitor the effectiveness of such services and for
            research, technical assistance, and policy development;
            and
              (5) assist eligible entities, through State-sponsored
            statewide or [tribal] Tribal youth suicide early
            intervention and prevention strategies, in achieving
            targets for youth suicide reductions under title V of
            the Social Security Act.
      (b) Eligible Entity.--
              (1) Definition.--In this section, the term ``eligible
            entity'' means--
                      (A) a State;
                      [(B) a public organization or private
                    nonprofit organization designated by a State to
                    develop or direct the State-sponsored statewide
                    youth suicide early intervention and prevention
                    strategy; or]
                      (B) a public organization or private
                    nonprofit organization designated by a State or
                    Indian Tribe (as defined under the Federally
                    Recognized Indian Tribe List Act of 1994) to
                    develop or direct the State-sponsored statewide
                    or Tribal youth suicide early intervention and
                    prevention strategy; or
                      (C) a Federally recognized Indian [tribe]
                    Tribe or [tribal] Tribal organization (as
                    defined in the Indian Self-Determination and
                    Education Assistance Act) or an urban Indian
                    organization (as defined in the Indian Health
                    Care Improvement Act) that is actively involved
                    in the development and continuation of a
                    [tribal] Tribal youth suicide early
                    intervention and prevention strategy.
              (2) Limitation.--In carrying out this section, the
            Secretary shall ensure that a State does not receive
            more than 1 grant or cooperative agreement under this
            section at any 1 time. For purposes of the preceding
            sentence, a State shall be considered to have received
            a grant or cooperative agreement if the eligible entity
            involved is the State or an entity designated by the
            State under paragraph (1)(B). Nothing in this paragraph
            shall be construed to apply to entities described in
            paragraph (1)(C).
              (3) Consideration.--In awarding grants under this
            section, the Secretary shall take into consideration
            the extent of the need of the applicant, including the
            incidence and prevalence of suicide in the State and
            among the populations of focus, including rates of
            suicide determined by the Centers for Disease Control
            and Prevention for the State or population of focus.
              (4) Consultation.--An entity described in paragraph
            (1)(A) or (1)(B) that applies for a grant or
            cooperative agreement under this section shall agree to
            consult or confer with entities described in paragraph
            (1)(C) and Native Hawaiian Health Care Systems, as
            applicable, in the applicable State with respect to the
            development and implementation of a statewide early
            intervention strategy.
      (c) Preference.--In providing assistance under a grant or
    cooperative agreement under this section, an eligible entity
    shall give preference to public organizations, private
    nonprofit organizations, political subdivisions, institutions
    of higher education, and [tribal] Tribal organizations actively
    involved with the State-sponsored statewide or [tribal] Tribal
    youth suicide early intervention and prevention strategy that--
              (1) provide early intervention and assessment
            services, including screening programs, to youth who
            are at risk for mental or emotional disorders that may
            lead to a suicide attempt, and that are integrated with
            school systems, educational institutions, juvenile
            justice systems, substance use disorder programs,
            mental health programs, foster care systems, pediatric
            health programs, and other child and youth support
            organizations;
              (2) demonstrate collaboration among early
            intervention and prevention services or certify that
            entities will engage in future collaboration;
              (3) employ or include in their applications a
            commitment to evaluate youth suicide early intervention
            and prevention practices and strategies adapted to the
            local community;
              (4) provide timely referrals for appropriate
            community-based mental health care and treatment of
            youth who are at risk for suicide in child-serving
            settings and agencies;
              (5) provide immediate support and information
            resources to families of youth who are at risk for
            suicide;
              (6) offer access to services and care to youth with
            diverse linguistic and cultural backgrounds;
              (7) offer appropriate postsuicide intervention
            services, care, and information to families, friends,
            schools, educational institutions, juvenile justice
            systems, substance use disorder programs, mental health
            programs, foster care systems, pediatric health
            programs, and other child and youth support
            organizations of youth who recently completed suicide;
              (8) offer continuous and up-to-date information and
            awareness campaigns that target parents, family
            members, child care professionals, community care
            providers, and the general public and highlight the
            risk factors associated with youth suicide and the
            life-saving help and care available from early
            intervention and prevention services;
              (9) ensure that information and awareness campaigns
            on youth suicide risk factors, and early intervention
            and prevention services, use effective communication
            mechanisms that are targeted to and reach youth,
            families, schools, educational institutions, pediatric
            health programs, and youth organizations;
              (10) provide a timely response system to ensure that
            child-serving professionals and providers are properly
            trained in youth suicide early intervention and
            prevention strategies and that child-serving
            professionals and providers involved in early
            intervention and prevention services are properly
            trained in effectively identifying youth who are at
            risk for suicide;
              (11) provide continuous training activities for child
            care professionals and community care providers on the
            latest youth suicide early intervention and prevention
            services practices and strategies;
              (12) conduct annual self-evaluations of outcomes and
            activities, including consulting with interested
            families and advocacy organizations;
              (13) provide services in areas or regions with rates
            of youth suicide that exceed the national average as
            determined by the Centers for Disease Control and
            Prevention; [and]
              (14) obtain informed written consent from a parent or
            legal guardian of an at-risk child before involving the
            child in a youth suicide early intervention and
            prevention program[.]; and
              (15) provide to parents, legal guardians, and family
            members of youth, supplies to securely store means
            commonly used in suicide, if applicable, within the
            household.
      (d) Requirement for [Direct Services] Suicide Prevention
    Activities.--Not less than 85 percent of grant funds received
    under this section shall be used to provide [direct services,
    of which not less than 5 percent shall be used for activities
    authorized under subsection (a)(3)] suicide prevention
    activities.
      (e) Coordination and Collaboration.--
              (1) In general.--In carrying out this section, the
            Secretary shall collaborate with relevant Federal
            agencies and suicide working groups responsible for
            early intervention and prevention services relating to
            youth suicide.
              (2) Consultation.--In carrying out this section, the
            Secretary shall consult with--
                      (A) State and local agencies, including
                    agencies responsible for early intervention and
                    prevention services under title XIX of the
                    Social Security Act, the State Children's
                    Health Insurance Program under title XXI of the
                    Social Security Act, and programs funded by
                    grants under title V of the Social Security
                    Act;
                      (B) local and national organizations that
                    serve youth at risk for suicide and their
                    families;
                      (C) relevant national medical and other
                    health and education specialty organizations;
                      (D) youth who are at risk for suicide, who
                    have survived suicide attempts, or who are
                    currently receiving care from early
                    intervention services;
                      (E) families and friends of youth who are at
                    risk for suicide, who have survived suicide
                    attempts, who are currently receiving care from
                    early intervention and prevention services, or
                    who have completed suicide;
                      (F) qualified professionals who possess the
                    specialized knowledge, skills, experience, and
                    relevant attributes needed to serve youth at
                    risk for suicide and their families; and
                      (G) third-party payers, managed care
                    organizations, and related commercial
                    industries.
              (3) Policy development.--In carrying out this
            section, the Secretary shall--
                      (A) coordinate and collaborate on policy
                    development at the Federal level with the
                    relevant Department of Health and Human
                    Services and Department of Education agencies
                    and suicide working groups; and
                      (B) consult on policy development at the
                    Federal level with the private sector,
                    including consumer, medical, suicide prevention
                    advocacy groups, and other health and education
                    professional-based organizations, with respect
                    to State-sponsored statewide or [tribal] Tribal
                    youth suicide early intervention and prevention
                    strategies.
      (f) Rule of Construction; Religious and Moral
    Accommodation.--Nothing in this section shall be construed to
    require suicide assessment, early intervention, or treatment
    services for youth whose parents or legal guardians object
    based on the parents' or legal guardians' religious beliefs or
    moral objections.
      (g) Evaluations and Report.--
              (1) Evaluations by eligible entities.--Not later than
            [18] 24 months after receiving a grant or cooperative
            agreement under this section, an eligible entity shall
            submit to the Secretary the results of an evaluation to
            be conducted by the entity concerning the effectiveness
            of the activities carried out under the grant or
            agreement.
              (2) Report.--Not later than [2 years after the date
            of enactment of Helping Families in Mental Health
            Crisis Reform Act of 2016] 3 years after December 31,
            2022, the Secretary shall submit to the appropriate
            committees of Congress a report concerning the results
            of--
                      (A) the evaluations conducted under paragraph
                    (1); and
                      (B) an evaluation conducted by the Secretary
                    to analyze the effectiveness and efficacy of
                    the activities conducted with grants,
                    collaborations, and consultations under this
                    section.
      (h) Rule of Construction; Student Medication.--Nothing in
    this section or section 520E-1 shall be construed to allow
    school personnel to require that a student obtain any
    medication as a condition of attending school or receiving
    services.
      (i) Prohibition.--Funds appropriated to carry out this
    section, section 520C, section 520E-1, or section 520E-2 shall
    not be used to pay for or refer for abortion.
      (j) Parental consent.--States and entities receiving funding
    under this section and section 520E-1 shall obtain prior
    written, informed consent from the child's parent or legal
    guardian for assessment services, school-sponsored programs,
    and treatment involving medication related to youth suicide
    conducted in elementary and secondary schools. The requirement
    of the preceding sentence does not apply in the following
    cases:
              (1) In an emergency, where it is necessary to protect
            the immediate health and safety of the student or other
            students.
              (2) Other instances, as defined by the State, where
            parental consent cannot reasonably be obtained.
      (k) Relation to Education Provisions.--Nothing in this
    section or section 520E-1 shall be construed to supersede
    section 444 of the General Education Provisions Act, including
    the requirement of prior parental consent for the disclosure of
    any education records. Nothing in this section or section 520E-
    1 shall be construed to modify or affect parental notification
    requirements for programs authorized under the Elementary and
    Secondary Education Act of 1965 (as amended by the No Child
    Left Behind Act of 2001; Public Law 107-110).
      (l) Definitions.--In this section:
              (1) Early intervention.--The term ``early
            intervention'' means a strategy or approach that is
            intended to prevent an outcome or to alter the course
            of an existing condition.
              (2) Educational institution; institution of higher
            education; school.--The term--
                      (A) ``educational institution'' means a
                    school or institution of higher education;
                      (B) ``institution of higher education'' has
                    the meaning given such term in section 101 of
                    the Higher Education Act of 1965; and
                      (C) ``school'' means an elementary school or
                    secondary school (as such terms are defined in
                    section 8101 of the Elementary and Secondary
                    Education Act of 1965).
              (3) Prevention.--The term ``prevention'' means a
            strategy or approach that reduces the likelihood or
            risk of onset, or delays the onset, of adverse health
            problems that have been known to lead to suicide.
              (4) Youth.--The term ``youth'' means individuals who
            are [between 10 and 24 years of age] up to 24 years of
            age.
      (m) Authorization of Appropriations.--For the purpose of
    carrying out this section, there are authorized to be
    appropriated [$30,000,000 for each of fiscal years 2018 through
    2022] $40,000,000 for each of fiscal years 2023 through 2027.

               *       *       *       *       *       *       *

    SEC. 520E-2. MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES [ON
                        CAMPUS]  FOR STUDENTS IN HIGHER EDUCATION.

      (a) In General.--The Secretary, acting through the Director
    of the Center for Mental Health Services and in consultation
    with the Secretary of Education, may award grants on a
    competitive basis to institutions of higher education to
    enhance services for students with mental health or substance
    use disorders that can lead to school failure, such as
    depression, substance use disorders, and suicide attempts,
    prevent mental and substance use disorders, reduce stigma, and
    improve the identification and treatment for students at risk,
    so that students will successfully complete their studies.
      (b) Use of Funds.--The Secretary may not make a grant to an
    institution of higher education under this section unless the
    institution agrees to use the grant only for one or more of the
    following:
              (1) Educating students, families, faculty, and staff
            to increase awareness of mental and substance use
            disorders.
              (2) The operation of hotlines.
              (3) Preparing informational material.
              (4) Providing outreach services to notify students
            about available mental and substance use disorder
            services.
              (5) Administering voluntary mental and substance use
            disorder screenings and assessments.
              (6) Supporting the training of students, faculty, and
            staff to respond effectively to students with mental
            and substance use disorders.
              (7) Creating a network infrastructure to link
            institutions of higher education with health care
            providers who treat mental and substance use disorders.
              (8) Providing mental and substance use disorders
            prevention and treatment services to students, which
            may include recovery support services and programming
            and early intervention, treatment, and management,
            including through the use of telehealth services.
              (9) Conducting research through a counseling or
            health center at the institution of higher education
            involved regarding improving the behavioral health of
            students through clinical services, outreach,
            prevention, or academic success, in a manner that is in
            compliance with all applicable personal privacy laws.
              (10) Supporting student groups on campus, including
            athletic teams, that engage in activities to educate
            students, including activities to reduce stigma
            surrounding mental and behavioral disorders, and
            promote mental health.
              (11) Employing appropriately trained staff.
              (12) Developing and supporting evidence-based and
            emerging best practices, including a focus on
            culturally and linguistically appropriate best
            practices.
      (c) Eligible grant recipients.--Any institution of higher
    education receiving a grant under this section may carry out
    activities under the grant through--
              (1) college counseling centers;
              (2) college and university psychological service
            centers;
              (3) mental health centers;
              (4) psychology training clinics; or
              (5) institution of higher education supported,
            evidence-based, mental health and substance use
            disorder programs.
      (d) Application.--To be eligible to receive a grant under
    this section, an institution of higher education shall prepare
    and submit an application to the Secretary at such time and in
    such manner as the Secretary may require. At a minimum, the
    application shall include the following:
              (1) A description of the population to be targeted by
            the program carried out under the grant, including
            veterans whenever possible and appropriate, and of
            identified mental and substance use disorder needs of
            students at the institution of higher education.
              (2) A description of Federal, State, local, private,
            and institutional resources currently available to
            address the needs described in paragraph (1) at the
            institution of higher education, which may include, as
            appropriate and in accordance with subsection (b)(7), a
            plan to seek input from relevant stakeholders in the
            community, including appropriate public and private
            entities, in order to carry out the program under the
            grant.
              (3) A description of the outreach strategies of the
            institution of higher education for promoting access to
            services, including a proposed plan for reaching those
            students most in need of mental health services.
              (4) A plan to evaluate program outcomes, including a
            description of the proposed use of funds, the program
            objectives, and how the objectives will be met.
              (5) An assurance that the institution will submit a
            report to the Secretary each fiscal year on the
            activities carried out with the grant and the results
            achieved through those activities.
              (6) An outline of the objectives of the program
            carried out under the grant.
              (7) For an institution of higher education proposing
            to use the grant for an activity described in paragraph
            (8) or (9) of subsection (b), a description of the
            policies and procedures of the institution of higher
            education that are related to applicable laws regarding
            access to, and sharing of, treatment records of
            students at any campus-based mental health center or
            partner organization, including the policies and State
            laws governing when such records can be accessed and
            shared for non-treatment purposes and a description of
            the process used by the institution of higher education
            to notify students of these policies and procedures,
            including the extent to which written consent is
            required.
              (8) An assurance that grant funds will be used to
            supplement and not supplant any other Federal, State,
            or local funds available to carry out activities of the
            type carried out under the grant.
      (e) Requirement of Matching Funds.--
              (1) In general.--The Secretary may make a grant under
            this section to an institution of higher education only
            if the institution agrees to make available (directly
            or through donations from public or private entities)
            non-Federal contributions in an amount that is not less
            than $1 for each $1 of Federal funds provided in the
            grant, toward the costs of activities carried out with
            the grant (as described in subsection (b)) and other
            activities by the institution to reduce student mental
            health and substance use disorders.
              (2) Determination of amount contributed.--Non-Federal
            contributions required under paragraph (1) may be in
            cash or in kind. Amounts provided by the Federal
            Government, or services assisted or subsidized to any
            significant extent by the Federal Government, may not
            be included in determining the amount of such non-
            Federal contributions.
              (3) Waiver.--The Secretary may waive the requirement
            established in paragraph (1) with respect to an
            institution of higher education if the Secretary
            determines that extraordinary need at the institution
            justifies the waiver.
      (f) Reports.--For each fiscal year that grants are awarded
    under this section, the Secretary shall conduct a study on the
    results of the grants and submit to the Congress a report on
    such results that includes the following:
              (1) An evaluation of the grant program outcomes,
            including a summary of activities carried out with the
            grant and the results achieved through those
            activities.
              (2) Recommendations on how to improve access to
            mental health and substance use disorder services at
            institutions of higher education, including efforts to
            reduce the incidence of suicide and substance use
            disorders.
      (g) Definition.--In this section, the term ``institution of
    higher education'' has the meaning given such term in section
    101 of the Higher Education Act of 1965.
      (h) Technical Assistance.--The Secretary may provide
    technical assistance to grantees in carrying out this section.
      (i) Authorization of Appropriations.--For the purpose of
    carrying out this section, there are authorized to be
    appropriated $7,000,000 for each of fiscal years [2018 through
    2022] 2023 through 2027.

               *       *       *       *       *       *       *

    SEC. 520E-4. TREATMENT REFERRAL ROUTING SERVICE.

      (a) In General.--The Secretary, acting through the Assistant
    Secretary, shall maintain the National Treatment Referral
    Routing Service (referred to in this section as the ``Routing
    Service'') to assist individuals and families in locating
    mental and substance use disorders treatment providers.
      (b) Activities of the Secretary.--To maintain the Routing
    Service, the activities of the Assistant Secretary shall
    include administering--
              (1) a nationwide, telephone number providing year-
            round access to information that is updated on a
            regular basis regarding local behavioral health
            providers and community-based organizations in a manner
            that is confidential, without requiring individuals to
            identify themselves, is in languages that include at
            least English and Spanish, and is at no cost to the
            individual using the Routing Service; and
              (2) an Internet website to provide a searchable,
            online treatment services locator of behavioral health
            treatment providers and community-based organizations,
            which shall include information on the name, location,
            contact information, and basic services provided by
            such providers and organizations.
      (c) Removing Practitioner Contact Information.--In the event
    that the Internet website described in subsection (b)(2)
    contains [information on any qualified practitioner that is
    certified to prescribe medication for opioid dependency under
    section 303(g)(2)(B) of the Controlled Substances Act]
    information on any practitioner who prescribes narcotic drugs
    in schedule III, IV, or V of section 202 of the Controlled
    Substances Act for the purpose of maintenance or detoxification
    treatment, the Assistant Secretary--
              (1) shall provide an opportunity to such practitioner
            to have the contact information of the practitioner
            removed from the website at the request of the
            practitioner; and
              (2) may evaluate other methods to periodically update
            the information displayed on such website.
      (d) Rule of Construction.--Nothing in this section shall be
    construed to prevent the Assistant Secretary from using any
    unobligated amounts otherwise made available to the
    Administration to maintain the Routing Service.

    [SEC. 520F. STRENGTHENING COMMUNITY CRISIS RESPONSE SYSTEMS.

      [(a) In General.--The Secretary shall award competitive
    grants to--
              [(1) State and local governments and Indian tribes
            and tribal organizations, to enhance community-based
            crisis response systems; or
              [(2) States to develop, maintain, or enhance a
            database of beds at inpatient psychiatric facilities,
            crisis stabilization units, and residential community
            mental health and residential substance use disorder
            treatment facilities, for adults with a serious mental
            illness, children with a serious emotional disturbance,
            or individuals with a substance use disorder.
      [(b) Applications.--
              [(1) In general.--To receive a grant under subsection
            (a), an entity shall submit to the Secretary an
            application, at such time, in such manner, and
            containing such information as the Secretary may
            require.
              [(2) Community-based crisis response plan.--An
            application for a grant under subsection (a)(1) shall
            include a plan for--
                      [(A) promoting integration and coordination
                    between local public and private entities
                    engaged in crisis response, including first
                    responders, emergency health care providers,
                    primary care providers, law enforcement, court
                    systems, health care payers, social service
                    providers, and behavioral health providers;
                      [(B) developing memoranda of understanding
                    with public and private entities to implement
                    crisis response services;
                      [(C) addressing gaps in community resources
                    for crisis intervention and prevention; and
                      [(D) developing models for minimizing
                    hospital readmissions, including through
                    appropriate discharge planning.
              [(3) Beds database plan.--An application for a grant
            under subsection (a)(2) shall include a plan for
            developing, maintaining, or enhancing a real-time,
            Internet-based bed database to collect, aggregate, and
            display information about beds in inpatient psychiatric
            facilities and crisis stabilization units, and
            residential community mental health and residential
            substance use disorder treatment facilities to
            facilitate the identification and designation of
            facilities for the temporary treatment of individuals
            in mental or substance use disorder crisis.
      [(c) Database Requirements.--A bed database described in this
    section is a database that--
              [(1) includes information on inpatient psychiatric
            facilities, crisis stabilization units, and residential
            community mental health and residential substance use
            disorder facilities in the State involved, including
            contact information for the facility or unit;
              [(2) provides real-time information about the number
            of beds available at each facility or unit and, for
            each available bed, the type of patient that may be
            admitted, the level of security provided, and any other
            information that may be necessary to allow for the
            proper identification of appropriate facilities for
            treatment of individuals in mental or substance use
            disorder crisis; and
              [(3) enables searches of the database to identify
            available beds that are appropriate for the treatment
            of individuals in mental or substance use disorder
            crisis.
      [(d) Evaluation.--An entity receiving a grant under
    subsection (a)(1) shall submit to the Secretary, at such time,
    in such manner, and containing such information as the
    Secretary may reasonably require, a report, including an
    evaluation of the effect of such grant on--
              [(1) local crisis response services and measures for
            individuals receiving crisis planning and early
            intervention supports;
              [(2) individuals reporting improved functional
            outcomes; and
              [(3) individuals receiving regular followup care
            following a crisis.
      [(e) Authorization of Appropriations.--There are authorized
    to be appropriated to carry out this section, $12,500,000 for
    the period of fiscal years 2018 through 2022.]

    SEC. 520F. MENTAL HEALTH CRISIS RESPONSE PARTNERSHIP PILOT PROGRAM.

      (a) In General.--The Secretary shall establish a pilot
    program under which the Secretary will award competitive grants
    to States, localities, territories, Indian Tribes, and Tribal
    organizations to establish new, or enhance existing, mobile
    crisis response teams that divert the response for mental
    health and substance use crises from law enforcement to mobile
    crisis teams, as described in subsection (b).
      (b) Mobile Crisis Teams Described.--A mobile crisis team
    described in this subsection is a team of individuals--
              (1) that is available to respond to individuals in
            crisis and provide immediate stabilization, referrals
            to community-based mental health and substance use
            disorder services and supports, and triage to a higher
            level of care if medically necessary;
              (2) which may include licensed counselors, clinical
            social workers, physicians, paramedics, crisis workers,
            peer support specialists, or other qualified
            individuals; and
              (3) which may provide support to divert behavioral
            health crisis calls from the 9-1-1 system to the 9-8-8
            system.
      (c) Priority.--In awarding grants under this section, the
    Secretary shall prioritize applications which account for the
    specific needs of the communities to be served, including
    children and families, veterans, rural and underserved
    populations, and other groups at increased risk of death from
    suicide or overdose.
      (d) Report.--
              (1) Initial report.--Not later than September 30,
            2024, the Secretary shall submit to Congress a report
            on steps taken by the entities specified in subsection
            (a) as of such date of enactment to strengthen the
            partnerships among mental health providers, substance
            use disorder treatment providers, primary care
            physicians, mental health and substance use crisis
            teams, paramedics, law enforcement officers, and other
            first responders.
              (2) Progress reports.--Not later than one year after
            the date on which the first grant is awarded to carry
            out this section, and for each year thereafter, the
            Secretary shall submit to Congress a report on the
            grants made during the year covered by the report,
            which shall include--
                      (A) impact data on the teams and people
                    served by such programs, including demographic
                    information of individuals served, volume, and
                    types of service utilization;
                      (B) outcomes of the number of linkages to
                    community-based resources, short-term crisis
                    receiving and stabilization facilities, and
                    diversion from law enforcement or hospital
                    emergency department settings;
                      (C) data consistent with the State block
                    grant requirements for continuous evaluation
                    and quality improvement, and other relevant
                    data as determined by the Secretary; and
                      (D) the Secretary's recommendations and best
                    practices for--
                              (i) States and localities providing
                            mobile crisis response and
                            stabilization services for youth and
                            adults; and
                              (ii) improvements to the program
                            established under this section.
      (e) Authorization of Appropriations.--There are authorized to
    be appropriated to carry out this section, $10,000,000 for each
    of fiscal years 2023 through 2027.

    SEC. 520G. GRANTS FOR JAIL DIVERSION PROGRAMS.

      (a) Program Authorized.--The Secretary shall make [up to 125]
    grants to States, political subdivisions of States, and Indian
    [tribes and tribal organizations] Tribes and Tribal
    organizations (as the terms ``Indian tribes'' and ``tribal
    organizations'' are defined in section 4 of the Indian Self-
    Determination and Education Assistance Act), acting directly or
    through agreements with other public or nonprofit entities, or
    a health facility or program operated by or in accordance with
    a contract or grant with the Indian Health Service, to develop
    and implement programs to divert individuals with a mental
    illness from the criminal justice system to community-based
    services.
      (b) Administration.--
              (1) Consultation.--The Secretary shall consult with
            the Attorney General and any other appropriate
            officials in carrying out this section.
              (2) Regulatory authority.--The Secretary shall issue
            regulations and guidelines necessary to carry out this
            section, including methodologies and outcome measures
            for evaluating programs carried out by States,
            political subdivisions of States, Indian [tribes, and
            tribal organizations] Tribes, and Tribal organizations
            receiving grants under subsection (a).
      (c) Applications.--
              (1) In general.--To receive a grant under subsection
            (a), the chief executive of a State, chief executive of
            a subdivision of a State, Indian [tribe or tribal
            organization] Tribe or Tribal organization, health
            facility or program described in subsection (a), or
            public or nonprofit entity referred to in subsection
            (a) shall prepare and submit an application to the
            Secretary at such time, in such manner, and containing
            such information as the Secretary shall reasonably
            require.
              (2) Content.--Such application shall--
                      (A) contain an assurance that--
                              (i) community-based mental health
                            services will be available for the
                            individuals who are diverted from the
                            criminal justice system, and that such
                            services are based on evidence-based
                            practices, reflect current research
                            findings, include case management,
                            assertive community treatment,
                            medication management and access,
                            integrated mental health and co-
                            occurring substance use disorder
                            treatment, and psychiatric
                            rehabilitation, and will be coordinated
                            with social services, including life
                            skills training, housing placement,
                            vocational training, education job
                            placement, and health care;
                              (ii) there has been relevant
                            interagency collaboration between the
                            appropriate criminal justice, mental
                            health, and substance use disorder
                            systems; and
                              (iii) the Federal support provided
                            will be used to supplement, and not
                            supplant, State, local, Indian [tribe,
                            or tribal organization] Tribe, or
                            Tribal organization sources of funding
                            that would otherwise be available;
                      (B) demonstrate that the diversion program
                    will be integrated with an existing system of
                    care for those with mental illness;
                      (C) explain the applicant's inability to fund
                    the program adequately without Federal
                    assistance;
                      (D) specify plans for obtaining necessary
                    support and continuing the proposed program
                    following the conclusion of Federal support;
                    and
                      (E) describe methodology and outcome measures
                    that will be used in evaluating the program.
      (d) Special Consideration Regarding Veterans.--In awarding
    grants under subsection (a), the Secretary shall, as
    appropriate, give special consideration to entities proposing
    to use grant funding to support jail diversion services for
    veterans.
      (e) Use of Funds.--A State, political subdivision of a State,
    Indian [tribe, or tribal organization] Tribe, or Tribal
    organization that receives a grant under subsection (a) may use
    funds received under such grant to--
              (1) integrate the diversion program into the existing
            system of care;
              (2) create or expand community-based mental health
            and co-occurring mental illness and substance use
            disorder services to accommodate the diversion program;
              (3) train professionals involved in the system of
            care, and law enforcement officers, attorneys, and
            judges;
              (4) provide community outreach and crisis
            intervention; and
              (5) develop programs to divert individuals prior to
            booking [or arrest], arrest, or release.
      (f) Federal Share.--
              (1) In general.--The Secretary shall pay to a State,
            political subdivision of a State, Indian [tribe, or
            tribal organization] Tribe, or Tribal organization
            receiving a grant under subsection (a) the Federal
            share of the cost of activities described in the
            application.
              (2) Federal share.--The Federal share of a grant made
            under this section shall not exceed 75 percent of the
            total cost of the program carried out by the State,
            political subdivision of a State, Indian [tribe, or
            tribal organization] Tribe, or Tribal organization.
            Such share shall be used for new expenses of the
            program carried out by such State, political
            subdivision of a State, Indian [tribe, or tribal
            organization] Tribe, or Tribal organization.
              (3) Non-federal share.--The non-Federal share of
            payments made under this section may be made in cash or
            in kind fairly evaluated, including planned equipment
            or services. The Secretary may waive the requirement of
            matching contributions.
      (g) Geographic Distribution.--The Secretary shall ensure that
    such grants awarded under subsection (a) are equitably
    distributed among the geographical regions of the United States
    and between urban and rural populations.
      (h) Training and Technical Assistance.--Training and
    technical assistance may be provided by the Secretary to assist
    a State, political subdivision of a State, Indian [tribe, or
    tribal organization] Tribe, or Tribal organization receiving a
    grant under subsection (a) in establishing and operating a
    diversion program.
      (i) Evaluations.--The programs described in subsection (a)
    shall be evaluated not less than one time in every 12-month
    period using the methodology and outcome measures identified in
    the grant application.
      (j) Authorization of Appropriations.--There are authorized to
    be appropriated to carry out this section [$4,269,000 for each
    of fiscal years 2018 through 2022] $14,000,000 for each of
    fiscal years 2023 through 2027.

    SEC. 520H. PEER-SUPPORTED MENTAL HEALTH SERVICES.

      (a) Grants Authorized.--The Secretary, acting through the
    Director of the Center for Mental Health Services, shall award
    grants to eligible entities to enable such entities to develop,
    expand, and enhance access to mental health peer-delivered
    services.
      (b) Use of Funds.--Grants awarded under subsection (a) shall
    be used to develop, expand, and enhance national, statewide, or
    community-focused programs, including virtual peer-support
    services and infrastructure, including by--
              (1) carrying out workforce development, recruitment,
            and retention activities, to train, recruit, and retain
            peer-support providers;
              (2) building connections between mental health
            treatment programs, including between community
            organizations and peer-support networks, including
            virtual peer-support networks, and with other mental
            health support services;
              (3) reducing stigma associated with mental health
            disorders;
              (4) expanding and improving virtual peer mental
            health support services, including adoption of
            technologies to expand access to virtual peer mental
            health support services, including by acquiring--
                      (A) appropriate physical hardware for such
                    virtual services;
                      (B) software and programs to efficiently run
                    peer-support services virtually; and
                      (C) other technology for establishing virtual
                    waiting rooms and virtual video platforms for
                    meetings; and
              (5) conducting research on issues relating to mental
            illness and the impact peer-support has on resiliency,
            including identifying--
                      (A) the signs of mental illness;
                      (B) the resources available to individuals
                    with mental illness and to their families; and
                      (C) the resources available to help support
                    individuals living with mental illness.
      (c) Special Consideration.--In carrying out this section, the
    Secretary shall give special consideration to the unique needs
    of rural areas.
      (d) Definition.--In this section, the term ``eligible
    entity'' means--
              (1) a nonprofit consumer-run organization that--
                      (A) is principally governed by people living
                    with a mental health condition; and
                      (B) mobilizes resources within and outside of
                    the mental health community, which may include
                    through peer-support networks, to increase the
                    prevalence and quality of long-term wellness of
                    individuals living with a mental health
                    condition, including those with a co-occurring
                    substance use disorder; or
              (2) a Federally recognized Tribe, Tribal
            organization, Urban Indian organization, or consortium
            of Tribes or Tribal organizations.
      (e) Authorization of Appropriations.--There is authorized to
    be appropriated to carry out this section $13,000,000 for each
    of fiscal years 2023 through 2027.

               *       *       *       *       *       *       *

    SEC. 520J. MENTAL HEALTH AWARENESS TRAINING GRANTS.

      (a) In General.--The Secretary shall award grants in
    accordance with the provisions of this section.
      (b) Mental Health Awareness Training Grants.--
              (1) In general.--The Secretary shall award grants to
            States, political subdivisions of States, [Indian
            tribes, tribal organizations] Indian Tribes, Tribal
            organizations, and nonprofit private entities to train
            teachers and other relevant school personnel to
            recognize symptoms of childhood and adolescent mental
            disorders, to refer family members to the appropriate
            mental health services if necessary, to train emergency
            services personnel veterans, law enforcement, and other
            categories of individuals, as determined by the
            Secretary, to identify and appropriately respond to
            persons with a mental illness, and to provide education
            to such teachers and personnel regarding resources that
            are available in the community for individuals with a
            mental illness.
              (2)  [Emergency Services Personnel] Emergency
            services personnel.--In this subsection, the term
            ``emergency services personnel'' includes paramedics,
            firefighters, and emergency medical technicians.
              (3)  [Distribution of Awards] Distribution of
            awards.--The Secretary shall ensure that such grants
            awarded under this subsection are equitably distributed
            among the geographical regions of the United States and
            between urban and rural populations.
              (4) Application.--A State, political subdivision of a
            State, [Indian tribe, tribal organization] Indian
            Tribe, Tribal organization, or nonprofit private entity
            that desires a grant under this subsection shall submit
            an application to the Secretary at such time, in such
            manner, and containing such information as the
            Secretary may require, including a plan for the
            rigorous evaluation of activities that are carried out
            with funds received under a grant under this
            subsection.
              (5) Use of Funds.--A State, political subdivision of
            a State, [Indian tribe, tribal organization] Indian
            Tribe, Tribal organization, or nonprofit private entity
            receiving a grant under this subsection shall use funds
            from such grant for evidence-based programs that
            provide training and education in accordance with
            paragraph (1) on matters including--
                      (A) recognizing the signs and symptoms of
                    mental illness; [and]
                      (B)(i) resources available in the community
                    for individuals with a mental illness and other
                    relevant resources; or
                      (ii) safely de-escalating crisis situations
                    involving individuals with a mental illness[.];
                    and
                      (C) suicide intervention and prevention,
                    including recognizing warning signs and how to
                    refer someone for help.
              (6) Evaluation.--A State, political subdivision of a
            State, [Indian tribe, tribal organization] Indian
            Tribe, Tribal organization, or nonprofit private entity
            that receives a grant under this subsection shall
            prepare and submit an evaluation to the Secretary at
            such time, in such manner, and containing such
            information as the Secretary may reasonably require,
            including an evaluation of activities carried out with
            funds received under the grant under this subsection
            and a process and outcome evaluation.
              (7) Authorization of Appropriations.--There is
            authorized to be appropriated to carry out this
            subsection [$14,693,000 for each of fiscal years 2018
            through 2022] $24,963,000 for each of fiscal years 2023
            through 2027.

    [SEC. 520K. INTEGRATION INCENTIVE GRANTS AND COOPERATIVE AGREEMENTS.

      [(a) Definitions.--In this section:
              [(1) Eligible entity.--The term ``eligible entity''
            means a State, or other appropriate State agency, in
            collaboration with 1 or more qualified community
            programs as described in section 1913(b)(1) or 1 or
            more community health centers as described in section
            330.
              [(2) Integrated care.--The term ``integrated care''
            means collaborative models or practices offering mental
            and physical health services, which may include
            practices that share the same space in the same
            facility.
              [(3) Special population.--The term ``special
            population'' means--
                      [(A) adults with a mental illness who have
                    co-occurring physical health conditions or
                    chronic diseases;
                      [(B) adults with a serious mental illness who
                    have co-occurring physical health conditions or
                    chronic diseases;
                      [(C) children and adolescents with a serious
                    emotional disturbance with co-occurring
                    physical health conditions or chronic diseases;
                    or
                      [(D) individuals with a substance use
                    disorder.
      [(b) Grants and Cooperative Agreements.--
              [(1) In general.--The Secretary may award grants and
            cooperative agreements to eligible entities to support
            the improvement of integrated care for primary care and
            behavioral health care in accordance with paragraph
            (2).
              [(2) Purposes.--A grant or cooperative agreement
            awarded under this section shall be designed to--
                      [(A) promote full integration and
                    collaboration in clinical practices between
                    primary and behavioral health care;
                      [(B) support the improvement of integrated
                    care models for primary care and behavioral
                    health care to improve the overall wellness and
                    physical health status of adults with a serious
                    mental illness or children with a serious
                    emotional disturbance; and
                      [(C) promote integrated care services related
                    to screening, diagnosis, prevention, and
                    treatment of mental and substance use
                    disorders, and co-occurring physical health
                    conditions and chronic diseases.
      [(c) Applications.--
              [(1) In general.--An eligible entity seeking a grant
            or cooperative agreement under this section shall
            submit an application to the Secretary at such time, in
            such manner, and accompanied by such information as the
            Secretary may require, including the contents described
            in paragraph (2).
              [(2) Contents.--The contents described in this
            paragraph are--
                      [(A) a description of a plan to achieve fully
                    collaborative agreements to provide services to
                    special populations;
                      [(B) a document that summarizes the policies,
                    if any, that serve as barriers to the provision
                    of integrated care, and the specific steps, if
                    applicable, that will be taken to address such
                    barriers;
                      [(C) a description of partnerships or other
                    arrangements with local health care providers
                    to provide services to special populations;
                      [(D) an agreement and plan to report to the
                    Secretary performance measures necessary to
                    evaluate patient outcomes and facilitate
                    evaluations across participating projects; and
                      [(E) a plan for sustainability beyond the
                    grant or cooperative agreement period under
                    subsection (e).
      [(d) Grant and Cooperative Agreement Amounts.--
              [(1) Target amount.--The target amount that an
            eligible entity may receive for a year through a grant
            or cooperative agreement under this section shall be
            $2,000,000.
              [(2) Adjustment permitted.--The Secretary, taking
            into consideration the quality of the application and
            the number of eligible entities that received grants
            under this section prior to the date of enactment of
            the Helping Families in Mental Health Crisis Reform Act
            of 2016, may adjust the target amount that an eligible
            entity may receive for a year through a grant or
            cooperative agreement under this section.
              [(3) Limitation.--An eligible entity receiving
            funding under this section may not allocate more than
            10 percent of funds awarded under this section to
            administrative functions, and the remaining amounts
            shall be allocated to health facilities that provide
            integrated care.
      [(e) Duration.--A grant or cooperative agreement under this
    section shall be for a period not to exceed 5 years.
      [(f) Report on Program Outcomes.--An eligible entity
    receiving a grant or cooperative agreement under this section
    shall submit an annual report to the Secretary that includes--
              [(1) the progress made to reduce barriers to
            integrated care as described in the entity's
            application under subsection (c); and
              [(2) a description of functional outcomes of special
            populations, including--
                      [(A) with respect to adults with a serious
                    mental illness, participation in supportive
                    housing or independent living programs,
                    attendance in social and rehabilitative
                    programs, participation in job training
                    opportunities, satisfactory performance in work
                    settings, attendance at scheduled medical and
                    mental health appointments, and compliance with
                    prescribed medication regimes;
                      [(B) with respect to individuals with co-
                    occurring mental illness and physical health
                    conditions and chronic diseases, attendance at
                    scheduled medical and mental health
                    appointments, compliance with prescribed
                    medication regimes, and participation in
                    learning opportunities related to improved
                    health and lifestyle practices; and
                      [(C) with respect to children and adolescents
                    with a serious emotional disturbance who have
                    co-occurring physical health conditions and
                    chronic diseases, attendance at scheduled
                    medical and mental health appointments,
                    compliance with prescribed medication regimes,
                    and participation in learning opportunities at
                    school and extracurricular activities.
      [(g) Technical Assistance for Primary-behavioral Health Care
    Integration.--
              [(1) In general.--The Secretary may provide
            appropriate information, training, and technical
            assistance to eligible entities that receive a grant or
            cooperative agreement under this section, in order to
            help such entities meet the requirements of this
            section, including assistance with--
                      [(A) development and selection of integrated
                    care models;
                      [(B) dissemination of evidence-based
                    interventions in integrated care;
                      [(C) establishment of organizational
                    practices to support operational and
                    administrative success; and
                      [(D) other activities, as the Secretary
                    determines appropriate.
              [(2) Additional dissemination of technical
            information.--The information and resources provided by
            the Secretary under paragraph (1) shall, as
            appropriate, be made available to States, political
            subdivisions of States, Indian tribes or tribal
            organizations (as defined in section 4 of the Indian
            Self-Determination and Education Assistance Act),
            outpatient mental health and addiction treatment
            centers, community mental health centers that meet the
            criteria under section 1913(c), certified community
            behavioral health clinics described in section 223 of
            the Protecting Access to Medicare Act of 2014, primary
            care organizations such as Federally qualified health
            centers or rural health clinics as defined in section
            1861(aa) of the Social Security Act, other community-
            based organizations, or other entities engaging in
            integrated care activities, as the Secretary determines
            appropriate.
      [(h) Authorization of Appropriations.--To carry out this
    section, there are authorized to be appropriated $51,878,000
    for each of fiscal years 2018 through 2022.]

    SEC. 520K. INTEGRATION INCENTIVE GRANTS AND COOPERATIVE AGREEMENTS.

      (a) Definitions.--In this section:
              (1) Collaborative care model.--The term
            ``collaborative care model'' means the evidence-based,
            integrated behavioral health service delivery method
            that includes--
                      (A) care directed by the primary care team;
                      (B) structured care management;
                      (C) regular assessments of clinical status
                    using developmentally appropriate, validated
                    tools; and
                      (D) modification of treatment as appropriate.
              (2) Eligible entity.--The term ``eligible entity''
            means a State, or an appropriate State agency, in
            collaboration with--
                      (A) 1 or more qualified community programs as
                    described in section 1913(b)(1);
                      (B) 1 or more health centers (as defined in
                    section 330(a)), a rural health clinic (as
                    defined in section 1961(aa) of the Social
                    Security Act), or a Federally qualified health
                    center (as defined in such section); or
                      (C) 1 or more primary health care practices.
              (3) Integrated care; bidirectional integrated care.--
                      (A) The term ``integrated care'' means models
                    or practices for coordinating and jointly
                    delivering behavioral and physical health
                    services, which may include practices that
                    share the same space in the same facility.
                      (B) The term ``bidirectional integrated
                    care'' means the integration of behavioral
                    health care and specialty physical health care,
                    as well as the integration of primary and
                    physical health care with specialty behavioral
                    health settings, including within primary
                    health care settings.
              (4) Primary health care provider.--The term ``primary
            health care provider'' means a provider who--
                      (A) provides health services related to
                    family medicine, internal medicine, pediatrics,
                    obstetrics, gynecology, or geriatrics; or
                      (B) is a doctor of medicine or osteopathy,
                    physician assistant, or nurse practitioner, who
                    is licensed to practice medicine by the State
                    in which such physician, assistant, or
                    practitioner primarily practices, including
                    within primary health care settings.
              (5) Primary health care practice.--The term ``primary
            health care practice'' means a medical practice of
            primary health care providers, including a practice
            within a larger health care system.
              (6) Special population.--The term ``special
            population'', for an eligible entity that is
            collaborating with an entity described in subparagraph
            (A) or (B) of paragraph (3), means--
                      (A) adults with a serious mental illness who
                    have a co-occurring physical health condition
                    or chronic disease;
                      (B) children and adolescents with a mental
                    illness who have a co-occurring physical health
                    condition or chronic disease;
                      (C) individuals with a substance use
                    disorder; or
                      (D) individuals with a mental illness who
                    have a co-occurring substance use disorder.
      (b) Grants and Cooperative Agreements.--
              (1) In general.--The Secretary may award grants and
            cooperative agreements to eligible entities to support
            the improvement of integrated care for physical and
            behavioral health care in accordance with paragraph
            (2).
              (2) Use of funds.--A grant or cooperative agreement
            awarded under this section shall be used--
                      (A) in the case of an eligible entity that is
                    collaborating with an entity described in
                    subparagraph (A) or (B) of subsection (a)(2)--
                              (i) to promote full integration and
                            collaboration in clinical practices
                            between physical and behavioral health
                            care for special populations including
                            each population listed in subsection
                            (a)(7);
                              (ii) to support the improvement of
                            integrated care models for physical and
                            behavioral health care to improve the
                            overall wellness and physical health
                            status of--
                                      (I) adults with a serious
                                    mental illness or children with
                                    a serious emotional
                                    disturbance; and
                                      (II) individuals with a
                                    substance use disorder; and
                              (iii) to promote bidirectional
                            integrated care services including
                            screening, diagnosis, prevention,
                            treatment, and recovery of mental and
                            substance use disorders, and co-
                            occurring physical health conditions
                            and chronic diseases; and
                      (B) in the case of an eligible entity that is
                    collaborating with a primary health care
                    practice, to support the uptake of the
                    collaborative care model, including by--
                              (i) hiring staff;
                              (ii) identifying and formalizing
                            contractual relationships with other
                            health care providers, including
                            providers who will function as
                            psychiatric consultants and behavioral
                            health care managers in providing
                            behavioral health integration services
                            through the collaborative care model;
                              (iii) purchasing or upgrading
                            software and other resources needed to
                            appropriately provide behavioral health
                            integration services through the
                            collaborative care model, including
                            resources needed to establish a patient
                            registry and implement measurement-
                            based care; and
                              (iv) for such other purposes as the
                            Secretary determines to be necessary.
      (c) Applications.--
              (1) In general.--An eligible entity that is
            collaborating with an entity described in subparagraph
            (A) or (B) of subsection (a)(2) seeking a grant or
            cooperative agreement under subsection (b)(2)(A) shall
            submit an application to the Secretary at such time, in
            such manner, and accompanied by such information as the
            Secretary may require, including the contents described
            in paragraph (2).
              (2) Contents.--Any such application of an eligible
            entity described in subparagraph (A) or (B) of
            subsection (a)(2) shall include--
                      (A) a description of a plan to achieve fully
                    collaborative agreements to provide
                    bidirectional integrated care to special
                    populations;
                      (B) a document that summarizes the policies,
                    if any, that are barriers to the provision of
                    integrated care, and the specific steps, if
                    applicable, that will be taken to address such
                    barriers;
                      (C) a description of partnerships or other
                    arrangements with local health care providers
                    to provide services to special populations;
                      (D) an agreement and plan to report to the
                    Secretary performance measures necessary to
                    evaluate patient outcomes and facilitate
                    evaluations across participating projects;
                      (E) a description of how validated rating
                    scales will be implemented to support the
                    improvement of patient outcomes using
                    measurement-based care, including those related
                    to depression screening, patient follow-up, and
                    symptom remission; and
                      (F) a plan for sustainability beyond the
                    grant or cooperative agreement period under
                    subsection (e).
              (3) Collaborative care model grants.--An eligible
            entity that is collaborating with a primary health care
            practice seeking a grant pursuant to subsection
            (b)(2)(B) shall submit an application to the Secretary
            at such time, in such manner, and accompanied by such
            information as the Secretary may require.
      (d) Grant and Cooperative Agreement Amounts.--
              (1) Target amount.--The target amount that an
            eligible entity may receive for a year through a grant
            or cooperative agreement under this section shall be--
                      (A) $2,000,000 for an eligible entity
                    described in subparagraph (A) or (B) of
                    subsection (a)(2); or
                      (B) $100,000 or less for an eligible entity
                    described in subparagraph (C) of subsection
                    (a)(2).
              (2) Adjustment permitted.--The Secretary, taking into
            consideration the quality of an eligible entity's
            application and the number of eligible entities that
            received grants under this section prior to the date of
            enactment of the Restoring Hope for Mental Health and
            Well-Being Act of 2022, may adjust the target amount
            that an eligible entity may receive for a year through
            a grant or cooperative agreement under this section.
              (3) Limitation.--An eligible entity that is
            collaborating with an entity described in subparagraph
            (A) or (B) of subsection (a)(2) receiving funding under
            this section--
                      (A) may not allocate more than 20 percent of
                    the funds awarded to such eligible entity under
                    this section to administrative functions; and
                      (B) shall allocate the remainder of such
                    funding to health facilities that provide
                    integrated care.
      (e) Duration.--A grant or cooperative agreement under this
    section shall be for a period not to exceed 5 years.
      (f) Report on Program Outcomes.--An eligible entity receiving
    a grant or cooperative agreement under this section--
              (1) that is collaborating with an entity described in
            subparagraph (A) or (B) of subsection (a)(2) shall
            submit an annual report to the Secretary that
            includes--
                      (A) the progress made to reduce barriers to
                    integrated care as described in the entity's
                    application under subsection (c); and
                      (B) a description of outcomes with respect to
                    each special population listed in subsection
                    (a)(7), including outcomes related to
                    education, employment, and housing; or
              (2) that is collaborating with a primary health care
            practice shall submit an annual report to the Secretary
            that includes--
                      (A) the progress made to improve access;
                      (B) the progress made to improve patient
                    outcomes; and
                      (C) the progress made to reduce referrals to
                    specialty care.
      (g) Technical Assistance for Primary-behavioral Health Care
    Integration.--
              (1) Certain recipients.--The Secretary may provide
            appropriate information, training, and technical
            assistance to eligible entities that are collaborating
            with an entity described in subparagraph (A) or (B) of
            subsection (a)(2) that receive a grant or cooperative
            agreement under this section, in order to help such
            entities meet the requirements of this section,
            including assistance with--
                      (A) development and selection of integrated
                    care models;
                      (B) dissemination of evidence-based
                    interventions in integrated care;
                      (C) establishment of organizational practices
                    to support operational and administrative
                    success; and
                      (D) other activities, as the Secretary
                    determines appropriate.
              (2) Collaborative care model recipients.--The
            Secretary shall provide appropriate information,
            training, and technical assistance to eligible entities
            that are collaborating with primary health care
            practices that receive funds under this section to help
            such entities implement the collaborative care model,
            including--
                      (A) developing financial models and budgets
                    for implementing and maintaining a
                    collaborative care model, based on practice
                    size;
                      (B) developing staffing models for essential
                    staff roles;
                      (C) providing strategic advice to assist
                    practices seeking to utilize other clinicians
                    for additional psychotherapeutic interventions;
                      (D) providing information technology
                    expertise to assist with building the
                    collaborative care model into electronic health
                    records, including assistance with care manager
                    tools, patient registry, ongoing patient
                    monitoring, and patient records;
                      (E) training support for all key staff and
                    operational consultation to develop practice
                    workflows;
                      (F) establishing methods to ensure the
                    sharing of best practices and operational
                    knowledge among primary health care physicians
                    and primary health care practices that provide
                    behavioral health integration services through
                    the collaborative care model; and
                      (G) providing guidance and instruction to
                    primary health care physicians and primary
                    health care practices on developing and
                    maintaining relationships with community-based
                    mental health and substance use disorder
                    facilities for referral and treatment of
                    patients whose clinical presentation or
                    diagnosis is best suited for treatment at such
                    facilities.
              (3) Additional dissemination of technical
            information.--In addition to providing the assistance
            described in paragraphs (1) and (2) to recipients of a
            grant or cooperative agreement under this section, the
            Secretary may also provide such assistance to other
            States and political subdivisions of States, Indian
            Tribes and Tribal organizations (as defined under the
            Federally Recognized Indian Tribe List Act of 1994),
            outpatient mental health and addiction treatment
            centers, community mental health centers that meet the
            criteria under section 1913(c), certified community
            behavioral health clinics described in section 223 of
            the Protecting Access to Medicare Act of 2014, primary
            care organizations such as Federally qualified health
            centers or rural health clinics as defined in section
            1861(aa) of the Social Security Act, primary health
            care practices, other community-based organizations,
            and other entities engaging in integrated care
            activities, as the Secretary determines appropriate.
      (h) Authorization of Appropriations.--To carry out this
    section, there is authorized to be appropriated $60,000,000 for
    each of fiscal years 2023 through 2027.

    SEC. 520L. ADULT SUICIDE PREVENTION.

      (a) Grants.--
              (1) In general.--The Assistant Secretary shall award
            grants to eligible entities described in paragraph (2)
            to implement suicide prevention and intervention
            programs, for individuals who are 25 years of age or
            older, that are designed to raise awareness of suicide,
            establish referral processes, and improve care and
            outcomes for such individuals who are at risk of
            suicide.
              (2) Eligible entities.--To be eligible to receive a
            grant under this section, an entity shall be a
            community-based primary care or behavioral health care
            setting, an emergency department, a State mental health
            agency (or State health agency with mental or
            behavioral health functions), public health agency, a
            territory of the United States, or an [Indian tribe]
            Indian Tribe or [tribal organization] Tribal
            organization (as the terms ``[Indian tribe] Indian
            Tribe'' and ``[tribal organization] Tribal
            organization'' are defined in section 4 of the Indian
            Self-Determination and Education Assistance Act).
              (3) Use of funds.--The grants awarded under paragraph
            (1) shall be used to implement programs, in accordance
            with such paragraph, that include one or more of the
            following components:
                      (A) Screening for suicide risk, suicide
                    intervention services, and services for
                    referral for treatment for individuals at risk
                    for suicide.
                      (B) Implementing evidence-based practices to
                    provide treatment for individuals at risk for
                    suicide, including appropriate followup
                    services.
                      [(C) Raising awareness and reducing stigma of
                    suicide.]
                      (C) Raising awareness of suicide prevention
                    resources, promoting help seeking among those
                    at risk for suicide.
      (b) Evaluations and Technical Assistance.--The Assistant
    Secretary shall--
              (1) evaluate the activities supported by grants
            awarded under subsection (a), and disseminate, as
            appropriate, the findings from the evaluation; and
              (2) provide appropriate information, training, and
            technical assistance, as appropriate, to eligible
            entities that receive a grant under this section, in
            order to help such entities to meet the requirements of
            this section, including assistance with selection and
            implementation of evidence-based interventions and
            frameworks to prevent suicide.
      (c) Duration.--A grant under this section shall be for a
    period of not more than 5 years.
      (d) Authorization of Appropriations.--There are authorized to
    be appropriated to carry out this section [$30,000,000 for the
    period of fiscal years 2018 through 2022] $30,000,000 for each
    of fiscal years 2023 through 2027.

    SEC. 520M. ASSERTIVE COMMUNITY TREATMENT GRANT PROGRAM.

      (a) In General.--The Assistant Secretary shall award grants
    to eligible entities--
              (1) to establish assertive community treatment
            programs for adults with a serious mental illness; or
              (2) to maintain or expand such programs.
      (b) Eligible Entities.--To be eligible to receive a grant
    under this section, an entity shall be a State, political
    subdivision of a State, [Indian tribe or tribal organization]
    Indian Tribe or Tribal organization (as such terms are defined
    in section 4 of the Indian Self-Determination and Education
    Assistance Act), mental health system, health care facility, or
    any other entity the Assistant Secretary deems appropriate.
      (c) Special Consideration.--In selecting among applicants for
    a grant under this section, the Assistant Secretary may give
    special consideration to the potential of the applicant's
    program to reduce hospitalization, homelessness, and
    involvement with the criminal justice system while improving
    the health and social outcomes of the patient.
      (d) Additional Activities.--The Assistant Secretary shall--
              (1) [not later than the end of fiscal year 2021] not
            later than the end of fiscal year 2026, submit a report
            to the appropriate congressional committees on the
            grant program under this section, including an
            evaluation of--
                      (A) any cost savings and public health
                    outcomes such as mortality, suicide, substance
                    use disorders, hospitalization, and use of
                    services;
                      (B) rates of involvement with the criminal
                    justice system of patients;
                      (C) rates of homelessness among patients; and
                      (D) patient and family satisfaction with
                    program participation; and
              (2) provide appropriate information, training, and
            technical assistance to grant recipients under this
            section to help such recipients to establish, maintain,
            or expand their assertive community treatment programs.
      (e) Authorization of Appropriations.--
              (1) In general.--To carry out this section, there is
            authorized to be appropriated [$5,000,000 for the
            period of fiscal years 2018 through 2022] $9,000,000
            for each of fiscal years 2023 through 2027.
              (2) Use of certain funds.--Of the funds appropriated
            to carry out this section in any fiscal year, not more
            than 5 percent shall be available to the Assistant
            Secretary for carrying out subsection (d).

    SEC. 520N. CRISIS RESPONSE CONTINUUM OF CARE.

      (a) In General.--The Secretary shall publish best practices
    for a crisis response continuum of care for use by health care
    providers, crisis services administrators, and crisis services
    providers in responding to individuals (including children and
    adolescents) experiencing mental health crises, substance-
    related crises, and crises arising from co-occurring disorders.
      (b) Best Practices.--
              (1) Scope of best practices.--The best practices
            published under subsection (a) shall define--
                      (A) a minimum set of core crisis response
                    services, as determined by the Secretary, for
                    each entity that furnishes such services,
                    that--
                              (i) do not require prior
                            authorization from an insurance
                            provider or group health plan nor a
                            referral from a health care provider
                            prior to the delivery of services;
                              (ii) provide for serving all
                            individuals regardless of age or
                            ability to pay;
                              (iii) provide for operating 24 hours
                            a day, 7 days a week; and
                              (iv) provide for care and support
                            through resources described in
                            paragraph (2)(A) until the individual
                            has been stabilized or transferred to
                            the next level of crisis care; and
                      (B) psychiatric stabilization, including the
                    point at which a case may be closed for--
                              (i) individuals screened over the
                            phone; and
                              (ii) individuals stabilized on the
                            scene by mobile teams.
              (2) Identification of essential functions.--The best
            practices published under subsection (a) shall identify
            the essential functions of each service in the crisis
            response continuum, which shall include at least the
            following:
                      (A) Identification of resources for referral
                    and enrollment in continuing mental health,
                    substance use, or other human services relevant
                    for the individual in crisis where necessary.
                      (B) Delineation of access and entry points to
                    services within the crisis response continuum.
                      (C) Development of protocols and agreements
                    for the transfer and receipt of individuals to
                    and from other segments of the crisis response
                    continuum segments as needed, and from outside
                    referrals including health care providers,
                    first responders including law enforcement,
                    paramedics, and firefighters, education
                    institutions, and community-based
                    organizations.
                      (D) Description of the qualifications of
                    crisis services staff, including roles for
                    physicians, licensed clinicians, case managers,
                    and peers (in accordance with State licensing
                    requirements or requirements applicable to
                    Tribal health professionals).
                      (E) The convening of collaborative meetings
                    of crisis response service providers, first
                    responders including law enforcement,
                    paramedics, and firefighters, and community
                    partners (including National Suicide Prevention
                    Lifeline or 9-8-8 call centers, 9-1-1 public
                    service answering points, and local mental
                    health and substance use disorder treatment
                    providers) operating in a common region for the
                    discussion of case management, best practices,
                    and general performance improvement.
              (3) Service capacity and quality best practices.--The
            best practices under subsection (a) shall include
            recommendations on--
                      (A) adequate volume of services to meet
                    population need;
                      (B) appropriate timely response; and
                      (C) capacity to meet the needs of different
                    patient populations that may experience a
                    mental health or substance use crisis,
                    including children, families, and all age
                    groups, cultural and linguistic minorities,
                    individuals with co-occurring mental health and
                    substance use disorders, individuals with
                    cognitive disabilities, individuals with
                    developmental delays, and individuals with
                    chronic medical conditions and physical
                    disabilities.
              (4) Implementation timeframe.--The Secretary shall--
                      (A) not later than 1 year after the date of
                    enactment of this section, publish and maintain
                    the best practices required by subsection (a);
                    and
                      (B) every two years thereafter, publish
                    updates.
              (5) Data collection and evaluations.--The Secretary,
            directly or through grants, contracts, or interagency
            agreements, shall collect data and conduct evaluations
            with respect to the provision of services and programs
            offered on the crisis response continuum for purposes
            of assessing the extent to which the provision of such
            services and programs meet certain objectives and
            outcomes measures as determined by the Secretary. Such
            objectives shall include--
                      (A) a reduction in reliance on law
                    enforcement response, as appropriate, to
                    individuals in crisis who would be more
                    appropriately served by a mobile crisis team
                    capable of responding to mental health and
                    substance-related crises;
                      (B) a reduction in boarding or extended
                    holding of patients in emergency room
                    facilities who require further psychiatric
                    care, including care for substance use
                    disorders;
                      (C) evidence of adequate access to crisis
                    care centers and crisis bed services; and
                      (D) evidence of adequate linkage to
                    appropriate post-crisis care and longitudinal
                    treatment for mental health or substance use
                    disorder when relevant.

    SEC. 520O. CENTER OF EXCELLENCE FOR EATING DISORDERS FOR EDUCATION AND
                        TRAINING ON EATING DISORDERS.

      (a) In General.--The Secretary, acting through the Assistant
    Secretary, shall maintain, by competitive grant or contract, a
    Center of Excellence for Eating Disorders (referred to in this
    section as the ``Center'') to improve the identification of,
    interventions for, and treatment of eating disorders in a
    manner that is developmentally, culturally, and linguistically
    appropriate.
      (b) Subgrants and Subcontracts.--The Center shall coordinate
    and implement the activities under subsection (c), in whole or
    in part, by awarding competitive subgrants or subcontracts--
              (1) across geographical regions; and
              (2) in a manner that is not duplicative.
      (c) Activities.--The Center--
              (1) shall--
                      (A) provide training and technical assistance
                    for--
                              (i) primary care and behavioral
                            health care providers to carry out
                            screening, brief intervention, and
                            referral to treatment for individuals
                            experiencing, or at risk for, eating
                            disorders; and
                              (ii) nonclinical community support
                            workers to identify and support
                            individuals with, or at
                            disproportionate risk for, eating
                            disorders;
                      (B) develop and provide training materials to
                    health care providers, including primary care
                    and behavioral health care providers, in the
                    effective treatment and ongoing support of
                    individuals with eating disorders, including
                    children and marginalized populations at
                    disproportionate risk for eating disorders;
                      (C) provide collaboration and coordination to
                    other centers of excellence, technical
                    assistance centers, and psychiatric
                    consultation lines of the Substance Abuse and
                    Mental Health Services Administration and the
                    Health Resources and Services Administration on
                    the identification, effective treatment, and
                    ongoing support of individuals with eating
                    disorders; and
                      (D) coordinate with the Director of the
                    Centers for Disease Control and Prevention and
                    the Administrator of the Health Resources and
                    Services Administration to disseminate training
                    to primary care and behavioral health care
                    providers; and
              (2) may--
                      (A) coordinate with electronic health record
                    systems for the integration of protocols
                    pertaining to screening, brief intervention,
                    and referral to treatment for individuals
                    experiencing, or at risk for, eating disorders;
                      (B) develop and provide training materials to
                    health care providers, including primary care
                    and behavioral health care providers, in the
                    effective treatment and ongoing support for
                    members of the Armed Forces and veterans
                    experiencing, or at risk for, eating disorders;
                    and
                      (C) consult with the Secretary of Defense and
                    the Secretary of Veterans Affairs on
                    prevention, identification, intervention for,
                    and treatment of eating disorders.
      (d) Authorization of Appropriations.--To carry out this
    section, there is authorized to be appropriated $1,000,000 for
    each of fiscal years 2023 through 2027.

               *       *       *       *       *       *       *

        Part C--Projects for Assistance in Transition From Homelessness

    SEC. 521. FORMULA GRANTS TO STATES.

      For the purpose of carrying out section 522, the Secretary,
    acting through the Director of the Center for Mental Health
    Services, shall for each of the fiscal years [2018 through
    2022] 2023 through 2027 make an allotment for each State in an
    amount determined in accordance with section 524. The Secretary
    shall make payments, as grants, each such fiscal year to each
    State from the allotment for the State if the Secretary
    approves for the fiscal year involved an application submitted
    by the State pursuant to section 529.

               *       *       *       *       *       *       *

    SEC. 535. FUNDING.

      (a) Authorization of Appropriations.--For the purpose of
    carrying out this part, there is authorized to be appropriated
    $64,635,000 for each of fiscal years [2018 through 2022] 2023
    through 2027.
      (b) Effect of Insufficient Appropriations for Minimum
    Allotments.--
              (1) In general.--If the amounts made available under
            subsection (a) for a fiscal year are insufficient for
            providing each State with an allotment under section
            521 of not less than the applicable amount under
            section 524(a)(1), the Secretary shall, from such
            amounts as are made available under such subsection,
            make grants to the States for providing to eligible
            homeless individuals the services specified in section
            522(b).
              (2) Rule of construction.--Paragraph (1) may not be
            construed to require the Secretary to make a grant
            under such paragraph to each State.

    Part D--Miscellaneous Provisions Relating to Substance Abuse and Mental
    Health

               *       *       *       *       *       *       *

    SEC. 544. GRANTS FOR REDUCING OVERDOSE DEATHS.

      (a) Establishment.--
              (1) In general.--The Secretary shall award grants to
            eligible entities to expand access to drugs or devices
            [approved or cleared] approved, cleared, or otherwise
            authorized under the Federal Food, Drug, and Cosmetic
            Act for emergency treatment of known or suspected
            opioid overdose.
              [(2) Maximum grant amount.--A grant awarded under
            this section may not be for more than $200,000 per
            grant year.
              [(3) Eligible entity.--For purposes of this section,
            the term ``eligible entity'' means a Federally
            qualified health center (as defined in section 1861(aa)
            of the Social Security Act), an opioid treatment
            program under part 8 of title 42, Code of Federal
            Regulations, any practitioner dispensing narcotic drugs
            pursuant to section 303(g) of the Controlled Substances
            Act, or any other entity that the Secretary deems
            appropriate.]
              (2) Eligible entity.--For purposes of this section,
            the term ``eligible entity'' means a State, Territory,
            locality, Indian Tribe (as defined in the Federally
            Recognized Indian Tribe List Act of 1994), Tribal
            organization, or Urban Indian organization (as those
            terms are defined in section 4 of the Indian Health
            Care Improvement Act).
              (3) Subgrants.--For the purposes for which a grant is
            awarded under this section, the eligible entity
            receiving the grant may award subgrants to a Federally
            qualified health center (as defined in section 1861(aa)
            of the Social Security Act), an opioid treatment
            program (as defined in section 8.2 of title 42, Code of
            Federal Regulations (or any successor regulations)),
            any practitioner dispensing narcotic drugs for the
            purpose of maintenance or detoxification treatment, or
            any nonprofit organization that the Secretary deems
            appropriate.
              (4) Prescribing.--For purposes of this section, the
            term ``prescribing'' means, with respect to a drug or
            device [approved or cleared] approved, cleared, or
            otherwise authorized under the Federal Food, Drug, and
            Cosmetic Act for emergency treatment of known or
            suspected opioid overdose, the practice of prescribing
            such drug or device--
                      (A) in conjunction with an opioid
                    prescription for patients at an elevated risk
                    of overdose, including patients prescribed with
                    both an opioid and a benzodiazepine;
                      (B) in conjunction with an opioid agonist
                    approved under section 505 of the Federal Food,
                    Drug, and Cosmetic Act for the treatment of
                    opioid use disorder;
                      (C) to the caregiver or a close relative of
                    patients at an elevated risk of overdose from
                    opioids; or
                      (D) in other circumstances in which a
                    provider identifies a patient is at an elevated
                    risk for an intentional or unintentional [drug
                    overdose] substance overdose from heroin or
                    prescription opioid therapies.
      (b) Application.--To be eligible to receive a grant under
    this section, an eligible entity shall submit to the Secretary,
    in such form and manner as specified by the Secretary, an
    application that describes--
              (1) the extent to which the area to which the entity
            will furnish services through use of the grant is
            experiencing significant morbidity and mortality caused
            by opioid abuse;
              (2) the criteria that will be used to identify
            eligible patients to participate in such program; and
              (3) a plan for sustaining the program after Federal
            support for the program has ended.
      (c) Use of Funds.--An eligible entity receiving a grant under
    this section may use amounts under the grant for any of the
    following activities, but may use not more than 20 percent of
    the grant funds for activities described in paragraphs (3) and
    (4):
              (1) To establish a program for prescribing a drug or
            device [approved or cleared] approved, cleared, or
            otherwise authorized under the Federal Food, Drug, and
            Cosmetic Act for emergency treatment of known or
            suspected opioid overdose.
              (2) To train and provide resources for health care
            providers and pharmacists on the prescribing of drugs
            or devices [approved or cleared] approved, cleared, or
            otherwise authorized under the Federal Food, Drug, and
            Cosmetic Act for emergency treatment of known or
            suspected opioid overdose.
              (3) To purchase drugs or devices [approved or
            cleared] approved, cleared, or otherwise authorized
            under the Federal Food, Drug, and Cosmetic Act for
            emergency treatment of known or suspected opioid
            overdose, for distribution under the program described
            in paragraph (1).
              (4) To offset the co-payments and other cost sharing
            associated with drugs or devices [approved or cleared]
            approved, cleared, or otherwise authorized under the
            Federal Food, Drug, and Cosmetic Act for emergency
            treatment of known or suspected opioid overdose.
              [(5) To establish protocols to connect patients who
            have experienced a drug overdose with appropriate
            treatment, including medication-assisted treatment and
            appropriate counseling and behavioral therapies.]
              (5) To establish protocols to connect patients who
            have experienced an overdose with appropriate
            treatment, including overdose reversal medications,
            medication assisted treatment, and appropriate
            counseling and behavioral therapies.
      (d) Improving Access to Overdose Treatment.--
              (1) Information on best practices.--
                      (A) Health and human services.--The Secretary
                    of Health and Human Services may provide
                    information to States, localities, Indian
                    Tribes, Tribal organizations, and Urban Indian
                    organizations on best practices for prescribing
                    or co-prescribing a drug or device approved,
                    cleared, or otherwise authorized under the
                    Federal Food, Drug, and Cosmetic Act for
                    emergency treatment of known or suspected
                    opioid overdose, including for patients
                    receiving chronic opioid therapy and patients
                    being treated for opioid use disorders.
                      (B) Defense.--The Secretary of Defense may
                    provide information to prescribers within
                    Department of Defense medical facilities on
                    best practices for prescribing or co-
                    prescribing a drug or device approved, cleared,
                    or otherwise authorized under the Federal Food,
                    Drug, and Cosmetic Act for emergency treatment
                    of known or suspected opioid overdose,
                    including for patients receiving chronic opioid
                    therapy and patients being treated for opioid
                    use disorders.
                      (C) Veterans affairs.--The Secretary of
                    Veterans Affairs may provide information to
                    prescribers within Department of Veterans
                    Affairs medical facilities on best practices
                    for prescribing or co-prescribing a drug or
                    device approved, cleared, or otherwise
                    authorized under the Federal Food, Drug, and
                    Cosmetic Act for emergency treatment of known
                    or suspected opioid overdose, including for
                    patients receiving chronic opioid therapy and
                    patients being treated for opioid use
                    disorders.
              (2) Rule of construction.--Nothing in this subsection
            shall be construed as establishing or contributing to a
            medical standard of care.
      [(d)] (e) Evaluations by Recipients.--As a condition of
    receipt of a grant under this section, an eligible entity
    shall, for each year for which the grant is received, submit to
    the Secretary an evaluation of activities funded by the grant
    which contains such information as the Secretary may reasonably
    require.
      [(e)] (f) Reports by the Secretary.--Not later than 5 years
    after the date on which the first grant under this section is
    awarded, the Secretary shall submit to the appropriate
    committees of the House of Representatives and of the Senate a
    report aggregating the information received from the grant
    recipients for such year under [subsection (d)] subsection (e)
    and evaluating the outcomes achieved by the programs funded by
    grants awarded under this section.
      [(f)] (g) Authorization of Appropriations.--There is
    authorized to be appropriated to carry out this section,
    $5,000,000 for the period of [fiscal years 2017 through 2021]
    fiscal years 2023 through 2027.

    SEC. 545. OPIOID OVERDOSE REVERSAL MEDICATION [ACCESS AND EDUCATION
                        GRANT PROGRAMS]  ACCESS, EDUCATION, AND CO-
                        PRESCRIBING GRANT PROGRAMS.

      (a)  [Grants to States] Grants.--The Secretary [shall make
    grants to States] shall make grants to States, localities,
    Indian Tribes (as defined by the Federally Recognized Indian
    Tribe List Act of 1994), Tribal organizations, and Urban Indian
    organizations (as those terms are defined in section 4 of the
    Indian Health Care Improvement Act) to--
              (1) [implement strategies for pharmacists to dispense
            a drug or device] implement strategies that increase
            access to drugs or devices [approved or cleared]
            approved, cleared, or otherwise authorized under the
            Federal Food, Drug, and Cosmetic Act for emergency
            treatment of known or suspected opioid overdose, as
            appropriate, pursuant to a standing order;
              (2) encourage pharmacies to dispense opioid overdose
            reversal medication pursuant to a standing order;
              [(3)] (4) develop or provide training materials that
            persons authorized to prescribe or dispense a drug or
            device [approved or cleared] approved, cleared, or
            otherwise authorized under the Federal Food, Drug, and
            Cosmetic Act for emergency treatment of known or
            suspected opioid overdose may use to educate the public
            concerning--
                      (A) when and how to safely administer such
                    drug or device; and
                      (B) steps to be taken after administering
                    such drug or device; and
              [(4)] (5) educate the public concerning the
            availability of drugs or devices [approved or cleared]
            approved, cleared, or otherwise authorized under the
            Federal Food, Drug, and Cosmetic Act for emergency
            treatment of known or suspected opioid overdose without
            a person-specific prescription.
      (b) Certain Requirement.--A grant may be made under this
    section only if the State involved has authorized standing
    orders to be issued for drugs or devices [approved or cleared]
    approved, cleared, or otherwise authorized under the Federal
    Food, Drug, and Cosmetic Act for emergency treatment of known
    or suspected opioid overdose.
      (c) Preference in Making Grants.--In making grants under this
    section, the Secretary may give preference to States that have
    a significantly higher rate of opioid overdoses than the
    national average, and that--
              (1) have not implemented standing orders regarding
            drugs or devices [approved or cleared] approved,
            cleared, or otherwise authorized under the Federal
            Food, Drug, and Cosmetic Act for emergency treatment of
            known or suspected opioid overdose;
              (2) authorize standing orders to be issued that
            permit community-based organizations, substance abuse
            programs, or other nonprofit entities to acquire,
            dispense, or administer drugs or devices [approved or
            cleared] approved, cleared, or otherwise authorized
            under the Federal Food, Drug, and Cosmetic Act for
            emergency treatment of known or suspected opioid
            overdose; or
              [(3)] (4) authorize standing orders to be issued that
            permit police, fire, or emergency medical services
            agencies to acquire and administer drugs or devices
            [approved or cleared] approved, cleared, or otherwise
            authorized under the Federal Food, Drug, and Cosmetic
            Act for emergency treatment of known or suspected
            opioid overdose.
      (d) Grant Terms.--
              (1) Number.--A State may not receive more than one
            grant under this section at a time.
              (2) Period.--A grant under this section shall be for
            a period of [3 years] 5 years.
              [[(3)] (4) Limitation.--A State may use not more than
            20 percent of a grant under this section for educating
            the public pursuant to subsection (a)(4).]
              (3) Limitations.--A State may--
                      (A) use not more than 10 percent of a grant
                    under this section for educating the public
                    pursuant to subsection (a)(5); and
                      (B) use not less than 20 percent of a grant
                    under this section to offset cost-sharing for
                    distribution and dispensing of drugs or devices
                    approved, cleared, or otherwise authorized
                    under the Federal Food, Drug, and Cosmetic Act
                    for emergency treatment of known or suspected
                    opioid overdose.
      (e) Applications.--To be eligible to receive a grant under
    this section, a State shall submit an application to the
    Secretary in such form and manner and containing such
    information as the Secretary may reasonably require, including
    detailed proposed expenditures of grant funds.
      (f) Reporting.--A State that receives a grant under this
    section shall, at least annually for the duration of the grant,
    submit a report to the Secretary evaluating the progress of the
    activities supported through the grant. Such reports shall
    include information on the number of pharmacies in the State
    that dispense a drug or device [approved or cleared] approved,
    cleared, or otherwise authorized under the Federal Food, Drug,
    and Cosmetic Act for emergency treatment of known or suspected
    opioid overdose under a standing order, and other information
    as the Secretary determines appropriate to evaluate the use of
    grant funds.
      (g) Definitions.--In this section the term ``standing order''
    means a document prepared by a person authorized to prescribe
    medication that permits another person to acquire, dispense, or
    administer medication without a person-specific prescription.
      (h) Authorization of Appropriations.--
              (1) In general.--To carry out this section, there are
            authorized to be appropriated $5,000,000 for the period
            of [fiscal years 2017 through 2019] fiscal years 2023
            through 2027.
              (2) Administrative costs.--Not more than 3 percent of
            the amounts made available to carry out this section
            may be used by the Secretary for administrative
            expenses of carrying out this section.

               *       *       *       *       *       *       *

    SEC. 548. STATE DEMONSTRATION GRANTS FOR COMPREHENSIVE OPIOID [ABUSE]
                        USE DISORDER RESPONSE.

      (a) Definitions.--In this section:
              (1) Dispenser.--The term ``dispenser'' has the
            meaning given the term in section 102 of the Controlled
            Substances Act (21 U.S.C. 802).
              (2) Prescriber.--The term ``prescriber'' means a
            dispenser who prescribes a controlled substance, or the
            agent of such a dispenser.
              (3) Prescriber of a schedule ii, iii, or iv
            controlled substance.--The term ``prescriber of a
            schedule II, III, or IV controlled substance'' does not
            include a prescriber of a schedule II, III, or IV
            controlled substance that dispenses the substance--
                      (A) for use on the premises on which the
                    substance is dispensed;
                      (B) in a hospital emergency room, when the
                    substance is in short supply;
                      (C) for a certified opioid treatment program;
                    or
                      (D) in other situations as the Secretary may
                    reasonably determine.
              (4) Schedule ii, iii, or iv controlled substance.--
            The term ``schedule II, III, or IV controlled
            substance'' means a controlled substance that is listed
            on schedule II, schedule III, or schedule IV of section
            202(c) of the Controlled Substances Act.
      (b) Grants for Comprehensive Opioid [Abuse] Use Disorder
    Response.--
              (1) In general.--The Secretary shall award grants to
            States, and combinations of States, to implement an
            integrated opioid [abuse] use disorder response
            initiative.
              (2) Purposes.--A State receiving a grant under this
            section shall establish a comprehensive response plan
            to opioid [abuse] use disorder, which may include--
                      (A) education efforts around [opioid use,
                    treatment, and addiction recovery] opioid use
                    disorders, and treatment for, and recovery from
                    opioid use disorders, including education of
                    residents, medical students, and physicians and
                    other prescribers of schedule II, III, or IV
                    controlled substances on relevant prescribing
                    guidelines, the prescription drug monitoring
                    program of the State described in subparagraph
                    (B), and overdose prevention methods;
                      (B) establishing, maintaining, or improving a
                    comprehensive prescription drug monitoring
                    program to track dispensing of schedule II,
                    III, or IV controlled substances, which may--
                              (i) provide for data sharing with
                            other States; and
                              (ii) allow all individuals authorized
                            by the State to write prescriptions for
                            schedule II, III, or IV controlled
                            substances to access the prescription
                            drug monitoring program of the State;
                      (C) developing, implementing, or expanding
                    prescription drug and opioid [addiction] use
                    disorder treatment programs by--
                              (i) expanding the availability of
                            treatment for prescription drug and
                            opioid [addiction] use disorder,
                            including medication-assisted treatment
                            and behavioral health therapy, as
                            appropriate;
                              (ii) developing, implementing, or
                            expanding screening for individuals in
                            treatment for prescription drug and
                            opioid [addiction] use disorder for
                            hepatitis C and HIV, and treating or
                            referring those individuals if
                            clinically appropriate; or
                              (iii) developing, implementing, or
                            expanding recovery support services and
                            programs at high schools or
                            institutions of higher education;
                      [(D) developing, implementing, and expanding
                    efforts to prevent overdose death from opioid
                    abuse or addiction to prescription medications
                    and opioids; and]
                      (D) developing, implementing, and expanding
                    efforts to prevent overdose death from opioid
                    or other prescription medication use disorders;
                    and
                      (E) advancing the education and awareness of
                    the public, providers, patients, consumers, and
                    other appropriate entities regarding the
                    dangers of opioid [abuse] use disorders, safe
                    disposal of prescription medications, and
                    detection of early warning signs of opioid use
                    disorders.
              (3) Application.--A State seeking a grant under this
            section shall submit to the Secretary an application in
            such form, and containing such information, as the
            Secretary may reasonably require.
              (4) Use of funds.--A State that receives a grant
            under this section shall use the grant for the cost,
            including the cost for technical assistance, training,
            and administration expenses, of carrying out an
            integrated opioid [abuse] use disorders response
            initiative as outlined by the State's comprehensive
            response plan to opioid [abuse] use disorders
            established under paragraph (2).
              (5) Priority considerations.--In awarding grants
            under this section, the Secretary shall, as
            appropriate, give priority to a State that--
                      (A)(i) provides civil liability protection
                    for first responders, health professionals, and
                    family members who have received appropriate
                    training in administering a drug or device
                    approved or cleared under the Federal Food,
                    Drug, and Cosmetic Act for emergency treatment
                    of known or suspected opioid overdose; and
                      (ii) submits to the Secretary a certification
                    by the attorney general of the State that the
                    attorney general has--
                              (I) reviewed any applicable civil
                            liability protection law to determine
                            the applicability of the law with
                            respect to first responders, health
                            care professionals, family members, and
                            other individuals who--
                                      (aa) have received
                                    appropriate training in
                                    administering a drug or device
                                    approved or cleared under the
                                    Federal Food, Drug, and
                                    Cosmetic Act for emergency
                                    treatment of known or suspected
                                    opioid overdose; and
                                      (bb) may administer a drug or
                                    device approved or cleared
                                    under the Federal Food, Drug,
                                    and Cosmetic Act for emergency
                                    treatment of known or suspected
                                    opioid overdose; and
                              (II) concluded that the law described
                            in subclause (I) provides adequate
                            civil liability protection applicable
                            to such persons;
                      (B) has a process for enrollment in services
                    and benefits necessary by criminal justice
                    agencies to initiate or continue treatment in
                    the community, under which an individual who is
                    incarcerated may, while incarcerated, enroll in
                    services and benefits that are necessary for
                    the individual to continue treatment upon
                    release from incarceration;
                      (C) ensures the capability of data sharing
                    with other States, where applicable, such as by
                    making data available to a prescription
                    monitoring hub;
                      (D) ensures that data recorded in the
                    prescription drug monitoring program database
                    of the State are regularly updated, to the
                    extent possible;
                      (E) ensures that the prescription drug
                    monitoring program of the State notifies
                    prescribers and dispensers of schedule II, III,
                    or IV controlled substances when overuse or
                    misuse of such controlled substances by
                    patients is suspected; and
                      (F) has in effect one or more statutes or
                    implements policies that maximize use of
                    prescription drug monitoring programs by
                    individuals authorized by the State to
                    prescribe schedule II, III, or IV controlled
                    substances.
              (6) Evaluation.--In conducting an evaluation of the
            program under this section pursuant to section 701 of
            the Comprehensive Addiction and Recovery Act of 2016,
            with respect to a State, the Secretary shall report on
            State legislation or policies related to maximizing the
            use of prescription drug monitoring programs and the
            incidence of opioid use disorders and overdose deaths
            in such State.
              (7) States with local prescription drug monitoring
            programs.--
                      (A) In general.--In the case of a State that
                    does not have a prescription drug monitoring
                    program, a county or other unit of local
                    government within the State that has a
                    prescription drug monitoring program shall be
                    treated as a State for purposes of this
                    section, including for purposes of eligibility
                    for grants under paragraph (1).
                      (B) Plan for interoperability.--In submitting
                    an application to the Secretary under paragraph
                    (3), a county or other unit of local government
                    shall submit a plan outlining the methods such
                    county or unit of local government shall use to
                    ensure the capability of data sharing with
                    other counties and units of local government
                    within the state and with other States, as
                    applicable.
      (c) Authorization of Funding.--For the purpose of carrying
    out this section, there are authorized to be appropriated
    $5,000,000 for each of fiscal years [2017 through 2021] 2023
    through 2027.

    SEC. 549. MENTAL AND BEHAVIORAL HEALTH OUTREACH AND EDUCATION [ON
                        COLLEGE CAMPUSES]  AT INSTITUTIONS OF HIGHER
                        EDUCATION.

      (a) Purpose.--It is the purpose of this section to increase
    access to, and reduce the stigma associated with, mental health
    services to ensure that students at institutions of higher
    education have the support necessary to successfully complete
    their studies.
      (b) National Public Education Campaign.--The Secretary,
    acting through the Assistant Secretary and in collaboration
    with the Director of the Centers for Disease Control and
    Prevention, shall convene an interagency, public-private sector
    working group to plan, establish, and begin coordinating and
    evaluating a targeted public education campaign that is
    designed to focus on mental and behavioral health on the
    campuses of institutions of higher education. Such campaign
    shall be designed to--
              (1) improve the general understanding of mental
            health and mental disorders;
              (2) encourage help-seeking behaviors relating to the
            promotion of mental health, prevention of mental
            disorders, and treatment of such disorders;
              (3) make the connection between mental and behavioral
            health and academic success; and
              (4) assist the general public in identifying the
            early warning signs and reducing the stigma of mental
            illness.
      (c) Composition.--The working group convened under subsection
    (b) shall include--
              (1) mental health consumers, including students and
            family members;
              (2) representatives of institutions of higher
            education, including minority-serving institutions as
            described in section 371(a) of the Higher Education Act
            of 1965 (20 U.S.C. 1067q) and community colleges;
              (3) representatives of national mental and behavioral
            health associations and associations of institutions of
            higher education;
              (4) representatives of health promotion and
            prevention organizations at institutions of higher
            education;
              (5) representatives of mental health providers,
            including community mental health centers; and
              (6) representatives of private-sector and public-
            sector groups with experience in the development of
            effective public health education campaigns.
      (d) Plan.--The working group under subsection (b) shall
    develop a plan that--
              (1) targets promotional and educational efforts to
            the age population of students at institutions of
            higher education and individuals who are employed in
            settings of institutions of higher education, including
            through the use of roundtables;
              (2) develops and proposes the implementation of
            research-based public health messages and activities;
              (3) provides support for local efforts to reduce
            stigma by using the National Health Information Center
            as a primary point of contact for information,
            publications, and service program referrals; and
              (4) develops and proposes the implementation of a
            social marketing campaign that is targeted at the
            population of students attending institutions of higher
            education and individuals who are employed in settings
            of institutions of higher education.
      (e) Definition.--In this section, 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).
      (f) Authorization of Appropriations.--To carry out this
    section, there are authorized to be appropriated $1,000,000 for
    the period of fiscal years [2018 through 2022] 2023 through
    2027.

    SEC. [550.]  550A. 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.]
              (1) In general.--The Secretary, in consultation with
            the individuals and entities specified in paragraph
            (2), shall build on existing best practices and
            previously developed guidelines to develop and
            periodically update consensus-based best practices,
            which may include model laws for implementing suggested
            minimum standards for operating, and promoting the
            availability of, high-quality 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;]
                      (A) Officials representing the agencies
                    described in subsection (e)(2).
                      [(C)] (B) directors or commissioners, as
                    applicable, of State health departments, tribal
                    health departments, State Medicaid programs,
                    and State insurance agencies;
                      [(D)] (C) representatives of health insurance
                    issuers;
                      [(E)] (D) 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)] (E) individuals with a history of
                    substance use disorder; and
                      [(G)] (F) other stakeholders identified by
                    the Secretary.
              (3) Availability.--The best practices referred to in
            paragraph (1) shall be--
                      (A) made publicly available; and
                      (B) published on the public website of the
                    Substance Abuse and Mental Health Services
                    Administration.
              (4) Exclusion of guideline on treatment services.--In
            developing the guidelines under paragraph (1), the
            Secretary may not include any guidelines with respect
            to substance use disorder treatment services.
      (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)] (g) 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)] (h) 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)] (i) 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.

               *       *       *       *       *       *       *

    Part E--Children With Serious Emotional Disturbances

               *       *       *       *       *       *       *

    SEC. 565. GENERAL PROVISIONS.

      (a) Duration of Support.--The period during which payments
    are made to a public entity from a grant under section 561(a)
    may not exceed 6 fiscal years.
      (b) Technical Assistance.--
              (1) In general.--The Secretary shall, upon the
            request of a public entity, regardless of whether such
            public entity is receiving a grant under section
            561(a)--
                      (A) provide technical assistance to the
                    entity regarding the process of submitting to
                    the Secretary applications for grants under
                    section 561(a); and
                      (B) provide to the entity training and
                    technical assistance with respect to the
                    planning, development, and operation of systems
                    of care described in section 562.
              (2) Authority for grants and contracts.--The
            Secretary may provide technical assistance under
            subsection (a) directly or through grants to, or
            contracts with, public and nonprofit private entities.
      (c) Evaluations and Reports by Secretary.--
              (1) In general.--The Secretary shall, directly or
            through contracts with public or private entities,
            provide for annual evaluations of programs carried out
            pursuant to section 561(a). The evaluations shall
            assess the effectiveness of the systems of care
            operated pursuant to such section, including
            longitudinal studies of outcomes of services provided
            by such systems, other studies regarding such outcomes,
            the effect of activities under this part on the
            utilization of hospital and other institutional
            settings, the barriers to and achievements resulting
            from interagency collaboration in providing community-
            based services to children with a serious emotional
            disturbance, and assessments by parents of the
            effectiveness of the systems of care.
              (2) Report to congress.--The Secretary shall, not
            later than 1 year after the date on which amounts are
            first appropriated under subsection (c), and annually
            thereafter, submit to the Congress a report summarizing
            evaluations carried out pursuant to paragraph (1)
            during the preceding fiscal year and making such
            recommendations for administrative and legislative
            initiatives with respect to this section as the
            Secretary determines to be appropriate.
      (d) Definitions.--For purposes of this part:
              (1) The term ``child'' means an individual through
            the age of 21 years.
              (2) The term ``family'', with respect to a child
            provided access to a system of care under section
            562(a), means--
                      (A) the legal guardian of the child; and
                      (B) [as appropriate regarding mental health
                    services for the child, the parents of the
                    child (biological or adoptive, as the case may
                    be) and any foster parents of the child] as
                    appropriate regarding mental health services
                    for the child and the parents or kinship
                    caregivers of the child.
              (3) The term ``funding agreement'', with respect to a
            grant under section 561(a) to a public entity, means
            that the Secretary may make such a grant only if the
            public entity makes the agreement involved.
              (4) The term ``serious emotional disturbance''
            includes, with respect to a child, any child who has a
            serious emotional disorder, a serious behavioral
            disorder, or a serious mental disorder.
      (e) Rule of Construction.--Nothing in this part shall be
    construed as limiting the rights of a child with a serious
    emotional disturbance under the Individuals with Disabilities
    Education Act.
      (f) Funding.--
      (1) Authorization of appropriations.--For the purpose of
    carrying out this part, there are authorized to be appropriated
    [$119,026,000 for each of fiscal years 2018 through 2022]
    $125,000,000 for each of fiscal years 2023 through 2027.
      (2) Limitation regarding technical assistance.--Not more than
    10 percent of the amounts appropriated under paragraph (1) for
    a fiscal year may be expended for carrying out subsection (b).

               *       *       *       *       *       *       *

                      PART K--MINORITY FELLOWSHIP PROGRAM

    SEC. 597. FELLOWSHIPS.

      (a) In General.--The Secretary shall maintain a program, to
    be known as the Minority Fellowship Program, under which the
    Secretary shall award fellowships, which may include stipends,
    for the purposes of--
              (1) increasing the knowledge of mental and substance
            use disorders practitioners on issues related to
            prevention, treatment, and recovery support for
            individuals who are from racial and ethnic minority
            populations and who have a mental or substance use
            disorder;
              (2) improving the quality of mental and substance use
            disorder prevention and treatment services delivered to
            racial and ethnic minority populations; and
              (3) increasing the number of culturally competent
            mental and substance use disorders professionals who
            teach, administer services, conduct research, and
            provide direct mental or substance use disorder
            services to racial and ethnic minority populations.
      (b) Training Covered.--The fellowships awarded under
    subsection (a) shall be for postbaccalaureate training
    (including for master's and doctoral degrees) for mental and
    substance use disorder treatment professionals, including [in
    the fields of psychiatry,] in the fields of crisis care
    management, psychiatry, nursing, social work, psychology,
    marriage and family therapy, mental health counseling, and
    substance use disorder and addiction counseling.
      (c) Authorization of Appropriations.--To carry out this
    section, there are authorized to be appropriated $12,669,000
    for each of fiscal years 2018 through 2022.

    SEC. [550.]  550A. SOBRIETY TREATMENT AND RECOVERY TEAMS.

      (a) In General.--The Secretary may make grants to States,
    units of local government, or tribal governments to establish
    or expand Sobriety Treatment And Recovery Team (referred to in
    this section as ``START'') or other similar programs to
    determine the effectiveness of pairing social workers or
    mentors with families that are struggling with a substance use
    disorder and child abuse or neglect in order to help provide
    peer support, intensive treatment, and child welfare services
    to such families.
      (b) Allowable Uses.--A grant awarded under this section may
    be used for one or more of the following activities:
              (1) Training eligible staff, including social
            workers, social services coordinators, child welfare
            specialists, substance use disorder treatment
            professionals, and mentors.
              (2) Expanding access to substance use disorder
            treatment services and drug testing.
              (3) Enhancing data sharing with law enforcement
            agencies, child welfare agencies, substance use
            disorder treatment providers, judges, and court
            personnel.
              (4) Program evaluation and technical assistance.
      (c) Program Requirements.--A State, unit of local government,
    or tribal government receiving a grant under this section
    shall--
              (1) serve only families for which--
                      (A) there is an open record with the child
                    welfare agency; and
                      (B) substance use disorder was a reason for
                    the record or finding described in paragraph
                    (1); and
              (2) coordinate any grants awarded under this section
            with any grant awarded under section 437(f) of the
            Social Security Act focused on improving outcomes for
            children affected by substance abuse.
      (d) Technical Assistance.--The Secretary may reserve not more
    than 5 percent of funds provided under this section to provide
    technical assistance on the establishment or expansion of
    programs funded under this section from the National Center on
    Substance Abuse and Child Welfare.
      (e) Coordination of Federal Activities to Promote the
    Availability of Housing for Individuals Experiencing
    Homelessness, Individuals With a Mental Illness, and
    Individuals With a Substance Use Disorder.--
              (1) In general.--The Secretary, acting through the
            Assistant Secretary, and the Secretary of Housing and
            Urban Development shall convene an interagency working
            group for the following purposes:
                      (A) To increase collaboration, cooperation,
                    and consultation among the Department of Health
                    and Human Services, the Department of Housing
                    and Urban Development, and the Federal agencies
                    listed in paragraph (2)(B), with respect to
                    promoting the availability of housing,
                    including recovery housing, for individuals
                    experiencing homelessness, individuals with
                    mental illnesses, and individuals with
                    substance use disorder.
                      (B) To align the efforts of such agencies and
                    avoid duplication of such efforts by such
                    agencies.
                      (C) To develop objectives, priorities, and a
                    long-term plan for supporting State, Tribal,
                    and local efforts with respect to the operation
                    of recovery housing that is consistent with the
                    best practices developed under this section.
                      (D) To coordinate enforcement of fair housing
                    practices, as appropriate, among Federal and
                    State agencies.
                      (E) To coordinate data collection on the
                    quality of recovery housing.
              (2) Composition.--The interagency working group under
            paragraph (1) shall be composed of--
                      (A) the Secretary, acting through the
                    Assistant Secretary, and the Secretary of
                    Housing and Urban Development, who shall serve
                    as the co-chairs; and
                      (B) representatives of each of the following
                    Federal agencies:
                              (i) The Centers for Medicare &
                            Medicaid Services.
                              (ii) The Substance Abuse and Mental
                            Health Services Administration.
                              (iii) The Health Resources and
                            Services Administration.
                              (iv) The Office of Inspector General.
                              (v) The Indian Health Service.
                              (vi) The Department of Agriculture.
                              (vii) The Department of Justice.
                              (viii) The Office of National Drug
                            Control Policy.
                              (ix) The Bureau of Indian Affairs.
                              (x) The Department of Labor.
                              (xi) The Department of Veterans
                            Affairs.
                              (xii) Any other Federal agency as the
                            co-chairs determine appropriate.
              (3) Meetings.--The working group shall meet on a
            quarterly basis.
              (4) Reports to congress.--Not later than 4 years
            after the date of the enactment of this section, the
            working group shall submit to the Committee on Energy
            and Commerce, the Committee on Ways and Means, the
            Committee on Agriculture, and the Committee on
            Financial Services of the House of Representatives and
            the Committee on Health, Education, Labor, and
            Pensions, the Committee on Agriculture, Nutrition, and
            Forestry, and the Committee on Finance of the Senate a
            report describing the work of the working group and any
            recommendations of the working group to improve
            Federal, State, and local coordination with respect to
            recovery housing and other housing resources and
            operations for individuals experiencing homelessness,
            individuals with a mental illness, and individuals with
            a substance use disorder.
      (f) Grants for Implementing National Recovery Housing Best
    Practices.--
              (1) In general.--The Secretary shall award grants to
            States (and political subdivisions thereof), Tribes,
            and territories--
                      (A) for the provision of technical assistance
                    to implement the guidelines and recommendations
                    developed under subsection (a); and
                      (B) to promote--
                              (i) the availability of recovery
                            housing for individuals with a
                            substance use disorder; and
                              (ii) the maintenance of recovery
                            housing in accordance with best
                            practices developed under this section.
              (2) State promotion plans.--Not later than 90 days
            after receipt of a grant under paragraph (1), and every
            2 years thereafter, each State (or political
            subdivisions thereof,) Tribe, or territory receiving a
            grant under paragraph (1) shall submit to the
            Secretary, and publish on a publicly accessible
            internet website of the State (or political
            subdivisions thereof), Tribe, or territory--
                      (A) the plan of the State (or political
                    subdivisions thereof), Tribe, or territory,
                    with respect to the promotion of recovery
                    housing for individuals with a substance use
                    disorder located within the jurisdiction of
                    such State (or political subdivisions thereof),
                    Tribe, or territory; and
                      (B) a description of how such plan is
                    consistent with the best practices developed
                    under this section.

    TITLE VII--HEALTH PROFESSIONS EDUCATION

               *       *       *       *       *       *       *

    PART D--INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES

               *       *       *       *       *       *       *

    SEC. 756. MENTAL AND BEHAVIORAL HEALTH EDUCATION AND TRAINING GRANTS.

      (a) Grants Authorized.--The Secretary may award grants to
    eligible institutions to support the recruitment of students
    for, and education and clinical experience of the students in--
              (1) accredited institutions of higher education or
            accredited professional training programs that are
            establishing or expanding internships or other field
            placement programs in mental health in psychiatry,
            psychology, school psychology, behavioral pediatrics,
            psychiatric nursing (which may include master's and
            doctoral level programs), social work, school social
            work, substance use disorder prevention and treatment,
            marriage and family therapy, occupational therapy
            (which may include master's and doctoral level
            programs), school counseling, or professional
            counseling, including such programs with a focus on
            child and adolescent mental health, trauma, and
            transitional-age youth;
              (2) accredited doctoral, internship, and post-
            doctoral residency programs of health service
            psychology (including clinical psychology, counseling,
            and school psychology) for the development and
            implementation of interdisciplinary training of
            psychology graduate students for providing behavioral
            health services, including trauma-informed care and
            substance use disorder prevention and treatment
            services, as well as the development of faculty in
            health service psychology;
              (3) accredited master's and doctoral degree programs
            of social work for the development and implementation
            of interdisciplinary training of social work graduate
            students for providing behavioral health services,
            including trauma-informed care and substance use
            disorder prevention and treatment services, and the
            development of faculty in social work; and
              (4) State-licensed mental health nonprofit and for-
            profit organizations to enable such organizations to
            pay for programs for preservice or in-service training
            in a behavioral health-related paraprofessional field
            with preference for preservice or in-service training
            of paraprofessional child and adolescent mental health
            workers.
      (b) Eligibility Requirements.--To be eligible for a grant
    under this section, an institution shall demonstrate--
              (1) an ability to recruit and place the students
            described in subsection (a) in areas with a high need
            and high demand population;
              (2) participation in the institutions' programs of
            individuals and groups from different racial, ethnic,
            cultural, geographic, religious, linguistic, and class
            backgrounds, and different genders and sexual
            orientations;
              (3) knowledge and understanding of the concerns of
            the individuals and groups described in paragraph (2),
            especially individuals with mental disorder symptoms or
            diagnoses, particularly children and adolescents, and
            transitional-age youth;
              (4) any internship or other field placement program
            assisted under the grant will prioritize cultural and
            linguistic competency; and
              (5) the institution will provide to the Secretary
            such data, assurances, and information as the Secretary
            may require.
      (c) Institutional Requirement.--For grants awarded under
    paragraphs (2) and (3) of subsection (a), at least 4 of the
    grant recipients shall be historically black colleges or
    universities or other minority-serving institutions.
      (d) Priority.--In selecting grant recipients under this
    section, the Secretary shall give priority to--
              (1) programs that have demonstrated the ability to
            train psychology, psychiatry, and social work
            professionals to work in integrated care settings for
            purposes of recipients under paragraphs (1), (2), and
            (3) of subsection (a); and
              (2) programs for paraprofessionals that emphasize the
            role of the family and the lived experience of the
            consumer and family-paraprofessional partnerships for
            purposes of recipients under subsection (a)(4).
      (e) Report to Congress.--Not later than 4 years after the
    date of enactment of the Helping Families in Mental Health
    Crisis Reform Act of 2016, the Secretary shall include in the
    biennial report submitted to Congress under section 501(m) an
    assessment on the effectiveness of the grants under this
    section in--
              (1) providing graduate students support for
            experiential training (internship or field placement);
              (2) recruiting students interested in behavioral
            health practice;
              (3) recruiting students in accordance with subsection
            (b)(1);
              (4) developing and implementing interprofessional
            training and integration within primary care;
              (5) developing and implementing accredited field
            placements and internships; and
              (6) collecting data on the number of students trained
            in behavioral health care and the number of available
            accredited internships and field placements.
      (f) Authorization of Appropriations.--[For each of fiscal
    years 2019 through 2023] For each of fiscal years 2023 through
    2027, there are authorized to be appropriated to carry out this
    section $50,000,000, to be allocated as follows:
              (1) For grants described in subsection (a)(1),
            $15,000,000.
              (2) For grants described in subsection (a)(2),
            $15,000,000.
              (3) For grants described in subsection (a)(3),
            $10,000,000.
              (4) For grants described in subsection (a)(4),
            $10,000,000.

               *       *       *       *       *       *       *

    SEC. 760. TRAINING DEMONSTRATION PROGRAM.

      (a) In General.--The Secretary shall establish a training
    demonstration program to award grants to eligible entities to
    support--
              (1) training for medical residents and fellows to
            practice psychiatry and addiction medicine in
            underserved, community-based settings that integrate
            primary care with mental and substance use disorders
            prevention and treatment services;
              (2) training for nurse practitioners, physician
            assistants, health service psychologists, and social
            workers to provide mental and substance use disorders
            services in underserved community-based settings that
            integrate primary care and mental and substance use
            disorders services; and
              (3) establishing, maintaining, or improving academic
            units or programs that--
                      (A) provide training for students or faculty,
                    including through clinical experiences and
                    research, to improve the ability to be able to
                    recognize, diagnose, and treat mental and
                    substance use disorders, with a special focus
                    on addiction; or
                      (B) develop evidence-based practices or
                    recommendations for the design of the units or
                    programs described in subparagraph (A),
                    including curriculum content standards.
      (b) Activities.--
              (1) Training for residents and fellows.--A recipient
            of a grant under subsection (a)(1)--
                      (A) shall use the grant funds--
                              (i)(I) to plan, develop, and operate
                            a training program for medical
                            psychiatry residents and fellows in
                            addiction medicine practicing in
                            eligible entities described in
                            subsection (c)(1); or
                              (II) to train new psychiatric
                            residents and fellows in addiction
                            medicine to provide and expand access
                            to integrated mental and substance use
                            disorders services; and
                              (ii) to provide at least 1 training
                            track that is--
                                      (I) a virtual training track
                                    that includes an in-person
                                    rotation at a teaching health
                                    center or in a community-based
                                    setting, followed by a virtual
                                    rotation in which the resident
                                    or fellow continues to support
                                    the care of patients at the
                                    teaching health center or in
                                    the community-based setting
                                    through the use of health
                                    information technology and, as
                                    appropriate, telehealth
                                    services;
                                      (II) an in-person training
                                    track that includes a rotation,
                                    during which the resident or
                                    fellow practices at a teaching
                                    health center or in a
                                    community-based setting; or
                                      (III) an in-person training
                                    track that includes a rotation
                                    during which the resident
                                    practices in a community-based
                                    setting that specializes in the
                                    treatment of infants, children,
                                    adolescents, or pregnant or
                                    postpartum women; and
                      (B) may use the grant funds to provide
                    additional support for the administration of
                    the program or to meet the costs of projects to
                    establish, maintain, or improve faculty
                    development, or departments, divisions, or
                    other units necessary to implement such
                    training.
              (2) Training for other providers.--A recipient of a
            grant under subsection (a)(2)--
                      (A) shall use the grant funds to plan,
                    develop, or operate a training program to
                    provide mental and substance use disorders
                    services in underserved, community-based
                    settings, as appropriate, that integrate
                    primary care and mental and substance use
                    disorders prevention and treatment services;
                    and
                      (B) may use the grant funds to provide
                    additional support for the administration of
                    the program or to meet the costs of projects to
                    establish, maintain, or improve faculty
                    development, or departments, divisions, or
                    other units necessary to implement such
                    program.
              (3) Academic units or programs.--A recipient of a
            grant under subsection (a)(3) shall enter into a
            partnership with organizations such as an education
            accrediting organization (such as the Liaison Committee
            on Medical Education, the Accreditation Council for
            Graduate Medical Education, the Commission on
            Osteopathic College Accreditation, the Accreditation
            Commission for Education in Nursing, the Commission on
            Collegiate Nursing Education, the Accreditation Council
            for Pharmacy Education, the Council on Social Work
            Education, American Psychological Association
            Commission on Accreditation, or the Accreditation
            Review Commission on Education for the Physician
            Assistant) to carry out activities under subsection
            (a)(3).
      (c) Eligible Entities.--
              (1) Training for residents and fellows.--To be
            eligible to receive a grant under subsection (a)(1), an
            entity shall--
                      (A) be a consortium consisting of--
                              (i) at least one teaching health
                            center; and
                              (ii) the sponsoring institution (or
                            parent institution of the sponsoring
                            institution) of--
                                      (I) a psychiatry residency
                                    program that is accredited by
                                    the Accreditation Council of
                                    Graduate Medical Education (or
                                    the parent institution of such
                                    a program); or
                                      (II) a fellowship in
                                    addiction medicine, as
                                    determined appropriate by the
                                    Secretary; or
                      (B) be an entity described in subparagraph
                    (A)(ii) that provides opportunities for
                    residents or fellows to train in community-
                    based settings that integrate primary care with
                    mental and substance use disorders prevention
                    and treatment services.
              (2) Training for other providers.--To be eligible to
            receive a grant under subsection (a)(2), an entity
            shall be--
                      (A) a teaching health center (as defined in
                    section 749A(f));
                      (B) a Federally qualified health center (as
                    defined in section 1905(l)(2)(B) of the Social
                    Security Act);
                      (C) a community mental health center (as
                    defined in section 1861(ff)(3)(B) of the Social
                    Security Act);
                      (D) a rural health clinic (as defined in
                    section 1861(aa) of the Social Security Act);
                      (E) a health center operated by the Indian
                    Health Service, an Indian tribe, a tribal
                    organization, or an urban Indian organization
                    (as defined in section 4 of the Indian Health
                    Care Improvement Act); or
                      (F) an entity with a demonstrated record of
                    success in providing training for nurse
                    practitioners, physician assistants, health
                    service psychologists, and social workers.
              (3) Academic units or programs.--To be eligible to
            receive a grant under subsection (a)(3), an entity
            shall be a school of medicine or osteopathic medicine,
            a nursing school, a physician assistant training
            program, a school of pharmacy, a school of social work,
            an accredited public or nonprofit private hospital, an
            accredited medical residency program, or a public or
            private nonprofit entity which the Secretary has
            determined is capable of carrying out such grant.
      (d) Priority.--
              (1) In general.--In awarding grants under subsection
            (a)(1) or (a)(2), the Secretary shall give priority to
            eligible entities that--
                      (A) demonstrate sufficient size, scope, and
                    capacity to undertake the requisite training of
                    an appropriate number of psychiatric residents,
                    fellows, nurse practitioners, physician
                    assistants, or social workers in addiction
                    medicine per year to meet the needs of the area
                    served;
                      (B) demonstrate experience in training
                    providers to practice team-based care that
                    integrates mental and substance use disorder
                    prevention and treatment services with primary
                    care in community-based settings;
                      (C) demonstrate experience in using health
                    information technology and, as appropriate,
                    telehealth to support--
                              (i) the delivery of mental and
                            substance use disorders services at the
                            eligible entities described in
                            subsections (c)(1) and (c)(2); and
                              (ii) community health centers in
                            integrating primary care and mental and
                            substance use disorders treatment; or
                      (D) have the capacity to expand access to
                    mental and substance use disorders services in
                    areas with demonstrated need, as determined by
                    the Secretary, such as tribal, rural, or other
                    underserved communities.
              (2) Academic units or programs.--In awarding grants
            under subsection (a)(3), the Secretary shall give
            priority to eligible entities that--
                      (A) have a record of training the greatest
                    percentage of mental and substance use
                    disorders providers who enter and remain in
                    these fields or who enter and remain in
                    settings with integrated primary care and
                    mental and substance use disorder prevention
                    and treatment services;
                      (B) have a record of training individuals who
                    are from underrepresented minority groups,
                    including native populations, or from a rural
                    or disadvantaged background;
                      (C) provide training in the care of
                    vulnerable populations such as infants,
                    children, adolescents, pregnant and postpartum
                    women, older adults, homeless individuals,
                    victims of abuse or trauma, individuals with
                    disabilities, and other groups as defined by
                    the Secretary;
                      (D) teach trainees the skills to provide
                    interprofessional, integrated care through
                    collaboration among health professionals; or
                      (E) provide training in cultural competency
                    and health literacy.
      (e) Duration.--Grants awarded under this section shall be for
    a minimum of 5 years.
      (f) Study and Report.--
              (1) Study.--
                      (A) In general.--The Secretary, acting
                    through the Administrator of the Health
                    Resources and Services Administration, shall
                    conduct a study on the results of the
                    demonstration program under this section.
                      (B) Data submission.--Not later than 90 days
                    after the completion of the first year of the
                    training program and each subsequent year that
                    the program is in effect, each recipient of a
                    grant under subsection (a) shall submit to the
                    Secretary such data as the Secretary may
                    require for analysis for the report described
                    in paragraph (2).
              (2) Report to congress.--Not later than 1 year after
            receipt of the data described in paragraph (1)(B), the
            Secretary shall submit to Congress a report that
            includes--
                      (A) an analysis of the effect of the
                    demonstration program under this section on the
                    quality, quantity, and distribution of mental
                    and substance use disorders services;
                      (B) an analysis of the effect of the
                    demonstration program on the prevalence of
                    untreated mental and substance use disorders in
                    the surrounding communities of health centers
                    participating in the demonstration; and
                      (C) recommendations on whether the
                    demonstration program should be expanded.
      (g) Authorization of Appropriations.--There are authorized to
    be appropriated to carry out this section $10,000,000 for each
    of fiscal years 2018 through 2022 and $31,700,000 for each of
    fiscal years 2023 through 2027.

               *       *       *       *       *       *       *

    TITLE XIX--BLOCK GRANTS

               *       *       *       *       *       *       *

      Part B--Block Grants Regarding Mental Health and [Substance Abuse]
                                 Substance Use

    Subpart I--Block Grants for Community Mental Health Services

               *       *       *       *       *       *       *

    SEC. 1912. STATE PLAN FOR COMPREHENSIVE COMMUNITY MENTAL HEALTH
                        SERVICES FOR CERTAIN INDIVIDUALS.

      (a) In General.--The Secretary may make a grant under section
    1911 only if--
              (1) the State involved submits to the Secretary a
            plan for providing comprehensive community mental
            health services to adults with a serious mental illness
            and to children with a serious emotional disturbance;
              (2) the plan meets the criteria specified in
            subsection (b); and
              (3) the plan is approved by the Secretary.
      (b) Criteria for Plan.--In accordance with subsection (a), a
    State shall submit to the Secretary a plan every two years
    that, at a minimum, includes each of the following:
              (1) System of care.--A description of the State's
            system of care that contains the following:
                      (A) Comprehensive community-based health
                    systems.--The plan shall--
                              (i) identify the single State agency
                            to be responsible for the
                            administration of the program under the
                            grant, including any third party who
                            administers mental health services and
                            is responsible for complying with the
                            requirements of this part with respect
                            to the grant;
                              (ii) provide for an organized
                            community-based system of care for
                            individuals with mental illness, and
                            describe available services and
                            resources in a comprehensive system of
                            care, including services for
                            individuals with co-occurring
                            disorders;
                              (iii) include a description of the
                            manner in which the State and local
                            entities will coordinate services to
                            maximize the efficiency, effectiveness,
                            quality, and cost-effectiveness of
                            services and programs to produce the
                            best possible outcomes (including
                            health services, rehabilitation
                            services, employment services, housing
                            services, educational services,
                            substance use disorder services, legal
                            services, law enforcement services,
                            social services, child welfare
                            services, medical and dental care
                            services, and other support services to
                            be provided with Federal, State, and
                            local public and private resources)
                            with other agencies to enable
                            individuals receiving services to
                            function outside of inpatient or
                            residential institutions, to the
                            maximum extent of their capabilities,
                            including services to be provided by
                            local school systems under the
                            Individuals with Disabilities Education
                            Act;
                              (iv) include a description of how the
                            State promotes evidence-based
                            practices, including those evidence-
                            based programs that address the needs
                            of individuals with early serious
                            mental illness regardless of the age of
                            the individual at onset, provide
                            comprehensive individualized treatment,
                            or integrate mental and physical health
                            services;
                              (v) include a description of case
                            management services;
                              (vi) include a description of
                            activities that seek to engage adults
                            with a serious mental illness or
                            children with a serious emotional
                            disturbance and their caregivers where
                            appropriate in making health care
                            decisions, including activities that
                            enhance communication among
                            individuals, families, caregivers, and
                            treatment providers; and
                              (vii) as appropriate to, and
                            reflective of, the uses the State
                            proposes for the block grant funds,
                            include--
                                      (I) a description of the
                                    activities intended to reduce
                                    hospitalizations and hospital
                                    stays using the block grant
                                    funds;
                                      (II) a description of the
                                    activities intended to reduce
                                    incidents of suicide using the
                                    block grant funds;
                                      (III) a description of how
                                    the State integrates mental
                                    health and primary care using
                                    the block grant funds, which
                                    may include providing, in the
                                    case of individuals with co-
                                    occurring mental and substance
                                    use disorders, both mental and
                                    substance use disorders
                                    services in primary care
                                    settings or arrangements to
                                    provide primary and specialty
                                    care services in community-
                                    based mental and substance use
                                    disorders settings; [and]
                                      (IV) a description of
                                    recovery and recovery support
                                    services for adults with a
                                    serious mental illness and
                                    children with a serious
                                    emotional disturbance[.]; and
                                      (V) a description of any
                                    evidence-based early
                                    intervention strategies and
                                    programs the State provides to
                                    prevent, delay, or reduce the
                                    severity and onset of mental
                                    illness and behavioral
                                    problems, including for
                                    children and adolescents,
                                    irrespective of experiencing a
                                    serious mental illness or
                                    serious emotional disturbance,
                                    as defined under subsection
                                    (c)(1).
                      (B) Mental health system data and
                    epidemiology.--The plan shall containan
                    estimate of the incidence and prevalence in the
                    State of serious mental illness among adults
                    and serious emotional disturbance among
                    children and present quantitative targets and
                    outcome measures for programs and services
                    provided under this subpart.
                      (C) Children's services.--In the case of
                    children with a serious emotional disturbance
                    (as defined pursuant to subsection (c)), the
                    plan shall provide for a system of integrated
                    social services, educational services, child
                    welfare services, juvenile justice services,
                    law enforcement services, and substance use
                    disorder services that, together with health
                    and mental health services, will be provided in
                    order for such children to receive care
                    appropriate for their multiple needs (such
                    system to include services provided under the
                    Individuals with Disabilities Education Act).
                      (D) Targeted services to rural and homeless
                    populations.--Theplan shall describe the
                    State's outreach to and services for
                    individuals who are homeless and how community-
                    based services will be provided to individuals
                    residing in rural areas.
                      (E) Management services.--The plan shall
                    describe the financial resources available, the
                    existing mental health workforce, and the
                    workforce trained in treating individuals with
                    co-occurring mental and substance use
                    disorders, and shall provide for the training
                    of providers of emergency health services
                    regarding mental health. The plan shall further
                    describe the manner in which the State intends
                    to expend the grant under section 1911 for the
                    fiscal year involved, and the manner in which
                    the State intends to comply with each of the
                    funding agreements in this subpart and subpart
                    III.
              (2) Goals and objectives.--The establishment of goals
            and objectives for the period of the plan, including
            targets and milestones that are intended to be met, and
            the activities that will be undertaken to achieve those
            targets.
      (c) Definitions Regarding Mental Illness and Emotional
    Disturbance; Methods for Estimate of Incidence and
    Prevalence.--
              (1) Establishment by secretary of definitions;
            dissemination.--For purposes of this subpart, the
            Secretary shall establish definitions for the terms
            ``adults with a serious mental illness'' and ``children
            with a serious emotional disturbance''. The Secretary
            shall disseminate the definitions to the States.
              (2) Standardized methods.--The Secretary shall
            establish standardized methods for making the estimates
            required in subsection (b)(11) with respect to a State.
            A funding agreement for a grant under section 1911 for
            the State is that the State will utilize such methods
            in making the estimates.
              (3) Date certain for compliance by secretary.--Not
            later than 90 days after the date of the enactment of
            the ADAMHA Reorganization Act, the Secretary shall
            establish the definitions described in paragraph (1),
            shall begin dissemination of the definitions to the
            States, and shall establish the standardized methods
            described in paragraph (2).
      (d) Requirement of Implementation of Plan.--
              (1) Complete implementation.--Except as provided in
            paragraph (2), in making a grant under section 1911 to
            a State for a fiscal year, the Secretary shall make a
            determination of the extent to which the State has
            implemented the plan required in subsection (a). If the
            Secretary determines that a State has not completely
            implemented the plan, the Secretary shall reduce the
            amount of the allotment under section 1911 for the
            State for the fiscal year involved by an amount equal
            to 10 percent of the amount determined under section
            1918 for the State for the fiscal year.
              (2) Substantial implementation and good faith effort
            regarding fiscal year 1993.--
                      (A) In making a grant under section 1911 to a
                    State for fiscal year 1993, the Secretary shall
                    make a determination of the extent to which the
                    State has implemented the plan required in
                    subsection (a). If the Secretary determines
                    that the State has not substantially
                    implemented the plan, the Secretary shall,
                    subject to subparagraph (B), reduce the amount
                    of the allotment under section 1911 for the
                    State for such fiscal year by an amount equal
                    to 10 percent of the amount determined under
                    section 1918 for the State for the fiscal year.
                      (B) In carrying out subparagraph (A), if the
                    Secretary determines that the State is making a
                    good faith effort to implement the plan
                    required in subsection (a), the Secretary may
                    make a reduction under such subparagraph in an
                    amount that is less than the amount specified
                    in such subparagraph, except that the reduction
                    may not be made in an amount that is less than
                    5 percent of the amount determined under
                    section 1918 for the State for fiscal year
                    1993.

               *       *       *       *       *       *       *

    SEC. 1920. FUNDING.

      (a) Authorization of Appropriations.--For the purpose of
    carrying out this subpart, and subpart III and section 505(c)
    with respect to mental health, there are authorized to be
    appropriated [$532,571,000 for each of fiscal years 2018
    through 2022] $857,571,000 for each of fiscal years 2023
    through 2027.
      (b) Allocations for Technical Assistance, Data Collection,
    and Program Evaluation.--
              (1) In general.--For the purpose of carrying out
            section 1948(a) with respect to mental health and the
            purposes specified in paragraphs (2) and (3), the
            Secretary shall obligate 5 percent of the amounts
            appropriated under subsection (a) for a fiscal year.
              (2) Data collection.--The purpose specified in this
            paragraph is carrying out sections 505(c) and 1971 with
            respect to mental health.
              (3) Program evaluation.--The purpose specified in
            this paragraph is the conduct of evaluations of
            prevention and treatment programs and services with
            respect to mental health to determine methods for
            improving the availability and quality of such programs
            and services.
      (c) Early Serious Mental Illness.--
              (1) In general.--Except as provided in paragraph (2),
            a State shall expend not less than 10 percent of the
            amount the State receives for carrying out this section
            for each fiscal year to support evidence-based programs
            that address the needs of individuals with early
            serious mental illness, including psychotic disorders,
            regardless of the age of the individual at onset.
              (2) State flexibility.--In lieu of expending 10
            percent of the amount the State receives under this
            section for a fiscal year as required under paragraph
            (1), a State may elect to expend not less than 20
            percent of such amount by the end of such succeeding
            fiscal year.
      (d) Crisis Care.--
              (1) In general.--Except as provided in paragraph (3),
            a State shall expend at least 5 percent of the amount
            the State receives pursuant to section 1911 for each
            fiscal year to support evidenced-based programs that
            address the crisis care needs of--
                      (A) individuals, including children and
                    adolescents, experiencing mental health crises,
                    substance-related crises, or crises arising
                    from co-occurring disorders; and
                      (B) persons with intellectual and
                    developmental disabilities.
              (2) Core elements.--At the discretion of the single
            State agency responsible for the administration of the
            program of the State under a grant under section 1911,
            funds expended pursuant to paragraph (1) may be used to
            fund some or all of the core crisis care service
            components, delivered according to evidence-based
            principles, including the following:
                      (A) Crisis call centers.
                      (B) 24/7 mobile crisis services.
                      (C) Crisis stabilization programs offering
                    acute care or subacute care in a hospital or
                    appropriately licensed facility, as determined
                    by the Substance Abuse and Mental Health
                    Services Administration, with referrals to
                    inpatient or outpatient care.
              (3) State flexibility.--In lieu of expending 5
            percent of the amount the State receives pursuant to
            section 1911 for a fiscal year to support evidence-
            based programs as required by paragraph (1), a State
            may elect to expend not less than 10 percent of such
            amount to support such programs by the end of two
            consecutive fiscal years.
              (4) Rule of construction.--With respect to funds
            expended pursuant to the set-aside in paragraph (1),
            section 1912(b)(1)(A)(vi) shall not apply.
      (e) Early Intervention Services.--In the case of a State with
    a State plan that provides for strategies and programs
    specified in section 1912(b)(1)(A)(vii)(VI), such State may
    expend not more than 5 percent of the amount of the allotment
    of the State pursuant to a funding agreement under section 1911
    for each fiscal year to support such strategies and programs.
      (f) Reports to Congress.--Not later than September 30, 2025,
    and biennially thereafter, the Secretary shall provide a report
    to the Congress on the crisis care and early intervention
    strategies and programs pursued by States pursuant to
    subsections (d) and (e). Each such report shall include--
              (1) a description of the each State's crisis care and
            early intervention activities;
              (2) the population served, including information on
            demographics, including age;
              (3) the outcomes of such activities, including--
                      (A) how such activities reduced
                    hospitalizations and hospital stays;
                      (B) how such activities reduced incidents of
                    suicidal ideation and behaviors; and
                      (C) how such activities reduced the severity
                    of onset of serious mental illness and serious
                    emotional disturbance; and
              (4) any other relevant information the Secretary
            deems necessary.

      Subpart II--[Block Grants for Prevention and Treatment of Substance
       Abuse] Block Grants for Substance Use Prevention, Treatment, and
                               Recovery Services

    SEC. 1921. FORMULA GRANTS TO STATES.

      (a) In General.--For the purpose described in subsection (b),
    the Secretary, acting through the Center for Substance Abuse
    Treatment, shall make an allotment each fiscal year for each
    State in an amount determined in accordance with section 1933.
    The Secretary shall make a grant to the State of the allotment
    made for the State for the fiscal year if the State submits to
    the Secretary an application in accordance with section 1932.
      (b) Authorized Activities.--A funding agreement for a grant
    under subsection (a) is that, subject to section 1931, the
    State involved will expend the grant only for the purpose of
    carrying out the plan developed in accordance with section
    1932(b) and for planning, carrying out, and evaluating
    activities to [prevent and treat substance use disorders]
    prevent, treat, and provide recovery support services for
    substance use disorders and for related activities authorized
    in section 1924.

    SEC. 1922. CERTAIN ALLOCATIONS.

      (a) Allocation Regarding Primary Prevention Programs.--A
    funding agreement for a grant under section 1921 is that, in
    expending the grant, the State involved--
              (1) will expend not less than 20 percent for programs
            for individuals who do not require treatment for
            [substance abuse] substance use disorders, which
            programs--
                      (A) educate and counsel the individuals on
                    [such abuse] such disorders; and
                      (B) provide for activities to reduce the risk
                    of [such abuse] such disorders by the
                    individuals;
              (2) will, in carrying out paragraph (1)--
                      (A) give priority to programs for populations
                    that are at risk of developing a pattern of
                    [such abuse] such disorders; and
                      (B) ensure that programs receiving priority
                    under subparagraph (A) develop community-based
                    strategies for the prevention of [such abuse]
                    such disorders, including strategies to
                    discourage the use of alcoholic beverages and
                    tobacco products by individuals to whom it is
                    unlawful to sell or distribute such beverages
                    or products.
      (b) Allocations Regarding Women.--
              (1) In general.--Subject to paragraph (2), a funding
            agreement for a grant under section 1921 for a fiscal
            year is that--
                      (A) in the case of a grant for fiscal year
                    1993, the State involved will expend not less
                    than 5 percent of the grant to increase
                    (relative to fiscal year 1992) the availability
                    of treatment services designed for pregnant
                    women and women with dependent children (either
                    by establishing new programs or expanding the
                    capacity of existing programs);
                      (B) in the case of a grant for fiscal year
                    1994, the State will expend not less than 5
                    percent of the grant to so increase (relative
                    to fiscal year 1993) the availability of such
                    services for such women; and
                      (C) in the case of a grant for any subsequent
                    fiscal year, the State will expend for such
                    services for such women not less than an amount
                    equal to the amount expended by the State for
                    fiscal year 1994.
              (2) Waiver.--
                      (A) Upon the request of a State, the
                    Secretary may provide to the State a waiver of
                    all or part of the requirement established in
                    paragraph (1) if the Secretary determines that
                    the State is providing an adequate level of
                    treatments services for women described in such
                    paragraph, as indicated by a comparison of the
                    number of such women seeking the services with
                    the availability in the State of the services.
                      (B) The Secretary shall approve or deny a
                    request for a waiver under subparagraph (A) not
                    later than 120 days after the date on which the
                    request is made.
                      (C) Any waiver provided by the Secretary
                    under subparagraph (A) shall be applicable only
                    to the fiscal year involved.
              (3) Childcare and prenatal care.--A funding agreement
            for a grant under section 1921 for a State is that each
            entity providing treatment services with amounts
            reserved under paragraph (1) by the State will,
            directly or through arrangements with other public or
            nonprofit private entities, make available prenatal
            care to women receiving such services and, while the
            women are receiving the services, childcare.

    SEC. 1923. INTRAVENOUS [SUBSTANCE ABUSE]  SUBSTANCE USE.

      (a) Capacity of Treatment Programs.--
              (1) Notification of reaching capacity.--A funding
            agreement for a grant under section 1921 is that the
            State involved will, in the case of programs of
            treatment for intravenous [drug abuse] substance use
            disorders, require that any such program receiving
            amounts from the grant, upon reaching 90 percent of its
            capacity to admit individuals to the program, provide
            to the State a notification of such fact.
              (2) Provision of treatment.--A funding agreement for
            a grant under section 1921 is that the State involved
            will, with respect to notifications under paragraph
            (1), ensure that each individual who requests and is in
            need of treatment for intravenous [drug abuse]
            substance use disorders is admitted to a program of
            such treatment not later than--
                      (A) 14 days after making the request for
                    admission to such a program; or
                      (B) 120 days after the date of such request,
                    if no such program has the capacity to admit
                    the individual on the date of such request and
                    if interim services are made available to the
                    individual not later than 48 hours after such
                    request.
      (b) Outreach to Persons Who Inject Drugs.--A funding
    agreement for a grant under section 1921 is that the State
    involved, in providing amounts from the grant to any entity for
    treatment services for persons who inject drugs, will require
    the entity to carry out activities to encourage individuals in
    need of such treatment to undergo treatment.

    SEC. 1924. REQUIREMENTS REGARDING [TUBERCULOSIS AND HUMAN
                        IMMUNODEFICIENCY VIRUS]  TUBERCULOSIS, VIRAL
                        HEPATITIS, AND HUMAN IMMUNODEFICIENCY VIRUS.

      (a) Tuberculosis.--
              (1) In general.--A funding agreement for a grant
            under section 1921 is that the State involved will
            require that any entity receiving amounts from the
            grant for operating a program of treatment for
            substance use disorders--
                      (A) will, directly or through arrangements
                    with other public or nonprofit private
                    entities, routinely make available tuberculosis
                    services to each individual receiving treatment
                    for such disorders; and
                      (B) in the case of an individual in need of
                    such treatment who is denied admission to the
                    program on the basis of the lack of the
                    capacity of the program to admit the
                    individual, will refer the individual to
                    another provider of tuberculosis services.
              [(2) Tuberculosis services.--For purposes of
            paragraph (1), the term ``tuberculosis services'', with
            respect to an individual, means--
                      [(A) counseling the individual with respect
                    to tuberculosis;
                      [(B) testing to determine whether the
                    individual has contracted such disease and
                    testing to determine the form of treatment for
                    the disease that is appropriate for the
                    individual; and
                      [(C) providing such treatment to the
                    individual.]
              (2) Designated states.--
                      (A) Fiscal years through fiscal year 2024.--
                    For purposes of this subsection, through
                    September 30, 2024, a State described in this
                    paragraph is any State whose rate of cases of
                    acquired immune deficiency syndrome is 10 or
                    more such cases per 100,000 individuals (as
                    indicated by the number of such cases reported
                    to and confirmed by the Director of the Centers
                    for Disease Control and Prevention for the most
                    recent calendar year for which such data are
                    available).
                      (B) Fiscal year 2025 and succeeding fiscal
                    years.--
                              (i) In general.--Beginning with
                            fiscal year 2025, for purposes of this
                            subsection, a State described in this
                            paragraph is any State whose rate of
                            cases of human immunodeficiency virus
                            is 10 or more such cases per 100,000
                            individuals (as indicated by the number
                            of such cases newly reported to and
                            confirmed by the Director of the
                            Centers for Disease Control and
                            Prevention for the most recent calendar
                            year for which such data are
                            available).
                              (ii) Continuation of designated state
                            status.--In the case of a State whose
                            rate of cases of human immunodeficiency
                            virus falls below the threshold
                            specified in clause (i) for a calendar
                            year, such State shall, notwithstanding
                            clause (i), continue to be described in
                            this paragraph unless the rate of cases
                            falls below such threshold for three
                            consecutive calendar years.
      (b) Human Immunodeficiency Virus.--
              (1) Requirement for certain states.--In the case of a
            State described in paragraph (2), a funding agreement
            for a grant under section 1921 is that--
                      (A) with respect to individuals undergoing
                    treatment for substance use disorders, the
                    State will, subject to paragraph (3), carry out
                    1 or more projects to make available to the
                    individuals early intervention services for HIV
                    disease at the sites at which the individuals
                    are undergoing such treatment;
                      (B) for the purpose of providing such early
                    intervention services through such projects,
                    the State will make available from the grant
                    the percentage that is applicable for the State
                    under paragraph (4); and
                      (C) the State will, subject to paragraph (5),
                    carry out such projects only in geographic
                    areas of the State that have the greatest need
                    for the projects.
              (2) Designated states.--For purposes of this
            subsection, a State described in this paragraph is any
            State whose rate of cases of acquired immune deficiency
            syndrome is 10 or more such cases per 100,000
            individuals (as indicated by the number of such cases
            reported to and confirmed by the Director of the
            Centers for Disease Control and Prevention for the most
            recent calendar year for which such data are
            available).
              (3) Use of existing programs regarding substance use
            disorders.--With respect to programs that provide
            treatment services for substance use disorders, a
            funding agreement for a grant under section 1921 for a
            designated State is that each such program
            participating in a project under paragraph (1) will be
            a program that began operation prior to the fiscal year
            for which the State is applying to receive the grant. A
            program that so began operation may participate in a
            project under paragraph (1) without regard to whether
            the program has been providing early intervention
            services for HIV disease.
              (4) Applicable percentage regarding expenditures for
            services.--
                      (A)(i) For purposes of paragraph (1)(B), the
                    percentage that is applicable under this
                    paragraph for a designated State is, subject to
                    subparagraph (B), the percentage by which the
                    amount of the grant under section 1921 for the
                    State for the fiscal year involved is an
                    increase over the amount specified in clause
                    (ii).
                      (ii) The amount specified in this clause is
                    the amount that was reserved by the designated
                    State involved from the allotment of the State
                    under section 1912A for fiscal year 1991 in
                    compliance with section 1916(c)(6)(A)(ii) (as
                    such sections were in effect for such fiscal
                    year).
                      (B) If the percentage determined under
                    subparagraph (A) for a designated State for a
                    fiscal year is less than 2 percent (including a
                    negative percentage, in the case of a State for
                    which there is no increase for purposes of such
                    subparagraph), the percentage applicable under
                    this paragraph for the State is 2 percent. If
                    the percentage so determined is 2 percent or
                    more, the percentage applicable under this
                    paragraph for the State is the percentage
                    determined under subparagraph (A), subject to
                    not exceeding 5 percent.
              (5) Requirement regarding rural areas.--
                      (A) A funding agreement for a grant under
                    section 1921 for a designated State is that, if
                    the State will carry out 2 or more projects
                    under paragraph (1), the State will carry out 1
                    such project in a rural area of the State,
                    subject to subparagraph (B).
                      (B) The Secretary shall waive the requirement
                    established in subparagraph (A) if the State
                    involved certifies to the Secretary that--
                              (i) there is insufficient demand in
                            the State to carry out a project under
                            paragraph (1) in any rural area of the
                            State; or
                              (ii) there are no rural areas in the
                            State.
              (6) Manner of providing services.--With respect to
            the provision of early intervention services for HIV
            disease to an individual, a funding agreement for a
            grant under section 1921 for a designated State is
            that--
                      (A) such services will be undertaken
                    voluntarily by, and with the informed consent
                    of, the individual; and
                      (B) undergoing such services will not be
                    required as a condition of receiving treatment
                    services for substance use disorders or any
                    other services.
              (7) Definitions.--For purposes of this subsection:
                      (A) The term ``designated State'' means a
                    State described in paragraph (2).
                      (B) The term ``early intervention services'',
                    with respect to HIV disease, means--
                              (i) appropriate pretest counseling;
                              (ii) testing individuals with respect
                            to such disease, including tests to
                            confirm the presence of the disease,
                            tests to diagnose the extent of the
                            deficiency in the immune system, and
                            tests to provide information on
                            appropriate therapeutic measures for
                            preventing and treating the
                            deterioration of the immune system and
                            for preventing and treating conditions
                            arising from the disease;
                              (iii) appropriate post-test
                            counseling; and
                              (iv) providing the therapeutic
                            measures described in clause (ii).
                      (C) The term ``HIV disease'' means infection
                    with the etiologic agent for acquired immune
                    deficiency syndrome.
      (c) Viral Hepatitis.--
              (1) In general.--A funding agreement for a grant
            under section 1921 is that the State involved will
            require that any entity receiving amounts from the
            grant for operating a program of treatment for
            substance use disorders--
                      (A) will, directly or through arrangements
                    with other public or nonprofit private
                    entities, routinely make available viral
                    hepatitis services to each individual receiving
                    treatment for such disorders; and
                      (B) in the case of an individual in need of
                    such treatment who is denied admission to the
                    program on the basis of the lack of the
                    capacity of the program to admit the
                    individual, will refer the individual to
                    another provider of viral hepatitis services.
              (2) Viral hepatitis services.--For purposes of
            paragraph (1), the term ``viral hepatitis services'',
            with respect to an individual, means--
                      (A) screening the individual for viral
                    hepatitis; and
                      (B) referring the individual to a provider
                    whose practice includes viral hepatitis
                    vaccination and treatment.
      [(c)] (d) Expenditure of Grant for Compliance With
    Agreements.--
              (1) In general.--A grant under section 1921 may be
            expended for purposes of compliance with the agreements
            required in this section, subject to paragraph (2).
              (2) Limitation.--A funding agreement for a grant
            under section 1921 for a State is that the grant will
            not be expended to make payment for any service
            provided for purposes of compliance with this section
            to the extent that payment has been made, or can
            reasonably be expected to be made, with respect to such
            service--
                      (A) under any State compensation program,
                    under any insurance policy, or under any
                    Federal or State health benefits program
                    (including the program established in title
                    XVIII of the Social Security Act and the
                    program established in title XIX of such Act);
                    or
                      (B) by an entity that provides health
                    services on a prepaid basis.
      [(d)] (e) Applicability of Certain Provision.--Section 1931
    applies to this section (and to each other provision of this
    subpart).

    SEC. 1925. GROUP HOMES FOR PERSONS IN RECOVERY FROM SUBSTANCE USE
                        DISORDERS.

      (a) State Revolving Funds for Establishment of Homes.--A
    State, using funds available under section 1921, may establish
    and maintain the ongoing operation of a revolving fund in
    accordance with this section to support group homes for persons
    in recovery from substance use disorders as follows:
              (1) The purpose of the fund is to make loans for the
            costs of establishing programs for the provision of
            housing in which individuals recovering from [alcohol
            or drug abuse] alcohol or other substance use disorders
            may reside in groups of not less than 6 individuals.
            The fund is established directly by the State or
            through the provision of a grant or contract to a
            nonprofit private entity.
              (2) The programs are carried out in accordance with
            guidelines issued under subsection (b).
              (3) Not less than $100,000 is available for the fund.
              (4) Loans made from the revolving fund do not exceed
            $4,000 and each such loan is repaid to the revolving
            fund by the residents of the housing involved not later
            than 2 years after the date on which the loan is made.
              (5) Each such loan is repaid by such residents
            through monthly installments, and a reasonable penalty
            is assessed for each failure to pay such periodic
            installments by the date specified in the loan
            agreement involved.
              (6) Such loans are made only to nonprofit private
            entities agreeing that, in the operation of the program
            established pursuant to the loan--
                      (A) the use of alcohol or any illegal drug in
                    the housing provided by the program will be
                    prohibited;
                      (B) any resident of the housing who violates
                    such prohibition will be expelled from the
                    housing;
                      (C) the costs of the housing, including fees
                    for rent and utilities, will be paid by the
                    residents of the housing; and
                      (D) the residents of the housing will,
                    through a majority vote of the residents,
                    otherwise establish policies governing
                    residence in the housing, including the manner
                    in which applications for residence in the
                    housing are approved.
      (b) Issuance by Secretary of Guidelines.--The Secretary shall
    ensure that there are in effect guidelines under this subpart
    for the operation of programs described in subsection (a).
      (c) Applicability to Territories.--The requirements
    established in subsection (a) shall not apply to any territory
    of the United States other than the Commonwealth of Puerto
    Rico.

    SEC. 1926. SALE OF TOBACCO PRODUCTS TO INDIVIDUALS UNDER AGE OF 21.

      (a) In General.--A funding agreement for a grant under
    section 1921 is that the State involved will--
              (1) annually conduct random, unannounced inspections
            to ensure that retailers do not sell tobacco products
            to individuals under the age of 21; and
              (2) annually submit to the Secretary a report
            describing--
                      (A) the activities carried out by the State
                    to ensure that retailers do not sell tobacco
                    products to individuals under the age of 21;
                      (B) the extent of success the State has
                    achieved in ensuring that retailers do not sell
                    tobacco products to individuals under the age
                    of 21; and
                      (C) the strategies to be utilized by the
                    State to ensure that retailers do not sell
                    tobacco products to individuals under the age
                    of 21 during the fiscal year for which the
                    grant is sought.
      (b) Noncompliance of State.--
              (1) In general.--Before making a grant under section
            1921 to a State, the Secretary shall make a
            determination of whether the State has maintained
            compliance with subsection (a). If, after notice to the
            State and an opportunity for a hearing, the Secretary
            determines that the State is not in compliance with
            such subsections, the Secretary shall reduce the amount
            of the allotment under such section for the State for
            the fiscal year involved by an amount up to 10 percent
            of the amount determined under section 1933 for the
            State for the applicable fiscal year.
              (2) Limitation.--
                      (A) In general.--A State shall not have funds
                    withheld pursuant to paragraph (1) if such
                    State for which the Secretary has made a
                    determination of noncompliance under such
                    paragraph--
                              (i) certifies to the Secretary by May
                            1 of the fiscal year for which the
                            funds are appropriated, consistent with
                            subparagraph (B), that the State will
                            commit additional State funds, in
                            accordance with paragraph (1), to
                            ensure that retailers do not sell
                            tobacco products to individuals under
                            21 years of age;
                              (ii) agrees to comply with a
                            negotiated agreement for a corrective
                            action plan that is approved by the
                            Secretary and carried out in accordance
                            with guidelines issued by the
                            Secretary; or
                              (iii) is a territory that receives
                            less than $1,000,000 for a fiscal year
                            under section 1921.
                      (B) Certification.--
                              (i) In general.--The amount of funds
                            to be committed by a State pursuant to
                            subparagraph (A)(i) shall be equal to 1
                            percent of such State's [substance
                            abuse] allocation determined under
                            section 1933 for each percentage point
                            by which the State misses the retailer
                            compliance rate goal established by the
                            Secretary.
                              (ii) State expenditures.--For a
                            fiscal year in which a State commits
                            funds as described in clause (i), such
                            State shall maintain State expenditures
                            for tobacco prevention programs and for
                            compliance activities at a level that
                            is not less than the level of such
                            expenditures maintained by the State
                            for the preceding fiscal year, plus the
                            additional funds for tobacco compliance
                            activities required under clause (i).
                            The State shall submit a report to the
                            Secretary on all State obligations of
                            funds for such fiscal year and all
                            State expenditures for the preceding
                            fiscal year for tobacco prevention and
                            compliance activities by program
                            activity by July 31 of such fiscal
                            year.
                              (iii) Discretion.--The Secretary
                            shall exercise discretion in enforcing
                            the timing of the State obligation of
                            the additional funds required by the
                            certification described in subparagraph
                            (A)(i) as late as July 31 of such
                            fiscal year.
                      (C) Failure to certify.--If a State described
                    in subparagraph (A) fails to certify to the
                    Secretary pursuant to subparagraph (A)(i) or
                    enter into, or comply with, a negotiated
                    agreement under subparagraph (A)(ii), the
                    Secretary may take action pursuant to paragraph
                    (1).
      (c) Implementation of Reporting Requirements.--
              (1) Transition period.--The Secretary shall--
                      (A) not withhold amounts under subsection (b)
                    for the 3-year period immediately following the
                    date of enactment of division N of the Further
                    Consolidated Appropriations Act, 2020; and
                      (B) use discretion in exercising its
                    authority under subsection (b) during the 2-
                    year period immediately following the 3-year
                    period described in subparagraph (A), to allow
                    for a transition period for implementation of
                    the reporting requirements under subsection
                    (a)(2).
              (2) Regulations or guidance.--Not later than 180 days
            after the date of enactment of division N of the
            Further Consolidated Appropriations Act, 2020, the
            Secretary shall update regulations under part 96 of
            title 45, Code of Federal Regulations or guidance on
            the retailer compliance rate goal under subsection (b),
            the use of funds provided under section 1921 for
            purposes of meeting the requirements of this section,
            and reporting requirements under subsection (a)(2).
              (3) Coordination.--The Secretary shall ensure the
            Assistant Secretary for Mental Health and Substance Use
            coordinates, as appropriate, with the Commissioner of
            Food and Drugs to ensure that the technical assistance
            provided to States under subsection (e) is consistent
            with applicable regulations for retailers issued under
            part 1140 of title 21, Code of Federal Regulations.
      (d) Transitional Grants.--
              (1) In general.--The Secretary shall award grants
            under this subsection to each State that receives
            funding under section 1921 to ensure compliance of each
            such State with this section.
              (2) Use of funds.--A State receiving a grant under
            this subsection--
                      (A) shall use amounts received under such
                    grant for activities to plan for or ensure
                    compliance in the State with subsection (a);
                    and
                      (B) in the case of a State for which the
                    Secretary has made a determination under
                    subsection (b) that the State is prepared to
                    meet, or has met, the requirements of
                    subsection (a), may use such funds for tobacco
                    cessation activities, strategies to prevent the
                    use of tobacco products by individuals under
                    the age of 21, or allowable uses under section
                    1921.
              (3) Supplement not supplant.--Grants under this
            subsection shall be used to supplement and not supplant
            other Federal, State, and local public funds provided
            for activities under paragraph (2).
              (4) Authorization of appropriations.--To carry out
            this subsection, there are authorized to be
            appropriated $18,580,790 for each of fiscal years 2020
            through 2024.
              (5) Sunset.--This subsection shall have no force or
            effect after September 30, 2024.
      (e) Technical Assistance.--The Secretary shall provide
    technical assistance to States related to the activities
    required under this section.

               *       *       *       *       *       *       *

    SEC. 1931. RESTRICTIONS ON EXPENDITURE OF GRANT.

      (a) In General.--
              (1) Certain restrictions.--A funding agreement for a
            grant under section 1921 is that the State involved
            will not expend the grant--
                      (A) to provide inpatient hospital services,
                    except as provided in subsection (b);
                      (B) to make cash payments to intended
                    recipients of health services;
                      (C) to purchase or improve land, purchase,
                    construct, or permanently improve (other than
                    minor remodeling) any building or other
                    facility, or purchase major medical equipment;
                      (D) to satisfy any requirement for the
                    expenditure of non-Federal funds as a condition
                    for the receipt of Federal funds;
                      (E) to provide financial assistance to any
                    entity other than a public or nonprofit private
                    entity; or
                      (F) to carry out any program prohibited by
                    section 256(b) of the Health Omnibus Programs
                    Extension of 1988 (42 U.S.C. 300ee-5).
              (2) Limitation on administrative expenses.--A funding
            agreement for a grant under section 1921 is that the
            State involved will not expend more than 5 percent of
            the grant to pay the costs of administering the grant.
              (3) Limitation regarding penal and correctional
            institutions.--A funding agreement for a State for a
            grant under section 1921 is that, in expending the
            grant for the purpose of providing treatment services
            in penal or correctional institutions of the State, the
            State will not expend more than an amount equal to the
            amount expended for such purpose by the State from the
            grant made under section 1912A to the State for fiscal
            year 1991 (as section 1912A was in effect for such
            fiscal year).
      (b) Exception Regarding Inpatient Hospital Services.--
              (1) Medical necessity as precondition.--With respect
            to compliance with the agreement made under subsection
            (a), a State may expend a grant under section 1921 to
            provide inpatient hospital services as treatment for
            substance use disorders only if it has been determined,
            in accordance with guidelines issued by the Secretary,
            that such treatment is a medical necessity for the
            individual involved, and that the individual cannot be
            effectively treated in a community-based, nonhospital,
            residential program of treatment.
              (2) Rate of payment.--In the case of an individual
            for whom a grant under section 1921 is expended to
            provide inpatient hospital services described in
            paragraph (1), a funding agreement for the grant for
            the State involved is that the daily rate of payment
            provided to the hospital for providing the services to
            the individual will not exceed the comparable daily
            rate provided for community-based, nonhospital,
            residential programs of treatment for [substance abuse]
            substance use disorders.
      (c) Waiver Regarding Construction of Facilities.--
              (1) In general.--The Secretary may provide to any
            State a waiver of the restriction established in
            subsection (a)(1)(C) for the purpose of authorizing the
            State to expend a grant under section 1921 for the
            construction of a new facility or rehabilitation of an
            existing facility, but not for land acquisition.
              (2) Standard regarding need for waiver.--The
            Secretary may approve a waiver under paragraph (1) only
            if the State demonstrates to the Secretary that
            adequate treatment cannot be provided through the use
            of existing facilities and that alternative facilities
            in existing suitable buildings are not available.
              (3) Amount.--In granting a waiver under paragraph
            (1), the Secretary shall allow the use of a specified
            amount of funds to construct or rehabilitate a
            specified number of beds for residential treatment and
            a specified number of slots for outpatient treatment,
            based on reasonable estimates by the State of the costs
            of construction or rehabilitation. In considering
            waiver applications, the Secretary shall ensure that
            the State has carefully designed a program that will
            minimize the costs of additional beds.
              (4) Matching funds.--The Secretary may grant a waiver
            under paragraph (1) only if the State agrees, with
            respect to the costs to be incurred by the State in
            carrying out the purpose of the waiver, to make
            available non-Federal contributions in cash toward such
            costs in an amount equal to not less than $1 for each
            $1 of Federal funds provided under section 1921.
              (5) Date certain for acting upon request.--The
            Secretary shall act upon a request for a waiver under
            paragraph (1) not later than 120 days after the date on
            which the request is made.

    SEC. 1932. APPLICATION FOR GRANT; APPROVAL OF STATE PLAN.

      (a) In General.--For purposes of section 1921, an application
    for a grant under such section for a fiscal year is in
    accordance with this section if, subject to subsection (c)--
              (1) the application is received by the Secretary not
            later than October 1 of the fiscal year for which the
            State is seeking funds;
              (2) the application contains each funding agreement
            that is described in this subpart or subpart III for
            such a grant (other than any such agreement that is not
            applicable to the State);
              (3) the agreements are made through certification
            from the chief executive officer of the State;
              (4) with respect to such agreements, the application
            provides assurances of compliance satisfactory to the
            Secretary;
              (5) the application contains the report required in
            section 1942(a);
              (6)(A) the application contains a plan in accordance
            with subsection (b) and the plan is approved by the
            Secretary; and
              (B) the State provides assurances satisfactory to the
            Secretary that the State complied with the provisions
            of the plan under subparagraph (A) that was approved by
            the Secretary for the most recent fiscal year for which
            the State received a grant under section 1921; and
              (7) the application (including the plan under
            paragraph (6)) is otherwise in such form, is made in
            such manner, and contains such agreements, assurances,
            and information as the Secretary determines to be
            necessary to carry out this subpart.
      (b) State Plan.--
              (1) In general.--In order for a State to be in
            compliance with subsection (a)(6), the State shall
            submit to the Secretary a plan that, at a minimum,
            includes the following:
                      (A) A description of the State's system of
                    care that--
                              (i) identifies the single State
                            agency responsible for the
                            administration of the program,
                            including any third party who
                            administers substance use disorder
                            services and is responsible for
                            complying with the requirements of the
                            grant;
                              (ii) provides information on the need
                            for substance use disorder prevention
                            and treatment services in the State,
                            including estimates on the number of
                            individuals who need treatment, who are
                            pregnant women, women with dependent
                            children, individuals with a co-
                            occurring mental health and substance
                            use disorder, persons who inject drugs,
                            and persons who are experiencing
                            homelessness;
                              (iii) provides aggregate information
                            on the number of individuals in
                            treatment within the State, including
                            the number of such individuals who are
                            pregnant women, women with dependent
                            children, individuals with a co-
                            occurring mental health and substance
                            use disorder, persons who inject drugs,
                            and persons who are experiencing
                            homelessness;
                              (iv) provides a description of the
                            system that is available to provide
                            services by modality, including the
                            provision of recovery support services;
                              (v) provides a description of the
                            State's comprehensive statewide
                            prevention efforts, including the
                            number of individuals being served in
                            the system, target populations, and
                            priority needs, and provides a
                            description of the amount of funds from
                            the prevention set-aside expended on
                            primary prevention;
                              (vi) provides a description of--
                                      (I) the State's comprehensive
                                    statewide recovery support
                                    services activities, including
                                    the number of individuals being
                                    served, target populations, and
                                    priority needs; and
                                      (II) the amount of funds
                                    received under this subpart
                                    expended on recovery support
                                    services, disaggregated by the
                                    amount expended for type of
                                    service activity;
                              [(vi)] (vii) provides a description
                            of the financial resources available;
                              [(vii)] (viii) describes the existing
                            substance use disorders workforce and
                            workforce trained in treating co-
                            occurring substance use and mental
                            disorders;
                              [(viii)] (ix) includes a description
                            of how the State promotes evidence-
                            based practices; and
                              [(ix)] (x) describes how the State
                            integrates substance use disorder
                            services and primary health care, which
                            in the case of those individuals with
                            co-occurring mental health and
                            substance use disorders may include
                            providing both mental health and
                            substance use disorder services in
                            primary care settings or providing
                            primary and specialty care services in
                            community-based mental health and
                            substance use disorder service
                            settings.
                      (B) The establishment of goals and objectives
                    for the period of the plan, including targets
                    and milestones that are intended to be met, and
                    the activities that will be undertaken to
                    achieve those targets.
                      (C) A description of how the State will
                    comply with each funding agreement for a grant
                    under section 1921 that is applicable to the
                    State, including a description of the manner in
                    which the State intends to expend grant funds.
              (2) Modifications.--
                      (A) Authority of secretary.--As a condition;
                    of making a grant under section 1921 to a State
                    for a fiscal year, the Secretary may require
                    that the State modify any provision of the plan
                    submitted by the State under subsection (a)(6)
                    (including provisions on priorities in carrying
                    out authorized activities). If the Secretary
                    approves the plan and makes the grant to the
                    State for the fiscal year, the Secretary may
                    not during such year require the State to
                    modify the plan.
                      (B) State request for modification.--If the
                    State determines that a modification to such
                    plan is necessary, the State may request the
                    Secretary to approve the modification. Any such
                    modification shall be in accordance with
                    paragraph (1) and section 1941.
              (3) Authority of center for substance abuse
            prevention.--With respect to plans submitted by the
            States under subsection (a)(6), including any
            modification under paragraph (2), the Secretary, acting
            through the Director of the Center for Substance Abuse
            Prevention, shall review and approve or disapprove the
            provisions of the plans that relate to prevention
            activities.
      (c) Waivers Regarding Certain Territories.--In the case of
    any territory of the United States except Puerto Rico, the
    Secretary may waive such provisions of this subpart and subpart
    III as the Secretary determines to be appropriate, other than
    the provisions of section 1931.
      (d) Issuance of Regulations; Precondition to Making Grants.--
              (1) Regulations.--Not later than August 25, 1992, the
            Secretary, acting as appropriate through the Director
            of the Center for Treatment Improvement or the Director
            of the Center for Substance Abuse Prevention, shall by
            regulation establish standards specifying the
            circumstances in which the Secretary will consider an
            application for a grant under section 1921 to be in
            accordance with this section.
              (2) Issuance as precondition to making grants.--The
            Secretary may not make payments under any grant under
            section 1921 for fiscal year 1993 on or after January
            1, 1993, unless the Secretary has issued standards
            under paragraph (1).
      (e) Waiver Authority for Certain Requirements.--
              (1) In general.--Upon the request of a State, the
            Secretary may waive the requirements of all or part of
            the sections described in paragraph (2) using objective
            criteria established by the Secretary by regulation
            after consultation with the States and other interested
            parties including consumers and providers.
              (2) Sections.--The sections described in paragraph
            (1) are sections 1922(b), 1923, 1924 and 1928.
              (3) Date certain for acting upon request.--The
            Secretary shall approve or deny a request for a waiver
            under paragraph (1) and inform the State of that
            decision not later than 120 days after the date on
            which the request and all the information needed to
            support the request are submitted.
              (4) Annual reporting requirement.--The Secretary
            shall annually report to the general public on the
            States that receive a waiver under this subsection.

    SEC. 1933. DETERMINATION OF AMOUNT OF ALLOTMENT.

      (a) States.--
              (1) In general.--Subject to subsection (b), the
            Secretary shall determine the amount of the allotment
            required in section 1921 for a State for a fiscal year
            as follows:
                      (A) The formula established in paragraph (1)
                    of section 1918(a) shall apply to this
                    subsection to the same extent and in the same
                    manner as the formula applies for purposes of
                    section 1918(a), except that, in the
                    application of such formula for purposes of
                    this subsection, the modifications described in
                    subparagraph (B) shall apply.
                      (B) For purposes of subparagraph (A), the
                    modifications described in this subparagraph
                    are as follows:
                              (i) The amount specified in paragraph
                            (2)(A) of section 1918(a) is deemed to
                            be the amount appropriated under
                            section 1935(a) for allotments under
                            section 1921 for the fiscal year
                            involved.
                              (ii) The term ``P'' is deemed to have
                            the meaning given in paragraph (2) of
                            this subsection. Section 1918(a)(5)(B)
                            applies to the data used in determining
                            such term for the States.
                              (iii) The factor determined under
                            paragraph (8) of section 1918(a) is
                            deemed to have the purpose of
                            reflecting the differences that exist
                            between the State involved and other
                            States in the costs of providing
                            authorized services.
              (2) Determination of term ``p''.--For purposes of
            this subsection, the term ``P'' means the percentage
            that is the arithmetic mean of the percentage
            determined under subparagraph (A) and the percentage
            determined under subparagraph (B), as follows:
                      (A) The percentage constituted by the ratio
                    of--
                              (i) an amount equal to the sum of the
                            total number of individuals who reside
                            in the State involved and are between
                            18 and 24 years of age (inclusive) and
                            the number of individuals in the State
                            who reside in urbanized areas of the
                            State and are between such years of
                            age; to
                              (ii) an amount equal to the total of
                            the respective sums determined for the
                            States under clause (i).
                      (B) The percentage constituted by the ratio
                    of--
                              (i) the total number of individuals
                            in the State who are between 25 and 64
                            years of age (inclusive); to
                              (ii) an amount equal to the sum of
                            the respective amounts determined for
                            the States under clause (i).
      (b) Minimum Allotments for States.--
              (1) In general.--With respect to fiscal year 2000,
            and each subsequent fiscal year, the amount of the
            allotment of a State under section 1921 shall not be
            less than the amount the State received under such
            section for the previous fiscal year increased by an
            amount equal to 30.65 percent of the percentage by
            which the aggregate amount allotted to all States for
            such fiscal year exceeds the aggregate amount allotted
            to all States for the previous fiscal year.
              (2) Limitations.--
                      (A) In general.--Except as provided in
                    subparagraph (B), a State shall not receive an
                    allotment under section 1921 for a fiscal year
                    in an amount that is less than an amount equal
                    to 0.375 percent of the amount appropriated
                    under section 1935(a) for such fiscal year.
                      (B) Exception.--In applying subparagraph (A),
                    the Secretary shall ensure that no State
                    receives an increase in its allotment under
                    section 1921 for a fiscal year (as compared to
                    the amount allotted to the State in the prior
                    fiscal year) that is in excess of an amount
                    equal to 300 percent of the percentage by which
                    the amount appropriated under section 1935(a)
                    for such fiscal year exceeds the amount
                    appropriated for the prior fiscal year.
              (3) Decrease in or equal appropriations.--If the
            amount appropriated under section 1935(a) for a fiscal
            year is equal to or less than the amount appropriated
            under such section for the prior fiscal year, the
            amount of the State allotment under section 1921 shall
            be equal to the amount that the State received under
            section 1921 in the prior fiscal year decreased by the
            percentage by which the amount appropriated for such
            fiscal year is less than the amount appropriated or
            such section for the prior fiscal year.
      (c) Territories.--
              (1) Determination under formula.--Subject to
            paragraphs (2) and (4), the amount of an allotment
            under section 1921 for a territory of the United States
            for a fiscal year shall be the product of--
                      (A) an amount equal to the amounts reserved
                    under paragraph (3) for the fiscal year; and
                      (B) a percentage equal to the quotient of--
                              (i) the civilian population of the
                            territory, as indicated by the most
                            recently available data; divided by
                              (ii) the aggregate civilian
                            population of the territories of the
                            United States, as indicated by such
                            data.
              (2) Minimum allotment for territories.--The amount of
            an allotment under section 1921 for a territory of the
            United States for a fiscal year shall be the greater
            of--
                      (A) the amount determined under paragraph (1)
                    for the territory for the fiscal year;
                      (B) $50,000; and
                      (C) with respect to fiscal years 1993 and
                    1994, an amount equal to 79.4 percent of the
                    amount received by the territory from
                    allotments made pursuant to this part for
                    fiscal year 1992.
              (3) Reservation of amounts.--The Secretary shall each
            fiscal year reserve for the territories of the United
            States 1.5 percent of the amounts appropriated under
            section 1935(a) for allotments under section 1921 for
            the fiscal year.
              (4) Availability of data on population.--With respect
            to data on the civilian population of the territories
            of the United States, if the Secretary determines for a
            fiscal year that recent such data for purposes of
            paragraph (1)(B) do not exist regarding a territory,
            the Secretary shall for such purposes estimate the
            civilian population of the territory by modifying the
            data on the territory to reflect the average extent of
            change occurring during the ensuing period in the
            population of all territories with respect to which
            recent such data do exist.
              (5) Applicability of certain provisions.--For
            purposes of subsections (a) and (b), the term ``State''
            does not include the territories of the United States.
      (d) Indian tribes and tribal organizations.--
              (1) In general.--If the Secretary--
                      (A) receives a request from the governing
                    body [of an Indian tribe or tribal
                    organization] of an Indian Tribe or Tribal
                    organization within any State that funds under
                    this subpart be provided directly by the
                    Secretary to [such tribe] such Tribe or
                    organization; and
                      (B) makes a determination that the members of
                    such [tribe or tribal organization] Tribe or
                    Tribal organization would be better served by
                    means of grants made directly by the [Secretary
                    under this] Secretary under this subpart;
            the Secretary shall reserve from the allotment under
            section 1921 for the State for the fiscal year involved
            an amount that bears the same ratio to the allotment as
            the amount provided under this subpart to the [tribe or
            tribal organization] Tribe or Tribal organization for
            fiscal year 1991 for activities relating to the
            prevention and treatment of the [abuse of alcohol and
            other drugs] use of substances bore to the amount of
            the portion of the allotment under this subpart for the
            State for such fiscal year that was expended for such
            activities.
              [(2) Tribe or tribal organization as grantee.--The
            amount reserved by the Secretary on the basis of a
            determination under this paragraph shall be granted to
            the Indian tribe or tribal organization serving the
            individuals for whom such a determination has been
            made.]
              (2) Indian tribe or tribal organization as grantee.--
            The amount reserved by the Secretary on the basis of a
            determination under this subsection shall be granted to
            the Indian Tribe or Tribal organization serving the
            individuals for whom such a determination has been
            made.
              (3) Application.--In order for an Indian [tribe or
            tribal organization] Tribe or Tribal organization to be
            eligible for a grant for a fiscal year under this
            paragraph, it shall submit to the Secretary a plan for
            such fiscal year that meets such criteria as the
            Secretary may prescribe.
              (4)  [Definition] Definitions.--[The terms ``Indian
            tribe'' and ``tribal organization'' have the same
            meaning given such terms] The terms ``Indian Tribe''
            and ``Tribal organization'' have the meanings given the
            terms ``Indian tribe'' and ``tribal organization'' in
            subsections (b) and (c) of section 4 of the Indian
            Self-Determination and Education Assistance Act.

    SEC. 1934. DEFINITIONS.

       For purposes of this subpart:
              (1) The term ``authorized activities'', subject to
            section 1931, means the activities described in section
            1921(b).
              (2) The term ``funding agreement'', with respect to a
            grant under section 1921 to a State, means that the
            Secretary may make such a grant only if the State makes
            the agreement involved.
              (3) The term ``prevention activities'', subject to
            section 1931, means activities to prevent substance use
            disorders.
              [(4) The term ``substance abuse'' means the abuse of
            alcohol or other drugs.]
              (4) The term ``substance use disorder'' means the
            recurrent use of alcohol or other drugs that causes
            clinically significant impairment.
              (5) The term ``treatment activities'' means treatment
            services and, subject to section 1931, authorized
            activities that are related to treatment services.
              (6) The term ``treatment facility'' means an entity
            that provides treatment services.
              (7) The term ``treatment services'', subject to
            section 1931, means treatment for substance use
            disorders.

    SEC. 1935. FUNDING.

      (a) Authorization of Appropriations.--For the purpose of
    carrying out this subpart, subpart III and section 505(d) with
    respect to [substance abuse] substance use disorders, and
    section 515(d), there are authorized to be [appropriated
    $1,858,079,000 for each of fiscal years 2018 through 2022..]
    appropriated $1,908,079,000 for each of fiscal years 2023
    through 2027.
      (b) Allocations for Technical Assistance, National Data Base,
    Data Collection, and Program Evaluations.--
              (1) In general.--
                      (A) For the purpose of carrying out section
                    1948(a) with respect to [substance abuse]
                    substance use disorders, section 515(d), and
                    the purposes specified in subparagraphs (B) and
                    (C), the Secretary shall obligate 5 percent of
                    the amounts appropriated under subsection (a)
                    each fiscal year.
                      (B) The purpose specified in this
                    subparagraph is [the collection of data in this
                    paragraph is] carrying out sections 505(d) and
                    1971 with respect to [substance abuse]
                    substance use disorders.
                      (C) The purpose specified in this
                    subparagraph is the conduct of evaluations of
                    authorized activities to determine methods for
                    improving the availability and quality of such
                    activities.
              (2) Activities of center for substance abuse
            prevention.--Of the amounts reserved under paragraph
            (1) for a fiscal year, the Secretary, acting through
            the Director of the Center for Substance Abuse
            Prevention, shall obligate 20 percent for carrying out
            paragraph (1)(C), section 1948(a) with respect to
            prevention activities, and section 515(d).
              (3) Core data set.--A State that receives a new
            grant, contract, or cooperative agreement from amounts
            available to the Secretary under paragraph (1), for the
            purposes of improving the data collection, analysis and
            reporting capabilities of the State, shall be required,
            as a condition of receipt of funds, to collect,
            analyze, and report to the Secretary for each fiscal
            year subsequent to receiving such funds a core data set
            to be determined by the Secretary in conjunction with
            the States.

    Subpart III--General Provisions

               *       *       *       *       *       *       *

    SEC. 1942. REQUIREMENT OF REPORTS AND AUDITS BY STATES.

      (a) Report.--A funding agreement for a grant under section
    1911 or 1921 is that the State involved will submit to the
    Secretary a report in such form and containing such information
    as the Secretary determines (after consultation with the
    States) to be necessary for securing a record and a description
    of--
              (1) the purposes for which the grant received by the
            State for the preceding fiscal year under the program
            involved were expended and a description of the
            activities of the State under the program; [and]
              (2) the recipients of amounts provided in the
            grant[.]; and
              (3) the amount provided to each recipient in the
            previous fiscal year.
      (b) Audits.--A funding agreement for a grant under section
    1911 or 1921 is that the State will, with respect to the grant,
    comply with chapter 75 of title 31, United States Code.
      (c) Availability to Public.--A funding agreement for a grant
    under section 1911 or 1921 is that the State involved will--
              (1) make copies of the reports and audits described
            in this section available for public inspection within
            the State; and
              (2) provide copies of the report under subsection
            (a), upon request, to any interested person (including
            any public agency).

               *       *       *       *       *       *       *

    SEC. 1949. PLANS FOR PERFORMANCE PARTNERSHIPS.

      (a) Development.--The Secretary in conjunction with States
    and other interested groups shall develop separate plans for
    the programs authorized under subparts I and II for creating
    more flexibility for States and accountability based on outcome
    and other performance measures. The plans shall each include--
              (1) a description of the flexibility that would be
            given to the States under the plan;
              (2) the common set of performance measures that would
            be used for accountability, including measures that
            would be used for the program under subpart II for
            pregnant addicts, HIV transmission, tuberculosis, and
            those with a co-occurring [substance abuse] substance
            use disorders and mental disorders, and for programs
            under subpart I for children with serious emotional
            disturbance and adults with serious mental illness and
            for individuals with co-occurring mental health and
            [substance abuse] substance use disorders disorders;
              (3) the definitions for the data elements to be used
            under the plan;
              (4) the obstacles to implementation of the plan and
            the manner in which such obstacles would be resolved;
              (5) the resources needed to implement the performance
            partnerships under the plan; and
              (6) an implementation strategy complete with
            recommendations for any necessary legislation.
      (b) Submission.--Not later than 2 years after the date of the
    enactment of this Act, the plans developed under subsection (a)
    shall be submitted to the Committee on Health, Education,
    Labor, and Pensions of the Senate and the Committee on Commerce
    of the House of Representatives.
      (c) Information.--As the elements of the plans described in
    subsection (a) are developed, States are encouraged to provide
    information to the Secretary on a voluntary basis.
      (d) Participants.--The Secretary shall include among those
    interested groups that participate in the development of the
    plan consumers of mental health or [substance abuse] substance
    use disorders services, providers, representatives of political
    divisions of States, and representatives of racial and ethnic
    groups including Native Americans.

               *       *       *       *       *       *       *

    SEC. 1954. DEFINITIONS.

      (a) Definitions for Subpart III.--For purposes of this
    subpart:
              (1) The term ``program involved'' means the program
            of grants established in section 1911 or 1921, or both,
            as indicated by whether the State involved is receiving
            or is applying to receive a grant under section 1911 or
            1921, or both.
              (2)(A) The term ``funding agreement'', with respect
            to a grant under section 1911, has the meaning given
            such term in section 1919.
              (B) The term ``funding agreement'', with respect to a
            grant under section 1921, has the meaning given such
            term in section 1934.
      (b) Definitions for Part B.--For purposes of this part:
              (1) The term ``Comptroller General'' means the
            Comptroller General of the United States.
              (2) The term ``State'', except as provided in
            sections 1918(c)(5) and 1933(c)(5), means each of the
            several States, the District of Columbia, and each of
            the territories of the United States.
              (3) The term ``territories of the United States''
            means each of the Commonwealth of Puerto Rico, American
            Samoa, Guam, the Commonwealth of the Northern Mariana
            Islands, the Virgin Islands, Palau, the Marshall
            Islands, and Micronesia.
              (4) The term ``interim services'', in the case of an
            individual in need of treatment for [substance abuse]
            substance use disorders who has been denied admission
            to a program of such treatment on the basis of the lack
            of the capacity of the program to admit the individual,
            means services for reducing the adverse health effects
            of [such abuse] such disorders, for promoting the
            health of the individual, and for reducing the risk of
            transmission of disease, which services are provided
            until the individual is admitted to such a program.

    SEC. 1955. SERVICES PROVIDED BY NONGOVERNMENTAL ORGANIZATIONS.

      (a) Purposes.--The purposes of this section are--
              (1) to prohibit discrimination against
            nongovernmental organizations and certain individuals
            on the basis of religion in the distribution of
            government funds to provide [substance abuse] substance
            use disorder services under this title and title V, and
            the receipt of services under such titles; and
              (2) to allow the organizations to accept the funds to
            provide the services to the individuals without
            impairing the religious character of the organizations
            or the religious freedom of the individuals.
      (b) Religious Organizations Included as Nongovernmental
    Providers.--
              (1) In general.--A State may administer and provide
            [substance abuse] substance use disorder services under
            any program under this title or title V through grants,
            contracts, or cooperative agreements to provide
            assistance to beneficiaries under such titles with
            nongovernmental organizations.
              (2) Requirement.--A State that elects to utilize
            nongovernmental organizations as provided for under
            paragraph (1) shall consider, on the same basis as
            other nongovernmental organizations, religious
            organizations to provide services under [substance
            abuse] substance use disorder programs under this title
            or title V, so long as the programs under such titles
            are implemented in a manner consistent with the
            Establishment Clause of the first amendment to the
            Constitution. Neither the Federal Government nor a
            State or local government receiving funds under such
            programs shall discriminate against an organization
            that provides services under, or applies to provide
            services under, such programs, on the basis that the
            organization has a religious character.
      (c) Religious Character and Independence.--
              (1) In general.--A religious organization that
            provides services under any [substance abuse] substance
            use disorder program under this title or title V shall
            retain its independence from Federal, State, and local
            governments, including such organization's control over
            the definition, development, practice, and expression
            of its religious beliefs.
              (2) Additional safeguards.--Neither the Federal
            Government nor a State or local government shall
            require a religious organization--
                      (A) to alter its form of internal governance;
                    or
                      (B) to remove religious art, icons,
                    scripture, or other symbols,
            in order to be eligible to provide services under any
            [substance abuse] substance use disorder program under
            this title or title V.
      (d) Employment Practices.--
              (1) Substance abuse.--A religious organization that
            provides services under any [substance abuse] substance
            use disorder program under this title or title V may
            require that its employees providing services under
            such program adhere to rules forbidding the use of
            drugs or alcohol.
              (2) Title vii exemption.--The exemption of a
            religious organization provided under section 702 or
            703(e)(2) of the Civil Rights Act of 1964 (42 U.S.C.
            2000e-1, 2000e-2(e)(2)) regarding employment practices
            shall not be affected by the religious organization's
            provision of services under, or receipt of funds from,
            any [substance abuse] substance use disorder program
            under this title or title V.
      (e) Rights of Beneficiaries of Assistance.--
              (1) In general.--If an individual described in
            paragraph (3) has an objection to the religious
            character of the organization from which the individual
            receives, or would receive, services funded under any
            [substance abuse] substance use disorder program under
            this title or title V, the appropriate Federal, State,
            or local governmental entity shall provide to such
            individual (if otherwise eligible for such services)
            within a reasonable period of time after the date of
            such objection, services that--
                      (A) are from an alternative provider that is
                    accessible to the individual; and
                      (B) have a value that is not less than the
                    value of the services that the individual would
                    have received from such organization.
              (2) Notice.--The appropriate Federal, State, or local
            governmental entity shall ensure that notice is
            provided to individuals described in paragraph (3) of
            the rights of such individuals under this section.
              (3) Individual described.--An individual described in
            this paragraph is an individual who receives or applies
            for services under any [substance abuse] substance use
            disorder program under this title or title V.
      (f) Nondiscrimination Against Beneficiaries.--A religious
    organization providing services through a grant, contract, or
    cooperative agreement under any [substance abuse] substance use
    disorder program under this title or title V shall not
    discriminate, in carrying out such program, against an
    individual described in subsection (e)(3) on the basis of
    religion, a religious belief, a refusal to hold a religious
    belief, or a refusal to actively participate in a religious
    practice.
      (g) Fiscal Accountability.--
              (1) In general.--Except as provided in paragraph (2),
            any religious organization providing services under any
            [substance abuse] substance use disorder program under
            this title or title V shall be subject to the same
            regulations as other nongovernmental organizations to
            account in accord with generally accepted accounting
            principles for the use of such funds provided under
            such program.
              (2) Limited audit.--Such organization shall segregate
            government funds provided under such [substance abuse]
            substance use disorder program into a separate account.
            Only the government funds shall be subject to audit by
            the government.
      (h) Compliance.--Any party that seeks to enforce such party's
    rights under this section may assert a civil action for
    injunctive relief exclusively in an appropriate Federal or
    State court against the entity, agency or official that
    allegedly commits such violation.
      (i) Limitations on Use of Funds for Certain Purposes.--No
    funds provided through a grant or contract to a religious
    organization to provide services under any [substance abuse]
    substance use disorder program under this title or title V
    shall be expended for sectarian worship, instruction, or
    proselytization.
      (j) Effect on State and Local Funds.--If a State or local
    government contributes State or local funds to carry out any
    [substance abuse] substance use disorder program under this
    title or title V, the State or local government may segregate
    the State or local funds from the Federal funds provided to
    carry out the program or may commingle the State or local funds
    with the Federal funds. If the State or local government
    commingles the State or local funds, the provisions of this
    section shall apply to the commingled funds in the same manner,
    and to the same extent, as the provisions apply to the Federal
    funds.
      (k) Treatment of Intermediate Contractors.--If a
    nongovernmental organization (referred to in this subsection as
    an ``intermediate organization''), acting under a contract or
    other agreement with the Federal Government or a State or local
    government, is given the authority under the contract or
    agreement to select nongovernmental organizations to provide
    services under any [substance abuse] substance use disorder
    program under this title or title V, the intermediate
    organization shall have the same duties under this section as
    the government but shall retain all other rights of a
    nongovernmental organization under this section.

    SEC. 1956. SERVICES FOR INDIVIDUALS WITH CO-OCCURRING DISORDERS.

      States may use funds available for treatment under sections
    1911 and 1921 to treat persons with co-occurring [substance
    abuse] substance use disorders and mental disorders as long as
    funds available under such sections are used for the purposes
    for which they were authorized by law and can be tracked for
    accounting purposes.

               *       *       *       *       *       *       *

    PART C--CERTAIN PROGRAMS REGARDING MENTAL HEALTH AND [SUBSTANCE ABUSE]
                                 SUBSTANCE USE

                   Subpart I--Data Infrastructure Development

    SEC. 1971. DATA INFRASTRUCTURE DEVELOPMENT.

      (a) In General.--The Secretary may make grants to, and enter
    into contracts or cooperative agreements with States for the
    purpose of developing and operating mental health or [substance
    abuse] substance use data collection, analysis, and reporting
    systems with regard to performance measures including capacity,
    process, and outcomes measures.
      (b) Projects.--The Secretary shall establish criteria to
    ensure that services will be available under this section to
    States that have a fundamental basis for the collection,
    analysis, and reporting of mental health and [substance abuse]
    substance use performance measures and States that do not have
    such basis. The Secretary will establish criteria for
    determining whether a State has a fundamental basis for the
    collection, analysis, and reporting of data.
      (c) Condition of Receipt of Funds.--As a condition of the
    receipt of an award under this section a State shall agree to
    collect, analyze, and report to the Secretary within 2 years of
    the date of the award on a core set of performance measures to
    be determined by the Secretary in conjunction with the States.
      (d) Matching Requirement.--
              (1) In general.--With respect to the costs of the
            program to be carried out under subsection (a) by a
            State, the Secretary may make an award under such
            subsection only if the applicant agrees to make
            available (directly or through donations from public or
            private entities) non-Federal contributions toward such
            costs in an amount that is not less than 50 percent of
            such costs.
              (2) Determination of amount contributed.--Non-Federal
            contributions under paragraph (1) may be in cash or in
            kind, fairly evaluated, including plant, equipment, or
            services. Amounts provided by the Federal Government,
            or services assisted or subsidized to any significant
            extent by the Federal Government, may not be included
            in determining the amount of such contributions.
      (e) Duration of Support.--The period during which payments
    may be made for a project under subsection (a) may be not less
    than 3 years nor more than 5 years.
      (f) Authorization of Appropriation.--
              (1) In general.--For the purpose of carrying out this
            section, there are authorized to be appropriated such
            sums as may be necessary for each of the fiscal years
            2001, 2002 and 2003.
              (2) Allocation.--Of the amounts appropriated under
            paragraph (1) for a fiscal year, 50 percent shall be
            expended to support data infrastructure development for
            mental health and 50 percent shall be expended to
            support data infrastructure development for [substance
            abuse] substance use.

       Subpart II--Interim Maintenance Treatment of Narcotics Dependence

    SEC. 1976. INTERIM MAINTENANCE TREATMENT.

      (a) Requirement Regarding Secretary.--Subject to the
    following subsections of this section, for the purpose of
    reducing the incidence of the transmission of HIV disease
    pursuant to the [intravenous abuse] intravenous use of heroin
    or other morphine-like drugs, the Secretary, in establishing
    conditions for the use of methadone in public or nonprofit
    private programs of treatment for dependence on such drugs,
    shall authorize such programs--
              (1) to dispense methadone for treatment purposes to
            individuals who--
                      (A) meet the conditions for admission to such
                    programs that dispense methadone as part of
                    comprehensive treatment for such dependence;
                    and
                      (B) are seeking admission to such programs
                    that so dispense methadone, but as a result of
                    the limited capacity of the programs, will not
                    gain such admission until 14 or more days after
                    seeking admission to the programs; and
              (2) in dispensing methadone to such individuals, to
            provide only minimum ancillary services during the
            period in which the individuals are waiting for
            admission to programs of comprehensive treatment.
      (b) Inapplicability of Requirement in Certain
    Circumstances.--
              (1) In general.--The requirement established in
            subsection (a) for the Secretary does not apply if any
            or all of the following conditions are met:
                      (A) The preponderance of scientific research
                    indicates that the risk of the transmission of
                    HIV disease pursuant to the [intravenous abuse]
                    intravenous use of drugs is minimal.
                      (B) The preponderance of scientific research
                    indicates that the medically supervised
                    dispensing of methadone is not an effective
                    method of reducing the extent of dependence on
                    heroin and other morphine-like drugs.
                      (C) The preponderance of available data
                    indicates that, of treatment programs that
                    dispense methadone as part of comprehensive
                    treatment, a substantial majority admit all
                    individuals seeking services to the programs
                    not later than 14 days after the individuals
                    seek admission to the programs.
              (2) Evaluation by secretary.--In evaluating whether
            any or all of the conditions described in paragraph (1)
            have been met, the Secretary shall consult with the
            National Commission on Acquired Immune Deficiency
            Syndrome.
      (c) Conditions for Obtaining Authorization From Secretary.--
              (1) In general.--In carrying out the requirement
            established in subsection (a), the Secretary shall,
            after consultation with the National Commission on
            Acquired Immune Deficiency Syndrome, by regulation
            issue such conditions for treatment programs to obtain
            authorization from the Secretary to provide interim
            maintenance treatment as may be necessary to carry out
            the purpose described in such subsection. Such
            conditions shall include conditions for preventing the
            unauthorized use of methadone.
              (2) Counseling on hiv disease.--The regulations
            issued under paragraph (1) shall provide that an
            authorization described in such paragraph may not be
            issued to a treatment program unless the program
            provides to recipients of the treatment counseling on
            preventing exposure to and the transmission of HIV
            disease.
              (3) Permission of relevant state as condition of
            authorization.--The regulations issued under paragraph
            (1) shall provide that the Secretary may not provide an
            authorization described in such paragraph to any
            treatment program in a State unless the chief public
            health officer of the State has certified to the
            Secretary that--
                      (A) such officer does not object to the
                    provision of such authorizations to treatment
                    programs in the State; and
                      (B) the provision of interim maintenance
                    services in the State will not reduce the
                    capacity of comprehensive treatment programs in
                    the State to admit individuals to the programs
                    (relative to the date on which such officer so
                    certifies).
              (4) Date certain for issuance of regulations; failure
            of secretary.--The Secretary shall issue the final rule
            for purposes of the regulations required in paragraph
            (1), and such rule shall be effective, not later than
            the expiration of the 180-day period beginning on the
            date of the enactment of the ADAMHA Reorganization Act.
            If the Secretary fails to meet the requirement of the
            preceding sentence, the proposed rule issued on March
            2, 1989, with respect to part 291 of title 21, Code of
            Federal Regulations (docket numbered 88N-0444; 54 Fed.
            Reg. 8973 et seq.) is deemed to take effect as a final
            rule upon the expiration of such period, and the
            provisions of paragraph (3) of this subsection are
            deemed to be incorporated into such rule.
      (d) Definitions.--For purposes of this section:
              (1) The term ``interim maintenance services'' means
            the provision of methadone in a treatment program under
            the circumstances described in paragraphs (1) and (2)
            of subsection (a).
              (2) The term ``HIV disease'' means infection with the
            etiologic agent for acquired immune deficiency
            syndrome.
              (3) The term ``treatment program'' means a public or
            nonprofit private program of treatment for dependence
            on heroin or other morphine-like drugs.

               *       *       *       *       *       *       *

        TITLE XXVII--REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE

    PART A--INDIVIDUAL AND GROUP MARKET REFORMS

               *       *       *       *       *       *       *

             Subpart 2--Exclusion of Plans; Enforcement; Preemption

    SEC. 2722. EXCLUSION OF CERTAIN PLANS.

      (a) Limitation on Application of Provisions Relating to Group
    Health Plans.--
              (1) In general.--The requirements of subparts 1 and 2
            and part D shall apply with respect to group health
            plans only--
                      (A) subject to paragraph (2), in the case of
                    a plan that is a nonfederal governmental plan,
                    and
                      (B) with respect to health insurance coverage
                    offered in connection with a group health plan
                    (including such a plan that is a church plan or
                    a governmental plan).
              (2) Treatment of nonfederal governmental plans.--
                      (A) Election to be excluded.--Except as
                    provided in subparagraph (D) or (E), if the
                    plan sponsor of a nonfederal governmental plan
                    which is a group health plan to which the
                    provisions of subparts 1 and 2 otherwise apply
                    makes an election under this subparagraph (in
                    such form and manner as the Secretary may by
                    regulations prescribe), then the requirements
                    of such subparts insofar as they apply directly
                    to group health plans (and not merely to group
                    health insurance coverage) shall not apply to
                    such governmental plans for such period except
                    as provided in this paragraph.
                      (B) Period of election.--An election under
                    subparagraph (A) shall apply--
                              (i) for a single specified plan year,
                            or
                              (ii) in the case of a plan provided
                            pursuant to a collective bargaining
                            agreement, for the term of such
                            agreement.
                    An election under clause (i) may be extended
                    through subsequent elections under this
                    paragraph.
                      (C) Notice to enrollees.--Under such an
                    election, the plan shall provide for--
                              (i) notice to enrollees (on an annual
                            basis and at the time of enrollment
                            under the plan) of the fact and
                            consequences of such election, and
                              (ii) certification and disclosure of
                            creditable coverage under the plan with
                            respect to enrollees in accordance with
                            section 2701(e).
                      (D) Election not applicable to requirements
                    concerning genetic information.--The election
                    described in subparagraph (A) shall not be
                    available with respect to the provisions of
                    subsections (a)(1)(F), (b)(3), (c), and (d) of
                    section 2702 and the provisions of sections
                    2701 and 2702(b) to the extent that such
                    provisions apply to genetic information.
                      (E) Election not applicable.--The election
                    described in subparagraph (A) shall not be
                    available with respect to the provisions of
                    subparts I and II.
                      (F) Sunset of election option.--
                              (i) In general.--Notwithstanding the
                            preceding provisions of this
                            paragraph--
                                      (I) no election described in
                                    subparagraph (A) with respect
                                    to section 2726 may be made on
                                    or after the date of the
                                    enactment of this subparagraph;
                                    and
                                      (II) except as provided in
                                    clause (ii), no such election
                                    with respect to section 2726
                                    expiring on or after the date
                                    that is 180 days after the date
                                    of such enactment may be
                                    renewed.
                              (ii) Exception for certain
                            collectively bargained plans.--
                            Notwithstanding clause (i)(II), a plan
                            described in subparagraph (B)(ii) that
                            is subject to multiple agreements
                            described in such subparagraph of
                            varying lengths and that has an
                            election described in subparagraph (A)
                            with respect to section 2726 in effect
                            as of the date of the enactment of this
                            subparagraph that expires on or after
                            the date that is 180 days after the
                            date of such enactment may extend such
                            election until the date on which the
                            term of the last such agreement
                            expires.
      (b) Exception for Certain Benefits.--The requirements of
    subparts 1 and 2 and part Dshall not apply to any individual
    coverage or any group health plan (or group health insurance
    coverage) in relation to its provision of excepted benefits
    described in section 2791(c)(1).
      (c) Exception for Certain Benefits If Certain Conditions
    Met.--
              (1) Limited, excepted benefits.--The requirements of
            subparts 1 and 2 and part Dshall not apply to any
            individual coverage or any group health plan (and group
            health insurance coverage offered in connection with a
            group health plan) in relation to its provision of
            excepted benefits described in section 2791(c)(2) if
            the benefits--
                      (A) are provided under a separate policy,
                    certificate, or contract of insurance; or
                      (B) are otherwise not an integral part of the
                    plan.
              (2) Noncoordinated, excepted benefits.--The
            requirements of subparts 1 and 2 and part Dshall not
            apply to any individual coverage or any group health
            plan (and group health insurance coverage offered in
            connection with a group health plan) in relation to its
            provision of excepted benefits described in section
            2791(c)(3) if all of the following conditions are met:
                      (A) The benefits are provided under a
                    separate policy, certificate, or contract of
                    insurance.
                      (B) There is no coordination between the
                    provision of such benefits and any exclusion of
                    benefits under any group health plan maintained
                    by the same plan sponsor.
                      (C) Such benefits are paid with respect to an
                    event without regard to whether benefits are
                    provided with respect to such an event under
                    any group health plan maintained by the same
                    plan sponsor or, with respect to individual
                    coverage, under any health insurance coverage
                    maintained by the same health insurance issuer.
              (3) Supplemental excepted benefits.--The requirements
            of this part and part Dshall not apply to any
            individual coverage or any group health plan (and group
            health insurance coverage) in relation to its provision
            of excepted benefits described in section 27971(c)(4)
            if the benefits are provided under a separate policy,
            certificate, or contract of insurance.
      (d) Treatment of Partnerships.--For purposes of this part and
    part D--
              (1) Treatment as a group health plan.--Any plan,
            fund, or program which would not be (but for this
            subsection) an employee welfare benefit plan and which
            is established or maintained by a partnership, to the
            extent that such plan, fund, or program provides
            medical care (including items and services paid for as
            medical care) to present or former partners in the
            partnership or to their dependents (as defined under
            the terms of the plan, fund, or program), directly or
            through insurance, reimbursement, or otherwise, shall
            be treated (subject to paragraph (2)) as an employee
            welfare benefit plan which is a group health plan.
              (2) Employer.--In the case of a group health plan,
            the term ``employer'' also includes the partnership in
            relation to any partner.
              (3) Participants of group health plans.--In the case
            of a group health plan, the term ``participant'' also
            includes--
                      (A) in connection with a group health plan
                    maintained by a partnership, an individual who
                    is a partner in relation to the partnership, or
                      (B) in connection with a group health plan
                    maintained by a self-employed individual (under
                    which one or more employees are participants),
                    the self-employed individual,
            if such individual is, or may become, eligible to
            receive a benefit under the plan or such individual's
            beneficiaries may be eligible to receive any such
            benefit.

               *       *       *       *       *       *       *

    Part C--Definitions; Miscellaneous Provisions

               *       *       *       *       *       *       *

    SEC. 2794. ENSURING THAT CONSUMERS GET VALUE FOR THEIR DOLLARS.

      (a) Initial Premium Review Process.--
              (1) In general.--The Secretary, in conjunction with
            States, shall establish a process for the annual
            review, beginning with the 2010 plan year and subject
            to subsection (b)(2)(A), of unreasonable increases in
            premiums for health insurance coverage.
              (2) Justification and disclosure.--The process
            established under paragraph (1) shall require health
            insurance issuers to submit to the Secretary and the
            relevant State a justification for an unreasonable
            premium increase prior to the implementation of the
            increase. Such issuers shall prominently post such
            information on their Internet websites. The Secretary
            shall ensure the public disclosure of information on
            such increases and justifications for all health
            insurance issuers.
      (b) Continuing Premium Review Process.--
              (1) Informing secretary of premium increase
            patterns.--As a condition of receiving a grant under
            subsection (c)(1), a State, through its Commissioner of
            Insurance, shall--
                      (A) provide the Secretary with information
                    about trends in premium increases in health
                    insurance coverage in premium rating areas in
                    the State; and
                      (B) make recommendations, as appropriate, to
                    the State Exchange about whether particular
                    health insurance issuers should be excluded
                    from participation in the Exchange based on a
                    pattern or practice of excessive or unjustified
                    premium increases.
              (2) Monitoring by secretary of premium increases.--
                      (A) In general.--Beginning with plan years
                    beginning in 2014, the Secretary, in
                    conjunction with the States and consistent with
                    the provisions of subsection (a)(2), shall
                    monitor premium increases of health insurance
                    coverage offered through an Exchange and
                    outside of an Exchange.
                      (B) Consideration in opening exchange.--In
                    determining under section 1312(f)(2)(B) of the
                    Patient Protection and Affordable Care Act
                    whether to offer qualified health plans in the
                    large group market through an Exchange, the
                    State shall take into account any excess of
                    premium growth outside of the Exchange as
                    compared to the rate of such growth inside the
                    Exchange.
      (c) Grants in Support of Process.--
              (1) Premium review grants during 2010 through 2014.--
            The Secretary shall carry out a program to award grants
            to States during the 5-year period beginning with
            fiscal year 2010 to assist such States in carrying out
            subsection (a), including--
                      (A) in reviewing and, if appropriate under
                    State law, approving premium increases for
                    health insurance coverage;
                      (B) in providing information and
                    recommendations to the Secretary under
                    subsection (b)(1); and
                      (C) in establishing centers (consistent with
                    subsection (d)) at academic or other nonprofit
                    institutions to collect medical reimbursement
                    information from health insurance issuers, to
                    analyze and organize such information, and to
                    make such information available to such
                    issuers, health care providers, health
                    researchers, health care policy makers, and the
                    general public.
              (2) Funding.--
                      (A) In general.--Out of all funds in the
                    Treasury not otherwise appropriated, there are
                    appropriated to the Secretary $250,000,000, to
                    be available for expenditure for grants under
                    paragraph (1) and subparagraph (B).
                      (B) Further availability for insurance reform
                    and consumer protection.--If the amounts
                    appropriated under subparagraph (A) are not
                    fully obligated under grants under paragraph
                    (1) by the end of fiscal year 2014, any
                    remaining funds shall remain available to the
                    Secretary for grants to States for planning and
                    implementing the insurance reforms and consumer
                    protections under part A.
                      (C) Allocation.--The Secretary shall
                    establish a formula for determining the amount
                    of any grant to a State under this subsection.
                    Under such formula--
                              (i) the Secretary shall consider the
                            number of plans of health insurance
                            coverage offered in each State and the
                            population of the State; and
                              (ii) no State qualifying for a grant
                            under paragraph (1) shall receive less
                            than $1,000,000, or more than
                            $5,000,000 for a grant year.
              (3) Parity implementation.--
                      (A) In general.--Beginning during the first
                    fiscal year that begins after the date of
                    enactment of this paragraph, the Secretary
                    shall, out of funds made available pursuant to
                    subparagraph (C), award grants to eligible
                    States to enforce and ensure compliance with
                    the mental health and substance use disorder
                    parity provisions of section 2726.
                      (B) Eligible state.--A State shall be
                    eligible for a grant awarded under this
                    paragraph only if such State--
                              (i) submits to the Secretary an
                            application for such grant at such
                            time, in such manner, and containing
                            such information as specified by the
                            Secretary; and
                              (ii) agrees to request and review
                            from health insurance issuers offering
                            group or individual health insurance
                            coverage the comparative analyses and
                            other information required of such
                            health insurance issuers under
                            subsection (a)(8)(A) of section 2726
                            relating to the design and application
                            of nonquantitative treatment
                            limitations imposed on mental health or
                            substance use disorder benefits.
                      (C) Authorization of appropriations.--There
                    are authorized to be appropriated $10,000,000
                    for each of the first five fiscal years
                    beginning after the date of the enactment of
                    this paragraph, to remain available until
                    expended, for purposes of awarding grants under
                    subparagraph (A).
      (d) Medical Reimbursement Data Centers.--
              (1) Functions.--A center established under subsection
            (c)(1)(C) shall--
                      (A) develop fee schedules and other database
                    tools that fairly and accurately reflect market
                    rates for medical services and the geographic
                    differences in those rates;
                      (B) use the best available statistical
                    methods and data processing technology to
                    develop such fee schedules and other database
                    tools;
                      (C) regularly update such fee schedules and
                    other database tools to reflect changes in
                    charges for medical services;
                      (D) make health care cost information readily
                    available to the public through an Internet
                    website that allows consumers to understand the
                    amounts that health care providers in their
                    area charge for particular medical services;
                    and
                      (E) regularly publish information concerning
                    the statistical methodologies used by the
                    center to analyze health charge data and make
                    such data available to researchers and policy
                    makers.
              (2) Conflicts of interest.--A center established
            under subsection (c)(1)(C) shall adopt by-laws that
            ensures that the center (and all members of the
            governing board of the center) is independent and free
            from all conflicts of interest. Such by-laws shall
            ensure that the center is not controlled or influenced
            by, and does not have any corporate relation to, any
            individual or entity that may make or receive payments
            for health care services based on the center's analysis
            of health care costs.
              (3) Rule of construction.--Nothing in this subsection
            shall be construed to permit a center established under
            subsection (c)(1)(C) to compel health insurance issuers
            to provide data to the center.

    SEC. 2794. UNIFORM FRAUD AND ABUSE REFERRAL FORMAT.

      The Secretary shall request the National Association of
    Insurance Commissioners to develop a model uniform report form
    for private health insurance issuer seeking to refer suspected
    fraud and abuse to State insurance departments or other
    responsible State agencies for investigation. The Secretary
    shall request that the National Association of Insurance
    Commissioners develop recommendations for uniform reporting
    standards for such referrals.

               *       *       *       *       *       *       *

                                  ----------

          HELPING FAMILIES IN MENTAL HEALTH CRISIS REFORM ACT OF 2016

    SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

      (a) Short Title.--This Act may be cited as the ``21st Century
    Cures Act''.
      (b) Table of Contents.--The table of contents for this Act is
    as follows:

    Sec. 1. Short title; table of contents.
         * * * * * * *

              DIVISION B--HELPING FAMILIES IN MENTAL HEALTH CRISIS

    Sec. 6000. Short title.

              TITLE VI--STRENGTHENING LEADERSHIP AND ACCOUNTABILITY

         * * * * * * *

       Subtitle C--Interdepartmental Serious Mental Illness Coordinating
                                    Committee

    [Sec. 6031. Interdepartmental Serious Mental Illness Coordinating
              Committee.]

               *       *       *       *       *       *       *

    DIVISION B--HELPING FAMILIES IN MENTAL HEALTH CRISIS

               *       *       *       *       *       *       *

    TITLE VI--STRENGTHENING LEADERSHIP AND ACCOUNTABILITY

               *       *       *       *       *       *       *

       Subtitle C--Interdepartmental Serious Mental Illness Coordinating
                                   Committee

    [SEC. 6031. INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING
                        COMMITTEE.

      [(a) Establishment.--
              [(1) In general.--Not later than 3 months after the
            date of enactment of this Act, the Secretary of Health
            and Human Services, or the designee of the Secretary,
            shall establish a committee to be known as the
            Interdepartmental Serious Mental Illness Coordinating
            Committee (in this section referred to as the
            ``Committee'').
              [(2) Federal advisory committee act.--Except as
            provided in this section, the provisions of the Federal
            Advisory Committee Act (5 U.S.C. App.) shall apply to
            the Committee.
      [(b) Meetings.--The Committee shall meet not fewer than 2
    times each year.
      [(c) Responsibilities.--Not later than 1 year after the date
    of enactment of this Act, and 5 years after such date of
    enactment, the Committee shall submit to Congress and any other
    relevant Federal department or agency a report including--
              [(1) a summary of advances in serious mental illness
            and serious emotional disturbance research related to
            the prevention of, diagnosis of, intervention in, and
            treatment and recovery of serious mental illnesses,
            serious emotional disturbances, and advances in access
            to services and support for adults with a serious
            mental illness or children with a serious emotional
            disturbance;
              [(2) an evaluation of the effect Federal programs
            related to serious mental illness have on public
            health, including public health outcomes such as--
                      [(A) rates of suicide, suicide attempts,
                    incidence and prevalence of serious mental
                    illnesses, serious emotional disturbances, and
                    substance use disorders, overdose, overdose
                    deaths, emergency hospitalizations, emergency
                    room boarding, preventable emergency room
                    visits, interaction with the criminal justice
                    system, homelessness, and unemployment;
                      [(B) increased rates of employment and
                    enrollment in educational and vocational
                    programs;
                      [(C) quality of mental and substance use
                    disorders treatment services; or
                      [(D) any other criteria as may be determined
                    by the Secretary; and
              [(3) specific recommendations for actions that
            agencies can take to better coordinate the
            administration of mental health services for adults
            with a serious mental illness or children with a
            serious emotional disturbance.
      [(d) Committee Extension.--Upon the submission of the second
    report under subsection (c), the Secretary shall submit a
    recommendation to Congress on whether to extend the operation
    of the Committee.
      [(e) Membership.--
              [(1) Federal members.--The Committee shall be
            composed of the following Federal representatives, or
            the designees of such representatives--
                      [(A) the Secretary of Health and Human
                    Services, who shall serve as the Chair of the
                    Committee;
                      [(B) the Assistant Secretary for Mental
                    Health and Substance Use;
                      [(C) the Attorney General;
                      [(D) the Secretary of Veterans Affairs;
                      [(E) the Secretary of Defense;
                      [(F) the Secretary of Housing and Urban
                    Development;
                      [(G) the Secretary of Education;
                      [(H) the Secretary of Labor;
                      [(I) the Administrator of the Centers for
                    Medicare & Medicaid Services; and
                      [(J) the Commissioner of Social Security.
              [(2) Non-federal members.--The Committee shall also
            include not less than 14 non-Federal public members
            appointed by the Secretary of Health and Human
            Services, of which--
                      [(A) at least 2 members shall be an
                    individual who has received treatment for a
                    diagnosis of a serious mental illness;
                      [(B) at least 1 member shall be a parent or
                    legal guardian of an adult with a history of a
                    serious mental illness or a child with a
                    history of a serious emotional disturbance;
                      [(C) at least 1 member shall be a
                    representative of a leading research, advocacy,
                    or service organization for adults with a
                    serious mental illness;
                      [(D) at least 2 members shall be--
                              [(i) a licensed psychiatrist with
                            experience in treating serious mental
                            illnesses;
                              [(ii) a licensed psychologist with
                            experience in treating serious mental
                            illnesses or serious emotional
                            disturbances;
                              [(iii) a licensed clinical social
                            worker with experience treating serious
                            mental illnesses or serious emotional
                            disturbances; or
                              [(iv) a licensed psychiatric nurse,
                            nurse practitioner, or physician
                            assistant with experience in treating
                            serious mental illnesses or serious
                            emotional disturbances;
                      [(E) at least 1 member shall be a licensed
                    mental health professional with a specialty in
                    treating children and adolescents with a
                    serious emotional disturbance;
                      [(F) at least 1 member shall be a mental
                    health professional who has research or
                    clinical mental health experience in working
                    with minorities;
                      [(G) at least 1 member shall be a mental
                    health professional who has research or
                    clinical mental health experience in working
                    with medically underserved populations;
                      [(H) at least 1 member shall be a State
                    certified mental health peer support
                    specialist;
                      [(I) at least 1 member shall be a judge with
                    experience in adjudicating cases related to
                    criminal justice or serious mental illness;
                      [(J) at least 1 member shall be a law
                    enforcement officer or corrections officer with
                    extensive experience in interfacing with adults
                    with a serious mental illness, children with a
                    serious emotional disturbance, or individuals
                    in a mental health crisis; and
                      [(K) at least 1 member shall have experience
                    providing services for homeless individuals and
                    working with adults with a serious mental
                    illness, children with a serious emotional
                    disturbance, or individuals in a mental health
                    crisis.
              [(3) Terms.--A member of the Committee appointed
            under subsection (e)(2) shall serve for a term of 3
            years, and may be reappointed for 1 or more additional
            3-year terms. Any member appointed to fill a vacancy
            for an unexpired term shall be appointed for the
            remainder of such term. A member may serve after the
            expiration of the member's term until a successor has
            been appointed.
      [(f) Working Groups.--In carrying out its functions, the
    Committee may establish working groups. Such working groups
    shall be composed of Committee members, or their designees, and
    may hold such meetings as are necessary.
      [(g) Sunset.--The Committee shall terminate on the date that
    is 6 years after the date on which the Committee is established
    under subsection (a)(1).]

               *       *       *       *       *       *       *

                                  ----------

                   PROTECTING ACCESS TO MEDICARE ACT OF 2014

               *       *       *       *       *       *       *
    TITLE II--OTHER HEALTH PROVISIONS

               *       *       *       *       *       *       *

    [SEC. 224. ASSISTED OUTPATIENT TREATMENT GRANT PROGRAM FOR INDIVIDUALS
                        WITH SERIOUS MENTAL ILLNESS.

      [(a) In general.--The Secretary shall establish a 4-year
    pilot program to award not more than 50 grants each year to
    eligible entities for assisted outpatient treatment programs
    for individuals with serious mental illness.
      [(b) Consultation.--The Secretary shall carry out this
    section in consultation with the Director of the National
    Institute of Mental Health, the Attorney General of the United
    States, the Administrator of the Administration for Community
    Living, and the Administrator of the Substance Abuse and Mental
    Health Services Administration.
      [(c) Selecting Among Applicants.--The Secretary--
              [(1) may only award grants under this section to
            applicants that have not previously implemented an
            assisted outpatient treatment program; and
              [(2) shall evaluate applicants based on their
            potential to reduce hospitalization, homelessness,
            incarceration, and interaction with the criminal
            justice system while improving the health and social
            outcomes of the patient.
      [(d) Use of Grant.--An assisted outpatient treatment program
    funded with a grant awarded under this section shall include--
              [(1) evaluating the medical and social needs of the
            patients who are participating in the program;
              [(2) preparing and executing treatment plans for such
            patients that--
                      [(A) include criteria for completion of
                    court-ordered treatment; and
                      [(B) provide for monitoring of the patient's
                    compliance with the treatment plan, including
                    compliance with medication and other treatment
                    regimens;
              [(3) providing for such patients case management
            services that support the treatment plan;
              [(4) ensuring appropriate referrals to medical and
            social service providers;
              [(5) evaluating the process for implementing the
            program to ensure consistency with the patient's needs
            and State law; and
              [(6) measuring treatment outcomes, including health
            and social outcomes such as rates of incarceration,
            health care utilization, and homelessness.
      [(e) Report.--Not later than the end of each of fiscal years
    2016, 2017, 2018, 2019, 2020, 2021, and 2022, the Secretary
    shall submit a report to the appropriate congressional
    committees on the grant program under this section. Each such
    report shall include an evaluation of the following:
              [(1) Cost savings and public health outcomes such as
            mortality, suicide, substance abuse, hospitalization,
            and use of services.
              [(2) Rates of incarceration by patients.
              [(3) Rates of homelessness among patients.
              [(4) Patient and family satisfaction with program
            participation.
      [(f) Definitions.--In this section:
              [(1) The term ``assisted outpatient treatment'' means
            medically prescribed mental health treatment that a
            patient receives while living in a community under the
            terms of a law authorizing a State or local court to
            order such treatment.
              [(2) The term ``eligible entity'' means a county,
            city, mental health system, mental health court, or any
            other entity with authority under the law of the State
            in which the grantee is located to implement, monitor,
            and oversee assisted outpatient treatment programs.
              [(3) The term ``Secretary'' means the Secretary of
            Health and Human Services.
      [(g) Funding.--
              [(1) Amount of grants.--A grant under this section
            shall be in an amount that is not more than $1,000,000
            for each of fiscal years 2015 through 2022. Subject to
            the preceding sentence, the Secretary shall determine
            the amount of each grant based on the population of the
            area, including estimated patients, to be served under
            the grant.
              [(2) Authorization of appropriations.--There are
            authorized to be appropriated to carry out this section
            $15,000,000 for each of fiscal years 2015 through 2017,
            $20,000,000 for fiscal year 2018, $19,000,000 for each
            of fiscal years 2019 and 2020, and $18,000,000 for each
            of fiscal years 2021 and 2022.]

    SEC. 224. ASSISTED OUTPATIENT TREATMENT GRANT PROGRAM FOR INDIVIDUALS
                        WITH SERIOUS MENTAL ILLNESS.

      (a) In General.--The Secretary shall carry out a program to
    award grants to eligible entities for assisted outpatient
    treatment programs for individuals with serious mental illness.
      (b) Consultation.--The Secretary shall carry out this section
    in consultation with the Director of the National Institute of
    Mental Health, the Attorney General of the United States, the
    Administrator of the Administration for Community Living, and
    the Assistant Secretary for Mental Health and Substance Use.
      (c) Selecting Among Applicants.--In awarding grants under
    this section, the Secretary--
              (1) may give preference to applicants that have not
            previously implemented an assisted outpatient treatment
            program; and
              (2) shall evaluate applicants based on their
            potential to reduce hospitalization, homelessness,
            incarceration, and interaction with the criminal
            justice system while improving the health and social
            outcomes of the patient.
      (d) Program Requirements.--An assisted outpatient treatment
    program funded with a grant awarded under this section shall
    include--
              (1) evaluating the medical and social needs of the
            patients who are participating in the program;
              (2) preparing and executing treatment plans for such
            patients that--
                      (A) include criteria for completion of court-
                    ordered treatment if applicable; and
                      (B) provide for monitoring of the patient's
                    compliance with the treatment plan, including
                    compliance with medication and other treatment
                    regimens;
              (3) providing for case management services that
            support the treatment plan;
              (4) ensuring appropriate referrals to medical and
            social services providers;
              (5) evaluating the process for implementing the
            program to ensure consistency with the patient's needs
            and State law; and
              (6) measuring treatment outcomes, including health
            and social outcomes such as rates of incarceration,
            health care utilization, and homelessness.
      (e) Report.--Not later than the end of fiscal year 2027, the
    Secretary shall submit a report to the appropriate
    congressional committees on the grant program under this
    section. Such report shall include an evaluation of the
    following:
              (1) Cost savings and public health outcomes such as
            mortality, suicide, substance abuse, hospitalization,
            and use of services.
              (2) Rates of incarceration of patients.
              (3) Rates of homelessness of patients.
              (4) Patient and family satisfaction with program
            participation.
              (5) Demographic information regarding participation
            of those served by the grant compared to demographic
            information in the population of the grant recipient.
      (f) Definitions.--In this section:
              (1) The term ``assisted outpatient treatment'' means
            medically prescribed mental health treatment that a
            patient receives while living in a community under the
            terms of a law authorizing a State or local civil court
            to order such treatment.
              (2) The term ``eligible entity'' means a county,
            city, mental health system, mental health court, or any
            other entity with authority under the law of the State
            in which the entity is located to implement, monitor,
            and oversee an assisted outpatient treatment program.
      (g) Funding.--
              (1) Amount of grants.--
                      (A) Maximum amount.--The amount of a grant
                    under this section shall not exceed $1,000,000
                    for any fiscal year.
                      (B) Determination.--Subject to subparagraph
                    (A), the Secretary shall determine the amount
                    of each grant under this section based on the
                    population of the area to be served through the
                    grant and an estimate of the number of patients
                    to be served.
              (2) Authorization of appropriations.--There is
            authorized to be appropriated to carry out this section
            $22,000,000 for each of fiscal years 2023 through 2027.

               *       *       *       *       *       *       *

                                  ----------

                COMPREHENSIVE ADDICTION AND RECOVERY ACT OF 2016

               *       *       *       *       *       *       *
    TITLE I--PREVENTION AND EDUCATION

               *       *       *       *       *       *       *

    SEC. 107. IMPROVING ACCESS TO OVERDOSE TREATMENT.

      (a) Grants for Reducing Overdose Deaths.--[Omitted Amends
    other Act]''.
      [(b) Improving Access to Overdose Treatment.--
              [(1) Information on best practices.--Not later than
            180 days after the date of enactment of this Act:
                      [(A) The Secretary of Health and Human
                    Services may provide information to prescribers
                    within Federally qualified health centers (as
                    defined in paragraph (4) of section 1861(aa) of
                    the Social Security Act (42 U.S.C. 1395x(aa))),
                    and the health care facilities of the Indian
                    Health Service, on best practices for
                    prescribing or co-prescribing a drug or device
                    approved or cleared under the Federal Food,
                    Drug, and Cosmetic Act (21 U.S.C. 301 et seq.)
                    for emergency treatment of known or suspected
                    opioid overdose, including for patients
                    receiving chronic opioid therapy and patients
                    being treated for opioid use disorders.
                      [(B) The Secretary of Defense may provide
                    information to prescribers within Department of
                    Defense medical facilities on best practices
                    for prescribing or co-prescribing a drug or
                    device approved or cleared under the Federal
                    Food, Drug, and Cosmetic Act (21 U.S.C. 301 et
                    seq.) for emergency treatment of known or
                    suspected opioid overdose, including for
                    patients receiving chronic opioid therapy and
                    patients being treated for opioid use
                    disorders.
                      [(C) The Secretary of Veterans Affairs may
                    provide information to prescribers within
                    Department of Veterans Affairs medical
                    facilities on best practices for prescribing or
                    co-prescribing a drug or device approved or
                    cleared under the Federal Food, Drug, and
                    Cosmetic Act (21 U.S.C. 301 et seq.) for
                    emergency treatment of known or suspected
                    opioid overdose, including for patients
                    receiving chronic opioid therapy and patients
                    being treated for opioid use disorders.
              [(2) Rule of construction.--Nothing in this
            subsection should be construed to establish or
            contribute to a medical standard of care.]

               *       *       *       *       *       *       *

                                  ----------

                    SUPPORT FOR PATIENTS AND COMMUNITIES ACT

    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.
         * * * * * * *

         Subtitle J--Alternatives to Opioids in the Emergency Department

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

               *       *       *       *       *       *       *

                      TITLE VII--PUBLIC HEALTH PROVISIONS

        Subtitle J--Alternatives to Opioids in the Emergency Department

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

      (a)  [Demonstration Program Grants.--] Grant Program._
              (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--
              (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] 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] Not later than the end of each of
    fiscal years 2024 and 2027, the Secretary shall submit to the
    Congress a report on the results of the 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] 2023 through 2027.

               *       *       *       *       *       *       *

                                  ----------

                           CONTROLLED SUBSTANCES ACT

    TITLE II--CONTROL AND ENFORCEMENT

               *       *       *       *       *       *       *

    Part C--Registration of Manufacturers, Distributors, and Dispensers of
    Controlled Substances; Piperidine Reporting

               *       *       *       *       *       *       *

                          persons required to register

      Sec. 302. (a)(1) Every person who manufactures or distributes
    any controlled substance or list I chemical, or who proposes to
    engage in the manufacture or distribution of any controlled
    substance or list I chemical, shall obtain annually a
    registration issued by the Attorney General in accordance with
    the rules and regulations promulgated by him.
      (2) Every person who dispenses, or who proposes to dispense,
    any controlled substance, shall obtain from the Attorney
    General a registration issued in accordance with the rules and
    regulations promulgated by him. The Attorney General shall, by
    regulation, determine the period of such registrations. In no
    event; however, shall such registrations be issued for less
    than one year nor for more than three years.
      (3)(A) Except as provided in subparagraph (C), the
    registration of any registrant under this title to manufacture,
    distribute, or dispense controlled substances or list I
    chemicals terminates if and when such registrant--
              (i) dies;
              (ii) ceases legal existence;
              (iii) discontinues business or professional practice;
            or
              (iv) surrenders such registration.
      (B) In the case of such a registrant who ceases legal
    existence or discontinues business or professional practice,
    such registrant shall promptly notify the Attorney General in
    writing of such fact.
      (C) No registration under this title to manufacture,
    distribute, or dispense controlled substances or list I
    chemicals, and no authority conferred thereby, may be assigned
    or otherwise transferred except upon such conditions as the
    Attorney General may specify and then only pursuant to written
    consent. A registrant to whom a registration is assigned or
    transferred pursuant to the preceding sentence may not
    manufacture, distribute, or dispense controlled substances or
    list I chemicals pursuant to such registration until the
    Attorney General receives such written consent.
      (D) In the case of a registrant under this title to
    manufacture, distribute, or dispense controlled substances or
    list I chemicals desiring to discontinue business or
    professional practice altogether or with respect to controlled
    substances and list I chemicals (without assigning or
    transferring such business or professional practice to another
    entity), such registrant shall return to the Attorney General
    for cancellation--
              (i) the registrant's certificate of registration;
              (ii) any unexecuted order forms in the registrant's
            possession; and
              (iii) any other documentation that the Attorney
            General may require.
      (b) Persons registered by the Attorney General under this
    title to manufacture, distribute, or dispense controlled
    substances or list I chemicals are authorized to possess,
    manufacture, distribute, or dispense such substances or
    chemicals (including any such activity in the conduct of
    research) to the extent authorized by their registration and in
    conformity with the other provisions of this title.
      (c) The following persons shall not be required to register
    and may lawfully possess any controlled substance or list I
    chemical under this title:
              (1) An agent or employee of any registered
            manufacturer, distributor, or dispenser of any
            controlled substance or list I chemical if such agent
            or employee is acting in the usual course of his
            business or employment.
              (2) A common or contract carrier or warehouseman, or
            an employee thereof, whose possession of the controlled
            substance or list I chemical is in the usual course of
            his business or employment.
              (3) An ultimate user who possesses such substance for
            a purpose specified in section 102(25).
      (d) The Attorney General may, by regulation, waive the
    requirement for registration of certain manufacturers,
    distributors, or dispensers if he finds it consistent with the
    public health and safety.
      (e)(1) A separate registration shall be required at each
    principal place of business or professional practice where the
    applicant manufactures, distributes, or dispenses controlled
    substances or list I chemicals.
      (2) Notwithstanding paragraph (1), a registrant who is a
    veterinarian shall not be required to have a separate
    registration in order to transport and dispense controlled
    substances in the usual course of veterinary practice at a site
    other than the registrant's registered principal place of
    business or professional practice, so long as the site of
    transporting and dispensing is located in a State where the
    veterinarian is licensed to practice veterinary medicine and is
    not a principal place of business or professional practice.
      (3) Notwithstanding paragraph (1), a registrant that is
    dispensing pursuant to section 303(g) narcotic drugs to
    individuals for maintenance treatment or detoxification
    treatment shall not be required to have a separate registration
    to incorporate one or more mobile medication units into the
    registrant's practice to dispense such narcotics at locations
    other than the registrant's principal place of business or
    professional practice described in paragraph (1), so long as
    the registrant meets such standards for operation of a mobile
    medication unit as the Attorney General may establish.
      (f) The Attorney General is authorized to inspect the
    establishment of a registrant or applicant for registration in
    accordance with the rules and regulations promulgated by him.
      (g)(1) An ultimate user who has lawfully obtained a
    controlled substance in accordance with this title may, without
    being registered, deliver the controlled substance to another
    person for the purpose of disposal of the controlled substance
    if--
              (A) the person receiving the controlled substance is
            authorized under this title to engage in such activity;
            and
              (B) the disposal takes place in accordance with
            regulations issued by the Attorney General to prevent
            diversion of controlled substances.
      (2) In developing regulations under this subsection, the
    Attorney General shall take into consideration the public
    health and safety, as well as the ease and cost of program
    implementation and participation by various communities. Such
    regulations may not require any entity to establish or operate
    a delivery or disposal program.
      (3) The Attorney General may, by regulation, authorize long-
    term care facilities, as defined by the Attorney General by
    regulation, to dispose of controlled substances on behalf of
    ultimate users who reside, or have resided, at such long-term
    care facilities in a manner that the Attorney General
    determines will provide effective controls against diversion
    and be consistent with the public health and safety.
      (4) If a person dies while lawfully in possession of a
    controlled substance for personal use, any person lawfully
    entitled to dispose of the decedent's property may deliver the
    controlled substance to another person for the purpose of
    disposal under the same conditions as provided in paragraph (1)
    for an ultimate user.
      (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.

                           registration requirements

      Sec. 303. (a) The Attorney General shall register an
    applicant to manufacture controlled substances in schedule I or
    II if he determines that such registration is consistent with
    the public interest and with United States obligations under
    international treaties, conventions, or protocols in effect on
    the effective date of this part. In determining the public
    interest, the following factors shall be considered:
              (1) maintenance of effective controls against
            diversion of particular controlled substances and any
            controlled substance in schedule I or II compounded
            therefrom into other than legitimate medical,
            scientific, research, or industrial channels, by
            limiting the importation and bulk manufacture of such
            controlled substances to a number of establishments
            which can produce an adequate and uninterrupted supply
            of these substances under adequately competitive
            conditions for legitimate medical, scientific,
            research, and industrial purposes;
              (2) compliance with applicable State and local law;
              (3) promotion of technical advances in the art of
            manufacturing these substances and the development of
            new substances;
              (4) prior conviction record of applicant under
            Federal and State laws relating to the manufacture,
            distribution, or dispensing of such substances;
              (5) past experience in the manufacture of controlled
            substances, and the existence in the establishment of
            effective control against diversion; and
              (6) such other factors as may be relevant to and
            consistent with the public health and safety.
      (b) The Attorney General shall register an applicant to
    distribute a controlled substance in schedule I or II unless he
    determines that the issuance of such registration is
    inconsistent with the public interest. In determining the
    public interest, the following factors shall be considered:
              (1) maintenance of effective controls against
            diversion of particular controlled substances into
            other than legitimate medical, scientific, and
            industrial channels;
              (2) compliance with applicable State and local law;
              (3) prior conviction record of applicant under
            Federal or State laws relating to the manufacture,
            distribution, or dispensing of such substances;
              (4) past experience in the distribution of controlled
            substances; and
              (5) such other factors as may be relevant to and
            consistent with the public health and safety.
      (c) Registration granted under subsections (a) and (b) of
    this section shall not entitle a registrant to (1) manufacture
    or distribute controlled substances in schedule I or II other
    than those specified in the registration, or (2) manufacture
    any quantity of those controlled substances in excess of the
    quota assigned pursuant to section 306.
      (d) The Attorney General shall register an applicant to
    manufacture controlled substances in schedule III, IV, or V,
    unless he determines that the issuance of such registration is
    inconsistent with the public interest. In determining the
    public interest, the following factors shall be considered:
              (1) maintenance of effective controls against
            diversion of particular controlled substances and any
            controlled substance in schedule III, IV, or V
            compounded therefrom into other than legitimate
            medical, scientific, or industrial channels;
              (2) compliance with applicable State and local law;
              (3) promotion of technical advances in the art of
            manufacturing these substances and the development of
            new substances;
              (4) prior conviction record of applicant under
            Federal or State laws relating to the manufacture,
            distribution, or dispensing of such substances;
              (5) past experience in the manufacture, distribution,
            and dispensing of controlled substances, and the
            existence in the establishment of effective controls
            against diversion; and
              (6) such other factors as may be relevant to and
            consistent with the public health and safety.
      (e) The Attorney General shall register an applicant to
    distribute controlled substances in schedule III, IV, or V,
    unless he determines that the issuance of such registration is
    inconsistent with the public interest. In determining the
    public interest, the following factors shall be considered:
              (1) maintenance of effective controls against
            diversion of particular controlled substances into
            other than legitimate medical, scientific, and
            industrial channels;
              (2) compliance with applicable State and local law;
              (3) prior conviction record of applicant under
            Federal or State laws relating to the manufacture,
            distribution, or dispensing of such substances;
              (4) past experience in the distribution of controlled
            substances; and
              (5) such other factors as may be relevant to and
            consistent with the public health and safety.
      (f) The Attorney General shall register practitioners
    (including pharmacies, as distinguished from pharmacists) to
    dispense, or conduct research with, controlled substances in
    schedule II, III, IV, or V and shall modify the registrations
    of pharmacies so registered to authorize them to dispense
    controlled substances by means of the Internet, if the
    applicant is authorized to dispense, or conduct research with
    respect to, controlled substances under the laws of the State
    in which he practices. The Attorney General may deny an
    application for such registration or such modification of
    registration if the Attorney General determines that the
    issuance of such registration or modification would be
    inconsistent with the public interest. In determining the
    public interest, the following factors shall be considered:
              (1) The recommendation of the appropriate State
            licensing board or professional disciplinary authority.
              (2) The applicant's experience in dispensing, or
            conducting research with respect to controlled
            substances.
              (3) The applicant's conviction record under Federal
            or State laws relating to the manufacture,
            distribution, or dispensing of controlled substances.
              (4) Compliance with applicable State, Federal, or
            local laws relating to controlled substances.
              (5) Such other conduct which may threaten the public
            health and safety.
    Separate registration under this part for practitioners
    engaging in research with controlled substances in schedule II,
    III, IV, or V, who are already registered under this part in
    another capacity, shall not be required. Registration
    applications by practitioners wishing to conduct research with
    controlled substances in schedule I shall be referred to the
    Secretary, who shall determine the qualifications and
    competency of each practitioner requesting registration, as
    well as the merits of the research protocol. The Secretary, in
    determining the merits of each research protocol, shall consult
    with the Attorney General as to effective procedures to
    adequately safeguard against diversion of such controlled
    substances from legitimate medical or scientific use.
    Registration for the purpose of bona fide research with
    controlled substances in schedule I by a practitioner deemed
    qualified by the Secretary may be denied by the Attorney
    General only on a ground specified in section 304(a). Article 7
    of the Convention on Psychotrophic Substances shall not be
    construed to prohibit, or impose additional restrictions upon,
    research involving drugs or other substances scheduled under
    the convention which is conducted in conformity with this
    subsection and other applicable provisions of this title.
      [(g)(1) Except as provided in paragraph (2), practitioners
    who dispense narcotic drugs to individuals for maintenance
    treatment or detoxification treatment] (g) Practitioners who
    dispense narcotic drugs (other than narcotic drugs in schedule
    III, IV, or V) to individuals for maintenance treatment or
    detoxification treatment  shall obtain annually a separate
    registration for that purpose. The Attorney General shall
    register an applicant to dispense narcotic drugs to individuals
    for maintenance treatment or detoxification treatment (or
    both)--
              [(A)] (1) if the applicant is a practitioner who is
            determined by the Secretary to be qualified (under
            standards established by the Secretary) to engage in
            the treatment with respect to which registration is
            sought;
              [(B)] (2) if the Attorney General determines that the
            applicant will comply with standards established by the
            Attorney General respecting [(i)] (A) security of
            stocks of narcotic drugs for such treatment, and [(ii)]
            (B) the maintenance of records (in accordance with
            section 307) on such drugs; and
              [(C)] (3) if the Secretary determines that the
            applicant will comply with standards established by the
            Secretary (after consultation with the Attorney
            General) respecting the quantities of narcotic drugs
            which may be provided for unsupervised use by
            individuals in such treatment.
      [(2)(A) Subject to subparagraphs (D) and (J), the
    requirements of paragraph (1) are waived in the case of the
    dispensing (including the prescribing), by a practitioner, of
    narcotic drugs in schedule III, IV, or V or combinations of
    such drugs if the practitioner meets the conditions specified
    in subparagraph (B) and the narcotic drugs or combinations of
    such drugs meet the conditions specified in subparagraph (C).
              [(B) For purposes of subparagraph (A), the conditions
            specified in this subparagraph with respect to a
            practitioner are that, before the initial dispensing of
            narcotic drugs in schedule III, IV, or V or
            combinations of such drugs to patients for maintenance
            or detoxification treatment, the practitioner submit to
            the Secretary a notification of the intent of the
            practitioner to begin dispensing the drugs or
            combinations for such purpose, and that the
            notification contain the following certifications by
            the practitioner:
              [(i) The practitioner is a qualifying practitioner
            (as defined in subparagraph (G)).
              [(ii) With respect to patients to whom the
            practitioner will provide such drugs or combinations of
            drugs, the practitioner has the capacity to provide
            directly, by referral, or in such other manner as
            determined by the Secretary--
                      [(I) all drugs approved by the Food and Drug
                    Administration for the treatment of opioid use
                    disorder, including for maintenance,
                    detoxification, overdose reversal, and relapse
                    prevention; and
                      [(II) appropriate counseling and other
                    appropriate ancillary services.
              [(iii)(I) The total number of such patients of the
            practitioner at any one time will not exceed the
            applicable number. Except as provided in subclause
            (II), the applicable number is 30.
              [(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).
              [(III) The Secretary may by regulation change such
            applicable number.
              [(IV) The Secretary may exclude from the applicable
            number patients to whom such drugs or combinations of
            drugs are directly administered by the qualifying
            practitioner in the office setting.
              [(C) For purposes of subparagraph (A), the conditions
            specified in this subparagraph with respect to narcotic
            drugs in schedule III, IV, or V or combinations of such
            drugs are as follows:
              [(i) The drugs or combinations of drugs have, under
            the Federal Food, Drug, and Cosmetic Act or section 351
            of the Public Health Service Act, been approved for use
            in maintenance or detoxification treatment.
              [(ii) The drugs or combinations of drugs have not
            been the subject of an adverse determination. For
            purposes of this clause, an adverse determination is a
            determination published in the Federal Register and
            made by the Secretary, after consultation with the
            Attorney General, that the use of the drugs or
            combinations of drugs for maintenance or detoxification
            treatment requires additional standards respecting the
            qualifications of practitioners to provide such
            treatment, or requires standards respecting the
            quantities of the drugs that may be provided for
            unsupervised use.
      [(D)(i) A waiver under subparagraph (A) with respect to a
    practitioner is not in effect unless (in addition to conditions
    under subparagraphs (B) and (C)) the following conditions are
    met:
              [(I) The notification under subparagraph (B) is in
            writing and states the name of the practitioner.
              [(II) The notification identifies the registration
            issued for the practitioner pursuant to subsection (f).
              [(III) If the practitioner is a member of a group
            practice, the notification states the names of the
            other practitioners in the practice and identifies the
            registrations issued for the other practitioners
            pursuant to subsection (f).
      [(ii) Upon receiving a determination from the Secretary under
    clause (iii) finding that a practitioner meets all requirements
    for a waiver under subparagraph (B), the Attorney General shall
    assign the practitioner involved an identification number under
    this paragraph for inclusion with the registration issued for
    the practitioner pursuant to subsection (f). The identification
    number so assigned shall be appropriate to preserve the
    confidentiality of patients for whom the practitioner has
    dispensed narcotic drugs under a waiver under subparagraph (A).
      [(iii) Not later than 45 days after the date on which the
    Secretary receives a notification under subparagraph (B), the
    Secretary shall make a determination of whether the
    practitioner involved meets all requirements for a waiver under
    subparagraph (B) and shall forward such determination to the
    Attorney General. If the Secretary fails to make such
    determination by the end of the such 45-day period, the
    Attorney General shall assign the practitioner an
    identification number described in clause (ii) at the end of
    such period.
      [(E)(i) If a practitioner is not registered under paragraph
    (1) and, in violation of the conditions specified in
    subparagraphs (B) through (D), dispenses narcotic drugs in
    schedule III, IV, or V or combinations of such drugs for
    maintenance treatment or detoxification treatment, the Attorney
    General may, for purposes of section 304(a)(4), consider the
    practitioner to have committed an act that renders the
    registration of the practitioner pursuant to subsection (f) to
    be inconsistent with the public interest.
      [(ii)(I) Upon the expiration of 45 days from the date on
    which the Secretary receives a notification under subparagraph
    (B), a practitioner who in good faith submits a notification
    under subparagraph (B) and reasonably believes that the
    conditions specified in subparagraphs (B) through (D) have been
    met shall, in dispensing narcotic drugs in schedule III, IV, or
    V or combinations of such drugs for maintenance treatment or
    detoxification treatment, be considered to have a waiver under
    subparagraph (A) until notified otherwise by the Secretary,
    except that such a practitioner may commence to prescribe or
    dispense such narcotic drugs for such purposes prior to the
    expiration of such 45-day period if it facilitates the
    treatment of an individual patient and both the Secretary and
    the Attorney General are notified by the practitioner of the
    intent to commence prescribing or dispensing such narcotic
    drugs.
      [(II) For purposes of subclause (I), the publication in the
    Federal Register of an adverse determination by the Secretary
    pursuant to subparagraph (C)(ii) shall (with respect to the
    narcotic drug or combination involved) be considered to be a
    notification provided by the Secretary to practitioners,
    effective upon the expiration of the 30-day period beginning on
    the date on which the adverse determination is so published.
      [(F)(i) With respect to the dispensing of narcotic drugs in
    schedule III, IV, or V or combinations of such drugs to
    patients for maintenance or detoxification treatment, a
    practitioner may, in his or her discretion, dispense such drugs
    or combinations for such treatment under a registration under
    paragraph (1) or a waiver under subparagraph (A) (subject to
    meeting the applicable conditions).
      [(ii) This paragraph may not be construed as having any legal
    effect on the conditions for obtaining a registration under
    paragraph (1), including with respect to the number of patients
    who may be served under such a registration.
      [(G) For purposes of this paragraph:
              [(i) The term ``group practice'' has the meaning
            given such term in section 1877(h)(4) of the Social
            Security Act.
              [(ii) The term ``qualifying physician'' means a
            physician who is licensed under State law and who meets
            one or more of the following conditions:
                      [(I) The physician holds a board
                    certification in addiction psychiatry or
                    addiction medicine from the American Board of
                    Medical Specialties.
                      [(II) The physician holds an addiction
                    certification or board certification from the
                    American Society of Addiction Medicine or the
                    American Board of Addiction Medicine.
                      [(III) The physician holds a board
                    certification in addiction medicine from the
                    American Osteopathic Association.
                      [(IV) The physician has, with respect to the
                    treatment and management of opiate-dependent
                    patients, completed not less than 8 hours of
                    training (through classroom situations,
                    seminars at professional society meetings,
                    electronic communications, or otherwise) that
                    is provided by the American Society of
                    Addiction Medicine, the American Academy of
                    Addiction Psychiatry, the American Medical
                    Association, the American Osteopathic
                    Association, the American Psychiatric
                    Association, or any other organization that the
                    Secretary determines is appropriate for
                    purposes of this subclause. Such training shall
                    include--
                              [(aa) opioid maintenance and
                            detoxification;
                              [(bb) appropriate clinical use of all
                            drugs approved by the Food and Drug
                            Administration for the treatment of
                            opioid use disorder;
                              [(cc) initial and periodic patient
                            assessments (including substance use
                            monitoring);
                              [(dd) individualized treatment
                            planning, overdose reversal, and
                            relapse prevention;
                              [(ee) counseling and recovery support
                            services;
                              [(ff) staffing roles and
                            considerations;
                              [(gg) diversion control; and
                              [(hh) other best practices, as
                            identified by the Secretary.
                      [(V) The physician has participated as an
                    investigator in one or more clinical trials
                    leading to the approval of a narcotic drug in
                    schedule III, IV, or V for maintenance or
                    detoxification treatment, as demonstrated by a
                    statement submitted to the Secretary by the
                    sponsor of such approved drug.
                      [(VI) The physician has such other training
                    or experience as the State medical licensing
                    board (of the State in which the physician will
                    provide maintenance or detoxification
                    treatment) considers to demonstrate the ability
                    of the physician to treat and manage opiate-
                    dependent patients.
                      [(VII) The physician has such other training
                    or experience as the Secretary considers to
                    demonstrate the ability of the physician to
                    treat and manage opiate-dependent patients. Any
                    criteria of the Secretary under this subclause
                    shall be established by regulation. Any such
                    criteria are effective only for 3 years after
                    the date on which the criteria are promulgated,
                    but may be extended for such additional
                    discrete 3-year periods as the Secretary
                    considers appropriate for purposes of this
                    subclause. Such an extension of criteria may
                    only be effectuated through a statement
                    published in the Federal Register by the
                    Secretary during the 30-day period preceding
                    the end of the 3-year period involved.
              [(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.
              [(iii) The term ``qualifying practitioner'' means--
                      [(I) a qualifying physician, as defined in
                    clause (ii);
                      [(II) a qualifying other practitioner, as
                    defined in clause (iv), who is a nurse
                    practitioner or physician assistant; or
                      [(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.
              [(iv) The term ``qualifying other practitioner''
            means a nurse practitioner, clinical nurse specialist,
            certified registered nurse anesthetist, certified nurse
            midwife, or physician assistant who satisfies each of
            the following:
                      [(I) The nurse practitioner, clinical nurse
                    specialist, certified registered nurse
                    anesthetist, certified nurse midwife, or
                    physician assistant is licensed under State law
                    to prescribe schedule III, IV, or V medications
                    for the treatment of pain.
                      [(II) The nurse practitioner, clinical nurse
                    specialist, certified registered nurse
                    anesthetist, certified nurse midwife, or
                    physician assistant has--
                              [(aa) completed not fewer than 24
                            hours of initial training addressing
                            each of the topics listed in clause
                            (ii)(IV) (through classroom situations,
                            seminars at professional society
                            meetings, electronic communications, or
                            otherwise) provided by the American
                            Society of Addiction Medicine, the
                            American Academy of Addiction
                            Psychiatry, the American Medical
                            Association, the American Osteopathic
                            Association, the American Nurses
                            Credentialing Center, the American
                            Psychiatric Association, the American
                            Association of Nurse Practitioners, the
                            American Academy of Physician
                            Assistants, or any other organization
                            that the Secretary determines is
                            appropriate for purposes of this
                            subclause; or
                              [(bb) has such other training or
                            experience as the Secretary determines
                            will demonstrate the ability of the
                            nurse practitioner, clinical nurse
                            specialist, certified registered nurse
                            anesthetist, certified nurse midwife,
                            or physician assistant to treat and
                            manage opiate-dependent patients.
                      [(III) The nurse practitioner, clinical nurse
                    specialist, certified registered nurse
                    anesthetist, certified nurse midwife, or
                    physician assistant is supervised by, or works
                    in collaboration with, a qualifying physician,
                    if the nurse practitioner, clinical nurse
                    specialist, certified registered nurse
                    anesthetist, certified nurse midwife, or
                    physician assistant is required by State law to
                    prescribe medications for the treatment of
                    opioid use disorder in collaboration with or
                    under the supervision of a physician.
    The Secretary may, by regulation, revise the requirements for
    being a qualifying other practitioner under this clause.
      [(H)(i) In consultation with the Administrator of the Drug
    Enforcement Administration, the Administrator of the Substance
    Abuse and Mental Health Services Administration, the Director
    of the National Institute on Drug Abuse, and the Commissioner
    of Food and Drugs, the Secretary shall issue regulations
    (through notice and comment rulemaking) or issue practice
    guidelines to address the following:
              [(I) Approval of additional credentialing bodies and
            the responsibilities of additional credentialing
            bodies.
              [(II) Additional exemptions from the requirements of
            this paragraph and any regulations under this
            paragraph.
              [(III) Such other elements of the requirements under
            this paragraph as the Secretary determines necessary
            for purposes of implementing such requirements.
    Nothing in such regulations or practice guidelines may
    authorize any Federal official or employee to exercise
    supervision or control over the practice of medicine or the
    manner in which medical services are provided.
      [(ii) Not later than 18 months after the date of enactment of
    the Opioid Use Disorder Treatment Expansion and Modernization
    Act, the Secretary shall update the treatment improvement
    protocol containing best practice guidelines for the treatment
    of opioid-dependent patients in office-based settings. The
    Secretary shall update such protocol in consultation with
    experts in opioid use disorder research and treatment.
      [(I) Notwithstanding section 708, nothing in this paragraph
    shall be construed to preempt any State law that--
              [(i) permits a qualifying practitioner to dispense
            narcotic drugs in schedule III, IV, or V, or
            combinations of such drugs, for maintenance or
            detoxification treatment in accordance with this
            paragraph to a total number of patients that is more
            than 30 or less than the total number applicable to the
            qualifying practitioner under subparagraph (B)(iii)(II)
            if a State enacts a law modifying such total number and
            the Attorney General is notified by the State of such
            modification; or
              [(ii) requires a qualifying practitioner to comply
            with additional requirements relating to the dispensing
            of narcotic drugs in schedule III, IV, or V, or
            combinations of such drugs, including requirements
            relating to the practice setting in which the
            qualifying practitioner practices and education,
            training, and reporting requirements.]
      (h) The Attorney General shall register an applicant to
    distribute a list I chemical unless the Attorney General
    determines that registration of the applicant is inconsistent
    with the public interest. Registration under this subsection
    shall not be required for the distribution of a drug product
    that is exempted under clause (iv) or (v) of section
    102(39)(A). In determining the public interest for the purposes
    of this subsection, the Attorney General shall consider--
              (1) maintenance by the applicant of effective
            controls against diversion of listed chemicals into
            other than legitimate channels;
              (2) compliance by the applicant with applicable
            Federal, State, and local law;
              (3) any prior conviction record of the applicant
            under Federal or State laws relating to controlled
            substances or to chemicals controlled under Federal or
            State law;
              (4) any past experience of the applicant in the
            manufacture and distribution of chemicals; and
              (5) such other factors as are relevant to and
            consistent with the public health and safety.
      (i)(1) For purposes of registration to manufacture a
    controlled substance under subsection (d) for use only in a
    clinical trial, the Attorney General shall register the
    applicant, or serve an order to show cause upon the applicant
    in accordance with section 304(c), not later than 180 days
    after the date on which the application is accepted for filing.
      (2) For purposes of registration to manufacture a controlled
    substance under subsection (a) for use only in a clinical
    trial, the Attorney General shall, in accordance with the
    regulations issued by the Attorney General, issue a notice of
    application not later than 90 days after the application is
    accepted for filing. Not later than 90 days after the date on
    which the period for comment pursuant to such notice ends, the
    Attorney General shall register the applicant, or serve an
    order to show cause upon the applicant in accordance with
    section 304(c), unless the Attorney General has granted a
    hearing on the application under section 1008(i) of the
    Controlled Substances Import and Export Act.
      (j) Emergency Medical Services That Administer Controlled
    Substances.--
              (1) Registration.--For the purpose of enabling
            emergency medical services professionals to administer
            controlled substances in schedule II, III, IV, or V to
            ultimate users receiving emergency medical services in
            accordance with the requirements of this subsection,
            the Attorney General--
                      (A) shall register an emergency medical
                    services agency if the agency submits an
                    application demonstrating it is authorized to
                    conduct such activity under the laws of each
                    State in which the agency practices; and
                      (B) may deny an application for such
                    registration if the Attorney General determines
                    that the issuance of such registration would be
                    inconsistent with the requirements of this
                    subsection or the public interest based on the
                    factors listed in subsection (f).
              (2) Option for single registration.--In registering
            an emergency medical services agency pursuant to
            paragraph (1), the Attorney General shall allow such
            agency the option of a single registration in each
            State where the agency administers controlled
            substances in lieu of requiring a separate registration
            for each location of the emergency medical services
            agency.
              (3) Hospital-based agency.--If a hospital-based
            emergency medical services agency is registered under
            subsection (f), the agency may use the registration of
            the hospital to administer controlled substances in
            accordance with this subsection without being
            registered under this subsection.
              (4) Administration outside physical presence of
            medical director or authorizing medical professional.--
            Emergency medical services professionals of a
            registered emergency medical services agency may
            administer controlled substances in schedule II, III,
            IV, or V outside the physical presence of a medical
            director or authorizing medical professional in the
            course of providing emergency medical services if the
            administration is--
                      (A) authorized by the law of the State in
                    which it occurs; and
                      (B) pursuant to--
                              (i) a standing order that is issued
                            and adopted by one or more medical
                            directors of the agency, including any
                            such order that may be developed by a
                            specific State authority; or
                              (ii) a verbal order that is--
                                      (I) issued in accordance with
                                    a policy of the agency; and
                                      (II) provided by a medical
                                    director or authorizing medical
                                    professional in response to a
                                    request by the emergency
                                    medical services professional
                                    with respect to a specific
                                    patient--
                                              (aa) in the case of a
                                            mass casualty incident;
                                            or
                                              (bb) to ensure the
                                            proper care and
                                            treatment of a specific
                                            patient.
              (5) Delivery.--A registered emergency medical
            services agency may deliver controlled substances from
            a registered location of the agency to an unregistered
            location of the agency only if the agency--
                      (A) designates the unregistered location for
                    such delivery; and
                      (B) notifies the Attorney General at least 30
                    days prior to first delivering controlled
                    substances to the unregistered location.
              (6) Storage.--A registered emergency medical services
            agency may store controlled substances--
                      (A) at a registered location of the agency;
                      (B) at any designated location of the agency
                    or in an emergency services vehicle situated at
                    a registered or designated location of the
                    agency; or
                      (C) in an emergency medical services vehicle
                    used by the agency that is--
                              (i) traveling from, or returning to,
                            a registered or designated location of
                            the agency in the course of responding
                            to an emergency; or
                              (ii) otherwise actively in use by the
                            agency under circumstances that provide
                            for security of the controlled
                            substances consistent with the
                            requirements established by regulations
                            of the Attorney General.
              (7) No treatment as distribution.--The delivery of
            controlled substances by a registered emergency medical
            services agency pursuant to this subsection shall not
            be treated as distribution for purposes of section 308.
              (8) Restocking of emergency medical services vehicles
            at a hospital.--Notwithstanding paragraph (13)(J), a
            registered emergency medical services agency may
            receive controlled substances from a hospital for
            purposes of restocking an emergency medical services
            vehicle following an emergency response, and without
            being subject to the requirements of section 308,
            provided all of the following conditions are satisfied:
                      (A) The registered or designated location of
                    the agency where the vehicle is primarily
                    situated maintains a record of such receipt in
                    accordance with paragraph (9).
                      (B) The hospital maintains a record of such
                    delivery to the agency in accordance with
                    section 307.
                      (C) If the vehicle is primarily situated at a
                    designated location, such location notifies the
                    registered location of the agency within 72
                    hours of the vehicle receiving the controlled
                    substances.
              (9) Maintenance of records.--
                      (A) In general.--A registered emergency
                    medical services agency shall maintain records
                    in accordance with subsections (a) and (b) of
                    section 307 of all controlled substances that
                    are received, administered, or otherwise
                    disposed of pursuant to the agency's
                    registration, without regard to subsection
                    307(c)(1)(B).
                      (B) Requirements.--Such records--
                              (i) shall include records of
                            deliveries of controlled substances
                            between all locations of the agency;
                            and
                              (ii) shall be maintained, whether
                            electronically or otherwise, at each
                            registered and designated location of
                            the agency where the controlled
                            substances involved are received,
                            administered, or otherwise disposed of.
              (10) Other requirements.--A registered emergency
            medical services agency, under the supervision of a
            medical director, shall be responsible for ensuring
            that--
                      (A) all emergency medical services
                    professionals who administer controlled
                    substances using the agency's registration act
                    in accordance with the requirements of this
                    subsection;
                      (B) the recordkeeping requirements of
                    paragraph (9) are met with respect to a
                    registered location and each designated
                    location of the agency;
                      (C) the applicable physical security
                    requirements established by regulation of the
                    Attorney General are complied with wherever
                    controlled substances are stored by the agency
                    in accordance with paragraph (6); and
                      (D) the agency maintains, at a registered
                    location of the agency, a record of the
                    standing orders issued or adopted in accordance
                    with paragraph (9).
              (11) Regulations.--The Attorney General may issue
            regulations--
                      (A) specifying, with regard to delivery of
                    controlled substances under paragraph (5)--
                              (i) the types of locations that may
                            be designated under such paragraph; and
                              (ii) the manner in which a
                            notification under paragraph (5)(B)
                            must be made;
                      (B) specifying, with regard to the storage of
                    controlled substances under paragraph (6), the
                    manner in which such substances must be stored
                    at registered and designated locations,
                    including in emergency medical service
                    vehicles; and
                      (C) addressing the ability of hospitals,
                    emergency medical services agencies, registered
                    locations, and designated locations to deliver
                    controlled substances to each other in the
                    event of--
                              (i) shortages of such substances;
                              (ii) a public health emergency; or
                              (iii) a mass casualty event.
              (12) Rule of construction.--Nothing in this
            subsection shall be construed--
                      (A) to limit the authority vested in the
                    Attorney General by other provisions of this
                    title to take measures to prevent diversion of
                    controlled substances; or
                      (B) to override the authority of any State to
                    regulate the provision of emergency medical
                    services consistent with this subsection.
              (13) Definitions.--In this section:
                      (A) The term ``authorizing medical
                    professional'' means an emergency or other
                    physician, or another medical professional
                    (including an advanced practice registered
                    nurse or physician assistant)--
                              (i) who is registered under this Act;
                              (ii) who is acting within the scope
                            of the registration; and
                              (iii) whose scope of practice under a
                            State license or certification includes
                            the ability to provide verbal orders.
                      (B) The term ``designated location'' means a
                    location designated by an emergency medical
                    services agency under paragraph (5).
                      (C) The term ``emergency medical services''
                    means emergency medical response and emergency
                    mobile medical services provided outside of a
                    fixed medical facility.
                      (D) The term ``emergency medical services
                    agency'' means an organization providing
                    emergency medical services, including such an
                    organization that--
                              (i) is governmental (including fire-
                            based and hospital-based agencies),
                            nongovernmental (including hospital-
                            based agencies), private, or volunteer-
                            based;
                              (ii) provides emergency medical
                            services by ground, air, or otherwise;
                            and
                              (iii) is authorized by the State in
                            which the organization is providing
                            such services to provide emergency
                            medical care, including the
                            administering of controlled substances,
                            to members of the general public on an
                            emergency basis.
                      (E) The term ``emergency medical services
                    professional'' means a health care professional
                    (including a nurse, paramedic, or emergency
                    medical technician) licensed or certified by
                    the State in which the professional practices
                    and credentialed by a medical director of the
                    respective emergency medical services agency to
                    provide emergency medical services within the
                    scope of the professional's State license or
                    certification.
                      (F) The term ``emergency medical services
                    vehicle'' means an ambulance, fire apparatus,
                    supervisor truck, or other vehicle used by an
                    emergency medical services agency for the
                    purpose of providing or facilitating emergency
                    medical care and transport or transporting
                    controlled substances to and from the
                    registered and designated locations.
                      (G) The term ``hospital-based'' means, with
                    respect to an agency, owned or operated by a
                    hospital.
                      (H) The term ``medical director'' means a
                    physician who is registered under subsection
                    (f) and provides medical oversight for an
                    emergency medical services agency.
                      (I) The term ``medical oversight'' means
                    supervision of the provision of medical care by
                    an emergency medical services agency.
                      (J) The term ``registered emergency medical
                    services agency'' means--
                              (i) an emergency medical services
                            agency that is registered pursuant to
                            this subsection; or
                              (ii) a hospital-based emergency
                            medical services agency that is covered
                            by the registration of the hospital
                            under subsection (f).
                      (K) The term ``registered location'' means a
                    location that appears on the certificate of
                    registration issued to an emergency medical
                    services agency under this subsection or
                    subsection (f), which shall be where the agency
                    receives controlled substances from
                    distributors.
                      (L) The term ``specific State authority''
                    means a governmental agency or other such
                    authority, including a regional oversight and
                    coordinating body, that, pursuant to State law
                    or regulation, develops clinical protocols
                    regarding the delivery of emergency medical
                    services in the geographic jurisdiction of such
                    agency or authority within the State that may
                    be adopted by medical directors.
                      (M) The term ``standing order'' means a
                    written medical protocol in which a medical
                    director determines in advance the medical
                    criteria that must be met before administering
                    controlled substances to individuals in need of
                    emergency medical services.
                      (N) The term ``verbal order'' means an oral
                    directive that is given through any method of
                    communication including by radio or telephone,
                    directly to an emergency medical services
                    professional, to contemporaneously administer a
                    controlled substance to individuals in need of
                    emergency medical services outside the physical
                    presence of the medical director or authorizing
                    medical professional.
      (k) In this section, the phrase ``factors as may be relevant
    to and consistent with the public health and safety'' means
    factors that are relevant to and consistent with the findings
    contained in section 101.
      (l) Required Training for Prescribers.--
              (1) Training required.--As a condition on
            registration under this section to dispense controlled
            substances in schedule II, III, IV, or V, the Attorney
            General shall require any qualified practitioner,
            beginning with the first applicable registration for
            the practitioner, to meet the following:
                      (A) If the practitioner is a physician, the
                    practitioner meets one or more of the following
                    conditions:
                              (i) The physician holds a board
                            certification in addiction psychiatry
                            or addiction medicine from the American
                            Board of Medical Specialties.
                              (ii) The physician holds a board
                            certification from the American Board
                            of Addiction Medicine.
                              (iii) The physician holds a board
                            certification in addiction medicine
                            from the American Osteopathic
                            Association.
                              (iv) The physician has, with respect
                            to the treatment and management of
                            patients with opioid or other substance
                            use disorders, completed not less than
                            8 hours of training (through classroom
                            situations, seminars at professional
                            society meetings, electronic
                            communications, or otherwise) that is
                            provided by--
                                      (I) the American Society of
                                    Addiction Medicine, the
                                    American Academy of Addiction
                                    Psychiatry, the American
                                    Medical Association, the
                                    American Osteopathic
                                    Association, the American
                                    Psychiatric Association, or any
                                    other organization accredited
                                    by the Accreditation Council
                                    for Continuing Medical
                                    Education (commonly known as
                                    the ``ACCME'');
                                      (II) any organization
                                    accredited by a State medical
                                    society accreditor that is
                                    recognized by the ACCME;
                                      (III) any organization
                                    accredited by the American
                                    Osteopathic Association to
                                    provide continuing medical
                                    education; or
                                      (IV) any organization
                                    approved by the Assistant
                                    Secretary for Mental Health and
                                    Substance Abuse or the ACCME.
                              (v) 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 first
                            registers or renews under this section
                            and has successfully completed a
                            comprehensive allopathic or osteopathic
                            medicine curriculum or accredited
                            medical residency that included not
                            less than 8 hours of training on
                            treating and managing patients with
                            opioid and other substance use
                            disorders, including the appropriate
                            clinical use of all drugs approved by
                            the Food and Drug Administration for
                            the treatment of a substance use
                            disorder.
                      (B) If the practitioner is not a physician,
                    the practitioner meets one or more of the
                    following conditions:
                              (i) The practitioner has completed
                            not fewer than 8 hours of training with
                            respect to the treatment and management
                            of patients with opioid or other
                            substance use disorders (through
                            classroom situations, seminars at
                            professional society meetings,
                            electronic communications, or
                            otherwise) provided by the American
                            Society of Addiction Medicine, the
                            American Academy of Addiction
                            Psychiatry, the American Medical
                            Association, the American Osteopathic
                            Association, the American Nurses
                            Credentialing Center, the American
                            Psychiatric Association, the American
                            Association of Nurse Practitioners, the
                            American Academy of Physician
                            Associates, or any other organization
                            approved or accredited by the Assistant
                            Secretary for Mental Health and
                            Substance Abuse or the or the
                            Accreditation Council for Continuing
                            Medical Education.
                              (ii) The practitioner has graduated
                            in good standing from an accredited
                            physician assistant school or
                            accredited school of advanced practice
                            nursing in the United States during the
                            5-year period immediately preceding the
                            date on which the practitioner first
                            registers or renews under this section
                            and has successfully completed a
                            comprehensive physician assistant or
                            advanced practice nursing curriculum
                            that included not fewer than 8 hours of
                            training on treating and managing
                            patients with opioid and other
                            substance use disorders, including the
                            appropriate clinical use of all drugs
                            approved by the Food and Drug
                            Administration for the treatment of a
                            substance use disorder.
              (2) One-time training.--The Attorney General shall
            not require any qualified practitioner to complete the
            training described in clause (iv) or (v) of paragraph
            (1)(A) or clause (i) or (ii) of paragraph (1)(B) more
            than once.
              (3) Rule of construction.--Nothing in this subsection
            shall be construed to preclude the use, by a qualified
            practitioner, of training received pursuant to this
            subsection to satisfy registration requirements of a
            State or for some other lawful purpose.
              (4) Definitions.--In this section:
                      (A) First applicable registration.--The term
                    ``first applicable registration'' means the
                    first registration or renewal of registration
                    by a qualified practitioner under this section
                    that occurs on or after the date that is 180
                    days after the date of enactment of the
                    Restoring Hope for Mental Health and Well-Being
                    Act of 2022.
                      (B) Qualified practitioner.--In this
                    subsection, the term ``qualified practitioner''
                    means a practitioner who--
                              (i) is licensed under State law to
                            prescribe controlled substances; and
                              (ii) is not solely a veterinarian.

               denial, revocation, or suspension of registration

      Sec. 304. (a) A registration pursuant to section 303 to
    manufacture, distribute, or dispense a controlled substance or
    a list I chemical may be suspended or revoked by the Attorney
    General upon a finding that the registrant--
              (1) has materially falsified any application filed
            pursuant to or required by this title or title III;
              (2) has been convicted of a felony under this title
            or title III or any other law of the United States, or
            of any State, relating to any substance defined in this
            title as a controlled substance or a list I chemical;
              (3) has had his State license or registration
            suspended, revoked, or denied by competent State
            authority and is no longer authorized by State law to
            engage in the manufacturing, distribution, or
            dispensing of controlled substances or list I chemicals
            or has had the suspension, revocation, or denial of his
            registration recommended by competent State authority;
              (4) has committed such acts as would render his
            registration under section 303 inconsistent with the
            public interest as determined under such section; or
              (5) has been excluded (or directed to be excluded)
            from participation in a program pursuant to section
            1128(a) of the Social Security Act.
    A registration pursuant to section [303(g)(1)] 303(g) to
    dispense a narcotic drug for maintenance treatment or
    detoxification treatment may be suspended or revoked by the
    Attorney General upon a finding that the registrant has failed
    to comply with any standard referred to in section [303(g)(1)]
    303(g).
      (b) The Attorney General may limit revocation or suspension
    of a registration to the particular controlled substance or
    list I chemical with respect to which grounds for revocation or
    suspension exist.
      (c)(1) Before taking action pursuant to this section, or
    pursuant to a denial of registration under section 303, the
    Attorney General shall serve upon the applicant or registrant
    an order to show cause why registration should not be denied,
    revoked, or suspended.
      (2) An order to show cause under paragraph (1) shall--
              (A) contain a statement of the basis for the denial,
            revocation, or suspension, including specific citations
            to any laws or regulations alleged to be violated by
            the applicant or registrant;
              (B) direct the applicant or registrant to appear
            before the Attorney General at a time and place stated
            in the order, but not less than 30 days after the date
            of receipt of the order; and
              (C) notify the applicant or registrant of the
            opportunity to submit a corrective action plan on or
            before the date of appearance.
      (3) Upon review of any corrective action plan submitted by an
    applicant or registrant pursuant to paragraph (2), the Attorney
    General shall determine whether denial, revocation, or
    suspension proceedings should be discontinued, or deferred for
    the purposes of modification, amendment, or clarification to
    such plan.
      (4) Proceedings to deny, revoke, or suspend shall be
    conducted pursuant to this section in accordance with
    subchapter II of chapter 5 of title 5, United States Code. Such
    proceedings shall be independent of, and not in lieu of,
    criminal prosecutions or other proceedings under this title or
    any other law of the United States.
      (5) The requirements of this subsection shall not apply to
    the issuance of an immediate suspension order under subsection
    (d).
      (d)(1) The Attorney General may, in his discretion, suspend
    any registration simultaneously with the institution of
    proceedings under this section, in cases where he finds that
    there is an imminent danger to the public health or safety. A
    failure to comply with a standard referred to in section
    [303(g)(1)] 303(g) may be treated under this subsection as
    grounds for immediate suspension of a registration granted
    under such section. A suspension under this subsection shall
    continue in effect until the conclusion of such proceedings,
    including judicial review thereof, unless sooner withdrawn by
    the Attorney General or dissolved by a court of competent
    jurisdiction.
      (2) In this subsection, the phrase ``imminent danger to the
    public health or safety'' means that, due to the failure of the
    registrant to maintain effective controls against diversion or
    otherwise comply with the obligations of a registrant under
    this title or title III, there is a substantial likelihood of
    an immediate threat that death, serious bodily harm, or abuse
    of a controlled substance will occur in the absence of an
    immediate suspension of the registration.
      (e) The suspension or revocation of a registration under this
    section shall operate to suspend or revoke any quota applicable
    under section 306.
      (f) In the event the Attorney General suspends or revokes a
    registration granted under section 303, all controlled
    substances or list I chemicals owned or possessed by the
    registrant pursuant to such registration at the time of
    suspension or the effective date of the revocation order, as
    the case may be, may, in the discretion of the Attorney
    General, be placed under seal. No disposition may be made of
    any controlled substances or list I chemicals under seal until
    the time for taking an appeal has elapsed or until all appeals
    have been concluded except that a court, upon application
    therefor, may at any time order the sale of perishable
    controlled substances or list I chemicals. Any such order shall
    require the deposit of the proceeds of the sale with the court.
    Upon a revocation order becoming final, all such controlled
    substances or list I chemicals (or proceeds of sale deposited
    in court) shall be forfeited to the United States; and the
    Attorney General shall dispose of such controlled substances or
    list I chemicals in accordance with section 511(e). All right,
    title, and interest in such controlled substances or list I
    chemicals shall vest in the United States upon a revocation
    order becoming final.
      (g) The Attorney General may, in his discretion, seize or
    place under seal any controlled substances or list I chemicals
    owned or possesed by a registrant whose registration has
    expired or who has ceased to practice or do business in the
    manner contemplated by his registration. Such controlled
    substances or list I chemicals shall be held for the benefit of
    the registrant, or his successor in interest. The Attorney
    General shall notify a registrant, or his successor in
    interest, who has any controlled substances or list I chemicals
    seized or placed under seal of the procedures to be followed to
    secure the return of the controlled substance or list I
    chemical and the conditions under which it will be returned.
    The Attorney General may not dispose of any controlled
    substance or list I chemical seized or placed under seal under
    this subsection until the expiration of one hundred and eighty
    days from the date such substance or chemical was seized or
    placed under seal.
      (h) The Attorney General may issue an order to prohibit,
    conditionally or unconditionally, and permanently or for such
    period as the Attorney General may determine, any person from
    being registered under this title to manufacture, distribute,
    or dispense a controlled substance or a list I chemical, if the
    Attorney General finds that--
              (1) such person meets or has met any of the
            conditions for suspension or revocation of registration
            under subsection (a); and
              (2) such person has a history of prior suspensions or
            revocations of registration.

               *       *       *       *       *       *       *

     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)] the controlled
            substance is a narcotic drug in schedule III, IV, or V
            to be administered for the purpose of maintenance or
            detoxification treatment [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;] and
                    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.

               *       *       *       *       *       *       *

                                  ----------

                              SOCIAL SECURITY ACT

    TITLE XVIII--HEALTH INSURANCE FOR THE AGED AND DISABLED

               *       *       *       *       *       *       *

       Part B--Supplementary Medical Insurance Benefits for the Aged and
    Disabled

               *       *       *       *       *       *       *

                              PAYMENT OF BENEFITS

      Sec.  1833. (a) Except as provided in section 1876, and
    subject to the succeeding provisions of this section, there
    shall be paid from the Federal Supplementary Medical Insurance
    Trust Fund, in the case of each individual who is covered under
    the insurance program established by this part and incurs
    expenses for services with respect to which benefits are
    payable under this part, amounts equal to--(1) in the case of
    services described in section 1832(a)(1)--80 percent of the
    reasonable charges for the services; except that (A) an
    organization which provides medical and other health services
    (or arranges for their availability) on a prepayment basis (and
    either is sponsored by a union or employer, or does not
    provide, or arrange for the provision of, any inpatient
    hospital services) may elect to be paid 80 percent of the
    reasonable cost of services for which payment may be made under
    this part on behalf of individuals enrolled in such
    organization in lieu of 80 percent of the reasonable charges
    for such services if the organization undertakes to charge such
    individuals no more than 20 percent of such reasonable cost
    plus any amounts payable by them as a result of subsection (b),
    (B) with respect to items and services described in section
    1861(s)(10)(A), the amounts paid shall be 100 percent of the
    reasonable charges for such items and services, (C) with
    respect to expenses incurred for those physicians' services for
    which payment may be made under this part that are described in
    section 1862(a)(4), the amounts paid shall be subject to such
    limitations as may be prescribed by regulations, (D) with
    respect to clinical diagnostic laboratory tests for which
    payment is made under this part (i)(I) on the basis of a fee
    schedule under subsection (h)(1) (for tests furnished before
    January 1, 2017) or section 1834(d)(1), the amount paid shall
    be equal to 80 percent (or 100 percent, in the case of such
    tests for which payment is made on an assignment-related basis)
    of the lesser of the amount determined under such fee schedule,
    the limitation amount for that test determined under subsection
    (h)(4)(B), or the amount of the charges billed for the tests,
    or (II) undersection 1834A (for tests furnished on or after
    January1, 2017), the amount paid shall be equal to 80
    percent(or 100 percent, in the case of such tests for
    whichpayment is made on an assignment-related basis) ofthe
    lesser of the amount determined under such sectionor the amount
    of the charges billed for the tests, or (ii) for tests
    furnished before January 1, 2017,on the basis of a negotiated
    rate established under subsection (h)(6), the amount paid shall
    be equal to 100 percent of such negotiated rate,,(E) with
    respect to services furnished to individuals who have been
    determined to have end stage renal disease, the amounts paid
    shall be determined subject to the provisions of section
    1881,(F) with respect to clinical social worker services under
    section 1861(s)(2)(N), the amounts paid shall be 80 percent of
    the lesser of (i) the actual charge for the services or (ii) 75
    percent of the amount determined for payment of a psychologist
    under clause (L),
                      (G) with respect to facility services
                    furnished in connection with a surgical
                    procedure specified pursuant to subsection
                    (i)(1)(A) and furnished to an individual in an
                    ambulatory surgical center described in such
                    subsection, for services furnished beginning
                    with the implementation date of a revised
                    payment system for such services in such
                    facilities specified in subsection (i)(2)(D),
                    the amounts paid shall be 80 percent of the
                    lesser of the actual charge for the services or
                    the amount determined by the Secretary under
                    such revised payment system,
              (H) with respect to services of a certified
            registered nurse anesthetist under section 1861(s)(11),
            the amounts paid shall be 80 percent of the least of
            the actual charge, the prevailing charge that would be
            recognized (or, for services furnished on or after
            January 1, 1992, the fee schedule amount provided under
            section 1848) if the services had been performed by an
            anesthesiologist, or the fee schedule for such services
            established by the Secretary in accordance with
            subsection (l), (I) with respect to covered items
            (described in section 1834(a)(13)), the amounts paid
            shall be the amounts described in section 1834(a)(1),
            and(J) with respect to expenses incurred for
            radiologist services (as defined in section
            1834(b)(6)), subject to section 1848, the amounts paid
            shall be 80 percent of the lesser of the actual charge
            for the services or the amount provided under the fee
            schedule established under section 1834(b), (K) with
            respect to certified nurse-midwife services under
            section 1861(s)(2)(L), the amounts paid shall be 80
            percent of the lesser of the actual charge for the
            services or the amount determined by a fee schedule
            established by the Secretary for the purposes of this
            subparagraph (but in no event shall such fee schedule
            exceed 65 percent of the prevailing charge that would
            be allowed for the same service performed by a
            physician, or, for services furnished on or after
            January 1, 1992, 65 percent (or 100 percent for
            services furnished on or after January 1, 2011) of the
            fee schedule amount provided under section 1848 for the
            same service performed by a physician), (L) with
            respect to qualified psychologist services under
            section 1861(s)(2)(M), the amounts paid shall be 80
            percent of the lesser of the actual charge for the
            services or the amount determined by a fee schedule
            established by the Secretary for the purposes of this
            subparagraph, (M) with respect to prosthetic devices
            and orthotics and prosthetics (as defined in section
            1834(h)(4)), the amounts paid shall be the amounts
            described in section 1834(h)(1), (N) with respect to
            expenses incurred for physicians' services (as defined
            in section 1848(j)(3)) other than personalized
            prevention plan services (as defined in section
            1861(hhh)(1)), the amounts paid shall be 80 percent of
            the payment basis determined under section 1848(a)(1),
            (O) with respect to services described in section
            1861(s)(2)(K) (relating to services furnished by
            physician assistants, nurse practitioners, or clinic
            nurse specialists), the amounts paid shall be equal to
            80 percent of (i) the lesser of the actual charge or 85
            percent of the fee schedule amount provided under
            section 1848, or (ii) in the case of services as an
            assistant at surgery, the lesser of the actual charge
            or 85 percent of the amount that would otherwise be
            recognized if performed by a physician who is serving
            as an assistant at surgery, (P) with respect to
            surgical dressings, the amounts paid shall be the
            amounts determined under section 1834(i), (Q) with
            respect to items or services for which fee schedules
            are established pursuant to section 1842(s), the
            amounts paid shall be 80 percent of the lesser of the
            actual charge or the fee schedule established in such
            section, (R) with respect to ambulance services, (i)
            the amounts paid shall be 80 percent of the lesser of
            the actual charge for the services or the amount
            determined by a fee schedule established by the
            Secretary under section 1834(l) and (ii) with respect
            to ambulance services described in section 1834(l)(8),
            the amounts paid shall be the amounts determined under
            section 1834(g) for outpatient critical access hospital
            services, (S) with respect to drugs and biologicals
            (including intravenous immune globulin (as defined in
            section 1861(zz))) not paid on a cost or prospective
            payment basis as otherwise provided in this part (other
            than items and services described in subparagraph (B)),
            the amounts paid shall be 80 percent of the lesser of
            the actual charge or the payment amount established in
            section 1842(o) (or, if applicable, under section 1847,
            1847A, or 1847B), (T) with respect to medical nutrition
            therapy services (as defined in section 1861(vv)), the
            amount paid shall be 80 percent (or 100 percent if such
            services are recommended with a grade of A or B by the
            United States Preventive Services Task Force for any
            indication or population and are appropriate for the
            individual) of the lesser of the actual charge for the
            services or 85 percent of the amount determined under
            the fee schedule established under section 1848(b) for
            the same services if furnished by a physician, (U) with
            respect to facility fees described in section
            1834(m)(2)(B), the amounts paid shall be 80 percent of
            the lesser of the actual charge or the amounts
            specified in such section, (V) notwithstanding
            subparagraphs (I) (relating to durable medical
            equipment), (M) (relating to prosthetic devices and
            orthotics and prosthetics), and (Q) (relating to
            1842(s) items), with respect to competitively priced
            items and services (described in section 1847(a)(2))
            that are furnished in a competitive area, the amounts
            paid shall be the amounts described in section
            1847(b)(5), (W) with respect to additional preventive
            services (as defined in section 1861(ddd)(1)), the
            amount paid shall be (i) in the case of such services
            which are clinical diagnostic laboratory tests, the
            amount determined under subparagraph (D) (if such
            subparagraph were applied, by substituting ``100
            percent'' for ``80 percent''), and (ii) in the case of
            all other such services, 100 percent of the lesser of
            the actual charge for the service or the amount
            determined under a fee schedule established by the
            Secretary for purposes of this subparagraph, (X) with
            respect to personalized prevention plan services (as
            defined in section 1861(hhh)(1)), the amount paid shall
            be 100 percent of the lesser of the actual charge for
            the services or the amount determined under the payment
            basis determined under section 1848, (Y) subject to
            subsection (dd), with respect to preventive services
            described in subparagraphs (A) and (B) of section
            1861(ddd)(3) that are appropriate for the individual
            and, in the case of such services described in
            subparagraph (A), are recommended with a grade of A or
            B by the United States Preventive Services Task Force
            for any indication or population, the amount paid shall
            be 100 percent of (i) except as provided in clause
            (ii), the lesser of the actual charge for the services
            or the amount determined under the fee schedule that
            applies to such services under this part, and (ii) in
            the case of such services that are covered OPD services
            (as defined in subsection (t)(1)(B)), the amount
            determined under subsection (t), (Z) with respect to
            Federally qualified health center services for which
            payment is made under section 1834(o), the amounts paid
            shall be 80 percent of the lesser of the actual charge
            or the amount determined under such section, (AA) with
            respect to an applicable disposable device (as defined
            in paragraph (2) of section 1834(s)) furnished to an
            individual pursuant to paragraph (1) of such section,
            the amount paid shall be equal to 80 percent of the
            lesser of the actual charge or the amount determined
            under paragraph (3) of such section, (BB) with respect
            to home infusion therapy, the amount paid shall be an
            amount equal to 80 percent of the lesser of the actual
            charge for the services or the amount determined under
            section 1834(u), (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, and (DD) with
            respect to a specified COVID-19 testing-related service
            described in paragraph (1) of subsection (cc) for which
            payment may be made under a specified outpatient
            payment provision described in paragraph (2) of such
            subsection, the amounts paid shall be 100 percent of
            the payment amount otherwise recognized under such
            respective specified outpatient payment provision for
            such service,;
              (2) in the case of services described in section
            1832(a)(2) (except those services described in
            subparagraphs (C), (D), (E), (F), (G), (H), and (I) of
            such section and unless otherwise specified in section
            1881)--
                      (A) with respect to home health services
                    (other than a covered osteoporosis drug) (as
                    defined in section 1861(kk)), the amount
                    determined under the prospective payment system
                    under section 1895;
                      (B) with respect to other items and services
                    (except those described in subparagraph (C),
                    (D), or (E) of this paragraph and except as may
                    be provided in section 1886 or section
                    1888(e)(9))--
                              (i) furnished before January 1, 1999,
                            the lesser of--
                                      (I) the reasonable cost of
                                    such services, as determined
                                    under section 1861(v), or
                                      (II) the customary charges
                                    with respect to such
                                    services,--less the amount a
                                    provider may charge as
                                    described in clause (ii) of
                                    section 1866(a)(2)(A), but in
                                    no case may the payment for
                                    such other services exceed 80
                                    percent of such reasonable
                                    cost, or
                              (ii) if such services are furnished
                            before January 1, 1999, by a public
                            provider of services, or by another
                            provider which demonstrates to the
                            satisfaction of the Secretary that a
                            significant portion of its patients are
                            low-income (and requests that payment
                            be made under this clause), free of
                            charge or at nominal charges to the
                            public, 80 percent of the amount
                            determined in accordance with section
                            1814(b)(2), or
                              (iii) if such services are furnished
                            on or after January 1, 1999, the amount
                            determined under subsection (t), or
                              (iv) if (and for so long as) the
                            conditions described in section
                            1814(b)(3) are met, the amounts
                            determined under the reimbursement
                            system described in such section;
                      (C) with respect to services described in the
                    second sentence of section 1861(p), 80 percent
                    of the reasonable charges for such services;
                      (D) with respect to clinical diagnostic
                    laboratory tests for which payment is made
                    under this part (i)(I)on the basis of a fee
                    schedule determined under subsection(h)(1) (for
                    tests furnished before January 1, 2017) or
                    section 1834(d)(1), the amount paid shall be
                    equal to 80 percent (or 100 percent, in the
                    case of such tests for which payment is made on
                    an assignment-related basis or to a provider
                    having an agreement under section 1866) of the
                    lesser of the amount determined under such fee
                    schedule, the limitation amount for that test
                    determined under subsection (h)(4)(B), or the
                    amount of the charges billed for the tests, or
                    (II) under section 1834A (for tests furnished
                    on or after January 1, 2017), the amount paid
                    shall be equal to 80 percent (or 100 percent,
                    in the case of such tests for which payment is
                    made on an assignment-related basis or to a
                    provider having an agreement under section
                    1866) of the lesser of the amount determined
                    under such section or the amount of the charges
                    billed for the tests, or (ii) for tests
                    furnished before January 1, 2017, on the basis
                    of a negotiated rate established under
                    subsection (h)(6), the amount paid shall be
                    equal to 100 percent of such negotiated rate
                    for such tests;
                      (E) with respect to--
                              (i) outpatient hospital radiology
                            services (including diagnostic and
                            therapeutic radiology, nuclear medicine
                            and CAT scan procedures, magnetic
                            resonance imaging, and ultrasound and
                            other imaging services, but excluding
                            screening mammography and, for services
                            furnished on or after January 1, 2005,
                            diagnostic mammography), and
                              (ii) effective for procedures
                            performed on or after October 1, 1989,
                            diagnostic procedures (as defined by
                            the Secretary) described in section
                            1861(s)(3) (other than diagnostic x-ray
                            tests and diagnostic laboratory tests),
                    the amount determined under subsection (n) or,
                    for services or procedures performed on or
                    after January 1, 1999, subsection (t);
                      (F) with respect to a covered osteoporosis
                    drug (as defined in section 1861(kk)) furnished
                    by a home health agency, 80 percent of the
                    reasonable cost of such service, as determined
                    under section 1861(v);
                      (G) with respect to items and services
                    described in section 1861(s)(10)(A), the lesser
                    of--
                              (i) the reasonable cost of such
                            services, as determined under section
                            1861(v), or
                              (ii) the customary charges with
                            respect to such services; and
                      (H) with respect to personalized prevention
                    plan services (as defined in section
                    1861(hhh)(1)) furnished by an outpatient
                    department of a hospital, the amount determined
                    under paragraph (1)(X),
                    or, if such services are furnished by a public
                    provider of services, or by another provider
                    which demonstrates to the satisfaction of the
                    Secretary that a significant portion of its
                    patients are low-income (and requests that
                    payment be made under this provision), free of
                    charge or at nominal charges to the public, the
                    amount determined in accordance with section
                    1814(b)(2);
              (3) in the case of services described in section
            1832(a)(2)(D)--
                      (A) except as provided in subparagraph (B),
                    the costs which are reasonable and related to
                    the cost of furnishing such services or which
                    are based on such other tests of reasonableness
                    as the Secretary may prescribe in regulations,
                    including those authorized under section
                    1861(v)(1)(A), less the amount a provider may
                    charge as described in clause (ii) of section
                    1866(a)(2)(A), but in no case may the payment
                    for such services (other than for items and
                    services described in section 1861(s)(10)(A))
                    exceed 80 percent of such costs; or
                      (B) with respect to the services described in
                    clause (ii) of section 1832(a)(2)(D) that are
                    furnished to an individual enrolled with a MA
                    plan under part C pursuant to a written
                    agreement described in section 1853(a)(4), the
                    amount (if any) by which--
                              (i) the amount of payment that would
                            have otherwise been provided (I) under
                            subparagraph (A) (calculated as if
                            ``100 percent'' were substituted for
                            ``80 percent'' in such subparagraph)
                            for such services if the individual had
                            not been so enrolled, or (II) in the
                            case of such services furnished on or
                            after the implementation date of the
                            prospective payment system under
                            section 1834(o), under such section
                            (calculated as if ``100 percent'' were
                            substituted for ``80 percent'' in such
                            section) for such services if the
                            individual had not been so enrolled;
                            exceeds
                              (ii) the amount of the payments
                            received under such written agreement
                            for such services (not including any
                            financial incentives provided for in
                            such agreement such as risk pool
                            payments, bonuses, or withholds),
                    less the amount the federally qualified health
                    center may charge as described in section
                    1857(e)(3)(B);
              (4) in the case of facility services described in
            section 1832(a)(2)(F), and outpatient hospital facility
            services furnished in connection with surgical
            procedures specified by the Secretary pursuant to
            section 1833(i)(1)(A), the applicable amount as
            determined under paragraph (2) or (3) of subsection (i)
            or subsection (t);
              (5) in the case of covered items (described in
            section 1834(a)(13)) the amounts described in section
            1834(a)(1);
              (6) in the case of outpatient critical access
            hospital services, the amounts described in section
            1834(g);
              (7) in the case of prosthetic devices and orthotics
            and prosthetics (as described in section 1834(h)(4)),
            the amounts described in section 1834(h);
              (8) in the case of--
                      (A) outpatient physical therapy services,
                    outpatient speech-language pathology services,
                    and outpatient occupational therapy services
                    furnished--
                              (i) by a rehabilitation agency,
                            public health agency, clinic,
                            comprehensive outpatient rehabilitation
                            facility, or skilled nursing facility,
                              (ii) by a home health agency to an
                            individual who is not homebound, or
                              (iii) by another entity under an
                            arrangement with an entity described in
                            clause (i) or (ii); and
                      (B) outpatient physical therapy services,
                    outpatient speech-language pathology services,
                    and outpatient occupational therapy services
                    furnished--
                              (i) by a hospital to an outpatient or
                            to a hospital inpatient who is entitled
                            to benefits under part A but has
                            exhausted benefits for inpatient
                            hospital services during a spell of
                            illness or is not so entitled to
                            benefits under part A, or
                              (ii) by another entity under an
                            arrangement with a hospital described
                            in clause (i),
            the amounts described in section 1834(k);
              (9) in the case of services described in section
            1832(a)(2)(E) that are not described in paragraph (8),
            the amounts described in section 1834(k); and
              (10) with respect to rural emergency hospital
            services furnished on or after January 1, 2023, the
            amounts determined under section 1834(x).
    Paragraph (3)(A) shall not apply to Federally qualified health
    center services furnished on or after the implementation date
    of the prospective payment system under section 1834(o). For
    services furnished on or after January 1, 2022, paragraph
    (1)(Y) shall apply with respect to a colorectal cancer
    screening test regardless of the code that is billed for the
    establishment of a diagnosis as a result of the test, or for
    the removal of tissue or other matter or other procedure that
    is furnished in connection with, as a result of, and in the
    same clinical encounter as the screening test.
      (b) Before applying subsection (a) with respect to expenses
    incurred by an individual during any calendar year, the total
    amount of the expenses incurred by such individual during such
    year (which would, except for this subsection, constitute
    incurred expenses from which benefits payable under subsection
    (a) are determinable) shall be reduced by a deductible of $75
    for calendar years before 1991, $100 for 1991 through 2004,
    $110 for 2005, and for a subsequent year the amount of such
    deductible for the previous year increased by the annual
    percentage increase in the monthly actuarial rate under section
    1839(a)(1) ending with such subsequent year (rounded to the
    nearest $1); except that (1) such total amount shall not
    include expenses incurred for preventive services described in
    subparagraph (A) of section 1861(ddd)(3) that are recommended
    with a grade of A or B by the United States Preventive Services
    Task Force for any indication or population and are appropriate
    for the individual., (2) such deductible shall not apply with
    respect to home health services (other than a covered
    osteoporosis drug (as defined in section 1861(kk))), (3) such
    deductible shall not apply with respect to clinical diagnostic
    laboratory tests for which payment is made under this part (A)
    under subsection (a)(1)(D)(i) or (a)(2)(D)(i) on an assignment-
    related basis, or to a provider having an agreement under
    section 1866, or (B) for tests furnished before January 1,
    2017,on the basis of a negotiated rate determined under
    subsection (h)(6), (4) such deductible shall not apply to
    Federally qualified health center services, (5) such deductible
    shall not apply with respect to screening mammography (as
    described in section 1861(jj)), (6) such deductible shall not
    apply with respect to screening pap smear and screening pelvic
    exam (as described in section 1861(nn)), (7) such deductible
    shall not apply with respect to ultrasound screening for
    abdominal aortic aneurysm (as defined in section 1861(bbb)),
    (8) such deductible shall not apply with respect to colorectal
    cancer screening tests (as described in section 1861(pp)(1)),
    (9) such deductible shall not apply with respect to an initial
    preventive physical examination (as defined in section
    1861(ww)), (10) such deductible shall not apply with respect to
    personalized prevention plan services (as defined in section
    1861(hhh)(1)), (11) such deductible shall not apply with
    respect to any specified COVID-19 testing-related service
    described in paragraph (1) of subsection (cc) for which payment
    may be made under a specified outpatient payment provision
    described in paragraph (2) of such subsection, and (12) such
    deductible shall not apply withrespect a COVID-19 vaccine and
    its administration describedin section 1861(s)(10)(A). The
    total amount of the expenses incurred by an individual as
    determined under the preceding sentence shall, after the
    reduction specified in such sentence, be further reduced by an
    amount equal to the expenses incurred for the first three pints
    of whole blood (or equivalent quantities of packed red blood
    cells, as defined under regulations) furnished to the
    individual during the calendar year, except that such
    deductible for such blood shall in accordance with regulations
    be appropriately reduced to the extent that there has been a
    replacement of such blood (or equivalent quantities of packed
    red blood cells, as so defined); and for such purposes blood
    (or equivalent quantities of packed red blood cells, as so
    defined) furnished such individual shall be deemed replaced
    when the institution or other person furnishing such blood (or
    such equivalent quantities of packed red blood cells, as so
    defined) is given one pint of blood for each pint of blood (or
    equivalent quantities of packed red blood cells, as so defined)
    furnished such individual with respect to which a deduction is
    made under this sentence. The deductible under the previous
    sentence for blood or blood cells furnished an individual in a
    year shall be reduced to the extent that a deductible has been
    imposed under section 1813(a)(2) to blood or blood cells
    furnished the individual in the year. Paragraph (1) of the
    first sentence of this subsection shall apply with respect to a
    colorectal cancer screening test regardless of the code that is
    billed for the establishment of a diagnosis as a result of the
    test, or for the removal of tissue or other matter or other
    procedure that is furnished in connection with, as a result of,
    and in the same clinical encounter as the screening test.
      (c)(1) Notwithstanding any other provision of this part, with
    respect to expenses incurred in a calendar year in connection
    with the treatment of mental, psychoneurotic, and personality
    disorders of an individual who is not an inpatient of a
    hospital at the time such expenses are incurred, there shall be
    considered as incurred expenses for purposes of subsections (a)
    and (b)--
              (A) for expenses incurred in years prior to 2010,
            only 62\1/2\ percent of such expenses;
              (B) for expenses incurred in 2010 or 2011, only 68\3/
            4\ percent of such expenses;
              (C) for expenses incurred in 2012, only 75 percent of
            such expenses;
              (D) for expenses incurred in 2013, only 81\1/4\
            percent of such expenses; and
              (E) for expenses incurred in 2014 or any subsequent
            calendar year, 100 percent of such expenses.
      (2) For purposes of subparagraphs (A) through (D) of
    paragraph (1), the term ``treatment'' does not include brief
    office visits (as defined by the Secretary) for the sole
    purpose of monitoring or changing drug prescriptions used in
    the treatment of such disorders or partial hospitalization
    services that are not directly provided by a physician
      (d) No payment may be made under this part with respect to
    any services furnished an individual to the extent that such
    individual is entitled (or would be entitled except for section
    1813) to have payment made with respect to such services under
    part A.
      (e) No payment shall be made to any provider of services or
    other person under this part unless there has been furnished
    such information as may be necessary in order to determine the
    amounts due such provider or other person under this part for
    the period with respect to which the amounts are being paid or
    for any prior period.
      (f)(1) In establishing limits under subsection (a) on payment
    for rural health clinic services provided by rural health
    clinics (other than such clinics in hospitals with less than 50
    beds), the Secretary shall establish such limit, for services
    provided prior to April 1, 2021--
              (A) in 1988, after March 31, at $46 per visit, and
              (B) in a subsequent year (before April 1, 2021), at
            the limit established under this paragraph for the
            previous year increased by the percentage increase in
            the MEI (as defined in section 1842(i)(3)) applicable
            to primary care services (as defined in section
            1842(i)(4)) furnished as of the first day of that year.
      (2) In establishing limits under subsection (a) on payment
    for rural health clinic services furnished on or after April 1,
    2021, by a rural health clinic (other than a rural health
    clinic described in paragraph (3)(B)), the Secretary shall
    establish such limit, for services provided--
              (A) in 2021, after March 31, at $100 per visit;
              (B) in 2022, at $113 per visit;
              (C) in 2023, at $126 per visit;
              (D) in 2024, at $139 per visit;
              (E) in 2025, at $152 per visit;
              (F) in 2026, at $165 per visit;
              (G) in 2027, at $178 per visit;
              (H) in 2028, at $190 per visit; and
              (I) in a subsequent year, at the limit established
            under this paragraph for the previous year increased by
            the percentage increase in the MEI applicable to
            primary care services furnished as of the first day of
            such subsequent year.
      (3)(A) In establishing limits under subsection (a) on payment
    for rural health clinic services furnished on or after April 1,
    2021, by a rural health clinic described in subparagraph (B),
    the Secretary shall establish such limit, with respect to each
    such rural health clinic, for services provided--
              (i) in 2021, after March 31, at an amount equal to
            the greater of--
                              (I) with respect to a rural health
                            clinic that had a per visit payment
                            amount established for services
                            furnished in 2020--
                                      (aa) the per visit payment
                                    amount applicable to such rural
                                    health clinic for rural health
                                    clinic services furnished in
                                    2020, increased by the
                                    percentage increase in the MEI
                                    applicable to primary care
                                    services furnished as of the
                                    first day of 2021; or
                                      (bb) the limit described in
                                    paragraph (2)(A); and
                              (II) with respect to a rural health
                            clinic that did not have a per visit
                            payment amount established for services
                            furnished in 2020--
                                      (aa) the per visit payment
                                    amount applicable to such rural
                                    health clinic for rural health
                                    clinic services furnished in
                                    2021; or
                                      (bb) the limit described in
                                    paragraph (2)(A); and
              (ii) in a subsequent year, at an amount equal to the
            greater of--
                      (I) the amount established under subclause
                    (I) or (II) of clause (i), as applicable, or
                    this subclause for the previous year with
                    respect to such rural health clinic, increased
                    by the percentage increase in the MEI
                    applicable to primary care services furnished
                    as of the first day of such subsequent year; or
                      (II) the limit established under paragraph
                    (2) for such subsequent year.
      (B) A rural health clinic described in this subparagraph is a
    rural health clinic that--
              (i) as of December 31, 2020, was in a hospital with
            less than 50 beds and after such date such hospital
            continues to have less than 50 beds (not taking into
            account any increase in the number of beds pursuant to
            a waiver under subsection (b)(1)(A) of section 1135
            during the emergency period described in subsection
            (g)(1)(B) of such section); and
              (ii)(I) as of December 31, 2020, was enrolled under
            section 1866(j) (including temporary enrollment during
            such emergency period for such emergency period); or
              (II) submitted an application for enrollment under
            section 1866(j) (or a request for such a temporary
            enrollment for such emergency period) that was received
            not later than December 31, 2020.
      (g)(1)(A) Subject to paragraphs (4) and (5), in the case of
    physical therapy services of the type described in section
    1861(p) and speech-language pathology services of the type
    described in such section through the application of section
    1861(ll)(2), but (except as provided in paragraph (6)) not
    described in subsection (a)(8)(B), and physical therapy
    services and speech-language pathology services of such type
    which are furnished by a physician or as incident to
    physicians' services, with respect to expenses incurred in any
    calendar year, no more than the amount specified in paragraph
    (2) for the year shall be considered as incurred expenses for
    purposes of subsections (a) and (b). The preceding sentence
    shall not apply to expenses incurred with respect to services
    furnished after December 31, 2017.
      (B) With respect to services furnished during 2018 or a
    subsequent year, in the case of physical therapy services of
    the type described in section 1861(p), speech-language
    pathology services of the type described in such section
    through the application of section 1861(ll)(2), and physical
    therapy services and speech-language pathology services of such
    type which are furnished by a physician or as incident to
    physicians' services, with respect to expenses incurred in any
    calendar year, any amount that is more than the amount
    specified in paragraph (2) for the year shall not be considered
    as incurred expenses for purposes of subsections (a) and (b)
    unless the applicable requirements of paragraph (7) are met.
      (2) The amount specified in this paragraph--
              (A) for 1999, 2000, and 2001, is $1,500, and
              (B) for a subsequent year is the amount specified in
            this paragraph for the preceding year increased by the
            percentage increase in the MEI (as defined in section
            1842(i)(3)) for such subsequent year;
    except that if an increase under subparagraph (B) for a year is
    not a multiple of $10, it shall be rounded to the nearest
    multiple of $10.
      (3)(A) Subject to paragraphs (4) and (5), in the case of
    occupational therapy services (of the type that are described
    in section 1861(p) (but (except as provided in paragraph (6))
    not described in subsection (a)(8)(B)) through the operation of
    section 1861(g) and of such type which are furnished by a
    physician or as incident to physicians' services), with respect
    to expenses incurred in any calendar year, no more than the
    amount specified in paragraph (2) for the year shall be
    considered as incurred expenses for purposes of subsections (a)
    and (b). The preceding sentence shall not apply to expenses
    incurred with respect to services furnished after December 31,
    2017.
      (B) With respect to services furnished during 2018 or a
    subsequent year, in the case of occupational therapy services
    (of the type that are described in section 1861(p) through the
    operation of section 1861(g) and of such type which are
    furnished by a physician or as incident to physicians'
    services), with respect to expenses incurred in any calendar
    year, any amount that is more than the amount specified in
    paragraph (2) for the year shall not be considered as incurred
    expenses for purposes of subsections (a) and (b) unless the
    applicable requirements of paragraph (7) are met.
      (4) This subsection shall not apply to expenses incurred with
    respect to services furnished during 2000, 2001, 2002, 2004,
    and 2005.
      (5)(A) With respect to expenses incurred during the period
    beginning on January 1, 2006, and ending on December 31, 2017,
    for services, the Secretary shall implement a process under
    which an individual enrolled under this part may, upon request
    of the individual or a person on behalf of the individual,
    obtain an exception from the uniform dollar limitation
    specified in paragraph (2), for services described in
    paragraphs (1) and (3) if the provision of such services is
    determined to be medically necessary and if the requirement of
    subparagraph (B) is met. Under such process, if the Secretary
    does not make a decision on such a request for an exception
    within 10 business days of the date of the Secretary's receipt
    of the request made in accordance with such requirement, the
    Secretary shall be deemed to have found the services to be
    medically necessary.
      (B) In the case of outpatient therapy services for which an
    exception is requested under the first sentence of subparagraph
    (A), the claim for such services shall contain an appropriate
    modifier (such as the KX modifier used as of the date of the
    enactment of this subparagraph) indicating that such services
    are medically necessary as justified by appropriate
    documentation in the medical record involved.
      (C)(i) In applying this paragraph with respect to a request
    for an exception with respect to expenses that would be
    incurred for outpatient therapy services (including services
    described in subsection (a)(8)(B)) that would exceed the
    threshold described in clause (ii) for a year, the request for
    such an exception, for services furnished on or after October
    1, 2012, shall be subject to a manual medical review process
    that, subject to subparagraph (E), is similar to the manual
    medical review process used for certain exceptions under this
    paragraph in 2006.
      (ii) The threshold under this clause for a year is $3,700.
    Such threshold shall be applied separately--
              (I) for physical therapy services and speech-language
            pathology services; and
              (II) for occupational therapy services.
      (E)(i) In place of the manual medical review process under
    subparagraph (C)(i), the Secretary shall implement a process
    for medical review under this subparagraph under which the
    Secretary shall identify and conduct medical review for
    services described in subparagraph (C)(i) furnished by a
    provider of services or supplier (in this subparagraph referred
    to as a ``therapy provider'') using such factors as the
    Secretary determines to be appropriate.
      (ii) Such factors may include the following:
              (I) The therapy provider has had a high claims denial
            percentage for therapy services under this part or is
            less compliant with applicable requirements under this
            title.
              (II) The therapy provider has a pattern of billing
            for therapy services under this part that is aberrant
            compared to peers or otherwise has questionable billing
            practices for such services, such as billing medically
            unlikely units of services in a day.
              (III) The therapy provider is newly enrolled under
            this title or has not previously furnished therapy
            services under this part.
              (IV) The services are furnished to treat a type of
            medical condition.
              (V) The therapy provider is part of group that
            includes another therapy provider identified using the
            factors determined under this subparagraph.
      (iii) For purposes of carrying out this subparagraph, the
    Secretary shall provide for the transfer, from the Federal
    Supplementary Medical Insurance Trust Fund under section 1841,
    of $5,000,000 to the Centers for Medicare & Medicaid Services
    Program Management Account for fiscal years 2015 and 2016, to
    remain available until expended. Such funds may not be used by
    a contractor under section 1893(h) for medical reviews under
    this subparagraph.
      (iv) The targeted review process under this subparagraph
    shall not apply to services for which expenses are incurred
    beyond the period for which the exceptions process under
    subparagraph (A) is implemented, except as such process is
    applied under paragraph (7)(B).
      (6)(A) In applying paragraphs (1) and (3) to services
    furnished during the period beginning not later than October 1,
    2012, and ending on December 31, 2017, the exclusion of
    services described in subsection (a)(8)(B) from the uniform
    dollar limitation specified in paragraph (2) shall not apply to
    such services furnished during 2012 through 2017.
      (B)(i) With respect to outpatient therapy services furnished
    beginning on or after January 1, 2013, and before January 1,
    2014, for which payment is made under section 1834(g), the
    Secretary shall count toward the uniform dollar limitations
    described in paragraphs (1) and (3) and the threshold described
    in paragraph (5)(C) the amount that would be payable under this
    part if such services were paid under section 1834(k)(1)(B)
    instead of being paid under section 1834(g).
      (ii) Nothing in clause (i) shall be construed as changing the
    method of payment for outpatient therapy services under section
    1834(g).
      (7) For purposes of paragraphs (1)(B) and (3)(B), with
    respect to services described in such paragraphs, the
    requirements described in this paragraph are as follows:
              (A) Inclusion of appropriate modifier.--The claim for
            such services contains an appropriate modifier (such as
            the KX modifier described in paragraph (5)(B))
            indicating that such services are medically necessary
            as justified by appropriate documentation in the
            medical record involved.
              (B) Targeted medical review for certain services
            above threshold.--
                      (i) In general.--In the case where expenses
                    that would be incurred for such services would
                    exceed the threshold described in clause (ii)
                    for the year, such services shall be subject to
                    the process for medical review implemented
                    under paragraph (5)(E).
                      (ii) Threshold.--The threshold under this
                    clause for--
                              (I) a year before 2028, is $3,000;
                              (II) 2028, is the amount specified in
                            subclause (I) increased by the
                            percentage increase in the MEI (as
                            defined in section 1842(i)(3)) for
                            2028; and
                              (III) a subsequent year, is the
                            amount specified in this clause for the
                            preceding year increased by the
                            percentage increase in the MEI (as
                            defined in section 1842(i)(3)) for such
                            subsequent year;
                    except that if an increase under subclause (II)
                    or (III) for a year is not a multiple of $10,
                    it shall be rounded to the nearest multiple of
                    $10.
                      (iii) Application.--The threshold under
                    clause (ii) shall be applied separately--
                              (I) for physical therapy services and
                            speech-language pathology services; and
                              (II) for occupational therapy
                            services.
                      (iv) Funding.--For purposes of carrying out
                    this subparagraph, the Secretary shall provide
                    for the transfer, from the Federal
                    Supplementary Medical Insurance Trust Fund
                    under section 1841 to the Centers for Medicare
                    & Medicaid Services Program Management Account,
                    of $5,000,000 for each fiscal year beginning
                    with fiscal year 2018, to remain available
                    until expended. Such funds may not be used by a
                    contractor under section 1893(h) for medical
                    reviews under this subparagraph.
      (8) With respect to services furnished on or after January 1,
    2013, where payment may not be made as a result of application
    of paragraphs (1) and (3), section 1879 shall apply in the same
    manner as such section applies to a denial that is made by
    reason of section 1862(a)(1).
      (h)(1)(A) Subject to section 1834(d)(1), the Secretary shall
    establish fee schedules for clinical diagnostic laboratory
    tests (including prostate cancer screening tests under section
    1861(oo) consisting of prostate-specific antigen blood tests)
    for which payment is made under this part, other than such
    tests performed by a provider of services for an inpatient of
    such provider.
      (B) In the case of clinical diagnostic laboratory tests
    performed by a physician or by a laboratory (other than tests
    performed by a qualified hospital laboratory (as defined in
    subparagraph (D)) for outpatients of such hospital), the fee
    schedules established under subparagraph (A) shall be
    established on a regional, statewide, or carrier service area
    basis (as the Secretary may determine to be appropriate) for
    tests furnished on or after July 1, 1984.
      (C) In the case of clinical diagnostic laboratory tests
    performed by a qualified hospital laboratory (as defined in
    subparagraph (D)) for outpatients of such hospital, the fee
    schedules established under subparagraph (A) shall be
    established on a regional, statewide, or carrier service area
    basis (as the Secretary may determine to be appropriate) for
    tests furnished on or after July 1, 1984.
      (D) In this subsection, the term ``qualified hospital
    laboratory'' means a hospital laboratory, in a sole community
    hospital (as defined in section 1886(d)(5)(D)(iii)), which
    provides some clinical diagnostic laboratory tests 24 hours a
    day in order to serve a hospital emergency room which is
    available to provide services 24 hours a day and 7 days a week.
      (2)(A)(i) Except as provided in clause (v), subparagraph (B),
    and paragraph (4), the Secretary shall set the fee schedules at
    60 percent (or, in the case of a test performed by a qualified
    hospital laboratory (as defined in paragraph (1)(D)) for
    outpatients of such hospital, 62 percent) of the prevailing
    charge level determined pursuant to the third and fourth
    sentences of section 1842(b)(3) for similar clinical diagnostic
    laboratory tests for the applicable region, State, or area for
    the 12-month period beginning July 1, 1984, adjusted annually
    (to become effective on January 1 of each year) by, subject to
    clause (iv), a percentage increase or decrease equal to the
    percentage increase or decrease in the Consumer Price Index for
    All Urban Consumers (United States city average) minus, for
    each of the years 2009 and 2010, 0.5 percentage points, and,
    for tests furnished before the dateof enactment of section
    1834A, subject to such other adjustments as the Secretary
    determines are justified by technological changes.
      (ii) Notwithstanding clause (i)--
              (I) any change in the fee schedules which would have
            become effective under this subsection for tests
            furnished on or after January 1, 1988, shall not be
            effective for tests furnished during the 3-month period
            beginning on January 1, 1988,
              (II) the Secretary shall not adjust the fee schedules
            under clause (i) to take into account any increase in
            the consumer price index for 1988,
              (III) the annual adjustment in the fee schedules
            determined under clause (i) for each of the years 1991,
            1992, and 1993 shall be 2 percent, and
              (IV) the annual adjustment in the fee schedules
            determined under clause (i) for each of the years 1994
            and 1995, 1998 through 2002, and 2004 through 2008
            shall be 0 percent.
      (iii) In establishing fee schedules under clause (i) with
    respect to automated tests and tests (other than cytopathology
    tests) which before July 1, 1984, the Secretary made subject to
    a limit based on lowest charge levels under the sixth sentence
    of section 1842(b)(3) performed after March 31, 1988, the
    Secretary shall reduce by 8.3 percent the fee schedules
    otherwise established for 1988, and such reduced fee schedules
    shall serve as the base for 1989 and subsequent years.
      (iv) After determining the adjustment to the fee schedules
    under clause (i), the Secretary shall reduce such adjustment--
              (I) for 2011 and each subsequent year, by the
            productivity adjustment described in section
            1886(b)(3)(B)(xi)(II); and
              (II) for each of 2011 through 2015, by 1.75
            percentage points.
    Subclause (I) shall not apply in a year where the adjustment to
    the fee schedules determined under clause (i) is 0.0 or a
    percentage decrease for a year. The application of the
    productivity adjustment under subclause (I) shall not result in
    an adjustment to the fee schedules under clause (i) being less
    than 0.0 for a year. The application of subclause (II) may
    result in an adjustment to the fee schedules under clause (i)
    being less than 0.0 for a year, and may result in payment rates
    for a year being less than such payment rates for the preceding
    year.
      (v) The Secretary shall reduce by 2 percent the fee schedules
    otherwise determined under clause (i) for 2013, and such
    reduced fee schedules shall serve as the base for 2014 and
    subsequent years.
      (B) The Secretary may make further adjustments or exceptions
    to the fee schedules to assure adequate reimbursement of (i)
    emergency laboratory tests needed for the provision of bona
    fide emergency services, and (ii) certain low volume high-cost
    tests where highly sophisticated equipment or extremely skilled
    personnel are necessary to assure quality.
      (3) In addition to the amounts provided under the fee
    schedules (for tests furnished before January 1, 2017)or under
    section 1834A (for tests furnished on or afterJanuary 1, 2017),
    subject to subsection (b)(5) of such section, the Secretary
    shall provide for and establish (A) a nominal fee to cover the
    appropriate costs in collecting the sample on which a clinical
    diagnostic laboratory test was performed and for which payment
    is made under this part, except that not more than one such fee
    may be provided under this paragraph with respect to samples
    collected in the same encounter, and (B) a fee to cover the
    transportation and personnel expenses for trained personnel to
    travel to the location of an individual to collect the sample,
    except that such a fee may be provided only with respect to an
    individual who is homebound or an inpatient in an inpatient
    facility (other than a hospital). In establishing a fee to
    cover the transportation and personnel expenses for trained
    personnel to travel to the location of an individual to collect
    a sample, the Secretary shall provide a method for computing
    the fee based on the number of miles traveled and the personnel
    costs associated with the collection of each individual sample,
    but the Secretary shall only be required to apply such method
    in the case of tests furnished during the period beginning on
    April 1, 1989, and ending on December 31, 1990, by a laboratory
    that establishes to the satisfaction of the Secretary (based on
    data for the 12-month period ending June 30, 1988) that (i) the
    laboratory is dependent upon payments under this title for at
    least 80 percent of its collected revenues for clinical
    diagnostic laboratory tests, (ii) at least 85 percent of its
    gross revenues for such tests are attributable to tests
    performed with respect to individuals who are homebound or who
    are residents in a nursing facility, and (iii) the laboratory
    provided such tests for residents in nursing facilities
    representing at least 20 percent of the number of such
    facilities in the State in which the laboratory is located.
      (4)(A) In establishing any fee schedule under this
    subsection, the Secretary may provide for an adjustment to take
    into account, with respect to the portion of the expenses of
    clinical diagnostic laboratory tests attributable to wages, the
    relative difference between a region's or local area's wage
    rates and the wage rate presumed in the data on which the
    schedule is based.
      (B) For purposes of subsections (a)(1)(D)(i) and
    (a)(2)(D)(i), the limitation amount for a clinical diagnostic
    laboratory test performed--
              (i) on or after July 1, 1986, and before April 1,
            1988, is equal to 115 percent of the median of all the
            fee schedules established for that test for that
            laboratory setting under paragraph (1),
              (ii) after March 31, 1988, and before January 1,
            1990, is equal to the median of all the fee schedules
            established for that test for that laboratory setting
            under paragraph (1),
              (iii) after December 31, 1989, and before January 1,
            1991, is equal to 93 percent of the median of all the
            fee schedules established for that test for that
            laboratory setting under paragraph (1),
              (iv) after December 31, 1990, and before January 1,
            1994, is equal to 88 percent of such median,
              (v) after December 31, 1993, and before January 1,
            1995, is equal to 84 percent of such median,
              (vi) after December 31, 1994, and before January 1,
            1996, is equal to 80 percent of such median,
              (vii) after December 31, 1995, and before January 1,
            1998, is equal to 76 percent of such median, and
              (viii) after December 31, 1997, is equal to 74
            percent of such median (or 100 percent of such median
            in the case of a clinical diagnostic laboratory test
            performed on or after January 1, 2001, that the
            Secretary determines is a new test for which no
            limitation amount has previously been established under
            this subparagraph).
      (5)(A) In the case of a bill or request for payment for a
    clinical diagnostic laboratory test for which payment may
    otherwise be made under this part on an assignment-related
    basis or under a provider agreement under section 1866, payment
    may be made only to the person or entity which performed or
    supervised the performance of such test; except that--
              (i) if a physician performed or supervised the
            performance of such test, payment may be made to
            another physician with whom he shares his practice,
              (ii) in the case of a test performed at the request
            of a laboratory by another laboratory, payment may be
            made to the referring laboratory but only if--
                      (I) the referring laboratory is located in,
                    or is part of, a rural hospital,
                      (II) the referring laboratory is wholly owned
                    by the entity performing such test, the
                    referring laboratory wholly owns the entity
                    performing such test, or both the referring
                    laboratory and the entity performing such test
                    are wholly-owned by a third entity, or
                      (III) not more than 30 percent of the
                    clinical diagnostic laboratory tests for which
                    such referring laboratory (but not including a
                    laboratory described in subclause (II)),
                    receives requests for testing during the year
                    in which the test is performed are performed by
                    another laboratory, and
              (iii) in the case of a clinical diagnostic laboratory
            test provided under an arrangement (as defined in
            section 1861(w)(1)) made by a hospital, critical access
            hospital, or skilled nursing facility, payment shall be
            made to the hospital or skilled nursing facility.
      (B) In the case of such a bill or request for payment for a
    clinical diagnostic laboratory test for which payment may
    otherwise be made under this part, and which is not described
    in subparagraph (A), payment may be made to the beneficiary
    only on the basis of the itemized bill of the person or entity
    which performed or supervised the performance of the test.
      (C) Payment for a clinical diagnostic laboratory test,
    including a test performed in a physician's office but
    excluding a test performed by a rural health clinic may only be
    made on an assignment-related basis or to a provider of
    services with an agreement in effect under section 1866.
      (D) A person may not bill for a clinical diagnostic
    laboratory test, including a test performed in a physician's
    office but excluding a test performed by a rural health clinic,
    other than on an assignment-related basis. If a person
    knowingly and willfully and on a repeated basis bills for a
    clinical diagnostic laboratory test in violation of the
    previous sentence, the Secretary may apply sanctions against
    the person in the same manner as the Secretary may apply
    sanctions against a physician in accordance with paragraph (2)
    of section 1842(j) in the same manner such paragraphs apply
    with respect to a physician. Paragraph (4) of such section
    shall apply in this subparagraph in the same manner as such
    paragraph applies to such section.
      (6) For tests furnished before January 1, 2017, inthe case of
    any diagnostic laboratory test payment for which is not made on
    the basis of a fee schedule under paragraph (1), the Secretary
    may establish a payment rate which is acceptable to the person
    or entity performing the test and which would be considered the
    full charge for such tests. Such negotiated rate shall be
    limited to an amount not in excess of the total payment that
    would have been made for the services in the absence of such
    rate.
      (7) Notwithstanding paragraphs (1) and (4)and section 1834A,
    the Secretary shall establish a national minimum payment amount
    under this part for a diagnostic or screening pap smear
    laboratory test (including all cervical cancer screening
    technologies that have been approved by the Food and Drug
    Administration as a primary screening method for detection of
    cervical cancer) equal to $14.60 for tests furnished in 2000.
    For such tests furnished in subsequent years, such national
    minimum payment amount shall be adjusted annually as provided
    in paragraph (2).
      (8)(A) The Secretary shall establish by regulation procedures
    for determining the basis for, and amount of, payment under
    this subsection for any clinical diagnostic laboratory test
    with respect to which a new or substantially revised HCPCS code
    is assigned on or after January 1, 2005 (in this paragraph
    referred to as ``new tests'').
      (B) Determinations under subparagraph (A) shall be made only
    after the Secretary--
              (i) makes available to the public (through an
            Internet website and other appropriate mechanisms) a
            list that includes any such test for which
            establishment of a payment amount under this subsection
            is being considered for a year;
              (ii) on the same day such list is made available,
            causes to have published in the Federal Register notice
            of a meeting to receive comments and recommendations
            (and data on which recommendations are based) from the
            public on the appropriate basis under this subsection
            for establishing payment amounts for the tests on such
            list;
              (iii) not less than 30 days after publication of such
            notice convenes a meeting, that includes
            representatives of officials of the Centers for
            Medicare & Medicaid Services involved in determining
            payment amounts, to receive such comments and
            recommendations (and data on which the recommendations
            are based);
              (iv) taking into account the comments and
            recommendations (and accompanying data) received at
            such meeting, develops and makes available to the
            public (through an Internet website and other
            appropriate mechanisms) a list of proposed
            determinations with respect to the appropriate basis
            for establishing a payment amount under this subsection
            for each such code, together with an explanation of the
            reasons for each such determination, the data on which
            the determinations are based, and a request for public
            written comments on the proposed determination; and
              (v) taking into account the comments received during
            the public comment period, develops and makes available
            to the public (through an Internet website and other
            appropriate mechanisms) a list of final determinations
            of the payment amounts for such tests under this
            subsection, together with the rationale for each such
            determination, the data on which the determinations are
            based, and responses to comments and suggestions
            received from the public.
      (C) Under the procedures established pursuant to subparagraph
    (A), the Secretary shall--
              (i) set forth the criteria for making determinations
            under subparagraph (A); and
              (ii) make available to the public the data (other
            than proprietary data) considered in making such
            determinations.
      (D) The Secretary may convene such further public meetings to
    receive public comments on payment amounts for new tests under
    this subsection as the Secretary deems appropriate.
      (E) For purposes of this paragraph:
              (i) The term ``HCPCS'' refers to the Health Care
            Procedure Coding System.
              (ii) A code shall be considered to be ``substantially
            revised'' if there is a substantive change to the
            definition of the test or procedure to which the code
            applies (such as a new analyte or a new methodology for
            measuring an existing analyte-specific test).
      (9) Notwithstanding any other provision in this part, in the
    case of any diagnostic laboratory test for HbA1c that is
    labeled by the Food and Drug Administration for home use and is
    furnished on or after April 1, 2008, the payment rate for such
    test shall be the payment rate established under this part for
    a glycated hemoglobin test (identified as of October 1, 2007,
    by HCPCS code 83036 (and any succeeding codes)).
      (i)(1) The Secretary shall, in consultation with appropriate
    medical organizations--
              (A) specify those surgical procedures which are
            appropriately (when considered in terms of the proper
            utilization of hospital inpatient facilities) performed
            on an inpatient basis in a hospital but which also can
            be performed safely on an ambulatory basis in an
            ambulatory surgical center (meeting the standards
            specified under section 1832(a)(2)(F)(i)), critical
            access hospital, or hospital outpatient department, and
              (B) specify those surgical procedures which are
            appropriately (when considered in terms of the proper
            utilization of hospital inpatient facilities) performed
            on an inpatient basis in a hospital but which also can
            be performed safely on an ambulatory basis in a
            physician's office.
    The lists of procedures established under subparagraphs (A) and
    (B) shall be reviewed and updated not less often than every 2
    years, in consultation with appropriate trade and professional
    organizations.
      (2)(A) For services furnished prior to the implementation of
    the system described in subparagraph (D), subject to
    subparagraph (E), the amount of payment to be made for facility
    services furnished in connection with a surgical procedure
    specified pursuant to paragraph (1)(A) and furnished to an
    individual in an ambulatory surgical center described in such
    paragraph shall be equal to 80 percent of a standard overhead
    amount established by the Secretary (with respect to each such
    procedure) on the basis of the Secretary's estimate of a fair
    fee which--
              (i) takes into account the costs incurred by such
            centers, or classes of centers, generally in providing
            services furnished in connection with the performance
            of such procedure, as determined in accordance with a
            survey (based upon a representative sample of
            procedures and facilities) of the actual audited costs
            incurred by such centers in providing such services,
              (ii) takes such costs into account in such a manner
            as will assure that the performance of the procedure in
            such a center will result in substantially less amounts
            paid under this title than would have been paid if the
            procedure had been performed on an inpatient basis in a
            hospital, and
              (iii) in the case of insertion of an intraocular lens
            during or subsequent to cataract surgery includes
            payment which is reasonable and related to the cost of
            acquiring the class of lens involved.
    Each amount so established shall be reviewed and updated not
    later than July 1, 1987, and annually thereafter to take
    account of varying conditions in different areas.
      (B) The amount of payment to be made under this part for
    facility services furnished, in connection with a surgical
    procedure specified pursuant to paragraph (1)(B), in a
    physician's office shall be equal to 80 percent of a standard
    overhead amount established by the Secretary (with respect to
    each such procedure) on the basis of the Secretary's estimate
    of a fair fee which--
              (i) takes into account additional costs, not usually
            included in the professional fee, incurred by
            physicians in securing, maintaining, and staffing the
            facilities and ancillary services appropriate for the
            performance of such procedure in the physician's
            office, and
              (ii) takes such items into account in such a manner
            which will assure that the performance of such
            procedure in the physician's office will result in
            substantially less amounts paid under this title than
            would have been paid if the services had been furnished
            on an inpatient basis in a hospital.
    Each amount so established shall be reviewed and updated not
    later than July 1, 1987, and annually thereafter to take
    account of varying conditions in different areas.
      (C)(i) Notwithstanding the second sentence of each of
    subparagraphs (A) and (B), except as otherwise specified in
    clauses (ii), (iii), and (iv), if the Secretary has not updated
    amounts established under such subparagraphs or under
    subparagraph (D), with respect to facility services furnished
    during a fiscal year (beginning with fiscal year 1986 or a
    calendar year (beginning with 2006)), such amounts shall be
    increased by the percentage increase in the Consumer Price
    Index for all urban consumers (U.S. city average) as estimated
    by the Secretary for the 12-month period ending with the
    midpoint of the year involved.
      (ii) In each of the fiscal years 1998 through 2002, the
    increase under this subparagraph shall be reduced (but not
    below zero) by 2.0 percentage points.
      (iii) In fiscal year 2004, beginning with April 1, 2004, the
    increase under this subparagraph shall be the Consumer Price
    Index for all urban consumers (U.S. city average) as estimated
    by the Secretary for the 12-month period ending with March 31,
    2003, minus 3.0 percentage points.
      (iv) In fiscal year 2005, the last quarter of calendar year
    2005, and each of calendar years 2006 through 2009, the
    increase under this subparagraph shall be 0 percent.
      (D)(i) Taking into account the recommendations in the report
    under section 626(d) of Medicare Prescription Drug,
    Improvement, and Modernization Act of 2003, the Secretary shall
    implement a revised payment system for payment of surgical
    services furnished in ambulatory surgical centers.
      (ii) In the year the system described in clause (i) is
    implemented, such system shall be designed to result in the
    same aggregate amount of expenditures for such services as
    would be made if this subparagraph did not apply, as estimated
    by the Secretary and taking into account reduced expenditures
    that would apply if subparagraph (E) were to continue to apply,
    as estimated by the Secretary.
      (iii) The Secretary shall implement the system described in
    clause (i) for periods in a manner so that it is first
    effective beginning on or after January 1, 2006, and not later
    than January 1, 2008.
      (iv) The Secretary may implement such system in a manner so
    as to provide for a reduction in any annual update for failure
    to report on quality measures in accordance with paragraph (7).
              (v) In implementing the system described in clause
            (i) for 2011 and each subsequent year, any annual
            update under such system for the year, after
            application of clause (iv), shall be reduced by the
            productivity adjustment described in section
            1886(b)(3)(B)(xi)(II). The application of the preceding
            sentence may result in such update being less than 0.0
            for a year, and may result in payment rates under the
            system described in clause (i) for a year being less
            than such payment rates for the preceding year.
      (vi) There shall be no administrative or judicial review
    under section 1869, 1878, or otherwise, of the classification
    system, the relative weights, payment amounts, and the
    geographic adjustment factor, if any, under this subparagraph.
      (E) With respect to surgical procedures furnished on or after
    January 1, 2007, and before the effective date of the
    implementation of a revised payment system under subparagraph
    (D), if--
              (i) the standard overhead amount under subparagraph
            (A) for a facility service for such procedure, without
            the application of any geographic adjustment, exceeds
              (ii) the Medicare OPD fee schedule amount established
            under the prospective payment system for hospital
            outpatient department services under paragraph (3)(D)
            of section 1833(t) for such service for such year,
            determined without regard to geographic adjustment
            under paragraph (2)(D) of such section,
    the Secretary shall substitute under subparagraph (A) the
    amount described in clause (ii) for the standard overhead
    amount for such service referred to in clause (i).
      (3)(A) The aggregate amount of the payments to be made under
    this part for outpatient hospital facility services or critical
    access hospital services furnished before January 1, 1999, in
    connection with surgical procedures specified under paragraph
    (1)(A) shall be equal to the lesser of--
              (i) the amount determined with respect to such
            services under subsection (a)(2)(B); or
              (ii) the blend amount (described in subparagraph
            (B)).
      (B)(i) The blend amount for a cost reporting period is the
    sum of--
              (I) the cost proportion (as defined in clause
            (ii)(I)) of the amount described in subparagraph
            (A)(i), and
              (II) the ASC proportion (as defined in clause
            (ii)(II)) of the standard overhead amount payable with
            respect to the same surgical procedure as if it were
            provided in an ambulatory surgical center in the same
            area, as determined under paragraph (2)(A), less the
            amount a provider may charge as described in clause
            (ii) of section 1866(a)(2)(A).
      (ii) Subject to paragraph (4), in this paragraph:
              (I) The term ``cost proportion'' means 75 percent for
            cost reporting periods beginning in fiscal year 1988,
            50 percent for portions of cost reporting periods
            beginning on or after October 1, 1988, and ending on or
            before December 31, 1990, and 42 percent for portions
            of cost reporting periods beginning on or after January
            1, 1991.
              (II) The term ``ASC proportion'' means 25 percent for
            cost reporting periods beginning in fiscal year 1988,
            50 percent for portions of cost reporting periods
            beginning on or after October 1, 1988, and ending on or
            before December 31, 1990, and 58 percent for portions
            of cost reporting periods beginning on or after January
            1, 1991.
      (4)(A) In the case of a hospital that--
              (i) makes application to the Secretary and
            demonstrates that it specializes in eye services or eye
            and ear services (as determined by the Secretary),
              (ii) receives more than 30 percent of its total
            revenues from outpatient services, and
              (iii) on October 1, 1987--
                      (I) was an eye specialty hospital or an eye
                    and ear specialty hospital, or
                      (II) was operated as an eye or eye and ear
                    unit (as defined in subparagraph (B)) of a
                    general acute care hospital which, on the date
                    of the application described in clause (i),
                    operates less than 20 percent of the beds that
                    the hospital operated on October 1, 1987, and
                    has sold or otherwise disposed of a substantial
                    portion of the hospital's other acute care
                    operations,
    the cost proportion and ASC proportion in effect under
    subclauses (I) and (II) of paragraph (3)(B)(ii) for cost
    reporting periods beginning in fiscal year 1988 shall remain in
    effect for cost reporting periods beginning on or after October
    1, 1988, and before January 1, 1995.
      (B) For purposes of this subparagraph (A)(iii)(II), the term
    ``eye or eye and ear unit'' means a physically separate or
    distinct unit containing separate surgical suites devoted
    solely to eye or eye and ear services.
      (5)(A) The Secretary is authorized to provide by regulations
    that in the case of a surgical procedure, specified by the
    Secretary pursuant to paragraph (1)(A), performed in an
    ambulatory surgical center described in such paragraph, there
    shall be paid (in lieu of any amounts otherwise payable under
    this part) with respect to the facility services furnished by
    such center and with respect to all related services (including
    physicians' services, laboratory, X-ray, and diagnostic
    services) a single all-inclusive fee established pursuant to
    subparagraph (B), if all parties furnishing all such services
    agree to accept such fee (to be divided among the parties
    involved in such manner as they shall have previously agreed
    upon) as full payment for the services furnished.
      (B) In implementing this paragraph, the Secretary shall
    establish with respect to each surgical procedure specified
    pursuant to paragraph (1)(A) the amount of the all-inclusive
    fee for such procedure, taking into account such factors as may
    be appropriate. The amount so established with respect to any
    surgical procedure shall be reviewed periodically and may be
    adjusted by the Secretary, when appropriate, to take account of
    varying conditions in different areas.
      (6) Any person, including a facility having an agreement
    under section 1832(a)(2)(F)(i), who knowingly and willfully
    presents, or causes to be presented, a bill or request for
    payment, for an intraocular lens inserted during or subsequent
    to cataract surgery for which payment may be made under
    paragraph (2)(A)(iii), is subject to a civil money penalty of
    not to exceed $2,000. The provisions of section 1128A (other
    than subsections (a) and (b)) shall apply to a civil money
    penalty under the previous sentence in the same manner as such
    provisions apply to a penalty or proceeding under section
    1128A(a).
      (7)(A) For purposes of paragraph (2)(D)(iv), the Secretary
    may provide, in the case of an ambulatory surgical center that
    does not submit, to the Secretary in accordance with this
    paragraph, data required to be submitted on measures selected
    under this paragraph with respect to a year, any annual
    increase provided under the system established under paragraph
    (2)(D) for such year shall be reduced by 2.0 percentage points.
    A reduction under this subparagraph shall apply only with
    respect to the year involved and the Secretary shall not take
    into account such reduction in computing any annual increase
    factor for a subsequent year.
      (B) Except as the Secretary may otherwise provide, the
    provisions of subparagraphs (B), (C), (D), and (E) of paragraph
    (17) of section 1833(t) shall apply with respect to services of
    ambulatory surgical centers under this paragraph in a similar
    manner to the manner in which they apply under such paragraph
    and, for purposes of this subparagraph, any reference to a
    hospital, outpatient setting, or outpatient hospital services
    is deemed a reference to an ambulatory surgical center, the
    setting of such a center, or services of such a center,
    respectively.
      (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).
      (j) Whenever a final determination is made that the amount of
    payment made under this part either to a provider of services
    or to another person pursuant to an assignment under section
    1842(b)(3)(B)(ii) was in excess of or less than the amount of
    payment that is due, and payment of such excess or deficit is
    not made (or effected by offset) within 30 days of the date of
    the determination, interest shall accrue on the balance of such
    excess or deficit not paid or offset (to the extent that the
    balance is owed by or owing to the provider) at a rate
    determined in accordance with the regulations of the Secretary
    of the Treasury applicable to charges for late payments (or, in
    the case of such a determination made with respect to a payment
    made on or after the date of the enactment of the CARES Act and
    during the period at the end of the emergency sentence
    described in section 1135(g)(1)(B) under the program described
    in section 421.214 of title 42, Code of Federal Regulations (or
    any successor regulation), at a rate of 4 percent).
      (k) With respect to services described in section
    1861(s)(10)(B), the Secretary may provide, instead of the
    amount of payment otherwise provided under this part, for
    payment of such an amount or amounts as reasonably reflects the
    general cost of efficiently providing such services.
      (l)(1)(A) The Secretary shall establish a fee schedule for
    services of certified registered nurse anesthetists under
    section 1861(s)(11).
      (B) In establishing the fee schedule under this paragraph the
    Secretary may utilize a system of time units, a system of base
    and time units, or any appropriate methodology.
      (C) The provisions of this subsection shall not apply to
    certain services furnished in certain hospitals in rural areas
    under the provisions of section 9320(k) of the Omnibus Budget
    Reconciliation Act of 1986, as amended by section 6132 of the
    Omnibus Budget Reconciliation Act of 1989.
      (2) Except as provided in paragraph (3), the fee schedule
    established under paragraph (1) shall be initially based on
    audited data from cost reporting periods ending in fiscal year
    1985 and such other data as the Secretary determines necessary.
      (3)(A) In establishing the initial fee schedule for those
    services, the Secretary shall adjust the fee schedule to the
    extent necessary to ensure that the estimated total amount
    which will be paid under this title for those services plus
    applicable coinsurance in 1989 will equal the estimated total
    amount which would be paid under this title for those services
    in 1989 if the services were included as inpatient hospital
    services and payment for such services was made under part A in
    the same manner as payment was made in fiscal year 1987,
    adjusted to take into account changes in prices and technology
    relating to the administration of anesthesia.
      (B) The Secretary shall also reduce the prevailing charge of
    physicians for medical direction of a certified registered
    nurse anesthetist, or the fee schedule for services of
    certified registered nurse anesthetists, or both, to the extent
    necessary to ensure that the estimated total amount which will
    be paid under this title plus applicable coinsurance for such
    medical direction and such services in 1989 and 1990 will not
    exceed the estimated total amount which would have been paid
    plus applicable coinsurance but for the enactment of the
    amendments made by section 9320 of the Omnibus Budget
    Reconciliation Act of 1986. A reduced prevailing charge under
    this subparagraph shall become the prevailing charge but for
    subsequent years for purposes of applying the economic index
    under the fourth sentence of section 1842(b)(3).
      (4)(A) Except as provided in subparagraphs (C) and (D), in
    determining the amount paid under the fee schedule under this
    subsection for services furnished on or after January 1, 1991,
    by a certified registered nurse anesthetist who is not
    medically directed--
              (i) the conversion factor shall be--
                      (I) for services furnished in 1991, $15.50,
                      (II) for services furnished in 1992, $15.75,
                      (III) for services furnished in 1993, $16.00,
                      (IV) for services furnished in 1994, $16.25,
                      (V) for services furnished in 1995, $16.50,
                      (VI) for services furnished in 1996, $16.75,
                    and
                      (VII) for services furnished in calendar
                    years after 1996, the previous year's
                    conversion factor increased by the update
                    determined under section 1848(d) for physician
                    anesthesia services for that year;
              (ii) the payment areas to be used shall be the fee
            schedule areas used under section 1848 (or, in the case
            of services furnished during 1991, the localities used
            under section 1842(b)) for purposes of computing
            payments for physicians' services that are anesthesia
            services;
              (iii) the geographic adjustment factors to be applied
            to the conversion factor under clause (i) for services
            in a fee schedule area or locality is--
                      (I) in the case of services furnished in
                    1991, the geographic work index value and the
                    geographic practice cost index value specified
                    in section 1842(q)(1)(B) for physicians'
                    services that are anesthesia services furnished
                    in the area or locality, and
                      (II) in the case of services furnished after
                    1991, the geographic work index value, the
                    geographic practice cost index value, and the
                    geographic malpractice index value used for
                    determining payments for physicians' services
                    that are anesthesia services under section
                    1848,
            with 70 percent of the conversion factor treated as
            attributable to work and 30 percent as attributable to
            overhead for services furnished in 1991 (and the
            portions attributable to work, practice expenses, and
            malpractice expenses in 1992 and thereafter being the
            same as is applied under section 1848).
      (B)(i) Except as provided in clause (ii) and subparagraph
    (D), in determining the amount paid under the fee schedule
    under this subsection for services furnished on or after
    January 1, 1991, and before January 1, 1994, by a certified
    registered nurse anesthetist who is medically directed, the
    Secretary shall apply the same methodology specified in
    subparagraph (A).
      (ii) The conversion factor used under clause (i) shall be--
              (I) for services furnished in 1991, $10.50,
              (II) for services furnished in 1992, $10.75, and
              (III) for services furnished in 1993, $11.00.
      (iii) In the case of services of a certified registered nurse
    anesthetist who is medically directed or medically supervised
    by a physician which are furnished on or after January 1, 1994,
    the fee schedule amount shall be one-half of the amount
    described in section 1848(a)(5)(B) with respect to the
    physician.
      (C) Notwithstanding subclauses (I) through (V) of
    subparagraph (A)(i)--
              (i) in the case of a 1990 conversion factor that is
            greater than $16.50, the conversion factor for a
            calendar year after 1990 and before 1996 shall be the
            1990 conversion factor reduced by the product of the
            last digit of the calendar year and one-fifth of the
            amount by which the 1990 conversion factor exceeds
            $16.50; and
              (ii) in the case of a 1990 conversion factor that is
            greater than $15.49 but less than $16.51, the
            conversion factor for a calendar year after 1990 and
            before 1996 shall be the greater of--
                      (I) the 1990 conversion factor, or
                      (II) the conversion factor specified in
                    subparagraph (A)(i) for the year involved.
      (D) Notwithstanding subparagraph (C), in no case may the
    conversion factor used to determine payment for services in a
    fee schedule area or locality under this subsection, as
    adjusted by the adjustment factors specified in subparagraphs
    (A)(iii), exceed the conversion factor used to determine the
    amount paid for physicians' services that are anesthesia
    services in the area or locality.
      (5)(A) Payment for the services of a certified registered
    nurse anesthetist (for which payment may otherwise be made
    under this part) may be made on the basis of a claim or request
    for payment presented by the certified registered nurse
    anesthetist furnishing such services, or by a hospital,
    critical access hospital, physician, group practice, or
    ambulatory surgical center with which the certified registered
    nurse anesthetist furnishing such services has an employment or
    contractual relationship that provides for payment to be made
    under this part for such services to such hospital, critical
    access hospital, physician, group practice, or ambulatory
    surgical center.
      (B) No hospital or critical access hospital that presents a
    claim or request for payment for services of a certified nurse
    anesthetist under this part may treat any uncollected
    coinsurance amount imposed under this part with respect to such
    services as a bad debt of such hospital or critical access
    hospital for purposes of this title.
      (6) If an adjustment under paragraph (3)(B) results in a
    reduction in the reasonable charge for a physicians' service
    and a nonparticipating physician furnishes the service to an
    individual entitled to benefits under this part after the
    effective date of the reduction, the physician's actual charge
    is subject to a limit under section 1842(j)(1)(D).
      (m)(1) In the case of physicians' services furnished in a
    year to an individual, who is covered under the insurance
    program established by this part and who incurs expenses for
    such services, in an area that is designated (under section
    332(a)(1)(A) of the Public Health Service Act) as a health
    professional shortage area as identified by the Secretary prior
    to the beginning of such year, in addition to the amount
    otherwise paid under this part, there also shall be paid to the
    physician (or to an employer or facility in the cases described
    in clause (A) of section 1842(b)(6)) (on a monthly or quarterly
    basis) from the Federal Supplementary Medical Insurance Trust
    Fund an amount equal to 10 percent of the payment amount for
    the service under this part.
      (2) For each health professional shortage area identified in
    paragraph (1) that consists of an entire county, the Secretary
    shall provide for the additional payment under paragraph (1)
    without any requirement on the physician to identify the health
    professional shortage area involved. The Secretary may
    implement the previous sentence using the method specified in
    subsection (u)(4)(C).
      (3) The Secretary shall post on the Internet website of the
    Centers for Medicare & Medicaid Services a list of the health
    professional shortage areas identified in paragraph (1) that
    consist of a partial county to facilitate the additional
    payment under paragraph (1) in such areas.
      (4) There shall be no administrative or judicial review under
    section 1869, section 1878, or otherwise, respecting--
              (A) the identification of a county or area;
              (B) the assignment of a specialty of any physician
            under this paragraph;
              (C) the assignment of a physician to a county under
            this subsection; or
              (D) the assignment of a postal ZIP Code to a county
            or other area under this subsection.
      (n)(1)(A) The aggregate amount of the payments to be made for
    all or part of a cost reporting period for services described
    in subsection (a)(2)(E)(i) furnished under this part on or
    after October 1, 1988, and before January 1, 1999, and for
    services described in subsection (a)(2)(E)(ii) furnished under
    this part on or after October 1, 1989, and before January 1,
    1999, shall be equal to the lesser of--
              (i) the amount determined with respect to such
            services under subsection (a)(2)(B), or
              (ii) the blend amount for radiology services and
            diagnostic procedures determined in accordance with
            subparagraph (B).
      (B)(i) The blend amount for radiology services and diagnostic
    procedures for a cost reporting period is the sum of--
              (I) the cost proportion (as defined in clause (ii))
            of the amount described in subparagraph (A)(i); and
              (II) the charge proportion (as defined in clause
            (ii)(II)) of 62 percent (for services described in
            subsection (a)(2)(E)(i)), or (for procedures described
            in subsection (a)(2)(E)(ii)), 42 percent or such other
            percent established by the Secretary (or carriers
            acting pursuant to guidelines issued by the Secretary)
            based on prevailing charges established with actual
            charge data, of the prevailing charge or (for services
            described in subsection (a)(2)(E)(i) furnished on or
            after January 1, 1989) the fee schedule amount
            established for participating physicians for the same
            services as if they were furnished in a physician's
            office in the same locality as determined under section
            1842(b), less the amount a provider may charge as
            described in clause (ii) of section 1866(a)(2)(A).
      (ii) In this subparagraph:
              (I) The term ``cost proportion'' means 50 percent,
            except that such term means 65 percent in the case of
            outpatient radiology services for portions of cost
            reporting periods which occur in fiscal year 1989 and
            in the case of diagnostic procedures described in
            subsection (a)(2)(E)(ii) for portions of cost reporting
            periods which occur in fiscal year 1990, and such term
            means 42 percent in the case of outpatient radiology
            services for portions of cost reporting periods
            beginning on or after January 1, 1991.
              (II) The term ``charge proportion'' means 100 percent
            minus the cost proportion.
      (o)(1) In the case of shoes described in section
    1861(s)(12)--
              (A) no payment may be made under this part, with
            respect to any individual for any year, for the
            furnishing of--
                      (i) more than one pair of custom molded shoes
                    (including inserts provided with such shoes)
                    and 2 additional pairs of inserts for such
                    shoes, or
                      (ii) more than one pair of extra-depth shoes
                    (not including inserts provided with such
                    shoes) and 3 pairs of inserts for such shoes,
                    and
              (B) with respect to expenses incurred in any calendar
            year, no more than the amount of payment applicable
            under paragraph (2) shall be considered as incurred
            expenses for purposes of subsections (a) and (b).
    Payment for shoes (or inserts) under this part shall be
    considered to include payment for any expenses for the fitting
    of such shoes (or inserts).
      (2)(A) Except as provided by the Secretary under
    subparagraphs (B) and (C), the amount of payment under this
    paragraph for custom molded shoes, extra-depth shoes, and
    inserts shall be the amount determined for such items by the
    Secretary under section 1834(h).
      (B) The Secretary may establish payment amounts for shoes and
    inserts that are lower than the amount established under
    section 1834(h) if the Secretary finds that shoes and inserts
    of an appropriate quality are readily available at or below the
    amount established under such section.
      (C) In accordance with procedures established by the
    Secretary, an individual entitled to benefits with respect to
    shoes described in section 1861(s)(12) may substitute
    modification of such shoes instead of obtaining one (or more,
    as specified by the Secretary) pair of inserts (other than the
    original pair of inserts with respect to such shoes). In such
    case, the Secretary shall substitute, for the payment amount
    established under section 1834(h), a payment amount that the
    Secretary estimates will assure that there is no net increase
    in expenditures under this subsection as a result of this
    subparagraph.
      (3) In this title, the term ``shoes'' includes, except for
    purposes of subparagraphs (A)(ii) and (B) of paragraph (2),
    inserts for extra-depth shoes.
      (q)(1) Each request for payment, or bill submitted, for an
    item or service furnished by an entity for which payment may be
    made under this part and for which the entity knows or has
    reason to believe there has been a referral by a referring
    physician (within the meaning of section 1877) shall include
    the name and unique physician identification number for the
    referring physician.
      (2)(A) In the case of a request for payment for an item or
    service furnished by an entity under this part on an
    assignment-related basis and for which information is required
    to be provided under paragraph (1) but not included, payment
    may be denied under this part.
      (B) In the case of a request for payment for an item or
    service furnished by an entity under this part not submitted on
    an assignment-related basis and for which information is
    required to be provided under paragraph (1) but not included--
              (i) if the entity knowingly and willfully fails to
            provide such information promptly upon request of the
            Secretary or a carrier, the entity may be subject to a
            civil money penalty in an amount not to exceed $2,000,
            and
              (ii) if the entity knowingly, willfully, and in
            repeated cases fails, after being notified by the
            Secretary of the obligations and requirements of this
            subsection to provide the information required under
            paragraph (1), the entity may be subject to exclusion
            from participation in the programs under this Act for a
            period not to exceed 5 years, in accordance with the
            procedures of subsections (c), (f), and (g) of section
            1128.
    The provisions of section 1128A (other than subsections (a) and
    (b)) shall apply to civil money penalties under clause (i) in
    the same manner as they apply to a penalty or proceeding under
    section 1128A(a).
      (r)(1) With respect to services described in section
    1861(s)(2)(K)(ii) (relating to nurse practitioner or clinical
    nurse specialist services), payment may be made on the basis of
    a claim or request for payment presented by the nurse
    practitioner or clinical nurse specialist furnishing such
    services, or by a hospital, critical access hospital, skilled
    nursing facility or nursing facility (as defined in section
    1919(a)), physician, group practice, or ambulatory surgical
    center with which the nurse practitioner or clinical nurse
    specialist has an employment or contractual relationship that
    provides for payment to be made under this part for such
    services to such hospital, physician, group practice, or
    ambulatory surgical center.
      (2) No hospital or critical access hospital that presents a
    claim or request for payment under this part for services
    described in section 1861(s)(2)(K)(ii) may treat any
    uncollected coinsurance amount imposed under this part with
    respect to such services as a bad debt of such hospital for
    purposes of this title.
      (s) The Secretary may not provide for payment under
    subsection (a)(1)(A) with respect to an organization unless the
    organization provides assurances satisfactory to the Secretary
    that the organization meets the requirement of section 1866(f)
    (relating to maintaining written policies and procedures
    respecting advance directives).
      (t) Prospective Payment System for Hospital Outpatient
    Department Services.--
              (1) Amount of payment.--
                      (A) In general.--With respect to covered OPD
                    services (as defined in subparagraph (B))
                    furnished during a year beginning with 1999,
                    the amount of payment under this part shall be
                    determined under a prospective payment system
                    established by the Secretary in accordance with
                    this subsection.
                      (B) Definition of covered opd services.--For
                    purposes of this subsection, the term ``covered
                    OPD services''--
                              (i) means hospital outpatient
                            services designated by the Secretary;
                              (ii) subject to clause (iv), includes
                            inpatient hospital services designated
                            by the Secretary that are covered under
                            this part and furnished to a hospital
                            inpatient who (I) is entitled to
                            benefits under part A but has exhausted
                            benefits for inpatient hospital
                            services during a spell of illness, or
                            (II) is not so entitled;
                              (iii) includes implantable items
                            described in paragraph (3), (6), or (8)
                            of section 1861(s);
                              (iv) does not include any therapy
                            services described in subsection (a)(8)
                            or ambulance services, for which
                            payment is made under a fee schedule
                            described in section 1834(k) or section
                            1834(l) and does not include screening
                            mammography (as defined in section
                            1861(jj)), diagnostic mammography, or
                            personalized prevention plan services
                            (as defined in section 1861(hhh)(1));
                            and
                              (v) does not include applicable items
                            and services (as defined in
                            subparagraph (A) of paragraph (21))
                            that are furnished on or after January
                            1, 2017, by an off-campus outpatient
                            department of a provider (as defined in
                            subparagraph (B) of such paragraph).
              (2) System requirements.--Under the payment system--
                      (A) the Secretary shall develop a
                    classification system for covered OPD services;
                      (B) the Secretary may establish groups of
                    covered OPD services, within the classification
                    system described in subparagraph (A), so that
                    services classified within each group are
                    comparable clinically and with respect to the
                    use of resources and so that an implantable
                    item is classified to the group that includes
                    the service to which the item relates;
                      (C) the Secretary shall, using data on claims
                    from 1996 and using data from the most recent
                    available cost reports, establish relative
                    payment weights for covered OPD services (and
                    any groups of such services described in
                    subparagraph (B)) based on median (or, at the
                    election of the Secretary, mean) hospital costs
                    and shall determine projections of the
                    frequency of utilization of each such service
                    (or group of services) in 1999;
                      (D) subject to paragraph (19), the Secretary
                    shall determine a wage adjustment factor to
                    adjust the portion of payment and coinsurance
                    attributable to labor-related costs for
                    relative differences in labor and labor-related
                    costs across geographic regions in a budget
                    neutral manner;
                      (E) the Secretary shall establish, in a
                    budget neutral manner, outlier adjustments
                    under paragraph (5) and transitional pass-
                    through payments under paragraph (6) and other
                    adjustments as determined to be necessary to
                    ensure equitable payments, such as adjustments
                    for certain classes of hospitals;
                      (F) the Secretary shall develop a method for
                    controlling unnecessary increases in the volume
                    of covered OPD services;
                      (G) the Secretary shall create additional
                    groups of covered OPD services that classify
                    separately those procedures that utilize
                    contrast agents from those that do not; and
                      (H) with respect to devices of brachytherapy
                    consisting of a seed or seeds (or radioactive
                    source), the Secretary shall create additional
                    groups of covered OPD services that classify
                    such devices separately from the other services
                    (or group of services) paid for under this
                    subsection in a manner reflecting the number,
                    isotope, and radioactive intensity of such
                    devices furnished, including separate groups
                    for palladium-103 and iodine-125 devices and
                    for stranded and non-stranded devices furnished
                    on or after July 1, 2007.
            For purposes of subparagraph (B), items and services
            within a group shall not be treated as ``comparable
            with respect to the use of resources'' if the highest
            median cost (or mean cost, if elected by the Secretary
            under subparagraph (C)) for an item or service within
            the group is more than 2 times greater than the lowest
            median cost (or mean cost, if so elected) for an item
            or service within the group; except that the Secretary
            may make exceptions in unusual cases, such as low
            volume items and services, but may not make such an
            exception in the case of a drug or biological that has
            been designated as an orphan drug under section 526 of
            the Federal Food, Drug and Cosmetic Act.
              (3) Calculation of base amounts.--
                      (A) Aggregate amounts that would be payable
                    if deductibles were disregarded.--The Secretary
                    shall estimate the sum of--
                              (i) the total amounts that would be
                            payable from the Trust Fund under this
                            part for covered OPD services in 1999,
                            determined without regard to this
                            subsection, as though the deductible
                            under section 1833(b) did not apply,
                            and
                              (ii) the total amounts of copayments
                            estimated to be paid under this
                            subsection by beneficiaries to
                            hospitals for covered OPD services in
                            1999, as though the deductible under
                            section 1833(b) did not apply.
                      (B) Unadjusted copayment amount.--
                              (i) In general.--For purposes of this
                            subsection, subject to clause (ii), the
                            ``unadjusted copayment amount''
                            applicable to a covered OPD service (or
                            group of such services) is 20 percent
                            of the national median of the charges
                            for the service (or services within the
                            group) furnished during 1996, updated
                            to 1999 using the Secretary's estimate
                            of charge growth during the period.
                              (ii) Adjusted to be 20 percent when
                            fully phased in.--If the pre-deductible
                            payment percentage for a covered OPD
                            service (or group of such services)
                            furnished in a year would be equal to
                            or exceed 80 percent, then the
                            unadjusted copayment amount shall be 20
                            percent of amount determined under
                            subparagraph (D).
                              (iii) Rules for new services.--The
                            Secretary shall establish rules for
                            establishment of an unadjusted
                            copayment amount for a covered OPD
                            service not furnished during 1996,
                            based upon its classification within a
                            group of such services.
                      (C) Calculation of conversion factors.--
                              (i) For 1999.--
                                      (I) In general.--The
                                    Secretary shall establish a
                                    1999 conversion factor for
                                    determining the medicare OPD
                                    fee schedule amounts for each
                                    covered OPD service (or group
                                    of such services) furnished in
                                    1999. Such conversion factor
                                    shall be established on the
                                    basis of the weights and
                                    frequencies described in
                                    paragraph (2)(C) and in such a
                                    manner that the sum for all
                                    services and groups of the
                                    products (described in
                                    subclause (II) for each such
                                    service or group) equals the
                                    total projected amount
                                    described in subparagraph (A).
                                      (II) Product described.--The
                                    Secretary shall determine for
                                    each service or group the
                                    product of the medicare OPD fee
                                    schedule amounts (taking into
                                    account appropriate adjustments
                                    described in paragraphs (2)(D)
                                    and (2)(E)) and the estimated
                                    frequencies for such service or
                                    group.
                              (ii) Subsequent years.--Subject to
                            paragraph (8)(B), the Secretary shall
                            establish a conversion factor for
                            covered OPD services furnished in
                            subsequent years in an amount equal to
                            the conversion factor established under
                            this subparagraph and applicable to
                            such services furnished in the previous
                            year increased by the OPD fee schedule
                            increase factor specified under clause
                            (iv) for the year involved.
                              (iii) Adjustment for service mix
                            changes.--Insofar as the Secretary
                            determines that the adjustments for
                            service mix under paragraph (2) for a
                            previous year (or estimates that such
                            adjustments for a future year) did (or
                            are likely to) result in a change in
                            aggregate payments under this
                            subsection during the year that are a
                            result of changes in the coding or
                            classification of covered OPD services
                            that do not reflect real changes in
                            service mix, the Secretary may adjust
                            the conversion factor computed under
                            this subparagraph for subsequent years
                            so as to eliminate the effect of such
                            coding or classification changes.
                              (iv) OPD fee schedule increase
                            factor.--For purposes of this
                            subparagraph, subject to paragraph (17)
                            and subparagraph (F) of this paragraph,
                            the ``OPD fee schedule increase
                            factor'' for services furnished in a
                            year is equal to the market basket
                            percentage increase applicable under
                            section 1886(b)(3)(B)(iii) to hospital
                            discharges occurring during the fiscal
                            year ending in such year, reduced by 1
                            percentage point for such factor for
                            services furnished in each of 2000 and
                            2002. In applying the previous sentence
                            for years beginning with 2000, the
                            Secretary may substitute for the market
                            basket percentage increase an annual
                            percentage increase that is computed
                            and applied with respect to covered OPD
                            services furnished in a year in the
                            same manner as the market basket
                            percentage increase is determined and
                            applied to inpatient hospital services
                            for discharges occurring in a fiscal
                            year.
                      (D) Calculation of medicare opd fee schedule
                    amounts.--The Secretary shall compute a
                    medicare OPD fee schedule amount for each
                    covered OPD service (or group of such services)
                    furnished in a year, in an amount equal to the
                    product of--
                              (i) the conversion factor computed
                            under subparagraph (C) for the year,
                            and
                              (ii) the relative payment weight
                            (determined under paragraph (2)(C)) for
                            the service or group.
                      (E) Pre-deductible payment percentage.--The
                    pre-deductible payment percentage for a covered
                    OPD service (or group of such services)
                    furnished in a year is equal to the ratio of--
                              (i) the medicare OPD fee schedule
                            amount established under subparagraph
                            (D) for the year, minus the unadjusted
                            copayment amount determined under
                            subparagraph (B) for the service or
                            group, to
                              (ii) the medicare OPD fee schedule
                            amount determined under subparagraph
                            (D) for the year for such service or
                            group.
                      (F) Productivity and other adjustment.--After
                    determining the OPD fee schedule increase
                    factor under subparagraph (C)(iv), the
                    Secretary shall reduce such increase factor--
                              (i) for 2012 and subsequent years, by
                            the productivity adjustment described
                            in section 1886(b)(3)(B)(xi)(II); and
                              (ii) for each of 2010 through 2019,
                            by the adjustment described in
                            subparagraph (G).
                    The application of this subparagraph may result
                    in the increase factor under subparagraph
                    (C)(iv) being less than 0.0 for a year, and may
                    result in payment rates under the payment
                    system under this subsection for a year being
                    less than such payment rates for the preceding
                    year.
                      (G) Other adjustment.--For purposes of
                    subparagraph (F)(ii), the adjustment described
                    in this subparagraph is--
                              (i) for each of 2010 and 2011, 0.25
                            percentage point;
                              (ii) for each of 2012 and 2013, 0.1
                            percentage point;
                              (iii) for 2014, 0.3 percentage point;
                              (iv) for each of 2015 and 2016, 0.2
                            percentage point; and
                              (v) for each of 2017, 2018, and 2019,
                            0.75 percentage point.
              (4) Medicare payment amount.--The amount of payment
            made from the Trust Fund under this part for a covered
            OPD service (and such services classified within a
            group) furnished in a year is determined, subject to
            paragraph (7), as follows:
                      (A) Fee schedule adjustments.--The medicare
                    OPD fee schedule amount (computed under
                    paragraph (3)(D)) for the service or group and
                    year is adjusted for relative differences in
                    the cost of labor and other factors determined
                    by the Secretary, as computed under paragraphs
                    (2)(D) and (2)(E).
                      (B) Subtract applicable deductible.--Reduce
                    the adjusted amount determined under
                    subparagraph (A) by the amount of the
                    deductible under section 1833(b), to the extent
                    applicable.
                      (C) Apply payment proportion to remainder.--
                    The amount of payment is the amount so
                    determined under subparagraph (B) multiplied by
                    the pre-deductible payment percentage (as
                    determined under paragraph (3)(E)) for the
                    service or group and year involved, plus the
                    amount of any reduction in the copayment amount
                    attributable to paragraph (8)(C).
              (5) Outlier adjustment.--
                      (A) In general.--Subject to subparagraph (D),
                    the Secretary shall provide for an additional
                    payment for each covered OPD service (or group
                    of services) for which a hospital's charges,
                    adjusted to cost, exceed--
                              (i) a fixed multiple of the sum of--
                                      (I) the applicable medicare
                                    OPD fee schedule amount
                                    determined under paragraph
                                    (3)(D), as adjusted under
                                    paragraph (4)(A) (other than
                                    for adjustments under this
                                    paragraph or paragraph (6));
                                    and
                                      (II) any transitional pass-
                                    through payment under paragraph
                                    (6); and
                              (ii) at the option of the Secretary,
                            such fixed dollar amount as the
                            Secretary may establish.
                      (B) Amount of adjustment.--The amount of the
                    additional payment under subparagraph (A) shall
                    be determined by the Secretary and shall
                    approximate the marginal cost of care beyond
                    the applicable cutoff point under such
                    subparagraph.
                      (C) Limit on aggregate outlier adjustments.--
                              (i) In general.--The total of the
                            additional payments made under this
                            paragraph for covered OPD services
                            furnished in a year (as estimated by
                            the Secretary before the beginning of
                            the year) may not exceed the applicable
                            percentage (specified in clause (ii))
                            of the total program payments estimated
                            to be made under this subsection for
                            all covered OPD services furnished in
                            that year. If this paragraph is first
                            applied to less than a full year, the
                            previous sentence shall apply only to
                            the portion of such year.
                              (ii) Applicable percentage.--For
                            purposes of clause (i), the term
                            ``applicable percentage'' means a
                            percentage specified by the Secretary
                            up to (but not to exceed)--
                                      (I) for a year (or portion of
                                    a year) before 2004, 2.5
                                    percent; and
                                      (II) for 2004 and thereafter,
                                    3.0 percent.
                      (D) Transitional authority.--In applying
                    subparagraph (A) for covered OPD services
                    furnished before January 1, 2002, the Secretary
                    may--
                              (i) apply such subparagraph to a bill
                            for such services related to an
                            outpatient encounter (rather than for a
                            specific service or group of services)
                            using OPD fee schedule amounts and
                            transitional pass-through payments
                            covered under the bill; and
                              (ii) use an appropriate cost-to-
                            charge ratio for the hospital involved
                            (as determined by the Secretary),
                            rather than for specific departments
                            within the hospital.
                      (E) Exclusion of separate drug and biological
                    apcs from outlier payments.--No additional
                    payment shall be made under subparagraph (A) in
                    the case of ambulatory payment classification
                    groups established separately for drugs or
                    biologicals.
              (6) Transitional pass-through for additional costs of
            innovative medical devices, drugs, and biologicals.--
                      (A) In general.--The Secretary shall provide
                    for an additional payment under this paragraph
                    for any of the following that are provided as
                    part of a covered OPD service (or group of
                    services):
                              (i) Current orphan drugs.--A drug or
                            biological that is used for a rare
                            disease or condition with respect to
                            which the drug or biological has been
                            designated as an orphan drug under
                            section 526 of the Federal Food, Drug
                            and Cosmetic Act if payment for the
                            drug or biological as an outpatient
                            hospital service under this part was
                            being made on the first date that the
                            system under this subsection is
                            implemented.
                              (ii) Current cancer therapy drugs and
                            biologicals and brachytherapy.--A drug
                            or biological that is used in cancer
                            therapy, including (but not limited to)
                            a chemotherapeutic agent, an
                            antiemetic, a hematopoietic growth
                            factor, a colony stimulating factor, a
                            biological response modifier, a
                            bisphosphonate, and a device of
                            brachytherapy or temperature monitored
                            cryoablation, if payment for such drug,
                            biological, or device as an outpatient
                            hospital service under this part was
                            being made on such first date.
                              (iii) Current radiopharmaceutical
                            drugs and biological products.--A
                            radiopharmaceutical drug or biological
                            product used in diagnostic, monitoring,
                            and therapeutic nuclear medicine
                            procedures if payment for the drug or
                            biological as an outpatient hospital
                            service under this part was being made
                            on such first date.
                              (iv) New medical devices, drugs, and
                            biologicals.--A medical device, drug,
                            or biological not described in clause
                            (i), (ii), or (iii) if--
                                      (I) payment for the device,
                                    drug, or biological as an
                                    outpatient hospital service
                                    under this part was not being
                                    made as of December 31, 1996;
                                    and
                                      (II) the cost of the drug or
                                    biological or the average cost
                                    of the category of devices is
                                    not insignificant in relation
                                    to the OPD fee schedule amount
                                    (as calculated under paragraph
                                    (3)(D)) payable for the service
                                    (or group of services)
                                    involved.
                      (B) Use of categories in determining
                    eligibility of a device for pass-through
                    payments.--The following provisions apply for
                    purposes of determining whether a medical
                    device qualifies for additional payments under
                    clause (ii) or (iv) of subparagraph (A):
                              (i) Establishment of initial
                            categories.--
                                      (I) In general.--The
                                    Secretary shall initially
                                    establish under this clause
                                    categories of medical devices
                                    based on type of device by
                                    April 1, 2001. Such categories
                                    shall be established in a
                                    manner such that each medical
                                    device that meets the
                                    requirements of clause (ii) or
                                    (iv) of subparagraph (A) as of
                                    January 1, 2001, is included in
                                    such a category and no such
                                    device is included in more than
                                    one category. For purposes of
                                    the preceding sentence, whether
                                    a medical device meets such
                                    requirements as of such date
                                    shall be determined on the
                                    basis of the program memoranda
                                    issued before such date.
                                      (II) Authorization of
                                    implementation other than
                                    through regulations.--The
                                    categories may be established
                                    under this clause by program
                                    memorandum or otherwise, after
                                    consultation with groups
                                    representing hospitals,
                                    manufacturers of medical
                                    devices, and other affected
                                    parties.
                              (ii) Establishing criteria for
                            additional categories.--
                                      (I) In general.--The
                                    Secretary shall establish
                                    criteria that will be used for
                                    creation of additional
                                    categories (other than those
                                    established under clause (i))
                                    through rulemaking (which may
                                    include use of an interim final
                                    rule with comment period).
                                      (II) Standard.--Such
                                    categories shall be established
                                    under this clause in a manner
                                    such that no medical device is
                                    described by more than one
                                    category. Such criteria shall
                                    include a test of whether the
                                    average cost of devices that
                                    would be included in a category
                                    and are in use at the time the
                                    category is established is not
                                    insignificant, as described in
                                    subparagraph (A)(iv)(II).
                                      (III) Deadline.--Criteria
                                    shall first be established
                                    under this clause by July 1,
                                    2001. The Secretary may
                                    establish in compelling
                                    circumstances categories under
                                    this clause before the date
                                    such criteria are established.
                                      (IV) Adding categories.--The
                                    Secretary shall promptly
                                    establish a new category of
                                    medical devices under this
                                    clause for any medical device
                                    that meets the requirements of
                                    subparagraph (A)(iv) and for
                                    which none of the categories in
                                    effect (or that were previously
                                    in effect) is appropriate.
                              (iii) Period for which category is in
                            effect.--A category of medical devices
                            established under clause (i) or (ii)
                            shall be in effect for a period of at
                            least 2 years, but not more than 3
                            years, that begins--
                                      (I) in the case of a category
                                    established under clause (i),
                                    on the first date on which
                                    payment was made under this
                                    paragraph for any device
                                    described by such category
                                    (including payments made during
                                    the period before April 1,
                                    2001); and
                                      (II) in the case of any other
                                    category, on the first date on
                                    which payment is made under
                                    this paragraph for any medical
                                    device that is described by
                                    such category.
                              (iv) Requirements treated as met.--A
                            medical device shall be treated as
                            meeting the requirements of
                            subparagraph (A)(iv), regardless of
                            whether the device meets the
                            requirement of subclause (I) of such
                            subparagraph, if--
                                      (I) the device is described
                                    by a category established and
                                    in effect under clause (i); or
                                      (II) the device is described
                                    by a category established and
                                    in effect under clause (ii) and
                                    an application under section
                                    515 of the Federal Food, Drug,
                                    and Cosmetic Act has been
                                    approved with respect to the
                                    device, or the device has been
                                    cleared for market under
                                    section 510(k) of such Act, or
                                    the device is exempt from the
                                    requirements of section 510(k)
                                    of such Act pursuant to
                                    subsection (l) or (m) of
                                    section 510 of such Act or
                                    section 520(g) of such Act.
                            Nothing in this clause shall be
                            construed as requiring an application
                            or prior approval (other than that
                            described in subclause (II)) in order
                            for a covered device described by a
                            category to qualify for payment under
                            this paragraph.
                      (C) Limited period of payment.--
                              (i) Drugs and biologicals.--Subject
                            to subparagraph (G), the payment under
                            this paragraph with respect to a drug
                            or biological shall only apply during a
                            period of at least 2 years, but not
                            more than 3 years, that begins--
                                      (I) on the first date this
                                    subsection is implemented in
                                    the case of a drug or
                                    biological described in clause
                                    (i), (ii), or (iii) of
                                    subparagraph (A) and in the
                                    case of a drug or biological
                                    described in subparagraph
                                    (A)(iv) and for which payment
                                    under this part is made as an
                                    outpatient hospital service
                                    before such first date; or
                                      (II) in the case of a drug or
                                    biological described in
                                    subparagraph (A)(iv) not
                                    described in subclause (I), on
                                    the first date on which payment
                                    is made under this part for the
                                    drug or biological as an
                                    outpatient hospital service.
                              (ii) Medical devices.--Payment shall
                            be made under this paragraph with
                            respect to a medical device only if
                            such device--
                                      (I) is described by a
                                    category of medical devices
                                    established and in effect under
                                    subparagraph (B); and
                                      (II) is provided as part of a
                                    service (or group of services)
                                    paid for under this subsection
                                    and provided during the period
                                    for which such category is in
                                    effect under such subparagraph.
                      (D) Amount of additional payment.--Subject to
                    subparagraph (E)(iii), the amount of the
                    payment under this paragraph with respect to a
                    device, drug, or biological provided as part of
                    a covered OPD service is--
                              (i) subject to subparagraph (H), in
                            the case of a drug or biological, the
                            amount by which the amount determined
                            under section 1842(o) (or if the drug
                            or biological is covered under a
                            competitive acquisition contract under
                            section 1847B, an amount determined by
                            the Secretary equal to the average
                            price for the drug or biological for
                            all competitive acquisition areas and
                            year established under such section as
                            calculated and adjusted by the
                            Secretary for purposes of this
                            paragraph) for the drug or biological
                            exceeds the portion of the otherwise
                            applicable medicare OPD fee schedule
                            that the Secretary determines is
                            associated with the drug or biological;
                            or
                              (ii) in the case of a medical device,
                            the amount by which the hospital's
                            charges for the device, adjusted to
                            cost, exceeds the portion of the
                            otherwise applicable medicare OPD fee
                            schedule that the Secretary determines
                            is associated with the device.
                      (E) Limit on aggregate annual adjustment.--
                              (i) In general.--The total of the
                            additional payments made under this
                            paragraph for covered OPD services
                            furnished in a year (as estimated by
                            the Secretary before the beginning of
                            the year) may not exceed the applicable
                            percentage (specified in clause (ii))
                            of the total program payments estimated
                            to be made under this subsection for
                            all covered OPD services furnished in
                            that year. If this paragraph is first
                            applied to less than a full year, the
                            previous sentence shall apply only to
                            the portion of such year. This clause
                            shall not apply for 2018 or 2020.
                              (ii) Applicable percentage.--For
                            purposes of clause (i), the term
                            ``applicable percentage'' means--
                                      (I) for a year (or portion of
                                    a year) before 2004, 2.5
                                    percent; and
                                      (II) for 2004 and thereafter,
                                    a percentage specified by the
                                    Secretary up to (but not to
                                    exceed) 2.0 percent.
                              (iii) Uniform prospective reduction
                            if aggregate limit projected to be
                            exceeded.--If the Secretary estimates
                            before the beginning of a year that the
                            amount of the additional payments under
                            this paragraph for the year (or portion
                            thereof) as determined under clause (i)
                            without regard to this clause will
                            exceed the limit established under such
                            clause, the Secretary shall reduce pro
                            rata the amount of each of the
                            additional payments under this
                            paragraph for that year (or portion
                            thereof) in order to ensure that the
                            aggregate additional payments under
                            this paragraph (as so estimated) do not
                            exceed such limit.
                      (F) Limitation of application of functional
                    equivalence standard.--
                              (i) In general.--The Secretary may
                            not publish regulations that apply a
                            functional equivalence standard to a
                            drug or biological under this
                            paragraph.
                              (ii) Application.--Clause (i) shall
                            apply to the application of a
                            functional equivalence standard to a
                            drug or biological on or after the date
                            of enactment of the Medicare
                            Prescription Drug, Improvement, and
                            Modernization Act of 2003 unless--
                                      (I) such application was
                                    being made to such drug or
                                    biological prior to such date
                                    of enactment; and
                                      (II) the Secretary applies
                                    such standard to such drug or
                                    biological only for the purpose
                                    of determining eligibility of
                                    such drug or biological for
                                    additional payments under this
                                    paragraph and not for the
                                    purpose of any other payments
                                    under this title.
                              (iii) Rule of construction.--Nothing
                            in this subparagraph shall be construed
                            to effect the Secretary's authority to
                            deem a particular drug to be identical
                            to another drug if the 2 products are
                            pharmaceutically equivalent and
                            bioequivalent, as determined by the
                            Commissioner of Food and Drugs.
                      (G) Pass-through extension for certain drugs
                    and biologicals.--In the case of a drug or
                    biological whose period of pass-through status
                    under this paragraph ended on December 31,
                    2017, and for which payment under this
                    subsection was packaged into a payment for a
                    covered OPD service (or group of services)
                    furnished beginning January 1, 2018, such pass-
                    through status shall be extended for a 2-year
                    period beginning on October 1, 2018.
                      (H) Temporary payment rule for certain drugs
                    and biologicals.--In the case of a drug or
                    biological whose period of pass-through status
                    under this paragraph ended on December 31,
                    2017, and for which payment under this
                    subsection was packaged into a payment for a
                    covered OPD service (or group of services)
                    furnished beginning January 1, 2018, the
                    payment amount for such drug or biological
                    under this subsection that is furnished during
                    the period beginning on October 1, 2018, and
                    ending on March 31, 2019, shall be the greater
                    of--
                              (i) the payment amount that would
                            otherwise apply under subparagraph
                            (D)(i) for such drug or biological
                            during such period; or
                              (ii) the payment amount that applied
                            under such subparagraph (D)(i) for such
                            drug or biological on December 31,
                            2017.
                      (I) Special payment adjustment rules for last
                    quarter of 2018.--In the case of a drug or
                    biological whose period of pass-through status
                    under this paragraph ended on December 31,
                    2017, and for which payment under this
                    subsection was packaged into a payment amount
                    for a covered OPD service (or group of
                    services) beginning January 1, 2018, the
                    following rules shall apply with respect to
                    payment amounts under this subsection for
                    covered a OPD service (or group of services)
                    furnished during the period beginning on
                    October 1, 2018, and ending on December 31,
                    2018:
                              (i) The Secretary shall remove the
                            packaged costs of such drug or
                            biological (as determined by the
                            Secretary) from the payment amount
                            under this subsection for the covered
                            OPD service (or group of services) with
                            which it is packaged.
                              (ii) The Secretary shall not make any
                            adjustments to payment amounts under
                            this subsection for a covered OPD
                            service (or group of services) for
                            which no costs were removed under
                            clause (i).
                      (J) Additional pass-through extension and
                    special payment adjustment rule for certain
                    diagnostic radiopharmaceuticals.--In the case
                    of a drug or biological furnished in the
                    context of a clinical study on diagnostic
                    imaging tests approved under a coverage with
                    evidence development determination whose period
                    of pass-through status under this paragraph
                    concluded on December 31, 2018, and for which
                    payment under this subsection was packaged into
                    a payment for a covered OPD service (or group
                    of services) furnished beginning January 1,
                    2019, the Secretary shall--
                              (i) extend such pass-through status
                            for such drug or biological for the 9-
                            month period beginning on January 1,
                            2020;
                              (ii) remove, during such period, the
                            packaged costs of such drug or
                            biological (as determined by the
                            Secretary) from the payment amount
                            under this subsection for the covered
                            OPD service (or group of services) with
                            which it is packaged; and
                              (iii) not make any adjustments to
                            payment amounts under this subsection
                            for a covered OPD service (or group of
                            services) for which no costs were
                            removed under clause (ii).
              (7) Transitional adjustment to limit decline in
            payment.--
                      (A) Before 2002.--Subject to subparagraph
                    (D), for covered OPD services furnished before
                    January 1, 2002, for which the PPS amount (as
                    defined in subparagraph (E)) is--
                              (i) at least 90 percent, but less
                            than 100 percent, of the pre-BBA amount
                            (as defined in subparagraph (F)), the
                            amount of payment under this subsection
                            shall be increased by 80 percent of the
                            amount of such difference;
                              (ii) at least 80 percent, but less
                            than 90 percent, of the pre-BBA amount,
                            the amount of payment under this
                            subsection shall be increased by the
                            amount by which (I) the product of 0.71
                            and the pre-BBA amount, exceeds (II)
                            the product of 0.70 and the PPS amount;
                              (iii) at least 70 percent, but less
                            than 80 percent, of the pre-BBA amount,
                            the amount of payment under this
                            subsection shall be increased by the
                            amount by which (I) the product of 0.63
                            and the pre-BBA amount, exceeds (II)
                            the product of 0.60 and the PPS amount;
                            or
                              (iv) less than 70 percent of the pre-
                            BBA amount, the amount of payment under
                            this subsection shall be increased by
                            21 percent of the pre-BBA amount.
                      (B) 2002.--Subject to subparagraph (D), for
                    covered OPD services furnished during 2002, for
                    which the PPS amount is--
                              (i) at least 90 percent, but less
                            than 100 percent, of the pre-BBA
                            amount, the amount of payment under
                            this subsection shall be increased by
                            70 percent of the amount of such
                            difference;
                              (ii) at least 80 percent, but less
                            than 90 percent, of the pre-BBA amount,
                            the amount of payment under this
                            subsection shall be increased by the
                            amount by which (I) the product of 0.61
                            and the pre-BBA amount, exceeds (II)
                            the product of 0.60 and the PPS amount;
                            or
                              (iii) less than 80 percent of the
                            pre-BBA amount, the amount of payment
                            under this subsection shall be
                            increased by 13 percent of the pre-BBA
                            amount.
                      (C) 2003.--Subject to subparagraph (D), for
                    covered OPD services furnished during 2003, for
                    which the PPS amount is--
                              (i) at least 90 percent, but less
                            than 100 percent, of the pre-BBA
                            amount, the amount of payment under
                            this subsection shall be increased by
                            60 percent of the amount of such
                            difference; or
                              (ii) less than 90 percent of the pre-
                            BBA amount, the amount of payment under
                            this subsection shall be increased by 6
                            percent of the pre-BBA amount.
                      (D) Hold harmless provisions.--
                              (i) Temporary treatment for certain
                            rural hospitals.--(I) In the case of a
                            hospital located in a rural area and
                            that has not more than 100 beds or a
                            sole community hospital (as defined in
                            section 1886(d)(5)(D)(iii)) located in
                            a rural area, for covered OPD services
                            furnished before January 1, 2006, for
                            which the PPS amount is less than the
                            pre-BBA amount, the amount of payment
                            under this subsection shall be
                            increased by the amount of such
                            difference.
                              (II) In the case of a hospital
                            located in a rural area and that has
                            not more than 100 beds and that is not
                            a sole community hospital (as defined
                            in section 1886(d)(5)(D)(iii)), for
                            covered OPD services furnished on or
                            after January 1, 2006, and before
                            January 1, 2013, for which the PPS
                            amount is less than the pre-BBA amount,
                            the amount of payment under this
                            subsection shall be increased by the
                            applicable percentage of the amount of
                            such difference. For purposes of the
                            preceding sentence, the applicable
                            percentage shall be 95 percent with
                            respect to covered OPD services
                            furnished in 2006, 90 percent with
                            respect to such services furnished in
                            2007, and 85 percent with respect to
                            such services furnished in 2008, 2009,
                            2010, 2011, or 2012.
                              (III) In the case of a sole community
                            hospital (as defined in section
                            1886(d)(5)(D)(iii)) that has not more
                            than 100 beds, for covered OPD services
                            furnished on or after January 1, 2009,
                            and before January 1, 2013, for which
                            the PPS amount is less than the pre-BBA
                            amount, the amount of payment under
                            this subsection shall be increased by
                            85 percent of the amount of such
                            difference. In the case of covered OPD
                            services furnished on or after January
                            1, 2010, and before March 1, 2012, the
                            preceding sentence shall be applied
                            without regard to the 100-bed
                            limitation.
                              (ii) Permanent treatment for cancer
                            hospitals and children's hospitals.--In
                            the case of a hospital described in
                            clause (iii) or (v) of section
                            1886(d)(1)(B), for covered OPD services
                            for which the PPS amount is less than
                            the pre-BBA amount, the amount of
                            payment under this subsection shall be
                            increased by the amount of such
                            difference.
                      (E) PPS amount defined.--In this paragraph,
                    the term ``PPS amount'' means, with respect to
                    covered OPD services, the amount payable under
                    this title for such services (determined
                    without regard to this paragraph), including
                    amounts payable as copayment under paragraph
                    (8), coinsurance under section
                    1866(a)(2)(A)(ii), and the deductible under
                    section 1833(b).
                      (F) Pre-BBA amount defined.--
                              (i) In general.--In this paragraph,
                            the ``pre-BBA amount'' means, with
                            respect to covered OPD services
                            furnished by a hospital in a year, an
                            amount equal to the product of the
                            reasonable cost of the hospital for
                            such services for the portions of the
                            hospital's cost reporting period (or
                            periods) occurring in the year and the
                            base OPD payment-to-cost ratio for the
                            hospital (as defined in clause (ii)).
                              (ii) Base payment-to-cost-ratio
                            defined.--For purposes of this
                            subparagraph, the ``base payment-to-
                            cost ratio'' for a hospital means the
                            ratio of--
                                      (I) the hospital's
                                    reimbursement under this part
                                    for covered OPD services
                                    furnished during the cost
                                    reporting period ending in 1996
                                    (or in the case of a hospital
                                    that did not submit a cost
                                    report for such period, during
                                    the first subsequent cost
                                    reporting period ending before
                                    2001 for which the hospital
                                    submitted a cost report),
                                    including any reimbursement for
                                    such services through cost-
                                    sharing described in
                                    subparagraph (E), to
                                      (II) the reasonable cost of
                                    such services for such period.
                            The Secretary shall determine such
                            ratios as if the amendments made by
                            section 4521 of the Balanced Budget Act
                            of 1997 were in effect in 1996.
                      (G) Interim payments.--The Secretary shall
                    make payments under this paragraph to hospitals
                    on an interim basis, subject to retrospective
                    adjustments based on settled cost reports.
                      (H) No effect on copayments.--Nothing in this
                    paragraph shall be construed to affect the
                    unadjusted copayment amount described in
                    paragraph (3)(B) or the copayment amount under
                    paragraph (8).
                      (I) Application without regard to budget
                    neutrality.--The additional payments made under
                    this paragraph--
                              (i) shall not be considered an
                            adjustment under paragraph (2)(E); and
                              (ii) shall not be implemented in a
                            budget neutral manner.
              (8) Copayment amount.--
                      (A) In general.--Except as provided in
                    subparagraphs (B) and (C), the copayment amount
                    under this subsection is the amount by which
                    the amount described in paragraph (4)(B)
                    exceeds the amount of payment determined under
                    paragraph (4)(C).
                      (B) Election to offer reduced copayment
                    amount.--The Secretary shall establish a
                    procedure under which a hospital, before the
                    beginning of a year (beginning with 1999), may
                    elect to reduce the copayment amount otherwise
                    established under subparagraph (A) for some or
                    all covered OPD services to an amount that is
                    not less than 20 percent of the medicare OPD
                    fee schedule amount (computed under paragraph
                    (3)(D)) for the service involved. Under such
                    procedures, such reduced copayment amount may
                    not be further reduced or increased during the
                    year involved and the hospital may disseminate
                    information on the reduction of copayment
                    amount effected under this subparagraph.
                      (C) Limitation on copayment amount.--
                              (i) To inpatient hospital deductible
                            amount.--In no case shall the copayment
                            amount for a procedure performed in a
                            year exceed the amount of the inpatient
                            hospital deductible established under
                            section 1813(b) for that year.
                              (ii) To specified percentage.--The
                            Secretary shall reduce the national
                            unadjusted copayment amount for a
                            covered OPD service (or group of such
                            services) furnished in a year in a
                            manner so that the effective copayment
                            rate (determined on a national
                            unadjusted basis) for that service in
                            the year does not exceed the following
                            percentage:
                                      (I) For procedures performed
                                    in 2001, on or after April 1,
                                    2001, 57 percent.
                                      (II) For procedures performed
                                    in 2002 or 2003, 55 percent.
                                      (III) For procedures
                                    performed in 2004, 50 percent.
                                      (IV) For procedures performed
                                    in 2005, 45 percent.
                                      (V) For procedures performed
                                    in 2006 and thereafter, 40
                                    percent.
                      (D) No impact on deductibles.--Nothing in
                    this paragraph shall be construed as affecting
                    a hospital's authority to waive the charging of
                    a deductible under section 1833(b).
                      (E) Computation ignoring outlier and pass-
                    through adjustments.--The copayment amount
                    shall be computed under subparagraph (A) as if
                    the adjustments under paragraphs (5) and (6)
                    (and any adjustment made under paragraph (2)(E)
                    in relation to such adjustments) had not
                    occurred.
              (9) Periodic review and adjustments components of
            prospective payment system.--
                      (A) Periodic review.--The Secretary shall
                    review not less often than annually and revise
                    the groups, the relative payment weights, and
                    the wage and other adjustments described in
                    paragraph (2) to take into account changes in
                    medical practice, changes in technology, the
                    addition of new services, new cost data, and
                    other relevant information and factors. The
                    Secretary shall consult with an expert outside
                    advisory panel composed of an appropriate
                    selection of representatives of providers to
                    review (and advise the Secretary concerning)
                    the clinical integrity of the groups and
                    weights. Such panel may use data collected or
                    developed by entities and organizations (other
                    than the Department of Health and Human
                    Services) in conducting such review.
                      (B) Budget neutrality adjustment.--If the
                    Secretary makes adjustments under subparagraph
                    (A), then the adjustments for a year may not
                    cause the estimated amount of expenditures
                    under this part for the year to increase or
                    decrease from the estimated amount of
                    expenditures under this part that would have
                    been made if the adjustments had not been made.
                    In determining adjustments under the preceding
                    sentence for 2004 and 2005, the Secretary shall
                    not take into account under this subparagraph
                    or paragraph (2)(E) any expenditures that would
                    not have been made but for the application of
                    paragraph (14).
                      (C) Update factor.--If the Secretary
                    determines under methodologies described in
                    paragraph (2)(F) that the volume of services
                    paid for under this subsection increased beyond
                    amounts established through those
                    methodologies, the Secretary may appropriately
                    adjust the update to the conversion factor
                    otherwise applicable in a subsequent year.
              (10) Special rule for ambulance services.--The
            Secretary shall pay for hospital outpatient services
            that are ambulance services on the basis described in
            section 1861(v)(1)(U), or, if applicable, the fee
            schedule established under section 1834(l).
              (11) Special rules for certain hospitals.--In the
            case of hospitals described in clause (iii) or (v) of
            section 1886(d)(1)(B)--
                      (A) the system under this subsection shall
                    not apply to covered OPD services furnished
                    before January 1, 2000; and
                      (B) the Secretary may establish a separate
                    conversion factor for such services in a manner
                    that specifically takes into account the unique
                    costs incurred by such hospitals by virtue of
                    their patient population and service intensity.
              (12) Limitation on review.--There shall be no
            administrative or judicial review under section 1869,
            1878, or otherwise of--
                      (A) the development of the classification
                    system under paragraph (2), including the
                    establishment of groups and relative payment
                    weights for covered OPD services, of wage
                    adjustment factors, other adjustments, and
                    methods described in paragraph (2)(F);
                      (B) the calculation of base amounts under
                    paragraph (3);
                      (C) periodic adjustments made under paragraph
                    (6);
                      (D) the establishment of a separate
                    conversion factor under paragraph (8)(B); and
                      (E) the determination of the fixed multiple,
                    or a fixed dollar cutoff amount, the marginal
                    cost of care, or applicable percentage under
                    paragraph (5) or the determination of
                    insignificance of cost, the duration of the
                    additional payments, the determination and
                    deletion of initial and new categories
                    (consistent with subparagraphs (B) and (C) of
                    paragraph (6)), the portion of the medicare OPD
                    fee schedule amount associated with particular
                    devices, drugs, or biologicals, and the
                    application of any pro rata reduction under
                    paragraph (6).
              (13) Authorization of adjustment for rural
            hospitals.--
                      (A) Study.--The Secretary shall conduct a
                    study to determine if, under the system under
                    this subsection, costs incurred by hospitals
                    located in rural areas by ambulatory payment
                    classification groups (APCs) exceed those costs
                    incurred by hospitals located in urban areas.
                      (B) Authorization of adjustment.--Insofar as
                    the Secretary determines under subparagraph (A)
                    that costs incurred by hospitals located in
                    rural areas exceed those costs incurred by
                    hospitals located in urban areas, the Secretary
                    shall provide for an appropriate adjustment
                    under paragraph (2)(E) to reflect those higher
                    costs by January 1, 2006.
              (14) Drug apc payment rates.--
                      (A) In general.--The amount of payment under
                    this subsection for a specified covered
                    outpatient drug (defined in subparagraph (B))
                    that is furnished as part of a covered OPD
                    service (or group of services)--
                              (i) in 2004, in the case of--
                                      (I) a sole source drug shall
                                    in no case be less than 88
                                    percent, or exceed 95 percent,
                                    of the reference average
                                    wholesale price for the drug;
                                      (II) an innovator multiple
                                    source drug shall in no case
                                    exceed 68 percent of the
                                    reference average wholesale
                                    price for the drug; or
                                      (III) a noninnovator multiple
                                    source drug shall in no case
                                    exceed 46 percent of the
                                    reference average wholesale
                                    price for the drug;
                              (ii) in 2005, in the case of--
                                      (I) a sole source drug shall
                                    in no case be less than 83
                                    percent, or exceed 95 percent,
                                    of the reference average
                                    wholesale price for the drug;
                                      (II) an innovator multiple
                                    source drug shall in no case
                                    exceed 68 percent of the
                                    reference average wholesale
                                    price for the drug; or
                                      (III) a noninnovator multiple
                                    source drug shall in no case
                                    exceed 46 percent of the
                                    reference average wholesale
                                    price for the drug; or
                              (iii) in a subsequent year, shall be
                            equal, subject to subparagraph (E)--
                                      (I) to the average
                                    acquisition cost for the drug
                                    for that year (which, at the
                                    option of the Secretary, may
                                    vary by hospital group (as
                                    defined by the Secretary based
                                    on volume of covered OPD
                                    services or other relevant
                                    characteristics)), as
                                    determined by the Secretary
                                    taking into account the
                                    hospital acquisition cost
                                    survey data under subparagraph
                                    (D); or
                                      (II) if hospital acquisition
                                    cost data are not available,
                                    the average price for the drug
                                    in the year established under
                                    section 1842(o), section 1847A,
                                    or section 1847B, as the case
                                    may be, as calculated and
                                    adjusted by the Secretary as
                                    necessary for purposes of this
                                    paragraph.
                      (B) Specified covered outpatient drug
                    defined.--
                              (i) In general.--In this paragraph,
                            the term ``specified covered outpatient
                            drug'' means, subject to clause (ii), a
                            covered outpatient drug (as defined in
                            section 1927(k)(2)) for which a
                            separate ambulatory payment
                            classification group (APC) has been
                            established and that is--
                                      (I) a radiopharmaceutical; or
                                      (II) a drug or biological for
                                    which payment was made under
                                    paragraph (6) (relating to
                                    pass-through payments) on or
                                    before December 31, 2002.
                              (ii) Exception.--Such term does not
                            include--
                                      (I) a drug or biological for
                                    which payment is first made on
                                    or after January 1, 2003, under
                                    paragraph (6);
                                      (II) a drug or biological for
                                    which a temporary HCPCS code
                                    has not been assigned; or
                                      (III) during 2004 and 2005,
                                    an orphan drug (as designated
                                    by the Secretary).
                      (C) Payment for designated orphan drugs
                    during 2004 and 2005.--The amount of payment
                    under this subsection for an orphan drug
                    designated by the Secretary under subparagraph
                    (B)(ii)(III) that is furnished as part of a
                    covered OPD service (or group of services)
                    during 2004 and 2005 shall equal such amount as
                    the Secretary may specify.
                      (D) Acquisition cost survey for hospital
                    outpatient drugs.--
                              (i) Annual gao surveys in 2004 and
                            2005.--
                                      (I) In general.--The
                                    Comptroller General of the
                                    United States shall conduct a
                                    survey in each of 2004 and 2005
                                    to determine the hospital
                                    acquisition cost for each
                                    specified covered outpatient
                                    drug. Not later than April 1,
                                    2005, the Comptroller General
                                    shall furnish data from such
                                    surveys to the Secretary for
                                    use in setting the payment
                                    rates under subparagraph (A)
                                    for 2006.
                                      (II) Recommendations.--Upon
                                    the completion of such surveys,
                                    the Comptroller General shall
                                    recommend to the Secretary the
                                    frequency and methodology of
                                    subsequent surveys to be
                                    conducted by the Secretary
                                    under clause (ii).
                              (ii) Subsequent secretarial
                            surveys.--The Secretary, taking into
                            account such recommendations, shall
                            conduct periodic subsequent surveys to
                            determine the hospital acquisition cost
                            for each specified covered outpatient
                            drug for use in setting the payment
                            rates under subparagraph (A).
                              (iii) Survey requirements.--The
                            surveys conducted under clauses (i) and
                            (ii) shall have a large sample of
                            hospitals that is sufficient to
                            generate a statistically significant
                            estimate of the average hospital
                            acquisition cost for each specified
                            covered outpatient drug. With respect
                            to the surveys conducted under clause
                            (i), the Comptroller General shall
                            report to Congress on the justification
                            for the size of the sample used in
                            order to assure the validity of such
                            estimates.
                              (iv) Differentiation in cost.--In
                            conducting surveys under clause (i),
                            the Comptroller General shall determine
                            and report to Congress if there is (and
                            the extent of any) variation in
                            hospital acquisition costs for drugs
                            among hospitals based on the volume of
                            covered OPD services performed by such
                            hospitals or other relevant
                            characteristics of such hospitals (as
                            defined by the Comptroller General).
                              (v) Comment on proposed rates.--Not
                            later than 30 days after the date the
                            Secretary promulgated proposed rules
                            setting forth the payment rates under
                            subparagraph (A) for 2006, the
                            Comptroller General shall evaluate such
                            proposed rates and submit to Congress a
                            report regarding the appropriateness of
                            such rates based on the surveys the
                            Comptroller General has conducted under
                            clause (i).
                      (E) Adjustment in payment rates for overhead
                    costs.--
                              (i) Medpac report on drug apc
                            design.--The Medicare Payment Advisory
                            Commission shall submit to the
                            Secretary, not later than July 1, 2005,
                            a report on adjustment of payment for
                            ambulatory payment classifications for
                            specified covered outpatient drugs to
                            take into account overhead and related
                            expenses, such as pharmacy services and
                            handling costs. Such report shall
                            include--
                                      (I) a description and
                                    analysis of the data available
                                    with regard to such expenses;
                                      (II) a recommendation as to
                                    whether such a payment
                                    adjustment should be made; and
                                      (III) if such adjustment
                                    should be made, a
                                    recommendation regarding the
                                    methodology for making such an
                                    adjustment.
                              (ii) Adjustment authorized.--The
                            Secretary may adjust the weights for
                            ambulatory payment classifications for
                            specified covered outpatient drugs to
                            take into account the recommendations
                            contained in the report submitted under
                            clause (i).
                      (F) Classes of drugs.--For purposes of this
                    paragraph:
                              (i) Sole source drugs.--The term
                            ``sole source drug'' means--
                                      (I) a biological product (as
                                    defined under section
                                    1861(t)(1)); or
                                      (II) a single source drug (as
                                    defined in section
                                    1927(k)(7)(A)(iv)).
                              (ii) Innovator multiple source
                            drugs.--The term ``innovator multiple
                            source drug'' has the meaning given
                            such term in section 1927(k)(7)(A)(ii).
                              (iii) Noninnovator multiple source
                            drugs.--The term ``noninnovator
                            multiple source drug'' has the meaning
                            given such term in section
                            1927(k)(7)(A)(iii).
                      (G) Reference average wholesale price.--The
                    term ``reference average wholesale price''
                    means, with respect to a specified covered
                    outpatient drug, the average wholesale price
                    for the drug as determined under section
                    1842(o) as of May 1, 2003.
                      (H) Inapplicability of expenditures in
                    determining conversion, weighting, and other
                    adjustment factors.--Additional expenditures
                    resulting from this paragraph shall not be
                    taken into account in establishing the
                    conversion, weighting, and other adjustment
                    factors for 2004 and 2005 under paragraph (9),
                    but shall be taken into account for subsequent
                    years.
              (15) Payment for new drugs and biologicals until
            hcpcs code assigned.--With respect to payment under
            this part for an outpatient drug or biological that is
            covered under this part and is furnished as part of
            covered OPD services for which a HCPCS code has not
            been assigned, the amount provided for payment for such
            drug or biological under this part shall be equal to 95
            percent of the average wholesale price for the drug or
            biological.
              (16) Miscellaneous provisions.--
                      (A) Application of reclassification of
                    certain hospitals.--If a hospital is being
                    treated as being located in a rural area under
                    section 1886(d)(8)(E), that hospital shall be
                    treated under this subsection as being located
                    in that rural area.
                      (B) Threshold for establishment of separate
                    apcs for drugs.--The Secretary shall reduce the
                    threshold for the establishment of separate
                    ambulatory payment classification groups (APCs)
                    with respect to drugs or biologicals to $50 per
                    administration for drugs and biologicals
                    furnished in 2005 and 2006.
                      (C) Payment for devices of brachytherapy and
                    therapeutic radiopharmaceuticals at charges
                    adjusted to cost.--Notwithstanding the
                    preceding provisions of this subsection, for a
                    device of brachytherapy consisting of a seed or
                    seeds (or radioactive source) furnished on or
                    after January 1, 2004, and before January 1,
                    2010, and for therapeutic radiopharmaceuticals
                    furnished on or after January 1, 2008, and
                    before January 1, 2010, the payment basis for
                    the device or therapeutic radiopharmaceutical
                    under this subsection shall be equal to the
                    hospital's charges for each device or
                    therapeutic radiopharmaceutical furnished,
                    adjusted to cost. Charges for such devices or
                    therapeutic radiopharmaceuticals shall not be
                    included in determining any outlier payment
                    under this subsection.
                      (D) Special payment rule.--
                              (i) In general.--In the case of
                            covered OPD services furnished on or
                            after April 1, 2013, in a hospital
                            described in clause (ii), if--
                                      (I) the payment rate that
                                    would otherwise apply under
                                    this subsection for
                                    stereotactic radiosurgery,
                                    complete course of treatment of
                                    cranial lesion(s) consisting of
                                    1 session that is multi-source
                                    Cobalt 60 based (identified as
                                    of January 1, 2013, by HCPCS
                                    code 77371 (and any succeeding
                                    code) and reimbursed as of such
                                    date under APC 0127 (and any
                                    succeeding classification
                                    group)); exceeds
                                      (II) the payment rate that
                                    would otherwise apply under
                                    this subsection for linear
                                    accelerator based stereotactic
                                    radiosurgery, complete course
                                    of therapy in one session
                                    (identified as of January 1,
                                    2013, by HCPCS code G0173 (and
                                    any succeeding code) and
                                    reimbursed as of such date
                                    under APC 0067 (and any
                                    succeeding classification
                                    group)),
                            the payment rate for the service
                            described in subclause (I) shall be
                            reduced to an amount equal to the
                            payment rate for the service described
                            in subclause (II).
                              (ii) Hospital described.--A hospital
                            described in this clause is a hospital
                            that is not--
                                      (I) located in a rural area
                                    (as defined in section
                                    1886(d)(2)(D));
                                      (II) classified as a rural
                                    referral center under section
                                    1886(d)(5)(C); or
                                      (III) a sole community
                                    hospital (as defined in section
                                    1886(d)(5)(D)(iii)).
                              (iii) Not budget neutral.--In making
                            any budget neutrality adjustments under
                            this subsection for 2013 (with respect
                            to covered OPD services furnished on or
                            after April 1, 2013, and before January
                            1, 2014) or a subsequent year, the
                            Secretary shall not take into account
                            the reduced expenditures that result
                            from the application of this
                            subparagraph.
                      (E) Application of appropriate use criteria
                    for certain imaging services.--For provisions
                    relating to the application of appropriate use
                    criteria for certain imaging services, see
                    section 1834(q).
                      (F) Payment incentive for the transition from
                    traditional x-ray imaging to digital
                    radiography.--Notwithstanding the previous
                    provisions of this subsection:
                              (i) Limitation on payment for film x-
                            ray imaging services.--In the case of
                            an imaging service that is an X-ray
                            taken using film and that is furnished
                            during 2017 or a subsequent year, the
                            payment amount for such service
                            (including the X-ray component of a
                            packaged service) that would otherwise
                            be determined under this section
                            (without application of this paragraph
                            and before application of any other
                            adjustment under this subsection) for
                            such year shall be reduced by 20
                            percent.
                              (ii) Phased-in limitation on payment
                            for computed radiography imaging
                            services.--In the case of an imaging
                            service that is an X-ray taken using
                            computed radiography technology (as
                            defined in section 1848(b)(9)(C))--
                                      (I) in the case of such a
                                    service furnished during 2018,
                                    2019, 2020, 2021, or 2022, the
                                    payment amount for such service
                                    (including the X-ray component
                                    of a packaged service) that
                                    would otherwise be determined
                                    under this section (without
                                    application of this paragraph
                                    and before application of any
                                    other adjustment under this
                                    subsection) for such year shall
                                    be reduced by 7 percent; and
                                      (II) in the case of such a
                                    service furnished during 2023
                                    or a subsequent year, the
                                    payment amount for such service
                                    (including the X-ray component
                                    of a packaged service) that
                                    would otherwise be determined
                                    under this section (without
                                    application of this paragraph
                                    and before application of any
                                    other adjustment under this
                                    subsection) for such year shall
                                    be reduced by 10 percent.
                              (iii) Application without regard to
                            budget neutrality.--The reductions made
                            under this subparagraph--
                                      (I) shall not be considered
                                    an adjustment under paragraph
                                    (2)(E); and
                                      (II) shall not be implemented
                                    in a budget neutral manner.
                              (iv) Implementation.--In order to
                            implement this subparagraph, the
                            Secretary shall adopt appropriate
                            mechanisms which may include use of
                            modifiers.
              (17) Quality reporting.--
                      (A) Reduction in update for failure to
                    report.--
                              (i) In general.--For purposes of
                            paragraph (3)(C)(iv) for 2009 and each
                            subsequent year, in the case of a
                            subsection (d) hospital (as defined in
                            section 1886(d)(1)(B)) that does not
                            submit, to the Secretary in accordance
                            with this paragraph, data required to
                            be submitted on measures selected under
                            this paragraph with respect to such a
                            year, the OPD fee schedule increase
                            factor under paragraph (3)(C)(iv) for
                            such year shall be reduced by 2.0
                            percentage points.
                              (ii) Non-cumulative application.--A
                            reduction under this subparagraph shall
                            apply only with respect to the year
                            involved and the Secretary shall not
                            take into account such reduction in
                            computing the OPD fee schedule increase
                            factor for a subsequent year.
                      (B) Form and manner of submission.--Each
                    subsection (d) hospital shall submit data on
                    measures selected under this paragraph to the
                    Secretary in a form and manner, and at a time,
                    specified by the Secretary for purposes of this
                    paragraph.
                      (C) Development of outpatient measures.--
                              (i) In general.--The Secretary shall
                            develop measures that the Secretary
                            determines to be appropriate for the
                            measurement of the quality of care
                            (including medication errors) furnished
                            by hospitals in outpatient settings and
                            that reflect consensus among affected
                            parties and, to the extent feasible and
                            practicable, shall include measures set
                            forth by one or more national consensus
                            building entities.
                              (ii) Construction.--Nothing in this
                            paragraph shall be construed as
                            preventing the Secretary from selecting
                            measures that are the same as (or a
                            subset of) the measures for which data
                            are required to be submitted under
                            section 1886(b)(3)(B)(viii).
                      (D) Replacement of measures.--For purposes of
                    this paragraph, the Secretary may replace any
                    measures or indicators in appropriate cases,
                    such as where all hospitals are effectively in
                    compliance or the measures or indicators have
                    been subsequently shown not to represent the
                    best clinical practice.
                      (E) Availability of data.--The Secretary
                    shall establish procedures for making data
                    submitted under this paragraph available to the
                    public. Such procedures shall ensure that a
                    hospital has the opportunity to review the data
                    that are to be made public with respect to the
                    hospital prior to such data being made public.
                    The Secretary shall report quality measures of
                    process, structure, outcome, patients'
                    perspectives on care, efficiency, and costs of
                    care that relate to services furnished in
                    outpatient settings in hospitals on the
                    Internet website of the Centers for Medicare &
                    Medicaid Services.
              (18) Authorization of adjustment for cancer
            hospitals.--
                      (A) Study.--The Secretary shall conduct a
                    study to determine if, under the system under
                    this subsection, costs incurred by hospitals
                    described in section 1886(d)(1)(B)(v) with
                    respect to ambulatory payment classification
                    groups exceed those costs incurred by other
                    hospitals furnishing services under this
                    subsection (as determined appropriate by the
                    Secretary). In conducting the study under this
                    subparagraph, the Secretary shall take into
                    consideration the cost of drugs and biologicals
                    incurred by such hospitals.
                      (B) Authorization of adjustment.--Insofar as
                    the Secretary determines under subparagraph (A)
                    that costs incurred by hospitals described in
                    section 1886(d)(1)(B)(v) exceed those costs
                    incurred by other hospitals furnishing services
                    under this subsection, the Secretary shall,
                    subject to subparagraph (C), provide for an
                    appropriate adjustment under paragraph (2)(E)
                    to reflect those higher costs effective for
                    services furnished on or after January 1, 2011.
                      (C) Target pcr adjustment.--In applying
                    section 419.43(i) of title 42 of the Code of
                    Federal Regulations to implement the
                    appropriate adjustment under this paragraph for
                    services furnished on or after January 1, 2018,
                    the Secretary shall use a target PCR that is
                    1.0 percentage points less than the target PCR
                    that would otherwise apply. In addition to the
                    percentage point reduction under the previous
                    sentence, the Secretary may consider making an
                    additional percentage point reduction to such
                    target PCR that takes into account payment
                    rates for applicable items and services
                    described in paragraph (21)(C) other than for
                    services furnished by hospitals described in
                    section 1886(d)(1)(B)(v). In making any budget
                    neutrality adjustments under this subsection
                    for 2018 or a subsequent year, the Secretary
                    shall not take into account the reduced
                    expenditures that result from the application
                    of this subparagraph.
              (19) Floor on area wage adjustment factor for
            hospital outpatient department services in frontier
            states.--
                      (A) In general.--Subject to subparagraph (B),
                    with respect to covered OPD services furnished
                    on or after January 1, 2011, the area wage
                    adjustment factor applicable under the payment
                    system established under this subsection to any
                    hospital outpatient department which is located
                    in a frontier State (as defined in section
                    1886(d)(3)(E)(iii)(II)) may not be less than
                    1.00. The preceding sentence shall not be
                    applied in a budget neutral manner.
                      (B) Limitation.--This paragraph shall not
                    apply to any hospital outpatient department
                    located in a State that receives a non-labor
                    related share adjustment under section
                    1886(d)(5)(H).
              (20) Not budget neutral application of reduced
            expenditures resulting from quality incentives for
            computed tomography.--The Secretary shall not take into
            account the reduced expenditures that result from the
            application of section 1834(p) in making any budget
            neutrality adjustments this subsection.
              (21) Services furnished by an off-campus outpatient
            department of a provider.--
                      (A) Applicable items and services.--For
                    purposes of paragraph (1)(B)(v) and this
                    paragraph, the term ``applicable items and
                    services'' means items and services other than
                    items and services furnished by a dedicated
                    emergency department (as defined in section
                    489.24(b) of title 42 of the Code of Federal
                    Regulations).
                      (B) Off-campus outpatient department of a
                    provider.--
                              (i) In general.--For purposes of
                            paragraph (1)(B)(v) and this paragraph,
                            subject to the subsequent provisions of
                            this subparagraph, the term ``off-
                            campus outpatient department of a
                            provider'' means a department of a
                            provider (as defined in section
                            413.65(a)(2) of title 42 of the Code of
                            Federal Regulations, as in effect as of
                            the date of the enactment of this
                            paragraph) that is not located--
                                      (I) on the campus (as defined
                                    in such section 413.65(a)(2))
                                    of such provider; or
                                      (II) within the distance
                                    (described in such definition
                                    of campus) from a remote
                                    location of a hospital facility
                                    (as defined in such section
                                    413.65(a)(2)).
                              (ii) Exception.--For purposes of
                            paragraph (1)(B)(v) and this paragraph,
                            the term ``off-campus outpatient
                            department of a provider'' shall not
                            include a department of a provider (as
                            so defined) that was billing under this
                            subsection with respect to covered OPD
                            services furnished prior to the date of
                            the enactment of this paragraph.
                              (iii) Deemed treatment for 2017.--For
                            purposes of applying clause (ii) with
                            respect to applicable items and
                            services furnished during 2017, a
                            department of a provider (as so
                            defined) not described in such clause
                            is deemed to be billing under this
                            subsection with respect to covered OPD
                            services furnished prior to November 2,
                            2015, if the Secretary received from
                            the provider prior to December 2, 2015,
                            an attestation (pursuant to section
                            413.65(b)(3) of title 42 of the Code of
                            Federal Regulations) that such
                            department was a department of a
                            provider (as so defined).
                              (iv) Alternative exception beginning
                            with 2018.--For purposes of paragraph
                            (1)(B)(v) and this paragraph with
                            respect to applicable items and
                            services furnished during 2018 or a
                            subsequent year, the term ``off-campus
                            outpatient department of a provider''
                            also shall not include a department of
                            a provider (as so defined) that is not
                            described in clause (ii) if--
                                      (I) the Secretary receives
                                    from the provider an
                                    attestation (pursuant to such
                                    section 413.65(b)(3)) not later
                                    than December 31, 2016 (or, if
                                    later, 60 days after the date
                                    of the enactment of this
                                    clause), that such department
                                    met the requirements of a
                                    department of a provider
                                    specified in section 413.65 of
                                    title 42 of the Code of Federal
                                    Regulations;
                                      (II) the provider includes
                                    such department as part of the
                                    provider on its enrollment form
                                    in accordance with the
                                    enrollment process under
                                    section 1866(j); and
                                      (III) the department met the
                                    mid-build requirement of clause
                                    (v) and the Secretary receives,
                                    not later than 60 days after
                                    the date of the enactment of
                                    this clause, from the chief
                                    executive officer or chief
                                    operating officer of the
                                    provider a written
                                    certification that the
                                    department met such
                                    requirement.
                              (v) Mid-build requirement
                            described.--The mid-build requirement
                            of this clause is, with respect to a
                            department of a provider, that before
                            November 2, 2015, the provider had a
                            binding written agreement with an
                            outside unrelated party for the actual
                            construction of such department.
                              (vi) Exclusion for certain cancer
                            hospitals.--For purposes of paragraph
                            (1)(B)(v) and this paragraph with
                            respect to applicable items and
                            services furnished during 2017 or a
                            subsequent year, the term ``off-campus
                            outpatient department of a provider''
                            also shall not include a department of
                            a provider (as so defined) that is not
                            described in clause (ii) if the
                            provider is a hospital described in
                            section 1886(d)(1)(B)(v) and--
                                      (I) in the case of a
                                    department that met the
                                    requirements of section 413.65
                                    of title 42 of the Code of
                                    Federal Regulations after
                                    November 1, 2015, and before
                                    the date of the enactment of
                                    this clause, the Secretary
                                    receives from the provider an
                                    attestation that such
                                    department met such
                                    requirements not later than 60
                                    days after such date of
                                    enactment; or
                                      (II) in the case of a
                                    department that meets such
                                    requirements after such date of
                                    enactment, the Secretary
                                    receives from the provider an
                                    attestation that such
                                    department meets such
                                    requirements not later than 60
                                    days after the date such
                                    requirements are first met with
                                    respect to such department.
                              (vii) Audit.--Not later than December
                            31, 2018, the Secretary shall audit the
                            compliance with requirements of clause
                            (iv) with respect to each department of
                            a provider to which such clause
                            applies. Not later than 2 years after
                            the date the Secretary receives an
                            attestation under clause (vi) relating
                            to compliance of a department of a
                            provider with requirements referred to
                            in such clause, the Secretary shall
                            audit the compliance with such
                            requirements with respect to the
                            department. If the Secretary finds as a
                            result of an audit under this clause
                            that the applicable requirements were
                            not met with respect to such
                            department, the department shall not be
                            excluded from the term ``off-campus
                            outpatient department of a provider''
                            under such clause.
                              (viii) Implementation.--For purposes
                            of implementing clauses (iii) through
                            (vii):
                                      (I) Notwithstanding any other
                                    provision of law, the Secretary
                                    may implement such clauses by
                                    program instruction or
                                    otherwise.
                                      (II) Subchapter I of chapter
                                    35 of title 44, United States
                                    Code, shall not apply.
                                      (III) For purposes of
                                    carrying out this subparagraph
                                    with respect to clauses (iii)
                                    and (iv) (and clause (vii)
                                    insofar as it relates to clause
                                    (iv)), $10,000,000 shall be
                                    available from the Federal
                                    Supplementary Medical Insurance
                                    Trust Fund under section 1841,
                                    to remain available until
                                    December 31, 2018. For purposes
                                    of carrying out this
                                    subparagraph with respect to
                                    clause (vi) (and clause (vii)
                                    insofar as it relates to such
                                    clause), $2,000,000 shall be
                                    available from the Federal
                                    Supplementary Medical Insurance
                                    Trust Fund under section 1841,
                                    to remain available until
                                    expended.
                      (C) Availability of payment under other
                    payment systems.--Payments for applicable items
                    and services furnished by an off-campus
                    outpatient department of a provider that are
                    described in paragraph (1)(B)(v) shall be made
                    under the applicable payment system under this
                    part (other than under this subsection) if the
                    requirements for such payment are otherwise
                    met.
                      (D) Information needed for implementation.--
                    Each hospital shall provide to the Secretary
                    such information as the Secretary determines
                    appropriate to implement this paragraph and
                    paragraph (1)(B)(v) (which may include
                    reporting of information on a hospital claim
                    using a code or modifier and reporting
                    information about off-campus outpatient
                    departments of a provider on the enrollment
                    form described in section 1866(j)).
                      (E) Limitations.--There shall be no
                    administrative or judicial review under section
                    1869, section 1878, or otherwise of the
                    following:
                              (i) The determination of the
                            applicable items and services under
                            subparagraph (A) and applicable payment
                            systems under subparagraph (C).
                              (ii) The determination of whether a
                            department of a provider meets the term
                            described in subparagraph (B).
                              (iii) Any information that hospitals
                            are required to report pursuant to
                            subparagraph (D).
                              (iv) The determination of an audit
                            under subparagraph (B)(vii).
              (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.
      (u) Incentive Payments for Physician Scarcity Areas.--
              (1) In general.--In the case of physicians' services
            furnished on or after January 1, 2005, and before July
            1, 2008--
                      (A) by a primary care physician in a primary
                    care scarcity county (identified under
                    paragraph (4)); or
                      (B) by a physician who is not a primary care
                    physician in a specialist care scarcity county
                    (as so identified),
            in addition to the amount of payment that would
            otherwise be made for such services under this part,
            there also shall be paid an amount equal to 5 percent
            of the payment amount for the service under this part.
              (2) Determination of ratios of physicians to medicare
            beneficiaries in area.--Based upon available data, the
            Secretary shall establish for each county or equivalent
            area in the United States, the following:
                      (A) Number of physicians practicing in the
                    area.--The number of physicians who furnish
                    physicians' services in the active practice of
                    medicine or osteopathy in that county or area,
                    other than physicians whose practice is
                    exclusively for the Federal Government,
                    physicians who are retired, or physicians who
                    only provide administrative services. Of such
                    number, the number of such physicians who are--
                              (i) primary care physicians; or
                              (ii) physicians who are not primary
                            care physicians.
                      (B) Number of medicare beneficiaries residing
                    in the area.--The number of individuals who are
                    residing in the county and are entitled to
                    benefits under part A or enrolled under this
                    part, or both (in this subsection referred to
                    as ``individuals'').
                      (C) Determination of ratios.--
                              (i) Primary care ratio.--The ratio
                            (in this paragraph referred to as the
                            ``primary care ratio'') of the number
                            of primary care physicians (determined
                            under subparagraph (A)(i)), to the
                            number of individuals determined under
                            subparagraph (B).
                              (ii) Specialist care ratio.--The
                            ratio (in this paragraph referred to as
                            the ``specialist care ratio'') of the
                            number of other physicians (determined
                            under subparagraph (A)(ii)), to the
                            number of individuals determined under
                            subparagraph (B).
              (3) Ranking of counties.--The Secretary shall rank
            each such county or area based separately on its
            primary care ratio and its specialist care ratio.
              (4) Identification of counties.--
                      (A) In general.--The Secretary shall
                    identify--
                              (i) those counties and areas (in this
                            paragraph referred to as ``primary care
                            scarcity counties'') with the lowest
                            primary care ratios that represent, if
                            each such county or area were weighted
                            by the number of individuals determined
                            under paragraph (2)(B), an aggregate
                            total of 20 percent of the total of the
                            individuals determined under such
                            paragraph; and
                              (ii) those counties and areas (in
                            this subsection referred to as
                            ``specialist care scarcity counties'')
                            with the lowest specialist care ratios
                            that represent, if each such county or
                            area were weighted by the number of
                            individuals determined under paragraph
                            (2)(B), an aggregate total of 20
                            percent of the total of the individuals
                            determined under such paragraph.
                      (B) Periodic revisions.--The Secretary shall
                    periodically revise the counties or areas
                    identified in subparagraph (A) (but not less
                    often than once every three years) unless the
                    Secretary determines that there is no new data
                    available on the number of physicians
                    practicing in the county or area or the number
                    of individuals residing in the county or area,
                    as identified in paragraph (2).
                      (C) Identification of counties where service
                    is furnished.--For purposes of paying the
                    additional amount specified in paragraph (1),
                    if the Secretary uses the 5-digit postal ZIP
                    Code where the service is furnished, the
                    dominant county of the postal ZIP Code (as
                    determined by the United States Postal Service,
                    or otherwise) shall be used to determine
                    whether the postal ZIP Code is in a scarcity
                    county identified in subparagraph (A) or
                    revised in subparagraph (B).
                      (D) Special rule.--With respect to
                    physicians' services furnished on or after
                    January 1, 2008, and before July 1, 2008, for
                    purposes of this subsection, the Secretary
                    shall use the primary care scarcity counties
                    and the specialty care scarcity counties (as
                    identified under the preceding provisions of
                    this paragraph) that the Secretary was using
                    under this subsection with respect to
                    physicians' services furnished on December 31,
                    2007.
                      (E) Judicial review.--There shall be no
                    administrative or judicial review under section
                    1869, 1878, or otherwise, respecting--
                              116.(i) the identification of a
                            county or area;
                              (ii) the assignment of a specialty of
                            any physician under this paragraph;
                              (iii) the assignment of a physician
                            to a county under paragraph (2); or
                              (iv) the assignment of a postal ZIP
                            Code to a county or other area under
                            this subsection.
              (5) Rural census tracts.--To the extent feasible, the
            Secretary shall treat a rural census tract of a
            metropolitan statistical area (as determined under the
            most recent modification of the Goldsmith Modification,
            originally published in the Federal Register on
            February 27, 1992 (57 Fed. Reg. 6725)), as an
            equivalent area for purposes of qualifying as a primary
            care scarcity county or specialist care scarcity county
            under this subsection.
              (6) Physician Defined.--For purposes of this
            paragraph, the term ``physician'' means a physician
            described in section 1861(r)(1) and the term ``primary
            care physician'' means a physician who is identified in
            the available data as a general practitioner, family
            practice practitioner, general internist, or
            obstetrician or gynecologist.
              (7) Publication of list of counties; posting on
            website.--With respect to a year for which a county or
            area is identified or revised under paragraph (4), the
            Secretary shall identify such counties or areas as part
            of the proposed and final rule to implement the
            physician fee schedule under section 1848 for the
            applicable year. The Secretary shall post the list of
            counties identified or revised under paragraph (4) on
            the Internet website of the Centers for Medicare &
            Medicaid Services.
      (v) Increase of FQHC Payment Limits.--In the case of services
    furnished by Federally qualified health centers (as defined in
    section 1861(aa)(4)), the Secretary shall establish payment
    limits with respect to such services under this part for
    services furnished--
              (1) in 2010, at the limits otherwise established
            under this part for such year increased by $5; and
              (2) in a subsequent year, at the limits established
            under this subsection for the previous year increased
            by the percentage increase in the MEI (as defined in
            section 1842(i)(3)) for such subsequent year.
      (w) Methods of Payment.--The Secretary may develop
    alternative methods of payment for items and services provided
    under clinical trials and comparative effectiveness studies
    sponsored or supported by an agency of the Department of Health
    and Human Services, as determined by the Secretary, to those
    that would otherwise apply under this section, to the extent
    such alternative methods are necessary to preserve the
    scientific validity of such trials or studies, such as in the
    case where masking the identity of interventions from patients
    and investigators is necessary to comply with the particular
    trial or study design.
      (x) Incentive Payments for Primary Care Services.--
              (1) In general.--In the case of primary care services
            furnished on or after January 1, 2011, and before
            January 1, 2016, by a primary care practitioner, in
            addition to the amount of payment that would otherwise
            be made for such services under this part, there also
            shall be paid (on a monthly or quarterly basis) an
            amount equal to 10 percent of the payment amount for
            the service under this part.
              (2) Definitions.--In this subsection:
                      (A) Primary care practitioner.--The term
                    ``primary care practitioner'' means an
                    individual--
                              (i) who--
                                      (I) is a physician (as
                                    described in section
                                    1861(r)(1)) who has a primary
                                    specialty designation of family
                                    medicine, internal medicine,
                                    geriatric medicine, or
                                    pediatric medicine; or
                                      (II) is a nurse practitioner,
                                    clinical nurse specialist, or
                                    physician assistant (as those
                                    terms are defined in section
                                    1861(aa)(5)); and
                              (ii) for whom primary care services
                            accounted for at least 60 percent of
                            the allowed charges under this part for
                            such physician or practitioner in a
                            prior period as determined appropriate
                            by the Secretary.
                      (B) Primary care services.--The term
                    ``primary care services'' means services
                    identified, as of January 1, 2009, by the
                    following HCPCS codes (and as subsequently
                    modified by the Secretary):
                              (i) 99201 through 99215.
                              (ii) 99304 through 99340.
                              (iii) 99341 through 99350.
              (3) Coordination with other payments.--The amount of
            the additional payment for a service under this
            subsection and subsection (m) shall be determined
            without regard to any additional payment for the
            service under subsection (m) and this subsection,
            respectively. The amount of the additional payment for
            a service under this subsection and subsection (z)
            shall be determined without regard to any additional
            payment for the service under subsection (z) and this
            subsection, respectively.
              (4) Limitation on review.--There shall be no
            administrative or judicial review under section 1869,
            1878, or otherwise, respecting the identification of
            primary care practitioners under this subsection.
      (y) Incentive Payments for Major Surgical Procedures
    Furnished in Health Professional Shortage Areas.--
              (1) In general.--In the case of major surgical
            procedures furnished on or after January 1, 2011, and
            before January 1, 2016, by a general surgeon in an area
            that is designated (under section 332(a)(1)(A) of the
            Public Health Service Act) as a health professional
            shortage area as identified by the Secretary prior to
            the beginning of the year involved, in addition to the
            amount of payment that would otherwise be made for such
            services under this part, there also shall be paid (on
            a monthly or quarterly basis) an amount equal to 10
            percent of the payment amount for the service under
            this part.
              (2) Definitions.--In this subsection:
                      (A) General surgeon.--In this subsection, the
                    term ``general surgeon'' means a physician (as
                    described in section 1861(r)(1)) who has
                    designated CMS specialty code 02-General
                    Surgery as their primary specialty code in the
                    physician's enrollment under section 1866(j).
                      (B) Major surgical procedures.--The term
                    ``major surgical procedures'' means physicians'
                    services which are surgical procedures for
                    which a 10-day or 90-day global period is used
                    for payment under the fee schedule under
                    section 1848(b).
              (3) Coordination with other payments.--The amount of
            the additional payment for a service under this
            subsection and subsection (m) shall be determined
            without regard to any additional payment for the
            service under subsection (m) and this subsection,
            respectively. The amount of the additional payment for
            a service under this subsection and subsection (z)
            shall be determined without regard to any additional
            payment for the service under subsection (z) and this
            subsection, respectively.
              (4) Application.--The provisions of paragraph (2) and
            (4) of subsection (m) shall apply to the determination
            of additional payments under this subsection in the
            same manner as such provisions apply to the
            determination of additional payments under subsection
            (m).
      (z) Incentive Payments for Participation in Eligible
    Alternative Payment Models.--
              (1) Payment incentive.--
                      (A) In general.--In the case of covered
                    professional services furnished by an eligible
                    professional during a year that is in the
                    period beginning with 2019 and ending with 2024
                    and for which the professional is a qualifying
                    APM participant with respect to such year, in
                    addition to the amount of payment that would
                    otherwise be made for such covered professional
                    services under this part for such year, there
                    also shall be paid to such professional an
                    amount equal to 5 percent of the estimated
                    aggregate payment amounts for such covered
                    professional services under this part for the
                    preceding year. For purposes of the previous
                    sentence, the payment amount for the preceding
                    year may be an estimation for the full
                    preceding year based on a period of such
                    preceding year that is less than the full year.
                    The Secretary shall establish policies to
                    implement this subparagraph in cases in which
                    payment for covered professional services
                    furnished by a qualifying APM participant in an
                    alternative payment model--
                              (i) is made to an eligible
                            alternative payment entity rather than
                            directly to the qualifying APM
                            participant; or
                              (ii) is made on a basis other than a
                            fee-for-service basis (such as payment
                            on a capitated basis).
                      (B) Form of payment.--Payments under this
                    subsection shall be made in a lump sum, on an
                    annual basis, as soon as practicable.
                      (C) Treatment of payment incentive.--Payments
                    under this subsection shall not be taken into
                    account for purposes of determining actual
                    expenditures under an alternative payment model
                    and for purposes of determining or rebasing any
                    benchmarks used under the alternative payment
                    model.
                      (D) Coordination.--The amount of the
                    additional payment under this subsection or
                    subsection (m) shall be determined without
                    regard to any additional payment under
                    subsection (m) and this subsection,
                    respectively. The amount of the additional
                    payment under this subsection or subsection (x)
                    shall be determined without regard to any
                    additional payment under subsection (x) and
                    this subsection, respectively. The amount of
                    the additional payment under this subsection or
                    subsection (y) shall be determined without
                    regard to any additional payment under
                    subsection (y) and this subsection,
                    respectively.
              (2) Qualifying apm participant.--For purposes of this
            subsection, the term ``qualifying APM participant''
            means the following:
                      (A) 2019 and 2020.--With respect to 2019 and
                    2020, an eligible professional for whom the
                    Secretary determines that at least 25 percent
                    of payments under this part for covered
                    professional services furnished by such
                    professional during the most recent period for
                    which data are available (which may be less
                    than a year) were attributable to such services
                    furnished under this part through an eligible
                    alternative payment entity.
                      (B) 2021 through 2024.--With respect to each
                    of 2021 through 2024, an eligible professional
                    described in either of the following clauses:
                              (i) Medicare payment threshold
                            option.--An eligible professional for
                            whom the Secretary determines that at
                            least 50 percent of payments under this
                            part for covered professional services
                            furnished by such professional during
                            the most recent period for which data
                            are available (which may be less than a
                            year) were attributable to such
                            services furnished under this part
                            through an eligible alternative payment
                            entity.
                              (ii) Combination all-payer and
                            medicare payment threshold option.--An
                            eligible professional--
                                      (I) for whom the Secretary
                                    determines, with respect to
                                    items and services furnished by
                                    such professional during the
                                    most recent period for which
                                    data are available (which may
                                    be less than a year), that at
                                    least 50 percent of the sum
                                    of--
                                              (aa) payments
                                            described in clause
                                            (i); and
                                              (bb) all other
                                            payments, regardless of
                                            payer (other than
                                            payments made by the
                                            Secretary of Defense or
                                            the Secretary of
                                            Veterans Affairs and
                                            other than payments
                                            made under title XIX in
                                            a State in which no
                                            medical home or
                                            alternative payment
                                            model is available
                                            under the State program
                                            under that title),
                                    meet the requirement described
                                    in clause (iii)(I) with respect
                                    to payments described in item
                                    (aa) and meet the requirement
                                    described in clause (iii)(II)
                                    with respect to payments
                                    described in item (bb);
                                      (II) for whom the Secretary
                                    determines at least 25 percent
                                    of payments under this part for
                                    covered professional services
                                    furnished by such professional
                                    during the most recent period
                                    for which data are available
                                    (which may be less than a year)
                                    were attributable to such
                                    services furnished under this
                                    part through an eligible
                                    alternative payment entity; and
                                      (III) who provides to the
                                    Secretary such information as
                                    is necessary for the Secretary
                                    to make a determination under
                                    subclause (I), with respect to
                                    such professional.
                              (iii) Requirement.--For purposes of
                            clause (ii)(I)--
                                      (I) the requirement described
                                    in this subclause, with respect
                                    to payments described in item
                                    (aa) of such clause, is that
                                    such payments are made to an
                                    eligible alternative payment
                                    entity; and
                                      (II) the requirement
                                    described in this subclause,
                                    with respect to payments
                                    described in item (bb) of such
                                    clause, is that such payments
                                    are made under arrangements in
                                    which--
                                              (aa) quality measures
                                            comparable to measures
                                            under the performance
                                            category described in
                                            section
                                            1848(q)(2)(B)(i) apply;
                                              (bb) certified EHR
                                            technology is used; and
                                              (cc) the eligible
                                            professional
                                            participates in an
                                            entity that--
                                                      (AA) bears
                                                    more than
                                                    nominal
                                                    financial risk
                                                    if actual
                                                    aggregate
                                                    expenditures
                                                    exceeds
                                                    expected
                                                    aggregate
                                                    expenditures;
                                                    or
                                                      (BB) with
                                                    respect to
                                                    beneficiaries
                                                    under title
                                                    XIX, is a
                                                    medical home
                                                    that meets
                                                    criteria
                                                    comparable to
                                                    medical homes
                                                    expanded under
                                                    section
                                                    1115A(c).
                      (C) Beginning in 2025.--With respect to 2025
                    and each subsequent year, an eligible
                    professional described in either of the
                    following clauses:
                              (i) Medicare payment threshold
                            option.--An eligible professional for
                            whom the Secretary determines that at
                            least 75 percent of payments under this
                            part for covered professional services
                            furnished by such professional during
                            the most recent period for which data
                            are available (which may be less than a
                            year) were attributable to such
                            services furnished under this part
                            through an eligible alternative payment
                            entity.
                              (ii) Combination all-payer and
                            medicare payment threshold option.--An
                            eligible professional--
                                      (I) for whom the Secretary
                                    determines, with respect to
                                    items and services furnished by
                                    such professional during the
                                    most recent period for which
                                    data are available (which may
                                    be less than a year), that at
                                    least 75 percent of the sum
                                    of--
                                              (aa) payments
                                            described in clause
                                            (i); and
                                              (bb) all other
                                            payments, regardless of
                                            payer (other than
                                            payments made by the
                                            Secretary of Defense or
                                            the Secretary of
                                            Veterans Affairs and
                                            other than payments
                                            made under title XIX in
                                            a State in which no
                                            medical home or
                                            alternative payment
                                            model is available
                                            under the State program
                                            under that title),
                                    meet the requirement described
                                    in clause (iii)(I) with respect
                                    to payments described in item
                                    (aa) and meet the requirement
                                    described in clause (iii)(II)
                                    with respect to payments
                                    described in item (bb);
                                      (II) for whom the Secretary
                                    determines at least 25 percent
                                    of payments under this part for
                                    covered professional services
                                    furnished by such professional
                                    during the most recent period
                                    for which data are available
                                    (which may be less than a year)
                                    were attributable to such
                                    services furnished under this
                                    part through an eligible
                                    alternative payment entity; and
                                      (III) who provides to the
                                    Secretary such information as
                                    is necessary for the Secretary
                                    to make a determination under
                                    subclause (I), with respect to
                                    such professional.
                              (iii) Requirement.--For purposes of
                            clause (ii)(I)--
                                      (I) the requirement described
                                    in this subclause, with respect
                                    to payments described in item
                                    (aa) of such clause, is that
                                    such payments are made to an
                                    eligible alternative payment
                                    entity; and
                                      (II) the requirement
                                    described in this subclause,
                                    with respect to payments
                                    described in item (bb) of such
                                    clause, is that such payments
                                    are made under arrangements in
                                    which--
                                              (aa) quality measures
                                            comparable to measures
                                            under the performance
                                            category described in
                                            section
                                            1848(q)(2)(B)(i) apply;
                                              (bb) certified EHR
                                            technology is used; and
                                              (cc) the eligible
                                            professional
                                            participates in an
                                            entity that--
                                                      (AA) bears
                                                    more than
                                                    nominal
                                                    financial risk
                                                    if actual
                                                    aggregate
                                                    expenditures
                                                    exceeds
                                                    expected
                                                    aggregate
                                                    expenditures;
                                                    or
                                                      (BB) with
                                                    respect to
                                                    beneficiaries
                                                    under title
                                                    XIX, is a
                                                    medical home
                                                    that meets
                                                    criteria
                                                    comparable to
                                                    medical homes
                                                    expanded under
                                                    section
                                                    1115A(c).
                      (D) Use of patient approach.--The Secretary
                    may base the determination of whether an
                    eligible professional is a qualifying APM
                    participant under this subsection and the
                    determination of whether an eligible
                    professional is a partial qualifying APM
                    participant under section 1848(q)(1)(C)(iii) by
                    using counts of patients in lieu of using
                    payments and using the same or similar
                    percentage criteria (as specified in this
                    subsection and such section, respectively), as
                    the Secretary determines appropriate. With
                    respect to 2023 and 2024, the Secretary shall
                    use the same percentage criteria for counts of
                    patients that are used in 2022.
              (3) Additional definitions.--In this subsection:
                      (A) Covered professional services.--The term
                    ``covered professional services'' has the
                    meaning given that term in section
                    1848(k)(3)(A).
                      (B) Eligible professional.--The term
                    ``eligible professional'' has the meaning given
                    that term in section 1848(k)(3)(B) and includes
                    a group that includes such professionals.
                      (C) Alternative payment model (apm).--The
                    term ``alternative payment model'' means, other
                    than for purposes of subparagraphs
                    (B)(ii)(I)(bb) and (C)(ii)(I)(bb) of paragraph
                    (2), any of the following:
                              (i) A model under section 1115A
                            (other than a health care innovation
                            award).
                              (ii) The shared savings program under
                            section 1899.
                              (iii) A demonstration under section
                            1866C.
                              (iv) A demonstration required by
                            Federal law.
                      (D) Eligible alternative payment entity.--The
                    term ``eligible alternative payment entity''
                    means, with respect to a year, an entity that--
                              (i) participates in an alternative
                            payment model that--
                                      (I) requires participants in
                                    such model to use certified EHR
                                    technology (as defined in
                                    subsection (o)(4)); and
                                      (II) provides for payment for
                                    covered professional services
                                    based on quality measures
                                    comparable to measures under
                                    the performance category
                                    described in section
                                    1848(q)(2)(B)(i); and
                              (ii)(I) bears financial risk for
                            monetary losses under such alternative
                            payment model that are in excess of a
                            nominal amount; or
                              (II) is a medical home expanded under
                            section 1115A(c).
              (4) Limitation.--There shall be no administrative or
            judicial review under section 1869, 1878, or otherwise,
            of the following:
                      (A) The determination that an eligible
                    professional is a qualifying APM participant
                    under paragraph (2) and the determination that
                    an entity is an eligible alternative payment
                    entity under paragraph (3)(D).
                      (B) The determination of the amount of the 5
                    percent payment incentive under paragraph
                    (1)(A), including any estimation as part of
                    such determination.
      (aa) Medical Review of Spinal Subluxation Services.--
              (1) In general.--The Secretary shall implement a
            process for the medical review (as described in
            paragraph (2)) of treatment by a chiropractor described
            in section 1861(r)(5) by means of manual manipulation
            of the spine to correct a subluxation (as described in
            such section) of an individual who is enrolled under
            this part and apply such process to such services
            furnished on or after January 1, 2017, focusing on
            services such as--
                      (A) services furnished by a such a
                    chiropractor whose pattern of billing is
                    aberrant compared to peers; and
                      (B) services furnished by such a chiropractor
                    who, in a prior period, has a services denial
                    percentage in the 85th percentile or greater,
                    taking into consideration the extent that
                    service denials are overturned on appeal.
              (2) Medical review.--
                      (A) Prior authorization medical review.--
                              (i) In general.--Subject to clause
                            (ii), the Secretary shall use prior
                            authorization medical review for
                            services described in paragraph (1)
                            that are furnished to an individual by
                            a chiropractor described in section
                            1861(r)(5) that are part of an episode
                            of treatment that includes more than 12
                            services. For purposes of the preceding
                            sentence, an episode of treatment shall
                            be determined by the underlying cause
                            that justifies the need for services,
                            such as a diagnosis code.
                              (ii) Ending application of prior
                            authorization medical review.--The
                            Secretary shall end the application of
                            prior authorization medical review
                            under clause (i) to services described
                            in paragraph (1) by such a chiropractor
                            if the Secretary determines that the
                            chiropractor has a low denial rate
                            under such prior authorization medical
                            review. The Secretary may subsequently
                            reapply prior authorization medical
                            review to such chiropractor if the
                            Secretary determines it to be
                            appropriate and the chiropractor has,
                            in the time period subsequent to the
                            determination by the Secretary of a low
                            denial rate with respect to the
                            chiropractor, furnished such services
                            described in paragraph (1).
                              (iii) Early request for prior
                            authorization review permitted.--
                            Nothing in this subsection shall be
                            construed to prevent such a
                            chiropractor from requesting prior
                            authorization for services described in
                            paragraph (1) that are to be furnished
                            to an individual before the
                            chiropractor furnishes the twelfth such
                            service to such individual for an
                            episode of treatment.
                      (B) Type of review.--The Secretary may use
                    pre-payment review or post-payment review of
                    services described in section 1861(r)(5) that
                    are not subject to prior authorization medical
                    review under subparagraph (A).
                      (C) Relationship to law enforcement
                    activities.--The Secretary may determine that
                    medical review under this subsection does not
                    apply in the case where potential fraud may be
                    involved.
              (3) No payment without prior authorization.--With
            respect to a service described in paragraph (1) for
            which prior authorization medical review under this
            subsection applies, the following shall apply:
                      (A) Prior authorization determination.--The
                    Secretary shall make a determination, prior to
                    the service being furnished, of whether the
                    service would or would not meet the applicable
                    requirements of section 1862(a)(1)(A).
                      (B) Denial of payment.--Subject to paragraph
                    (5), no payment may be made under this part for
                    the service unless the Secretary determines
                    pursuant to subparagraph (A) that the service
                    would meet the applicable requirements of such
                    section 1862(a)(1)(A).
              (4) Submission of information.--A chiropractor
            described in section 1861(r)(5) may submit the
            information necessary for medical review by fax, by
            mail, or by electronic means. The Secretary shall make
            available the electronic means described in the
            preceding sentence as soon as practicable.
              (5) Timeliness.--If the Secretary does not make a
            prior authorization determination under paragraph
            (3)(A) within 14 business days of the date of the
            receipt of medical documentation needed to make such
            determination, paragraph (3)(B) shall not apply.
              (6) Application of limitation on beneficiary
            liability.--Where payment may not be made as a result
            of the application of paragraph (2)(B), section 1879
            shall apply in the same manner as such section applies
            to a denial that is made by reason of section
            1862(a)(1).
              (7) Review by contractors.--The medical review
            described in paragraph (2) may be conducted by medicare
            administrative contractors pursuant to section
            1874A(a)(4)(G) or by any other contractor determined
            appropriate by the Secretary that is not a recovery
            audit contractor.
              (8) Multiple services.--The Secretary shall, where
            practicable, apply the medical review under this
            subsection in a manner so as to allow an individual
            described in paragraph (1) to obtain, at a single time
            rather than on a service-by-service basis, an
            authorization in accordance with paragraph (3)(A) for
            multiple services.
              (9) Construction.--With respect to a service
            described in paragraph (1) that has been affirmed by
            medical review under this subsection, nothing in this
            subsection shall be construed to preclude the
            subsequent denial of a claim for such service that does
            not meet other applicable requirements under this Act.
              (10) Implementation.--
                      (A) Authority.--The Secretary may implement
                    the provisions of this subsection by interim
                    final rule with comment period.
                      (B) Administration.--Chapter 35 of title 44,
                    United States Code, shall not apply to medical
                    review under this 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] first begins prescribing narcotic
                    drugs in schedule III, IV, or V of section 202
                    of the Controlled Substances Act for the
                    purpose of maintenance or detoxification
                    treatment on or after January 1, 2021.
              (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.
      (cc) Specified COVID-19 Testing-Related Services.--For
    purposes of subsection (a)(1)(DD):
              (1) Description.--
                      (A) In general.--A specified COVID-19
                    testing-related service described in this
                    paragraph is a medical visit that--
                              (i) is in any of the categories of
                            HCPCS evaluation and management service
                            codes described in subparagraph (B);
                              (ii) is furnished during any portion
                            of the emergency period (as defined in
                            section 1135(g)(1)(B)) (beginning on or
                            after the date of enactment of this
                            subsection);
                              (iii) results in an order for or
                            administration of a clinical diagnostic
                            laboratory test described in section
                            1852(a)(1)(B)(iv)(IV); and
                              (iv) relates to the furnishing or
                            administration of such test or to the
                            evaluation of such individual for
                            purposes of determining the need of
                            such individual for such test.
                      (B) Categories of hcpcs codes.--For purposes
                    of subparagraph (A), the categories of HCPCS
                    evaluation and management services codes are
                    the following:
                              (i) Office and other outpatient
                            services.
                              (ii) Hospital observation services.
                              (iii) Emergency department services.
                              (iv) Nursing facility services.
                              (v) Domiciliary, rest home, or
                            custodial care services.
                              (vi) Home services.
                              (vii) Online digital evaluation and
                            management services.
              (2) Specified outpatient payment provision.--A
            specified outpatient payment provision described in
            this paragraph is any of the following:
                      (A) The hospital outpatient prospective
                    payment system under subsection (t).
                      (B) The physician fee schedule under section
                    1848.
                      (C) The prospective payment system developed
                    under section 1834(o).
                      (D) Section 1834(g), with respect to an
                    outpatient critical access hospital service.
                      (E) The payment basis determined in
                    regulations pursuant to section 1833(a)(3) for
                    rural health clinic services.
      (dd) Special Coinsurance Rule for Certain Colorectal Cancer
    Screening Tests.--
              (1) In general.--In the case of a colorectal cancer
            screening test to which paragraph (1)(Y) of subsection
            (a) would not apply but for the third sentence of such
            subsection that is furnished during a year beginning on
            or after January 1, 2022, and before January 1, 2030,
            the amount paid shall be equal to the specified percent
            (as defined in paragraph (2)) for such year of the
            lesser of the actual charge for the service or the
            amount determined under the fee schedule that applies
            to such test under this part (or, in the case such test
            is a covered OPD service (as defined in subsection
            (t)(1)(B)), the amount determined under subsection
            (t)).
              (2) Specified percent defined.--For purposes of
            paragraph (1), the term ``specified percent'' means--
                      (A) for 2022, 80 percent;
                      (B) for 2023 through 2026, 85 percent; and
                      (C) for 2027 through 2029, 90 percent.

            SPECIAL PAYMENT RULES FOR PARTICULAR ITEMS AND SERVICES

      Sec. 1834. (a) Payment for Durable Medical Equipment.--
              (1) General rule for payment.--
                      (A) In general.--With respect to a covered
                    item (as defined in paragraph (13)) for which
                    payment is determined under this subsection,
                    payment shall be made in the frequency
                    specified in paragraphs (2) through (7) and in
                    an amount equal to 80 percent of the payment
                    basis described in subparagraph (B).
                      (B) Payment basis.--Subject to subparagraph
                    (F)(i), the payment basis described in this
                    subparagraph is the lesser of--
                              (i) the actual charge for the item,
                            or
                              (ii) the payment amount recognized
                            under paragraphs (2) through (7) of
                            this subsection for the item;
                    except that clause (i) shall not apply if the
                    covered item is furnished by a public home
                    health agency (or by another home health agency
                    which demonstrates to the satisfaction of the
                    Secretary that a significant portion of its
                    patients are low income) free of charge or at
                    nominal charges to the public.
                      (C) Exclusive payment rule.--Subject to
                    subparagraph (F)(ii), this subsection shall
                    constitute the exclusive provision of this
                    title for payment for covered items under this
                    part or under part A to a home health agency.
                      (D) Reduction in fee schedules for certain
                    items.--With respect to a seat-lift chair or
                    transcutaneous electrical nerve stimulator
                    furnished on or after April 1, 1990, the
                    Secretary shall reduce the payment amount
                    applied under subparagraph (B)(ii) for such an
                    item by 15 percent, and, in the case of a
                    transcutaneous electrical nerve stimulator
                    furnished on or after January 1, 1991, the
                    Secretary shall further reduce such payment
                    amount (as previously reduced) by 45 percent.
                      (E) Clinical conditions for coverage.--
                              (i) In general.--The Secretary shall
                            establish standards for clinical
                            conditions for payment for covered
                            items under this subsection.
                              (ii) Requirements.--The standards
                            established under clause (i) shall
                            include the specification of types or
                            classes of covered items that require,
                            as a condition of payment under this
                            subsection, a face-to-face examination
                            of the individual by a physician (as
                            defined in section 1861(r)), a
                            physician assistant, nurse
                            practitioner, or a clinical nurse
                            specialist (as those terms are defined
                            in section 1861(aa)(5)) and a
                            prescription for the item.
                              (iii) Priority of establishment of
                            standards.--In establishing the
                            standards under this subparagraph, the
                            Secretary shall first establish
                            standards for those covered items for
                            which the Secretary determines there
                            has been a proliferation of use,
                            consistent findings of charges for
                            covered items that are not delivered,
                            or consistent findings of falsification
                            of documentation to provide for payment
                            of such covered items under this part.
                              (iv) Standards for power
                            wheelchairs.--Effective on the date of
                            the enactment of this subparagraph, in
                            the case of a covered item consisting
                            of a motorized or power wheelchair for
                            an individual, payment may not be made
                            for such covered item unless a
                            physician (as defined in section
                            1861(r)(1)), a physician assistant,
                            nurse practitioner, or a clinical nurse
                            specialist (as those terms are defined
                            in section 1861(aa)(5)) has conducted a
                            face-to-face examination of the
                            individual and written a prescription
                            for the item.
                              (v) Limitation on payment for covered
                            items.--Payment may not be made for a
                            covered item under this subsection
                            unless the item meets any standards
                            established under this subparagraph for
                            clinical condition of coverage.
                      (F) Application of competitive acquisition;
                    limitation of inherent reasonableness
                    authority.--In the case of covered items
                    furnished on or after January 1, 2011, subject
                    to subparagraphs (G) and (H), that are included
                    in a competitive acquisition program in a
                    competitive acquisition area under section
                    1847(a)--
                              (i) the payment basis under this
                            subsection for such items and services
                            furnished in such area shall be the
                            payment basis determined under such
                            competitive acquisition program;
                              (ii) the Secretary may (and, in the
                            case of covered items furnished on or
                            after January 1, 2016, subject to
                            clause (iii), shall) use information on
                            the payment determined under such
                            competitive acquisition programs to
                            adjust the payment amount otherwise
                            recognized under subparagraph (B)(ii)
                            for an area that is not a competitive
                            acquisition area under section 1847 and
                            in the case of such adjustment,
                            paragraph (10)(B) shall not be applied;
                            and
                              (iii) in the case of covered items
                            furnished on or after January 1, 2016,
                            the Secretary shall continue to make
                            such adjustments described in clause
                            (ii) as, under such competitive
                            acquisition programs, additional
                            covered items are phased in or
                            information is updated as contracts
                            under section 1847 are recompeted in
                            accordance with section 1847(b)(3)(B).
                      (G) Use of information on competitive bid
                    rates.--The Secretary shall specify by
                    regulation the methodology to be used in
                    applying the provisions of subparagraph (F)(ii)
                    and subsection (h)(1)(H)(ii). In promulgating
                    such regulation, the Secretary shall consider
                    the costs of items and services in areas in
                    which such provisions would be applied compared
                    to the payment rates for such items and
                    services in competitive acquisition areas.In
                    the case of items and services furnished on or
                    after January 1, 2019, in making any
                    adjustments under clause (ii) or (iii) of
                    subparagraph (F), under subsection
                    (h)(1)(H)(ii), or under section 1842(s)(3)(B),
                    the Secretary shall--
                              (i) solicit and take into account
                            stakeholder input; and
                              (ii) take into account the highest
                            amount bid by a winning supplier in a
                            competitive acquisition area and a
                            comparison of each of the following
                            with respect to non-competitive
                            acquisition areas and competitive
                            acquisition areas:
                                      (I) The average travel
                                    distance and cost associated
                                    with furnishing items and
                                    services in the area.
                                      (II) The average volume of
                                    items and services furnished by
                                    suppliers in the area.
                                      (III) The number of suppliers
                                    in the area.
                      (H) Diabetic supplies.--
                              (i) In general.--On or after the date
                            described in clause (ii), the payment
                            amount under this part for diabetic
                            supplies, including testing strips,
                            that are non-mail order items (as
                            defined by the Secretary) shall be
                            equal to the single payment amounts
                            established under the national mail
                            order competition for diabetic supplies
                            under section 1847.
                              (ii) Date described.--The date
                            described in this clause is the date of
                            the implementation of the single
                            payment amounts under the national mail
                            order competition for diabetic supplies
                            under section 1847.
                      (I) Treatment of vacuum erection systems.--
                    Effective for items and services furnished on
                    and after July 1, 2015, vacuum erection systems
                    described as prosthetic devices described in
                    section 1861(s)(8) shall be treated in the same
                    manner as erectile dysfunction drugs are
                    treated for purposes of section 1860D-
                    2(e)(2)(A).
              (2) Payment for inexpensive and other routinely
            purchased durable medical equipment.--
                      (A) In general.--Payment for an item of
                    durable medical equipment (as defined in
                    paragraph (13))--
                              (i) the purchase price of which does
                            not exceed $150,
                              (ii) which the Secretary determines
                            is acquired at least 75 percent of the
                            time by purchase,
                              (iii) which is an accessory used in
                            conjunction with a nebulizer,
                            aspirator, or a ventilator excluded
                            under paragraph (3)(A), or
                              (iv) in the case of devices furnished
                            on or after October 1, 2015, which
                            serves as a speech generating device or
                            which is an accessory that is needed
                            for the individual to effectively
                            utilize such a device,
                    shall be made on a rental basis or in a lump-
                    sum amount for the purchase of the item. The
                    payment amount recognized for purchase or
                    rental of such equipment is the amount
                    specified in subparagraph (B) for purchase or
                    rental, except that the total amount of
                    payments with respect to an item may not exceed
                    the payment amount specified in subparagraph
                    (B) with respect to the purchase of the item.
                      (B) Payment amount.--For purposes of
                    subparagraph (A), the amount specified in this
                    subparagraph, with respect to the purchase or
                    rental of an item furnished in a carrier
                    service area--
                              (i) in 1989 and in 1990 is the
                            average reasonable charge in the area
                            for the purchase or rental,
                            respectively, of the item for the 12-
                            month period ending on June 30, 1987,
                            increased by the percentage increase in
                            the consumer price index for all urban
                            consumers (U.S. city average) for the
                            6-month period ending with December
                            1987;
                              (ii) in 1991 is the sum of (I) 67
                            percent of the local payment amount for
                            the item or device computed under
                            subparagraph (C)(i)(I) for 1991, and
                            (II) 33 percent of the national limited
                            payment amount for the item or device
                            computed under subparagraph (C)(ii) for
                            1991;
                              (iii) in 1992 is the sum of (I) 33
                            percent of the local payment amount for
                            the item or device computed under
                            subparagraph (C)(i)(II) for 1992, and
                            (II) 67 percent of the national limited
                            payment amount for the item or device
                            computed under subparagraph (C)(ii) for
                            1992; and
                              (iv) in 1993 and each subsequent year
                            is the national limited payment amount
                            for the item or device computed under
                            subparagraph (C)(ii) for that year
                            (reduced by 10 percent, in the case of
                            a blood glucose testing strip furnished
                            after 1997 for an individual with
                            diabetes).
                      (C) Computation of local payment amount and
                    national limited payment amount.--For purposes
                    of subparagraph (B)--
                              (i) the local payment amount for an
                            item or device for a year is equal to--
                                      (I) for 1991, the amount
                                    specified in subparagraph
                                    (B)(i) for 1990 increased by
                                    the covered item update for
                                    1991, and
                                      (II) for 1992, 1993, and 1994
                                    the amount determined under
                                    this clause for the preceding
                                    year increased by the covered
                                    item update for the year; and
                              (ii) the national limited payment
                            amount for an item or device for a year
                            is equal to--
                                      (I) for 1991, the local
                                    payment amount determined under
                                    clause (i) for such item or
                                    device for that year, except
                                    that the national limited
                                    payment amount may not exceed
                                    100 percent of the weighted
                                    average of all local payment
                                    amounts determined under such
                                    clause for such item for that
                                    year and may not be less than
                                    85 percent of the weighted
                                    average of all local payment
                                    amounts determined under such
                                    clause for such item,
                                      (II) for 1992 and 1993, the
                                    amount determined under this
                                    clause for the preceding year
                                    increased by the covered item
                                    update for such subsequent
                                    year,
                                      (III) for 1994, the local
                                    payment amount determined under
                                    clause (i) for such item or
                                    device for that year, except
                                    that the national limited
                                    payment amount may not exceed
                                    100 percent of the median of
                                    all local payment amounts
                                    determined under such clause
                                    for such item for that year and
                                    may not be less than 85 percent
                                    of the median of all local
                                    payment amounts determined
                                    under such clause for such item
                                    or device for that year, and
                                      (IV) for each subsequent
                                    year, the amount determined
                                    under this clause for the
                                    preceding year increased by the
                                    covered item update for such
                                    subsequent year.
              (3) Payment for items requiring frequent and
            substantial servicing.--
                      (A) In general.--Payment for a covered item
                    (such as IPPB machines and ventilators,
                    excluding ventilators that are either
                    continuous airway pressure devices or
                    intermittent assist devices with continuous
                    airway pressure devices) for which there must
                    be frequent and substantial servicing in order
                    to avoid risk to the patient's health shall be
                    made on a monthly basis for the rental of the
                    item and the amount recognized is the amount
                    specified in subparagraph (B).
                      (B) Payment amount.--For purposes of
                    subparagraph (A), the amount specified in this
                    subparagraph, with respect to an item or device
                    furnished in a carrier service area--
                              (i) in 1989 and in 1990 is the
                            average reasonable charge in the area
                            for the rental of the item or device
                            for the 12-month period ending with
                            June 1987, increased by the percentage
                            increase in the consumer price index
                            for all urban consumers (U.S. city
                            average) for the 6-month period ending
                            with December 1987;
                              (ii) in 1991 is the sum of (I) 67
                            percent of the local payment amount for
                            the item or device computed under
                            subparagraph (C)(i)(I) for 1991, and
                            (II) 33 percent of the national limited
                            payment amount for the item or device
                            computed under subparagraph (C)(ii) for
                            1991;
                              (iii) in 1992 is the sum of (I) 33
                            percent of the local payment amount for
                            the item or device computed under
                            subparagraph (C)(i)(II) for 1992, and
                            (II) 67 percent of the national limited
                            payment amount for the item or device
                            computed under subparagraph (C)(ii) for
                            1992; and
                              (iv) in 1993 and each subsequent year
                            is the national limited payment amount
                            for the item or device computed under
                            subparagraph (C)(ii) for that year.
                      (C) Computation of local payment amount and
                    national limited payment amount.--For purposes
                    of subparagraph (B)--
                              (i) the local payment amount for an
                            item or device for a year is equal to--
                                      (I) for 1991, the amount
                                    specified in subparagraph
                                    (B)(i) for 1990 increased by
                                    the covered item update for
                                    1991, and
                                      (II) for 1992, 1993, and 1994
                                    the amount determined under
                                    this clause for the preceding
                                    year increased by the covered
                                    item update for the year; and
                              (ii) the national limited payment
                            amount for an item or device for a year
                            is equal to--
                                      (I) for 1991, the local
                                    payment amount determined under
                                    clause (i) for such item or
                                    device for that year, except
                                    that the national limited
                                    payment amount may not exceed
                                    100 percent of the weighted
                                    average of all local payment
                                    amounts determined under such
                                    clause for such item for that
                                    year and may not be less than
                                    85 percent of the weighted
                                    average of all local payment
                                    amounts determined under such
                                    clause for such item,
                                      (II) for 1992 and 1993, the
                                    amount determined under this
                                    clause for the preceding year
                                    increased by the covered item
                                    update for such subsequent
                                    year,
                                      (III) for 1994, the local
                                    payment amount determined under
                                    clause (i) for such item or
                                    device for that year, except
                                    that the national limited
                                    payment amount may not exceed
                                    100 percent of the median of
                                    all local payment amounts
                                    determined under such clause
                                    for such item for that year and
                                    may not be less than 85 percent
                                    of the median of all local
                                    payment amounts determined
                                    under such clause for such item
                                    or device for that year, and
                                      (IV) for each subsequent
                                    year, the amount determined
                                    under this clause for the
                                    preceding year increased by the
                                    covered item update for such
                                    subsequent year.
              (4) Payment for certain customized items.--Payment
            with respect to a covered item that is uniquely
            constructed or substantially modified to meet the
            specific needs of an individual patient, and for that
            reason cannot be grouped with similar items for
            purposes of payment under this title, shall be made in
            a lump-sum amount (A) for the purchase of the item in a
            payment amount based upon the carrier's individual
            consideration for that item, and (B) for the reasonable
            and necessary maintenance and servicing for parts and
            labor not covered by the supplier's or manufacturer's
            warranty, when necessary during the period of medical
            need, and the amount recognized for such maintenance
            and servicing shall be paid on a lump-sum, as needed
            basis based upon the carrier's individual consideration
            for that item. In the case of a wheelchair furnished on
            or after January 1, 1992, the wheelchair shall be
            treated as a customized item for purposes of this
            paragraph if the wheelchair has been measured, fitted,
            or adapted in consideration of the patient's body size,
            disability, period of need, or intended use, and has
            been assembled by a supplier or ordered from a
            manufacturer who makes available customized features,
            modifications, or components for wheelchairs that are
            intended for an individual patient's use in accordance
            with instructions from the patient's physician.
              (5) Payment for oxygen and oxygen equipment.--
                      (A) In general.--Payment for oxygen and
                    oxygen equipment shall be made on a monthly
                    basis in the monthly payment amount recognized
                    under paragraph (9) for oxygen and oxygen
                    equipment (other than portable oxygen
                    equipment), subject to subparagraphs (B), (C),
                    (E), and (F).
                      (B) Add-on for portable oxygen equipment.--
                    When portable oxygen equipment is used, but
                    subject to subparagraph (D), the payment amount
                    recognized under subparagraph (A) shall be
                    increased by the monthly payment amount
                    recognized under paragraph (9) for portable
                    oxygen equipment.
                      (C) Volume adjustment.--When the attending
                    physician prescribes an oxygen flow rate--
                              (i) exceeding 4 liters per minute,
                            the payment amount recognized under
                            subparagraph (A), subject to
                            subparagraph (D), shall be increased by
                            50 percent, or
                              (ii) of less than 1 liter per minute,
                            the payment amount recognized under
                            subparagraph (A) shall be decreased by
                            50 percent.
                      (D) Limit on adjustment.--When portable
                    oxygen equipment is used and the attending
                    physician prescribes an oxygen flow rate
                    exceeding 4 liters per minute, there shall only
                    be an increase under either subparagraph (B) or
                    (C), whichever increase is larger, and not
                    under both such subparagraphs.
                      (E) Recertification for patients receiving
                    home oxygen therapy.--In the case of a patient
                    receiving home oxygen therapy services who, at
                    the time such services are initiated, has an
                    initial arterial blood gas value at or above a
                    partial pressure of 56 or an arterial oxygen
                    saturation at or above 89 percent (or such
                    other values, pressures, or criteria as the
                    Secretary may specify) no payment may be made
                    under this part for such services after the
                    expiration of the 90-day period that begins on
                    the date the patient first receives such
                    services unless the patient's attending
                    physician certifies that, on the basis of a
                    follow-up test of the patient's arterial blood
                    gas value or arterial oxygen saturation
                    conducted during the final 30 days of such 90-
                    day period, there is a medical need for the
                    patient to continue to receive such services.
                      (F) Rental Cap.--
                              (i) In general.--Payment for oxygen
                            equipment (including portable oxygen
                            equipment) under this paragraph may not
                            extend over a period of continuous use
                            (as determined by the Secretary) of
                            longer than 36 months.
                              (ii) Payments and rules after rental
                            cap.--After the 36th continuous month
                            during which payment is made for the
                            equipment under this paragraph--
                                      (I) the supplier furnishing
                                    such equipment under this
                                    subsection shall continue to
                                    furnish the equipment during
                                    any period of medical need for
                                    the remainder of the reasonable
                                    useful lifetime of the
                                    equipment, as determined by the
                                    Secretary;
                                      (II) payments for oxygen
                                    shall continue to be made in
                                    the amount recognized for
                                    oxygen under paragraph (9) for
                                    the period of medical need; and
                                      (III) maintenance and
                                    servicing payments shall, if
                                    the Secretary determines such
                                    payments are reasonable and
                                    necessary, be made (for parts
                                    and labor not covered by the
                                    supplier's or manufacturer's
                                    warranty, as determined by the
                                    Secretary to be appropriate for
                                    the equipment), and such
                                    payments shall be in an amount
                                    determined to be appropriate by
                                    the Secretary.
              (6) Payment for other covered items (other than
            durable medical equipment).--Payment for other covered
            items (other than durable medical equipment and other
            covered items described in paragraph (3), (4), or (5))
            shall be made in a lump-sum amount for the purchase of
            the item in the amount of the purchase price recognized
            under paragraph (8).
              (7) Payment for other items of durable medical
            equipment.--
                      (A) Payment.--In the case of an item of
                    durable medical equipment not described in
                    paragraphs (2) through (6), the following rules
                    shall apply:
                              (i) Rental.--
                                      (I) In general.--Except as
                                    provided in clause (iii),
                                    payment for the item shall be
                                    made on a monthly basis for the
                                    rental of the item during the
                                    period of medical need (but
                                    payments under this clause may
                                    not extend over a period of
                                    continuous use (as determined
                                    by the Secretary) of longer
                                    than 13 months).
                                      (II) Payment amount.--Subject
                                    to subclause (III) and
                                    subparagraph (B), the amount
                                    recognized for the item, for
                                    each of the first 3 months of
                                    such period, is 10 percent of
                                    the purchase price recognized
                                    under paragraph (8) with
                                    respect to the item, and, for
                                    each of the remaining months of
                                    such period, is 7.5 percent of
                                    such purchase price.
                                      (III) Special rule for power-
                                    driven wheelchairs.--For
                                    purposes of payment for power-
                                    driven wheelchairs, subclause
                                    (II) shall be applied by
                                    substituting ``15 percent'' and
                                    ``6 percent'' for ``10
                                    percent'' and ``7.5 percent'',
                                    respectively.
                              (ii) Ownership after rental.--On the
                            first day that begins after the 13th
                            continuous month during which payment
                            is made for the rental of an item under
                            clause (i), the supplier of the item
                            shall transfer title to the item to the
                            individual.
                              (iii) Purchase agreement option for
                            complex, rehabilitative power-driven
                            wheelchairs.--In the case of a complex,
                            rehabilitative power-driven wheelchair,
                            at the time the supplier furnishes the
                            item, the supplier shall offer the
                            individual the option to purchase the
                            item, and payment for such item shall
                            be made on a lump-sum basis if the
                            individual exercises such option.
                              (iv) Maintenance and servicing.--
                            After the supplier transfers title to
                            the item under clause (ii) or in the
                            case of a power-driven wheelchair for
                            which a purchase agreement has been
                            entered into under clause (iii),
                            maintenance and servicing payments
                            shall, if the Secretary determines such
                            payments are reasonable and necessary,
                            be made (for parts and labor not
                            covered by the supplier's or
                            manufacturer's warranty, as determined
                            by the Secretary to be appropriate for
                            the particular type of durable medical
                            equipment), and such payments shall be
                            in an amount determined to be
                            appropriate by the Secretary.
                      (B) Range for rental amounts.--
                              (i) For 1989.--For items furnished
                            during 1989, the payment amount
                            recognized under subparagraph (A)(i)
                            shall not be more than 115 percent, and
                            shall not be less than 85 percent, of
                            the prevailing charge established for
                            rental of the item in January 1987,
                            increased by the percentage increase in
                            the consumer price index for all urban
                            consumers (U.S. city average) for the
                            6-month period ending with December
                            1987.
                              (ii) For 1990.--For items furnished
                            during 1990, clause (i) shall apply in
                            the same manner as it applies to items
                            furnished during 1989.
                      (C) Replacement of items.--
                              (i) Establishment of reasonable
                            useful lifetime.--In accordance with
                            clause (iii), the Secretary shall
                            determine and establish a reasonable
                            useful lifetime for items of durable
                            medical equipment for which payment may
                            be made under this paragraph.
                              (ii) Payment for replacement items.--
                            If the reasonable lifetime of such an
                            item, as so established, has been
                            reached during a continuous period of
                            medical need, or the carrier determines
                            that the item is lost or irreparably
                            damaged, the patient may elect to have
                            payment for an item serving as a
                            replacement for such item made--
                                      (I) on a monthly basis for
                                    the rental of the replacement
                                    item in accordance with
                                    subparagraph (A); or
                                      (II) in the case of an item
                                    for which a purchase agreement
                                    has been entered into under
                                    subparagraph (A)(iii), in a
                                    lump-sum amount for the
                                    purchase of the item.
                              (iii) Length of reasonable useful
                            lifetime.--The reasonable useful
                            lifetime of an item of durable medical
                            equipment under this subparagraph shall
                            be equal to 5 years, except that, if
                            the Secretary determines that, on the
                            basis of prior experience in making
                            payments for such an item under this
                            title, a reasonable useful lifetime of
                            5 years is not appropriate with respect
                            to a particular item, the Secretary
                            shall establish an alternative
                            reasonable lifetime for such item.
              (8) Purchase price recognized for miscellaneous
            devices and items.--For purposes of paragraphs (6) and
            (7), the amount that is recognized under this paragraph
            as the purchase price for a covered item is the amount
            described in subparagraph (C) of this paragraph,
            determined as follows:
                      (A) Computation of local purchase price.--
                    Each carrier under section 1842 shall compute a
                    base local purchase price for the item as
                    follows:
                              (i) The carrier shall compute a base
                            local purchase price, for each item
                            described--
                                      (I) in paragraph (6) equal to
                                    the average reasonable charge
                                    in the locality for the
                                    purchase of the item for the
                                    12-month period ending with
                                    June 1987, or
                                      (II) in paragraph (7) equal
                                    to the average of the purchase
                                    prices on the claims submitted
                                    on an assignment-related basis
                                    for the unused item supplied
                                    during the 6-month period
                                    ending with December 1986.
                              (ii) The carrier shall compute a
                            local purchase price, with respect to
                            the furnishing of each particular
                            item--
                                      (I) in 1989 and 1990, equal
                                    to the base local purchase
                                    price computed under clause (i)
                                    increased by the percentage
                                    increase in the consumer price
                                    index for all urban consumers
                                    (U.S. city average) for the 6-
                                    month period ending with
                                    December 1987,
                                      (II) in 1991, equal to the
                                    local purchase price computed
                                    under this clause for the
                                    previous year, increased by the
                                    covered item update for 1991,
                                    and decreased by the percentage
                                    by which the average of the
                                    reasonable charges for claims
                                    paid for all items described in
                                    paragraph (7) is lower than the
                                    average of the purchase prices
                                    submitted for such items during
                                    the final 9 months of 1988; or
                                      (III) in 1992, 1993, and 1994
                                    equal to the local purchase
                                    price computed under this
                                    clause for the previous year
                                    increased by the covered item
                                    update for the year.
                      (B) Computation of national limited purchase
                    price.--With respect to the furnishing of a
                    particular item in a year, the Secretary shall
                    compute a national limited purchase price--
                              (i) for 1991, equal to the local
                            purchase price computed under
                            subparagraph (A)(ii) for the item for
                            the year, except that such national
                            limited purchase price may not exceed
                            100 percent of the weighted average of
                            all local purchase prices for the item
                            computed under such subparagraph for
                            the year, and may not be less than 85
                            percent of the weighted average of all
                            local purchase prices for the item
                            computed under such subparagraph for
                            the year;
                              (ii) for 1992 and 1993, the amount
                            determined under this subparagraph for
                            the preceding year increased by the
                            covered item update for such subsequent
                            year;
                              (iii) for 1994, the local purchase
                            price computed under subparagraph
                            (A)(ii) for the item for the year,
                            except that such national limited
                            purchase price may not exceed 100
                            percent of the median of all local
                            purchase prices computed for the item
                            under such subparagraph for the year
                            and may not be less than 85 percent of
                            the median of all local purchase prices
                            computed under such subparagraph for
                            the item for the year; and
                              (iv) for each subsequent year, equal
                            to the amount determined under this
                            subparagraph for the preceding year
                            increased by the covered item update
                            for such subsequent year.
                      (C) Purchase price recognized.--For purposes
                    of paragraphs (6) and (7), the amount that is
                    recognized under this paragraph as the purchase
                    price for each item furnished--
                              (i) in 1989 or 1990, is 100 percent
                            of the local purchase price computed
                            under subparagraph (A)(ii)(I);
                              (ii) in 1991, is the sum of (I) 67
                            percent of the local purchase price
                            computed under subparagraph (A)(ii)(II)
                            for 1991, and (II) 33 percent of the
                            national limited purchase price
                            computed under subparagraph (B) for
                            1991;
                              (iii) in 1992, is the sum of (I) 33
                            percent of the local purchase price
                            computed under subparagraph
                            (A)(ii)(III) for 1992, and (II) 67
                            percent of the national limited
                            purchase price computed under
                            subparagraph (B) for 1992; and
                              (iv) in 1993 or a subsequent year, is
                            the national limited purchase price
                            computed under subparagraph (B) for
                            that year.
              (9) Monthly payment amount recognized with respect to
            oxygen and oxygen equipment.--For purposes of paragraph
            (5), the amount that is recognized under this paragraph
            for payment for oxygen and oxygen equipment is the
            monthly payment amount described in subparagraph (C) of
            this paragraph. Such amount shall be computed
            separately (i) for all items of oxygen and oxygen
            equipment (other than portable oxygen equipment) and
            (ii) for portable oxygen equipment (each such group
            referred to in this paragraph as an ``item'').
                      (A) Computation of local monthly payment
                    rate.--Each carrier under this section shall
                    compute a base local payment rate for each item
                    as follows:
                              (i) The carrier shall compute a base
                            local average monthly payment rate per
                            beneficiary as an amount equal to (I)
                            the total reasonable charges for the
                            item during the 12-month period ending
                            with December 1986, divided by (II) the
                            total number of months for all
                            beneficiaries receiving the item in the
                            area during the 12-month period for
                            which the carrier made payment for the
                            item under this title.
                              (ii) The carrier shall compute a
                            local average monthly payment rate for
                            the item applicable--
                                      (I) to 1989 and 1990, equal
                                    to 95 percent of the base local
                                    average monthly payment rate
                                    computed under clause (i) for
                                    the item increased by the
                                    percentage increase in the
                                    consumer price index for all
                                    urban consumers (U.S. city
                                    average) for the 6-month period
                                    ending with December 1987, or
                                      (II) to 1991, 1992, 1993, and
                                    1994 equal to the local average
                                    monthly payment rate computed
                                    under this clause for the item
                                    for the previous year increased
                                    by the covered item increase
                                    for the year.
                      (B) Computation of national limited monthly
                    payment rate.--With respect to the furnishing
                    of an item in a year, the Secretary shall
                    compute a national limited monthly payment rate
                    equal to--
                              (i) for 1991, the local monthly
                            payment rate computed under
                            subparagraph (A)(ii)(II) for the item
                            for the year, except that such national
                            limited monthly payment rate may not
                            exceed 100 percent of the weighted
                            average of all local monthly payment
                            rates computed for the item under such
                            subparagraph for the year, and may not
                            be less than 85 percent of the weighted
                            average of all local monthly payment
                            rates computed for the item under such
                            subparagraph for the year;
                              (ii) for 1992 and 1993, the amount
                            determined under this subparagraph for
                            the preceding year increased by the
                            covered item update for such subsequent
                            year;
                              (iii) for 1994, the local monthly
                            payment rate computed under
                            subparagraph (A)(ii) for the item for
                            the year, except that such national
                            limited monthly payment rate may not
                            exceed 100 percent of the median of all
                            local monthly payment rates computed
                            for the item under such subparagraph
                            for the year and may not be less than
                            85 percent of the median of all local
                            monthly payment rates computed for the
                            item under such subparagraph for the
                            year;
                              (iv) for 1995, 1996, and 1997, equal
                            to the amount determined under this
                            subparagraph for the preceding year
                            increased by the covered item update
                            for such subsequent year;
                              (v) for 1998, 75 percent of the
                            amount determined under this
                            subparagraph for 1997; and
                              (vi) for 1999 and each subsequent
                            year, 70 percent of the amount
                            determined under this subparagraph for
                            1997.
                      (C) Monthly payment amount recognized.--For
                    purposes of paragraph (5), the amount that is
                    recognized under this paragraph as the base
                    monthly payment amount for each item
                    furnished--
                              (i) in 1989 and in 1990, is 100
                            percent of the local average monthly
                            payment rate computed under
                            subparagraph (A)(ii) for the item;
                              (ii) in 1991, is the sum of (I) 67
                            percent of the local average monthly
                            payment rate computed under
                            subparagraph (A)(ii)(II) for the item
                            for 1991, and (II) 33 percent of the
                            national limited monthly payment rate
                            computed under subparagraph (B)(i) for
                            the item for 1991;
                              (iii) in 1992, is the sum of (I) 33
                            percent of the local average monthly
                            payment rate computed under
                            subparagraph (A)(ii)(II) for the item
                            for 1992, and (II) 67 percent of the
                            national limited monthly payment rate
                            computed under subparagraph (B)(ii) for
                            the item for 1992; and
                              (iv) in a subsequent year, is the
                            national limited monthly payment rate
                            computed under subparagraph (B) for the
                            item for that year.
                      (D) Authority to create classes.--
                              (i) In general.--Subject to clause
                            (ii), the Secretary may establish
                            separate classes for any item of oxygen
                            and oxygen equipment and separate
                            national limited monthly payment rates
                            for each of such classes.
                              (ii) Budget neutrality.--The
                            Secretary may take actions under clause
                            (i) only to the extent such actions do
                            not result in expenditures for any year
                            to be more or less than the
                            expenditures which would have been made
                            if such actions had not been taken. The
                            requirement of the preceding sentence
                            shall not apply beginning with the
                            second calendar quarter beginning on or
                            after the date of the enactment of this
                            sentence.
              (10) Exceptions and adjustments.--
                      (A) Areas outside continental united
                    states.--Exceptions to the amounts recognized
                    under the previous provisions of this
                    subsection shall be made to take into account
                    the unique circumstances of covered items
                    furnished in Alaska, Hawaii, or Puerto Rico.
                      (B) Adjustment for inherent reasonableness.--
                    The Secretary is authorized to apply the
                    provisions of paragraphs (8) and (9) of section
                    1842(b) to covered items and suppliers of such
                    items and payments under this subsection in an
                    area and with respect to covered items and
                    services for which the Secretary does not make
                    a payment amount adjustment under paragraph
                    (1)(F).
                      (C) Transcutaneous electrical nerve
                    stimulator (tens).--In order to permit an
                    attending physician time to determine whether
                    the purchase of a transcutaneous electrical
                    nerve stimulator is medically appropriate for a
                    particular patient, the Secretary may determine
                    an appropriate payment amount for the initial
                    rental of such item for a period of not more
                    than 2 months. If such item is subsequently
                    purchased, the payment amount with respect to
                    such purchase is the payment amount determined
                    under paragraph (2).
              (11) Improper billing and requirement of physician
            order.--
                      (A) Improper billing for certain rental
                    items.--Notwithstanding any other provision of
                    this title, a supplier of a covered item for
                    which payment is made under this subsection and
                    which is furnished on a rental basis shall
                    continue to supply the item without charge
                    (other than a charge provided under this
                    subsection for the maintenance and servicing of
                    the item) after rental payments may no longer
                    be made under this subsection. If a supplier
                    knowingly and willfully violates the previous
                    sentence, the Secretary may apply sanctions
                    against the supplier under section 1842(j)(2)
                    in the same manner such sanctions may apply
                    with respect to a physician.
                      (B) Requirement of physician order.--
                              (i) In general.--The Secretary is
                            authorized to require, for specified
                            covered items, that payment may be made
                            under this subsection with respect to
                            the item only if a physician enrolled
                            under section 1866(j) or an eligible
                            professional under section
                            1848(k)(3)(B) that is enrolled under
                            section 1866(j) has communicated to the
                            supplier, before delivery of the item,
                            a written order for the item.
                              (ii) Requirement for face to face
                            encounter.--The Secretary shall require
                            that such an order be written pursuant
                            to a physician, a physician assistant,
                            a nurse practitioner, or a clinical
                            nurse specialist (as those terms are
                            defined in section 1861(aa)(5))
                            documenting such physician, physician
                            assistant, practitioner, or specialist
                            has had a face-to-face encounter
                            (including through use of telehealth
                            under subsection (m) and other than
                            with respect to encounters that are
                            incident to services involved) with the
                            individual involved during the 6-month
                            period preceding such written order, or
                            other reasonable timeframe as
                            determined by the Secretary.
              (12) Regional carriers.--The Secretary may designate,
            by regulation under section 1842, one carrier for one
            or more entire regions to process all claims within the
            region for covered items under this section.
              (13) Covered item.--In this subsection, the term
            ``covered item'' means durable medical equipment (as
            defined in section 1861(n)), including such equipment
            described in section 1861(m)(5), but not including
            implantable items for which payment may be made under
            section 1833(t).
              (14) Covered item update.--In this subsection, the
            term ``covered item update'' means, with respect to a
            year--
                      (A) for 1991 and 1992, the percentage
                    increase in the consumer price index for all
                    urban consumers (U.S. city average) for the 12-
                    month period ending with June of the previous
                    year reduced by 1 percentage point;
                      (B) for 1993, 1994, 1995, 1996, and 1997, the
                    percentage increase in the consumer price index
                    for all urban consumers (U.S. city average) for
                    the 12-month period ending with June of the
                    previous year;
                      (C) for each of the years 1998 through 2000,
                    0 percentage points;
                      (D) for 2001, the percentage increase in the
                    consumer price index for all urban consumers
                    (U.S. city average) for the 12-month period
                    ending with June 2000;
                      (E) for 2002, 0 percentage points;
                      (F) for 2003, the percentage increase in the
                    consumer price index for all urban consumers
                    (U.S. urban average) for the 12-month period
                    ending with June of 2002;
                      (G) for 2004 through 2006--
                              (i) subject to clause (ii), in the
                            case of class III medical devices
                            described in section 513(a)(1)(C) of
                            the Federal Food, Drug, and Cosmetic
                            Act (21 U.S.C. 360(c)(1)(C)), the
                            percentage increase described in
                            subparagraph (B) for the year involved;
                            and
                              (ii) in the case of covered items not
                            described in clause (i), 0 percentage
                            points;
                      (H) for 2007--
                              (i) subject to clause (ii), in the
                            case of class III medical devices
                            described in section 513(a)(1)(C) of
                            the Federal Food, Drug, and Cosmetic
                            Act (21 U.S.C. 360(c)(1)(C)), the
                            percentage change determined by the
                            Secretary to be appropriate taking into
                            account recommendations contained in
                            the report of the Comptroller General
                            of the United States under section
                            302(c)(1)(B) of the Medicare
                            Prescription Drug, Improvement, and
                            Modernization Act of 2003; and
                              (ii) in the case of covered items not
                            described in clause (i), 0 percentage
                            points;
                      (I) for 2008--
                              (i) subject to clause (ii), in the
                            case of class III medical devices
                            described in section 513(a)(1)(C) of
                            the Federal Food, Drug, and Cosmetic
                            Act (21 U.S.C. 360(c)(1)(C)), the
                            percentage increase described in
                            subparagraph (B) (as applied to the
                            payment amount for 2007 determined
                            after the application of the percentage
                            change under subparagraph (H)(i)); and
                              (ii) in the case of covered items not
                            described in clause (i), 0 percentage
                            points;
                      (J) for 2009--
                              (i) in the case of items and services
                            furnished in any geographic area, if
                            such items or services were selected
                            for competitive acquisition in any area
                            under the competitive acquisition
                            program under section
                            1847(a)(1)(B)(i)(I) before July 1,
                            2008, including related accessories but
                            only if furnished with such items and
                            services selected for such competition
                            and diabetic supplies but only if
                            furnished through mail order, - 9.5
                            percent; or
                              (ii) in the case of other items and
                            services, the percentage increase in
                            the consumer price index for all urban
                            consumers (U.S. urban average) for the
                            12-month period ending with June 2008;
                      (K) for 2010, the percentage increase in the
                    consumer price index for all urban consumers
                    (U.S. urban average) for the 12-month period
                    ending with June of the previous year; and
                      (L) for 2011 and each subsequent year--
                              (i) the percentage increase in the
                            consumer price index for all urban
                            consumers (United States city average)
                            for the 12-month period ending with
                            June of the previous year, reduced by--
                              (ii) the productivity adjustment
                            described in section
                            1886(b)(3)(B)(xi)(II).
            The application of subparagraph (L)(ii) may result in
            the covered item update under this paragraph being less
            than 0.0 for a year, and may result in payment rates
            under this subsection for a year being less than such
            payment rates for the preceding year.
              (15) Advance determinations of coverage for certain
            items.--
                      (A) Development of lists of items by
                    secretary.--The Secretary may develop and
                    periodically update a list of items for which
                    payment may be made under this subsection that
                    the Secretary determines, on the basis of prior
                    payment experience, are frequently subject to
                    unnecessary utilization throughout a carrier's
                    entire service area or a portion of such area.
                      (B) Development of lists of suppliers by
                    secretary.--The Secretary may develop and
                    periodically update a list of suppliers of
                    items for which payment may be made under this
                    subsection with respect to whom--
                              (i) the Secretary has found that a
                            substantial number of claims for
                            payment under this part for items
                            furnished by the supplier have been
                            denied on the basis of the application
                            of section 1862(a)(1); or
                              (ii) the Secretary has identified a
                            pattern of overutilization resulting
                            from the business practice of the
                            supplier.
                      (C) Determinations of coverage in advance.--A
                    carrier shall determine in advance of delivery
                    of an item whether payment for the item may not
                    be made because the item is not covered or
                    because of the application of section
                    1862(a)(1) if--
                              (i) the item is included on the list
                            developed by the Secretary under
                            subparagraph (A);
                              (ii) the item is furnished by a
                            supplier included on the list developed
                            by the Secretary under subparagraph
                            (B); or
                              (iii) the item is a customized item
                            (other than inexpensive items specified
                            by the Secretary) and the patient to
                            whom the item is to be furnished or the
                            supplier requests that such advance
                            determination be made.
              (16) Disclosure of information and surety bond.--The
            Secretary shall not provide for the issuance (or
            renewal) of a provider number for a supplier of durable
            medical equipment, for purposes of payment under this
            part for durable medical equipment furnished by the
            supplier, unless the supplier provides the Secretary on
            a continuing basis--
                      (A) with--
                              (i) full and complete information as
                            to the identity of each person with an
                            ownership or control interest (as
                            defined in section 1124(a)(3)) in the
                            supplier or in any subcontractor (as
                            defined by the Secretary in
                            regulations) in which the supplier
                            directly or indirectly has a 5 percent
                            or more ownership interest; and
                              (ii) to the extent determined to be
                            feasible under regulations of the
                            Secretary, the name of any disclosing
                            entity (as defined in section
                            1124(a)(2)) with respect to which a
                            person with such an ownership or
                            control interest in the supplier is a
                            person with such an ownership or
                            control interest in the disclosing
                            entity; and
                      (B) with a surety bond in a form specified by
                    the Secretary and in an amount that is not less
                    than $50,000 that the Secretary determines is
                    commensurate with the volume of the billing of
                    the supplier.
            The Secretary may waive the requirement of a bond under
            subparagraph (B) in the case of a supplier that
            provides a comparable surety bond under State law. The
            Secretary, at the Secretary's discretion, may impose
            the requirements of the first sentence with respect to
            some or all providers of items or services under part A
            or some or all suppliers or other persons (other than
            physicians or other practitioners, as defined in
            section 1842(b)(18)(C)) who furnish items or services
            under this part.
              (17) Prohibition against unsolicited telephone
            contacts by suppliers.--
                      (A) In general.--A supplier of a covered item
                    under this subsection may not contact an
                    individual enrolled under this part by
                    telephone regarding the furnishing of a covered
                    item to the individual unless 1 of the
                    following applies:
                              (i) The individual has given written
                            permission to the supplier to make
                            contact by telephone regarding the
                            furnishing of a covered item.
                              (ii) The supplier has furnished a
                            covered item to the individual and the
                            supplier is contacting the individual
                            only regarding the furnishing of such
                            covered item.
                              (iii) If the contact is regarding the
                            furnishing of a covered item other than
                            a covered item already furnished to the
                            individual, the supplier has furnished
                            at least 1 covered item to the
                            individual during the 15-month period
                            preceding the date on which the
                            supplier makes such contact.
                      (B) Prohibiting payment for items furnished
                    subsequent to unsolicited contacts.--If a
                    supplier knowingly contacts an individual in
                    violation of subparagraph (A), no payment may
                    be made under this part for any item
                    subsequently furnished to the individual by the
                    supplier.
                      (C) Exclusion from program for suppliers
                    engaging in pattern of unsolicited contacts.--
                    If a supplier knowingly contacts individuals in
                    violation of subparagraph (A) to such an extent
                    that the supplier's conduct establishes a
                    pattern of contacts in violation of such
                    subparagraph, the Secretary shall exclude the
                    supplier from participation in the programs
                    under this Act, in accordance with the
                    procedures set forth in subsections (c), (f),
                    and (g) of section 1128.
              (18) Refund of amounts collected for certain
            disallowed items.--
                      (A) In general.--If a nonparticipating
                    supplier furnishes to an individual enrolled
                    under this part a covered item for which no
                    payment may be made under this part by reason
                    of paragraph (17)(B), the supplier shall refund
                    on a timely basis to the patient (and shall be
                    liable to the patient for) any amounts
                    collected from the patient for the item,
                    unless--
                              (i) the supplier establishes that the
                            supplier did not know and could not
                            reasonably have been expected to know
                            that payment may not be made for the
                            item by reason of paragraph (17)(B), or
                              (ii) before the item was furnished,
                            the patient was informed that payment
                            under this part may not be made for
                            that item and the patient has agreed to
                            pay for that item.
                      (B) Sanctions.--If a supplier knowingly and
                    willfully fails to make refunds in violation of
                    subparagraph (A), the Secretary may apply
                    sanctions against the supplier in accordance
                    with section 1842(j)(2).
                      (C) Notice.--Each carrier with a contract in
                    effect under this part with respect to
                    suppliers of covered items shall send any
                    notice of denial of payment for covered items
                    by reason of paragraph (17)(B) and for which
                    payment is not requested on an assignment-
                    related basis to the supplier and the patient
                    involved.
                      (D) Timely basis defined.--A refund under
                    subparagraph (A) is considered to be on a
                    timely basis only if--
                              (i) in the case of a supplier who
                            does not request reconsideration or
                            seek appeal on a timely basis, the
                            refund is made within 30 days after the
                            date the supplier receives a denial
                            notice under subparagraph (C), or
                              (ii) in the case in which such a
                            reconsideration or appeal is taken, the
                            refund is made within 15 days after the
                            date the supplier receives notice of an
                            adverse determination on
                            reconsideration or appeal.
              (19) Certain upgraded items.--
                      (A) Individual's right to choose upgraded
                    item.--Notwithstanding any other provision of
                    this title, the Secretary may issue regulations
                    under which an individual may purchase or rent
                    from a supplier an item of upgraded durable
                    medical equipment for which payment would be
                    made under this subsection if the item were a
                    standard item.
                      (B) Payments to supplier.--In the case of the
                    purchase or rental of an upgraded item under
                    subparagraph (A)--
                              (i) the supplier shall receive
                            payment under this subsection with
                            respect to such item as if such item
                            were a standard item; and
                              (ii) the individual purchasing or
                            renting the item shall pay the supplier
                            an amount equal to the difference
                            between the supplier's charge and the
                            amount under clause (i).
                    In no event may the supplier's charge for an
                    upgraded item exceed the applicable fee
                    schedule amount (if any) for such item.
                      (C) Consumer protection safeguards.--Any
                    regulations under subparagraph (A) shall
                    provide for consumer protection standards with
                    respect to the furnishing of upgraded equipment
                    under subparagraph (A). Such regulations shall
                    provide for--
                              (i) determination of fair market
                            prices with respect to an upgraded
                            item;
                              (ii) full disclosure of the
                            availability and price of standard
                            items and proof of receipt of such
                            disclosure information by the
                            beneficiary before the furnishing of
                            the upgraded item;
                              (iii) conditions of participation for
                            suppliers in the billing arrangement;
                              (iv) sanctions of suppliers who are
                            determined to engage in coercive or
                            abusive practices, including exclusion;
                            and
                              (v) such other safeguards as the
                            Secretary determines are necessary.
              (20) Identification of quality standards.--
                      (A) In general.--Subject to subparagraph (C),
                    the Secretary shall establish and implement
                    quality standards for suppliers of items and
                    services described in subparagraph (D) to be
                    applied by recognized independent accreditation
                    organizations (as designated under subparagraph
                    (B)) and with which such suppliers shall be
                    required to comply in order to--
                              (i) furnish any such item or service
                            for which payment is made under this
                            part; and
                              (ii) receive or retain a provider or
                            supplier number used to submit claims
                            for reimbursement for any such item or
                            service for which payment may be made
                            under this title.
                      (B) Designation of independent accreditation
                    organizations.--Not later than the date that is
                    1 year after the date on which the Secretary
                    implements the quality standards under
                    subparagraph (A), notwithstanding section
                    1865(a), the Secretary shall designate and
                    approve one or more independent accreditation
                    organizations for purposes of such
                    subparagraph.
                      (C) Quality standards.--The quality standards
                    described in subparagraph (A) may not be less
                    stringent than the quality standards that would
                    otherwise apply if this paragraph did not apply
                    and shall include consumer services standards.
                      (D) Items and services described.--The items
                    and services described in this subparagraph are
                    the following items and services, as the
                    Secretary determines appropriate:
                              (i) Covered items (as defined in
                            paragraph (13)) for which payment may
                            otherwise be made under this
                            subsection.
                              (ii) Prosthetic devices and orthotics
                            and prosthetics described in section
                            1834(h)(4).
                              (iii) Items and services described in
                            section 1842(s)(2).
                      (E) Implementation.--The Secretary may
                    establish by program instruction or otherwise
                    the quality standards under this paragraph,
                    including subparagraph (F), after consultation
                    with representatives of relevant parties. Such
                    standards shall be applied prospectively and
                    shall be published on the Internet website of
                    the Centers for Medicare & Medicaid Services.
                      (F) Application of accreditation
                    requirement.--In implementing quality standards
                    under this paragraph--
                              (i) subject to clause (ii) and
                            subparagraph (G), the Secretary shall
                            require suppliers furnishing items and
                            services described in subparagraph (D)
                            on or after October 1, 2009, directly
                            or as a subcontractor for another
                            entity, to have submitted to the
                            Secretary evidence of accreditation by
                            an accreditation organization
                            designated under subparagraph (B) as
                            meeting applicable quality standards,
                            except that the Secretary shall not
                            require under this clause pharmacies to
                            obtain such accreditation before
                            January 1, 2010, except that the
                            Secretary shall not require a pharmacy
                            to have submitted to the Secretary such
                            evidence of accreditation prior to
                            January 1, 2011; and
                              (ii) in applying such standards and
                            the accreditation requirement of clause
                            (i) with respect to eligible
                            professionals (as defined in section
                            1848(k)(3)(B)), and including such
                            other persons, such as orthotists and
                            prosthetists, as specified by the
                            Secretary, furnishing such items and
                            services--
                                      (I) such standards and
                                    accreditation requirement shall
                                    not apply to such professionals
                                    and persons unless the
                                    Secretary determines that the
                                    standards being applied are
                                    designed specifically to be
                                    applied to such professionals
                                    and persons; and
                                      (II) the Secretary may exempt
                                    such professionals and persons
                                    from such standards and
                                    requirement if the Secretary
                                    determines that licensing,
                                    accreditation, or other
                                    mandatory quality requirements
                                    apply to such professionals and
                                    persons with respect to the
                                    furnishing of such items and
                                    services.
                      (G) Application of accreditation requirement
                    to certain pharmacies.--
                              (i) In general.--With respect to
                            items and services furnished on or
                            after January 1, 2011, in implementing
                            quality standards under this
                            paragraph--
                                      (I) subject to subclause
                                    (II), in applying such
                                    standards and the accreditation
                                    requirement of subparagraph
                                    (F)(i) with respect to
                                    pharmacies described in clause
                                    (ii) furnishing such items and
                                    services, such standards and
                                    accreditation requirement shall
                                    not apply to such pharmacies;
                                    and
                                      (II) the Secretary may apply
                                    to such pharmacies an
                                    alternative accreditation
                                    requirement established by the
                                    Secretary if the Secretary
                                    determines such alternative
                                    accreditation requirement is
                                    more appropriate for such
                                    pharmacies.
                              (ii) Pharmacies described.--A
                            pharmacy described in this clause is a
                            pharmacy that meets each of the
                            following criteria:
                                      (I) The total billings by the
                                    pharmacy for such items and
                                    services under this title are
                                    less than 5 percent of total
                                    pharmacy sales, as determined
                                    based on the average total
                                    pharmacy sales for the previous
                                    3 calendar years, 3 fiscal
                                    years, or other yearly period
                                    specified by the Secretary.
                                      (II) The pharmacy has been
                                    enrolled under section 1866(j)
                                    as a supplier of durable
                                    medical equipment, prosthetics,
                                    orthotics, and supplies, has
                                    been issued (which may include
                                    the renewal of) a provider
                                    number for at least 5 years,
                                    and for which a final adverse
                                    action (as defined in section
                                    424.57(a) of title 42, Code of
                                    Federal Regulations) has not
                                    been imposed in the past 5
                                    years.
                                      (III) The pharmacy submits to
                                    the Secretary an attestation,
                                    in a form and manner, and at a
                                    time, specified by the
                                    Secretary, that the pharmacy
                                    meets the criteria described in
                                    subclauses (I) and (II). Such
                                    attestation shall be subject to
                                    section 1001 of title 18,
                                    United States Code.
                                      (IV) The pharmacy agrees to
                                    submit materials as requested
                                    by the Secretary, or during the
                                    course of an audit conducted on
                                    a random sample of pharmacies
                                    selected annually, to verify
                                    that the pharmacy meets the
                                    criteria described in
                                    subclauses (I) and (II).
                                    Materials submitted under the
                                    preceding sentence shall
                                    include a certification by an
                                    accountant on behalf of the
                                    pharmacy or the submission of
                                    tax returns filed by the
                                    pharmacy during the relevant
                                    periods, as requested by the
                                    Secretary.
              (21) Special payment rule for specified items and
            supplies.--
                      (A) In general.--Notwithstanding the
                    preceding provisions of this subsection, for
                    specified items and supplies (described in
                    subparagraph (B)) furnished during 2005, the
                    payment amount otherwise determined under this
                    subsection for such specified items and
                    supplies shall be reduced by the percentage
                    difference between--
                              (i) the amount of payment otherwise
                            determined for the specified item or
                            supply under this subsection for 2002,
                            and
                              (ii) the amount of payment for the
                            specified item or supply under chapter
                            89 of title 5, United States Code, as
                            identified in the column entitled
                            ``Median FEHP Price'' in the table
                            entitled ``SUMMARY OF MEDICARE PRICES
                            COMPARED TO VA, MEDICAID, RETAIL, AND
                            FEHP PRICES FOR 16 ITEMS'' included in
                            the Testimony of the Inspector General
                            before the Senate Committee on
                            Appropriations, June 12, 2002, or any
                            subsequent report by the Inspector
                            General.
                      (B) Specified item or supply described.--For
                    purposes of subparagraph (A), a specified item
                    or supply means oxygen and oxygen equipment,
                    standard wheelchairs (including standard power
                    wheelchairs), nebulizers, diabetic supplies
                    consisting of lancets and testing strips,
                    hospital beds, and air mattresses, but only if
                    the HCPCS code for the item or supply is
                    identified in a table referred to in
                    subparagraph (A)(ii).
                      (C) Application of update to special payment
                    amount.--The covered item update under
                    paragraph (14) for specified items and supplies
                    for 2006 and each subsequent year shall be
                    applied to the payment amount under
                    subparagraph (A) unless payment is made for
                    such items and supplies under section 1847.
              (22) Special payment rule for diabetic supplies.--
            Notwithstanding the preceding provisions of this
            subsection, for purposes of determining the payment
            amount under this subsection for diabetic supplies
            furnished on or after the first day of the calendar
            quarter during 2013 that is at least 30 days after the
            date of the enactment of this paragraph and before the
            date described in paragraph (1)(H)(ii), the Secretary
            shall recalculate and apply the covered item update
            under paragraph (14) as if subparagraph (J)(i) of such
            paragraph was amended by striking ``but only if
            furnished through mail order''.
      (b) Fee Schedules for Radiologist Services.--
              (1) Development.--The Secretary shall develop--
                      (A) a relative value scale to serve as the
                    basis for the payment for radiologist services
                    under this part, and
                      (B) using such scale and appropriate
                    conversion factors and subject to subsection
                    (c)(1)(A), fee schedules (on a regional,
                    statewide, locality, or carrier service area
                    basis) for payment for radiologist services
                    under this part, to be implemented for such
                    services furnished during 1989.
              (2) Consultation.--In carrying out paragraph (1), the
            Secretary shall regularly consult closely with the
            Physician Payment Review Commission, the American
            College of Radiology, and other organizations
            representing physicians or suppliers who furnish
            radiologist services and shall share with them the data
            and data analysis being used to make the determinations
            under paragraph (1), including data on variations in
            current medicare payments by geographic area, and by
            service and physician specialty.
              (3) Considerations.--In developing the relative value
            scale and fee schedules under paragraph (1), the
            Secretary--
                      (A) shall take into consideration variations
                    in the cost of furnishing such services among
                    geographic areas and among different sites
                    where services are furnished, and
                      (B) may also take into consideration such
                    other factors respecting the manner in which
                    physicians in different specialties furnish
                    such services as may be appropriate to assure
                    that payment amounts are equitable and designed
                    to promote effective and efficient provision of
                    radiologist services by physicians in the
                    different specialties.
              (4) Savings.--
                      (A) Budget neutral fee schedules.--The
                    Secretary shall develop preliminary fee
                    schedules for 1989, which are designed to
                    result in the same amount of aggregate payments
                    (net of any coinsurance and deductibles under
                    sections 1833(a)(1)(J) and 1833(b)) for
                    radiologist services furnished in 1989 as would
                    have been made if this subsection had not been
                    enacted.
                      (B) Initial savings.--The fee schedules
                    established for payment purposes under this
                    subsection for services furnished in 1989 shall
                    be 97 percent of the amounts permitted under
                    these preliminary fee schedules developed under
                    subparagraph (A).
                      (C)  1990 fee schedules.--For radiologist
                    services (other than portable X-ray services)
                    furnished under this part during 1990, after
                    March 31 of such year, the conversion factors
                    used under this subsection shall be 96 percent
                    of the conversion factors that applied under
                    this subsection as of December 31, 1989.
                      (D)  1991 fee schedules.--For radiologist
                    services (other than portable X-ray services)
                    furnished under this part during 1991, the
                    conversion factors used in a locality under
                    this subsection shall, subject to clause (vii),
                    be reduced to the adjusted conversion factor
                    for the locality determined as follows:
                              (i) National weighted average
                            conversion factor.--The Secretary shall
                            estimate the national weighted average
                            of the conversion factors used under
                            this subsection for services furnished
                            during 1990 beginning on April 1, using
                            the best available data.
                              (ii) Reduced national weighted
                            average.--The national weighted average
                            estimated under clause (i) shall be
                            reduced by 13 percent.
                              (iii) Computation of 1990 locality
                            index relative to national average.--
                            The Secretary shall establish an index
                            which reflects, for each locality, the
                            ratio of the conversion factor used in
                            the locality under this subsection to
                            the national weighted average estimated
                            under clause (i).
                              (iv) Adjusted conversion factor.--The
                            adjusted conversion factor for the
                            professional or technical component of
                            a service in a locality is the sum of
                            \1/2\ of the locally-adjusted amount
                            determined under clause (v) and \1/2\
                            of the GPCI-adjusted amount determined
                            under clause (vi).
                              (v) Locally-adjusted amount.--For
                            purposes of clause (iv), the locally
                            adjusted amount determined under this
                            clause is the product of (I) the
                            national weighted average conversion
                            factor computed under clause (ii), and
                            (II) the index value established under
                            clause (iii) for the locality.
                              (vi) GPCI-adjusted amount.--For
                            purposes of clause (iv), the GPCI-
                            adjusted amount determined under this
                            clause is the sum of--
                                      (I) the product of (a) the
                                    portion of the reduced national
                                    weighted average conversion
                                    factor computed under clause
                                    (ii) which is attributable to
                                    physician work and (b) the
                                    geographic work index value for
                                    the locality (specified in
                                    Addendum C to the Model Fee
                                    Schedule for Physician Services
                                    (published on September 4,
                                    1990, 55 Federal Register pp.
                                    36238-36243)); and
                                      (II) the product of (a) the
                                    remaining portion of the
                                    reduced national weighted
                                    average conversion factor
                                    computed under clause (ii), and
                                    (b) the geographic practice
                                    cost index value specified in
                                    section 1842(b)(14)(C)(iv) for
                                    the locality.
                            In applying this clause with respect to
                            the professional component of a
                            service, 80 percent of the conversion
                            factor shall be considered to be
                            attributable to physician work and with
                            respect to the technical component of
                            the service, 0 percent shall be
                            considered to be attributable to
                            physician work.
                              (vii) Limits on conversion factor.--
                            The conversion factor to be applied to
                            a locality to the professional or
                            technical component of a service shall
                            not be reduced under this subparagraph
                            by more than 9.5 percent below the
                            conversion factor applied in the
                            locality under subparagraph (C) to such
                            component, but in no case shall the
                            conversion factor be less than 60
                            percent of the national weighted
                            average of the conversion factors
                            (computed under clause (i)).
                      (E) Rule for certain scanning services.--In
                    the case of the technical components of
                    magnetic resonance imaging (MRI) services and
                    computer assisted tomography (CAT) services
                    furnished after December 31, 1990, the amount
                    otherwise payable shall be reduced by 10
                    percent.
                      (F) Subsequent updating.--For radiologist
                    services furnished in subsequent years, the fee
                    schedules shall be the schedules for the
                    previous year updated by the percentage
                    increase in the MEI (as defined in section
                    1842(i)(3)) for the year.
                      (G) Nonparticipating physicians and
                    suppliers.--Each fee schedule so established
                    shall provide that the payment rate recognized
                    for nonparticipating physicians and suppliers
                    is equal to the appropriate percent (as defined
                    in section 1842(b)(4)(A)(iv)) of the payment
                    rate recognized for participating physicians
                    and suppliers.
              (5) Limiting charges of nonparticipating physicians
            and suppliers.--
                      (A) In general.--In the case of radiologist
                    services furnished after January 1, 1989, for
                    which payment is made under a fee schedule
                    under this subsection, if a nonparticipating
                    physician or supplier furnishes the service to
                    an individual entitled to benefits under this
                    part, the physician or supplier may not charge
                    the individual more than the limiting charge
                    (as defined in subparagraph (B)).
                      (B) Limiting charge defined.--In subparagraph
                    (A), the term ``limiting charge'' means, with
                    respect to a service furnished--
                              (i) in 1989, 125 percent of the
                            amount specified for the service in the
                            appropriate fee schedule established
                            under paragraph (1),
                              (ii) in 1990, 120 percent of the
                            amount specified for the service in the
                            appropriate fee schedule established
                            under paragraph (1), and
                              (iii) after 1990, 115 percent of the
                            amount specified for the service in the
                            appropriate fee schedule established
                            under paragraph (1).
                      (C) Enforcement.--If a physician or supplier
                    knowingly and willfully bills in violation of
                    subparagraph (A), the Secretary may apply
                    sanctions against such physician or supplier in
                    accordance with section 1842(j)(2) in the same
                    manner as such sanctions may apply to a
                    physician.
              (6) Radiologist services defined.--For the purposes
            of this subsection and section 1833(a)(1)(J), the term
            ``radiologist services'' only includes radiology
            services performed by, or under the direction or
            supervision of, a physician--
                      (A) who is certified, or eligible to be
                    certified, by the American Board of Radiology,
                    or
                      (B) for whom radiology services account for
                    at least 50 percent of the total amount of
                    charges made under this part.
      (c) Payment and Standards for Screening Mammography.--
              (1) In general.--With respect to expenses incurred
            for screening mammography (as defined in section
            1861(jj)), payment may be made only--
                      (A) for screening mammography conducted
                    consistent with the frequency permitted under
                    paragraph (2); and
                      (B) if the screening mammography is conducted
                    by a facility that has a certificate (or
                    provisional certificate) issued under section
                    354 of the Public Health Service Act.
              (2) Frequency covered.--
                      (A) In general.--Subject to revision by the
                    Secretary under subparagraph (B)--
                              (i) no payment may be made under this
                            part for screening mammography
                            performed on a woman under 35 years of
                            age;
                              (ii) payment may be made under this
                            part for only one screening mammography
                            performed on a woman over 34 years of
                            age, but under 40 years of age; and
                              (iii) in the case of a woman over 39
                            years of age, payment may not be made
                            under this part for screening
                            mammography performed within 11 months
                            following the month in which a previous
                            screening mammography was performed.
                      (B) Revision of frequency.--
                              (i) Review.--The Secretary, in
                            consultation with the Director of the
                            National Cancer Institute, shall review
                            periodically the appropriate frequency
                            for performing screening mammography,
                            based on age and such other factors as
                            the Secretary believes to be pertinent.
                              (ii) Revision of frequency.--The
                            Secretary, taking into consideration
                            the review made under clause (i), may
                            revise from time to time the frequency
                            with which screening mammography may be
                            paid for under this subsection.
      (d) Frequency Limits and Payment for Colorectal Cancer
    Screening Tests.--
              (1) Screening fecal-occult blood tests.--
                      (A) Payment amount.--The payment amount for
                    colorectal cancer screening tests consisting of
                    screening fecal-occult blood tests is equal to
                    the payment amount established for diagnostic
                    fecal-occult blood tests under section 1833(h).
                      (B) Frequency limit.--No payment may be made
                    under this part for a colorectal cancer
                    screening test consisting of a screening fecal-
                    occult blood test--
                              (i) if the individual is under 50
                            years of age; or
                              (ii) if the test is performed within
                            the 11 months after a previous
                            screening fecal-occult blood test.
              (2) Screening flexible sigmoidoscopies.--
                      (A) Fee schedule.--With respect to colorectal
                    cancer screening tests consisting of screening
                    flexible sigmoidoscopies, payment under section
                    1848 shall be consistent with payment under
                    such section for similar or related services.
                      (B) Payment limit.--In the case of screening
                    flexible sigmoidoscopy services, payment under
                    this part shall not exceed such amount as the
                    Secretary specifies, based upon the rates
                    recognized for diagnostic flexible
                    sigmoidoscopy services.
                      (C) Facility payment limit.--
                              (i) In general.--Notwithstanding
                            subsections (i)(2)(A) and (t) of
                            section 1833, in the case of screening
                            flexible sigmoidoscopy services
                            furnished on or after January 1, 1999,
                            that--
                                      (I) in accordance with
                                    regulations, may be performed
                                    in an ambulatory surgical
                                    center and for which the
                                    Secretary permits ambulatory
                                    surgical center payments under
                                    this part, and
                                      (II) are performed in an
                                    ambulatory surgical center or
                                    hospital outpatient department,
                            payment under this part shall be based
                            on the lesser of the amount under the
                            fee schedule that would apply to such
                            services if they were performed in a
                            hospital outpatient department in an
                            area or the amount under the fee
                            schedule that would apply to such
                            services if they were performed in an
                            ambulatory surgical center in the same
                            area.
                              (ii) Limitation on coinsurance.--
                            Subject to section 1833(a)(1)(Y), but
                            notwithstanding any other provision of
                            this title, in the case of a
                            beneficiary who receives the services
                            described in clause (i)--
                                      (I) in computing the amount
                                    of any applicable copayment,
                                    the computation of such
                                    coinsurance shall be based upon
                                    the fee schedule under which
                                    payment is made for the
                                    services, and
                                      (II) the amount of such
                                    coinsurance is equal to 25
                                    percent of the payment amount
                                    under the fee schedule
                                    described in subclause (I).
                      (D) Special rule for detected lesions.--
                    Subject to section 1833(a)(1)(Y), if during the
                    course of such screening flexible
                    sigmoidoscopy, a lesion or growth is detected
                    which results in a biopsy or removal of the
                    lesion or growth, payment under this part shall
                    not be made for the screening flexible
                    sigmoidoscopy but shall be made for the
                    procedure classified as a flexible
                    sigmoidoscopy with such biopsy or removal.
                      (E) Frequency limit.--No payment may be made
                    under this part for a colorectal cancer
                    screening test consisting of a screening
                    flexible sigmoidoscopy--
                              (i) if the individual is under 50
                            years of age; or
                              (ii) if the procedure is performed
                            within the 47 months after a previous
                            screening flexible sigmoidoscopy or, in
                            the case of an individual who is not at
                            high risk for colorectal cancer, if the
                            procedure is performed within the 119
                            months after a previous screening
                            colonoscopy.
              (3) Screening colonoscopy.--
                      (A) Fee schedule.--With respect to colorectal
                    cancer screening test consisting of a screening
                    colonoscopy, payment under section 1848 shall
                    be consistent with payment amounts under such
                    section for similar or related services.
                      (B) Payment limit.--In the case of screening
                    colonoscopy services, payment under this part
                    shall not exceed such amount as the Secretary
                    specifies, based upon the rates recognized for
                    diagnostic colonoscopy services.
                      (C) Facility payment limit.--
                              (i) In general.--Notwithstanding
                            subsections (i)(2)(A) and (t) of
                            section 1833, in the case of screening
                            colonoscopy services furnished on or
                            after January 1, 1999, that are
                            performed in an ambulatory surgical
                            center or a hospital outpatient
                            department, payment under this part
                            shall be based on the lesser of the
                            amount under the fee schedule that
                            would apply to such services if they
                            were performed in a hospital outpatient
                            department in an area or the amount
                            under the fee schedule that would apply
                            to such services if they were performed
                            in an ambulatory surgical center in the
                            same area.
                              (ii) Limitation on coinsurance.--
                            Subject to section 1833(a)(1)(Y), but
                            notwithstanding any other provision of
                            this title, in the case of a
                            beneficiary who receives the services
                            described in clause (i)--
                                      (I) in computing the amount
                                    of any applicable coinsurance,
                                    the computation of such
                                    coinsurance shall be based upon
                                    the fee schedule under which
                                    payment is made for the
                                    services, and
                                      (II) the amount of such
                                    coinsurance is equal to 25
                                    percent of the payment amount
                                    under the fee schedule
                                    described in subclause (I).
                      (D) Special rule for detected lesions.--
                    Subject to section 1833(a)(1)(Y), if during the
                    course of such screening colonoscopy, a lesion
                    or growth is detected which results in a biopsy
                    or removal of the lesion or growth, payment
                    under this part shall not be made for the
                    screening colonoscopy but shall be made for the
                    procedure classified as a colonoscopy with such
                    biopsy or removal.
                      (E) Frequency limit.--No payment may be made
                    under this part for a colorectal cancer
                    screening test consisting of a screening
                    colonoscopy for individuals at high risk for
                    colorectal cancer if the procedure is performed
                    within the 23 months after a previous screening
                    colonoscopy or for other individuals if the
                    procedure is performed within the 119 months
                    after a previous screening colonoscopy or
                    within 47 months after a previous screening
                    flexible sigmoidoscopy.
      (e) Accreditation Requirement for Advanced Diagnostic Imaging
    Services.--
              (1) In general.--
                      (A) In general.--Beginning with January 1,
                    2012, with respect to the technical component
                    of advanced diagnostic imaging services for
                    which payment is made under the fee schedule
                    established under section 1848(b) and that are
                    furnished by a supplier, payment may only be
                    made if such supplier is accredited by an
                    accreditation organization designated by the
                    Secretary under paragraph (2)(B)(i).
                      (B) Advanced diagnostic imaging services
                    defined.--In this subsection, the term
                    ``advanced diagnostic imaging services''
                    includes--
                              (i) diagnostic magnetic resonance
                            imaging, computed tomography, and
                            nuclear medicine (including positron
                            emission tomography); and
                              (ii) such other diagnostic imaging
                            services, including services described
                            in section 1848(b)(4)(B) (excluding X-
                            ray, ultrasound, and fluoroscopy), as
                            specified by the Secretary in
                            consultation with physician specialty
                            organizations and other stakeholders.
                      (C) Supplier defined.--In this subsection,
                    the term ``supplier'' has the meaning given
                    such term in section 1861(d).
              (2) Accreditation organizations.--
                      (A) Factors for designation of accreditation
                    organizations.--The Secretary shall consider
                    the following factors in designating
                    accreditation organizations under subparagraph
                    (B)(i) and in reviewing and modifying the list
                    of accreditation organizations designated
                    pursuant to subparagraph (C):
                              (i) The ability of the organization
                            to conduct timely reviews of
                            accreditation applications.
                              (ii) Whether the organization has
                            established a process for the timely
                            integration of new advanced diagnostic
                            imaging services into the
                            organization's accreditation program.
                              (iii) Whether the organization uses
                            random site visits, site audits, or
                            other strategies for ensuring
                            accredited suppliers maintain adherence
                            to the criteria described in paragraph
                            (3).
                              (iv) The ability of the organization
                            to take into account the capacities of
                            suppliers located in a rural area (as
                            defined in section 1886(d)(2)(D)).
                              (v) Whether the organization has
                            established reasonable fees to be
                            charged to suppliers applying for
                            accreditation.
                              (vi) Such other factors as the
                            Secretary determines appropriate.
                      (B) Designation.--Not later than January 1,
                    2010, the Secretary shall designate
                    organizations to accredit suppliers furnishing
                    the technical component of advanced diagnostic
                    imaging services. The list of accreditation
                    organizations so designated may be modified
                    pursuant to subparagraph (C).
                      (C) Review and modification of list of
                    accreditation organizations.--
                              (i) In general.--The Secretary shall
                            review the list of accreditation
                            organizations designated under
                            subparagraph (B) taking into account
                            the factors under subparagraph (A).
                            Taking into account the results of such
                            review, the Secretary may, by
                            regulation, modify the list of
                            accreditation organizations designated
                            under subparagraph (B).
                              (ii) Special rule for accreditations
                            done prior to removal from list of
                            designated accreditation
                            organizations.--In the case where the
                            Secretary removes an organization from
                            the list of accreditation organizations
                            designated under subparagraph (B), any
                            supplier that is accredited by the
                            organization during the period
                            beginning on the date on which the
                            organization is designated as an
                            accreditation organization under
                            subparagraph (B) and ending on the date
                            on which the organization is removed
                            from such list shall be considered to
                            have been accredited by an organization
                            designated by the Secretary under
                            subparagraph (B) for the remaining
                            period such accreditation is in effect.
              (3) Criteria for accreditation.--The Secretary shall
            establish procedures to ensure that the criteria used
            by an accreditation organization designated under
            paragraph (2)(B) to evaluate a supplier that furnishes
            the technical component of advanced diagnostic imaging
            services for the purpose of accreditation of such
            supplier is specific to each imaging modality. Such
            criteria shall include--
                      (A) standards for qualifications of medical
                    personnel who are not physicians and who
                    furnish the technical component of advanced
                    diagnostic imaging services;
                      (B) standards for qualifications and
                    responsibilities of medical directors and
                    supervising physicians, including standards
                    that recognize the considerations described in
                    paragraph (4);
                      (C) procedures to ensure that equipment used
                    in furnishing the technical component of
                    advanced diagnostic imaging services meets
                    performance specifications;
                      (D) standards that require the supplier have
                    procedures in place to ensure the safety of
                    persons who furnish the technical component of
                    advanced diagnostic imaging services and
                    individuals to whom such services are
                    furnished;
                      (E) standards that require the establishment
                    and maintenance of a quality assurance and
                    quality control program by the supplier that is
                    adequate and appropriate to ensure the
                    reliability, clarity, and accuracy of the
                    technical quality of diagnostic images produced
                    by such supplier; and
                      (F) any other standards or procedures the
                    Secretary determines appropriate.
              (4) Recognition in standards for the evaluation of
            medical directors and supervising physicians.--The
            standards described in paragraph (3)(B) shall recognize
            whether a medical director or supervising physician--
                      (A) in a particular specialty receives
                    training in advanced diagnostic imaging
                    services in a residency program;
                      (B) has attained, through experience, the
                    necessary expertise to be a medical director or
                    a supervising physician;
                      (C) has completed any continuing medical
                    education courses relating to such services; or
                      (D) has met such other standards as the
                    Secretary determines appropriate.
              (5) Rule for accreditations made prior to
            designation.--In the case of a supplier that is
            accredited before January 1, 2010, by an accreditation
            organization designated by the Secretary under
            paragraph (2)(B) as of January 1, 2010, such supplier
            shall be considered to have been accredited by an
            organization designated by the Secretary under such
            paragraph as of January 1, 2012, for the remaining
            period such accreditation is in effect.
      (f) Reduction in Payments for Physician Pathology Services
    During 1991.--
              (1) In general.--For physician pathology services
            furnished under this part during 1991, the prevailing
            charges used in a locality under this part shall be 7
            percent below the prevailing charges used in the
            locality under this part in 1990 after March 31.
              (2) Limitation.--The prevailing charge for the
            technical and professional components of an physician
            pathology service furnished by a physician through an
            independent laboratory shall not be reduced pursuant to
            paragraph (1) to the extent that such reduction would
            reduce such prevailing charge below 115 percent of the
            prevailing charge for the professional component of
            such service when furnished by a hospital-based
            physician in the same locality. For purposes of the
            preceding sentence, an independent laboratory is a
            laboratory that is independent of a hospital and
            separate from the attending or consulting physicians'
            office.
      (g) Payment for Outpatient Critical Access Hospital
    Services.--
              (1) In general.--The amount of payment for outpatient
            critical access hospital services of a critical access
            hospital is equal to 101 percent of the reasonable
            costs of the hospital in providing such services,
            unless the hospital makes the election under paragraph
            (2).
              (2) Election of cost-based hospital outpatient
            service payment plus fee schedule for professional
            services.--A critical access hospital may elect to be
            paid for outpatient critical access hospital services
            amounts equal to the sum of the following, less the
            amount that such hospital may charge as described in
            section 1866(a)(2)(A):
                      (A) Facility fee.--With respect to facility
                    services, not including any services for which
                    payment may be made under subparagraph (B), 101
                    percent of the reasonable costs of the critical
                    access hospital in providing such services.
                      (B) Fee schedule for professional services.--
                    With respect to professional services otherwise
                    included within outpatient critical access
                    hospital services, 115 percent of such amounts
                    as would otherwise be paid under this part if
                    such services were not included in outpatient
                    critical access hospital services. Subsections
                    (x) and (y) of section 1833 shall not be taken
                    into account in determining the amounts that
                    would otherwise be paid pursuant to the
                    preceding sentence.
            The Secretary may not require, as a condition for
            applying subparagraph (B) with respect to a critical
            access hospital, that each physician or other
            practitioner providing professional services in the
            hospital must assign billing rights with respect to
            such services, except that such subparagraph shall not
            apply to those physicians and practitioners who have
            not assigned such billing rights.
              (3) Disregarding charges.--The payment amounts under
            this subsection shall be determined without regard to
            the amount of the customary or other charge.
              (4) Treatment of clinical diagnostic laboratory
            services.--No coinsurance, deductible, copayment, or
            other cost-sharing otherwise applicable under this part
            shall apply with respect to clinical diagnostic
            laboratory services furnished as an outpatient critical
            access hospital service. Nothing in this title shall be
            construed as providing for payment for clinical
            diagnostic laboratory services furnished as part of
            outpatient critical access hospital services, other
            than on the basis described in this subsection. For
            purposes of the preceding sentence and section
            1861(mm)(3), clinical diagnostic laboratory services
            furnished by a critical access hospital shall be
            treated as being furnished as part of outpatient
            critical access services without regard to whether the
            individual with respect to whom such services are
            furnished is physically present in the critical access
            hospital, or in a skilled nursing facility or a clinic
            (including a rural health clinic) that is operated by a
            critical access hospital, at the time the specimen is
            collected.
              (5) Coverage of costs for certain emergency room on-
            call providers.--In determining the reasonable costs of
            outpatient critical access hospital services under
            paragraphs (1) and (2)(A), the Secretary shall
            recognize as allowable costs, amounts (as defined by
            the Secretary) for reasonable compensation and related
            costs for physicians, physician assistants, nurse
            practitioners, and clinical nurse specialists who are
            on-call (as defined by the Secretary) to provide
            emergency services but who are not present on the
            premises of the critical access hospital involved, and
            are not otherwise furnishing services covered under
            this title and are not on-call at any other provider or
            facility.
      (h) Payment for Prosthetic Devices and Orthotics and
    Prosthetics.--
              (1) General rule for payment.--
                      (A) In general.--Payment under this
                    subsection for prosthetic devices and orthotics
                    and prosthetics shall be made in a lump-sum
                    amount for the purchase of the item in an
                    amount equal to 80 percent of the payment basis
                    described in subparagraph (B).
                      (B) Payment basis.--Except as provided in
                    subparagraphs (C), (E), and (H)(i), the payment
                    basis described in this subparagraph is the
                    lesser of--
                              (i) the actual charge for the item;
                            or
                              (ii) the amount recognized under
                            paragraph (2) as the purchase price for
                            the item.
                      (C) Exception for certain public home health
                    agencies.--Subparagraph (B)(i) shall not apply
                    to an item furnished by a public home health
                    agency (or by another home health agency which
                    demonstrates to the satisfaction of the
                    Secretary that a significant portion of its
                    patients are low income) free of charge or at
                    nominal charges to the public.
                      (D) Exclusive payment rule.--Subject to
                    subparagraph (H)(ii), this subsection shall
                    constitute the exclusive provision of this
                    title for payment for prosthetic devices,
                    orthotics, and prosthetics under this part or
                    under part A to a home health agency.
                      (E) Exception for certain items.--Payment for
                    ostomy supplies, tracheostomy supplies, and
                    urologicals shall be made in accordance with
                    subparagraphs (B) and (C) of section
                    1834(a)(2).
                      (F) Special payment rules for certain
                    prosthetics and custom-fabricated orthotics.--
                              (i) In general.--No payment shall be
                            made under this subsection for an item
                            of custom-fabricated orthotics
                            described in clause (ii) or for an item
                            of prosthetics unless such item is--
                                      (I) furnished by a qualified
                                    practitioner; and
                                      (II) fabricated by a
                                    qualified practitioner or a
                                    qualified supplier at a
                                    facility that meets such
                                    criteria as the Secretary
                                    determines appropriate.
                              (ii) Description of custom-fabricated
                            item.--
                                      (I) In general.--An item
                                    described in this clause is an
                                    item of custom-fabricated
                                    orthotics that requires
                                    education, training, and
                                    experience to custom-fabricate
                                    and that is included in a list
                                    established by the Secretary in
                                    subclause (II). Such an item
                                    does not include shoes and shoe
                                    inserts.
                                      (II) List of items.--The
                                    Secretary, in consultation with
                                    appropriate experts in
                                    orthotics (including national
                                    organizations representing
                                    manufacturers of orthotics),
                                    shall establish and update as
                                    appropriate a list of items to
                                    which this subparagraph
                                    applies. No item may be
                                    included in such list unless
                                    the item is individually
                                    fabricated for the patient over
                                    a positive model of the
                                    patient.
                              (iii) Qualified practitioner
                            defined.--In this subparagraph, the
                            term ``qualified practitioner'' means a
                            physician or other individual who--
                                      (I) is a qualified physical
                                    therapist or a qualified
                                    occupational therapist;
                                      (II) in the case of a State
                                    that provides for the licensing
                                    of orthotics and prosthetics,
                                    is licensed in orthotics or
                                    prosthetics by the State in
                                    which the item is supplied; or
                                      (III) in the case of a State
                                    that does not provide for the
                                    licensing of orthotics and
                                    prosthetics, is specifically
                                    trained and educated to provide
                                    or manage the provision of
                                    prosthetics and custom-designed
                                    or -fabricated orthotics, and
                                    is certified by the American
                                    Board for Certification in
                                    Orthotics and Prosthetics, Inc.
                                    or by the Board for Orthotist/
                                    Prosthetist Certification, or
                                    is credentialed and approved by
                                    a program that the Secretary
                                    determines, in consultation
                                    with appropriate experts in
                                    orthotics and prosthetics, has
                                    training and education
                                    standards that are necessary to
                                    provide such prosthetics and
                                    orthotics.
                              (iv) Qualified supplier defined.--In
                            this subparagraph, the term ``qualified
                            supplier'' means any entity that is
                            accredited by the American Board for
                            Certification in Orthotics and
                            Prosthetics, Inc. or by the Board for
                            Orthotist/Prosthetist Certification, or
                            accredited and approved by a program
                            that the Secretary determines has
                            accreditation and approval standards
                            that are essentially equivalent to
                            those of such Board.
                      (G) Replacement of prosthetic devices and
                    parts.--
                              (i) In general.--Payment shall be
                            made for the replacement of prosthetic
                            devices which are artificial limbs, or
                            for the replacement of any part of such
                            devices, without regard to continuous
                            use or useful lifetime restrictions if
                            an ordering physician determines that
                            the provision of a replacement device,
                            or a replacement part of such a device,
                            is necessary because of any of the
                            following:
                                      (I) A change in the
                                    physiological condition of the
                                    patient.
                                      (II) An irreparable change in
                                    the condition of the device, or
                                    in a part of the device.
                                      (III) The condition of the
                                    device, or the part of the
                                    device, requires repairs and
                                    the cost of such repairs would
                                    be more than 60 percent of the
                                    cost of a replacement device,
                                    or, as the case may be, of the
                                    part being replaced.
                              (ii) Confirmation may be required if
                            device or part being replaced is less
                            than 3 years old.--If a physician
                            determines that a replacement device,
                            or a replacement part, is necessary
                            pursuant to clause (i)--
                                      (I) such determination shall
                                    be controlling; and
                                      (II) such replacement device
                                    or part shall be deemed to be
                                    reasonable and necessary for
                                    purposes of section
                                    1862(a)(1)(A);
                            except that if the device, or part,
                            being replaced is less than 3 years old
                            (calculated from the date on which the
                            beneficiary began to use the device or
                            part), the Secretary may also require
                            confirmation of necessity of the
                            replacement device or replacement part,
                            as the case may be.
                      (H) Application of competitive acquisition to
                    orthotics; limitation of inherent
                    reasonableness authority.--In the case of
                    orthotics described in paragraph (2)(C) of
                    section 1847(a) furnished on or after January
                    1, 2011, subject to subsection (a)(1)(G), that
                    are included in a competitive acquisition
                    program in a competitive acquisition area under
                    such section--
                              (i) the payment basis under this
                            subsection for such orthotics furnished
                            in such area shall be the payment basis
                            determined under such competitive
                            acquisition program; and
                              (ii) subject to subsection (a)(1)(G),
                            the Secretary may use information on
                            the payment determined under such
                            competitive acquisition programs to
                            adjust the payment amount otherwise
                            recognized under subparagraph (B)(ii)
                            for an area that is not a competitive
                            acquisition area under section 1847,
                            and in the case of such adjustment,
                            paragraphs (8) and (9) of section
                            1842(b) shall not be applied.
              (2) Purchase price recognized.--For purposes of
            paragraph (1), the amount that is recognized under this
            paragraph as the purchase price for prosthetic devices,
            orthotics, and prosthetics is the amount described in
            subparagraph (C) of this paragraph, determined as
            follows:
                      (A) Computation of local purchase price.--
                    Each carrier under section 1842 shall compute a
                    base local purchase price for the item as
                    follows:
                              (i) The carrier shall compute a base
                            local purchase price for each item
                            equal to the average reasonable charge
                            in the locality for the purchase of the
                            item for the 12-month period ending
                            with June 1987.
                              (ii) The carrier shall compute a
                            local purchase price, with respect to
                            the furnishing of each particular
                            item--
                                      (I) in 1989 and 1990, equal
                                    to the base local purchase
                                    price computed under clause (i)
                                    increased by the percentage
                                    increase in the consumer price
                                    index for all urban consumers
                                    (United States city average)
                                    for the 6-month period ending
                                    with December 1987, or
                                      (II) in 1991, 1992 or 1993,
                                    equal to the local purchase
                                    price computed under this
                                    clause for the previous year
                                    increased by the applicable
                                    percentage increase for the
                                    year.
                      (B) Computation of regional purchase price.--
                    With respect to the furnishing of a particular
                    item in each region (as defined by the
                    Secretary), the Secretary shall compute a
                    regional purchase price--
                              (i) for 1992, equal to the average
                            (weighted by relative volume of all
                            claims among carriers) of the local
                            purchase prices for the carriers in the
                            region computed under subparagraph
                            (A)(ii)(II) for the year, and
                              (ii) for each subsequent year, equal
                            to the regional purchase price computed
                            under this subparagraph for the
                            previous year increased by the
                            applicable percentage increase for the
                            year.
                      (C) Purchase price recognized.--For purposes
                    of paragraph (1) and subject to subparagraph
                    (D), the amount that is recognized under this
                    paragraph as the purchase price for each item
                    furnished--
                              (i) in 1989, 1990, or 1991, is 100
                            percent of the local purchase price
                            computed under subparagraph (A)(ii);
                              (ii) in 1992, is the sum of (I) 75
                            percent of the local purchase price
                            computed under subparagraph (A)(ii)(II)
                            for 1992, and (II) 25 percent of the
                            regional purchase price computed under
                            subparagraph (B) for 1992;
                              (iii) in 1993, is the sum of (I) 50
                            percent of the local purchase price
                            computed under subparagraph (A)(ii)(II)
                            for 1993, and (II) 50 percent of the
                            regional purchase price computed under
                            subparagraph (B) for 1993; and
                              (iv) in 1994 or a subsequent year, is
                            the regional purchase price computed
                            under subparagraph (B) for that year.
                      (D) Range on amount recognized.--The amount
                    that is recognized under subparagraph (C) as
                    the purchase price for an item furnished--
                              (i) in 1992, may not exceed 125
                            percent, and may not be lower than 85
                            percent, of the average of the purchase
                            prices recognized under such
                            subparagraph for all the carrier
                            service areas in the United States in
                            that year; and
                              (ii) in a subsequent year, may not
                            exceed 120 percent, and may not be
                            lower than 90 percent, of the average
                            of the purchase prices recognized under
                            such subparagraph for all the carrier
                            service areas in the United States in
                            that year.
              (3) Applicability of certain provisions relating to
            durable medical equipment.--Paragraphs (12) and (17)
            and subparagraphs (A) and (B) of paragraph (10) and
            paragraph (11) of subsection (a) shall apply to
            prosthetic devices, orthotics, and prosthetics in the
            same manner as such provisions apply to covered items
            under such subsection.
              (4) Definitions.--In this subsection--
                      (A) the term ``applicable percentage
                    increase'' means--
                              (i) for 1991, 0 percent;
                              (ii) for 1992 and 1993, the
                            percentage increase in the consumer
                            price index for all urban consumers
                            (United States city average) for the
                            12-month period ending with June of the
                            previous year;
                              (iii) for 1994 and 1995, 0 percent;
                              (iv) for 1996 and 1997, the
                            percentage increase in the consumer
                            price index for all urban consumers
                            (United States city average) for the
                            12-month period ending with June of the
                            previous year;
                              (v) for each of the years 1998
                            through 2000, 1 percent;
                              (vi) for 2001, the percentage
                            increase in the consumer price index
                            for all urban consumers (U.S. city
                            average) for the 12-month period ending
                            with June 2000;
                              (vii) for 2002, 1 percent;
                              (viii) for 2003, the percentage
                            increase in the consumer price index
                            for all urban consumers (United States
                            city average) for the 12-month period
                            ending with June of the previous year;
                              (ix) for 2004, 2005, and 2006, 0
                            percent;
                              (x) for for each of 2007 through
                            2010, the percentage increase in the
                            consumer price index for all urban
                            consumers (United States city average)
                            for the 12-month period ending with
                            June of the previous year; and
                              (xi) for 2011 and each subsequent
                            year--
                                      (I) the percentage increase
                                    in the consumer price index for
                                    all urban consumers (United
                                    States city average) for the
                                    12-month period ending with
                                    June of the previous year,
                                    reduced by--
                                      (II) the productivity
                                    adjustment described in section
                                    1886(b)(3)(B)(xi)(II).
                      (B) the term ``prosthetic devices'' has the
                    meaning given such term in section 1861(s)(8),
                    except that such term does not include
                    parenteral and enteral nutrition nutrients,
                    supplies, and equipment and does not include an
                    implantable item for which payment may be made
                    under section 1833(t); and
                      (C) the term ``orthotics and prosthetics''
                    has the meaning given such term in section
                    1861(s)(9) (and includes shoes described in
                    section 1861(s)(12)), but does not include
                    intraocular lenses or medical supplies
                    (including catheters, catheter supplies, ostomy
                    bags, and supplies related to ostomy care)
                    furnished by a home health agency under section
                    1861(m)(5).
            The application of subparagraph (A)(xi)(II) may result
            in the applicable percentage increase under
            subparagraph (A) being less than 0.0 for a year, and
            may result in payment rates under this subsection for a
            year being less than such payment rates for the
            preceding year.
              (5) Documentation created by orthotists and
            prosthetists.--For purposes of determining the
            reasonableness and medical necessity of orthotics and
            prosthetics, documentation created by an orthotist or
            prosthetist shall be considered part of the
            individual's medical record to support documentation
            created by eligible professionals described in section
            1848(k)(3)(B).
      (i) Payment for Surgical Dressings.--
              (1) In general.--Payment under this subsection for
            surgical dressings (described in section 1861(s)(5))
            shall be made in a lump sum amount for the purchase of
            the item in an amount equal to 80 percent of the lesser
            of--
                      (A) the actual charge for the item; or
                      (B) a payment amount determined in accordance
                    with the methodology described in subparagraphs
                    (B) and (C) of subsection (a)(2) (except that
                    in applying such methodology, the national
                    limited payment amount referred to in such
                    subparagraphs shall be initially computed based
                    on local payment amounts using average
                    reasonable charges for the 12-month period
                    ending December 31, 1992, increased by the
                    covered item updates described in such
                    subsection for 1993 and 1994).
              (2) Exceptions.--Paragraph (1) shall not apply to
            surgical dressings that are--
                      (A) furnished as an incident to a physician's
                    professional service; or
                      (B) furnished by a home health agency.
      (j) Requirements for Suppliers of Medical Equipment and
    Supplies.--
              (1) Issuance and renewal of supplier number.--
                      (A) Payment.--Except as provided in
                    subparagraph (C), no payment may be made under
                    this part after the date of the enactment of
                    the Social Security Act Amendments of 1994 for
                    items furnished by a supplier of medical
                    equipment and supplies unless such supplier
                    obtains (and renews at such intervals as the
                    Secretary may require) a supplier number.
                      (B) Standards for possessing a supplier
                    number.--A supplier may not obtain a supplier
                    number unless--
                              (i) for medical equipment and
                            supplies furnished on or after the date
                            of the enactment of the Social Security
                            Act Amendments of 1994 and before
                            January 1, 1996, the supplier meets
                            standards prescribed by the Secretary
                            in regulations issued on June 18, 1992;
                            and
                              (ii) for medical equipment and
                            supplies furnished on or after January
                            1, 1996, the supplier meets revised
                            standards prescribed by the Secretary
                            (in consultation with representatives
                            of suppliers of medical equipment and
                            supplies, carriers, and consumers) that
                            shall include requirements that the
                            supplier--
                                      (I) comply with all
                                    applicable State and Federal
                                    licensure and regulatory
                                    requirements;
                                      (II) maintain a physical
                                    facility on an appropriate
                                    site;
                                      (III) have proof of
                                    appropriate liability
                                    insurance; and
                                      (IV) meet such other
                                    requirements as the Secretary
                                    may specify.
                      (C) Exception for items furnished as incident
                    to a physician's service.--Subparagraph (A)
                    shall not apply with respect to medical
                    equipment and supplies furnished incident to a
                    physician's service.
                      (D) Prohibition against multiple supplier
                    numbers.--The Secretary may not issue more than
                    one supplier number to any supplier of medical
                    equipment and supplies unless the issuance of
                    more than one number is appropriate to identify
                    subsidiary or regional entities under the
                    supplier's ownership or control.
                      (E) Prohibition against delegation of
                    supplier determinations.--The Secretary may not
                    delegate (other than by contract under section
                    1842) the responsibility to determine whether
                    suppliers meet the standards necessary to
                    obtain a supplier number.
              (2) Certificates of medical necessity.--
                      (A) Limitation on information provided by
                    suppliers on certificates of medical
                    necessity.--
                              (i) In general.--Effective 60 days
                            after the date of the enactment of the
                            Social Security Act Amendments of 1994,
                            a supplier of medical equipment and
                            supplies may distribute to physicians,
                            or to individuals entitled to benefits
                            under this part, a certificate of
                            medical necessity for commercial
                            purposes which contains no more than
                            the following information completed by
                            the supplier:
                                      (I) An identification of the
                                    supplier and the beneficiary to
                                    whom such medical equipment and
                                    supplies are furnished.
                                      (II) A description of such
                                    medical equipment and supplies.
                                      (III) Any product code
                                    identifying such medical
                                    equipment and supplies.
                                      (IV) Any other administrative
                                    information (other than
                                    information relating to the
                                    beneficiary's medical
                                    condition) identified by the
                                    Secretary.
                              (ii) Information on payment amount
                            and charges.--If a supplier distributes
                            a certificate of medical necessity
                            containing any of the information
                            permitted to be supplied under clause
                            (i), the supplier shall also list on
                            the certificate of medical necessity
                            the fee schedule amount and the
                            supplier's charge for the medical
                            equipment or supplies being furnished
                            prior to distribution of such
                            certificate to the physician.
                              (iii) Penalty.--Any supplier of
                            medical equipment and supplies who
                            knowingly and willfully distributes a
                            certificate of medical necessity in
                            violation of clause (i) or fails to
                            provide the information required under
                            clause (ii) is subject to a civil money
                            penalty in an amount not to exceed
                            $1,000 for each such certificate of
                            medical necessity so distributed. The
                            provisions of section 1128A (other than
                            subsections (a) and (b)) shall apply to
                            civil money penalties under this
                            subparagraph in the same manner as they
                            apply to a penalty or proceeding under
                            section 1128A(a).
                      (B) Definition.--For purposes of this
                    paragraph, the term ``certificate of medical
                    necessity'' means a form or other document
                    containing information required by the carrier
                    to be submitted to show that an item is
                    reasonable and necessary for the diagnosis or
                    treatment of illness or injury or to improve
                    the functioning of a malformed body member.
              (3) Coverage and review criteria.--The Secretary
            shall annually review the coverage and utilization of
            items of medical equipment and supplies to determine
            whether such items should be made subject to coverage
            and utilization review criteria, and if appropriate,
            shall develop and apply such criteria to such items.
              (4) Limitation on patient liability.--If a supplier
            of medical equipment and supplies (as defined in
            paragraph (5))--
                      (A) furnishes an item or service to a
                    beneficiary for which no payment may be made by
                    reason of paragraph (1);
                      (B) furnishes an item or service to a
                    beneficiary for which payment is denied in
                    advance under subsection (a)(15); or
                      (C) furnishes an item or service to a
                    beneficiary for which payment is denied under
                    section 1862(a)(1);
            any expenses incurred for items and services furnished
            to an individual by such a supplier not on an assigned
            basis shall be the responsibility of such supplier. The
            individual shall have no financial responsibility for
            such expenses and the supplier shall refund on a timely
            basis to the individual (and shall be liable to the
            individual for) any amounts collected from the
            individual for such items or services. The provisions
            of subsection (a)(18) shall apply to refunds required
            under the previous sentence in the same manner as such
            provisions apply to refunds under such subsection.
              (5) Definition.--The term ``medical equipment and
            supplies'' means--
                      (A) durable medical equipment (as defined in
                    section 1861(n));
                      (B) prosthetic devices (as described in
                    section 1861(s)(8));
                      (C) orthotics and prosthetics (as described
                    in section 1861(s)(9));
                      (D) surgical dressings (as described in
                    section 1861(s)(5));
                      (E) such other items as the Secretary may
                    determine; and
                      (F) for purposes of paragraphs (1) and (3)--
                              (i) home dialysis supplies and
                            equipment (as described in section
                            1861(s)(2)(F)),
                              (ii) immunosuppressive drugs (as
                            described in section 1861(s)(2)(J)),
                              (iii) therapeutic shoes for diabetics
                            (as described in section 1861(s)(12)),
                              (iv) oral drugs prescribed for use as
                            an anticancer therapeutic agent (as
                            described in section 1861(s)(2)(Q)),
                            and
                              (v) self-administered erythropoetin
                            (as described in section
                            1861(s)(2)(P)).
      (k) Payment for Outpatient Therapy Services and Comprehensive
    Outpatient Rehabilitation Services.--
              (1) In general.--With respect to services described
            in section 1833(a)(8) or 1833(a)(9) for which payment
            is determined under this subsection, the payment basis
            shall be--
                      (A) for services furnished during 1998, the
                    amount determined under paragraph (2); or
                      (B) for services furnished during a
                    subsequent year, 80 percent of the lesser of--
                              (i) the actual charge for the
                            services, or
                              (ii) the applicable fee schedule
                            amount (as defined in paragraph (3))
                            for the services.
              (2) Payment in 1998 based upon adjusted reasonable
            costs.--The amount under this paragraph for services is
            the lesser of--
                      (A) the charges imposed for the services, or
                      (B) the adjusted reasonable costs (as defined
                    in paragraph (4)) for the services,
            less 20 percent of the amount of the charges imposed
            for such services.
              (3) Applicable fee schedule amount.--In this
            subsection, the term ``applicable fee schedule amount''
            means, with respect to services furnished in a year,
            the amount determined under the fee schedule
            established under section 1848 for such services
            furnished during the year or, if there is no such fee
            schedule established for such services, the amount
            determined under the fee schedule established for such
            comparable services as the Secretary specifies.
              (4) Adjusted reasonable costs.--In paragraph (2), the
            term ``adjusted reasonable costs'' means, with respect
            to any services, reasonable costs determined for such
            services, reduced by 10 percent. The 10-percent
            reduction shall not apply to services described in
            section 1833(a)(8)(B) (relating to services provided by
            hospitals).
              (5) Uniform coding.--For claims for services
            submitted on or after April 1, 1998, for which the
            amount of payment is determined under this subsection,
            the claim shall include a code (or codes) under a
            uniform coding system specified by the Secretary that
            identifies the services furnished.
              (6) Restraint on billing.--The provisions of
            subparagraphs (A) and (B) of section 1842(b)(18) shall
            apply to therapy services for which payment is made
            under this subsection in the same manner as they apply
            to services provided by a practitioner described in
            section 1842(b)(18)(C).
              (7) Adjustment in discount for certain multiple
            therapy services.--In the case of therapy services
            furnished on or after April 1, 2013, and for which
            payment is made under this subsection pursuant to the
            applicable fee schedule amount (as defined in paragraph
            (3)), instead of the 25 percent multiple procedure
            payment reduction specified in the final rule published
            by the Secretary in the Federal Register on November
            29, 2010, the reduction percentage shall be 50 percent.
      (l) Establishment of Fee Schedule for Ambulance Services.--
              (1) In general.--The Secretary shall establish a fee
            schedule for payment for ambulance services whether
            provided directly by a supplier or provider or under
            arrangement with a provider under this part through a
            negotiated rulemaking process described in title 5,
            United States Code, and in accordance with the
            requirements of this subsection.
              (2) Considerations.--In establishing such fee
            schedule, the Secretary shall--
                      (A) establish mechanisms to control increases
                    in expenditures for ambulance services under
                    this part;
                      (B) establish definitions for ambulance
                    services which link payments to the type of
                    services provided;
                      (C) consider appropriate regional and
                    operational differences;
                      (D) consider adjustments to payment rates to
                    account for inflation and other relevant
                    factors; and
                      (E) phase in the application of the payment
                    rates under the fee schedule in an efficient
                    and fair manner consistent with paragraph (11),
                    except that such phase-in shall provide for
                    full payment of any national mileage rate for
                    ambulance services provided by suppliers that
                    are paid by carriers in any of the 50 States
                    where payment by a carrier for such services
                    for all such suppliers in such State did not,
                    prior to the implementation of the fee
                    schedule, include a separate amount for all
                    mileage within the county from which the
                    beneficiary is transported.
              (3) Savings.--In establishing such fee schedule, the
            Secretary shall--
                      (A) ensure that the aggregate amount of
                    payments made for ambulance services under this
                    part during 2000 does not exceed the aggregate
                    amount of payments which would have been made
                    for such services under this part during such
                    year if the amendments made by section 4531(a)
                    of the Balanced Budget Act of 1997 continued in
                    effect, except that in making such
                    determination the Secretary shall assume an
                    update in such payments for 2002 equal to
                    percentage increase in the consumer price index
                    for all urban consumers (U.S. city average) for
                    the 12-month period ending with June of the
                    previous year reduced in the case of 2002 by
                    1.0 percentage points;
                      (B) set the payment amounts provided under
                    the fee schedule for services furnished in 2001
                    and each subsequent year at amounts equal to
                    the payment amounts under the fee schedule for
                    services furnished during the previous year,
                    increased, subject to subparagraph (C) and the
                    succeeding sentence of this paragraph, by the
                    percentage increase in the consumer price index
                    for all urban consumers (U.S. city average) for
                    the 12-month period ending with June of the
                    previous year reduced in the case of 2002 by
                    1.0 percentage points; and
                      (C) for 2011 and each subsequent year, after
                    determining the percentage increase under
                    subparagraph (B) for the year, reduce such
                    percentage increase by the productivity
                    adjustment described in section
                    1886(b)(3)(B)(xi)(II).
            The application of subparagraph (C) may result in the
            percentage increase under subparagraph (B) being less
            than 0.0 for a year, and may result in payment rates
            under the fee schedule under this subsection for a year
            being less than such payment rates for the preceding
            year.
              (4) Consultation.--In establishing the fee schedule
            for ambulance services under this subsection, the
            Secretary shall consult with various national
            organizations representing individuals and entities who
            furnish and regulate ambulance services and share with
            such organizations relevant data in establishing such
            schedule.
              (5) Limitation on review.--There shall be no
            administrative or judicial review under section 1869 or
            otherwise of the amounts established under the fee
            schedule for ambulance services under this subsection,
            including matters described in paragraph (2).
              (6) Restraint on billing.--The provisions of
            subparagraphs (A) and (B) of section 1842(b)(18) shall
            apply to ambulance services for which payment is made
            under this subsection in the same manner as they apply
            to services provided by a practitioner described in
            section 1842(b)(18)(C).
              (7) Coding system.--The Secretary may require the
            claim for any services for which the amount of payment
            is determined under this subsection to include a code
            (or codes) under a uniform coding system specified by
            the Secretary that identifies the services furnished.
              (8) Services furnished by critical access
            hospitals.--Notwithstanding any other provision of this
            subsection, the Secretary shall pay 101 percent of the
            reasonable costs incurred in furnishing ambulance
            services if such services are furnished--
                      (A) by a critical access hospital (as defined
                    in section 1861(mm)(1)), or
                      (B) by an entity that is owned and operated
                    by a critical access hospital,
            but only if the critical access hospital or entity is
            the only provider or supplier of ambulance services
            that is located within a 35-mile drive of such critical
            access hospital.
              (9) Transitional assistance for rural providers.--In
            the case of ground ambulance services furnished on or
            after July 1, 2001, and before January 1, 2004, for
            which the transportation originates in a rural area (as
            defined in section 1886(d)(2)(D)) or in a rural census
            tract of a metropolitan statistical area (as determined
            under the most recent modification of the Goldsmith
            Modification, originally published in the Federal
            Register on February 27, 1992 (57 Fed. Reg. 6725)), the
            fee schedule established under this subsection shall
            provide that, with respect to the payment rate for
            mileage for a trip above 17 miles, and up to 50 miles,
            the rate otherwise established shall be increased by
            not less than \1/2\ of the additional payment per mile
            established for the first 17 miles of such a trip
            originating in a rural area.
              (10) Phase-in providing floor using blend of fee
            schedule and regional fee schedules.--In carrying out
            the phase-in under paragraph (2)(E) for each level of
            ground service furnished in a year, the portion of the
            payment amount that is based on the fee schedule shall
            be the greater of the amount determined under such fee
            schedule (without regard to this paragraph) or the
            following blended rate of the fee schedule under
            paragraph (1) and of a regional fee schedule for the
            region involved:
                      (A) For 2004 (for services furnished on or
                    after July 1, 2004), the blended rate shall be
                    based 20 percent on the fee schedule under
                    paragraph (1) and 80 percent on the regional
                    fee schedule.
                      (B) For 2005, the blended rate shall be based
                    40 percent on the fee schedule under paragraph
                    (1) and 60 percent on the regional fee
                    schedule.
                      (C) For 2006, the blended rate shall be based
                    60 percent on the fee schedule under paragraph
                    (1) and 40 percent on the regional fee
                    schedule.
                      (D) For 2007, 2008, and 2009, the blended
                    rate shall be based 80 percent on the fee
                    schedule under paragraph (1) and 20 percent on
                    the regional fee schedule.
                      (E) For 2010 and each succeeding year, the
                    blended rate shall be based 100 percent on the
                    fee schedule under paragraph (1).
            For purposes of this paragraph, the Secretary shall
            establish a regional fee schedule for each of the nine
            census divisions (referred to in section 1886(d)(2))
            using the methodology (used in establishing the fee
            schedule under paragraph (1)) to calculate a regional
            conversion factor and a regional mileage payment rate
            and using the same payment adjustments and the same
            relative value units as used in the fee schedule under
            such paragraph.
              (11) Adjustment in payment for certain long trips.--
            In the case of ground ambulance services furnished on
            or after July 1, 2004, and before January 1, 2009,
            regardless of where the transportation originates, the
            fee schedule established under this subsection shall
            provide that, with respect to the payment rate for
            mileage for a trip above 50 miles the per mile rate
            otherwise established shall be increased by \1/4\ of
            the payment per mile otherwise applicable to miles in
            excess of 50 miles in such trip.
              (12) Assistance for rural providers furnishing
            services in low population density areas.--
                      (A) In general.--In the case of ground
                    ambulance services furnished on or after July
                    1, 2004, and before January 1, 2023, for which
                    the transportation originates in a qualified
                    rural area (identified under subparagraph
                    (B)(iii)), the Secretary shall provide for a
                    percent increase in the base rate of the fee
                    schedule for a trip established under this
                    subsection. In establishing such percent
                    increase, the Secretary shall estimate the
                    average cost per trip for such services (not
                    taking into account mileage) in the lowest
                    quartile as compared to the average cost per
                    trip for such services (not taking into account
                    mileage) in the highest quartile of all rural
                    county populations.
                      (B) Identification of qualified rural
                    areas.--
                              (i) Determination of population
                            density in area.--Based upon data from
                            the United States decennial census for
                            the year 2000, the Secretary shall
                            determine, for each rural area, the
                            population density for that area.
                              (ii) Ranking of areas.--The Secretary
                            shall rank each such area based on such
                            population density.
                              (iii) Identification of qualified
                            rural areas.--The Secretary shall
                            identify those areas (in subparagraph
                            (A) referred to as ``qualified rural
                            areas'') with the lowest population
                            densities that represent, if each such
                            area were weighted by the population of
                            such area (as used in computing such
                            population densities), an aggregate
                            total of 25 percent of the total of the
                            population of all such areas.
                              (iv) Rural area.--For purposes of
                            this paragraph, the term ``rural area''
                            has the meaning given such term in
                            section 1886(d)(2)(D). If feasible, the
                            Secretary shall treat a rural census
                            tract of a metropolitan statistical
                            area (as determined under the most
                            recent modification of the Goldsmith
                            Modification, originally published in
                            the Federal Register on February 27,
                            1992 (57 Fed. Reg. 6725) as a rural
                            area for purposes of this paragraph.
                              (v) Judicial review.--There shall be
                            no administrative or judicial review
                            under section 1869, 1878, or otherwise,
                            respecting the identification of an
                            area under this subparagraph.
              (13) Temporary increase for ground ambulance
            services.--
                      (A) In general.--After computing the rates
                    with respect to ground ambulance services under
                    the other applicable provisions of this
                    subsection, in the case of such services
                    furnished on or after July 1, 2004, and before
                    January 1, 2007, and for such services
                    furnished on or after July 1, 2008, and before
                    January 1, 2023, for which the transportation
                    originates in--
                              (i) a rural area described in
                            paragraph (9) or in a rural census
                            tract described in such paragraph, the
                            fee schedule established under this
                            section shall provide that the rate for
                            the service otherwise established,
                            after the application of any increase
                            under paragraphs (11) and (12), shall
                            be increased by 2 percent (or 3 percent
                            if such service is furnished on or
                            after July 1, 2008, and before January
                            1, 2023); and
                              (ii) an area not described in clause
                            (i), the fee schedule established under
                            this subsection shall provide that the
                            rate for the service otherwise
                            established, after the application of
                            any increase under paragraph (11),
                            shall be increased by 1 percent (or 2
                            percent if such service is furnished on
                            or after July 1, 2008, and before
                            January 1, 2023).
                      (B) Application of increased payments after
                    applicable period.--The increased payments
                    under subparagraph (A) shall not be taken into
                    account in calculating payments for services
                    furnished after the applicable period specified
                    in such subparagraph.
              (14) Providing appropriate coverage of rural air
            ambulance services.--
                      (A) In general.--The regulations described in
                    section 1861(s)(7) shall provide, to the extent
                    that any ambulance services (whether ground or
                    air) may be covered under such section, that a
                    rural air ambulance service (as defined in
                    subparagraph (C)) is reimbursed under this
                    subsection at the air ambulance rate if the air
                    ambulance service--
                              (i) is reasonable and necessary based
                            on the health condition of the
                            individual being transported at or
                            immediately prior to the time of the
                            transport; and
                              (ii) complies with equipment and crew
                            requirements established by the
                            Secretary.
                      (B) Satisfaction of requirement of medically
                    necessary.--The requirement of subparagraph
                    (A)(i) is deemed to be met for a rural air
                    ambulance service if--
                              (i) subject to subparagraph (D), such
                            service is requested by a physician or
                            other qualified medical personnel (as
                            specified by the Secretary) who
                            certifies or reasonably determines that
                            the individual's condition is such that
                            the time needed to transport the
                            individual by land or the instability
                            of transportation by land poses a
                            threat to the individual's survival or
                            seriously endangers the individual's
                            health; or
                              (ii) such service is furnished
                            pursuant to a protocol that is
                            established by a State or regional
                            emergency medical service (EMS) agency
                            and recognized or approved by the
                            Secretary under which the use of an air
                            ambulance is recommended, if such
                            agency does not have an ownership
                            interest in the entity furnishing such
                            service.
                      (C) Rural air ambulance service defined.--For
                    purposes of this paragraph, the term ``rural
                    air ambulance service'' means fixed wing and
                    rotary wing air ambulance service in which the
                    point of pick up of the individual occurs in a
                    rural area (as defined in section
                    1886(d)(2)(D)) or in a rural census tract of a
                    metropolitan statistical area (as determined
                    under the most recent modification of the
                    Goldsmith Modification, originally published in
                    the Federal Register on February 27, 1992 (57
                    Fed. Reg. 6725)).
                      (D) Limitation.--
                              (i) In general.--Subparagraph (B)(i)
                            shall not apply if there is a financial
                            or employment relationship between the
                            person requesting the rural air
                            ambulance service and the entity
                            furnishing the ambulance service, or an
                            entity under common ownership with the
                            entity furnishing the air ambulance
                            service, or a financial relationship
                            between an immediate family member of
                            such requester and such an entity.
                              (ii) Exception.--Where a hospital and
                            the entity furnishing rural air
                            ambulance services are under common
                            ownership, clause (i) shall not apply
                            to remuneration (through employment or
                            other relationship) by the hospital of
                            the requester or immediate family
                            member if the remuneration is for
                            provider-based physician services
                            furnished in a hospital (as described
                            in section 1887) which are reimbursed
                            under part A and the amount of the
                            remuneration is unrelated directly or
                            indirectly to the provision of rural
                            air ambulance services.
              (15) Payment adjustment for non-emergency ambulance
            transports for esrd beneficiaries.--The fee schedule
            amount otherwise applicable under the preceding
            provisions of this subsection shall be reduced by 10
            percent for ambulance services furnished during the
            period beginning on October 1, 2013, and ending on
            September 30, 2018, and by 23 percent for such services
            furnished on or after October 1, 2018, consisting of
            non-emergency basic life support services involving
            transport of an individual with end-stage renal disease
            for renal dialysis services (as described in section
            1881(b)(14)(B)) furnished other than on an emergency
            basis by a provider of services or a renal dialysis
            facility.
              (16) Prior authorization for repetitive scheduled
            non-emergent ambulance transports.--
                      (A) In general.--Beginning January 1, 2017,
                    if the expansion to all States of the model of
                    prior authorization described in paragraph (2)
                    of section 515(a) of the Medicare Access and
                    CHIP Reauthorization Act of 2015 meets the
                    requirements described in paragraphs (1)
                    through (3) of section 1115A(c), then the
                    Secretary shall expand such model to all
                    States.
                      (B) Funding.--The Secretary shall use funds
                    made available under section 1893(h)(10) to
                    carry out this paragraph.
                      (C) Clarification regarding budget
                    neutrality.--Nothing in this paragraph may be
                    construed to limit or modify the application of
                    section 1115A(b)(3)(B) to models described in
                    such section, including with respect to the
                    model described in subparagraph (A) and
                    expanded beginning on January 1, 2017, under
                    such subparagraph.
              (17) Submission of cost and other information.--
                      (A) Development of data collection system.--
                    The Secretary shall develop a data collection
                    system (which may include use of a cost survey)
                    to collect cost, revenue, utilization, and
                    other information determined appropriate by the
                    Secretary with respect to providers of services
                    (in this paragraph referred to as
                    ``providers'') and suppliers of ground
                    ambulance services. Such system shall be
                    designed to collect information--
                              (i) needed to evaluate the extent to
                            which reported costs relate to payment
                            rates under this subsection;
                              (ii) on the utilization of capital
                            equipment and ambulance capacity,
                            including information consistent with
                            the type of information described in
                            section 1121(a); and
                              (iii) on different types of ground
                            ambulance services furnished in
                            different geographic locations,
                            including rural areas and low
                            population density areas described in
                            paragraph (12).
                      (B) Specification of data collection
                    system.--
                              (i) In general.--The Secretary
                            shall--
                                      (I) not later than December
                                    31, 2019, specify the data
                                    collection system under
                                    subparagraph (A); and
                                      (II) identify the providers
                                    and suppliers of ground
                                    ambulance services that would
                                    be required to submit
                                    information under such data
                                    collection system, including
                                    the representative sample
                                    described in clause (ii).
                              (ii) Determination of representative
                            sample.--
                                      (I) In general.--Not later
                                    than December 31, 2019, with
                                    respect to the data collection
                                    for the first year under such
                                    system, and for each subsequent
                                    year through 2024, the
                                    Secretary shall determine a
                                    representative sample to submit
                                    information under the data
                                    collection system.
                                      (II) Requirements.--The
                                    sample under subclause (I)
                                    shall be representative of the
                                    different types of providers
                                    and suppliers of ground
                                    ambulance services (such as
                                    those providers and suppliers
                                    that are part of an emergency
                                    service or part of a government
                                    organization) and the
                                    geographic locations in which
                                    ground ambulance services are
                                    furnished (such as urban,
                                    rural, and low population
                                    density areas).
                                      (III) Limitation.--The
                                    Secretary shall not include an
                                    individual provider or supplier
                                    of ground ambulance services in
                                    the sample under subclause (I)
                                    in 2 consecutive years, to the
                                    extent practicable.
                      (C) Reporting of cost information.--For each
                    year, a provider or supplier of ground
                    ambulance services identified by the Secretary
                    under subparagraph (B)(i)(II) as being required
                    to submit information under the data collection
                    system with respect to a period for the year
                    shall submit to the Secretary information
                    specified under the system. Such information
                    shall be submitted in a form and manner, and at
                    a time, specified by the Secretary for purposes
                    of this subparagraph.
                      (D) Payment reduction for failure to
                    report.--
                              (i) In general.--Beginning January 1,
                            2022, subject to clause (ii), a 10
                            percent reduction to payments under
                            this subsection shall be made for the
                            applicable period (as defined in clause
                            (ii)) to a provider or supplier of
                            ground ambulance services that--
                                      (I) is required to submit
                                    information under the data
                                    collection system with respect
                                    to a period under subparagraph
                                    (C); and
                                      (II) does not sufficiently
                                    submit such information, as
                                    determined by the Secretary.
                              (ii) Applicable period defined.--For
                            purposes of clause (i), the term
                            ``applicable period'' means, with
                            respect to a provider or supplier of
                            ground ambulance services, a year
                            specified by the Secretary not more
                            than 2 years after the end of the
                            period with respect to which the
                            Secretary has made a determination
                            under clause (i)(II) that the provider
                            or supplier of ground ambulance
                            services failed to sufficiently submit
                            information under the data collection
                            system.
                              (iii) Hardship exemption.--The
                            Secretary may exempt a provider or
                            supplier from the payment reduction
                            under clause (i) with respect to an
                            applicable period in the event of
                            significant hardship, such as a natural
                            disaster, bankruptcy, or other similar
                            situation that the Secretary determines
                            interfered with the ability of the
                            provider or supplier of ground
                            ambulance services to submit such
                            information in a timely manner for the
                            specified period.
                              (iv) Informal review.--The Secretary
                            shall establish a process under which a
                            provider or supplier of ground
                            ambulance services may seek an informal
                            review of a determination that the
                            provider or supplier is subject to the
                            payment reduction under clause (i).
                      (E) Ongoing data collection.--
                              (i) Revision of data collection
                            system.--The Secretary may, as the
                            Secretary determines appropriate and,
                            if available, taking into consideration
                            the report (or reports) under
                            subparagraph (F), revise the data
                            collection system under subparagraph
                            (A).
                              (ii) Subsequent data collection.--In
                            order to continue to evaluate the
                            extent to which reported costs relate
                            to payment rates under this subsection
                            and for other purposes the Secretary
                            deems appropriate, the Secretary shall
                            require providers and suppliers of
                            ground ambulance services to submit
                            information for years after 2024 as the
                            Secretary determines appropriate, but
                            in no case less often than once every 3
                            years.
                      (F) Ground ambulance data collection system
                    study.--
                              (i) In general.--Not later than the
                            second June 15th following the date on
                            which the Secretary transmits data for
                            the first representative sample of
                            providers and suppliers of ground
                            ambulance services to the Medicare
                            Payment Advisory Commission, and as
                            determined necessary by such Commission
                            thereafter,, such Commission shall
                            assess, and submit to Congress a report
                            on, information submitted by providers
                            and suppliers of ground ambulance
                            services through the data collection
                            system under subparagraph (A), the
                            adequacy of payments for ground
                            ambulance services under this
                            subsection, and geographic variations
                            in the cost of furnishing such
                            services.
                              (ii) Contents.--A report under clause
                            (i) shall contain the following:
                                      (I) An analysis of
                                    information submitted through
                                    the data collection system.
                                      (II) An analysis of any
                                    burden on providers and
                                    suppliers of ground ambulance
                                    services associated with the
                                    data collection system.
                                      (III) A recommendation as to
                                    whether information should
                                    continue to be submitted
                                    through such data collection
                                    system or if such system should
                                    be revised under subparagraph
                                    (E)(i).
                                      (IV) Other information
                                    determined appropriate by the
                                    Commission.
                      (G) Public availability.--The Secretary shall
                    post information on the results of the data
                    collection under this paragraph on the Internet
                    website of the Centers for Medicare & Medicaid
                    Services, as determined appropriate by the
                    Secretary.
                      (H) Implementation.--The Secretary shall
                    implement this paragraph through notice and
                    comment rulemaking.
                      (I) Administration.--Chapter 35 of title 44,
                    United States Code, shall not apply to the
                    collection of information required under this
                    subsection.
                      (J) Limitations on review.--There shall be no
                    administrative or judicial review under section
                    1869, section 1878, or otherwise of the data
                    collection system or identification of
                    respondents under this paragraph.
                      (K) Funding for implementation.--For purposes
                    of carrying out subparagraph (A), the Secretary
                    shall provide for the transfer, from the
                    Federal Supplementary Medical Insurance Trust
                    Fund under section 1841, of $15,000,000 to the
                    Centers for Medicare & Medicaid Services
                    Program Management Account for fiscal year
                    2018. Amounts transferred under this
                    subparagraph shall remain available until
                    expended.
      (m) Payment for Telehealth Services.--
              (1) In general.--Subject to paragraphs (8) and (9),
            the Secretary shall pay for telehealth services that
            are furnished via a telecommunications system by a
            physician (as defined in section 1861(r)) or a
            practitioner (as defined in paragraph (4)(E)) to an
            eligible telehealth individual enrolled under this part
            notwithstanding that the individual physician or
            practitioner providing the telehealth service is not at
            the same location as the beneficiary. For purposes of
            the preceding sentence, in the case of any Federal
            telemedicine demonstration program conducted in Alaska
            or Hawaii, the term ``telecommunications system''
            includes store-and-forward technologies that provide
            for the asynchronous transmission of health care
            information in single or multimedia formats.
              (2) Payment amount.--
                      (A) Distant site.--Subject to paragraph (8),
                    the Secretary shall pay to a physician or
                    practitioner located at a distant site that
                    furnishes a telehealth service to an eligible
                    telehealth individual an amount equal to the
                    amount that such physician or practitioner
                    would have been paid under this title had such
                    service been furnished without the use of a
                    telecommunications system.
                      (B) Facility fee for originating site.--
                              (i) In general.--Subject to clauses
                            (ii) and (iii) and paragraph (6)(C),
                            with respect to a telehealth service,
                            subject to section 1833(a)(1)(U), there
                            shall be paid to the originating site a
                            facility fee equal to--
                                      (I) for the period beginning
                                    on October 1, 2001, and ending
                                    on December 31, 2001, and for
                                    2002, $20; and
                                      (II) for a subsequent year,
                                    the facility fee specified in
                                    subclause (I) or this subclause
                                    for the preceding year
                                    increased by the percentage
                                    increase in the MEI (as defined
                                    in section 1842(i)(3)) for such
                                    subsequent year.
                              (ii) No facility fee if originating
                            site is the home.--No facility fee
                            shall be paid under this subparagraph
                            to an originating site described in
                            paragraph (4)(C)(ii)(X).
                              (iii) No facility fee for new
                            sites.--With respect to telehealth
                            services identified in paragraph
                            (4)(F)(i) as of the date of the
                            enactment of this clause that are
                            furnished during the 151-day period
                            beginning on the first day after the
                            end of the emergency period described
                            in section 1135(g)(1)(B), a facility
                            fee shall only be paid under this
                            subparagraph to an originating site
                            that is described in paragraph
                            (4)(C)(ii) (other than subclause (X) of
                            such paragraph).
                      (C) Telepresenter not required.--Nothing in
                    this subsection shall be construed as requiring
                    an eligible telehealth individual to be
                    presented by a physician or practitioner at the
                    originating site for the furnishing of a
                    service via a telecommunications system, unless
                    it is medically necessary (as determined by the
                    physician or practitioner at the distant site).
              (3) Limitation on beneficiary charges.--
                      (A) Physician and practitioner.--The
                    provisions of section 1848(g) and subparagraphs
                    (A) and (B) of section 1842(b)(18) shall apply
                    to a physician or practitioner receiving
                    payment under this subsection in the same
                    manner as they apply to physicians or
                    practitioners under such sections.
                      (B) Originating site.--The provisions of
                    section 1842(b)(18) shall apply to originating
                    sites receiving a facility fee in the same
                    manner as they apply to practitioners under
                    such section.
              (4) Definitions.--For purposes of this subsection:
                      (A) Distant site.--Subject to paragraph (8),
                    the term``distant site'' means the site at
                    which the physician or practitioner is located
                    at the time the service is provided via a
                    telecommunications system.
                      (B) Eligible telehealth individual.--The term
                    ``eligible telehealth individual'' means an
                    individual enrolled under this part who
                    receives a telehealth service furnished at an
                    originating site.
                      (C) Originating site.--
                              (i) In general.--Except as provided
                            in clause (iii) and paragraphs (5),
                            (6), and (7), the term``originating
                            site'' means only those sites described
                            in clause (ii) at which the eligible
                            telehealth individual is located at the
                            time the service is furnished via a
                            telecommunications system and only if
                            such site is located--
                                      (I) in an area that is
                                    designated as a rural health
                                    professional shortage area
                                    under section 332(a)(1)(A) of
                                    the Public Health Service Act
                                    (42 U.S.C. 254e(a)(1)(A));
                                      (II) in a county that is not
                                    included in a Metropolitan
                                    Statistical Area; or
                                      (III) from an entity that
                                    participates in a Federal
                                    telemedicine demonstration
                                    project that has been approved
                                    by (or receives funding from)
                                    the Secretary of Health and
                                    Human Services as of December
                                    31, 2000.
                              (ii) Sites described.--The sites
                            referred to in clause (i) are the
                            following sites:
                                      (I) The office of a physician
                                    or practitioner.
                                      (II) A critical access
                                    hospital (as defined in section
                                    1861(mm)(1)).
                                      (III) A rural health clinic
                                    (as defined in section
                                    1861(aa)(2)).
                                      (IV) A Federally qualified
                                    health center (as defined in
                                    section 1861(aa)(4)).
                                      (V) A hospital (as defined in
                                    section 1861(e)).
                                      (VI) A hospital-based or
                                    critical access hospital-based
                                    renal dialysis center
                                    (including satellites).
                                      (VII) A skilled nursing
                                    facility (as defined in section
                                    1819(a)).
                                      (VIII) A community mental
                                    health center (as defined in
                                    section 1861(ff)(3)(B)).
                                      (IX) A renal dialysis
                                    facility, but only for purposes
                                    of section 1881(b)(3)(B).
                                      (X) The home of an
                                    individual, but only for
                                    purposes of section
                                    1881(b)(3)(B) or telehealth
                                    services described in paragraph
                                    (7).
                                      (XI) A rural emergency
                                    hospital (as defined in section
                                    1861(kkk)(2)).
                              (iii) Expanding access to telehealth
                            services.--With respect to telehealth
                            services identified in subparagraph
                            (F)(i) as of the date of the enactment
                            of this clause that are furnished
                            during the 151-day period beginning on
                            the first day after the end of the
                            emergency period described in section
                            1135(g)(1)(B), the term ``originating
                            site'' means any site in the United
                            States at which the eligible telehealth
                            individual is located at the time the
                            service is furnished via a
                            telecommunications system, including
                            the home of an individual.
                      (D) Physician.--The term ``physician'' has
                    the meaning given that term in section 1861(r).
                      (E) Practitioner.--The term ``practitioner''
                    has the meaning given that term in section
                    1842(b)(18)(C) and, for the 151-day period
                    beginning on the first day after the end of the
                    period at the end of the emergency sentence
                    described in section 1135(g)(1)(B), shall
                    include a qualified occupational therapist (as
                    such term is used in section 1861(g)), a
                    qualified physical therapist (as such term is
                    used in section 1861(p)), a qualified speech-
                    language pathologist (as defined in section
                    1861(ll)(4)(A)), and a qualified audiologist
                    (as defined in section 1861(ll)(4)(B)).
                      (F) Telehealth service.--
                              (i) In general.--Subject to paragraph
                            (8), the term``telehealth service''
                            means professional consultations,
                            office visits, and office psychiatry
                            services (identified as of July 1,
                            2000, by HCPCS codes 99241-99275,
                            99201-99215, 90804-90809, and 90862
                            (and as subsequently modified by the
                            Secretary)), and any additional service
                            specified by the Secretary.
                              (ii) Yearly update.--The Secretary
                            shall establish a process that
                            provides, on an annual basis, for the
                            addition or deletion of services (and
                            HCPCS codes), as appropriate, to those
                            specified in clause (i) for authorized
                            payment under paragraph (1).
              (5) Treatment of home dialysis monthly esrd-related
            visit.--The geographic requirements described in
            paragraph (4)(C)(i) shall not apply with respect to
            telehealth services furnished on or after January 1,
            2019, for purposes of section 1881(b)(3)(B), at an
            originating site described in subclause (VI), (IX), or
            (X) of paragraph (4)(C)(ii).
              (6) Treatment of stroke telehealth services.--
                      (A) Non-application of originating site
                    requirements.--The requirements described in
                    paragraph (4)(C) shall not apply with respect
                    to telehealth services furnished on or after
                    January 1, 2019, for purposes of diagnosis,
                    evaluation, or treatment of symptoms of an
                    acute stroke, as determined by the Secretary.
                      (B) Inclusion of certain sites.--With respect
                    to telehealth services described in
                    subparagraph (A), the term ``originating site''
                    shall include any hospital (as defined in
                    section 1861(e)) or critical access hospital
                    (as defined in section 1861(mm)(1)), any mobile
                    stroke unit (as defined by the Secretary), or
                    any other site determined appropriate by the
                    Secretary, at which the eligible telehealth
                    individual is located at the time the service
                    is furnished via a telecommunications system.
                      (C) No originating site facility fee for new
                    sites.--No facility fee shall be paid under
                    paragraph (2)(B) to an originating site with
                    respect to a telehealth service described in
                    subparagraph (A) if the originating site does
                    not otherwise meet the requirements for an
                    originating site under paragraph (4)(C).
              (7) Treatment of substance use disorder services and
            mental health services furnished through telehealth.--
                      (A) In general.--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, or, on or after the first day after
                    the end of the emergency period described in
                    section 1135(g)(1)(B), subject to subparagraph
                    (B), to an eligible telehealth individual for
                    purposes of diagnosis, evaluation, or treatment
                    of a 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) or, for the period for which
                    clause (iii) of paragraph (4)(C) applies, at
                    any site described in such clause.
                      (B) Requirements for mental health services
                    furnished through telehealth.--
                              (i) In general.--Payment may not be
                            made under this paragraph for
                            telehealth services furnished on or
                            after the day that is the 152nd day
                            after the end of the period at the end
                            of the emergency sentence described in
                            section 1135(g)(1)(B)) by a physician
                            or practitioner to an eligible
                            telehealth individual for purposes of
                            diagnosis, evaluation, or treatment of
                            a mental health disorder unless such
                            physician or practitioner furnishes an
                            item or service in person, without the
                            use of telehealth, for which payment is
                            made under this title (or would have
                            been made under this title if such
                            individual were entitled to, or
                            enrolled for, benefits under this title
                            at the time such item or service is
                            furnished)--
                                      (I) within the 6-month period
                                    prior to the first time such
                                    physician or practitioner
                                    furnishes such a telehealth
                                    service to the eligible
                                    telehealth individual; and
                                      (II) during subsequent
                                    periods in which such physician
                                    or practitioner furnishes such
                                    telehealth services to the
                                    eligible telehealth individual,
                                    at such times as the Secretary
                                    determines appropriate.
                              (ii) Clarification.--This
                            subparagraph shall not apply if payment
                            would otherwise be allowed--
                                      (I) under this paragraph
                                    (with respect to telehealth
                                    services furnished to an
                                    eligible telehealth individual
                                    with a substance use disorder
                                    diagnosis for purposes of
                                    treatment of such disorder or
                                    co-occurring mental health
                                    disorder); or
                                      (II) under this subsection
                                    without application of this
                                    paragraph.
              (8) Enhancing telehealth services for federally
            qualified health centers and rural health clinics.--
                      (A) In general.--During the emergency period
                    described in section 1135(g)(1)(B) and, during
                    the 151-day period beginning on the first day
                    after the end of such emergency period--
                              (i) the Secretary shall pay for
                            telehealth services that are furnished
                            via a telecommunications system by a
                            Federally qualified health center or a
                            rural health clinic to an eligible
                            telehealth individual enrolled under
                            this part notwithstanding that the
                            Federally qualified health center or
                            rural clinic providing the telehealth
                            service is not at the same location as
                            the beneficiary;
                              (ii) the amount of payment to a
                            Federally qualified health center or
                            rural health clinic that serves as a
                            distant site for such a telehealth
                            service shall be determined under
                            subparagraph (B); and
                              (iii) for purposes of this
                            subsection--
                                      (I) the term ``distant site''
                                    includes a Federally qualified
                                    health center or rural health
                                    clinic that furnishes a
                                    telehealth service to an
                                    eligible telehealth individual;
                                    and
                                      (II) the term ``telehealth
                                    services'' includes a rural
                                    health clinic service or
                                    Federally qualified health
                                    center service that is
                                    furnished using telehealth to
                                    the extent that payment codes
                                    corresponding to services
                                    identified by the Secretary
                                    under clause (i) or (ii) of
                                    paragraph (4)(F) are listed on
                                    the corresponding claim for
                                    such rural health clinic
                                    service or Federally qualified
                                    health center service.
                      (B) Special payment rule.--
                              (i) In general.--The Secretary shall
                            develop and implement payment methods
                            that apply under this subsection to a
                            Federally qualified health center or
                            rural health clinic that serves as a
                            distant site that furnishes a
                            telehealth service to an eligible
                            telehealth individual during the
                            periods for which subparagraph (A)
                            applies. Such payment methods shall be
                            based on payment rates that are similar
                            to the national average payment rates
                            for comparable telehealth services
                            under the physician fee schedule under
                            section 1848. Notwithstanding any other
                            provision of law, the Secretary may
                            implement such payment methods through
                            program instruction or otherwise.
                              (ii) Exclusion from fqhc pps
                            calculation and rhc air calculation.--
                            Costs associated with telehealth
                            services shall not be used to determine
                            the amount of payment for Federally
                            qualified health center services under
                            the prospective payment system under
                            section 1834(o) or for rural health
                            clinic services under the methodology
                            for all-inclusive rates (established by
                            the Secretary) under section
                            1833(a)(3).
              (9) Treatment of telehealth services furnished using
            audio-only telecommunications technology.--The
            Secretary shall continue to provide coverage and
            payment under this part for telehealth services
            identified in paragraph (4)(F)(i) as of the date of the
            enactment of this paragraph that are furnished via an
            audio-only telecommunications system during the 151-day
            period beginning on the first day after the end of the
            emergency period described in section 1135(g)(1)(B).
            For purposes of the previous sentence, the term
            ``telehealth service'' means a telehealth service
            identified as of the date of the enactment of this
            paragraph by a HCPCS code (and any succeeding codes)
            for which the Secretary has not applied the
            requirements of paragraph (1) and the first sentence of
            section 410.78(a)(3) of title 42, Code of Federal
            Regulations, during such emergency period.
      (n) Authority To Modify or Eliminate Coverage of Certain
    Preventive Services.--Notwithstanding any other provision of
    this title, effective beginning on January 1, 2010, if the
    Secretary determines appropriate, the Secretary may--
              (1) modify--
                      (A) the coverage of any preventive service
                    described in subparagraph (A) of section
                    1861(ddd)(3) to the extent that such
                    modification is consistent with the
                    recommendations of the United States Preventive
                    Services Task Force; and
                      (B) the services included in the initial
                    preventive physical examination described in
                    subparagraph (B) of such section; and
              (2) provide that no payment shall be made under this
            title for a preventive service described in
            subparagraph (A) of such section that has not received
            a grade of A, B, C, or I by such Task Force.
      (o) Development and Implementation of Prospective Payment
    System.--
              (1) Development.--
                      (A) In general.--The Secretary shall develop
                    a prospective payment system for payment for
                    Federally qualified health center services
                    furnished by Federally qualified health centers
                    under this title. Such system shall include a
                    process for appropriately describing the
                    services furnished by Federally qualified
                    health centers and shall establish payment
                    rates for specific payment codes based on such
                    appropriate descriptions of services. Such
                    system shall be established to take into
                    account the type, intensity, and duration of
                    services furnished by Federally qualified
                    health centers. Such system may include
                    adjustments, including geographic adjustments,
                    determined appropriate by the Secretary.
                      (B) Collection of data and evaluation.--By
                    not later than January 1, 2011, the Secretary
                    shall require Federally qualified health
                    centers to submit to the Secretary such
                    information as the Secretary may require in
                    order to develop and implement the prospective
                    payment system under this subsection, including
                    the reporting of services using HCPCS codes.
              (2) Implementation.--
                      (A) In general.--Notwithstanding section
                    1833(a)(3)(A), the Secretary shall provide, for
                    cost reporting periods beginning on or after
                    October 1, 2014, for payments of prospective
                    payment rates for Federally qualified health
                    center services furnished by Federally
                    qualified health centers under this title in
                    accordance with the prospective payment system
                    developed by the Secretary under paragraph (1).
                      (B) Payments.--
                              (i) Initial payments.--The Secretary
                            shall implement such prospective
                            payment system so that the estimated
                            aggregate amount of prospective payment
                            rates (determined prior to the
                            application of section 1833(a)(1)(Z))
                            under this title for Federally
                            qualified health center services in the
                            first year that such system is
                            implemented is equal to 100 percent of
                            the estimated amount of reasonable
                            costs (determined without the
                            application of a per visit payment
                            limit or productivity screen and prior
                            to the application of section
                            1866(a)(2)(A)(ii)) that would have
                            occurred for such services under this
                            title in such year if the system had
                            not been implemented.
                              (ii) Payments in subsequent years.--
                            Payment rates in years after the year
                            of implementation of such system shall
                            be the payment rates in the previous
                            year increased--
                                      (I) in the first year after
                                    implementation of such system,
                                    by the percentage increase in
                                    the MEI (as defined in section
                                    1842(i)(3)) for the year
                                    involved; and
                                      (II) in subsequent years, by
                                    the percentage increase in a
                                    market basket of Federally
                                    qualified health center goods
                                    and services as promulgated
                                    through regulations, or if such
                                    an index is not available, by
                                    the percentage increase in the
                                    MEI (as defined in section
                                    1842(i)(3)) for the year
                                    involved.
                      (C) Preparation for pps implementation.--
                    Notwithstanding any other provision of law, the
                    Secretary may establish and implement by
                    program instruction or otherwise the payment
                    codes to be used under the prospective payment
                    system under this section.
              (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] first
                            begins prescribing narcotic drugs in
                            schedule III, IV, or V of section 202
                            of the Controlled Substances Act for
                            the purpose of maintenance or
                            detoxification treatment on or after
                            January 1, 2021.
                      (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.
              (4) Payment for certain services furnished by
            federally qualified health centers to hospice
            patients.--
                      (A) Attending physician services for hospice
                    patients.--In the case of services described in
                    section?1812(d)(2)(A)(ii) furnished on or after
                    January 1, 2022, by an attending physician (as
                    defined in section 1861(dd)(3)(B), other than a
                    physician or practitioner who is employed by a
                    hospice program) who is employed by or working
                    under contract with a Federally qualified
                    health center, a Federally qualified health
                    center shall be paid for such services under
                    the prospective payment system under this
                    subsection.
                      (B) Mental health visits furnished via
                    telecommunications technology.--In the case of
                    mental health visits furnished via interactive,
                    real-time, audio and video telecommunications
                    technology or audio-only interactions, the in-
                    person mental health visit requirements
                    established under section 405.2463(b)(3) of
                    title 42 of the Code of Federal Regulations (or
                    a successor regulation) shall not apply prior
                    to the day that is the 152nd day after the end
                    of the emergency period described in section
                    1135(g)(1)(B)).
      (p) Quality Incentives To Promote Patient Safety and Public
    Health in Computed Tomography.--
              (1) Quality incentives.--In the case of an applicable
            computed tomography service (as defined in paragraph
            (2)) for which payment is made under an applicable
            payment system (as defined in paragraph (3)) and that
            is furnished on or after January 1, 2016, using
            equipment that is not consistent with the CT equipment
            standard (described in paragraph (4)), the payment
            amount for such service shall be reduced by the
            applicable percentage (as defined in paragraph (5)).
              (2) Applicable computed tomography services
            defined.--In this subsection, the term ``applicable
            computed tomography service'' means a service billed
            using diagnostic radiological imaging codes for
            computed tomography (identified as of January 1, 2014,
            by HCPCS codes 70450-70498, 71250-71275, 72125-72133,
            72191-72194, 73200-73206, 73700-73706, 74150-74178,
            74261-74263, and 75571-75574 (and any succeeding
            codes).
              (3) Applicable payment system defined.--In this
            subsection, the term ``applicable payment system''
            means the following:
                      (A) The technical component and the technical
                    component of the global fee under the fee
                    schedule established under section 1848(b).
                      (B) The prospective payment system for
                    hospital outpatient department services under
                    section 1833(t).
              (4) Consistency with ct equipment standard.--In this
            subsection, the term ``not consistent with the CT
            equipment standard'' means, with respect to an
            applicable computed tomography service, that the
            service was furnished using equipment that does not
            meet each of the attributes of the National Electrical
            Manufacturers Association (NEMA) Standard XR-29-2013,
            entitled ``Standard Attributes on CT Equipment Related
            to Dose Optimization and Management''. Through
            rulemaking, the Secretary may apply successor
            standards.
              (5) Applicable percentage defined.--In this
            subsection, the term ``applicable percentage'' means--
                      (A) for 2016, 5 percent; and
                      (B) for 2017 and subsequent years, 15
                    percent.
              (6) Implementation.--
                      (A) Information.--The Secretary shall require
                    that information be provided and attested to by
                    a supplier and a hospital outpatient department
                    that indicates whether an applicable computed
                    tomography service was furnished that was not
                    consistent with the CT equipment standard
                    (described in paragraph (4)). Such information
                    may be included on a claim and may be a
                    modifier. Such information shall be verified,
                    as appropriate, as part of the periodic
                    accreditation of suppliers under section
                    1834(e) and hospitals under section 1865(a).
                      (B) Administration.--Chapter 35 of title 44,
                    United States Code, shall not apply to
                    information described in subparagraph (A).
      (q) Recognizing Appropriate Use Criteria for Certain Imaging
    Services.--
              (1) Program established.--
                      (A) In general.--The Secretary shall
                    establish a program to promote the use of
                    appropriate use criteria (as defined in
                    subparagraph (B)) for applicable imaging
                    services (as defined in subparagraph (C))
                    furnished in an applicable setting (as defined
                    in subparagraph (D)) by ordering professionals
                    and furnishing professionals (as defined in
                    subparagraphs (E) and (F), respectively).
                      (B) Appropriate use criteria defined.--In
                    this subsection, the term ``appropriate use
                    criteria'' means criteria, only developed or
                    endorsed by national professional medical
                    specialty societies or other provider-led
                    entities, to assist ordering professionals and
                    furnishing professionals in making the most
                    appropriate treatment decision for a specific
                    clinical condition for an individual. To the
                    extent feasible, such criteria shall be
                    evidence-based.
                      (C) Applicable imaging service defined.--In
                    this subsection, the term ``applicable imaging
                    service'' means an advanced diagnostic imaging
                    service (as defined in subsection (e)(1)(B))
                    for which the Secretary determines--
                              (i) one or more applicable
                            appropriate use criteria specified
                            under paragraph (2) apply;
                              (ii) there are one or more qualified
                            clinical decision support mechanisms
                            listed under paragraph (3)(C); and
                              (iii) one or more of such mechanisms
                            is available free of charge.
                      (D) Applicable setting defined.--In this
                    subsection, the term ``applicable setting''
                    means a physician's office, a hospital
                    outpatient department (including an emergency
                    department), an ambulatory surgical center, and
                    any other provider-led outpatient setting
                    determined appropriate by the Secretary.
                      (E) Ordering professional defined.--In this
                    subsection, the term ``ordering professional''
                    means a physician (as defined in section
                    1861(r)) or a practitioner described in section
                    1842(b)(18)(C) who orders an applicable imaging
                    service.
                      (F) Furnishing professional defined.--In this
                    subsection, the term ``furnishing
                    professional'' means a physician (as defined in
                    section 1861(r)) or a practitioner described in
                    section 1842(b)(18)(C) who furnishes an
                    applicable imaging service.
              (2) Establishment of applicable appropriate use
            criteria.--
                      (A) In general.--Not later than November 15,
                    2015, the Secretary shall through rulemaking,
                    and in consultation with physicians,
                    practitioners, and other stakeholders, specify
                    applicable appropriate use criteria for
                    applicable imaging services only from among
                    appropriate use criteria developed or endorsed
                    by national professional medical specialty
                    societies or other provider-led entities.
                      (B) Considerations.--In specifying applicable
                    appropriate use criteria under subparagraph
                    (A), the Secretary shall take into account
                    whether the criteria--
                              (i) have stakeholder consensus;
                              (ii) are scientifically valid and
                            evidence based; and
                              (iii) are based on studies that are
                            published and reviewable by
                            stakeholders.
                      (C) Revisions.--The Secretary shall review,
                    on an annual basis, the specified applicable
                    appropriate use criteria to determine if there
                    is a need to update or revise (as appropriate)
                    such specification of applicable appropriate
                    use criteria and make such updates or revisions
                    through rulemaking.
                      (D) Treatment of multiple applicable
                    appropriate use criteria.--In the case where
                    the Secretary determines that more than one
                    appropriate use criterion applies with respect
                    to an applicable imaging service, the Secretary
                    shall apply one or more applicable appropriate
                    use criteria under this paragraph for the
                    service.
              (3) Mechanisms for consultation with applicable
            appropriate use criteria.--
                      (A) Identification of mechanisms to consult
                    with applicable appropriate use criteria.--
                              (i) In general.--The Secretary shall
                            specify qualified clinical decision
                            support mechanisms that could be used
                            by ordering professionals to consult
                            with applicable appropriate use
                            criteria for applicable imaging
                            services.
                              (ii) Consultation.--The Secretary
                            shall consult with physicians,
                            practitioners, health care technology
                            experts, and other stakeholders in
                            specifying mechanisms under this
                            paragraph.
                              (iii) Inclusion of certain
                            mechanisms.--Mechanisms specified under
                            this paragraph may include any or all
                            of the following that meet the
                            requirements described in subparagraph
                            (B)(ii):
                                      (I) Use of clinical decision
                                    support modules in certified
                                    EHR technology (as defined in
                                    section 1848(o)(4)).
                                      (II) Use of private sector
                                    clinical decision support
                                    mechanisms that are independent
                                    from certified EHR technology,
                                    which may include use of
                                    clinical decision support
                                    mechanisms available from
                                    medical specialty
                                    organizations.
                                      (III) Use of a clinical
                                    decision support mechanism
                                    established by the Secretary.
                      (B) Qualified clinical decision support
                    mechanisms.--
                              (i) In general.--For purposes of this
                            subsection, a qualified clinical
                            decision support mechanism is a
                            mechanism that the Secretary determines
                            meets the requirements described in
                            clause (ii).
                              (ii) Requirements.--The requirements
                            described in this clause are the
                            following:
                                      (I) The mechanism makes
                                    available to the ordering
                                    professional applicable
                                    appropriate use criteria
                                    specified under paragraph (2)
                                    and the supporting
                                    documentation for the
                                    applicable imaging service
                                    ordered.
                                      (II) In the case where there
                                    is more than one applicable
                                    appropriate use criterion
                                    specified under such paragraph
                                    for an applicable imaging
                                    service, the mechanism
                                    indicates the criteria that it
                                    uses for the service.
                                      (III) The mechanism
                                    determines the extent to which
                                    an applicable imaging service
                                    ordered is consistent with the
                                    applicable appropriate use
                                    criteria so specified.
                                      (IV) The mechanism generates
                                    and provides to the ordering
                                    professional a certification or
                                    documentation that documents
                                    that the qualified clinical
                                    decision support mechanism was
                                    consulted by the ordering
                                    professional.
                                      (V) The mechanism is updated
                                    on a timely basis to reflect
                                    revisions to the specification
                                    of applicable appropriate use
                                    criteria under such paragraph.
                                      (VI) The mechanism meets
                                    privacy and security standards
                                    under applicable provisions of
                                    law.
                                      (VII) The mechanism performs
                                    such other functions as
                                    specified by the Secretary,
                                    which may include a requirement
                                    to provide aggregate feedback
                                    to the ordering professional.
                      (C) List of mechanisms for consultation with
                    applicable appropriate use criteria.--
                              (i) Initial list.--Not later than
                            April 1, 2016, the Secretary shall
                            publish a list of mechanisms specified
                            under this paragraph.
                              (ii) Periodic updating of list.--The
                            Secretary shall identify on an annual
                            basis the list of qualified clinical
                            decision support mechanisms specified
                            under this paragraph.
              (4) Consultation with applicable appropriate use
            criteria.--
                      (A) Consultation by ordering professional.--
                    Beginning with January 1, 2017, subject to
                    subparagraph (C), with respect to an applicable
                    imaging service ordered by an ordering
                    professional that would be furnished in an
                    applicable setting and paid for under an
                    applicable payment system (as defined in
                    subparagraph (D)), an ordering professional
                    shall--
                              (i) consult with a qualified decision
                            support mechanism listed under
                            paragraph (3)(C); and
                              (ii) provide to the furnishing
                            professional the information described
                            in clauses (i) through (iii) of
                            subparagraph (B).
                      (B) Reporting by furnishing professional.--
                    Beginning with January 1, 2017, subject to
                    subparagraph (C), with respect to an applicable
                    imaging service furnished in an applicable
                    setting and paid for under an applicable
                    payment system (as defined in subparagraph
                    (D)), payment for such service may only be made
                    if the claim for the service includes the
                    following:
                              (i) Information about which qualified
                            clinical decision support mechanism was
                            consulted by the ordering professional
                            for the service.
                              (ii) Information regarding--
                                      (I) whether the service
                                    ordered would adhere to the
                                    applicable appropriate use
                                    criteria specified under
                                    paragraph (2);
                                      (II) whether the service
                                    ordered would not adhere to
                                    such criteria; or
                                      (III) whether such criteria
                                    was not applicable to the
                                    service ordered.
                              (iii) The national provider
                            identifier of the ordering professional
                            (if different from the furnishing
                            professional).
                      (C) Exceptions.--The provisions of
                    subparagraphs (A) and (B) and paragraph (6)(A)
                    shall not apply to the following:
                              (i) Emergency services.--An
                            applicable imaging service ordered for
                            an individual with an emergency medical
                            condition (as defined in section
                            1867(e)(1)).
                              (ii) Inpatient services.--An
                            applicable imaging service ordered for
                            an inpatient and for which payment is
                            made under part A.
                              (iii) Significant hardship.--An
                            applicable imaging service ordered by
                            an ordering professional who the
                            Secretary may, on a case-by-case basis,
                            exempt from the application of such
                            provisions if the Secretary determines,
                            subject to annual renewal, that
                            consultation with applicable
                            appropriate use criteria would result
                            in a significant hardship, such as in
                            the case of a professional who
                            practices in a rural area without
                            sufficient Internet access.
                      (D) Applicable payment system defined.--In
                    this subsection, the term ``applicable payment
                    system'' means the following:
                              (i) The physician fee schedule
                            established under section 1848(b).
                              (ii) The prospective payment system
                            for hospital outpatient department
                            services under section 1833(t).
                              (iii) The ambulatory surgical center
                            payment systems under section 1833(i).
              (5) Identification of outlier ordering
            professionals.--
                      (A) In general.--With respect to applicable
                    imaging services furnished beginning with 2017,
                    the Secretary shall determine, on an annual
                    basis, no more than five percent of the total
                    number of ordering professionals who are
                    outlier ordering professionals.
                      (B) Outlier ordering professionals.--The
                    determination of an outlier ordering
                    professional shall--
                              (i) be based on low adherence to
                            applicable appropriate use criteria
                            specified under paragraph (2), which
                            may be based on comparison to other
                            ordering professionals; and
                              (ii) include data for ordering
                            professionals for whom prior
                            authorization under paragraph (6)(A)
                            applies.
                      (C) Use of two years of data.--The Secretary
                    shall use two years of data to identify outlier
                    ordering professionals under this paragraph.
                      (D) Process.--The Secretary shall establish a
                    process for determining when an outlier
                    ordering professional is no longer an outlier
                    ordering professional.
                      (E) Consultation with stakeholders.--The
                    Secretary shall consult with physicians,
                    practitioners and other stakeholders in
                    developing methods to identify outlier ordering
                    professionals under this paragraph.
              (6) Prior authorization for ordering professionals
            who are outliers.--
                      (A) In general.--Beginning January 1, 2020,
                    subject to paragraph (4)(C), with respect to
                    services furnished during a year, the Secretary
                    shall, for a period determined appropriate by
                    the Secretary, apply prior authorization for
                    applicable imaging services that are ordered by
                    an outlier ordering professional identified
                    under paragraph (5).
                      (B) Appropriate use criteria in prior
                    authorization.--In applying prior authorization
                    under subparagraph (A), the Secretary shall
                    utilize only the applicable appropriate use
                    criteria specified under this subsection.
                      (C) Funding.--For purposes of carrying out
                    this paragraph, the Secretary shall provide for
                    the transfer, from the Federal Supplementary
                    Medical Insurance Trust Fund under section
                    1841, of $5,000,000 to the Centers for Medicare
                    & Medicaid Services Program Management Account
                    for each of fiscal years 2019 through 2021.
                    Amounts transferred under the preceding
                    sentence shall remain available until expended.
              (7) Construction.--Nothing in this subsection shall
            be construed as granting the Secretary the authority to
            develop or initiate the development of clinical
            practice guidelines or appropriate use criteria.
      (r) Payment for Renal Dialysis Services for Individuals With
    Acute Kidney Injury.--
              (1) Payment rate.--In the case of renal dialysis
            services (as defined in subparagraph (B) of section
            1881(b)(14)) furnished under this part by a renal
            dialysis facility or provider of services paid under
            such section during a year (beginning with 2017) to an
            individual with acute kidney injury (as defined in
            paragraph (2)), the amount of payment under this part
            for such services shall be the base rate for renal
            dialysis services determined for such year under such
            section, as adjusted by any applicable geographic
            adjustment factor applied under subparagraph
            (D)(iv)(II) of such section and may be adjusted by the
            Secretary (on a budget neutral basis for payments under
            this paragraph) by any other adjustment factor under
            subparagraph (D) of such section.
              (2) Individual with acute kidney injury defined.--In
            this subsection, the term ``individual with acute
            kidney injury'' means an individual who has acute loss
            of renal function and does not receive renal dialysis
            services for which payment is made under section
            1881(b)(14).
      (s) Payment for Applicable Disposable Devices.--
              (1) Separate payment.--The Secretary shall make a
            payment (separate from the payments otherwise made
            under section 1895) in the amount established under
            paragraph (3) to a home health agency for an applicable
            disposable device (as defined in paragraph (2)) when
            furnished on or after January 1, 2017, to an individual
            who receives home health services for which payment is
            made under section 1895(b).
              (2) Applicable disposable device.--In this
            subsection, the term applicable disposable device means
            a disposable device that, as determined by the
            Secretary, is--
                      (A) a disposable negative pressure wound
                    therapy device that is an integrated system
                    comprised of a non-manual vacuum pump, a
                    receptacle for collecting exudate, and
                    dressings for the purposes of wound therapy;
                    and
                      (B) a substitute for, and used in lieu of, a
                    negative pressure wound therapy durable medical
                    equipment item that is an integrated system of
                    a negative pressure vacuum pump, a separate
                    exudate collection canister, and dressings that
                    would otherwise be covered for individuals for
                    such wound therapy.
              (3) Payment amount.--The separate payment amount
            established under this paragraph for an applicable
            disposable device for a year shall be equal to the
            amount of the payment that would be made under section
            1833(t) (relating to payment for covered OPD services)
            for the year for the Level I Healthcare Common
            Procedure Coding System (HCPCS) code for which the
            description for a professional service includes the
            furnishing of such device.
      (t) Site-of-Service Price Transparency.--
              (1) In general.--In order to facilitate price
            transparency with respect to items and services for
            which payment may be made either to a hospital
            outpatient department or to an ambulatory surgical
            center under this title, the Secretary shall, for 2018
            and each year thereafter, make available to the public
            via a searchable Internet website, with respect to an
            appropriate number of such items and services--
                      (A) the estimated payment amount for the item
                    or service under the outpatient department fee
                    schedule under subsection (t) of section 1833
                    and the ambulatory surgical center payment
                    system under subsection (i) of such section;
                    and
                      (B) the estimated amount of beneficiary
                    liability applicable to the item or service.
              (2) Calculation of estimated beneficiary liability.--
            For purposes of paragraph (1)(B), the estimated amount
            of beneficiary liability, with respect to an item or
            service, is the amount for such item or service for
            which an individual who does not have coverage under a
            Medicare supplemental policy certified under section
            1882 or any other supplemental insurance coverage is
            responsible.
              (3) Implementation.--In carrying out this subsection,
            the Secretary--
                      (A) shall include in the notice described in
                    section 1804(a) a notification of the
                    availability of the estimated amounts made
                    available under paragraph (1); and
                      (B) may utilize mechanisms in existence on
                    the date of enactment of this subsection, such
                    as the portion of the Internet website of the
                    Centers for Medicare & Medicaid Services on
                    which information comparing physician
                    performance is posted (commonly referred to as
                    the Physician Compare Internet website), to
                    make available such estimated amounts under
                    such paragraph.
              (4) Funding.--For purposes of implementing this
            subsection, the Secretary shall provide for the
            transfer, from the Federal Supplementary Medical
            Insurance Trust Fund under section 1841 to the Centers
            for Medicare & Medicaid Services Program Management
            Account, of $6,000,000 for fiscal year 2017, to remain
            available until expended.
      (u) Payment and Related Requirements for Home Infusion
    Therapy.--
              (1) Payment.--
                      (A) Single payment.--
                              (i) In general.--Subject to clause
                            (iii) and subparagraphs (B) and (C),
                            the Secretary shall implement a payment
                            system under which a single payment is
                            made under this title to a qualified
                            home infusion therapy supplier for
                            items and services described in
                            subparagraphs (A) and (B) of section
                            1861(iii)(2)) furnished by a qualified
                            home infusion therapy supplier (as
                            defined in section 1861(iii)(3)(D)) in
                            coordination with the furnishing of
                            home infusion drugs (as defined in
                            section 1861(iii)(3)(C)) under this
                            part.
                              (ii) Unit of single payment.--A unit
                            of single payment under the payment
                            system implemented under this
                            subparagraph is for each infusion drug
                            administration calendar day in the
                            individual's home. The Secretary shall,
                            as appropriate, establish single
                            payment amounts for types of infusion
                            therapy, including to take into account
                            variation in utilization of nursing
                            services by therapy type.
                              (iii) Limitation.--The single payment
                            amount determined under this
                            subparagraph after application of
                            subparagraph (B) and paragraph (3)
                            shall not exceed the amount determined
                            under the fee schedule under section
                            1848 for infusion therapy services
                            furnished in a calendar day if
                            furnished in a physician office
                            setting, except such single payment
                            shall not reflect more than 5 hours of
                            infusion for a particular therapy in a
                            calendar day.
                      (B) Required adjustments.--The Secretary
                    shall adjust the single payment amount
                    determined under subparagraph (A) for home
                    infusion therapy services under section
                    1861(iii)(1) to reflect other factors such as--
                              (i) a geographic wage index and other
                            costs that may vary by region; and
                              (ii) patient acuity and complexity of
                            drug administration.
                      (C) Discretionary adjustments.--
                              (i) In general.--Subject to clause
                            (ii), the Secretary may adjust the
                            single payment amount determined under
                            subparagraph (A) (after application of
                            subparagraph (B)) to reflect outlier
                            situations and other factors as the
                            Secretary determines appropriate.
                              (ii) Requirement of budget
                            neutrality.--Any adjustment under this
                            subparagraph shall be made in a budget
                            neutral manner.
              (2) Considerations.--In developing the payment system
            under this subsection, the Secretary may consider the
            costs of furnishing infusion therapy in the home,
            consult with home infusion therapy suppliers, consider
            payment amounts for similar items and services under
            this part and part A, and consider payment amounts
            established by Medicare Advantage plans under part C
            and in the private insurance market for home infusion
            therapy (including average per treatment day payment
            amounts by type of home infusion therapy).
              (3) Annual updates.--
                      (A) In general.--Subject to subparagraph (B),
                    the Secretary shall update the single payment
                    amount under this subsection from year to year
                    beginning in 2022 by increasing the single
                    payment amount from the prior year by the
                    percentage increase in the Consumer Price Index
                    for all urban consumers (United States city
                    average) for the 12-month period ending with
                    June of the preceding year.
                      (B) Adjustment.--For each year, the Secretary
                    shall reduce the percentage increase described
                    in subparagraph (A) by the productivity
                    adjustment described in section
                    1886(b)(3)(B)(xi)(II). The application of the
                    preceding sentence may result in a percentage
                    being less than 0.0 for a year, and may result
                    in payment being less than such payment rates
                    for the preceding year.
              (4) Authority to apply prior authorization.--The
            Secretary may, as determined appropriate by the
            Secretary, apply prior authorization for home infusion
            therapy services under section 1861(iii)(1).
              (5) Accreditation of qualified home infusion therapy
            suppliers.--
                      (A) Factors for designation of accreditation
                    organizations.--The Secretary shall consider
                    the following factors in designating
                    accreditation organizations under subparagraph
                    (B) and in reviewing and modifying the list of
                    accreditation organizations designated pursuant
                    to subparagraph (C):
                              (i) The ability of the organization
                            to conduct timely reviews of
                            accreditation applications.
                              (ii) The ability of the organization
                            to take into account the capacities of
                            suppliers located in a rural area (as
                            defined in section 1886(d)(2)(D)).
                              (iii) Whether the organization has
                            established reasonable fees to be
                            charged to suppliers applying for
                            accreditation.
                              (iv) Such other factors as the
                            Secretary determines appropriate.
                      (B) Designation.--Not later than January 1,
                    2021, the Secretary shall designate
                    organizations to accredit suppliers furnishing
                    home infusion therapy. The list of
                    accreditation organizations so designated may
                    be modified pursuant to subparagraph (C).
                      (C) Review and modification of list of
                    accreditation organizations.--
                              (i) In general.--The Secretary shall
                            review the list of accreditation
                            organizations designated under
                            subparagraph (B) taking into account
                            the factors under subparagraph (A).
                            Taking into account the results of such
                            review, the Secretary may, by
                            regulation, modify the list of
                            accreditation organizations designated
                            under subparagraph (B).
                              (ii) Special rule for accreditations
                            done prior to removal from list of
                            designated accreditation
                            organizations.--In the case where the
                            Secretary removes an organization from
                            the list of accreditation organizations
                            designated under subparagraph (B), any
                            supplier that is accredited by the
                            organization during the period
                            beginning on the date on which the
                            organization is designated as an
                            accreditation organization under
                            subparagraph (B) and ending on the date
                            on which the organization is removed
                            from such list shall be considered to
                            have been accredited by an organization
                            designated by the Secretary under
                            subparagraph (B) for the remaining
                            period such accreditation is in effect.
                      (D) Rule for accreditations made prior to
                    designation.--In the case of a supplier that is
                    accredited before January 1, 2021, by an
                    accreditation organization designated by the
                    Secretary under subparagraph (B) as of January
                    1, 2019, such supplier shall be considered to
                    have been accredited by an organization
                    designated by the Secretary under such
                    paragraph as of January 1, 2023, for the
                    remaining period such accreditation is in
                    effect.
              (6) Notification of infusion therapy options
            available prior to furnishing home infusion therapy.--
            Prior to the furnishing of home infusion therapy to an
            individual, the physician who establishes the plan
            described in section 1861(iii)(1) for the individual
            shall provide notification (in a form, manner, and
            frequency determined appropriate by the Secretary) of
            the options available (such as home, physician's
            office, hospital outpatient department) for the
            furnishing of infusion therapy under this part.
              (7) Home infusion therapy services temporary
            transitional payment.--
                      (A) Temporary transitional payment.--
                              (i) In general.--The Secretary shall,
                            in accordance with the payment
                            methodology described in subparagraph
                            (B) and subject to the provisions of
                            this paragraph, provide a home infusion
                            therapy services temporary transitional
                            payment under this part to an eligible
                            home infusion supplier (as defined in
                            subparagraph (F)) for items and
                            services described in subparagraphs (A)
                            and (B) of section 1861(iii)(2))
                            furnished during the period specified
                            in clause (ii) by such supplier in
                            coordination with the furnishing of
                            transitional home infusion drugs (as
                            defined in clause (iii)).
                              (ii) Period specified.--For purposes
                            of clause (i), the period specified in
                            this clause is the period beginning on
                            January 1, 2019, and ending on the day
                            before the date of the implementation
                            of the payment system under paragraph
                            (1)(A).
                              (iii) Transitional home infusion drug
                            defined.--For purposes of this
                            paragraph, the term ``transitional home
                            infusion drug'' has the meaning given
                            to the term ``home infusion drug''
                            under section 1861(iii)(3)(C)), except
                            that clause (ii) of such section shall
                            not apply if a drug described in such
                            clause is identified in clauses (i),
                            (ii), (iii) or (iv) of subparagraph (C)
                            as of the date of the enactment of this
                            paragraph.
                      (B) Payment methodology.--For purposes of
                    this paragraph, the Secretary shall establish a
                    payment methodology, with respect to items and
                    services described in subparagraph (A)(i).
                    Under such payment methodology the Secretary
                    shall--
                              (i) create the three payment
                            categories described in clauses (i),
                            (ii), and (iii) of subparagraph (C);
                              (ii) assign drugs to such categories,
                            in accordance with such clauses;
                              (iii) assign appropriate Healthcare
                            Common Procedure Coding System (HCPCS)
                            codes to each payment category; and
                              (iv) establish a single payment
                            amount for each such payment category,
                            in accordance with subparagraph (D),
                            for each infusion drug administration
                            calendar day in the individual's home
                            for drugs assigned to such category.
                      (C) Payment categories.--
                              (i) Payment category 1.--The
                            Secretary shall create a payment
                            category 1 and assign to such category
                            drugs which are covered under the Local
                            Coverage Determination on External
                            Infusion Pumps (LCD number L33794) and
                            billed with the following HCPCS codes
                            (as identified as of January 1, 2018,
                            and as subsequently modified by the
                            Secretary): J0133, J0285, J0287, J0288,
                            J0289, J0895, J1170, J1250, J1265,
                            J1325, J1455, J1457, J1570, J2175,
                            J2260, J2270, J2274, J2278, J3010, or
                            J3285.
                              (ii) Payment category 2.--The
                            Secretary shall create a payment
                            category 2 and assign to such category
                            drugs which are covered under such
                            local coverage determination and billed
                            with the following HCPCS codes (as
                            identified as of January 1, 2018, and
                            as subsequently modified by the
                            Secretary): J1555 JB, J1559 JB, J1561
                            JB, J1562 JB, J1569 JB, or J1575 JB.
                              (iii) Payment category 3.--The
                            Secretary shall create a payment
                            category 3 and assign to such category
                            drugs which are covered under such
                            local coverage determination and billed
                            with the following HCPCS codes (as
                            identified as of January 1, 2018, and
                            as subsequently modified by the
                            Secretary): J9000, J9039, J9040, J9065,
                            J9100, J9190, J9200, J9360, or J9370.
                              (iv) Infusion drugs not otherwise
                            included.--With respect to drugs that
                            are not included in payment category 1,
                            2, or 3 under clause (i), (ii), or
                            (iii), respectively, the Secretary
                            shall assign to the most appropriate of
                            such categories, as determined by the
                            Secretary, drugs which are--
                                      (I) covered under such local
                                    coverage determination and
                                    billed under HCPCS codes J7799
                                    or J7999 (as identified as of
                                    July 1, 2017, and as
                                    subsequently modified by the
                                    Secretary); or
                                      (II) billed under any code
                                    that is implemented after the
                                    date of the enactment of this
                                    paragraph and included in such
                                    local coverage determination or
                                    included in subregulatory
                                    guidance as a home infusion
                                    drug described in subparagraph
                                    (A)(i).
                      (D) Payment amounts.--
                              (i) In general.--Under the payment
                            methodology, the Secretary shall pay
                            eligible home infusion suppliers, with
                            respect to items and services described
                            in subparagraph (A)(i) furnished during
                            the period described in subparagraph
                            (A)(ii) by such supplier to an
                            individual, at amounts equal to the
                            amounts determined under the physician
                            fee schedule established under section
                            1848 for services furnished during the
                            year for codes and units of such codes
                            described in clauses (ii), (iii), and
                            (iv) with respect to drugs included in
                            the payment category under subparagraph
                            (C) specified in the respective clause,
                            determined without application of the
                            geographic adjustment under subsection
                            (e) of such section.
                              (ii) Payment amount for category 1.--
                            For purposes of clause (i), the codes
                            and units described in this clause,
                            with respect to drugs included in
                            payment category 1 described in
                            subparagraph (C)(i), are one unit of
                            HCPCS code 96365 plus three units of
                            HCPCS code 96366 (as identified as of
                            January 1, 2018, and as subsequently
                            modified by the Secretary).
                              (iii) Payment amount for category
                            2.--For purposes of clause (i), the
                            codes and units described in this
                            clause, with respect to drugs included
                            in payment category 2 described in
                            subparagraph (C)(i), are one unit of
                            HCPCS code 96369 plus three units of
                            HCPCS code 96370 (as identified as of
                            January 1, 2018, and as subsequently
                            modified by the Secretary).
                              (iv) Payment amount for category 3.--
                            For purposes of clause (i), the codes
                            and units described in this clause,
                            with respect to drugs included in
                            payment category 3 described in
                            subparagraph (C)(i), are one unit of
                            HCPCS code 96413 plus three units of
                            HCPCS code 96415 (as identified as of
                            January 1, 2018, and as subsequently
                            modified by the Secretary).
                      (E) Clarifications.--
                              (i) Infusion drug administration
                            day.--For purposes of this subsection,
                            with respect to the furnishing of
                            transitional home infusion drugs or
                            home infusion drugs to an individual by
                            an eligible home infusion supplier or a
                            qualified home infusion therapy
                            supplier, a reference to payment to
                            such supplier for an infusion drug
                            administration calendar day in the
                            individual's home shall refer to
                            payment only for the date on which
                            professional services (as described in
                            section 1861(iii)(2)(A)) were furnished
                            to administer such drugs to such
                            individual. For purposes of the
                            previous sentence, an infusion drug
                            administration calendar day shall
                            include all such drugs administered to
                            such individual on such day.
                              (ii) Treatment of multiple drugs
                            administered on same infusion drug
                            administration day.--In the case that
                            an eligible home infusion supplier,
                            with respect to an infusion drug
                            administration calendar day in an
                            individual's home, furnishes to such
                            individual transitional home infusion
                            drugs which are not all assigned to the
                            same payment category under
                            subparagraph (C), payment to such
                            supplier for such infusion drug
                            administration calendar day in the
                            individual's home shall be a single
                            payment equal to the amount of payment
                            under this paragraph for the drug,
                            among all such drugs so furnished to
                            such individual during such calendar
                            day, for which the highest payment
                            would be made under this paragraph.
                      (F) Eligible home infusion suppliers.--In
                    this paragraph, the term ``eligible home
                    infusion supplier'' means a supplier that is
                    enrolled under this part as a pharmacy that
                    provides external infusion pumps and external
                    infusion pump supplies and that maintains all
                    pharmacy licensure requirements in the State in
                    which the applicable infusion drugs are
                    administered.
                      (G) Implementation.--Notwithstanding any
                    other provision of law, the Secretary may
                    implement this paragraph by program instruction
                    or otherwise.
      (v) Payment for Outpatient Physical Therapy Services and
    Outpatient Occupational Therapy Services Furnished by a Therapy
    Assistant.--
              (1) In general.--In the case of an outpatient
            physical therapy service or outpatient occupational
            therapy service furnished on or after January 1, 2022,
            for which payment is made under section 1848 or
            subsection (k), that is furnished in whole or in part
            by a therapy assistant (as defined by the Secretary),
            the amount of payment for such service shall be an
            amount equal to 85 percent of the amount of payment
            otherwise applicable for the service under this part.
            Nothing in the preceding sentence shall be construed to
            change applicable requirements with respect to such
            services.
              (2) Use of modifier.--
                      (A) Establishment.--Not later than January 1,
                    2019, the Secretary shall establish a modifier
                    to indicate (in a form and manner specified by
                    the Secretary), in the case of an outpatient
                    physical therapy service or outpatient
                    occupational therapy service furnished in whole
                    or in part by a therapy assistant (as so
                    defined), that the service was furnished by a
                    therapy assistant.
                      (B) Required use.--Each request for payment,
                    or bill submitted, for an outpatient physical
                    therapy service or outpatient occupational
                    therapy service furnished in whole or in part
                    by a therapy assistant (as so defined) on or
                    after January 1, 2020, shall include the
                    modifier established under subparagraph (A) for
                    each such service.
              (3) Implementation.--The Secretary shall implement
            this subsection through notice and comment rulemaking.
      (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.
      (x) Payment Rules Relating to Rural Emergency Hospitals.--
              (1) Payment for rural emergency hospital services.--
            In the case of rural emergency hospital services (as
            defined in section 1861(kkk)(1)), furnished by a rural
            emergency hospital (as defined in section 1861(kkk)(2))
            on or after January 1, 2023, the amount of payment for
            such services shall be equal to the amount of payment
            that would otherwise apply under section 1833(t) for
            covered OPD services (as defined in section
            1833(t)(1)(B) (other than clause (ii) of such
            section)), increased by 5 percent to reflect the higher
            costs incurred by such hospitals, and shall include the
            application of any copayment amount determined under
            section 1833(t)(8) as if such increase had not
            occurred.
              (2) Additional facility payment.--
                      (A) In general.--The Secretary shall make
                    monthly payments to a rural emergency hospital
                    in an amount that is equal to \1/12\ of the
                    annual additional facility payment specified in
                    subparagraph (B).
                      (B) Annual additional facility payment
                    amount.--The annual additional facility payment
                    amount specified in this subparagraph is--
                              (i) for 2023, a Medicare subsidy
                            amount determined under subparagraph
                            (C); and
                              (ii) for 2024 and each subsequent
                            year, the amount determined under this
                            subparagraph for the preceding year,
                            increased by the hospital market basket
                            percentage increase.
                      (C) Determination of medicare subsidy
                    amount.--For purposes of subparagraph (B)(i),
                    the Medicare subsidy amount determined under
                    this subparagraph is an amount equal to--
                              (i) the excess (if any) of--
                                      (I) the total amount that the
                                    Secretary determines was paid
                                    under this title to all
                                    critical access hospitals in
                                    2019; over
                                      (II) the estimated total
                                    amount that the Secretary
                                    determines would have been paid
                                    under this title to such
                                    hospitals in 2019 if payment
                                    were made for inpatient
                                    hospital, outpatient hospital,
                                    and skilled nursing facility
                                    services under the applicable
                                    prospective payment systems for
                                    such services during such year;
                                    divided by
                              (ii) the total number of such
                            hospitals in 2019.
                      (D) Reporting on use of the additional
                    facility payment.--A rural emergency hospital
                    receiving the additional facility payment under
                    this paragraph shall maintain detailed
                    information as specified by the Secretary as to
                    how the facility has used the additional
                    facility payments. Such information shall be
                    made available to the Secretary upon request.
              (3) Payment for ambulance services.--For provisions
            relating to payment for ambulance services furnished by
            an entity owned and operated by a rural emergency
            hospital, see section 1834(l).
              (4) Payment for post-hospital extended care
            services.--For provisions relating to payment for post-
            hospital extended care services furnished by a rural
            emergency hospital that has a unit that is a distinct
            part licensed as a skilled nursing facility, see
            section 1888(e).
              (5) Source of payments.--
                      (A) In general.--Except as provided in
                    subparagraph (B), payments under this
                    subsection shall be made from the Federal
                    Supplementary Medical Insurance Trust Fund
                    under section 1841.
                      (B) Additional facility payment and post-
                    hospital extended care services.--Payments
                    under paragraph (2) shall be made from the
                    Federal Hospital Insurance Trust Fund under
                    section 1817.
      (y) Payment for Certain Services Furnished by Rural Health
    Clinics to Hospice Patients.--
              (1) Attending physician services for hospice
            patients.--In the case of services described in section
            1812(d)(2)(A)(ii) furnished on or after January 1,
            2022, by an attending physician (as defined in section
            1861(dd)(3)(B), other than a physician or practitioner
            who is employed by a hospice program) who is employed
            by or working under contract with a rural health
            clinic, a rural health clinic shall be paid for such
            services under the methodology for all-inclusive rates
            (established by the Secretary) under section
            1833(a)(3), subject to the limits described in section
            1833(f).
              (2) Mental health visits furnished via
            telecommunications technology.--In the case of mental
            health visits furnished via interactive, real-time,
            audio and video telecommunications technology or audio-
            only interactions, the in-person mental health visit
            requirements established under section 405.2463(b)(3)
            of title 42 of the Code of Federal Regulations (or a
            successor regulation) shall not apply prior to the day
            that is the 152nd day after the end of the emergency
            period described in section 1135(g)(1)(B)).

               *       *       *       *       *       *       *

    Part E--Miscellaneous Provisions

               *       *       *       *       *       *       *

    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.
              (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); and
                      (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.--
              (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.

               *       *       *       *       *       *       *

    TITLE XIX--GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS

               *       *       *       *       *       *       *

                               PAYMENT TO STATES

      Sec. 1903. (a) From the sums appropriated therefor, the
    Secretary (except as otherwise provided in this section) shall
    pay to each State which has a plan approved under this title,
    for each quarter, beginning with the quarter commencing January
    1, 1966--
              (1) an amount equal to the Federal medical assistance
            percentage (as defined in section 1905(b), subject to
            subsections (g) and (j) of this section and subsection
            1923(f)) of the total amount expended during such
            quarter as medical assistance under the State plan;
            plus
              (2)(A) an amount equal to 75 per centum of so much of
            the sums expended during such quarter (as found
            necessary by the Secretary for the proper and efficient
            administration of the State plan) as are attributable
            to compensation or training of skilled professional
            medical personnel, and staff directly supporting such
            personnel, of the State agency or any other public
            agency; plus
              (B) notwithstanding paragraph (1) or subparagraph
            (A), with respect to amounts expended for nursing aide
            training and competency evaluation programs, and
            competency evaluation programs, described in section
            1919(e)(1) (including the costs for nurse aides to
            complete such competency evaluation programs),
            regardless of whether the programs are provided in or
            outside nursing facilities or of the skill of the
            personnel involved in such programs, an amount equal to
            50 percent (or, for calendar quarters beginning on or
            after July 1, 1988, and before October 1, 1990, the
            lesser of 90 percent or the Federal medical assistance
            percentage plus 25 percentage points) of so much of the
            sums expended during such quarter (as found necessary
            by the Secretary for the proper and efficient
            administration of the State plan) as are attributable
            to such programs; plus
              (C) an amount equal to 75 percent of so much of the
            sums expended during such quarter (as found necessary
            by the Secretary for the proper and efficient
            administration of the State plan) as are attributable
            to preadmission screening and resident review
            activities conducted by the State under section
            1919(e)(7); plus
              (D) for each calendar quarter during--
                      (i) fiscal year 1991, an amount equal to 90
                    percent,
                      (ii) fiscal year 1992, an amount equal to 85
                    percent,
                      (iii) fiscal year 1993, an amount equal to 80
                    percent, and
                      (iv) fiscal year 1994 and thereafter, an
                    amount equal to 75 percent,
            of so much of the sums expended during such quarter (as
            found necessary by the Secretary for the proper and
            efficient administration of the State plan) as are
            attributable to State activities under section 1919(g);
            plus
              (E) an amount equal to 75 percent of so much of the
            sums expended during such quarter (as found necessary
            by the Secretary for the proper and efficient
            administration of the State plan) as are attributable
            to translation or interpretation services in connection
            with the enrollment of, retention of, and use of
            services under this title by, children of families for
            whom English is not the primary language; plus
              (3) an amount equal to--
                      (A)(i) 90 per centum of so much of the sums
                    expended during such quarter as are
                    attributable to the design, development, or
                    installation of such mechanized claims
                    processing and information retrieval systems as
                    the Secretary determines are likely to provide
                    more efficient, economical, and effective
                    administration of the plan and to be compatible
                    with the claims processing and information
                    retrieval systems utilized in the
                    administration of title XVIII, including the
                    State's share of the cost of installing such a
                    system to be used jointly in the administration
                    of such State's plan and the plan of any other
                    State approved under this title,
                      (ii) 90 per centum of so much of the sums
                    expended during any such quarter in the fiscal
                    year ending June 30, 1972, or the fiscal year
                    ending June 30, 1973, as are attributable to
                    the design, development, or installation of
                    cost determination systems for State-owned
                    general hospitals (except that the total amount
                    paid to all States under this clause for either
                    such fiscal year shall not exceed $150,000),
                    and
                      (iii) an amount equal to the Federal medical
                    assistance percentage (as defined in section
                    1905(b)) of so much of the sums expended during
                    such quarter (as found necessary by the
                    Secretary for the proper and efficient
                    administration of the State plan) as are
                    attributable to such developments or
                    modifications of systems of the type described
                    in clause (i) as are necessary for the
                    efficient collection and reporting on child
                    health measures; and
                      (B) 75 per centum of so much of the sums
                    expended during such quarter as are
                    attributable to the operation of systems
                    (whether such systems are operated directly by
                    the State or by another person under a contract
                    with the State) of the type described in
                    subparagraph (A)(i) (whether or not designed,
                    developed, or installed with assistance under
                    such subparagraph) which are approved by the
                    Secretary and which include provision for
                    prompt written notice to each individual who is
                    furnished services covered by the plan, or to
                    each individual in a sample group of
                    individuals who are furnished such services, of
                    the specific services (other than confidential
                    services) so covered, the name of the person or
                    persons furnishing the services, the date or
                    dates on which the services were furnished, and
                    the amount of the payment or payments made
                    under the plan on account of the services; and
                      (C)(i) 75 per centum of the sums expended
                    with respect to costs incurred during such
                    quarter (as found necessary by the Secretary
                    for the proper and efficient administration of
                    the State plan) as are attributable to the
                    performance of medical and utilization review
                    by a utilization and quality control peer
                    review organization or by an entity which meets
                    the requirements of section 1152, as determined
                    by the Secretary, under a contract entered into
                    under section 1902(d); and
                      (ii) 75 percent of the sums expended with
                    respect to costs incurred during such quarter
                    (as found necessary by the Secretary for the
                    proper and efficient administration of the
                    State plan) as are attributable to the
                    performance of independent external reviews
                    conducted under section 1932(c)(2); and
                      (D) 75 percent of so much of the sums
                    expended by the State plan during a quarter in
                    1991, 1992, or 1993, as the Secretary
                    determines is attributable to the statewide
                    adoption of a drug use review program which
                    conforms to the requirements of section
                    1927(g);
                      (E) 50 percent of the sums expended with
                    respect to costs incurred during such quarter
                    as are attributable to providing--
                              (i) services to identify and educate
                            individuals who are likely to be
                            eligible for medical assistance under
                            this title and who have Sickle Cell
                            Disease or who are carriers of the
                            sickle cell gene, including education
                            regarding how to identify such
                            individuals; or
                              (ii) education regarding the risks of
                            stroke and other complications, as well
                            as the prevention of stroke and other
                            complications, in individuals who are
                            likely to be eligible for medical
                            assistance under this title and who
                            have Sickle Cell Disease; and
                      (F)(i) 100 percent of so much of the sums
                    expended during such quarter as are
                    attributable to payments to Medicaid providers
                    described in subsection (t)(1) to encourage the
                    adoption and use of certified EHR technology;
                    and
                      (ii) 90 percent of so much of the sums
                    expended during such quarter as are
                    attributable to payments for reasonable
                    administrative expenses related to the
                    administration of payments described in clause
                    (i) if the State meets the condition described
                    in subsection (t)(9); plus
                      (H)(i) 90 percent of the sums expended during
                    the quarter as are attributable to the design,
                    development, or installation of such mechanized
                    verification and information retrieval systems
                    as the Secretary determines are necessary to
                    implement section 1902(ee) (including a system
                    described in paragraph (2)(B) thereof), and
                      (ii) 75 percent of the sums expended during
                    the quarter as are attributable to the
                    operation of systems to which clause (i)
                    applies, plus
              (4) an amount equal to 100 percent of the sums
            expended during the quarter which are attributable to
            the costs of the implementation and operation of the
            immigration status verification system described in
            section 1137(d); plus
              (5) an amount equal to 90 per centum of the sums
            expended during such quarter which are attributable to
            the offering, arranging, and furnishing (directly or on
            a contract basis) of family planning services and
            supplies;
              (6) subject to subsection (b)(3), an amount equal
            to--
                      (A) 90 per centum of the sums expended during
                    such a quarter within the twelve-quarter period
                    beginning with the first quarter in which a
                    payment is made to the State pursuant to this
                    paragraph, and
                      (B) 75 per centum of the sums expended during
                    each succeeding calendar quarter,
            with respect to costs incurred during such quarter (as
            found necessary by the Secretary for the elimination of
            fraud in the provision and administration of medical
            assistance provided under the State plan) which are
            attributable to the establishment and operation of
            (including the training of personnel employed by) a
            State medicaid fraud control unit (described in
            subsection (q)); plus
              (7) subject to section 1919(g)(3)(B), an amount equal
            to 50 per centum of the remainder of the amounts
            expended during such quarter as found necessary by the
            Secretary for the proper and efficient administration
            of the State plan.
      (b)(1) Notwithstanding the preceding provisions of this
    section, the amount determined under subsection (a)(1) for any
    State for any quarter beginning after December 31, 1969, shall
    not take into account any amounts expended as medical
    assistance with respect to individuals aged 65 or over and
    disabled individuals entitled to hospital insurance benefits
    under title XVIII which would not have been so expended if the
    individuals involved had been enrolled in the insurance program
    established by part B of title XVIII, other than amounts
    expended under provisions of the plan of such State required by
    section 1902(a)(34).
      (2) For limitation on Federal participation for capital
    expenditures which are out of conformity with a comprehensive
    plan of a State or areawide planning agency, see section 1122.
      (3) The amount of funds which the Secretary is otherwise
    obligated to pay a State during a quarter under subsection
    (a)(6) may not exceed the higher of--
              (A) $125,000, or
              (B) one-quarter of 1 per centum of the sums expended
            by the Federal, State, and local governments during the
            previous quarter in carrying out the State's plan under
            this title.
      (4) Amounts expended by a State for the use of an enrollment
    broker in marketing medicaid managed care organizations and
    other managed care entities to eligible individuals under this
    title shall be considered, for purposes of subsection (a)(7),
    to be necessary for the proper and efficient administration of
    the State plan but only if the following conditions are met
    with respect to the broker:
              (A) The broker is independent of any such entity and
            of any health care providers (whether or not any such
            provider participates in the State plan under this
            title) that provide coverage of services in the same
            State in which the broker is conducting enrollment
            activities.
              (B) No person who is an owner, employee, consultant,
            or has a contract with the broker either has any direct
            or indirect financial interest with such an entity or
            health care provider or has been excluded from
            participation in the program under this title or title
            XVIII or debarred by any Federal agency, or subject to
            a civil money penalty under this Act.
      (5) Notwithstanding the preceding provisions of this section,
    the amount determined under subsection (a)(1) for any State
    shall be decreased in a quarter by the amount of any health
    care related taxes (described in section 1902(w)(3)(A)) that
    are imposed on a hospital described in subsection (w)(3)(F) in
    that quarter.
      (c) Nothing in this title shall be construed as prohibiting
    or restricting, or authorizing the Secretary to prohibit or
    restrict, payment under subsection (a) for medical assistance
    for covered services furnished to a child with a disability
    because such services are included in the child's
    individualized education program established pursuant to part B
    of the Individuals with Disabilities Education Act or furnished
    to an infant or toddler with a disability because such services
    are included in the child's individualized family service plan
    adopted pursuant to part C of such Act.
      (d)(1) Prior to the beginning of each quarter, the Secretary
    shall estimate the amount to which a State will be entitled
    under subsections (a) and (b) for such quarter, such estimates
    to be based on (A) a report filed by the State containing its
    estimate of the total sum to be expended in such quarter in
    accordance with the provisions of such subsections, and stating
    the amount appropriated or made available by the State and its
    political subdivisions for such expenditures in such quarter,
    and if such amount is less than the State's proportionate share
    of the total sum of such estimated expenditures, the source or
    sources from which the difference is expected to be derived,
    and (B) such other investigation as the Secretary may find
    necessary.
      (2)(A) The Secretary shall then pay to the State, in such
    installments as he may determine, the amount so estimated,
    reduced or increased to the extent of any overpayment or
    underpayment which the Secretary determines was made under this
    section to such State for any prior quarter and with respect to
    which adjustment has not already been made under this
    subsection.
      (B) Expenditures for which payments were made to the State
    under subsection (a) shall be treated as an overpayment to the
    extent that the State or local agency administering such plan
    has been reimbursed for such expenditures by a third party
    pursuant to the provisions of its plan in compliance with
    section 1902(a)(25).
      (C) For purposes of this subsection, when an overpayment is
    discovered, which was made by a State to a person or other
    entity, the State shall have a period of 1 year in which to
    recover or attempt to recover such overpayment before
    adjustment is made in the Federal payment to such State on
    account of such overpayment. Except as otherwise provided in
    subparagraph (D), the adjustment in the Federal payment shall
    be made at the end of the 1-year period, whether or not
    recovery was made.
      (D)(i) In any case where the State is unable to recover a
    debt which represents an overpayment (or any portion thereof)
    made to a person or other entity on account of such debt having
    been discharged in bankruptcy or otherwise being uncollectable,
    no adjustment shall be made in the Federal payment to such
    State on account of such overpayment (or portion thereof).
      (ii) In any case where the State is unable to recover a debt
    which represents an overpayment (or any portion thereof) made
    to a person or other entity due to fraud within 1 year of
    discovery because there is not a final determination of the
    amount of the overpayment under an administrative or judicial
    process (as applicable), including as a result of a judgment
    being under appeal, no adjustment shall be made in the Federal
    payment to such State on account of such overpayment (or
    portion thereof) before the date that is 30 days after the date
    on which a final judgment (including, if applicable, a final
    determination on an appeal) is made.
      (3)(A) The pro rata share to which the United States is
    equitably entitled, as determined by the Secretary, of the net
    amount recovered during any quarter by the State or any
    political subdivision thereof with respect to medical
    assistance furnished under the State plan shall be considered
    an overpayment to be adjusted under this subsection.
      (B)(i) Subparagraph (A) and paragraph (2)(B) shall not apply
    to any amount recovered or paid to a State as part of the
    comprehensive settlement of November 1998 between manufacturers
    of tobacco products, as defined in section 5702(d) of the
    Internal Revenue Code of 1986, and State Attorneys General, or
    as part of any individual State settlement or judgment reached
    in litigation initiated or pursued by a State against one or
    more such manufacturers.
      (ii) Except as provided in subsection (i)(19), a State may
    use amounts recovered or paid to the State as part of a
    comprehensive or individual settlement, or a judgment,
    described in clause (i) for any expenditures determined
    appropriate by the State.
      (4) Upon the making of any estimate by the Secretary under
    this subsection, any appropriations available for payments
    under this section shall be deemed obligated.
      (5) In any case in which the Secretary estimates that there
    has been an overpayment under this section to a State on the
    basis of a claim by such State that has been disallowed by the
    Secretary under section 1116(d), and such State disputes such
    disallowance, the amount of the Federal payment in controversy
    shall, at the option of the State, be retained by such State or
    recovered by the Secretary pending a final determination with
    respect to such payment amount. If such final determination is
    to the effect that any amount was properly disallowed, and the
    State chose to retain payment of the amount in controversy, the
    Secretary shall offset, from any subsequent payments made to
    such State under this title, an amount equal to the proper
    amount of the disallowance plus interest on such amount
    disallowed for the period beginning on the date such amount was
    disallowed and ending on the date of such final determination
    at a rate (determined by the Secretary) based on the average of
    the bond equivalent of the weekly 90-day treasury bill auction
    rates during such period.
      (6)(A) Each State (as defined in subsection (w)(7)(D)) shall
    include, in the first report submitted under paragraph (1)
    after the end of each fiscal year, information related to--
              (i) provider-related donations made to the State or
            units of local government during such fiscal year, and
              (ii) health care related taxes collected by the State
            or such units during such fiscal year.
      (B) Each State shall include, in the first report submitted
    under paragraph (1) after the end of each fiscal year,
    information related to the total amount of payment adjustments
    made, and the amount of payment adjustments made to individual
    providers (by provider), under section 1923(c) during such
    fiscal year.
      (e) A State plan approved under this title may include, as a
    cost with respect to hospital services under the plan under
    this title, periodic expenditures made to reflect transitional
    allowances established with respect to a hospital closure or
    conversion under section 1884.
      (f)(1)(A) Except as provided in paragraph (4), payment under
    the preceding provisions of this section shall not be made with
    respect to any amount expended as medical assistance in a
    calendar quarter, in any State, for any member of a family the
    annual income of which exceeds the applicable income limitation
    determined under this paragraph.
      (B)(i) Except as provided in clause (ii) of this
    subparagraph, the applicable income limitation with respect to
    any family is the amount determined, in accordance with
    standards prescribed by the Secretary, to be equivalent to
    133\1/3\ percent of the highest amount which would ordinarily
    be paid to a family of the same size without any income or
    resources, in the form of money payments, under the plan of the
    State approved under part A of title IV of this Act.
      (ii) If the Secretary finds that the operation of a uniform
    maximum limits payments to families of more than one size, he
    may adjust the amount otherwise determined under clause (i) to
    take account of families of different sizes.
      (C) The total amount of any applicable income limitation
    determined under subparagraph (B) shall, if it is not a
    multiple of $100 or such other amount as the Secretary may
    prescribe, be rounded to the next higher multiple of $100 or
    such other amount, as the case may be.
      (2)(A) In computing a family's income for purposes of
    paragraph (1), there shall be excluded any costs (whether in
    the form of insurance premiums or otherwise and regardless of
    whether such costs are reimbursed under another public program
    of the State or political subdivision thereof) incurred by such
    family for medical care or for any other type of remedial care
    recognized under State law or, (B) notwithstanding section 1916
    at State option, an amount paid by such family, at the family's
    option, to the State, provided that the amount, when combined
    with costs incurred in prior months, is sufficient when
    excluded from the family's income to reduce such family's
    income below the applicable income limitation described in
    paragraph (1). The amount of State expenditures for which
    medical assistance is available under subsection (a)(1) will be
    reduced by amounts paid to the State pursuant to this
    subparagraph.
      (3) For purposes of paragraph (1)(B), in the case of a family
    consisting of only one individual, the ``highest amount which
    would ordinarily be paid'' to such family under the State's
    plan approved under part A of title IV of this Act shall be the
    amount determined by the State agency (on the basis of
    reasonable relationship to the amounts payable under such plan
    to families consisting of two or more persons) to be the amount
    of the aid which would ordinarily be payable under such plan to
    a family (without any income or resources) consisting of one
    person if such plan provided for aid to such a family.
      (4) The limitations on payment imposed by the preceding
    provisions of this subsection shall not apply with respect to
    any amount expended by a State as medical assistance for any
    individual described in section 1902(a)(10)(A)(i)(III),
    1902(a)(10)(A)(i)(IV), 1902(a)(10)(A)(i)(V),
    1902(a)(10)(A)(i)(VI), 1902(a)(10)(A)(i)(VII),
    1902(a)(10)(A)(i)(VIII),1902(a)(10)(A)(i)(IX),
    1902(a)(10)(A)(ii)(IX), 1902(a)(10)(A)(ii)(X),
    1902(a)(10)(A)(ii)(XIII), 1902(a)(10)(A)(ii)(XIV), or
    1902(a)(10)(A)(ii)(XV), 1902(a)(10)(A)(ii)(XVI),
    1902(a)(10)(A)(ii)(XVII), 1902(a)(10)(A)(ii)(XVIII),
    1902(a)(10)(A)(ii)(XIX), 1902(a)(10)(A)(ii)(XX),
    1902(a)(10)(A)(ii)(XXI), 1902(a)(10)(A)(ii)(XXII), 1905(p)(1)
    or for any individual--
              (A) who is receiving aid or assistance under any plan
            of the State approved under title I, X, XIV or XVI, or
            part A of title IV, or with respect to whom
            supplemental security income benefits are being paid
            under title XVI, or
              (B) who is not receiving such aid or assistance, and
            with respect to whom such benefits are not being paid,
            but (i) is eligible to receive such aid or assistance,
            or to have such benefits paid with respect to him, or
            (ii) would be eligible to receive such aid or
            assistance, or to have such benefits paid with respect
            to him if he were not in a medical institution, or
              (C) with respect to whom there is being paid, or who
            is eligible, or would be eligible if he were not in a
            medical institution, to have paid with respect to him,
            a State supplementary payment and is eligible for
            medical assistance equal in amount, duration, and scope
            to the medical assistance made available to individuals
            described in section 1902(a)(10)(A), or who is a PACE
            program eligible individual enrolled in a PACE program
            under section 1934, but only if the income of such
            individual (as determined under section 1612, but
            without regard to subsection (b) thereof) does not
            exceed 300 percent of the supplemental security income
            benefit rate established by section 1611(b)(1),
    at the time of the provision of the medical assistance giving
    rise to such expenditure.
      (g)(1) Subject to paragraph (3), with respect to amounts paid
    for the following services furnished under the State plan after
    June 30, 1973 (other than services furnished pursuant to a
    contract with a health maintenance organization as defined in
    section 1876 or which is a qualified health maintenance
    organization (as defined in section 1310(d) of the Public
    Health Service Act)), the Federal medical assistance percentage
    shall be decreased as follows: After an individual has received
    inpatient hospital services or services in an intermediate care
    facility for the mentally retarded for 60 days or inpatient
    mental hospital services for 90 days (whether or not such days
    are consecutive), during any fiscal year, the Federal medical
    assistance percentage with respect to amounts paid for any such
    care furnished thereafter to such individual shall be decreased
    by a per centum thereof (determined under paragraph (5)) unless
    the State agency responsible for the administration of the plan
    makes a showing satisfactory to the Secretary that, with
    respect to each calendar quarter for which the State submits a
    request for payment at the full Federal medical assistance
    percentage for amounts paid for inpatient hospital services or
    services in an intermediate care facility for the mentally
    retarded furnished beyond 60 days (or inpatient mental hospital
    services furnished beyond 90 days), such State has an effective
    program of medical review of the care of patients in mental
    hospitals and intermediate care facilities for the mentally
    retarded pursuant to paragraphs (26) and (31) of section
    1902(a) whereby the professional management of each case is
    reviewed and evaluated at least annually by independent
    professional review teams. In determining the number of days on
    which an individual has received services described in this
    subsection, there shall not be counted any days with respect to
    which such individual is entitled to have payments made (in
    whole or in part) on his behalf under section 1812.
      (2) The Secretary shall, as part of his validation procedures
    under this subsection, conduct timely sample onsite surveys of
    private and public institutions in which recipients of medical
    assistance may receive care and services under a State plan
    approved under this title, and his findings with respect to
    such surveys (as well as the showings of the State agency
    required under this subsection) shall be made available for
    public inspection.
      (3)(A) No reduction in the Federal medical assistance
    percentage of a State otherwise required to be imposed under
    this subsection shall take effect--
              (i) if such reduction is due to the State's
            unsatisfactory or invalid showing made with respect to
            a calendar quarter beginning before January 1, 1977;
              (ii) before January 1, 1978;
              (iii) unless a notice of such reduction has been
            provided to the State at least 30 days before the date
            such reduction takes effect; or
              (iv) due to the State's unsatisfactory or invalid
            showing made with respect to a calendar quarter
            beginning after September 30, 1977, unless notice of
            such reduction has been provided to the State no later
            than the first day of the fourth calendar quarter
            following the calendar quarter with respect to which
            such showing was made.
      (B) The Secretary shall waive application of any reduction in
    the Federal medical assistance percentage of a State otherwise
    required to be imposed under paragraph (1) because a showing by
    the State, made under such paragraph with respect to a calendar
    quarter ending after January 1, 1977, and before January 1,
    1978, is determined to be either unsatisfactory under such
    paragraph or invalid under paragraph (2), if the Secretary
    determines that the State's showing made under paragraph (1)
    with respect to any calendar quarter ending on or before
    December 31, 1978, is satisfactory under such paragraph and is
    valid under paragraph (2).
      (4)(A) The Secretary may not find the showing of a State,
    with respect to a calendar quarter under paragraph (1), to be
    satisfactory if the showing is submitted to the Secretary later
    than the 30th day after the last day of the calendar quarter,
    unless the State demonstrates to the satisfaction of the
    Secretary good cause for not meeting such deadline.
      (B) The Secretary shall find a showing of a State, with
    respect to a calendar quarter under paragraph (1), to be
    satisfactory under such paragraph with respect to the
    requirement that the State conduct annual onsite inspections in
    mental hospitals and intermediate care facilities for the
    mentally retarded under paragraphs (26) and (31) of section
    1902(a), if the showing demonstrates that the State has
    conducted such an onsite inspection during the 12-month period
    ending on the last date of the calendar quarter--
              (i) in each of not less than 98 per centum of the
            number of such hospitals and facilities requiring such
            inspection, and
              (ii) in every such hospital or facility which has 200
            or more beds,
    and that, with respect to such hospitals and facilities not
    inspected within such period, the State has exercised good
    faith and due diligence in attempting to conduct such
    inspection, or if the State demonstrates to the satisfaction of
    the Secretary that it would have made such a showing but for
    failings of a technical nature only.
      (5) In the case of a State's unsatisfactory or invalid
    showing made with respect to a type of facility or
    institutional services in a calendar quarter, the per centum
    amount of the reduction of the State's Federal medical
    assistance percentage for that type of services under paragraph
    (1) is equal to 33\1/3\ per centum multiplied by a fraction,
    the denominator of which is equal to the total number of
    patients receiving that type of services in that quarter under
    the State plan in facilities or institutions for which a
    showing was required to be made under this subsection, and the
    numerator of which is equal to the number of such patients
    receiving such type of services in that quarter in those
    facilities or institutions for which a satisfactory and valid
    showing was not made for that calendar quarter.
      (6)(A) Recertifications required under section 1902(a)(44)
    shall be conducted at least every 60 days in the case of
    inpatient hospital services.
      (B) Such recertifications in the case of services in an
    intermediate care facility for the mentally retarded shall be
    conducted at least--
              (i) 60 days after the date of the initial
            certification,
              (ii) 180 days after the date of the initial
            certification,
              (iii) 12 months after the date of the initial
            certification,
              (iv) 18 months after the date of the initial
            certification,
              (v) 24 months after the date of the initial
            certification, and
              (vi) every 12 months thereafter.
      (C) For purposes of determining compliance with the schedule
    established by this paragraph, a recertification shall be
    considered to have been done on a timely basis if it was
    performed not later than 10 days after the date the
    recertification was otherwise required and the State
    establishes good cause why the physician or other person making
    such recertification did not meet such schedule.
      (i) Payment under the preceding provisions of this section
    shall not be made--
              (1) for organ transplant procedures unless the State
            plan provides for written standards respecting the
            coverage of such procedures and unless such standards
            provide that--
                      (A) similarly situated individuals are
                    treated alike; and
                      (B) any restriction, on the facilities or
                    practitioners which may provide such
                    procedures, is consistent with the
                    accessibility of high quality care to
                    individuals eligible for the procedures under
                    the State plan; or
              (2) with respect to any amount expended for an item
            or service (other than an emergency item or service,
            not including items or services furnished in an
            emergency room of a hospital) furnished--
                      (A) under the plan by any individual or
                    entity during any period when the individual or
                    entity is excluded from participation under
                    title V, XVIII, or XX or under this title
                    pursuant to section 1128, 1128A, 1156, or
                    1842(j)(2);
                      (B) at the medical direction or on the
                    prescription of a physician, during the period
                    when such physician is excluded from
                    participation under title V, XVIII, or XX or
                    under this title pursuant to section 1128,
                    1128A, 1156, or 1842(j)(2) and when the person
                    furnishing such item or service knew or had
                    reason to know of the exclusion (after a
                    reasonable time period after reasonable notice
                    has been furnished to the person);
                      (C) by any individual or entity to whom the
                    State has failed to suspend payments under the
                    plan during any period when there is pending an
                    investigation of a credible allegation of fraud
                    against the individual or entity, as determined
                    by the State in accordance with regulations
                    promulgated by the Secretary for purposes of
                    section 1862(o) and this subparagraph, unless
                    the State determines in accordance with such
                    regulations there is good cause not to suspend
                    such payments;
                      (D) beginning on July 1, 2018, under the plan
                    by any provider of services or person whose
                    participation in the State plan is terminated
                    (as described in section 1902(kk)(8)) after the
                    date that is 60 days after the date on which
                    such termination is included in the database or
                    other system under section 1902(ll); or
                      (E) with respect to any amount expended for
                    such an item or service furnished during
                    calendar quarters beginning on or after October
                    1, 2017, subject to section
                    1902(kk)(4)(A)(ii)(II), within a geographic
                    area that is subject to a moratorium imposed
                    under section 1866(j)(7) by a provider or
                    supplier that meets the requirements specified
                    in subparagraph (C)(iii) of such section,
                    during the period of such moratorium; or
              (3) with respect to any amount expended for inpatient
            hospital services furnished under the plan (other than
            amounts attributable to the special situation of a
            hospital which serves a disproportionate number of low
            income patients with special needs) to the extent that
            such amount exceeds the hospital's customary charges
            with respect to such services or (if such services are
            furnished under the plan by a public institution free
            of charge or at nominal charges to the public) exceeds
            an amount determined on the basis of those items
            (specified in regulations prescribed by the Secretary)
            included in the determination of such payment which the
            Secretary finds will provide fair compensation to such
            institution for such services; or
              (4) with respect to any amount expended for care or
            services furnished under the plan by a hospital unless
            such hospital has in effect a utilization review plan
            which meets the requirements imposed by section 1861(k)
            for purposes of title XVIII; and if such hospital has
            in effect such a utilization review plan for purposes
            of title XVIII, such plan shall serve as the plan
            required by this subsection (with the same standards
            and procedures and the same review committee or group)
            as a condition of payment under this title; the
            Secretary is authorized to waive the requirements of
            this paragraph if the State agency demonstrates to his
            satisfaction that it has in operation utilization
            review procedures which are superior in their
            effectiveness to the procedures required under section
            1861(k); or
              (5) with respect to any amount expended for any drug
            product for which payment may not be made under part B
            of title XVIII because of section 1862(c); or
              (6) with respect to any amount expended for inpatient
            hospital tests (other than in emergency situations) not
            specifically ordered by the attending physician or
            other responsible practitioner; or
              (7) with respect to any amount expended for clinical
            diagnostic laboratory tests performed by a physician,
            independent laboratory, or hospital, to the extent such
            amount exceeds the amount that would be recognized
            under section 1833(h) for such tests performed for an
            individual enrolled under part B of title XVIII; or
              (8) with respect to any amount expended for medical
            assistance (A) for nursing facility services to
            reimburse (or otherwise compensate) a nursing facility
            for payment of a civil money penalty imposed under
            section 1919(h) or (B) for home and community care to
            reimburse (or otherwise compensate) a provider of such
            care for payment of a civil money penalty imposed under
            this title or title XI or for legal expenses in defense
            of an exclusion or civil money penalty under this title
            or title XI if there is no reasonable legal ground for
            the provider's case; or
              (9) with respect to any amount expended for non-
            emergency transportation authorized under section
            1902(a)(4), unless the State plan provides for the
            methods and procedures required under section
            1902(a)(30)(A); or
              (10)(A) with respect to covered outpatient drugs
            unless there is a rebate agreement in effect under
            section 1927 with respect to such drugs or unless
            section 1927(a)(3) applies,
              (B) with respect to any amount expended for an
            innovator multiple source drug (as defined in section
            1927(k)) dispensed on or after July 1, 1991, if, under
            applicable State law, a less expensive multiple source
            drug could have been dispensed, but only to the extent
            that such amount exceeds the upper payment limit for
            such multiple source drug;
              (C) with respect to covered outpatient drugs
            described in section 1927(a)(7), unless information
            respecting utilization data and coding on such drugs
            that is required to be submitted under such section is
            submitted in accordance with such section;
              (D) with respect to any amount expended for
            reimbursement to a pharmacy under this title for the
            ingredient cost of a covered outpatient drug for which
            the pharmacy has already received payment under this
            title (other than with respect to a reasonable
            restocking fee for such drug); and
              (E) with respect to any amount expended for a covered
            outpatient drug for which a suspension under section
            1927(c)(4)(B)(ii)(II) is in effect; or
              (11) with respect to any amount expended for
            physicians' services furnished on or after the first
            day of the first quarter beginning more than 60 days
            after the date of establishment of the physician
            identifier system under section 1902(x), unless the
            claim for the services includes the unique physician
            identifier provided under such system; or
              (12) with respect to any amounts expended for--
                      (A) a vacuum erection system that is not
                    medically necessary; or
                      (B) the insertion, repair, or removal and
                    replacement of a penile prosthetic implant
                    (unless such insertion, repair, or removal and
                    replacement is medically necessary); or
              (13) with respect to any amount expended to reimburse
            (or otherwise compensate) a nursing facility for
            payment of legal expenses associated with any action
            initiated by the facility that is dismissed on the
            basis that no reasonable legal ground existed for the
            institution of such action; or
              (14) with respect to any amount expended on
            administrative costs to carry out the program under
            section 1928; or
              (15) with respect to any amount expended for a
            single-antigen vaccine and its administration in any
            case in which the administration of a combined-antigen
            vaccine was medically appropriate (as determined by the
            Secretary); or
              (16) with respect to any amount expended for which
            funds may not be used under the Assisted Suicide
            Funding Restriction Act of 1997; or
              (17) with respect to any amount expended for roads,
            bridges, stadiums, or any other item or service not
            covered under a State plan under this title; or
              (18) with respect to any amount expended for home
            health care services provided by an agency or
            organization unless the agency or organization provides
            the State agency on a continuing basis a surety bond in
            a form specified by the Secretary under paragraph (7)
            of section 1861(o) and in an amount that is not less
            than $50,000 or such comparable surety bond as the
            Secretary may permit under the last sentence of such
            section; or
              (19) with respect to any amount expended on
            administrative costs to initiate or pursue litigation
            described in subsection (d)(3)(B);
              (20) with respect to amounts expended for medical
            assistance provided to an individual described in
            subclause (XV) or (XVI) of section 1902(a)(10)(A)(ii)
            for a fiscal year unless the State demonstrates to the
            satisfaction of the Secretary that the level of State
            funds expended for such fiscal year for programs to
            enable working individuals with disabilities to work
            (other than for such medical assistance) is not less
            than the level expended for such programs during the
            most recent State fiscal year ending before the date of
            the enactment of this paragraph;
              (21) with respect to amounts expended for covered
            outpatient drugs described in section 1927(d)(2)(C)
            (relating to drugs when used for cosmetic purposes or
            hair growth), except where medically necessary, and
            section 1927(d)(2)(K) (relating to drugs when used for
            treatment of sexual or erectile dysfunction);
              (22) with respect to amounts expended for medical
            assistance for an individual who declares under section
            1137(d)(1)(A) to be a citizen or national of the United
            States for purposes of establishing eligibility for
            benefits under this title, unless the requirement of
            section 1902(a)(46)(B) is met;
              (23) with respect to amounts expended for medical
            assistance for covered outpatient drugs (as defined in
            section 1927(k)(2)) for which the prescription was
            executed in written (and non-electronic) form unless
            the prescription was executed on a tamper-resistant
            pad;
              (24) if a State is required to implement an asset
            verification program under section 1940 and fails to
            implement such program in accordance with such section,
            with respect to amounts expended by such State for
            medical assistance for individuals subject to asset
            verification under such section, unless--
                      (A) the State demonstrates to the Secretary's
                    satisfaction that the State made a good faith
                    effort to comply;
                      (B) not later than 60 days after the date of
                    a finding that the State is in noncompliance,
                    the State submits to the Secretary (and the
                    Secretary approves) a corrective action plan to
                    remedy such noncompliance; and
                      (C) not later than 12 months after the date
                    of such submission (and approval), the State
                    fulfills the terms of such corrective action
                    plan;
              (25) with respect to any amounts expended for medical
            assistance for individuals for whom the State does not
            report enrollee encounter data (as defined by the
            Secretary) to the Medicaid Statistical Information
            System (MSIS) in a timely manner (as determined by the
            Secretary);
              (26) with respect to any amounts expended for medical
            assistance for individuals described in subclause
            (VIII) of subsection (a)(10)(A)(i) other than medical
            assistance provided through benchmark coverage
            described in section 1937(b)(1) or benchmark equivalent
            coverage described in section 1937(b)(2); or
              (27) with respect to any amounts expended by the
            State on the basis of a fee schedule for items
            described in section 1861(n) and furnished on or after
            January 1, 2018, as determined in the aggregate with
            respect to each class of such items as defined by the
            Secretary, in excess of the aggregate amount, if any,
            that would be paid for such items within such class on
            a fee-for-service basis under the program under part B
            of title XVIII, including, as applicable, under a
            competitive acquisition program under section 1847 in
            an area of the State.
    Nothing in paragraph (1) shall be construed as permitting a
    State to provide services under its plan under this title that
    are not reasonable in amount, duration, and scope to achieve
    their purpose. Paragraphs (1), (2), (16), (17), and (18) shall
    apply with respect to items or services furnished and amounts
    expended by or through a managed care entity (as defined in
    section 1932(a)(1)(B)) in the same manner as such paragraphs
    apply to items or services furnished and amounts expended
    directly by the State.
      (j) Notwithstanding the preceding provisions of this section,
    the amount determined under subsection (a)(1) for any State for
    any quarter shall be adjusted in accordance with section 1914.
      (k) The Secretary is authorized to provide at the request of
    any State (and without cost to such State) such technical and
    actuarial assistance as may be necessary to assist such State
    to contract with any medicaid managed care organization which
    meets the requirements of subsection (m) of this section for
    the purpose of providing medical care and services to
    individuals who are entitled to medical assistance under this
    title.
      (l)(1) Subject to paragraphs (3) and (4), with respect to any
    amount expended for personal care services or home health care
    services requiring an in-home visit by a provider that are
    provided under a State plan under this title (or under a waiver
    of the plan) and furnished in a calendar quarter beginning on
    or after January 1, 2020 (or, in the case of home health care
    services, on or after January 1, 2023), unless a State requires
    the use of an electronic visit verification system for such
    services furnished in such quarter under the plan or such
    waiver, the Federal medical assistance percentage shall be
    reduced--
              (A) in the case of personal care services--
                      (i) for calendar quarters in 2020, by .25
                    percentage points;
                      (ii) for calendar quarters in 2021, by .5
                    percentage points;
                      (iii) for calendar quarters in 2022, by .75
                    percentage points; and
                      (iv) for calendar quarters in 2023 and each
                    year thereafter, by 1 percentage point; and
              (B) in the case of home health care services--
                      (i) for calendar quarters in 2023 and 2024,
                    by .25 percentage points;
                      (ii) for calendar quarters in 2025, by .5
                    percentage points;
                      (iii) for calendar quarters in 2026, by .75
                    percentage points; and
                      (iv) for calendar quarters in 2027 and each
                    year thereafter, by 1 percentage point.
      (2) Subject to paragraphs (3) and (4), in implementing the
    requirement for the use of an electronic visit verification
    system under paragraph (1), a State shall--
              (A) consult with agencies and entities that provide
            personal care services, home health care services, or
            both under the State plan (or under a waiver of the
            plan) to ensure that such system--
                      (i) is minimally burdensome;
                      (ii) takes into account existing best
                    practices and electronic visit verification
                    systems in use in the State; and
                      (iii) is conducted in accordance with the
                    requirements of HIPAA privacy and security law
                    (as defined in section 3009 of the Public
                    Health Service Act);
              (B) take into account a stakeholder process that
            includes input from beneficiaries, family caregivers,
            individuals who furnish personal care services or home
            health care services, and other stakeholders, as
            determined by the State in accordance with guidance
            from the Secretary; and
              (C) ensure that individuals who furnish personal care
            services, home health care services, or both under the
            State plan (or under a waiver of the plan) are provided
            the opportunity for training on the use of such system.
      (3) Paragraphs (1) and (2) shall not apply in the case of a
    State that, as of the date of the enactment of this subsection,
    requires the use of any system for the electronic verification
    of visits conducted as part of both personal care services and
    home health care services, so long as the State continues to
    require the use of such system with respect to the electronic
    verification of such visits.
      (4)(A) In the case of a State described in subparagraph (B),
    the reduction under paragraph (1) shall not apply--
              (i) in the case of personal care services, for
            calendar quarters in 2020; and
              (ii) in the case of home health care services, for
            calendar quarters in 2023.
      (B) For purposes of subparagraph (A), a State described in
    this subparagraph is a State that demonstrates to the Secretary
    that the State--
              (i) has made a good faith effort to comply with the
            requirements of paragraphs (1) and (2) (including by
            taking steps to adopt the technology used for an
            electronic visit verification system); and
              (ii) in implementing such a system, has encountered
            unavoidable system delays.
      (5) In this subsection:
              (A) The term ``electronic visit verification system''
            means, with respect to personal care services or home
            health care services, a system under which visits
            conducted as part of such services are electronically
            verified with respect to--
                      (i) the type of service performed;
                      (ii) the individual receiving the service;
                      (iii) the date of the service;
                      (iv) the location of service delivery;
                      (v) the individual providing the service; and
                      (vi) the time the service begins and ends.
              (B) The term ``home health care services'' means
            services described in section 1905(a)(7) provided under
            a State plan under this title (or under a waiver of the
            plan).
              (C) The term ``personal care services'' means
            personal care services provided under a State plan
            under this title (or under a waiver of the plan),
            including services provided under section 1905(a)(24),
            1915(c), 1915(i), 1915(j), or 1915(k) or under a wavier
            under section 1115.
      (6)(A) In the case in which a State requires personal care
    service and home health care service providers to utilize an
    electronic visit verification system operated by the State or a
    contractor on behalf of the State, the Secretary shall pay to
    the State, for each quarter, an amount equal to 90 per centum
    of so much of the sums expended during such quarter as are
    attributable to the design, development, or installation of
    such system, and 75 per centum of so much of the sums for the
    operation and maintenance of such system.
      (B) Subparagraph (A) shall not apply in the case in which a
    State requires personal care service and home health care
    service providers to utilize an electronic visit verification
    system that is not operated by the State or a contractor on
    behalf of the State.
      (m)(1)(A) The term ``medicaid managed care organization''
    means a health maintenance organization, an eligible
    organization with a contract under section 1876 or a
    Medicare+Choice organization with a contract under part C of
    title XVIII, a provider sponsored organization, or any other
    public or private organization, which meets the requirement of
    section 1902(w) and--
              (i) makes services it provides to individuals
            eligible for benefits under this title accessible to
            such individuals, within the area served by the
            organization, to the same extent as such services are
            made accessible to individuals (eligible for medical
            assistance under the State plan) not enrolled with the
            organization, and
              (ii) has made adequate provision against the risk of
            insolvency, which provision is satisfactory to the
            State, meets the requirements of subparagraph (C)(i)
            (if applicable), and which assures that individuals
            eligible for benefits under this title are in no case
            held liable for debts of the organization in case of
            the organization's insolvency.
    An organization that is a qualified health maintenance
    organization (as defined in section 1310(d) of the Public
    Health Service Act) is deemed to meet the requirements of
    clauses (i) and (ii).
      (B) The duties and functions of the Secretary, insofar as
    they involve making determinations as to whether an
    organization is a medicaid managed care organization within the
    meaning of subparagraph (A), shall be integrated with the
    administration of section 1312 (a) and (b) of the Public Health
    Service Act.
      (C)(i) Subject to clause (ii), a provision meets the
    requirements of this subparagraph for an organization if the
    organization meets solvency standards established by the State
    for private health maintenance organizations or is licensed or
    certified by the State as a risk-bearing entity.
      (ii) Clause (i) shall not apply to an organization if--
              (I) the organization is not responsible for the
            provision (directly or through arrangements with
            providers of services) of inpatient hospital services
            and physicians' services;
              (II) the organization is a public entity;
              (III) the solvency of the organization is guaranteed
            by the State; or
              (IV) the organization is (or is controlled by) one or
            more Federally-qualified health centers and meets
            solvency standards established by the State for such an
            organization.
    For purposes of subclause (IV), the term ``control'' means the
    possession, whether direct or indirect, of the power to direct
    or cause the direction of the management and policies of the
    organization through membership, board representation, or an
    ownership interest equal to or greater than 50.1 percent.
      (2)(A) Except as provided in subparagraphs (B), (C), and (G),
    no payment shall be made under this title to a State with
    respect to expenditures incurred by it for payment (determined
    under a prepaid capitation basis or under any other risk basis)
    for services provided by any entity (including a health
    insuring organization) which is responsible for the provision
    (directly or through arrangements with providers of services)
    of inpatient hospital services and any other service described
    in paragraph (2), (3), (4), (5), or (7) of section 1905(a) or
    for the provision of any three or more of the services
    described in such paragraphs unless--
              (i) the Secretary has determined that the entity is a
            medicaid managed care organization organization as
            defined in paragraph (1);
              (iii) such services are provided for the benefit of
            individuals eligible for benefits under this title in
            accordance with a contract between the State and the
            entity under which prepaid payments to the entity are
            made on an actuarially sound basis and under which the
            Secretary must provide prior approval for contracts
            providing for expenditures in excess of $1,000,000 for
            1998 and, for a subsequent year, the amount established
            under this clause for the previous year increased by
            the percentage increase in the consumer price index for
            all urban consumers over the previous year;
              (iv) such contract provides that the Secretary and
            the State (or any person or organization designated by
            either) shall have the right to audit and inspect any
            books and records of the entity (and of any
            subcontractor) that pertain (I) to the ability of the
            entity to bear the risk of potential financial losses,
            or (II) to services performed or determinations of
            amounts payable under the contract;
              (v) such contract provides that in the entity's
            enrollment, reenrollment, or disenrollment of
            individuals who are eligible for benefits under this
            title and eligible to enroll, reenroll, or disenroll
            with the entity pursuant to the contract, the entity
            will not discriminate among such individuals on the
            basis of their health status or requirements for health
            care services;
              (vi) such contract (I) permits individuals who have
            elected under the plan to enroll with the entity for
            provision of such benefits to terminate such enrollment
            in accordance with section 1932(a)(4), and (II)
            provides for notification in accordance with such
            section of each such individual, at the time of the
            individual's enrollment, of such right to terminate
            such enrollment;
              (vii) such contract provides that, in the case of
            medically necessary services which were provided (I) to
            an individual enrolled with the entity under the
            contract and entitled to benefits with respect to such
            services under the State's plan and (II) other than
            through the organization because the services were
            immediately required due to an unforeseen illness,
            injury, or condition, either the entity or the State
            provides for reimbursement with respect to those
            services,
              (viii) such contract provides for disclosure of
            information in accordance with section 1124 and
            paragraph (4) of this subsection;
              (ix) such contract provides, in the case of an entity
            that has entered into a contract for the provision of
            services with a Federally-qualified health center or a
            rural health clinic, that the entity shall provide
            payment that is not less than the level and amount of
            payment which the entity would make for the services if
            the services were furnished by a provider which is not
            a Federally-qualified health center or a rural health
            clinic;
              (x) any physician incentive plan that it operates
            meets the requirements described in section 1876(i)(8);
              (xi) such contract provides for maintenance of
            sufficient patient encounter data to identify the
            physician who delivers services to patients and for the
            provision of such data to the State at a frequency and
            level of detail to be specified by the Secretary;
              (xii) such contract, and the entity complies with the
            applicable requirements of section 1932; and
                      (xiii) such contract provides that (I)
                    covered outpatient drugs dispensed to
                    individuals eligible for medical assistance who
                    are enrolled with the entity shall be subject
                    to the same rebate required by the agreement
                    entered into under section 1927 as the State is
                    subject to and that the State shall collect
                    such rebates from manufacturers, (II)
                    capitation rates paid to the entity shall be
                    based on actual cost experience related to
                    rebates and subject to the Federal regulations
                    requiring actuarially sound rates, and (III)
                    the entity shall report to the State, on such
                    timely and periodic basis as specified by the
                    Secretary in order to include in the
                    information submitted by the State to a
                    manufacturer and the Secretary under section
                    1927(b)(2)(A), information on the total number
                    of units of each dosage form and strength and
                    package size by National Drug Code of each
                    covered outpatient drug dispensed to
                    individuals eligible for medical assistance who
                    are enrolled with the entity and for which the
                    entity is responsible for coverage of such drug
                    under this subsection (other than covered
                    outpatient drugs that under subsection (j)(1)
                    of section 1927 are not subject to the
                    requirements of that section) and such other
                    data as the Secretary determines necessary to
                    carry out this subsection.
      (B) Subparagraph (A) except with respect to clause (ix) of
    subparagraph (A), does not apply with respect to payments under
    this title to a State with respect to expenditures incurred by
    it for payment for services provided by an entity which--
              (i)(I) received a grant of at least $100,000 in the
            fiscal year ending June 30, 1976, under section
            329(d)(1)(A) or 330(d)(1) of the Public Health Service
            Act, and for the period beginning July 1, 1976, and
            ending on the expiration of the period for which
            payments are to be made under this title has been the
            recipient of a grant under either such section; and
              (II) provides to its enrollees, on a prepaid
            capitation risk basis or on any other risk basis, all
            of the services and benefits described in paragraphs
            (1), (2), (3), (4)(C), and (5) of section 1905(a) and,
            to the extent required by section 1902(a)(10)(D) to be
            provided under a State plan for medical assistance, the
            services and benefits described in paragraph (7) of
            section 1905(a); or
              (ii) is a nonprofit primary health care entity
            located in a rural area (as defined by the Appalachian
            Regional Commission)--
                      (I) which received in the fiscal year ending
                    June 30, 1976, at least $100,000 (by grant,
                    subgrant, or subcontract) under the Appalachian
                    Regional Development Act of 1965, and
                      (II) for the period beginning July 1, 1976,
                    and ending on the expiration of the period for
                    which payments are to be made under this title
                    either has been the recipient of a grant,
                    subgrant, or subcontract under such Act or has
                    provided services under a contract (initially
                    entered into during a year in which the entity
                    was the recipient of such a grant, subgrant, or
                    subcontract) with a State agency under this
                    title on a prepaid capitation risk basis or on
                    any other risk basis; or
              (iii) which has contracted with the single State
            agency for the provision of services (but not including
            inpatient hospital services) to persons eligible under
            this title on a prepaid risk basis prior to 1970.
      (G) In the case of an entity which is receiving (and has
    received during the previous two years) a grant of at least
    $100,000 under section 329(d)(1)(A) or 330(d)(1) of the Public
    Health Service Act or is receiving (and has received during the
    previous two years) at least $100,000 (by grant, subgrant, or
    subcontract) under the Appalachian Regional Development Act of
    1965, clause (i) of subparagraph (A) shall not apply.
      (H) In the case of an individual who--
              (i) in a month is eligible for benefits under this
            title and enrolled with a medicaid managed care
            organization with a contract under this paragraph or
            with a primary care case manager with a contract
            described in section 1905(t)(3),
              (ii) in the next month (or in the next 2 months) is
            not eligible for such benefits, but
              (iii) in the succeeding month is again eligible for
            such benefits,
    the State plan, subject to subparagraph (A)(vi), may enroll the
    individual for that succeeding month with the organization
    described in clause (i) if the organization continues to have a
    contract under this paragraph with the State or with the
    manager described in such clause if the manager continues to
    have a contract described in section 1905(t)(3) with the State.
      (3) No payment shall be made under this title to a State with
    respect to expenditures incurred by the State for payment for
    services provided by a managed care entity (as defined under
    section 1932(a)(1)) under the State plan under this title (or
    under a waiver of the plan) unless the State--
              (A) beginning on July 1, 2018, has a contract with
            such entity that complies with the requirement
            specified in section 1932(d)(5); and
              (B) beginning on January 1, 2018, complies with the
            requirement specified in section 1932(d)(6)(A).
      (4)(A) Each medicaid managed care organization which is not a
    qualified health maintenance organization (as defined in
    section 1310(d) of the Public Health Service Act) must report
    to the State and, upon request, to the Secretary, the Inspector
    General of the Department of Health and Human Services, and the
    Comptroller General a description of transactions between the
    organization and a party in interest (as defined in section
    1318(b) of such Act), including the following transactions:
              (i) Any sale or exchange, or leasing of any property
            between the organization and such a party.
              (ii) Any furnishing for consideration of goods,
            services (including management services), or facilities
            between the organization and such a party, but not
            including salaries paid to employees for services
            provided in the normal course of their employment.
              (iii) Any lending of money or other extension of
            credit between the organization and such a party.
    The State or Secretary may require that information reported
    respecting an organization which controls, or is controlled by,
    or is under common control with, another entity be in the form
    of a consolidated financial statement for the organization and
    such entity.
      (B) Each organization shall make the information reported
    pursuant to subparagraph (A) available to its enrollees upon
    reasonable request.
      (5)(A) If the Secretary determines that an entity with a
    contract under this subsection--
              (i) fails substantially to provide medically
            necessary items and services that are required (under
            law or under the contract) to be provided to an
            individual covered under the contract, if the failure
            has adversely affected (or has substantial likelihood
            of adversely affecting) the individual;
              (ii) imposes premiums on individuals enrolled under
            this subsection in excess of the premiums permitted
            under this title;
              (iii) acts to discriminate among individuals in
            violation of the provision of paragraph (2)(A)(v),
            including expulsion or refusal to re-enroll an
            individual or engaging in any practice that would
            reasonably be expected to have the effect of denying or
            discouraging enrollment (except as permitted by this
            subsection) by eligible individuals with the
            organization whose medical condition or history
            indicates a need for substantial future medical
            services;
              (iv) misrepresents or falsifies information that is
            furnished--
                      (I) to the Secretary or the State under this
                    subsection, or
                      (II) to an individual or to any other entity
                    under this subsection, or
              (v) fails to comply with the requirements of section
            1876(i)(8),
    the Secretary may provide, in addition to any other remedies
    available under law, for any of the remedies described in
    subparagraph (B).
      (B) The remedies described in this subparagraph are--
              (i) civil money penalties of not more than $25,000
            for each determination under subparagraph (A), or, with
            respect to a determination under clause (iii) or
            (iv)(I) of such subparagraph, of not more than $100,000
            for each such determination, plus, with respect to a
            determination under subparagraph (A)(ii), double the
            excess amount charged in violation of such subparagraph
            (and the excess amount charged shall be deducted from
            the penalty and returned to the individual concerned),
            and plus, with respect to a determination under
            subparagraph (A)(iii), $15,000 for each individual not
            enrolled as a result of a practice described in such
            subparagraph, or
              (ii) denial of payment to the State for medical
            assistance furnished under the contract under this
            subsection for individuals enrolled after the date the
            Secretary notifies the organization of a determination
            under subparagraph (A) and until the Secretary is
            satisfied that the basis for such determination has
            been corrected and is not likely to recur.
    The provisions of section 1128A (other than subsections (a) and
    (b)) shall apply to a civil money penalty under clause (i) in
    the same manner as such provisions apply to a penalty or
    proceeding under section 1128A(a).
      (6)(A) For purposes of this subsection and section
    1902(e)(2)(A), in the case of the State of New Jersey, the term
    ``contract'' shall be deemed to include an undertaking by the
    State agency, in the State plan under this title, to operate a
    program meeting all requirements of this subsection.
      (B) The undertaking described in subparagraph (A) must
    provide--
              (i) for the establishment of a separate entity
            responsible for the operation of a program meeting the
            requirements of this subsection, which entity may be a
            subdivision of the State agency administering the State
            plan under this title;
              (ii) for separate accounting for the funds used to
            operate such program; and
              (iii) for setting the capitation rates and any other
            payment rates for services provided in accordance with
            this subsection using a methodology satisfactory to the
            Secretary designed to ensure that total Federal
            matching payments under this title for such services
            will be lower than the matching payments that would be
            made for the same services, if provided under the State
            plan on a fee for service basis to an actuarially
            equivalent population.
      (C) The undertaking described in subparagraph (A) shall be
    subject to approval (and annual re-approval) by the Secretary
    in the same manner as a contract under this subsection.
      (D) The undertaking described in subparagraph (A) shall not
    be eligible for a waiver under section 1915(b).
      (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).
      (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).
      (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 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).
      (o) Notwithstanding the preceding provisions of this section,
    no payment shall be made to a State under the preceding
    provisions of this section for expenditures for medical
    assistance provided for an individual under its State plan
    approved under this title to the extent that a private insurer
    (as defined by the Secretary by regulation and including a
    group health plan (as defined in section 607(1) of the Employee
    Retirement Income Security Act of 1974), a service benefit
    plan, and a health maintenance organization) would have been
    obligated to provide such assistance but for a provision of its
    insurance contract which has the effect of limiting or
    excluding such obligation because the individual is eligible
    for or is provided medical assistance under the plan.
      (p)(1) When a political subdivision of a State makes, for the
    State of which it is a political subdivision, or one State
    makes, for another State, the enforcement and collection of
    rights of support or payment assigned under section 1912,
    pursuant to a cooperative arrangement under such section
    (either within or outside of such State), there shall be paid
    to such political subdivision or such other State from amounts
    which would otherwise represent the Federal share of payments
    for medical assistance provided to the eligible individuals on
    whose behalf such enforcement and collection was made, an
    amount equal to 15 percent of any amount collected which is
    attributable to such rights of support or payment.
      (2) Where more than one jurisdiction is involved in such
    enforcement or collection, the amount of the incentive payment
    determined under paragraph (1) shall be allocated among the
    jurisdictions in a manner to be prescribed by the Secretary.
      (q) For the purposes of this section, the term ``State
    medicaid fraud control unit'' means a single identifiable
    entity of the State government which the Secretary certifies
    (and annually recertifies) as meeting the following
    requirements:
              (1) The entity (A) is a unit of the office of the
            State Attorney General or of another department of
            State government which possesses statewide authority to
            prosecute individuals for criminal violations, (B) is
            in a State the constitution of which does not provide
            for the criminal prosecution of individuals by a
            statewide authority and has formal procedures, approved
            by the Secretary, that (i) assure its referral of
            suspected criminal violations relating to the program
            under this title to the appropriate authority or
            authorities in the State for prosecution and (ii)
            assure its assistance of, and coordination with, such
            authority or authorities in such prosecutions, or (C)
            has a formal working relationship with the office of
            the State Attorney General and has formal procedures
            (including procedures for its referral of suspected
            criminal violations to such office) which are approved
            by the Secretary and which provide effective
            coordination of activities between the entity and such
            office with respect to the detection, investigation,
            and prosecution of suspected criminal violations
            relating to the program under this title.
              (2) The entity is separate and distinct from the
            single State agency that administers or supervises the
            administration of the State plan under this title.
              (3) The entity's function is conducting a statewide
            program for the investigation and prosecution of
            violations of all applicable State laws regarding any
            and all aspects of fraud in connection with (A) any
            aspect of the provision of medical assistance and the
            activities of providers of such assistance under the
            State plan under this title; and (B) upon the approval
            of the Inspector General of the relevant Federal
            agency, any aspect of the provision of health care
            services and activities of providers of such services
            under any Federal health care program (as defined in
            section 1128B(f)(1)), if the suspected fraud or
            violation of law in such case or investigation is
            primarily related to the State plan under this title.
              (4)(A) The entity has--
                      (i) procedures for reviewing complaints of
                    abuse or neglect of patients in health care
                    facilities which receive payments under the
                    State plan under this title;
                      (ii) at the option of the entity, procedures
                    for reviewing complaints of abuse or neglect of
                    patients residing in board and care facilities
                    and of patients (who are receiving medical
                    assistance under the State plan under this
                    title (or waiver of such plan)) in a
                    noninstitutional or other setting; and
                      (iii) procedures for acting upon such
                    complaints under the criminal laws of the State
                    or for referring such complaints to other State
                    agencies for action.
              (B) For purposes of this paragraph, the term ``board
            and care facility'' means a residential setting which
            receives payment (regardless of whether such payment is
            made under the State plan under this title) from or on
            behalf of two or more unrelated adults who reside in
            such facility, and for whom one or both of the
            following is provided:
                      (i) Nursing care services provided by, or
                    under the supervision of, a registered nurse,
                    licensed practical nurse, or licensed nursing
                    assistant.
                      (ii) A substantial amount of personal care
                    services that assist residents with the
                    activities of daily living, including personal
                    hygiene, dressing, bathing, eating, toileting,
                    ambulation, transfer, positioning, self-
                    medication, body care, travel to medical
                    services, essential shopping, meal preparation,
                    laundry, and housework.
              (5) The entity provides for the collection, or
            referral for collection to a single State agency, of
            overpayments that are made under the State plan or
            under any Federal health care program (as so defined)
            to health care facilities and that are discovered by
            the entity in carrying out its activities. All funds
            collected in accordance with this paragraph shall be
            credited exclusively to, and available for expenditure
            under, the Federal health care program (including the
            State plan under this title) that was subject to the
            activity that was the basis for the collection.
              (6) The entity employs such auditors, attorneys,
            investigators, and other necessary personnel and is
            organized in such a manner as is necessary to promote
            the effective and efficient conduct of the entity's
            activities.
              (7) The entity submits to the Secretary an
            application and annual reports containing such
            information as the Secretary determines, by regulation,
            to be necessary to determine whether the entity meets
            the other requirements of this subsection.
      (r)(1) In order to receive payments under subsection (a) for
    use of automated data systems in administration of the State
    plan under this title, a State must, in addition to meeting the
    requirements of paragraph (3), have in operation mechanized
    claims processing and information retrieval systems that meet
    the requirements of this subsection and that the Secretary has
    found--
              (A) are adequate to provide efficient, economical,
            and effective administration of such State plan;
              (B) are compatible with the claims processing and
            information retrieval systems used in the
            administration of title XVIII, and for this purpose--
                      (i) have a uniform identification coding
                    system for providers, other payees, and
                    beneficiaries under this title or title XVIII;
                      (ii) provide liaison between States and
                    carriers and intermediaries with agreements
                    under title XVIII to facilitate timely exchange
                    of appropriate data;
                      (iii) provide for exchange of data between
                    the States and the Secretary with respect to
                    persons sanctioned under this title or title
                    XVIII; and
                      (iv) effective for claims filed on or after
                    October 1, 2010, incorporate compatible
                    methodologies of the National Correct Coding
                    Initiative administered by the Secretary (or
                    any successor initiative to promote correct
                    coding and to control improper coding leading
                    to inappropriate payment) and such other
                    methodologies of that Initiative (or such other
                    national correct coding methodologies) as the
                    Secretary identifies in accordance with
                    paragraph (4);
              (C) are capable of providing accurate and timely
            data;
              (D) are complying with the applicable provisions of
            part C of title XI;
              (E) are designed to receive provider claims in
            standard formats to the extent specified by the
            Secretary; and
              (F) effective for claims filed on or after January 1,
            1999, provide for electronic transmission of claims
            data in the format specified by the Secretary and
            consistent with the Medicaid Statistical Information
            System (MSIS) (including detailed individual enrollee
            encounter data and other information that the Secretary
            may find necessary and including, for data submitted to
            the Secretary on or after January 1, 2010, data
            elements from the automated data system that the
            Secretary determines to be necessary for program
            integrity, program oversight, and administration, at
            such frequency as the Secretary shall determine).
      (2) In order to meet the requirements of this paragraph,
    mechanized claims processing and information retrieval systems
    must meet the following requirements:
              (A) The systems must be capable of developing
            provider, physician, and patient profiles which are
            sufficient to provide specific information as to the
            use of covered types of services and items, including
            prescribed drugs.
              (B) The State must provide that information on
            probable fraud or abuse which is obtained from, or
            developed by, the systems, is made available to the
            State's medicaid fraud control unit (if any) certified
            under subsection (q) of this section.
              (C) The systems must meet all performance standards
            and other requirements for initial approval developed
            by the Secretary.
      (3) In order to meet the requirements of this paragraph, a
    State must have in operation an eligibility determination
    system which provides for data matching through the Public
    Assistance Reporting Information System (PARIS) facilitated by
    the Secretary (or any successor system), including matching
    with medical assistance programs operated by other States.
      (4) For purposes of paragraph (1)(B)(iv), the Secretary shall
    do the following:
              (A) Not later than September 1, 2010:
                      (i) Identify those methodologies of the
                    National Correct Coding Initiative administered
                    by the Secretary (or any successor initiative
                    to promote correct coding and to control
                    improper coding leading to inappropriate
                    payment) which are compatible to claims filed
                    under this title.
                      (ii) Identify those methodologies of such
                    Initiative (or such other national correct
                    coding methodologies) that should be
                    incorporated into claims filed under this title
                    with respect to items or services for which
                    States provide medical assistance under this
                    title and no national correct coding
                    methodologies have been established under such
                    Initiative with respect to title XVIII.
                      (iii) Notify States of--
                              (I) the methodologies identified
                            under subparagraphs (A) and (B) (and of
                            any other national correct coding
                            methodologies identified under
                            subparagraph (B)); and
                              (II) how States are to incorporate
                            such methodologies into claims filed
                            under this title.
              (B) Not later than March 1, 2011, submit a report to
            Congress that includes the notice to States under
            clause (iii) of subparagraph (A) and an analysis
            supporting the identification of the methodologies made
            under clauses (i) and (ii) of subparagraph (A).
      (s) Notwithstanding the preceding provisions of this section,
    no payment shall be made to a State under this section for
    expenditures for medical assistance under the State plan
    consisting of a designated health service (as defined in
    subsection (h)(6) of section 1877) furnished to an individual
    on the basis of a referral that would result in the denial of
    payment for the service under title XVIII if such title
    provided for coverage of such service to the same extent and
    under the same terms and conditions as under the State plan,
    and subsections (f) and (g)(5) of such section shall apply to a
    provider of such a designated health service for which payment
    may be made under this title in the same manner as such
    subsections apply to a provider of such a service for which
    payment may be made under such title.
      (t)(1) For purposes of subsection (a)(3)(F), the payments
    described in this paragraph to encourage the adoption and use
    of certified EHR technology are payments made by the State in
    accordance with this subsection --
              (A) to Medicaid providers described in paragraph
            (2)(A) not in excess of 85 percent of net average
            allowable costs (as defined in paragraph (3)(E)) for
            certified EHR technology (and support services
            including maintenance and training that is for, or is
            necessary for the adoption and operation of, such
            technology) with respect to such providers; and
              (B) to Medicaid providers described in paragraph
            (2)(B) not in excess of the maximum amount permitted
            under paragraph (5) for the provider involved.
      (2) In this subsection and subsection (a)(3)(F), the term
    ``Medicaid provider'' means--
              (A) an eligible professional (as defined in paragraph
            (3)(B))--
                      (i) who is not hospital-based and has at
                    least 30 percent of the professional's patient
                    volume (as estimated in accordance with a
                    methodology established by the Secretary)
                    attributable to individuals who are receiving
                    medical assistance under this title;
                      (ii) who is not described in clause (i), who
                    is a pediatrician, who is not hospital-based,
                    and who has at least 20 percent of the
                    professional's patient volume (as estimated in
                    accordance with a methodology established by
                    the Secretary) attributable to individuals who
                    are receiving medical assistance under this
                    title; and
                      (iii) who practices predominantly in a
                    Federally qualified health center or rural
                    health clinic and has at least 30 percent of
                    the professional's patient volume (as estimated
                    in accordance with a methodology established by
                    the Secretary) attributable to needy
                    individuals (as defined in paragraph (3)(F));
                    and
              (B)(i) a children's hospital, or
              (ii) an acute-care hospital that is not described in
            clause (i) and that has at least 10 percent of the
            hospital's patient volume (as estimated in accordance
            with a methodology established by the Secretary)
            attributable to individuals who are receiving medical
            assistance under this title.
    An eligible professional shall not qualify as a Medicaid
    provider under this subsection unless any right to payment
    under sections 1848(o) and 1853(l) with respect to the eligible
    professional has been waived in a manner specified by the
    Secretary. For purposes of calculating patient volume under
    subparagraph (A)(iii), insofar as it is related to
    uncompensated care, the Secretary may require the adjustment of
    such uncompensated care data so that it would be an appropriate
    proxy for charity care, including a downward adjustment to
    eliminate bad debt data from uncompensated care. In applying
    subparagraphs (A) and (B)(ii), the methodology established by
    the Secretary for patient volume shall include individuals
    enrolled in a Medicaid managed care plan (under section 1903(m)
    or section 1932).
      (3) In this subsection and subsection (a)(3)(F):
              (A) The term ``certified EHR technology'' means a
            qualified electronic health record (as defined in
            3000(13) of the Public Health Service Act) that is
            certified pursuant to section 3001(c)(5) of such Act as
            meeting standards adopted under section 3004 of such
            Act that are applicable to the type of record involved
            (as determined by the Secretary, such as an ambulatory
            electronic health record for office-based physicians or
            an inpatient hospital electronic health record for
            hospitals).
              (B) The term ``eligible professional'' means a--
                      (i) physician;
                      (ii) dentist;
                      (iii) certified nurse mid-wife;
                      (iv) nurse practitioner; and
                      (v) physician assistant insofar as the
                    assistant is practicing in a rural health
                    clinic that is led by a physician assistant or
                    is practicing in a Federally qualified health
                    center that is so led.
              (C) The term ``average allowable costs'' means, with
            respect to certified EHR technology of Medicaid
            providers described in paragraph (2)(A) for--
                      (i) the first year of payment with respect to
                    such a provider, the average costs for the
                    purchase and initial implementation or upgrade
                    of such technology (and support services
                    including training that is for, or is necessary
                    for the adoption and initial operation of, such
                    technology) for such providers, as determined
                    by the Secretary based upon studies conducted
                    under paragraph (4)(C); and
                      (ii) a subsequent year of payment with
                    respect to such a provider, the average costs
                    not described in clause (i) relating to the
                    operation, maintenance, and use of such
                    technology for such providers, as determined by
                    the Secretary based upon studies conducted
                    under paragraph (4)(C).
              (D) The term ``hospital-based'' means, with respect
            to an eligible professional, a professional (such as a
            pathologist, anesthesiologist, or emergency physician)
            who furnishes substantially all of the individual's
            professional services in a hospital inpatient or
            emergency room setting and through the use of the
            facilities and equipment, including qualified
            electronic health records, of the hospital. The
            determination of whether an eligible professional is a
            hospital-based eligible professional shall be made on
            the basis of the site of service (as defined by the
            Secretary) and without regard to any employment or
            billing arrangement between the eligible professional
            and any other provider.
              (E) The term ``net average allowable costs'' means,
            with respect to a Medicaid provider described in
            paragraph (2)(A), average allowable costs reduced by
            the average payment the Secretary estimates will be
            made to such Medicaid providers (determined on a
            percentage or other basis for such classes or types of
            providers as the Secretary may specify) from other
            sources (other than under this subsection, or by the
            Federal government or a State or local government) that
            is directly attributable to payment for certified EHR
            technology or support services described in
            subparagraph (C).
              (F) The term ``needy individual'' means, with respect
            to a Medicaid provider, an individual--
                      (i) who is receiving assistance under this
                    title;
                      (ii) who is receiving assistance under title
                    XXI;
                      (iii) who is furnished uncompensated care by
                    the provider; or
                      (iv) for whom charges are reduced by the
                    provider on a sliding scale basis based on an
                    individual's ability to pay.
      (4)(A) With respect to a Medicaid provider described in
    paragraph (2)(A), subject to subparagraph (B), in no case
    shall--
                      (i) the net average allowable costs under
                    this subsection for the first year of payment
                    (which may not be later than 2016), which is
                    intended to cover the costs described in
                    paragraph (3)(C)(i), exceed $25,000 (or such
                    lesser amount as the Secretary determines based
                    on studies conducted under subparagraph (C));
                      (ii) the net average allowable costs under
                    this subsection for a subsequent year of
                    payment, which is intended to cover costs
                    described in paragraph (3)(C)(ii), exceed
                    $10,000; and
                      (iii) payments be made for costs described in
                    clause (ii) after 2021 or over a period of
                    longer than 5 years.
      (B) In the case of Medicaid provider described in paragraph
    (2)(A)(ii), the dollar amounts specified in subparagraph (A)
    shall be \2/3\ of the dollar amounts otherwise specified.
      (C) For the purposes of determining average allowable costs
    under this subsection, the Secretary shall study the average
    costs to Medicaid providers described in paragraph (2)(A) of
    purchase and initial implementation and upgrade of certified
    EHR technology described in paragraph (3)(C)(i) and the average
    costs to such providers of operations, maintenance, and use of
    such technology described in paragraph (3)(C)(ii). In
    determining such costs for such providers, the Secretary may
    utilize studies of such amounts submitted by States.
      (5)(A) In no case shall the payments described in paragraph
    (1)(B) with respect to a Medicaid provider described in
    paragraph (2)(B) exceed--
              (i) in the aggregate the product of--
                              (I) the overall hospital EHR amount
                            for the provider computed under
                            subparagraph (B); and
                              (II) the Medicaid share for such
                            provider computed under subparagraph
                            (C);
              (ii) in any year 50 percent of the product described
            in clause (i); and
              (iii) in any 2-year period 90 percent of such
            product.
      (B) For purposes of this paragraph, the overall hospital EHR
    amount, with respect to a Medicaid provider, is the sum of the
    applicable amounts specified in section 1886(n)(2)(A) for such
    provider for the first 4 payment years (as estimated by the
    Secretary) determined as if the Medicare share specified in
    clause (ii) of such section were 1. The Secretary shall
    establish, in consultation with the State, the overall hospital
    EHR amount for each such Medicaid provider eligible for
    payments under paragraph (1)(B). For purposes of this
    subparagraph in computing the amounts under section
    1886(n)(2)(C) for payment years after the first payment year,
    the Secretary shall assume that in subsequent payment years
    discharges increase at the average annual rate of growth of the
    most recent 3 years for which discharge data are available per
    year.
      (C) The Medicaid share computed under this subparagraph, for
    a Medicaid provider for a period specified by the Secretary,
    shall be calculated in the same manner as the Medicare share
    under section 1886(n)(2)(D) for such a hospital and period,
    except that there shall be substituted for the numerator under
    clause (i) of such section the amount that is equal to the
    number of inpatient-bed-days (as established by the Secretary)
    which are attributable to individuals who are receiving medical
    assistance under this title and who are not described in
    section 1886(n)(2)(D)(i). In computing inpatient-bed-days under
    the previous sentence, the Secretary shall take into account
    inpatient-bed-days attributable to inpatient-bed-days that are
    paid for individuals enrolled in a Medicaid managed care plan
    (under section 1903(m) or section 1932).
      (D) In no case may the payments described in paragraph (1)(B)
    with respect to a Medicaid provider described in paragraph
    (2)(B) be paid--
              (i) for any year beginning after 2016 unless the
            provider has been provided payment under paragraph
            (1)(B) for the previous year; and
              (ii) over a period of more than 6 years of payment.
      (6) Payments described in paragraph (1) are not in accordance
    with this subsection unless the following requirements are met:
              (A)(i) The State provides assurances satisfactory to
            the Secretary that amounts received under subsection
            (a)(3)(F) with respect to payments to a Medicaid
            provider are paid, subject to clause (ii), directly to
            such provider (or to an employer or facility to which
            such provider has assigned payments) without any
            deduction or rebate.
              (ii) Amounts described in clause (i) may also be paid
            to an entity promoting the adoption of certified EHR
            technology, as designated by the State, if
            participation in such a payment arrangement is
            voluntary for the eligible professional involved and if
            such entity does not retain more than 5 percent of such
            payments for costs not related to certified EHR
            technology (and support services including maintenance
            and training) that is for, or is necessary for the
            operation of, such technology.
              (B) A Medicaid provider described in paragraph (2)(A)
            is responsible for payment of the remaining 15 percent
            of the net average allowable cost and shall be
            determined to have met such responsibility to the
            extent that the payment to the Medicaid provider is not
            in excess of 85 percent of the net average allowable
            cost.
              (C)(i) Subject to clause (ii), with respect to
            payments to a Medicaid provider--
                      (I) for the first year of payment to the
                    Medicaid provider under this subsection, the
                    Medicaid provider demonstrates that it is
                    engaged in efforts to adopt, implement, or
                    upgrade certified EHR technology; and
                      (II) for a year of payment, other than the
                    first year of payment to the Medicaid provider
                    under this subsection, the Medicaid provider
                    demonstrates meaningful use of certified EHR
                    technology through a means that is approved by
                    the State and acceptable to the Secretary, and
                    that may be based upon the methodologies
                    applied under section 1848(o) or 1886(n).
              (ii) In the case of a Medicaid provider who has
            completed adopting, implementing, or upgrading such
            technology prior to the first year of payment to the
            Medicaid provider under this subsection, clause (i)(I)
            shall not apply and clause (i)(II) shall apply to each
            year of payment to the Medicaid provider under this
            subsection, including the first year of payment.
              (D) To the extent specified by the Secretary, the
            certified EHR technology is compatible with State or
            Federal administrative management systems.
    For purposes of subparagraph (B), a Medicaid provider described
    in paragraph (2)(A) may accept payments for the costs described
    in such subparagraph from a State or local government. For
    purposes of subparagraph (C), in establishing the means
    described in such subparagraph, which may include clinical
    quality reporting to the State, the State shall ensure that
    populations with unique needs, such as children, are
    appropriately addressed.
      (7) With respect to Medicaid providers described in paragraph
    (2)(A), the Secretary shall ensure coordination of payment with
    respect to such providers under sections 1848(o) and 1853(l)
    and under this subsection to assure no duplication of funding.
    Such coordination shall include, to the extent practicable, a
    data matching process between State Medicaid agencies and the
    Centers for Medicare & Medicaid Services using national
    provider identifiers. For such purposes, the Secretary may
    require the submission of such data relating to payments to
    such Medicaid providers as the Secretary may specify.
      (8) In carrying out paragraph (6)(C), the State and Secretary
    shall seek, to the maximum extent practicable, to avoid
    duplicative requirements from Federal and State governments to
    demonstrate meaningful use of certified EHR technology under
    this title and title XVIII. In doing so, the Secretary may deem
    satisfaction of requirements for such meaningful use for a
    payment year under title XVIII to be sufficient to qualify as
    meaningful use under this subsection. The Secretary may also
    specify the reporting periods under this subsection in order to
    carry out this paragraph.
      (9) In order to be provided Federal financial participation
    under subsection (a)(3)(F)(ii), a State must demonstrate to the
    satisfaction of the Secretary, that the State--
              (A) is using the funds provided for the purposes of
            administering payments under this subsection, including
            tracking of meaningful use by Medicaid providers;
              (B) is conducting adequate oversight of the program
            under this subsection, including routine tracking of
            meaningful use attestations and reporting mechanisms;
            and
              (C) is pursuing initiatives to encourage the adoption
            of certified EHR technology to promote health care
            quality and the exchange of health care information
            under this title, subject to applicable laws and
            regulations governing such exchange.
      (10) The Secretary shall periodically submit reports to the
    Committee on Energy and Commerce of the House of
    Representatives and the Committee on Finance of the Senate on
    status, progress, and oversight of payments described in
    paragraph (1), including steps taken to carry out paragraph
    (7). Such reports shall also describe the extent of adoption of
    certified EHR technology among Medicaid providers resulting
    from the provisions of this subsection and any improvements in
    health outcomes, clinical quality, or efficiency resulting from
    such adoption.
      (u)(1)(A) Notwithstanding subsection (a)(1), if the ratio of
    a State's erroneous excess payments for medical assistance (as
    defined in subparagraph (D)) to its total expenditures for
    medical assistance under the State plan approved under this
    title exceeds 0.03, for the period consisting of the third and
    fourth quarters of fiscal year 1983, or for any full fiscal
    year thereafter, then the Secretary shall make no payment for
    such period or fiscal year with respect to so much of such
    erroneous excess payments as exceeds such allowable error rate
    of 0.03.
      (B) The Secretary may waive, in certain limited cases, all or
    part of the reduction required under subparagraph (A) with
    respect to any State if such State is unable to reach the
    allowable error rate for a period or fiscal year despite a good
    faith effort by such State.
      (C) In estimating the amount to be paid to a State under
    subsection (d), the Secretary shall take into consideration the
    limitation on Federal financial participation imposed by
    subparagraph (A) and shall reduce the estimate he makes under
    subsection (d)(1), for purposes of payment to the State under
    subsection (d)(3), in light of any expected erroneous excess
    payments for medical assistance (estimated in accordance with
    such criteria, including sampling procedures, as he may
    prescribe and subject to subsequent adjustment, if necessary,
    under subsection (d)(2)).
      (D)(i) For purposes of this subsection, the term ``erroneous
    excess payments for medical assistance'' means the total of--
              (I) payments under the State plan with respect to
            ineligible individuals and families, and
              (II) overpayments on behalf of eligible individuals
            and families by reason of error in determining the
            amount of expenditures for medical care required of an
            individual or family as a condition of eligibility.
      (ii) In determining the amount of erroneous excess payments
    for medical assistance to an ineligible individual or family
    under clause (i)(I), if such ineligibility is the result of an
    error in determining the amount of the resources of such
    individual or family, the amount of the erroneous excess
    payment shall be the smaller of (I) the amount of the payment
    with respect to such individual or family, or (II) the
    difference between the actual amount of such resources and the
    allowable resource level established under the State plan.
      (iii) In determining the amount of erroneous excess payments
    for medical assistance to an individual or family under clause
    (i)(II), the amount of the erroneous excess payment shall be
    the smaller of (I) the amount of the payment on behalf of the
    individual or family, or (II) the difference between the actual
    amount incurred for medical care by the individual or family
    and the amount which should have been incurred in order to
    establish eligibility for medical assistance.
      (iv) In determining the amount of erroneous excess payments,
    there shall not be included any error resulting from a failure
    of an individual to cooperate or give correct information with
    respect to third-party liability as required under section
    1912(a)(1)(C) or 402(a)(26)(C) or with respect to payments made
    in violation of section 1906.
      (v) In determining the amount of erroneous excess payments,
    there shall not be included any erroneous payments made for
    ambulatory prenatal care provided during a presumptive
    eligibility period (as defined in section 1920(b)(1)), for
    items and services described in subsection (a) of section 1920A
    provided to a child during a presumptive eligibility period
    under such section, for medical assistance provided to an
    individual described in subsection (a) of section 1920B during
    a presumptive eligibility period under such section, or for
    medical assistance provided to an individual during a
    presumptive eligibility period resulting from a determination
    of presumptive eligibility made by a hospital that elects under
    section 1902(a)(47)(B) to be a qualified entity for such
    purpose.
      (E) For purposes of subparagraph (D), there shall be
    excluded, in determining both erroneous excess payments for
    medical assistance and total expenditures for medical
    assistance--
              (i) payments with respect to any individual whose
            eligibility therefor was determined exclusively by the
            Secretary under an agreement pursuant to section 1634
            and such other classes of individuals as the Secretary
            may by regulation prescribe whose eligibility was
            determined in part under such an agreement; and
              (ii) payments made as the result of a technical
            error.
      (2) The State agency administering the plan approved under
    this title shall, at such times and in such form as the
    Secretary may specify, provide information on the rates of
    erroneous excess payments made (or expected, with respect to
    future periods specified by the Secretary) in connection with
    its administration of such plan, together with any other data
    he requests that are reasonably necessary for him to carry out
    the provisions of this subsection.
      (3)(A) If a State fails to cooperate with the Secretary in
    providing information necessary to carry out this subsection,
    the Secretary, directly or through contractual or such other
    arrangements as he may find appropriate, shall establish the
    error rates for that State on the basis of the best data
    reasonably available to him and in accordance with such
    techniques for sampling and estimating as he finds appropriate.
      (B) In any case in which it is necessary for the Secretary to
    exercise his authority under subparagraph (A) to determine a
    State's error rates for a fiscal year, the amount that would
    otherwise be payable to such State under this title for
    quarters in such year shall be reduced by the costs incurred by
    the Secretary in making (directly or otherwise) such
    determination.
      (4) This subsection shall not apply with respect to Puerto
    Rico, Guam, the Virgin Islands, the Northern Mariana Islands,
    or American Samoa.
      (v)(1) Notwithstanding the preceding provisions of this
    section, except as provided in paragraphs (2) and (4), no
    payment may be made to a State under this section for medical
    assistance furnished to an alien who is not lawfully admitted
    for permanent residence or otherwise permanently residing in
    the United States under color of law.
      (2) Payment shall be made under this section for care and
    services that are furnished to an alien described in paragraph
    (1) only if--
              (A) such care and services are necessary for the
            treatment of an emergency medical condition of the
            alien,
              (B) such alien otherwise meets the eligibility
            requirements for medical assistance under the State
            plan approved under this title (other than the
            requirement of the receipt of aid or assistance under
            title IV, supplemental security income benefits under
            title XVI, or a State supplementary payment), and
              (C) such care and services are not related to an
            organ transplant procedure.
      (3) For purposes of this subsection, the term ``emergency
    medical condition'' means a medical condition (including
    emergency labor and delivery) manifesting itself by acute
    symptoms of sufficient severity (including severe pain) such
    that the absence of immediate medical attention could
    reasonably be expected to result in--
              (A) placing the patient's health in serious jeopardy,
              (B) serious impairment to bodily functions, or
              (C) serious dysfunction of any bodily organ or part.
      (4)(A) A State may elect (in a plan amendment under this
    title) to provide medical assistance under this title,
    notwithstanding sections 401(a), 402(b), 403, and 421 of the
    Personal Responsibility and Work Opportunity Reconciliation Act
    of 1996, to children and pregnant women who are lawfully
    residing in the United States (including battered individuals
    described in section 431(c) of such Act) and who are otherwise
    eligible for such assistance, within either or both of the
    following eligibility categories:
              (i) Pregnant women.--Women during pregnancy (and
            during the 60-day period beginning on the last day of
            the pregnancy).
              (ii) Children.--Individuals under 21 years of age,
            including optional targeted low-income children
            described in section 1905(u)(2)(B).
      (B) In the case of a State that has elected to provide
    medical assistance to a category of aliens under subparagraph
    (A), no debt shall accrue under an affidavit of support against
    any sponsor of such an alien on the basis of provision of
    assistance to such category and the cost of such assistance
    shall not be considered as an unreimbursed cost.
      (C) As part of the State's ongoing eligibility
    redetermination requirements and procedures for an individual
    provided medical assistance as a result of an election by the
    State under subparagraph (A), a State shall verify that the
    individual continues to lawfully reside in the United States
    using the documentation presented to the State by the
    individual on initial enrollment. If the State cannot
    successfully verify that the individual is lawfully residing in
    the United States in this manner, it shall require that the
    individual provide the State with further documentation or
    other evidence to verify that the individual is lawfully
    residing in the United States.
      (w)(1)(A) Notwithstanding the previous provisions of this
    section, for purposes of determining the amount to be paid to a
    State (as defined in paragraph (7)(D)) under subsection (a)(1)
    for quarters in any fiscal year, the total amount expended
    during such fiscal year as medical assistance under the State
    plan (as determined without regard to this subsection) shall be
    reduced by the sum of any revenues received by the State (or by
    a unit of local government in the State) during the fiscal
    year--
              (i) from provider-related donations (as defined in
            paragraph (2)(A)), other than--
                      (I) bona fide provider-related donations (as
                    defined in paragraph (2)(B)), and
                      (II) donations described in paragraph (2)(C);
              (ii) from health care related taxes (as defined in
            paragraph (3)(A)), other than broad-based health care
            related taxes (as defined in paragraph (3)(B));
              (iii) from a broad-based health care related tax, if
            there is in effect a hold harmless provision (described
            in paragraph (4)) with respect to the tax; or
              (iv) only with respect to State fiscal years (or
            portions thereof) occurring on or after January 1,
            1992, and before October 1, 1995, from broad-based
            health care related taxes to the extent the amount of
            such taxes collected exceeds the limit established
            under paragraph (5).
      (B) Notwithstanding the previous provisions of this section,
    for purposes of determining the amount to be paid to a State
    under subsection (a)(7) for all quarters in a Federal fiscal
    year (beginning with fiscal year 1993), the total amount
    expended during the fiscal year for administrative expenditures
    under the State plan (as determined without regard to this
    subsection) shall be reduced by the sum of any revenues
    received by the State (or by a unit of local government in the
    State) during such quarters from donations described in
    paragraph (2)(C), to the extent the amount of such donations
    exceeds 10 percent of the amounts expended under the State plan
    under this title during the fiscal year for purposes described
    in paragraphs (2), (3), (4), (6), and (7) of subsection (a).
      (C)(i) Except as otherwise provided in clause (ii),
    subparagraph (A)(i) shall apply to donations received on or
    after January 1, 1992.
      (ii) Subject to the limits described in clause (iii) and
    subparagraph (E), subparagraph (A)(i) shall not apply to
    donations received before the effective date specified in
    subparagraph (F) if such donations are received under programs
    in effect or as described in State plan amendments or related
    documents submitted to the Secretary by September 30, 1991, and
    applicable to State fiscal year 1992, as demonstrated by State
    plan amendments, written agreements, State budget
    documentation, or other documentary evidence in existence on
    that date.
      (iii) In applying clause (ii) in the case of donations
    received in State fiscal year 1993, the maximum amount of such
    donations to which such clause may be applied may not exceed
    the total amount of such donations received in the
    corresponding period in State fiscal year 1992 (or not later
    than 5 days after the last day of the corresponding period).
      (D)(i) Except as otherwise provided in clause (ii),
    subparagraphs (A)(ii) and (A)(iii) shall apply to taxes
    received on or after January 1, 1992.
      (ii) Subparagraphs (A)(ii) and (A)(iii) shall not apply to
    impermissible taxes (as defined in clause (iii)) received
    before the effective date specified in subparagraph (F) to the
    extent the taxes (including the tax rate or base) were in
    effect, or the legislation or regulations imposing such taxes
    were enacted or adopted, as of November 22, 1991.
      (iii) In this subparagraph and subparagraph (E), the term
    ``impermissible tax'' means a health care related tax for which
    a reduction may be made under clause (ii) or (iii) of
    subparagraph (A).
      (E)(i) In no case may the total amount of donations and taxes
    permitted under the exception provided in subparagraphs (C)(ii)
    and (D)(ii) for the portion of State fiscal year 1992 occurring
    during calendar year 1992 exceed the limit under paragraph (5)
    minus the total amount of broad-based health care related taxes
    received in the portion of that fiscal year.
      (ii) In no case may the total amount of donations and taxes
    permitted under the exception provided in subparagraphs (C)(ii)
    and (D)(ii) for State fiscal year 1993 exceed the limit under
    paragraph (5) minus the total amount of broad-based health care
    related taxes received in that fiscal year.
      (F) In this paragraph in the case of a State--
              (i) except as provided in clause (iii), with a State
            fiscal year beginning on or before July 1, the
            effective date is October 1, 1992,
              (ii) except as provided in clause (iii), with a State
            fiscal year that begins after July 1, the effective
            date is January 1, 1993, or
              (iii) with a State legislature which is not scheduled
            to have a regular legislative session in 1992, with a
            State legislature which is not scheduled to have a
            regular legislative session in 1993, or with a
            provider-specific tax enacted on November 4, 1991, the
            effective date is July 1, 1993.
      (2)(A) In this subsection (except as provided in paragraph
    (6)), the term ``provider-related donation'' means any donation
    or other voluntary payment (whether in cash or in kind) made
    (directly or indirectly) to a State or unit of local government
    by--
              (i) a health care provider (as defined in paragraph
            (7)(B)),
              (ii) an entity related to a health care provider (as
            defined in paragraph (7)(C)), or
              (iii) an entity providing goods or services under the
            State plan for which payment is made to the State under
            paragraph (2), (3), (4), (6), or (7) of subsection (a).
      (B) For purposes of paragraph (1)(A)(i)(I), the term ``bona
    fide provider-related donation'' means a provider-related
    donation that has no direct or indirect relationship (as
    determined by the Secretary) to payments made under this title
    to that provider, to providers furnishing the same class of
    items and services as that provider, or to any related entity,
    as established by the State to the satisfaction of the
    Secretary. The Secretary may by regulation specify types of
    provider-related donations described in the previous sentence
    that will be considered to be bona fide provider-related
    donations.
      (C) For purposes of paragraph (1)(A)(i)(II), donations
    described in this subparagraph are funds expended by a
    hospital, clinic, or similar entity for the direct cost
    (including costs of training and of preparing and distributing
    outreach materials) of State or local agency personnel who are
    stationed at the hospital, clinic, or entity to determine the
    eligibility of individuals for medical assistance under this
    title and to provide outreach services to eligible or
    potentially eligible individuals.
      (3)(A) In this subsection (except as provided in paragraph
    (6)), the term ``health care related tax'' means a tax (as
    defined in paragraph (7)(F)) that--
              (i) is related to health care items or services, or
            to the provision of, the authority to provide, or
            payment for, such items or services, or
              (ii) is not limited to such items or services but
            provides for treatment of individuals or entities that
            are providing or paying for such items or services that
            is different from the treatment provided to other
            individuals or entities.
    In applying clause (i), a tax is considered to relate to health
    care items or services if at least 85 percent of the burden of
    such tax falls on health care providers.
      (B) In this subsection, the term ``broad-based health care
    related tax'' means a health care related tax which is imposed
    with respect to a class of health care items or services (as
    described in paragraph (7)(A)) or with respect to providers of
    such items or services and which, except as provided in
    subparagraphs (D), (E), and (F)--
              (i) is imposed at least with respect to all items or
            services in the class furnished by all non-Federal,
            nonpublic providers in the State (or, in the case of a
            tax imposed by a unit of local government, the area
            over which the unit has jurisdiction) or is imposed
            with respect to all non-Federal, nonpublic providers in
            the class; and
              (ii) is imposed uniformly (in accordance with
            subparagraph (C)).
      (C)(i) Subject to clause (ii), for purposes of subparagraph
    (B)(ii), a tax is considered to be imposed uniformly if--
              (I) in the case of a tax consisting of a licensing
            fee or similar tax on a class of health care items or
            services (or providers of such items or services), the
            amount of the tax imposed is the same for every
            provider providing items or services within the class;
              (II) in the case of a tax consisting of a licensing
            fee or similar tax imposed on a class of health care
            items or services (or providers of such services) on
            the basis of the number of beds (licensed or otherwise)
            of the provider, the amount of the tax is the same for
            each bed of each provider of such items or services in
            the class;
              (III) in the case of a tax based on revenues or
            receipts with respect to a class of items or services
            (or providers of items or services) the tax is imposed
            at a uniform rate for all items and services (or
            providers of such items of services) in the class on
            all the gross revenues or receipts, or net operating
            revenues, relating to the provision of all such items
            or services (or all such providers) in the State (or,
            in the case of a tax imposed by a unit of local
            government within the State, in the area over which the
            unit has jurisdiction); or
              (IV) in the case of any other tax, the State
            establishes to the satisfaction of the Secretary that
            the tax is imposed uniformly.
      (ii) Subject to subparagraphs (D) and (E), a tax imposed with
    respect to a class of health care items and services is not
    considered to be imposed uniformly if the tax provides for any
    credits, exclusions, or deductions which have as their purpose
    or effect the return to providers of all or a portion of the
    tax paid in a manner that is inconsistent with subclauses (I)
    and (II) of subparagraph (E)(ii) or provides for a hold
    harmless provision described in paragraph (4).
      (D) A tax imposed with respect to a class of health care
    items and services is considered to be imposed uniformly--
              (i) notwithstanding that the tax is not imposed with
            respect to items or services (or the providers thereof)
            for which payment is made under a State plan under this
            title or title XVIII, or
              (ii) in the case of a tax described in subparagraph
            (C)(i)(III), notwithstanding that the tax provides for
            exclusion (in whole or in part) of revenues or receipts
            from a State plan under this title or title XVIII.
      (E)(i) A State may submit an application to the Secretary
    requesting that the Secretary treat a tax as a broad-based
    health care related tax, notwithstanding that the tax does not
    apply to all health care items or services in class (or all
    providers of such items and services), provides for a credit,
    deduction, or exclusion, is not applied uniformly, or otherwise
    does not meet the requirements of subparagraph (B) or (C).
    Permissible waivers may include exemptions for rural or sole-
    community providers.
      (ii) The Secretary shall approve such an application if the
    State establishes to the satisfaction of the Secretary that--
              (I) the net impact of the tax and associated
            expenditures under this title as proposed by the State
            is generally redistributive in nature, and
              (II) the amount of the tax is not directly correlated
            to payments under this title for items or services with
            respect to which the tax is imposed.
    The Secretary shall by regulation specify types of credits,
    exclusions, and deductions that will be considered to meet the
    requirements of this subparagraph.
      (F) In no case shall a tax not qualify as a broad-based
    health care related tax under this paragraph because it does
    not apply to a hospital that is described in section 501(c)(3)
    of the Internal Revenue Code of 1986 and exempt from taxation
    under section 501(a) of such Code and that does not accept
    payment under the State plan under this title or under title
    XVIII.
      (4) For purposes of paragraph (1)(A)(iii), there is in effect
    a hold harmless provision with respect to a broad-based health
    care related tax imposed with respect to a class of items or
    services if the Secretary determines that any of the following
    applies:
              (A) The State or other unit of government imposing
            the tax provides (directly or indirectly) for a payment
            (other than under this title) to taxpayers and the
            amount of such payment is positively correlated either
            to the amount of such tax or to the difference between
            the amount of the tax and the amount of payment under
            the State plan.
              (B) All or any portion of the payment made under this
            title to the taxpayer varies based only upon the amount
            of the total tax paid.
              (C)(i) The State or other unit of government imposing
            the tax provides (directly or indirectly) for any
            payment, offset, or waiver that guarantees to hold
            taxpayers harmless for any portion of the costs of the
            tax.
              (ii) For purposes of clause (i), a determination of
            the existence of an indirect guarantee shall be made
            under paragraph (3)(i) of section 433.68(f) of title
            42, Code of Federal Regulations, as in effect on
            November 1, 2006, except that for portions of fiscal
            years beginning on or after January 1, 2008, and before
            October 1, 2011, ``5.5 percent'' shall be substituted
            for ``6 percent'' each place it appears.
    The provisions of this paragraph shall not prevent use of the
    tax to reimburse health care providers in a class for
    expenditures under this title nor preclude States from relying
    on such reimbursement to justify or explain the tax in the
    legislative process.
      (5)(A) For purposes of this subsection, the limit under this
    subparagraph with respect to a State is an amount equal to 25
    percent (or, if greater, the State base percentage, as defined
    in subparagraph (B)) of the non-Federal share of the total
    amount expended under the State plan during a State fiscal year
    (or portion thereof), as it would be determined pursuant to
    paragraph (1)(A) without regard to paragraph (1)(A)(iv).
      (B)(i) In subparagraph (A), the term ``State base
    percentage'' means, with respect to a State, an amount
    (expressed as a percentage) equal to--
              (I) the total of the amount of health care related
            taxes (whether or not broad-based) and the amount of
            provider-related donations (whether or not bona fide)
            projected to be collected (in accordance with clause
            (ii)) during State fiscal year 1992, divided by
              (II) the non-Federal share of the total amount
            estimated to be expended under the State plan during
            such State fiscal year.
      (ii) For purposes of clause (i)(I), in the case of a tax that
    is not in effect throughout State fiscal year 1992 or the rate
    (or base) of which is increased during such fiscal year, the
    Secretary shall project the amount to be collected during such
    fiscal year as if the tax (or increase) were in effect during
    the entire State fiscal year.
      (C)(i) The total amount of health care related taxes under
    subparagraph (B)(i)(I) shall be determined by the Secretary
    based on only those taxes (including the tax rate or base)
    which were in effect, or for which legislation or regulations
    imposing such taxes were enacted or adopted, as of November 22,
    1991.
      (ii) The amount of provider-related donations under
    subparagraph (B)(i)(I) shall be determined by the Secretary
    based on programs in effect on September 30, 1991, and
    applicable to State fiscal year 1992, as demonstrated by State
    plan amendments, written agreements, State budget
    documentation, or other documentary evidence in existence on
    that date.
      (iii) The amount of expenditures described in subparagraph
    (B)(i)(II) shall be determined by the Secretary based on the
    best data available as of the date of the enactment of this
    subsection.
      (6)(A) Notwithstanding the provisions of this subsection, the
    Secretary may not restrict States' use of funds where such
    funds are derived from State or local taxes (or funds
    appropriated to State university teaching hospitals)
    transferred from or certified by units of government within a
    State as the non-Federal share of expenditures under this
    title, regardless of whether the unit of government is also a
    health care provider, except as provided in section 1902(a)(2),
    unless the transferred funds are derived by the unit of
    government from donations or taxes that would not otherwise be
    recognized as the non-Federal share under this section.
      (B) For purposes of this subsection, funds the use of which
    the Secretary may not restrict under subparagraph (A) shall not
    be considered to be a provider-related donation or a health
    care related tax.
      (7) For purposes of this subsection:
              (A) Each of the following shall be considered a
            separate class of health care items and services:
                      (i) Inpatient hospital services.
                      (ii) Outpatient hospital services.
                      (iii) Nursing facility services (other than
                    services of intermediate care facilities for
                    the mentally retarded).
                      (iv) Services of intermediate care facilities
                    for the mentally retarded.
                      (v) Physicians' services.
                      (vi) Home health care services.
                      (vii) Outpatient prescription drugs.
                      (viii) Services of managed care organizations
                    (including health maintenance organizations,
                    preferred provider organizations, and such
                    other similar organizations as the Secretary
                    may specify by regulation).
                      (ix) Such other classification of health care
                    items and services consistent with this
                    subparagraph as the Secretary may establish by
                    regulation.
              (B) The term ``health care provider'' means an
            individual or person that receives payments for the
            provision of health care items or services.
              (C) An entity is considered to be ``related'' to a
            health care provider if the entity--
                      (i) is an organization, association,
                    corporation or partnership formed by or on
                    behalf of health care providers;
                      (ii) is a person with an ownership or control
                    interest (as defined in section 1124(a)(3)) in
                    the provider;
                      (iii) is the employee, spouse, parent, child,
                    or sibling of the provider (or of a person
                    described in clause (ii)); or
                      (iv) has a similar, close relationship (as
                    defined in regulations) to the provider.
              (D) The term ``State'' means only the 50 States and
            the District of Columbia but does not include any State
            whose entire program under this title is operated under
            a waiver granted under section 1115.
              (E) The ``State fiscal year'' means, with respect to
            a specified year, a State fiscal year ending in that
            specified year.
              (F) The term ``tax'' includes any licensing fee,
            assessment, or other mandatory payment, but does not
            include payment of a criminal or civil fine or penalty
            (other than a fine or penalty imposed in lieu of or
            instead of a fee, assessment, or other mandatory
            payment).
              (G) The term ``unit of local government'' means, with
            respect to a State, a city, county, special purpose
            district, or other governmental unit in the State.
      (x)(1) For purposes of section 1902(a)(46)(B)(i), the
    requirement of this subsection is, with respect to an
    individual declaring to be a citizen or national of the United
    States, that, subject to paragraph (2), there is presented
    satisfactory documentary evidence of citizenship or nationality
    (as defined in paragraph (3)) of the individual.
      (2) The requirement of paragraph (1) shall not apply to an
    individual declaring to be a citizen or national of the United
    States who is eligible for medical assistance under this
    title--
              (A) and is entitled to or enrolled for benefits under
            any part of title XVIII;
              (B) and is receiving--
                      (i) disability insurance benefits under
                    section 223 or monthly insurance benefits under
                    section 202 based on such individual's
                    disability (as defined in section 223(d)); or
                      (ii) supplemental security income benefits
                    under title XVI;
              (C) and with respect to whom--
                      (i) child welfare services are made available
                    under part B of title IV on the basis of being
                    a child in foster care; or
                      (ii) adoption or foster care assistance is
                    made available under part E of title IV;
              (D) pursuant to the application of section 1902(e)(4)
            (and, in the case of an individual who is eligible for
            medical assistance on such basis, the individual shall
            be deemed to have provided satisfactory documentary
            evidence of citizenship or nationality and shall not be
            required to provide further documentary evidence on any
            date that occurs during or after the period in which
            the individual is eligible for medical assistance on
            such basis); or
              (E) on such basis as the Secretary may specify under
            which satisfactory documentary evidence of citizenship
            or nationality has been previously presented.
      (3)(A) For purposes of this subsection, the term
    ``satisfactory documentary evidence of citizenship or
    nationality'' means--
              (i) any document described in subparagraph (B); or
              (ii) a document described in subparagraph (C) and a
            document described in subparagraph (D).
      (B) The following are documents described in this
    subparagraph:
              (i) A United States passport.
              (ii) Form N-550 or N-570 (Certificate of
            Naturalization).
              (iii) Form N-560 or N-561 (Certificate of United
            States Citizenship).
              (iv) A valid State-issued driver's license or other
            identity document described in section 274A(b)(1)(D) of
            the Immigration and Nationality Act, but only if the
            State issuing the license or such document requires
            proof of United States citizenship before issuance of
            such license or document or obtains a social security
            number from the applicant and verifies before
            certification that such number is valid and assigned to
            the applicant who is a citizen.
              (v)(I) Except as provided in subclause (II), a
            document issued by a federally recognized Indian tribe
            evidencing membership or enrollment in, or affiliation
            with, such tribe (such as a tribal enrollment card or
            certificate of degree of Indian blood).
              (II) With respect to those federally recognized
            Indian tribes located within States having an
            international border whose membership includes
            individuals who are not citizens of the United States,
            the Secretary shall, after consulting with such tribes,
            issue regulations authorizing the presentation of such
            other forms of documentation (including tribal
            documentation, if appropriate) that the Secretary
            determines to be satisfactory documentary evidence of
            citizenship or nationality for purposes of satisfying
            the requirement of this subsection.
              (vi) Such other document as the Secretary may
            specify, by regulation, that provides proof of United
            States citizenship or nationality and that provides a
            reliable means of documentation of personal identity.
      (C) The following are documents described in this
    subparagraph:
              (i) A certificate of birth in the United States.
              (ii) Form FS-545 or Form DS-1350 (Certification of
            Birth Abroad).
              (iii) Form I-197 (United States Citizen
            Identification Card).
              (iv) Form FS-240 (Report of Birth Abroad of a Citizen
            of the United States).
              (v) Such other document (not described in
            subparagraph (B)(iv)) as the Secretary may specify that
            provides proof of United States citizenship or
            nationality.
      (D) The following are documents described in this
    subparagraph:
              (i) Any identity document described in section
            274A(b)(1)(D) of the Immigration and Nationality Act.
              (ii) Any other documentation of personal identity of
            such other type as the Secretary finds, by regulation,
            provides a reliable means of identification.
      (E) A reference in this paragraph to a form includes a
    reference to any successor form.
      (4) In the case of an individual declaring to be a citizen or
    national of the United States with respect to whom a State
    requires the presentation of satisfactory documentary evidence
    of citizenship or nationality under section 1902(a)(46)(B)(i),
    the individual shall be provided at least the reasonable
    opportunity to present satisfactory documentary evidence of
    citizenship or nationality under this subsection as is provided
    under clauses (i) and (ii) of section 1137(d)(4)(A) to an
    individual for the submittal to the State of evidence
    indicating a satisfactory immigration status.
      (5) Nothing in subparagraph (A) or (B) of section
    1902(a)(46), the preceding paragraphs of this subsection, or
    the Deficit Reduction Act of 2005, including section 6036 of
    such Act, shall be construed as changing the requirement of
    section 1902(e)(4) that a child born in the United States to an
    alien mother for whom medical assistance for the delivery of
    such child is available as treatment of an emergency medical
    condition pursuant to subsection (v) shall be deemed eligible
    for medical assistance during the first year of such child's
    life.
      (y) Payments for Establishment of Alternate Non-Emergency
    Services Providers.--
              (1) Payments.--In addition to the payments otherwise
            provided under subsection (a), subject to paragraph
            (2), the Secretary shall provide for payments to States
            under such subsection for the establishment of
            alternate non-emergency service providers (as defined
            in section 1916A(e)(5)(B)), or networks of such
            providers.
              (2) Limitation.--The total amount of payments under
            this subsection shall not exceed $50,000,000 during the
            4-year period beginning with 2006. This subsection
            constitutes budget authority in advance of
            appropriations Acts and represents the obligation of
            the Secretary to provide for the payment of amounts
            provided under this subsection.
              (3) Preference.--In providing for payments to States
            under this subsection, the Secretary shall provide
            preference to States that establish, or provide for,
            alternate non-emergency services providers or networks
            of such providers that--
                      (A) serve rural or underserved areas where
                    beneficiaries under this title may not have
                    regular access to providers of primary care
                    services; or
                      (B) are in partnership with local community
                    hospitals.
              (4) Form and manner of payment.--Payment to a State
            under this subsection shall be made only upon the
            filing of such application in such form and in such
            manner as the Secretary shall specify. Payment to a
            State under this subsection shall be made in the same
            manner as other payments under section 1903(a).
      (z) Medicaid Transformation Payments.--
              (1) In general.--In addition to the payments provided
            under subsection (a), subject to paragraph (4), the
            Secretary shall provide for payments to States for the
            adoption of innovative methods to improve the
            effectiveness and efficiency in providing medical
            assistance under this title.
              (2) Permissible uses of funds.--The following are
            examples of innovative methods for which funds provided
            under this subsection may be used:
                      (A) Methods for reducing patient error rates
                    through the implementation and use of
                    electronic health records, electronic clinical
                    decision support tools, or e-prescribing
                    programs.
                      (B) Methods for improving rates of collection
                    from estates of amounts owed under this title.
                      (C) Methods for reducing waste, fraud, and
                    abuse under the program under this title, such
                    as reducing improper payment rates as measured
                    by annual payment error rate measurement (PERM)
                    project rates.
                      (D) Implementation of a medication risk
                    management program as part of a drug use review
                    program under section 1927(g).
                      (E) Methods in reducing, in clinically
                    appropriate ways, expenditures under this title
                    for covered outpatient drugs, particularly in
                    the categories of greatest drug utilization, by
                    increasing the utilization of generic drugs
                    through the use of education programs and other
                    incentives to promote greater use of generic
                    drugs.
                      (F) Methods for improving access to primary
                    and specialty physician care for the uninsured
                    using integrated university-based hospital and
                    clinic systems.
              (3) Application; terms and conditions.--
                      (A) In general.--No payments shall be made to
                    a State under this subsection unless the State
                    applies to the Secretary for such payments in a
                    form, manner, and time specified by the
                    Secretary.
                      (B) Terms and conditions.--Such payments are
                    made under such terms and conditions consistent
                    with this subsection as the Secretary
                    prescribes.
                      (C) Annual report.--Payment to a State under
                    this subsection is conditioned on the State
                    submitting to the Secretary an annual report on
                    the programs supported by such payment. Such
                    report shall include information on--
                              (i) the specific uses of such
                            payment;
                              (ii) an assessment of quality
                            improvements and clinical outcomes
                            under such programs; and
                              (iii) estimates of cost savings
                            resulting from such programs.
              (4) Funding.--
                      (A) Limitation on funds.--The total amount of
                    payments under this subsection shall be equal
                    to, and shall not exceed--
                              (i) $75,000,000 for fiscal year 2007;
                            and
                              (ii) $75,000,000 for fiscal year
                            2008.
                    This subsection constitutes budget authority in
                    advance of appropriations Acts and represents
                    the obligation of the Secretary to provide for
                    the payment of amounts provided under this
                    subsection.
                      (B) Allocation of funds.--The Secretary shall
                    specify a method for allocating the funds made
                    available under this subsection among States.
                    Such method shall provide preference for States
                    that design programs that target health
                    providers that treat significant numbers of
                    Medicaid beneficiaries. Such method shall
                    provide that not less than 25 percent of such
                    funds shall be allocated among States the
                    population of which (as determined according to
                    data collected by the United States Census
                    Bureau) as of July 1, 2004, was more than 105
                    percent of the population of the respective
                    State (as so determined) as of April 1, 2000.
                      (C) Form and manner of payment.--Payment to a
                    State under this subsection shall be made in
                    the same manner as other payments under section
                    1903(a). There is no requirement for State
                    matching funds to receive payments under this
                    subsection.
              (5) Medication risk management program.--
                      (A) In general.--For purposes of this
                    subsection, the term ``medication risk
                    management program'' means a program for
                    targeted beneficiaries that ensures that
                    covered outpatient drugs are appropriately used
                    to optimize therapeutic outcomes through
                    improved medication use and to reduce the risk
                    of adverse events.
                      (B) Elements.--Such program may include the
                    following elements:
                              (i) The use of established principles
                            and standards for drug utilization
                            review and best practices to analyze
                            prescription drug claims of targeted
                            beneficiaries and identify outlier
                            physicians.
                              (ii) On an ongoing basis provide
                            outlier physicians--
                                      (I) a comprehensive pharmacy
                                    claims history for each
                                    targeted beneficiary under
                                    their care;
                                      (II) information regarding
                                    the frequency and cost of
                                    relapses and hospitalizations
                                    of targeted beneficiaries under
                                    the physician's care; and
                                      (III) applicable best
                                    practice guidelines and
                                    empirical references.
                              (iii) Monitor outlier physician's
                            prescribing, such as failure to refill,
                            dosage strengths, and provide
                            incentives and information to encourage
                            the adoption of best clinical
                            practices.
                      (C) Targeted beneficiaries.--For purposes of
                    this paragraph, the term ``targeted
                    beneficiaries'' means Medicaid eligible
                    beneficiaries who are identified as having high
                    prescription drug costs and medical costs, such
                    as individuals with behavioral disorders or
                    multiple chronic diseases who are taking
                    multiple medications.
      (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; and
                              [(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]
                              [(iii)] (ii) 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, post-partum 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 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.
      (bb) Supplemental Payment Reporting Requirements.--
              (1) Collection and availability of supplemental
            payment data.--
                      (A) In general.--Not later than October 1,
                    2021, the Secretary shall establish a system
                    for each State to submit reports, as determined
                    appropriate by the Secretary, on supplemental
                    payments data, as a requirement for a State
                    plan or State plan amendment that would provide
                    for a supplemental payment.
                      (B) Requirements.--Each report submitted by a
                    State in accordance with the requirement
                    established under subparagraph (A) shall
                    include the following:
                              (i) An explanation of how
                            supplemental payments made under the
                            State plan or a State plan amendment
                            will result in payments that are
                            consistent with section 1902(a)(30)(A),
                            including standards with respect to
                            efficiency, economy, quality of care,
                            and access, along with the stated
                            purpose and intended effects of the
                            supplemental payment.
                              (ii) The criteria used to determine
                            which providers are eligible to receive
                            the supplemental payment.
                              (iii) A comprehensive description of
                            the methodology used to calculate the
                            amount of, and distribute, the
                            supplemental payment to each eligible
                            provider, including--
                                      (I) data on the amount of the
                                    supplemental payment made to
                                    each eligible provider, if
                                    known, or, if the total amount
                                    is distributed using a formula
                                    based on data from 1 or more
                                    fiscal years, data on the total
                                    amount of the supplemental
                                    payments for the fiscal year or
                                    years available to all
                                    providers eligible to receive a
                                    supplemental payment;
                                      (II) if applicable, the
                                    specific criteria with respect
                                    to Medicaid service,
                                    utilization, or cost data to be
                                    used as the basis for
                                    calculations regarding the
                                    amount or distribution of the
                                    supplemental payment; and
                                      (III) the timing of the
                                    supplemental payment made to
                                    each eligible provider.
                              (iv) An assurance that the total
                            Medicaid payments made to an inpatient
                            hospital provider, including the
                            supplemental payment, will not exceed
                            upper payment limits.
                              (v) If not already submitted, an
                            upper payment limit demonstration under
                            section 447.272 of title 42, Code of
                            Federal Regulations (as such section is
                            in effect as of the date of enactment
                            of this subsection).
                      (C) Public availability.--The Secretary shall
                    make all reports and related data submitted
                    under this paragraph publicly available on the
                    website of the Centers for Medicare & Medicaid
                    Services on a timely basis.
              (2) Supplemental payment defined.--
                      (A) In general.--Subject to subparagraph (B),
                    in this subsection, the term ``supplemental
                    payment'' means a payment to a provider that is
                    in addition to any base payment made to the
                    provider under the State plan under this title
                    or under demonstration authority.
                      (B) DSH payments excluded.--Such term does
                    not include a disproportionate share hospital
                    payment made under section 1923.

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